A 19-year-old student has been brought to the emergency department after her mother found her in bed drowsy and unable to get up unaided. She is fatigued but does not complain of any particular problems. However, her mother reports that she has had problems with eating for the past year: she has become a vegetarian and eats only small amounts. Her mother puts this down to stress as the girl is a high-achiever and a perfectionist trying to do many activities at college. She has been very sporty and exercises daily.
Lately she has been feeling unwell, generally tired and dizzy but managing to go to college. Examinations: This girl’s score on the Glasgow Coma Scale is 14/15 (opening eyes to command, moving limbs spontaneously, coherent speech). She looks very thin, with prominent bony structures (while claiming to be a little overweight) and fine body hair. She has had amenorrhoea for six…
