Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

130 Anorexia Nervosa

Signs & Symptoms

■Mental status exam:

➣Intense preoccupation w/ food

➣Slow eating

➣Depression

➣Loss of energy

➣Loss of sexual interest

➣Social withdrawal

➣Cognitive impairments: impaired concentration & poor judg-

ment

➣50% of all anorexics also binge-eat & purge

■Physical exam:

➣Cachexia

➣Slow pulse rate

➣Hypotension

➣Cold & blue extremities

➣Dry skin

➣Fine body hair (lanugo)

➣Scars or abrasions in the knuckles (associated w/ self-induced

emesis)

➣Wasting of dental enamel (associated w/ self-induced emesis)

➣Constipation

➣Cold intolerance

➣Lethargy

tests

Laboratory

■Usually show alterations in metabolic function:

➣Decreased gonadotropin levels:

LH (to prepubertal pattern)

FSH

Estrogen

➣Elevated growth hormone

➣Elevated resting plasma cortisol

➣Decreased fT3

➣Elevated cholesterol & carotene

■Dehydration

■Elevated BUN

■Elevated LFTs

■Leukopenia

■Anemia