Nadelson Adam C, Babatunde Victor D, Yee Eric U, Patwardhan Vilas R
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2017 Apr;32(4):486-489. doi: 10.1007/s11606-016-3879-8.
Aminotransferase elevations have been described in patients with anorexia nervosa. Hypothesized etiologies have included ischemic hepatitis, refeeding-induced transaminitis, and the process of autophagy. Supervised enteral nutrition is the mainstay of treatment for severe anorexia, but an increase in aminotransferase levels after initiation of enteral feeding presents clinicians with a diagnostic dilemma. We present a 31-year-old woman with anorexia nervosa (body mass index [BMI] of 13.5 kg/m) who experienced a worsening of aminotransferase elevations even after the initiation of enteral feeding. Despite nutritional supplementation, the patient's weight continued to fall for 6 days. Peak aminotransferase concentrations correlated with the patient's lowest weight and improved only after an increase in BMI was eventually achieved. Secondary causes of severe transaminitis were investigated, and after no cause was found, a liver biopsy was performed. Pathology was consistent with liver injury secondary to severe malnutrition rather than from refeeding syndrome. This case highlights malnutrition as an important cause of aminotransferase elevations and underscores the need for judicious early weight restoration in patients with anorexia and abnormal liver chemistry.
神经性厌食症患者中曾有转氨酶升高的报道。推测的病因包括缺血性肝炎、再喂养引起的转氨酶升高以及自噬过程。监督下的肠内营养是重度厌食症治疗的主要方法，但开始肠内喂养后转氨酶水平升高给临床医生带来了诊断难题。我们报告一名31岁神经性厌食症女性患者（体重指数[BMI]为13.5kg/m²），即使开始肠内喂养后转氨酶升高仍加重。尽管进行了营养补充，患者体重仍持续下降6天。转氨酶峰值浓度与患者最低体重相关，仅在BMI最终增加后才有所改善。对严重转氨酶升高的继发原因进行了调查，在未发现病因后进行了肝活检。病理结果与严重营养不良继发的肝损伤一致，而非再喂养综合征。该病例突出了营养不良是转氨酶升高的重要原因，并强调了对厌食症且肝功能异常患者进行明智的早期体重恢复的必要性。
