PCOS Eating Disorders

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PCOS Eating Disorders
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Eating Disorders

• Age of onset 10 to 30 years of age
• Incidence 1 of women
• Pathological eating is of two types
• Anorexia nervosa
• Bulimia nervosa
• Commoner in white race and middle and higher
  socioeconomic strata

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Clinical Features

• Weight loss occurs to the degree of 25 or 15
  below normal for age and height
• Behavioral abnormalities
• Attitude of denial
• Distorted body image
• Abnormal food handling

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Clinical Features

• At least one of the following clinical
  feature present
• Lanugo hair
• Bradycardia
• Over activity
• Episodes of overeating or bulimia
• Self induced vomiting
• 50 of bullimias are associated with anorexia

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Clinical Features

• Additional features
• Amenorrhoea
• Constipation
• Hypotension
• Hypercarotenimia
• Diabetes insipidus

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- Fries H, Acta Psychiatr Scand Suppl 248,1974.
Fries Four Stages of Dieting Behavior

• Dieting For Cosmetic Reasons
• Dieting due to neurotic fixation on food intake
  and weight
• The anorectic reaction
• True anorexia nervosa

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Pathophysiology

• Self-starvation
• Malnutrition
• Protein deficiency
• Disruption of multiple organ systems hypoglycemia
  
• Severe loss of fat stores
• Multiple vitamin deficiencies

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Pathophysiology

• Delayed puberty, amenorrhea, anovulation, low
  estrogen states
• Euthyroid sick state or hypothyroid state
• Neuropathy, myopathy, encephalopathy,
  hypothermia.
• Cardiovascular effects
• bradycardia
• orthostatic hypotension
• shock due to congestive heart failure

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Pathophysiology

• Renal Disturbances
• Decreased glomerular filtration rate (GFR),
• Elevated BUN
• Edema
• Acidosis with dehydration
• Hypokalemia
• Hypochloremic alkalosis with vomiting
• Hyperaldosteronism.
• Bone marrow suppression leading to
  abnormalities of
• platelet
• erythrocyte
• leukocyte

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Pathophysiology

• Gastrointestinal problems
• Constipation
• Delayed gastric emptying
• Gastric dilation and rupture
• Dental enamel erosion
• Palatal trauma
• Enlarged parotids
• Esophagitis
• Mallory Weiss lesions
• Diminished gag reflex
• Elevated transaminases

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Menstrual Function And Anorexia

• Frischs concept of critical weight
• Onset and regularity of menstrual function
  necessitate maintaining weight above a critical
  level.
• At age of 13, 10th percentile body weight 17
  of body fat
• At age of 16 years, 10th percentile body weight
  22 of body fat
• Menstrual dysfunction results when total body fat
  drops to lt 22
• High levels of CRH corticotrophin releasing
  hormone and leptin also alter menstrual function

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Causes of Death in Anorexia ( 5-15 )

• Commonest Cause of Death - Suicide
• Other causes are . . .
• Shock
• Cardiac dysrhythmias
• If anorexia is associated with bulimia then
  prognosis is worse with a death rate of 5-40

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Investigations

• Complete blood count may reveal
• normocytic normochromic anemia and mild
  leukopenia due to bone marrow suppression
• Chemistry panel
• Severe hypokalemia
• due to laxative abuse or alkalemia from
  vomiting
• Significant electrolyte abnormalities
• due to dehydration
• Hypocalcemia
• due to dietary deficiency and associated protein
  deficiency.
• Ionized calcium is the best measure of calcium
  concentration in the body.

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Investigations

• Possible ECG changes include . . .
• nonspecific ST- and T-segment abnormalities
• atrial tachycardia
• idioventricular conduction delay
• heart block
• nodal rhythms
• ventricular escape
• premature ventricular contractions
• prolonged QTC interval
• Total and fractionated serum protein, liver
  function studies, and clotting studies may
  quantify the degree of starvation and protein
  malnutrition.

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Investigations

• Urinalysis may rule out
• urinary tract infections
• dehydration
• renal acidosis abnormalities.
• Fecal occult blood may be indicative of
• esophagitis
• gastritis
• repetitive colonic trauma from laxative abuse
• a bleeding disorder
• severe protein malnutrition.

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Investigations

• Serum thyroid function often shows hypothyroid
  state
• Imaging Studies
• Chest radiographs. . .
• rib fractures from repetitive vomiting in
  the presence of hypocalcemia
• cardiomegaly from imalnutrition
• other medical illnesses such as pneumonia.
• Abdominal radiographs
• An ileus due to electrolyte disturbances

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Management

• Team approach
• psychiatry, adolescent medicine specialists,
  endocrinologists
• Individual and family psychotherapy
• anorexia nervosa
• Cognitive-behavioral therapy
• bulimia nervosa.
• Stabilization for any life-threatening conditions
  
• shock, cardiac arrhythmias
• Protection of the patient to prevent suicide.

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Management

• Rehydration
• correction of electrolyte abnormalities
  (eg, hypokalemia)
• Forced feedings
• total parenteral nutrition or tube feedings to
  replace nutrients
• Daily caloric intake 2600 cal /day is advised
• Rarely drugs like serotonin reuptake inhibitors
  required
• Ongoing psychiatric care to prevent relapse

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Prognosis

• Is related to the severity of the underlying
  personality and family psychopathology
• The prognosis for patients with a bulimic
  component is worse than for those without bulimia
• Death for patients with bulimia is 5-40
• A small percentage of patients become symptom
  free
• 30 remain chronically ill
• Rest are vulnerable to the return of symptoms
  during stressful times

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Take Home Message

• Eating disorders are relatively rare in India
• May be diagnosed more often if actively looked
  for
• Active search may help early diagnosis, as well
  as effective treatment and will reduce high
  mortality associated with it.
• Change of lifestyle, psychological counseling of
  not only the peripubertal girls but also of their
  disturbed family may go a long way to prevent
  these potentially catastrophic conditions

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Concept Dr. Duru Shah

• Editors
• Dr. Sangeeta Agrawal
• Dr. Reena Wani

• Contributors
• Dr. Suvarna Khadilkar
• Dr. Vaman Khadilkar

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We acknowledge the efforts of our

• Coordinators
• Dr. Sangeeta Agrawal - Central
• Dr. Narendra Malhotra - North
• Dr. Hema Divakar - South
• Dr. P. C. Mahapatra - East
• Dr. Uday Thanawala - West
• In bringing the FOGSI YOUTH EXPRESS to your
  city.

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This Youth Express has been possible through an
educational grant from

• Charak Pharma Pvt. Ltd
• CIPLA Ltd.
• Emcure Pharmaceuticals Ltd
• GlaxoSmithKline Pharmaceuticals Limited
• Glenmark Pharmaceuticals Ltd.
• Metropolis Health Service (India) Pvt.Ltd.
• Organon India Ltd
• Roche Pharmaceuticals Ltd.
• Sandoz Private Limited
• USV Limited
• Wyeth Limited