CSSD Eating Disorders in Athletes 2 — Questions and Answers
Question 1: Which hormonal change is most characteristic of hypothalamic amenorrhea in female athletes with low energy availability?
- Elevated LH pulse frequency
- Suppressed GnRH pulsatility (Correct answer)
- Increased FSH secretion
- Elevated estradiol levels
Correct answer: Suppressed GnRH pulsatility
Low energy availability suppresses GnRH pulsatility from the hypothalamus, disrupting the entire HPG axis and causing amenorrhea.
Question 2: A male endurance athlete presents with low libido, fatigue, and stress fractures. Which condition best explains this cluster in the context of the Male Athlete Triad?
- Overtraining syndrome alone
- Relative Energy Deficiency in Sport (RED-S) (Correct answer)
- Primary hypogonadism
- Iron deficiency anemia
Correct answer: Relative Energy Deficiency in Sport (RED-S)
RED-S describes the broad health and performance consequences of low energy availability in male athletes, including hormonal and bone health impairments.
Question 3: Which validated screening tool uses items such as 'I am terrified of being overweight' and is commonly used in athletic populations for eating disorder risk?
- SCOFF questionnaire
- Eating Attitudes Test (EAT-26) (Correct answer)
- BULIT-R
- FAST questionnaire
Correct answer: Eating Attitudes Test (EAT-26)
The EAT-26 is a widely validated self-report screening tool that assesses eating disorder attitudes and behaviors, including fear of weight gain.
Question 4: An athlete with anorexia nervosa resumes eating after prolonged restriction. Which electrolyte abnormality is the primary concern during refeeding?
- Hyperkalemia
- Hypernatremia
- Hypophosphatemia (Correct answer)
- Hypercalcemia
Correct answer: Hypophosphatemia
Refeeding syndrome is characterized by a dangerous drop in serum phosphate as insulin drives phosphate into cells during renewed carbohydrate metabolism.
Question 5: Which sport category has consistently shown the highest prevalence of clinical eating disorders in research studies?
- Team ball sports
- Aesthetic and weight-class sports (Correct answer)
- Sprint and power sports
- Outdoor endurance sports
Correct answer: Aesthetic and weight-class sports
Aesthetic sports (gymnastics, figure skating) and weight-class sports (wrestling, rowing) show the highest prevalence due to weight and appearance pressures.
Question 6: What does a DXA scan finding of a Z-score of -2.0 or below indicate in an athlete?
- Normal bone density for age
- Osteopenia requiring monitoring
- Low bone mineral density relative to age-matched peers (Correct answer)
- Osteoporosis by WHO definition
Correct answer: Low bone mineral density relative to age-matched peers
A Z-score of -2.0 or below indicates bone mineral density that is significantly lower than age- and sex-matched peers, which is the threshold of concern in athletes.
Question 7: Which neurotransmitter system dysregulation is most associated with binge-purge cycles in bulimia nervosa?
- Dopaminergic reward pathways
- GABAergic inhibition
- Serotonin signaling (Correct answer)
- Norepinephrine reuptake
Correct answer: Serotonin signaling
Dysregulation of serotonin signaling is strongly implicated in bulimia nervosa, which is why SSRIs (particularly fluoxetine) are an approved pharmacological treatment.
CSSD Eating Disorders in Athletes 2
Which hormonal change is most characteristic of hypothalamic amenorrhea in female athletes with low energy availability?