Dr. Eric Daiter, MD - Ovulation Cycles, Disorders and Available Treatments

Ovulation Dysfunction
  • Ovarian Dysfunction
  • Pituitary Dysfunction
  • Hypothalamic &
      CNS Dysfunction
    ¬ Polycystic Syndrome
    ¬ Anorexia Nervosa

Clinical Evaluation

Treatment Options

Anorexia nervosa is characterized by a morbid fear of obesity. The reason for this disorder is not clear but many believe it originates because of an inability to cope with sexuality and represents the woman’s desire to return to a prepubertal state. The mortality rate with anorexia nervosa is high (5-15%) so a heightened index of suspicion is warranted. These women are typically success, appearance and achievement oriented with a tendency to be overachievers. The diagnosis is based on standard criteria, including

refusal to maintain a normal body weight, with loss of 25% of original body weight or a weight of 15% below normal for age and height
special attitudes regarding food, including a distorted body image with the feeling of personal obesity
one of a variety of signs or symptoms, including lanugo hair, bradycardia, overactivity, episodes of bulimia, or vomiting
amenorrhea
no known medical or psychiatric disorder leading to the weight loss

In addition to the historical and physical findings, laboratory evaluation may reveal

normal TSH and free T4 but low T3 and high reverse T3, simulating the “euthyroid sick state.” This may be a nonspecific response to starvation in which energy is conserved by preferentially converting T4 to reversed T3 (which is less bioactive)
low FSH and low LH concentrations, resulting in hypogonadotropic hypogonadism
increased plasma cortisol level (which can be used to distinguish the lab findings of anorexia from panhypopituitarism)

Extensive hormonal evaluation is not clinically necessary when the diagnosis is clear. Treatment can be difficult but often a careful frank discussion revealing the relationship between the ovulatory dysfunction and anorexia is all that is required. Treatment is more difficult in the presence of denial, due to noncompliance, and referral to an appropriate counselor may be required.

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