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| System | Primary Alterations in Extreme AN | Clinical Manifestations | |--------|-----------------------------------|--------------------------| | | Bradycardia, hypotension, reduced cardiac output, myocardial atrophy | Syncope, orthostatic intolerance, arrhythmias | | Gastrointestinal | Delayed gastric emptying, reduced pancreatic enzymes | Early satiety, constipation, abdominal pain | | Endocrine | Hypothalamic‑pituitary‑gonadal suppression, cortisol elevation, low IGF‑1 | Amenorrhea, osteopenia/osteoporosis, impaired stress response | | Renal | Dehydration, electrolyte imbalances (hypokalemia, hyponatremia) | Acute kidney injury, cardiac arrhythmia | | Hematologic | Anemia, leukopenia, thrombocytopenia | Fatigue, increased infection risk | | Neuropsychiatric | Neurotransmitter dysregulation (serotonin, dopamine), brain volume loss | Cognitive deficits, depressive symptoms, obsessive‑compulsive traits | The internet and social media platforms have transformed

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