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The increasing frequency and the younger onset of eating disorder is becoming a social problem in Japan. The diagnostic criteria of anorexia nervosa according to DSM IV include weight loss and amenorrhea, however, it does not include "no or low weight gain" and "stunted growth" in growing children and adolescents. In this study, we analyzed the growth and endocrine function in 45 patients (39 females and 6 males) with anorexia nervosa. The age at the onset of disease (the onset of weight loss) varied from 10 to 16 yr old. When plotting the changes of height and weight in each individual on the growth chart for Japanese children, 8 out of 45 showed decreased or no weight gain before the apparent onset of weight loss, for more than two years. The stunted growth was associated with decreased weight gain. Endocrine function was tested in 36 patients. Approximately half of the children and adolescents showed exaggerated growth hormone response to provocative tests, while the rest showed low growth hormone levels. Gonadotrophins and thyrotropin responses to LHRH and TSH stimulation were decreased in most of the cases tested. About 80% of the patients recovered from the critical weight loss, but the recovery of height is not always successful. In conclusion, eating disorders with severe weight loss in growing children sometimes result in irreversible growth failure. Plotting the growth chart is helpful for finding the "true" onset of eating disorder.

Stunted Growth and Hypothalamic-Pituitary Dysfunction before and after Eating Disorders in Children and Adolescents