Circadian Rhythms of Body Temperature in Patients with Anorexia Nervosa, Hypothermia and Hypophosphatemia
Anorexia nervosa is a prolonged illness principally affecting young girls after puberty. The clinical manifestations include self-induced, severe weight loss, amenorrhea and psychopathology. The etiology has been studied extensively (1,2) but remains unknown. Central body temperature in patients with anorexia nervosa may be reduced by up to 1°C. Patients with marked weight loss show a fall in plasma levels of LH, FSH and estrogens reflecting hypothalamo-pituitary dysfunction. This has led to the suggestion that the hypothermia in anorexia nervosa may reflect a disorder of the hypothalamic thermoregulatory centers (3). Measurements of the thermal responses to exercise demonstrated that patients with anorexia nervosa can regulate body temperature in a thermoneutral environment (4). The onset of vasodilation following immersion of an arm in a hot water bath is delayed in these patients (5) indicating a shift in the threshold temperature for vasodilation (6). Our own studies confirmed the hormonal dysfunction although circadian temperature rhythms were normal (7). Itoh (8) has suggested that hypothalamic dysfunction may be a dominant factor in the pathophysiology of anorexia nervosa. In case reports of two severely affected patients the hypothermia was accompanied by respiratory distress, hyperventilation and hypophosphatemia (9–11). The present study was undertaken to investigate the relationship of the hypothermia and hypophosphatemia in this rare syndrome.
KeywordsCircadian Rhythm Anorexia Nervosa Bulimia Nervosa Severe Weight Loss Hypothalamic Dysfunction
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