Document Detail


Pellagra may be a rare secondary complication of anorexia nervosa: a systematic review of the literature.
MedLine Citation:
PMID:  12777163     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pellagra is a nutritional wasting disease attributable to a combined deficiency of tryptophan and niacin (nicotinic acid). It is characterized clinically by four classic symptoms often referred to as the four Ds: diarrhea, dermatitis, dementia, and death. Prior to the development of these symptoms, other nonspecific symptoms insidiously manifest and mostly affect the dermatological, neuropsychiatric, and gastrointestinal systems. A review of the literature reveals several case reports describing pellagra in patients with anorexia nervosa. The most common features of pellagra in patients with anorexia nervosa are cutaneous manifestations such as erythema on sun-exposed areas, glossitis, and stomatitis. Health care providers might consider a trial of 150-500 mg niacin if anorexic patients exhibit these cutaneous findings. Pellagra can be diagnosed if cutaneous symptoms resolve within 24-48 hours after oral niacin administration. To further corroborate a diagnosis of pellagra in anorexic patients, specific 24-hour urine tests for niacin metabolites and 5-hydroxy-indole-acetic acid could be run prior to treatment with niacin being instituted. Other factors, such as mycotoxins, excessive dietary leucine intake (although not in anorexia), estrogens and progestogens, carcinoid syndrome, and various medications, might also lead to the development of pellagra. Although pellagra appears to be a rare, yet possible secondary complication of anorexia nervosa, it should be considered in the work-up of patients who exhibit cutaneous manifestations subsequent to sunlight exposure.
Authors:
Jonathan E Prousky
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Alternative medicine review : a journal of clinical therapeutic     Volume:  8     ISSN:  1089-5159     ISO Abbreviation:  Altern Med Rev     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-06-02     Completed Date:  2004-02-19     Revised Date:  2005-11-04    
Medline Journal Info:
Nlm Unique ID:  9705340     Medline TA:  Altern Med Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-5     Citation Subset:  K    
Affiliation:
Canadian College of Naturopathic Medicine, 1255 Sheppard Avenue East, Toronto, Ontario, Canada M2K 1E2. jprousky@ccnm.edu
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MeSH Terms
Descriptor/Qualifier:
Anorexia Nervosa / complications*
Humans
Niacin / therapeutic use
Pellagra / drug therapy,  etiology*
Chemical
Reg. No./Substance:
59-67-6/Niacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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