Chipkevitch E
Division of Adolescent Medicine, Darcy Vargas Children's Hospital, São Paulo, Brazil.
Brain Dev. 1994 May-Jun;16(3):175-9, discussion 180-2. doi: 10.1016/0387-7604(94)90064-7.
This review presents 21 cases, found in the literature, of a CNS lesion (a tumor in 19 of them) associated with emaciation, anorexia and several psychic symptoms that had led to the diagnosis of anorexia nervosa (AN). Anorexia and psychic disturbances preceded the neurologic signs and/or the correct diagnosis in all patients (by a mean of 2.9 years, range = 0.2-17 years). Anorexia had begun before the age of 25 years in 18 patients of which two-thirds were females. Only a few cases fulfilled the DSM-III-R criteria for AN; the majority could be characterized as 'atypical AN'. Although AN is usually conceived as a primarily psychogenic disorder, structural lesions of the hypothalamus (or other sites involved in food regulation) in animal models and in these human cases mimic many features of AN, suggesting the possibility of an as yet unidentified structural hypothalamic disorder to be implicated in the etiopathogeny of AN. The unusually high incidence of germ-cell tumors in this review (33%) suggests that they are more likely than other tumors to influence the limbic system toward an anorectic syndrome.
本综述介绍了文献中发现的21例中枢神经系统病变（其中19例为肿瘤），这些病变与消瘦、厌食及多种精神症状相关，最终导致神经性厌食症（AN）的诊断。在所有患者中，厌食和精神障碍均先于神经体征和/或正确诊断出现（平均提前2.9年，范围为0.2 - 17年）。18例患者在25岁之前就已出现厌食，其中三分之二为女性。只有少数病例符合AN的DSM - III - R标准；大多数可被归类为“非典型AN”。尽管AN通常被认为主要是一种心因性疾病，但动物模型和这些人类病例中的下丘脑（或其他参与食物调节的部位）结构病变模仿了AN的许多特征，这表明可能存在一种尚未明确的下丘脑结构紊乱参与了AN的病因学。本综述中生殖细胞肿瘤的异常高发病率（33%）表明，它们比其他肿瘤更有可能影响边缘系统，导致厌食综合征。
