Analysis of treatment efficacy in girls with anorexia nervosa (III).

OBJECTIVES: So far, no unequivocal answer has been provided to the question of how to treat girls with anorexia nervosa (AN). The goal of the study was evaluation of treatment results and search for prognostic factors, regarding the outcome of administered therapy in girls with AN.

PATIENTS AND METHODS: The analysis comprised eighty-seven (87) patients with diagnosis of AN. In the course of treatment, the patients received only a balanced and highly energetic diet. The effects of dietetic procedure were evaluated, comparing clinical data and routine laboratory test results (full blood cell count, serum concentrations of sodium, potassium, glucose, cholesterol, triglycerides, total calcium, phosphates, total protein and the urea) at the onset and on the last day of hospitalisation and also an analysis of clinical data in patients with regained menstrual cycles was performed. Also, on admission to hospital, serum concentrations of TSH, FT4, FT3, E2, T and cortisol were measured (the last hormone - three times - at 8:00, 17:00 and 24:00). Moreover, a stimulation test with GnRH was performed to assess LH and FSH release. A comparison was made between the clinical data, the results of routine laboratory tests and hormone concentrations, obtained at the beginning of the therapy in the group of cured girls (the girls with regained menses) and the group, in which the therapy did not bring complete elimination of the disease.

RESULTS: After hospitalisation, 75.9% of the patients with AN continued outpatient treatment. In all the patients, who adhered to proposed therapy, menstruation cycles returned within 1 to 12 months. It was found that in the group with positive treatment outcome, the patients were older, demonstrated higher BMI values at the beginning of the therapy, as well as shorter disease duration than those in the group of patients who refused further treatment. In the group of cured patients, estradiol concentrations were significantly higher and cortisol concentrations (at 17:00 and 24:00) were significantly lower, in comparison to the uncured group.

CONCLUSIONS: The findings suggest that body weight increase by proper diet application is the most important element of therapy in AN. Patient's age, disease duration, the degree of body weight loss and serum concentrations of estradiol and cortisol at 17:00 and 24:00 are the prognostic factors for the outcome of therapy in anorexia nervosa.