Keywords
Pericardial effusion
Pleural effusion
Feeding and eating disorders
Endocrine systems disease
Adolescent
How to Cite
Abstract
Introduction: Anorexia nervosa is a psychiatric disorder that entails serious somatic sequelae, including endocrine and cardiovascular involvement. One of its rarest and most severe manifestations is polyserositis, which demands prompt clinical management.
Objective: To describe a case of anorexia nervosa complicated by polyserositis and profound endocrine dysfunction, emphasizing the diagnostic process, multidisciplinary management, and clinical evolution.
Case presentation: A 17-year-old female adolescent presented with a 10-month history of progressive weight loss, amenorrhea, cold intolerance, and autonomic symptoms. She was admitted after a syncopal episode with signs of shock—hypotension, bradycardia, and cachexia. Transthoracic echocardiography revealed a moderate-to-severe pericardial effusion with hemodynamic compromise, necessitating pericardiectomy and drainage. An exudative pleural effusion was also documented. Rheumatologic and oncologic work-ups were negative. Endocrine assessment showed hypogonadotropic hypogonadism, suppressed insulin-like growth factor-1 (IGF-1), elevated growth hormone levels, and dysregulation of the thyrotropic axis, all in the context of severe malnutrition. A progressive nutritional rehabilitation program was instituted, achieving a weekly weight gain of 600 g, which led to normalization of the hormonal profile and complete clinical resolution.
Discussion: Polyserositis in anorexia nervosa is a rare yet potentially life-threatening presentation. Its pathophysiology involves prolonged malnutrition, neuroendocrine dysfunction, and cardiovascular alterations. Diagnostic evaluation must rule out infectious, neoplastic, and autoimmune etiologies and should be conducted within a multidisciplinary framework.
Conclusion: This case underscores the need to consider anorexia nervosa as an underlying cause of polyserositis in severely malnourished adolescents. Monitored nutritional rehabilitation and a coordinated multidisciplinary approach were pivotal to achieving clinical and hormonal recovery.
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