Aiko Koga1, Masafumi Murakami1, Yu Kurihra1, Tsuyoshi Ishida2, Mariko Hosokawa1, Naho Tamura1, Masatoshi Imamura3, Keisuke Kawai4. 1. Department of Psychosomatic Medicine, Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, Chiba, 272-8516, Japan. 2. Department of Clinical Examination Laboratory, Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, Chiba, 272-8516, Japan. 3. Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, Chiba, 272-8516, Japan. 4. Department of Psychosomatic Medicine, Kohnodai Hospital, National Center for Global Health Medicine, 1-7-1, Kohnodai, Ichikawa City, Chiba, 272-8516, Japan. kawai@cephal.med.kyushu-u.ac.jp.
Abstract
PURPOSE: We previously reported three cases of portal hypertension in patients with prolonged anorexia nervosa (AN) with laxative abuse and self-induced vomiting; we now report a fourth, similar case. METHODS: A 34-year-old woman with anorexia nervosa, binge-eating/purging type (AN-BP), presented to the Kohnodai Hospital National Center for Global Health and Medicine Psychosomatic Medicine Department for treatment of low body weight. We conducted hepatic and renal biopsies and cardiac magnetic resonance imaging (CMR) to evaluate her complicated liver disease, renal failure, and cardiac insufficiency, respectively. RESULTS: Enhanced computed tomography revealed ascites, splenomegaly, and gastroesophageal varices, indicating portal hypertension. The liver and kidney biopsies demonstrated chronic hepatitis without evidence of hepatic cirrhosis and tubulointerstitial nephritis, respectively. CMR demonstrated decreased myocardial mass. CONCLUSION: We found tubulointerstitial nephritis and decreased myocardial mass in a patient with non-cirrhotic portal hypertension and prolonged AN with laxative abuse and habitual self-induced vomiting. We propose that reciprocal interactions between multiple factors related to AN, including laxative toxicity, dehydration, renal disorder, and cardiac insufficiency, result in portal hypertension. Level of Evidence Level V.
PURPOSE: We previously reported three cases of portal hypertension in patients with prolonged anorexia nervosa (AN) with laxative abuse and self-induced vomiting; we now report a fourth, similar case. METHODS: A 34-year-old woman with anorexia nervosa, binge-eating/purging type (AN-BP), presented to the Kohnodai Hospital National Center for Global Health and Medicine Psychosomatic Medicine Department for treatment of low body weight. We conducted hepatic and renal biopsies and cardiac magnetic resonance imaging (CMR) to evaluate her complicated liver disease, renal failure, and cardiac insufficiency, respectively. RESULTS: Enhanced computed tomography revealed ascites, splenomegaly, and gastroesophageal varices, indicating portal hypertension. The liver and kidney biopsies demonstrated chronic hepatitis without evidence of hepatic cirrhosis and tubulointerstitial nephritis, respectively. CMR demonstrated decreased myocardial mass. CONCLUSION: We found tubulointerstitial nephritis and decreased myocardial mass in a patient with non-cirrhotic portal hypertension and prolonged AN with laxative abuse and habitual self-induced vomiting. We propose that reciprocal interactions between multiple factors related to AN, including laxative toxicity, dehydration, renal disorder, and cardiac insufficiency, result in portal hypertension. Level of Evidence Level V.
Authors: Stefano Giovinazzo; S G Sukkar; G M Rosa; A Zappi; G P Bezante; M Balbi; C Brunelli Journal: Eat Weight Disord Date: 2018-09-01 Impact factor: 4.652