Managing adolescents with eating disorders

Anorexia nervosa is a complex psychiatric disorder with endocrinologic manifestations primarily affecting adolescent females. The classic triad of presenting symptoms is weight loss in excess of 15% of ideal body weight, behavioral changes and amenorrhea (secondary or primary). The menstrual irregularities may cause the patient or family to seek gynecologic consultation before the diagnosis of primary psychiatric disorder has been made. Bulimia is a separate disease entity characterized by compulsive overeating binges followed by compensatory purging behavior to maintain a desired weight. Depending on the degree of psychiatric disturbance, purging, and ultimate body weight, such patients may or may not present with menstrual abnormalities. Hypoestrogenic hypothalamic amenorrhea in both types of patients may result in osteoporosis, stress fractures, and infertility. Obese women, in contrast to the above, most often have abnormally heavy bleeding patterns secondary to chronic anovulation. Their-short term gynecologic concerns may be cycle control or infertility, but over the long term they are at increased risk for endometrial hyperplasia and cancer.