| System | Primary Alterations in Extreme AN | Clinical Manifestations | |--------|-----------------------------------|--------------------------| | Cardiovascular | Bradycardia, hypotension, reduced cardiac output, myocardial atrophy | Syncope, orthostatic intolerance, arrhythmias | | Gastrointestinal | Delayed gastric emptying, reduced pancreatic enzymes | Early satiety, constipation, abdominal pain | | Endocrine | Hypothalamic‑pituitary‑gonadal suppression, cortisol elevation, low IGF‑1 | Amenorrhea, osteopenia/osteoporosis, impaired stress response | | Renal | Dehydration, electrolyte imbalances (hypokalemia, hyponatremia) | Acute kidney injury, cardiac arrhythmia | | Hematologic | Anemia, leukopenia, thrombocytopenia | Fatigue, increased infection risk | | Neuropsychiatric | Neurotransmitter dysregulation (serotonin, dopamine), brain volume loss | Cognitive deficits, depressive symptoms, obsessive‑compulsive traits |

Figure 1 (not displayed) illustrates the cascade from caloric restriction to multi‑system dysfunction.

Pharmacotherapy – no FDA‑approved medication for AN; however, low‑dose olanzapine and fluoxetine have demonstrated modest benefits on weight gain and anxiety in adjunctive use.

1.2. Epidemiology

1.3. Rationale for focus on extreme cases

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Figure 1 (not displayed) illustrates the cascade from caloric restriction to multi‑system dysfunction. skinnyfans com siterip extreme anorexic women 1482 28 better

Pharmacotherapy – no FDA‑approved medication for AN; however, low‑dose olanzapine and fluoxetine have demonstrated modest benefits on weight gain and anxiety in adjunctive use.

1.2. Epidemiology

1.3. Rationale for focus on extreme cases | System | Primary Alterations in Extreme AN