04/16/21

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Eating disorders and

reproductive

disturbances

Błażej Męczekalski

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Eating disorders

• Primarily affect young women
• Only 5-10% cases are male
• Peak age of onset is during

adolescence

for anorexia nervosa (13-15 years)
for bulimia nervosa (17-25 years)
• in the adolescent age group it has

increased dramatically since 1985

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Eating disorders

• in the adolescent age group it has

increased dramatically since 1985

• In US the prevalance of anorexia

nervosa in adolescent females is

0,5% (following obesity, asthma)

• Prevalance correlates with socio-

economic development

• Mortality rate for AN is 9%

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Anorexia nervosa

• Condition characterized by

excessive weight loss, pre-
occupation with body weight and
shape and cognitive distortion in
body image

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Bulimia nervosa

• Major features are recurrent cycles

of binging followed by inappropriate
compensatory mechanism such

- as self-induced vomiting,
- excessive excercising,
- starvation or the use of laxatives
- diet pills or diuretics

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Anorexia nervosa -

diagnostic criteria

A. Refusal to maintain body weight over a minimally

normal weight for age and height or failure to

make expected weight gain during period of

growth, leading to body weight below 15% of that

expected

B. Intense fear of gaining weight or becoming fat,

even though underweight

C. Disturbance in the way in which one’s body

weight or shape is experienced, undue influence of

body shape and weight on self-evaluation or denial

of the seriousness of current low body weight

D. In post-menarchal females amenorrhea

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Bulimia nervosa –

diagnostic criteria

A. Reccurent episodes of binge eating.
- eating in a discrete period of time an

amount of food that is definitely larger than

most of people would eat in a similar

circumstance

- a sense of lack control over eating during

the episodes

B. Reccurent inaproprate compensatory

behaviour to prevent weight such as self-

induced vomiting, misuse of laxatives,

diuretics

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Bulimia nervosa –

diagnostic criteria

C. The binge eating and inappropriate

compensatory behaviour both occur on

average, at least twice a week for 3

month

D. Self evaluation is unduly influenced by

body shape and weight

E. The disturbance does not occur

exclusively during episodes of anorexia

nervosa

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Anorexia nervosa –

hormonal profile

• Low LH, FSH
• Low estradiol
• High CRH, beta-EP
• Mild hypercortisolism
• GH increased
• Low T3 (decreased conversion of T4 to T3)
• Normal TSH
• Low leptin

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Anorexia nervosa –

complications of eating

disorders

• Cardiovascular (bradycardia,

orthostatic hypotension, dysrythmias)

• Gastrointestinal (constipation,

intestinal atony, oesophagitis)

• Dermatological (brittle hair and nails,

lanugo, Russel’s sign)

• Skeletal (osteopenia, fractures)
• Haematological ( low sedimantation

rate, mild anemia, leucopenia)

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Anorexia nervosa -

osteopenia

• Low estradiol
• Low IGF –1
• Low calcium diet
• High cortisol

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Anorexia nervosa -

osteopenia

• Bone densitometry should be

perform in any patient who has
been amenorrheic for more than 6
months

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Bone mass density

• 60% of peak bone mass is gained

during adolescent years

• Peak bone massis achieved by the

end of second decade of life

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Eating dosorders –

principles of treatment

• Restore weight
• Normalize eating pattern
• Reverse the medical complications

of eating disorder

• Resolve underlying psychosocial

issues that led to its development

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Eating dosorders –

hormone replacement

therapy

• Natural estrogen
• Progesteron and progestins

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Calcium intake

• Dietary calcium intake 1200-1500

kcal/d

• Vitamin D 400 IU

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Eating disorders –

important points

• Prevention of eating disorders
• Management of amenorrhea in

female athletes

• Effective treatments for

osteoporosis in young women with
eating disorders

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Introduction

• State the purpose of the

discussion

• Identify yourself

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Topics of Discussion

• State the main ideas you’ll be

talking about

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Topic One

• Details about this topic
• Supporting information and

examples

• How it relates to your audience

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Topic Two

• Details about this topic
• Supporting information and

examples

• How it relates to your audience

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Topic Three

• Details about this topic
• Supporting information and

examples

• How it relates to your audience

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Real Life

• Give an example or real life

anecdote

• Sympathize with the audience’s

situation if appropriate

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What This Means

• Add a strong statement that

summarizes how you feel or think
about this topic

• Summarize key points you want

your audience to remember

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Next Steps

• Summarize any actions required of

your audience

• Summarize any follow up action

items required of you