A 13-year-old girl consults us for weight loss, asthenia, secondary amenorrhea and constipation. Examination revealed a temperature of 35ºC, weight below the 3rd percentile, bradycardia and orthostatic hypotension. Laboratory tests showed anemia with mild leukopenia, cholesterol of 230 mg/dL and on the electrocardiogram a flattened T wave with ST-segment elevation and prolonged QTc. What process would you suspect and what would you do next?
The correct answer is 1. The symptoms and signs described are the biological findings associated with anorexia nervosa. The ECG disturbances are derived from electrolyte disturbances.
Suspect anorexia nervosa and inquire about intake, body image, etc.
Suspect hypothyroidism and request TSH and thyroid hormones.
Suspect cardiomyopathy and request echocardiography.
I would suspect celiac disease and request anti-transglutaminase IgA antibodies.
Suspect panhypopituitarism and request a cranial CT scan.
The symptoms and signs described are the biological findings associated with anorexia nervosa.