{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:10Z","timestamp":1784557030891,"version":"3.55.0"},"reference-count":24,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Iron metabolism and markers hereof are altered in anorexia nervosa (AN) but far from completely understood. We report a case of extreme hyperferritinemia in a patient with AN and discuss the possible mechanisms and current knowledge about the association between hyperferritinemia and AN. A 20-year-old woman with a history of AN presented with bradycardia, weariness, and malaise in addition to an incidentally very high ferritin level. The symptoms disappeared spontaneously after a short admission. There were no signs suggestive of systemic, hematological, or malignant disease causing the very high concentration of ferritin. Her body weight was in decline, leading up to admission, but did initially increase after discharge accompanied by declining ferritin concentration. However, a clear association between ferritin dynamics and weight changes or physical activity was not identified and neither were other causes of the hyperferritinemia. Around one in four patients with AN have increased ferritin concentrations. Our case represents the highest ferritin concentration reported in a patient with AN without other underlying causes or comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Perturbed iron metabolism is frequent in restrictive type anorexia nervosa but incompletely understood.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Altered ferritin in anorexia nervosa may be linked to nutritional status.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-22-0405","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T11:13:52Z","timestamp":1679570032000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Extreme hyperferritinemia in restrictive type anorexia nervosa"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6551-3606","authenticated-orcid":true,"given":"Christine Hvolby","family":"Amanoal","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Viborg Regional Hospital, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lene Kongsgaard","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Viborg Regional Hospital, Denmark"},{"name":"Research Unit for Multimorbidity, Viborg Regional Hospital, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0522-0320","authenticated-orcid":true,"given":"Henrik Holm","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Viborg Regional Hospital, Denmark"},{"name":"Research Unit for Multimorbidity, Viborg Regional Hospital, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"American Journal of Psychiatry","first-page":"1073","article-title":"Mortality in anorexia nervosa","volume":"152","author":"Sullivan","year":"1995","unstructured":"Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry19951521073\u20131074. (https:\/\/doi.org\/10.1176\/ajp.152.7.1073)"},{"key":"bib2","series-title":"Archives of General Psychiatry","first-page":"724","article-title":"Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies","volume":"68","author":"Arcelus","year":"2011","unstructured":"Arcelus JMitchell AJWales J & Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry201168724\u2013731. (https:\/\/doi.org\/10.1001\/archgenpsychiatry.2011.74)"},{"key":"bib3","series-title":"Current Opinion in Psychiatry","first-page":"515","article-title":"Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa","volume":"34","author":"van Eeden","year":"2021","unstructured":"van Eeden AEvan Hoeken D & Hoek HW. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry202134515\u2013524. (https:\/\/doi.org\/10.1097\/YCO.0000000000000739)"},{"key":"bib4","series-title":"Pediatrics","first-page":"1240","article-title":"Identification and management of eating disorders in children and adolescents","volume":"126","author":"Rosen","year":"2010","unstructured":"Rosen DS & American Academy of Pediatrics Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics20101261240\u20131253. (https:\/\/doi.org\/10.1542\/peds.2010-2821)"},{"key":"bib5","series-title":"Eating Disorders: Recognition and Treatment","year":"2020","unstructured":"National Institute for Healthand Care Excellence (NICE). Eating Disorders: Recognition and Treatment: London: National Institute for Health and CareExcellence:Clinical Guidelines; 2020. Available at https:\/\/www.nice.org.uk\/guidance\/ng69"},{"key":"bib6","series-title":"American Family Physician","first-page":"22","article-title":"Eating disorders in primary care: diagnosis and management","volume":"103","author":"Klein","year":"2021","unstructured":"Klein DASylvester JE & Schvey NA. Eating disorders in primary care: diagnosis and management. American Family Physician202110322\u201332."