A 14-year-old female presents with three months of amenorrhea. Her weight is 82% of the expected for age and height, and she frequently vomits and refuses most foods. Which condition is most suspected?

A 14-year-old female presents with three months of amenorrhea. Her weight is 82% of the expected for age and height, and she frequently vomits and refuses most foods. Which condition is most suspected?

• A. Bulimia nervosa
• B. Anorexia nervosa
• C. Depression
• D. Substance abuse

Answer: (B)

The key idea is recognizing anorexia nervosa in an adolescent with amenorrhea and marked low weight due to restrictive eating. When body fat falls substantially, the brain reduces the signaling to the ovaries (hypothalamic-pituitary-ovarian axis), lowering estrogen and stopping menses. Three months of missed periods in a 14-year-old, with a weight at about 82% of what’s expected and clear avoidance of food (often accompanied by vomiting), fits a pattern of restrictive eating leading to significant undernutrition and secondary amenorrhea. In anorexia nervosa, the emphasis is on extreme dietary restriction and weight loss, rather than the binge-purge pattern typical of bulimia (which often occurs at normal or higher-than-average weight). Depression can affect appetite, but the combination of substantial underweight and amenorrhea strongly points to anorexia. Substance abuse would usually bring other signs and a different clinical picture.

The key idea is recognizing anorexia nervosa in an adolescent with amenorrhea and marked low weight due to restrictive eating. When body fat falls substantially, the brain reduces the signaling to the ovaries (hypothalamic-pituitary-ovarian axis), lowering estrogen and stopping menses. Three months of missed periods in a 14-year-old, with a weight at about 82% of what’s expected and clear avoidance of food (often accompanied by vomiting), fits a pattern of restrictive eating leading to significant undernutrition and secondary amenorrhea.

In anorexia nervosa, the emphasis is on extreme dietary restriction and weight loss, rather than the binge-purge pattern typical of bulimia (which often occurs at normal or higher-than-average weight). Depression can affect appetite, but the combination of substantial underweight and amenorrhea strongly points to anorexia. Substance abuse would usually bring other signs and a different clinical picture.