Biochemical and ultrasonic abnormalities of the pancreas in anorexia nervosa

Seven of 10 patients with anorexia nervosa had ultrasonic and/or biochemical abnormalities of the pancreas. Seven patients had elevated amylase creatinine clearance ratios (greater than 4%), three patients had elevated serum amylase values (greater than 90 units/liter), and three patients had reduced echogenicity of the pancreas. There was no consistent association between presenting abdominal symptoms and abnormal ultrasonic and biochemical studies of the pancreas. After nutritional repletion, all studies reverted to normal. An eleventh patient, who was initially diagnosed as having anorexia nervosa but later found to have an astrocytoma of the medulla, had reduced echogenicity of the pancreas, suggesting malnutrition as the cause of these abnormal pancreatic studies. Pancreatic abnormalities due to protein-calorie malnutrition may be common in anorexia nervosa and must be differentiated from primary pancreatitis.