Sally is a 15-year-old student referred to ED by her GP with 12 months’ weight loss, new bradycardia, postural tachycardia and hypotension.

The GP suspects anorexia nervosa. Sally reports intermittent nausea, bloating, abdominal pain and constipation.

She began trying to “eat healthier” 18-months ago. Gradually she has become increasingly restrictive about food, reducing portion sizes and skipping meals. 

Sally experienced menarche at age 11. She has been amenorrhoeic for six months and has never been sexually active.