Development of Cushing's disease in a patient with anorexia nervosa

A young woman developed clinical features of anorexia nervosa with a maximal loss of ideal body weight of 54 per cent at the age of 16 yr. A partial recovery from the anorectic symptoms was encountered six years later. At the age of 27 yr pituitary Cushing's disease was diagnosed and corticotroph cell pituitary adenoma subsequently removed by transsphenoidal surgery. Within two years after the operation the clinical and biochemical signs of hypercortisolism had disappeared but some of the anorectic features reappeared. Without neglecting the likelihood of a simple coincidence, the possibility of a common pathogenetic mechanism for anorexia nervosa and Cushing's disease, either affecting the function of the hypothalamic serotonergic pathways or concentration of glucocorticoid receptors, is discussed.