Keifenheim Katharina Eva, Giel Katrin Elisabeth, Leehr Elisabeth Johanna, Becker Sandra, Mörike Klaus, Zipfel Stephan, Teufel Martin
Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Klinik, Universitätsklinikum Tübingen, Germany.
Dtsch Med Wochenschr. 2013 Aug;138(33):1670. doi: 10.1055/s-0033-1343313. Epub 2013 Aug 2.
We report on a 24-year-old patient with secondary amenorrhoea, underweight (BMI 15,0 kg/m²), and a fear of weight gain, who used laxatives, diuretics, excessive sport and human chorionic gonadotropin (hCG) for weight regulation.
On physical examination, cachexia, bradycardia, lanugo hair on face and back, and cyanosis of hands and feet were observed. In the laboratory findings, leukopenia, recurrent low potassium and an elevated mean corpuscular volume (MCV) were remarkable.
DIAGNOSIS, TREATMENT AND COURSE: We diagnosed anorexia nervosa, binge/purging type (AN-BP). We treated the patient for seven weeks in a multimodal setting specific for patients with eating disorders. She gained 3.9 kg (11% of her initial weight). Special challenges included the complications of her laxative abuse as well as her distinct body image disturbance. With knowledge of her background, we understood this misuse of hCG.
Purging behaviour should be questioned in detail in patients with eating disorders, because purging methods are not always reported right away and are accompanied with great shame. However, purging behaviour can be very dangerous to one's health. Using a hCG diet (Hollywood diet) is a rare purging method in patients with anorexia nervosa.
我们报告一名24岁继发性闭经、体重过轻（体重指数15.0kg/m²）且害怕体重增加的患者，其使用泻药、利尿剂、过度运动及人绒毛膜促性腺激素（hCG）来控制体重。
体格检查发现恶病质、心动过缓、面部及背部有胎毛、手脚发绀。实验室检查结果显示白细胞减少、反复低钾及平均红细胞体积（MCV）升高显著。
诊断、治疗与病程：我们诊断为神经性厌食症，暴食/清除型（AN-BP）。我们在针对饮食失调患者的多模式环境中对该患者进行了为期七周的治疗。她体重增加了3.9kg（占其初始体重的11%）。特殊挑战包括她滥用泻药的并发症以及她明显的身体形象障碍。了解她的背景后，我们理解了她对hCG的误用。
对于饮食失调患者，应详细询问清除行为，因为清除方法并不总是能立即被报告，且会伴随着极大的羞耻感。然而，清除行为对健康可能非常危险。使用hCG饮食法（好莱坞饮食法）是神经性厌食症患者中一种罕见的清除方法。
