Case of a Girl with Secondary Amenorrhea and an Eating Disorder
This clinical case describes a 13-year-old female who presents with secondary amenorrhea. She has lost 3 kg since age 12, but on close examination of her growth charts, this seemingly small amount of weight loss at a time of expected rapid growth translates into a significant decrease in BMI percentile. Her history, vital signs, physical exam, and laboratory work are consistent with a diagnosis of anorexia nervosa. Untreated anorexia can lead to grave outcomes such as osteopenia, cardiac arrest, suicide, infertility, and the development of chronic anorexia nervosa that becomes refractory to treatment. The most effective treatment is aggressive nutritional rehabilitation through the administration of nutrient-dense meals. Family-based treatment is the most evidence-based modality for refeeding anorexic adolescents, especially those who are young with a short duration of illness. It is imperative that parents understand the gravity of this diagnosis and the need for timely and aggressive treatment.
KeywordsAmenorrhea Anorexia nervosa Bone health Family-based treatment Maudsley method
- 7.Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. 2010;67:1025–32. https://doi.org/10.1001/archgenpsychiatry.2010.128.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Lock JD, Legrange D. Anorexia nervosa in adolescents: a treatment manual. 2nd ed. New York: The Guilford Press; 2013.Google Scholar
- 9.Accurso EC, Ciao AC, Fitzsimmons-Craft EE, Lock JD, Le Grange D. Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behav Res Ther. 2014;56:1–6. https://doi.org/10.1016/j.brat.2014.02.006.CrossRefPubMedPubMedCentralGoogle Scholar
Suggested Educational Reading and References
- Maudsley Parents website: www.maudsleyparents.org