On physical examination, he appeared severely cachectic, with bitemporal wasting, scleral icterus and jaundice, severe generalized weakness, crepitus along the right supraclavicular region, and decreased pedal pulses bilaterally. Vital signs were significant for a temperature of 35.9☌, a pulse of 60 beats per minute, and a blood pressure of 74/48 mm Hg. He had lost 141 pounds over the past 1 year (220 to 79 pounds) with Hydroxycut ™, decreased oral intake, and excessive exercise (ran 10 miles daily). He was admitted 4 weeks earlier for bradycardia with a hospital course complicated by transaminitis, pancreatitis, pneumomediastinum, and refeeding syndrome. His mental status was back to baseline with a flat affect, and his hypoglycemia resolved.Ī 24-year-old male with a history of AN was transferred from an outside hospital to The Mount Sinai Hospital. A repeat total testosterone at discharge was 141 ng/dL. On the 26th hospital day, the patient was discharged home on an oral diet along with supplemental EN via a gastrostomy tube. Blood pressure remained stable without the use of vasopressors, and the bradycardia slowly improved over the course of weeks. The EN formula was slowly increased to a goal of 21 kcal/kg/day, and the PN was tapered off with no evidence of refeeding syndrome. He was given a dextrose infusion for hypoglycemia and then started on parenteral nutrition (PN) and enteral nutrition (EN) with a presumptive diagnosis of AN. Endocrine evaluation revealed a thyroid-stimulating hormone (TSH) 2.6 μIU/mL (normal, 0.34 to 5.60), free thyroxine (T4) 0.8 ng/dL (normal, 0.6 to 1.1 ng/dL), free triiodothyronine (T3) 1.8 pg/mL (normal, 2.5 to 3.9 pg/mL), total T3 20 ng/dL (normal, 87 to 178 ng/dL), morning cortisol 25.1 μg/dL (normal, 6.7 to 22.6 μg/dL), adrenocorticotropic hormone (ACTH) 24 pg/mL (normal, 0 to 46 pg/mL), testosterone 88 ng/dL (normal, 170 to 780 ng/dL), IGF-1 <25 ng/mL (normal, 116 to 358 ng/mL), and prolactin 11.5 ng/mL. Repeat finger-stick glucose was 15 mg/dL. His laboratory workup was significant for hypokalemia, azotemia, an albumin of 4.3 mg/dL, and a transaminitis. He was arousable but would not converse, bradycardic, and with acrocyanosis on his hands. On physical examination, he appeared severely cachectic, with sarcopenia and short stature. Vital signs were significant for a temperature of 34.4☌, a pulse of 30 to 40 beats per minute, and a blood pressure of 90/50 mm Hg. He also complained of worsening fatigue and constipation. He had come to medical attention for complaints of erectile dysfunction and was started on testosterone replacement therapy. According to his parents, he had always been thin and a “poor eater” but recently lost weight from 115 to 70 pounds at a height of 63 inches over the past few months. We present 4 male patients with AN and significant endocrine dysfunction at 2 hospitals between 20, to highlight the challenges associated with their medical management.Ī 20-year-old male without available past medical history presented to The Mount Sinai Hospital with severe progressive weakness and bradycardia. The influence of AN on these endocrine pathways is frequently missed, especially in male patients. Serious consequences involve the endocrine system, including the hypothalamic-pituitary-gonadal axis, hypothalamic-pituitary-thyroid axis, hypothalamic-growth hormone (GH)-insulin-like growth factor 1 (IGF-1) axis, hypothalamic-pituitary-adrenal axis, effects on bone metabolism, and neuroendocrine signaling mechanisms in the modulation of appetite. The more recent DSM V diagnostic criteria have been revised to exclude amenorrhea ( 4).ĪN is associated with significant morbidity and mortality. In fact, a female bias is evidenced by previous diagnostic criteria, which include amenorrhea but not low testosterone or decreased libido. This number may be underestimated and may constitute as much as 25% of the total AN population, as male AN is less frequently recognized and diagnosed ( 3). Although more common in females, an estimated 5 to 10% of affected patients are males. AN can be further categorized into three types: restricting, binge and purging, and as yet not classified ( 2). The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV diagnostic criteria included: a) failure to maintain weight above 85% of ideal b) distorted body image or denial of seriousness of low body weight, fear of gaining weight and c) amenorrhea ( 1). Anorexia nervosa (AN) is a serious psychiatric disorder characterized by abnormal eating behaviors, resulting in weight loss and increased mortality.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |