Anorexia nervosa: a mistaken diagnosis

Abstract

Eating disorders in the form of anorexia and bulimia are becoming increasingly common in young adults and children. Most of the patients are initially seen by their general practitioner (GP) and it may take several months before the facts are pieced together and an underlying eating disorder is identified. However, other medical conditions, albeit rare, should be considered when assessing these young adults as potentially missing them can lead to devastating consequences. This case highlights how a 15-year-old girl who presented to her GP with a history suggestive of an eating disorder and had a body mass index below the 0.4th centile, in fact had classical symptoms and clinical signs of primary adrenal failure, or Addison's disease.

A Challenging diagnosis that eventually results in a life-threatening condition: Addison’s disease and adrenal crisis

“…Another case, strikingly similar to our own, describes a young man lacking concern for his deteriorating health, who was appreciated to suffer from both obsessional traits and depression; later a mistaken diagnosis of anorexia nervosa was made before primary adrenal insufficiency was confirmed 15. Other cases presenting as anorexia nervosa can be found in the literature, which is not surprising given that vomiting along with weight loss are common manifestations of adrenal insufficiency 16. Even then, as always, the cardinal sign of extreme fatigue prevails and the importance of suspecting and not so readily dismissing this rare diagnosis cannot be stressed enough, before the symptoms of debility and lack of concern for their own physical state make the affected ‘sink and expire’ and eventually encounter a life-threatening adrenal crisis at a much too young age.…”

Wilkie’s syndrome, a missed opportunity

“…When addressing these symptoms in the clinical practice, the possibility of an underlying eating disorder is often considered. However, some patients will have an undiagnosed pathology that could be missed, including Addison disease and Wilkie’s syndrome [ 6 ], as was presented in our case. Since Rokitansky first description in 1861, Wilkie’s syndrome is a rare cause of duodenal obstruction [ 4 ] caused by the compression of the third portion of the duodenum by the SMA or one of its branches against the aorta [ 5 , 7 ].…”

“…The treatment will depend on the degree of obstruction. A conservative treatment can be offered at first, which includes some weight gain and the change of some eating habits, which to a certain extent can help relieve the symptoms [ 6 , 7 ]. When a conservative treatment fails, surgery is usually indicated.…”

Case Series: Four Cases of Anorexia Nervosa Concomitant with Central Adrenal Insufficiency

“…The clinical symptoms of anorexia nervosa and Addison's disease are similar [1]. Addison's disease has been misdiagnosed as anorexia nervosa in some cases [1,2].…”

“…The clinical symptoms of anorexia nervosa and Addison's disease are similar [1]. Addison's disease has been misdiagnosed as anorexia nervosa in some cases [1,2]. In contrast to Addison's disease, however, the hypothalamius-pituitary-adrenal (HPA) axis is activated in anorexia nervosa [3].…”