神経性食思不振症の剖検例

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Two patients of anorexia nervosa and one patient of chronic anorectic state were admitted and dead in Tokyo Police Hospital. And these three cases were examined by autopsy. Case I was a 17-year old female with 2 years history of anorexia nervosa who was admitted with complaints of abdominal distension and vomitting, and she died of acute gastro-duodenal distension accompanying massive mucosal hemorrhage due to arteriomesenteric compression of duodenum. Case 2 was a 40 year old female with 20 years history of anorexia nervosa, who had several espisodes of hospitalization with complaints of weight loss, vomitting, cough and bloody sputa. Finally, she was admitted in the state of hypoglycemic coma and died. Case 3 was a 38-year old female with 4 years history of anorectic state, she was diagnosed as suspected Sheehans' syndrome, and was admitted with complaints of anorexia. Finally, she died of reccurrent hypoglycemic coma. These three cases had common histopathological findings which were systemic organ's atrophy with metabolic disturbance (brain, heart, gastrointestinal tracts, liver, spleen, pancreas, endocrine glands, uterus, skeletal muscle, adipose tissue, lymphnodes), pneumonia, pulmonary emphysema, arteriosclerosis, dropsy, and hemorrhagic tendency. Though Case 1 had the shortest history of anorexia among the three cases, the organs of this case showed irreversible histological changes which were loss of nerve cells of brain and cardiac muscle cells. The organ atrophy of Case 2 was most severe in the three cases because of its longest history of anorexia. Furthermore, this case had fibrosis of thyroid, bronchiectasia and chronic bronchitis, marked fatty metamorphosis of liver with patchy necrotic foci and osteoporosis. Case 3 had no pituitary gland necrosis, so diagnosis of Sheehans' syndrome was false and anorexia nervosa was not ruled out. This case had most severe brain damage in the three cases due to reccurrent hypoglycemia. Autopsy findings of anorexia nervosa resemble that of hunger disease, but simple hunger state and anorexia nervosa are different diseases. And it is considered that the patients with anorexia nervosa have unknown pathological findings corresponding with psychiatric causes and inadequate hormonal activities. According to the above mentioned histopathological findings of these three cases, the patients with anorexia nervosa have multiple organ's atrophy and functional insufficiency due to marked hyponutrition. Although the etiology and mechanism of anorexia nervosa are not clear yet, it is supposed that the insufficiency itself affects patients' psychiatric state and appetite. In short, the complaints of anorexia and selfishness are accelerated by these damages. So, the hyponutrition should be treated as soon as possible to avoid the irreversible changes in organs.
日本心身医学会の論文
1986-06-01

神経性食思不振症の剖検例

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