Alendronate for the treatment of osteopenia in anorexia nervosa: a randomized, double-blind, placebo-controlled trial.

Osteopenia is a serious medical complication of anorexia nervosa, with no known effective treatment. We conducted a double-blinded, randomized trial comparing alendronate (10 mg daily) with placebo in 32 adolescents with anorexia nervosa (mean age, 16.9 +/- 1.

Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: implications for refeeding and monitoring.

Purpose: To determine the incidence of hypophosphatemia in adolescents with anorexia nervosa (AN) hospitalized for nutritional rehabilitation and to examine factors predisposing to its development.

Methods: A retrospective chart review of 69 patients (66 female, 3 male) with AN consecutively admitted to an inpatient adolescent medical unit between July 1, 1998 and June 30, 2000. Mean age was 15.

Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa.

Purpose: To determine the amount of time necessary for stabilization of blood pressure and heart rate in patients with anorexia nervosa (AN) and the percentage of ideal body weight (IBW) at which this occurs.

Methods: A retrospective study was conducted on 36 adolescent patients (33 F, 3 M) with AN, restricting type (Diagnostic and Statistical Manual of Mental Disorders, Fourth edition [DSM-IV] criteria), admitted to a specialized eating disorders unit for nutritional rehabilitation between October 1996 and August 1998. Mean age was 16.

The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa.

Introduction: Osteopenia is a serious complication of anorexia nervosa (AN). Although in other states of estrogen deficiency, estrogen replacement therapy increases bone mass, its role in AN remains unresolved.

Study Objective: To study the effect of estrogen-progestin administration on bone mass in AN.

Cardiac arrest and delirium: presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa.

Aim: To describe the clinical presentation of the refeeding syndrome and highlight the dangers of performing nutritional rehabilitation too rapidly in a severely malnourished patient.

Design: Retrospective case review of adolescents admitted with anorexia nervosa who developed the refeeding syndrome.

Results: Between July 1993 and July 1994, 3 of 48 adolescent females developed the refeeding syndrome.

The metabolic responses to starvation and refeeding in adolescents with anorexia nervosa.

Adaptive changes in metabolism result in decreased energy requirements in AN. A retrospective study of 21 hospitalized female AN patients demonstrated that indirect calorimetry (IC) measurement of resting energy expenditure (REE) was significantly lower than REE calculated by the Harris-Benedict equation (HBE). The HBE was adjusted by multiple-regression analysis to reflect the hypometabolic state of AN, and the adjusted equation was prospectively validated in 37 hospitalized female AN patients.

Resumption of menses in anorexia nervosa.

Objective: To determine factors associated with resumption of menses (ROM) in adolescents with anorexia nervosa.

Design: Cohort study with 2-year follow-up.

Setting: Tertiary care referral center.

Searching for Clues to Fever of Unknown Origin.

A 13-year-old adolescent girl of Greek descent presented with fever of unknown origin and arthralgias of wrists and ankles 3 weeks following vacationing in Greece. On the initial physical examination there were no signs of arthritis and the neurologic signs were normal. On the outpatient follow-up, fever and arthralgia persisted and pedal pulses were absent.

Directly observed preventive therapy. Turning the tide against tuberculosis.

Objective: To compare compliance between directly observed preventive therapy and daily treatment for students with inactive (class II) tuberculosis.

Design: Cohort analytic study and cost-effectiveness analysis. Students found to be positive for purified protein derivative and having no abnormal chest x-ray films on mandated screening were advised to have prophylactic treatment with isoniazid.

Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging.

Objective: To determine the reversibility of the loss of brain parenchyma and ventricular enlargement in patients with anorexia nervosa after refeeding.

Study Design: Quantitative magnetic resonance imaging was performed on three groups of subjects: (1) 12 female adolescents hospitalized with anorexia nervosa, (2) the same 12 patients after nutritional rehabilitation, a mean of 11.1 months later, and (3) 12 healthy age-matched control subjects.

Medical complications in male adolescents with anorexia nervosa.

Purpose: Medical information on male anorectics is scant. We present data on 10 males with anorexia nervosa, who were treated at our Eating Disorders Center during a twelve-year period.

Methods: Retrospective chart review.

Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa.

Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3.

Amenorrhea in anorexia nervosa. Neuroendocrine control of hypothalamic dysfunction.

Amenorrhea is one of the cardinal features of anorexia nervosa and is associated with hypothalamic dysfunction. Earlier theories of weight loss, decreased body fat, or exercise do not fully explain the etiology of amenorrhea in anorexia nervosa. Disturbances in central dopaminergic and opioid activity have been described in anorexia nervosa and both these substances are known to modulate gonadotropin-releasing hormone (GnRH)-mediated luteinizing hormone (LH) release.

Adolescent obesity and cardiovascular risk: a rational approach to management.

Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized.

Amenorrhrea in Anorexia Nervosa: Etiology and Implications.

Amenorrhea is one of the necessary criteria for diagnosis of anorexia nervosa in female adolescents, but its exact pathophysiology remains controversial. Involvement of hyperthalamic dysfunction may be due to malnutrition or to an underlying neurotransmitter abnormality. The association of anorexia nervosa with both osteopenia and hypoestrogenemia gives clinical and therapeutic significance to an understanding of the underlying pathophysiology.

Passive smoking alters lipid profiles in adolescents.

Although cigarette smoking is associated with elevation of plasma lipid levels and changes in lipoprotein distribution, it is not known whether passive smoking is associated with an alteration in lipid profiles. The relation between plasma cotinine, a marker of exposure to tobacco smoke, and lipid profiles was studied in healthy adolescents from a suburban New York high school district who were undergoing preparticipation sports physicals. Forty-four percent of the adolescents reported that one or both parents currently smoked.

Management of Adolescents with Eating Disorders: Role of the Primary Physician and Family.

It has been demonstrated that family dynamics and relationships are important in the development, promulgation, and potential resolution of eating disorders in adolescents. This chapter emphasizes the role of the health care provider in working with the adolescent patient with eating disorders and his or her family.

Chest pain in adolescents.

Adolescents with chest pain were compared with healthy adolescents to determine if they were more likely to believe they had cardiac disease and were less healthy than their peers. Perceptions were examined with a questionnaire and results analyzed by chi 2 analysis. Twenty-two percent of adolescents with chest pain were diagnosed with cardiac problems, a prevalence rate higher than previous reports.

Effect of weight restoration on the dyslipoproteinemia of anorexia nervosa.

Dyslipoproteinemia, a risk factor for atherosclerosis, has been described in anorexia nervosa (AN). To assess whether dyslipoproteinemia is present in our AN population, and to investigate the effect of controlled refeeding, we prospectively examined lipid profiles in 16 hospitalized adolescents with anorexia nervosa on admission and at discharge with a body weight of 90% of ideal. Healthy high school females served as controls.

Blunted growth hormone responses to clonidine in adolescent girls with early anorexia nervosa. Evidence for an early hypothalamic defect.

We studied growth hormone (GH) levels in 14 adolescents with anorexia nervosa (AN), 12-20 years of age. All had amenorrhea and the duration of symptoms ranged from 2-24 months. There was no difference in unstimulated GH between the girls with AN and endocrinologically normal girls.