McDonald Heather M, Lin Tony, Bursztyn Lulu L C D
Department of Ophthalmology, Western University, London, ON, Canada.
Centre for Neuroscience Studies, Western University, London, ON, Canada.
Eur J Clin Nutr. 2022 Jan;76(1):173-176. doi: 10.1038/s41430-021-00896-4. Epub 2021 Mar 19.
A young woman presented with significant weight loss and malnutrition secondary to decreased food intake. Her presentation was felt to be consistent with a psychiatric diagnosis of avoidant restrictive food intake disorder (ARFID). She received 3 years of treatment for ARFID, but failed to make significant progress and ultimately required a feeding tube. Incidentally, she noted severe visual field changes at this time, which triggered further workup including an MRI of the head. This revealed the true diagnosis of a suprasellar and pineal germinoma. There are several cases in the literature of germinomas presenting with decreased food intake that were misdiagnosed as anorexia nervosa. However, this is the first reported case of a multifocal germinoma presenting as ARFID. Criteria for the diagnosis of ARFID do not include body image distortion, potentially making this eating disorder more prone to misdiagnosis.
一名年轻女性因食物摄入量减少出现显著体重减轻和营养不良。她的表现被认为符合回避性限制性食物摄入障碍（ARFID）的精神科诊断。她接受了3年的ARFID治疗，但未取得显著进展，最终需要插入喂食管。偶然的是，她此时注意到严重的视野改变，这引发了包括头部MRI在内的进一步检查。这揭示了鞍上和松果体生殖细胞瘤的真正诊断。文献中有几例生殖细胞瘤表现为食物摄入量减少而被误诊为神经性厌食症的病例。然而，这是首例报告的以ARFID形式出现的多灶性生殖细胞瘤病例。ARFID的诊断标准不包括身体形象扭曲，这可能使这种饮食失调更容易被误诊。
