Anorexia nervosa in a patient with congenital adrenal hyperplasia

Life stressors and hormonal dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis are common factors that play a role in both anorexia nervosa (AN) and congenital adrenal hyperplasia (CAH). The complexity of combined CAH and AN on the HPA axis has not, to our knowledge, been previously illustrated. We present a report of an adolescent with CAH who developed AN, requiring hospitalized management. We use this case to review the pathophysiology of CAH and AN as it relates to the stress response and hormonal dysregulation within the HPA axis. We then highlight the interplay between these conditions, and provide support to the theory that AN acts as a chronic stressor in patients with CAH, leading to HPA axis hyperactivity and elevated levels of androgen precursors. It is prudent for the medical team to monitor and modify CAH steroid dosing during the acute phase of AN, weaning appropriately with AN treatment success.