Girardon N, Corcos M
Institut Mutualiste Montsouris, Paris.
Presse Med. 1999 Jan 16;28(2):103-5.
The development of somatic complications observed in patients with eating disorders depends both on the duration of the clinical course and on the gravity of the symptoms and psychological factors. It would thus appear advisable to obtain a complete endocrine (gonadotropic, thyroid, hypothalamo-hypophyseal-adrenal) work-up which could be repeated every year after the patient has controlled the behavior disorder. Two aspects of these complications predominate: osteoporosis and infertility. OSTEOPOROSIS: A common finding after anorexia nevrosa, osteoporosis can lead to multiple, sometimes spontaneous, fractures. Bone mass can be assessed with biphotonic absorptiometry. The indication for estroprogestogen prophylaxis is debatable, depending on the patient's psychological profile, but also because efficacy has not always been demonstrated. Third-generation biphosphonates appear to offer promising results. INFERTILITY: Among a population of women consulting for infertility, a non-negligible percentage have infraclinical manifestations of anorexia nevrosa. The question of prescribing estroprogestogens, which would allow normal cycles and a certain vaginal trophicity, is often raised. We advocate a dose coordination between endocrinologists, infertility specialists and psychiatrists in order to better define the precise modalities of a given treatment aimed at regulating hypothalamo-pituitary function or favoring procreation.
饮食失调患者出现躯体并发症的情况，既取决于临床病程的长短，也取决于症状的严重程度和心理因素。因此，建议在患者控制了行为障碍后，每年进行一次全面的内分泌检查（促性腺激素、甲状腺、下丘脑 - 垂体 - 肾上腺）。这些并发症主要有两个方面：骨质疏松症和不孕症。骨质疏松症：神经性厌食症后常见的情况，骨质疏松症可导致多处骨折，有时甚至是自发性骨折。可通过双能吸收法评估骨量。雌激素 - 孕激素预防的指征存在争议，这既取决于患者的心理状况，也因为其疗效并非总能得到证实。第三代双膦酸盐似乎显示出有前景的结果。不孕症：在因不孕前来咨询的女性人群中，有不可忽视的比例存在神经性厌食症的亚临床症状。经常会提出开具雌激素 - 孕激素的问题，这可以使月经周期正常并维持一定的阴道营养状态。我们主张内分泌学家、不孕症专家和精神科医生之间进行剂量协调，以便更好地确定针对调节下丘脑 - 垂体功能或促进生育的特定治疗的精确方式。
