SHM Converge Scientific Abstract ePoster Gallery-Iron Overload in Anorexia: Diagnostic Pitfalls and Endocrine Implications

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This case report describes a 21-year-old man who presented with severe weight loss, fatigue, hypotension, bradycardia, and endocrine abnormalities, along with unexpectedly elevated iron studies and liver injury. Initial findings raised concern for iron overload disorders such as hereditary or juvenile hemochromatosis. Imaging showed iron deposition in the liver and spleen, and liver biopsy confirmed iron accumulation in Kupffer cells and hepatocytes. However, genetic testing for common hemochromatosis-related mutations was negative, and MRI showed no iron deposition in the pituitary or heart.<br /><br />A psychiatric evaluation revealed restrictive eating, meal skipping, avoidance of carbohydrates, excessive exercise, and body image disturbance, leading to a diagnosis of anorexia nervosa. The authors emphasize that anorexia nervosa can mimic hemochromatosis because both may cause weight loss, bradycardia, pituitary dysfunction, and iron abnormalities. In this patient, malnutrition likely contributed to altered iron transport and apparent iron overload.<br /><br />The report highlights the risk of anchoring bias when early findings suggest a rare genetic disorder. Clinicians should consider eating disorders in the differential diagnosis of unexplained iron overload, especially when endocrine dysfunction and severe malnutrition are present. The patient improved with nutritional rehabilitation, remained stable during refeeding, and was discharged for outpatient follow-up with psychiatry, endocrinology, and hepatology.

Asset Subtitle

Luke P. Coffman

Meta Tag

Author List Grant Flindt, Kehinde Odedosu, Luke P. Coffman

Category Clinical Vignettes

Concept Anorexia Nervosa

Concept Iron Overload

Concept Nutritional Rehabilitation

Concept Hemochromatosis

Concept Anchoring Bias

Distinguished Non-Finalist

Presenter Organization UT Southwestern Medical Center

Presenting Author Luke P. Coffman

Track Adult

Keywords

anorexia nervosa

hemochromatosis

iron overload

weight loss

bradycardia

hypotension

liver injury

malnutrition

endocrine dysfunction

psychiatric evaluation

Anorexia Nervosa

Iron Overload

Nutritional Rehabilitation

Hemochromatosis

Anchoring Bias