title: The fatal outcome of an individual with anorexia nervosa and Sheehan's syndrome as a result of acute enterocolitis: a case report.
abstract: OBJECTIVE
  To illustrate the close association between a disturbed psychosocial up-bringing, frequent physical illness, and medical interventions.
  
  
  METHODS
  We report a case of a 44-year-old woman with anorexia nervosa (AN) and Sheehan's syndrome who died as a result of a toxic cardiac arrest.
  
  
  RESULTS
  The patient presented with a BMI of 13.6 kg/m(2). She refused any intensive-care treatment and died from toxic cardiac arrest. Postmortem examination revealed an acute gastroenterocolitis.
  
  
  CONCLUSIONS
  The history of this patient illustrates how psychological deprivation led to eating disturbances, early pregnancy, and the life-threatening delivery of twins. This resulted in a diagnosis of Sheehan's syndrome, hepatitis C, and a ventricular ulcer. A psychosocial event triggered a late exacerbation of her AN. A helpful alliance between patient and staff did not occur as she rejected it.
authors.affiliation: University Hospital Charité, Campus Benjamin Franklin, Berlin, Germany. werner.koepp@gmx.de
authors.forename: Werner
authors.initials: W
authors.lastname: Köpp
authors.forename: Felicitas
authors.initials: F
authors.lastname: Rost
authors.forename: Sybille
authors.initials: S
authors.lastname: Kiesewetter
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Deter
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000628:therapy; D004760:Enterocolitis / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000150:complications* / Q000188:drug therapy; D008016:Life Change Events; D011247:Pregnancy