Malnutrition in a compulsive runner: a case conference.

A 28-yr-old, female marathon and "fitness" runner presented with leg swelling, fatigue, and loss of endurance. She was running an hour or more daily in addition to regular biking and swimming. She was an instructor in a fitness center. For 2 months prior to her leg swelling, she had increased fatigue and decreased exercise tolerance. She had been seen previously for a slow healing hamstring strain. She had not had a menstrual period for over 2 yr and had refused evaluation. She admitted to very low dietary intake, which she had always denied. She was worried about her body fat. She denied recent blood loss, diuretic or cathartic use, and induced vomiting. She appeared malnourished, pale, and older than her stated age. Her weight was 41.4 kg. Her blood pressure was 90/60, and her pulse was 100 per minute. She had pitting edema of the lower extremities to the knees. The diagnosis of anorexia nervosa was made and will be discussed.