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      Extreme hyperferritinemia in restrictive type anorexia nervosa

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          Abstract

          Summary

          Iron metabolism and markers hereof are altered in anorexia nervosa (AN) but far from completely understood. We report a case of extreme hyperferritinemia in a patient with AN and discuss the possible mechanisms and current knowledge about the association between hyperferritinemia and AN. A 20-year-old woman with a history of AN presented with bradycardia, weariness, and malaise in addition to an incidentally very high ferritin level. The symptoms disappeared spontaneously after a short admission. There were no signs suggestive of systemic, hematological, or malignant disease causing the very high concentration of ferritin. Her body weight was in decline, leading up to admission, but did initially increase after discharge accompanied by declining ferritin concentration. However, a clear association between ferritin dynamics and weight changes or physical activity was not identified and neither were other causes of the hyperferritinemia. Around one in four patients with AN have increased ferritin concentrations. Our case represents the highest ferritin concentration reported in a patient with AN without other underlying causes or comorbidities.

          Learning points

          • Perturbed iron metabolism is frequent in restrictive type anorexia nervosa but incompletely understood.

          • Altered ferritin in anorexia nervosa may be linked to nutritional status.

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          Most cited references24

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          Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.

          Jon Arcelus, Alex J Mitchell, Jackie Wales … (2011)
          Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified. To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience). English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders. Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis. From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.
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            Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

            Annelies van Eeden, Daphne van Hoeken, Hans W. Hoek (2021)
            To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality. Recent findings Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, anorexia nervosa and bulimia nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk. Summary Anorexia nervosa and bulimia nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.
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              Mortality in anorexia nervosa.

              Robert Sullivan (1995)
              The author's goal was to shed light on the debate regarding the mortality rate over time associated with anorexia nervosa. He conducted a meta-analytic study using weighted linear regression to combine crude mortality proportions from 42 published studies to estimate the mortality associated with anorexia nervosa over time. The crude rate of mortality due to all causes of death for subjects with anorexia nervosa in these studies was 5.9% (178 deaths in 3,006 subjects). The aggregate mortality rate was estimated to be 0.56% per year, or approximately 5.6% per decade. The aggregate estimated mortality rate for subjects with anorexia nervosa is substantially greater than that reported for female psychiatric inpatients and for the general population.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 08 March 2023
                Publication date Collection: 2023
                Volume: 2023
                Electronic Location Identifier: 22-0405
                Affiliations
                [1 ]Department of Internal Medicine , Viborg Regional Hospital, Denmark
                [2 ]Research Unit for Multimorbidity , Viborg Regional Hospital, Denmark
                [3 ]Department of Clinical Medicine , Aarhus University, Denmark
                Author notes
                Correspondence should be addressed to H H Thomsen; Email: henrik.holm.thomsen@ 123456clin.au.dk
                Author information
                http://orcid.org/0000-0001-6551-3606
                http://orcid.org/0000-0003-0522-0320
                Article
                Publisher ID: EDM220405
                DOI: 10.1530/EDM-22-0405
                PMC ID: 10083646
                PubMed ID: 36951802
                SO-VID: 9091c0cf-aaa7-40df-9e5d-596800b2bd80
                Copyright © © the author(s)
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                History
                Date received : 07 December 2022
                Date accepted : 08 March 2023
                Categories
                Subject: Adolescent/Young Adult
                Subject: Female
                Subject: White
                Subject: Denmark
                Subject: Adrenal
                Subject: Cardiovascular Endocrinology
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

                Keywords: adolescent/young adult,female,white,denmark,adrenal,cardiovascular endocrinology,unique/unexpected symptoms or presentations of a disease,march,2023
                Data availability:
                Keywords: adolescent/young adult, female, white, denmark, adrenal, cardiovascular endocrinology, unique/unexpected symptoms or presentations of a disease, march, 2023

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