},{"key":"bib7","series-title":"BMC Psychiatry","article-title":"Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment","volume":"13","author":"Marzola","year":"2013","unstructured":"Marzola ENasser JAHashim SAShih PAB & Kaye WH. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry201313 290. (https:\/\/doi.org\/10.1186\/1471-244X-13-290)"},{"key":"bib8","series-title":"Journal of Eating Disorders","article-title":"A retrospective analysis of biochemical and haematological parameters in patients with eating disorders","volume":"5","author":"Barron","year":"2017","unstructured":"Barron LJBarron RFJohnson JCSWagner IWard CJBWard SRBBarron FM & Ward WK. A retrospective analysis of biochemical and haematological parameters in patients with eating disorders. Journal of Eating Disorders20175 32. (https:\/\/doi.org\/10.1186\/s40337-017-0158-y)"},{"key":"bib9","series-title":"Clinical Nutrition","first-page":"1353","article-title":"Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow-up study","volume":"23","author":"Nova","year":"2004","unstructured":"Nova ELopez-Vidriero IVarela PToro OCasas JJ & Marcos AA. Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow-up study. Clinical Nutrition2004231353\u20131359. (https:\/\/doi.org\/10.1016\/j.clnu.2004.05.004)"},{"key":"bib10","series-title":"Eating and Weight Disorders","first-page":"411","article-title":"Increased ferritin levels in patients with anorexia nervosa: impact of weight gain","volume":"21","author":"Wanby","year":"2016","unstructured":"Wanby PBerglund JBrudin LHedberg D & Carlsson M. Increased ferritin levels in patients with anorexia nervosa: impact of weight gain. Eating and Weight Disorders201621411\u2013417. (https:\/\/doi.org\/10.1007\/s40519-015-0246-4)"},{"key":"bib11","series-title":"Clinical Nutrition","first-page":"5391","article-title":"Dietary intake and nutritional status in adolescents and young adults with anorexia nervosa: a 3-year follow-up study","volume":"40","author":"Pettersson","year":"2021","unstructured":"Pettersson CSvedlund AWallengren OSwolin-Eide DPaulson Karlsson G & Elleg\u00e5rd L. Dietary intake and nutritional status in adolescents and young adults with anorexia nervosa: a 3-year follow-up study. Clinical Nutrition2021405391\u20135398. (https:\/\/doi.org\/10.1016\/j.clnu.2021.08.014)"},{"key":"bib12","series-title":"Journal of Paediatrics and Child Health","first-page":"430","article-title":"Iron status and haematological changes in adolescent female inpatients with anorexia nervosa","volume":"40","author":"Kennedy","year":"2004","unstructured":"Kennedy AKohn MLammi A & Clarke S. Iron status and haematological changes in adolescent female inpatients with anorexia nervosa. Journal of Paediatrics and Child Health200440430\u2013432. (https:\/\/doi.org\/10.1111\/j.1440-1754.2004.00432.x)"},{"key":"bib13","series-title":"Annals of Clinical Biochemistry","first-page":"504","article-title":"Unexpected increased ferritin concentration in patients with anorexia nervosa","volume":"50","author":"Tran","year":"2013","unstructured":"Tran JStory CMoore D & Metz M. Unexpected increased ferritin concentration in patients with anorexia nervosa. Annals of Clinical Biochemistry201350504\u2013506. (https:\/\/doi.org\/10.1177\/0004563213490289)"},{"key":"bib14","series-title":"American Journal of Clinical Nutrition","first-page":"548","article-title":"Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation","volume":"95","author":"Papillard-Marechal","year":"2012","unstructured":"Papillard-Marechal SSznajder MHurtado-Nedelec MAlibay YMartin-Schmitt CDehoux MWesterman MBeaumont CChevallier BPuy H, Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation. American Journal of Clinical Nutrition201295548\u2013554. (https:\/\/doi.org\/10.3945\/ajcn.111.025817)"},{"key":"bib15","series-title":"Acta Cardiologica","first-page":"395","article-title":"Ferritin and body mass index predict cardiac dysfunction in female adolescents with anorexia of the restrictive type","volume":"70","author":"Docx","year":"2015","unstructured":"Docx MKFWeyler JSimons ARamet J & Mertens L. Ferritin and body mass index