anorexia

Anorexia nervosa is self-induced starvation, resulting in marked weight loss; bulimia is a condition in which the patient binges on food and then induces vomiting. These eating disorders occur primarily in previously healthy young women who have developed an obsession with attaining thinness.

The clinical findings in anorexia nervosa are generally similar to those in severe PEM. In addition, effects on the endocrine system are prominent. Amenorrhea, resulting from decreased secretion of gonadotropin-releasing hormone (and subsequent decreased secretion of luteinizing hormone and follicle-stimulating hormone), is so common that its presence is a diagnostic feature for the disorder.

Other common findings, related to decreased thyroid hormone release, include cold intolerance, bradycardia, constipation, and changes in the skin and hair.

The skin becomes dry and scaly and may be yellow because of excess carotene in the blood. Body hair may be increased but is usually fine and pale (lanugo).

Bone density is decreased, most likely owing to low estrogen levels, which mimic the postmenopausal acceleration of osteoporosis.

As expected with severe PEM, anemia, lymphopenia, and hypoalbuminemia may be present. A major complication of anorexia nervosa is an increased susceptibility to cardiac arrhythmia and sudden death, resulting in all likelihood from hypokalemia.