Sports Medicine: Just the Facts

CHAPTER 98 • THE FEMALE ATHLETE 575

• Risk factors for disordered eating and the female ath-
  lete triad include the following:
  
  
  1. Chronic dieting
  
  
  2. Low self-esteem
  
  
  3. Family dysfunction
  
  
  4. Physical abuse
  
  
  5. Biological factors
  
  
  6. Perfectionism
  
  
  7. Lack of nutrition knowledge
  
  
  8. An emphasis on body weight for performance or
     appearance
  
  
  9. Pressure to lose weight from parents, coaches,
     judges, and peers
  
  
  10. A drive to win at any cost
  
  
  11. Self-identity as an athlete only (no identity out-
      side of sports)
  
  
  12. A sudden increase in training
  
  
  13. Exercising through injury
  
  
  14. Overtraining (especially when undernourished)
  
  
  15. A traumatic event such as an injury or loss of a
      coach
  
  
  16. Vulnerable times such as an adolescent growth
      spurt, entering college, retiring from athletics,
      and postpartum depression
      •Any athlete with one of the diagnostic criteria of the
      female athlete triad should be evaluated for the other
      two by a thorough history and a physical examination.
      a. Laboratory tests that may be helpful include the
      following:
      1.Complete blood count (CBC)
      2. Electrolytes, calcium, magnesium, phosphorus,
      blood urea nitrogen (BUN), creatinine, choles-
      terol, albumin, and total protein
  
  
  
  

TABLE 98-4 Signs, Symptoms, and Medical
Complications of Anorexia Nervosa and Bulimia Nervosa
Orofacial
Perimolysis
Dental caries
Cheilosis
Enlargement of the parotid gland
Submandibular adenopathy
Cardiovascular
Postural and nonpostural hypotension
Acrocyanosis
Electrocardiographic abnormalities: Low voltage, prolonged QT
interval, and prominent U waves
Sinus bradycardia
Atrial and ventricular arrhythmias
Left ventricular changes: Decreased mass and cavity size
Mitral-valve prolapse
Cardiomyopathy (caused by ipecac poisoning)
Gastrointestinal
Esophagitis hematemesis (including the Mallory-Weiss syndrome)
Delayed gastric emptying
Decreased intestinal motility
Constipation
Rectal prolapse
Gastric dilatation and rupture
Abnormal results on liver-function tests
Elevated serum amylase level
Endocrine and metabolic
Hypokalemia (including hypokalemic nephropathy)
Hyponatremia, (rarely) hypernatremia
Hypomagnesaemia
Hyperphosphatemia
Hypoglycemia
Hypothermia
Euthyroid sick syndrome
Hypercortisolism, elevated free cortisol level in urine
Low serum estradiol level
Decreased serum testosterone level
Amenorrhea, oligomenorrhea
Delay in puberty
Arrested growth
Osteoporosis
Lipid abnormalities
Obesity
Renal
Renal calculi
Reproductive
Infertility
Insufficient weight gain during pregnancy
Low-birth-weight infants
Integumentary
Dry skin and hair
Hair loss
Lanugo
Yellow skin caused by hypercarotenemia
Neurologic
Peripheral neuropathy
Reversible cortical atrophy
Ventricular enlargement
Hematologic
Anemia
Leukopenia
Neutropenia
Thrombocytopenia

SOURCE: Becker: N Engl J Med, 340(14):1092–1098, 1999

TABLE 98-5 Abnormalities That May Indicate

an Undisclosed Eating Disorder

Somatic

Arrested growth

Marked change or frequent fluctuation in weight

Inability to gain weight

Fatigue

Constipation or diarrhea

Susceptibility to fractures

Delayed menarche

Hypokalemia, hyperphosphatemia, metabolic acidosis or alkalosis, or

high serum amylase levels

Behavioral

Change in eating habits

Difficulty eating in social settings

Reluctance to be weighed

Depression

Social withdrawal

Absence from school or work

Deceptive or secretive behavior

Stealing (e.g., to obtain food)

Substance abuse

Excessive exercise

SOURCE: Becker: N Engl J Med340(14):1092–1098, 1999.