American Association of Clinical Endocrinoligist's (AACE) 23rd Annual Scientific and Clinical Congress:

Male Anorexia Nervosa: Self-imposed Malnutrition’s Systemic Effects

AN should be suspected in men with multiple endocrine dysfunction

Anorexia nervosa (AN) is a serious eating disorder that is usually associated with young women. According to Aren Skolnick, DO, “There is a small and probably underestimated male population with anorexia.” Female anorexia often is characterized as purging behavior whereas men with AN tend to exercise excessively.

Doctor Skolnick, who is currently completing his fellowship in Endocrinology, Diabetes and Metabolism at North Shore-Long Island Jewish Medical Center, presented Endocrinopathies in Young Men: A Diagnosis Uncovered during the 23rd Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinology held in Las Vegas, NV.

Suspected Prevalence
Although it is reported that males make up about 10% of the AN population, Dr. Skolnick estimates, “The percentage is probably as high as 25% because some of these men are not correctly diagnosed.”

Case Synopsis
In his lecture, Dr. Skolnick discussed the case of a 23-year-old male who presented in the emergency department for “disorganized behavior and starving himself.” Over a 2-month time period, the patient had lost 35 pounds. He suffered from untreated depression, and during physical examination, he exhibited lethargy, cachexia, flat affect, and bradycardia.

  • Several tests were performed (eg, lab, echocardiogram, EKG).
  • An endocrinology consultation revealed hypoglycemia, and the patient was administered dextrose 50% injection and started on IV dextrose.
  • A differential diagnosis of malnutrition was made and related to the patient’s AN and depression.
  • Young man was hospitalized, treated for psychosis/depression, transferred to the coronary care unit, and enteral feedings were started because he refused to eat.
  • The patient finally started to eat on hospital day 15.

Endocrine Impact
Anorexia nervosa is a systemic problem. Being anorexic and protein/caloric malnourished is detrimental to the body's cardiac, pulmonary, gastrointestinal, hematologic, renal, neurologic, and skin systems. Potential systemic effects are listed below.

  • Hypothalamic-pituitary-gonadal axis (eg, decreased testosterone, libido, depression)
  • Hypothalamic-pituitary-thyroid axis ( thyroid function tests may be relatively normal, but the patient exhibits symptoms of hypothyroidism)
  • Hypothalamic-GH (growth hormone)-IGF (insulin-like growth factor)-1 axis (eg, growth can be affected during adolescence)
  • Hypothalamic-pituitary-adrenal axis (eg, cortisol resistance)
  • Bone metabolism (eg, osteopenia, osteoporosis)
  • Hypoglycemia (depletion of glycogen stores)

 

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