IMAGES IN RESUSCITATION

Sudden cardiac death due to catecholamine cardiomyopathy in anorexia nervosa

The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclear. The short-term physical risk during undernutrition period of the disease is partially predicted by anthropometric and electrolytic parameters.

The objective of the study was to evaluate hormonal profiles in a large cohort of AN and their relationship with critical states.

This was an observational monocentric cross-sectional study performed in the endocrinological unit.

Participants included 210 young female subjects with restrictive-type AN and 42 female controls of comparable age.

The following hormonal parameters were measured: thyroid hormones, GH, IGF-I, cortisol, oestradiol, FSH, LH, SHBG, dehydroepiandrosterone sulfate, plasma metanephrines, and bone markers. Their relation with registered short-term evolution of AN subjects after hormonal assessment was evaluated.

Except for metanephrines and dehydroepiandrosterone sulfate, most of the hormonal abnormalities previously reported in AN were confirmed. The manifestation of these hormonal abnormalities started below different body mass index (BMI) levels, ranging between 17 and 15 kg/m², even though an important percentage of normal values for every parameter was still noticed for very low BMIs. All patients who developed critical states during the 3 months after the hormonal assessment presented with BMI less than 15 kg/m² and a very increased level of cortisol, GH, and increased values of metanephrines.

The hormonal response to undernutrition is heterogeneous in a large population with restrictive AN. In clinical practice, metanephrines, GH, and/or cortisol data could be used as important predictors for severe short-term outcome.