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Practice Clinical Updates

Eating disorders in children and young people

BMJ 2017; 359 doi: (Published 07 December 2017) Cite this as: BMJ 2017;359:j5245
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Addison’s disease and primary hyperparathyroidism should be considered in differential diagnosis of eating disorder in children and young people.

Bould and colleagues mentioned diabetes and hyperthyroidism in the differential diagnosis of eating disorders in children and young people (1), but did not include 2 other important endocrine disorders—Addison’s disease and primary hyperparathyroidism. Children and adolescents with Addison’s disease and primary hyperparathyroidism can present with severe weight loss, anorexia, nausea and vomiting, all of which mimic eating disorders (2-4). Serum electrolytes including calcium level must be obtained in pediatric patients with weight loss to ensure that these treatable and potentially life-threatening endocrine conditions are ruled out. . Additionally, morning cortisol and adrenocorticotropic hormone levels should be obtained to evaluate for Addison’s disease.

1. Bould H, Newbegin C, Stewart A, Stein A, Fazel M. Eating disorders in children and young people. BMJ: British Medical Journal (Online). 2017;359.
2. Thompson MD, Kalmar E, Bowden SA. Severe hyponatraemia with absence of hyperkalaemia in rapidly progressive Addison's disease. BMJ case reports. 2015;2015:bcr2015209903.
3. Allo M, Thompson NW, Harness JK, Nishiyama RH. Primary hyperparathyroidism in children, adolescents, and young adults. World journal of surgery. 1982;6(6):771-5.
4. Kollars J, Zarroug AE, van Heerden J, Lteif A, Stavlo P, Suarez L, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005;115(4):974-80.

Competing interests: No competing interests

18 March 2018
Sasigarn A. Bowden
Pediatric Endocrinologist
Nationwide Children's Hospital
700 Children's Drive, Columbus, Ohio 43205, USA