Comorbidity of anorexia nervosa in a male patient with congenital hypogonadism: Case report

Erkek hipogonadizmi testisin androjen üretme yetersizliğine bağlı oluşmaktadır. Hastalarda, dolaşımda düşük testosteron seviyeleri yanında osteopeni, kas kütlesi, libido, enerji ve dayanıklılıkta azalma, bilişsel işlevlerde düşüş, yağ miktarında artış ve erektil işlev bozukluğu gibi klinik belirtiler gözlenir. Anoreksiya nervoza (AN) erkeklerde oldukça nadir görülen, genelde kadınlardan on kat daha az görülen ve ortaya çıkış nedenlerinden seyrine kadar pek çok alanda farklılıklar gösteren bir durumdur. Açlık fizyolojisine bağlı olarak AN da önemli tıbbi komplikasyonlar gelişmektedir ve bu genel bir tıbbi hastalık gibi pek çok sistemi etkilemektedir. ANde etkilenen sistemlerden biri de genitoüriner sistemdir; uzun süren AN tablosunun veya kaşeksinin hipogonadizme neden olabildiği bilinmektedir. Bu yazıda bebeklikten itibaren hipogonadizm teşhisi olan ve tedavi almayan, 18 yaşında iken AN gelişen bir vaka sunulmaktadır.

Konjenital hipogonadizmi olan erkek hastada ek hastalık olarak anoreksiya nervoza: Olgu sunumu

Male hypogonadism is a result of insufficient testicular androgen production. In addition to low circulating testosterone levels, patients develop clinical symptoms such as osteopenia, decrease in muscle mass, ibido, energy and stamina, decline in cognitive function, increased adiposity, and erectile dysfunction. Anorexia nervosa (AN) is quite rarely seen in men, being usually ten times less common than in women, and shows differences in many aspects, from causation to presentation. As AN is connected to hunger physiology, it entails significant medical complications affecting, as in any general medical condition, a number of systems, including the genitourinary system. It is known that a prolonged manifestation of AN or cachexia may cause hypogonadism. This article presents the case of a patient with untreated hypogonadism, diagnosed in his infancy, who at the age of 18 developed AN.

PDF

___

1. Kaya N, Cilli AS. Anorexia nervosa. General Medical Journal 1997; 7:107-110. (Turkish)
2. Aydemir O, Koroglu E. Eating Disorders: In Koroglu E (Translation Editor). DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition. Ankara: Hekimler Yayin Birligi, 1998, 727-746. (Turkish)
3. OBrien J, Patrick A. Cost of the acute hospitalization for anorexia nervosa and bulimia. Value in Health 2001; 4:146-152.
4. Tomova A, Kumanov P. Sex differences and similarities of hormonal alterations in patients with anorexia nervosa. Andrologia 1999; 31:143-147.
5. Klapper F, Gurney VW, Wiseman CV, Cheng HT, Halmi KA. Psychiatric management of eating disorders. Nutr Clin Care 1999; 2:354-360.
6. Grossmann M , Thomas MC, Panagiotopoulos S, Sharpe K, Macisaac RJ, Clarke S, Zajac JD, Jerums G. Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab 2008; 93:1834-1840.
7. Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2006; 295:1288-1299.
8. Clement K, Vaisse C, Lahlou N, Cabrol S, Pelloux V, Cassuto D, Gourmelen M, Dina C, Chambaz J, Lacorte JM, Basdevant A, Bougneres P, Lebouc Y, Froguel P, Guy-Grand B. A mutation in the human leptin receptor gene causes obesity and pituitary dysfunction. Nature 1998; 392:398-401.
9. Goldstone AP, Holland AJ, Hauffa BP, Hokken-Koelega AC, Tauber M; speakers contributors at the Second Expert Meeting of the Comprehensive Care of Patients with PWS. Recommendations for the diagnosis and management of Prader Willi syndrome. J Clin Endocrinol Metab 2008; 93:4183-4197.
10. Rosen DS. Eating disorders in children and young adolescents: etiology, classification, clinical features and treatment. Adolesc Med 2003; 14:49-59.
11. Lai KY, Pang AH, Wong CK. Case study: early-onset anorexia nervosa in a Chinese boy. J Am Acad Child Adolesc Psychiatry 1995; 34:383-386.
12. Isik Y, Gokler B. Psychodynamics of anorexia nervosa. Psychiatry in Turkiye 2001; 3:10-15. (Turkish)
13. Tomova A, Kumanov P. Sex differences and similarities of hormonal alterations in patients with anorexia nervosa. Andrologia 1999; 31:143-147.
14. Klapper F, Gurney VW, Wiseman CV, Cheng HT, Halmi KA. Psychiatric management of eating disorders. Nutr Clin Care 1999; 2:354-362.
15. Maner F. Eating Disorders. Psikiyatri Dünyası 2001; 5:130-139. (Turkish)
16. Canat S. Eating Disorders: In Gulec C, Koroglu E (editors). Basics of Psychiatry. Ankara: Hekimler Yayin Birligi, 1998; 661-672. (Turkish)
17. Johnson ME, Brems C, Fischer P. Sex role conflict, social desirability, and eating-disorder attitudes and behaviors. J Gen Psychol 1996; 123:75-87.
18. Oleinikov AN. Specific factors of sex behavior in patients with anorexia nervosa and bulimia. Zh Nevrol Psikhiatr Im S S Korsakova 2000; 100:19-22. (Russian)
19. Inui A. Eating behavior in anorexia nervosa -- an excess of both orexigenic and anorexigenic signaling? Mol Psychiatry 2001; 6:620-624.
20. Pagotto U, Gambineri A, Vicennati V, Heiman ML, Tschöp M, Pasquali R. Plasma ghrelin, obesity, and the polycystic ovary syndrome: correlation with insulin resistance and androgen levels. J Clin Endocrinol Metab 2002; 87:5625-5629.
21. Glintborg D, Andersen M, Hagen C, Frystyk J, Hulstrom V, Flyvbjerg A, Hermann AP. Evaluation of metabolic risk markers in polycystic ovary syndrome (PCOS). Adiponectin, ghrelin, leptin and body composition in hirsute PCOS patients and controls. Eur J Endocrinol 2006; 155:337-345.
22. Blum WF, Englaro P, Hanitsch S, Juul A, Hertel NT, Müller J, Skakkebaek NE, Heiman ML, Birkett M, Attanasio AM, Kiess W, Rascher W. Plasma leptin levels in healthy children and adolescents: dependence on body mass index, body fat mass, gender, pubertal stage and testosterone. J Clin Endocrinol Metab 1997; 82:2904-2910.
23. Wabitsch M, Blum WF, Muche R, Braun M, Hube F, Rascher W, Heinze E, Teller W, Hauner H. Contribution of androgens to the gender difference in leptin production in obese children and adolescents. J Clin Invest 1997; 100:808-813.
24. Russ MJ, Ackerman SH, Barakat R, Levy B. Hypogonadotropic hypogonadism and delayed puberty in a man with anorexia nervosa. Psychosomatics 1986; 27:737-739.
25. Wesselius CL, Anderson G. A case study of a male with anorexia nervosa and low testosterone levels. J Clin Psychiatry 1982; 43:428-429.
26. Ohzeki T, Shiraki K, Igarashi Y, Egi S, Kamoshita S, Kobayashi N. A 25-year-old man with congenital hypothalamic hypogonadism and anorexia nervosa. Exp Clin Endocrinol 1991; 97:97-98.