Recurrent acute hepatic dysfunction in severe anorexia nervosa

Abstract

Anorexia nervosa (AN) is an eating disorder predominantly affecting young women. Abnormal liver function tests (LFT's) resulting from AN is well-described but to date few cases of dramatic rises in liver enzymes have been described. We report a 32-year-old women with severe anorexia having dramatic rise in LFT's with liver failure during extremely poor nutritional status. Acute rise in liver enzymes observed on several occasions in this patient resulted from ischaemic hepatitis secondary to liver hypoperfusion. Clinicians caring for patients with severe AN should monitor haemodynamic parameters with the knowledge that acute liver failure can be a consequence of sudden liver hypoperfusion. Therapeutic intervention comprising volume support with gradual nutritional support results in normalization of LFT's.

Associations of Elevated Liver Enzymes among Hospitalized Adolescents with Anorexia Nervosa

“…23 Hepatocytes from one-quarter of patients with AN who had acute liver injury demonstrated autophagosomes, a morphologic hallmark of autophagy. 23 These findings are consistent with other studies in which authors have found resolution of liver enzyme abnormalities with nutritional support and hydration, 5,6,10,11,24,25 supporting malnutrition as a potential cause of elevated liver enzymes. Only 4.1% of patients developed elevated liver enzymes after admission compared with the larger 37.0% who presented with elevated liver enzymes on admission.…”

“…4 Liver enzyme abnormalities among patients with AN remain poorly characterized. The few studies of elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in AN are limited to case reports [4][5][6][7][8][9][10] and studies with small sample sizes, [11][12][13][14][15] with a wide range in the reported prevalence of elevated ALT/AST, from 0% to 76%. 11 In initial studies researchers found that elevated ALT/AST was associated with lower body mass index (BMI) 11,13 and decreased percentage body fat.…”

Hypertransaminasemia in severely malnourished adult anorexia nervosa patients: Risk factors and evolution under enteral nutrition

“…It has been suggested that recurrence of hepatic abnormalities in some patients may in some cases be related to liver hypoperfusion. 23 We studied a large cohort of 126 consecutive severely malnourished patients, hospitalized for the first time for nutritional management. This took place initially as exclusive continuous enteral nutrition (isotonic and iso-caloric) at 10 kcal/kg/d, as recommended in the literature in severe malnourished AN patients.…”

Risk factors for elevated liver enzymes during refeeding of severely malnourished patients with eating disorders: a retrospective cohort study

“…Some reports have presented the relationship between low body mass index (BMI) and hepatocellular injuries [7–11]. Suggested etiologies include acute liver hypoperfusion [12, 13], hepatic steatosis with oxidative stress [6], and starvation-induced hepatocyte autophagy [14, 15]. …”