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Polycythemia
5%
4/77
Elevated TSH
10%
8/77
Normal menstrual cycles
1%
1/77
Elevated estrogen levels
Low bone density
78%
60/77
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This young gymnast with amenorrhea and anorexia is likely to also have low bone mineral density. This combination of signs is referred to as the female athlete triad. The female athlete triad is the combination of an eating disorder, osteoporosis, and amenorrhea. The triad is often seen in females who participate in sports that emphasize low body weight, such as gymnastics, ballet, track, among others. These patients often present with amenorrhea or stress fractures secondary to their eating disorder. Low body weight states leads to hormonal imbalances resulting in amenorrhea. Decreased caloric intake and reduced estrogen levels lead to decreased bone mineral density, which can cause osteoporosis. Incorrect answers: Answer 1: Anemia, rather than polycythemia, is commonly associated with anorexia. Answer 2: Elevated TSH levels are not commonly associated with eating disorders or the female athlete triad. Answer 3: Patients with eating disorders tend to have amenorrhea not normal menstrual cycles. Answer 4: Decreased, rather than increased, estrogen is commonly associated with anorexia.
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