Resumption of menses after 32 years in anorexia nervosa.

In anorexia nervosa estrogen deficient amenorrhea is associated with reduced bone mineral density and increased fracture risk. We report a case of a 53 years old female patient affected with AN since the age of 17 years when also amenorrhea started. During the subsequent 31 years she refused to modify her body weight, she always remained with a BMI below 17, and amenorrhea persisted throughout all the period. In November 2005, when she was 48 years old (BMI 15.6 kg/m²), she came to the Eating Disorder Unit of Niguarda Hospital to treat surgical complication of lower limb wound persisting after two operation; she also presented a marked reduction of bone density. After 6 months of intensive day hospital treatment she got a normal body weight and resumption of menses; in the following four years she has still been well and with normal menses, and bone density showed an improvement.

Laboratory evaluation in patients with anorexia nervosa: usefulness and limits.

OBJECTIVE: Eating Disorders (ED), anorexia nervosa (AN) in particular, are significant causes of morbidity and mortality. The purpose of this study is to evaluate how laboratory studies can help to diagnose AN and to choose the type of care according to the degree of medical compromission, particularly in primary care. PATIENTS AND METHODS: During the years 2002-2009, in our Eating Disorder Centre, we evaluated 298 ED patients diagnosed by criteria Diagnostic and Statistical Manual of Mental Disorders (DMS-IVR) using anthropometric and laboratory tests. RESULTS: In our 298 ED patients we identified 264 with a BMI value below 17.5 Kg/m(2) (Anorexia Nervosa patients) and 34 subjects with a BMI higher than 17.5 Kg/m(2), but lower than 20 (Eating Disorder Not Otherwise Specified patients). Sixty percent of the subjects showed normal values with respect to the 38 common laboratory tests used in the clinical setting. In the subgroup of AN patients with more severe malnutrition (BMI lower than 14.15 Kg/m(2)), the percentage of abnormal laboratory values was higher, but always below fifty percent; in 19 laboratory test we found a significant correlation between the BMI value and that of the laboratory test. CONCLUSIONS: The laboratory tests may result as normal even in AN subjects with severe malnutrition and their use without a multi-dimensional evaluation may be misleading, and can even delay the care of patients.