predict cardiac dysfunction in female adolescents with anorexia of the restrictive type. Acta Cardiologica201570395\u2013399. (https:\/\/doi.org\/10.1080\/ac.70.4.3094647)"},{"key":"bib16","series-title":"International Journal of Eating Disorders","first-page":"616","article-title":"A case report of oxidative stress in a patient with anorexia nervosa","volume":"39","author":"Tajiri","year":"2006","unstructured":"Tajiri KShimizu YTsuneyama K & Sugiyama T. A case report of oxidative stress in a patient with anorexia nervosa. International Journal of Eating Disorders200639616\u2013618. (https:\/\/doi.org\/10.1002\/eat.20326)"},{"key":"bib17","series-title":"Clinical Chemistry","first-page":"1419","article-title":"Total and cause-specific mortality by moderately and markedly increased ferritin concentrations: general population study and metaanalysis","volume":"60","author":"Ellervik","year":"2014","unstructured":"Ellervik CMarott JLTybj\u00e6rg-Hansen ASchnohr P & Nordestgaard BG. Total and cause-specific mortality by moderately and markedly increased ferritin concentrations: general population study and metaanalysis. Clinical Chemistry2014601419\u20131428. (https:\/\/doi.org\/10.1373\/clinchem.2014.229013)"},{"key":"bib18","series-title":"Hematology","first-page":"817","article-title":"Hyperferritinemia: causes and significance in a general hospital","volume":"23","author":"Senjo","year":"2018","unstructured":"Senjo HHiguchi TOkada S & Takahashi O. Hyperferritinemia: causes and significance in a general hospital. Hematology201823817\u2013822. (https:\/\/doi.org\/10.1080\/10245332.2018.1488569)"},{"key":"bib19","series-title":"IUBMB Life","first-page":"414","article-title":"Ferritin, cellular iron storage and regulation","volume":"69","author":"Arosio","year":"2017","unstructured":"Arosio PElia L & Poli M. Ferritin, cellular iron storage and regulation. IUBMB Life201769414\u2013422. (https:\/\/doi.org\/10.1002\/iub.1621)"},{"key":"bib20","series-title":"American Journal of Clinical Pathology","first-page":"582","article-title":"Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings","volume":"118","author":"Abella","year":"2002","unstructured":"Abella EFeliu EGranada IMill\u00e1 FOriol ARibera JMS\u00e1nchez-Planell LBerga LIReverter JC & Rozman C. Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings. American Journal of Clinical Pathology2002118582\u2013588. (https:\/\/doi.org\/10.1309\/2Y7X-YDXK-006B-XLT2)"},{"key":"bib21","series-title":"Eating and Weight Disorders","first-page":"1763","article-title":"High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa","volume":"25","author":"Boillot","year":"2020","unstructured":"Boillot ARinguenet DKapila YPallier AColon PBouchard P & Rang\u00e9 H. High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa. Eating and Weight Disorders2020251763\u20131770. (https:\/\/doi.org\/10.1007\/s40519-019-00832-3)"},{"key":"bib22","series-title":"Medicine and Science in Sports and Exercise","first-page":"1596","article-title":"Recent advances in iron metabolism: Relevance for Health, Exercise, and Performance","volume":"47","author":"Buratti","year":"2015","unstructured":"Buratti PGammella ERybinska ICairo G & Recalcati S. Recent advances in iron metabolism: Relevance for Health, Exercise, and Performance. Medicine and Science in Sports and Exercise2015471596\u20131604. (https:\/\/doi.org\/10.1249\/MSS.0000000000000593)"},{"key":"bib23","series-title":"Nutrients","article-title":"Iron Metabolism following Twice a Day Endurance Exercise in Female Long-Distance Runners","volume":"14","author":"Ishibashi","year":"2022","unstructured":"Ishibashi AMaeda NKojima C & Goto K. Iron Metabolism following Twice a Day Endurance Exercise in Female Long-Distance Runners. Nutrients202214 1907. (https:\/\/doi.org\/10.3390\/nu14091907)"},{"key":"bib24","series-title":"Diagnostics","article-title":"A comparative study for measuring serum ferritin levels with three different laboratory methods: Enzyme-linked immunosorbent assay versus Cobas e411 and Cobas Integra 400 methods","volume":"12","author":"Dahman","year":"2022","unstructured":"Dahman LSSumaily KMSabi EMHassan MAThalab AMSayad ASKalaib SMBAlhadhrmi FM. A comparative study for measuring serum ferritin levels with three different laboratory methods: Enzyme-linked immunosorbent assay versus Cobas e411 and Cobas Integra 400 methods. Diagnostics202212 320. 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