Severe enduring anorexia nervosa with significant height increase in adulthood: A case report

Anorexia nervosa (AN) is a severe psychiatric disorder characterized by restrictive eating, low body weight, and distorted body image, and is often complicated by endocrine dysfunction. While hypogonadism and delayed puberty are well documented in female patients, reports in males remain scarce because of the lower prevalence of AN in this group. Hypogonadism may result in impaired pubertal development, growth arrest, and reduced testicular volume in male patients. Although weight restoration can sometimes enable catch-up growth when AN begins before puberty, the long-term potential for pubertal onset and height gain in severe enduring anorexia nervosa (SEAN) remains unclear.

We present the case of a male patient with SEAN who showed persistent growth delay and absence of pubertal development during adolescence and early adulthood. Radiographic evaluation revealed the presence of unfused epiphyseal plates. Following sustained nutritional rehabilitation and partial weight restoration, the patient showed delayed pubertal onset accompanied by significant height gain. Endocrine assessment confirmed activation of the hypothalamic-pituitary-gonadal axis, with normalization of testosterone levels and gonadal function.

This case demonstrates the potential for delayed puberty and substantial catch-up growth in adult male patients with SEAN, provided that epiphyseal closure has not yet occurred. Sustained nutritional rehabilitation is essential for pubertal activation. These findings highlight height gain as a clinically relevant and potentially motivational factor in treatment, while also contributing to a broader understanding of growth outcomes in chronically malnourished populations.