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Carney triad — Clinical Guidelines

Overview

The Female Athlete Triad is a syndrome characterized by interrelated conditions of low energy availability (often with disordered eating), menstrual dysfunction, and low bone mineral density, commonly observed in physically active females, particularly adolescent and young adult athletes 3 4 6.

Diagnosis

Low Energy Availability: Often assessed through dietary intake and physical activity logs 3 4.

Menstrual Dysfunction: Evaluation includes history of menstrual cycles and signs of amenorrhea or oligomenorrhea 3 4.

Bone Mineral Density: Dual-energy X-ray absorptiometry (DXA) scans to assess bone density 3 4.

Disordered Eating: Screening tools such as the Eating Disorder Inventory or clinical interviews 3 6.

Management

Nutritional Counseling: Focus on balanced nutrition and energy balance 3 4.

Medical Monitoring: Regular follow-ups for hormonal status and bone health 3 4.

Psychological Support: Mental health interventions for disordered eating behaviors 3 6.

Activity Modification: Adjusting training regimens to ensure adequate energy availability 3 4.

Calcium and Vitamin D Supplementation: To support bone health 3 4.

Special Populations

Pediatrics: Early detection and intervention crucial to prevent long-term health issues 6.

Pregnancy: Specific considerations for energy needs and bone health during and post-pregnancy are not extensively covered in provided abstracts [].

Key Recommendations

Early Identification and Intervention: Essential to prevent progression to serious endpoints like clinical eating disorders, amenorrhea, and osteoporosis (Evidence: Strong 3 4).

Comprehensive Care Team: Involving nutritionists, endocrinologists, and mental health professionals for holistic management (Evidence: Moderate 6).

Education and Awareness: Increase awareness among healthcare providers to improve recognition and treatment of the Female Athlete Triad (Evidence: Expert opinion 9).

References

1 Rauf S, Khokhar S. Female Athlete Triad: Lack of Awareness and Subsequent Consequences. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2023. link 2 Nattiv A, De Souza MJ, Koltun KJ, Misra M, Kussman A, Williams NI et al.. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2021. link 3 Horn E, Gergen N, McGarry KA. The female athlete triad. Rhode Island medical journal (2013) 2014. link 4 De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ et al.. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. British journal of sports medicine 2014. link 5 De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ et al.. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2014. link 6 Thein-Nissenbaum JM, Carr KE. Female athlete triad syndrome in the high school athlete. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2011. link 7 Pantano KJ. Strategies used by physical therapists in the U.S. for treatment and prevention of the female athlete triad. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2009. link 8 Emans PJ, van Aalst J, van Heurn EL, Marcelis C, Kootstra G, Beets-Tan RG et al.. The Currarino triad: neurosurgical considerations. Neurosurgery 2006. link 9 Troy K, Hoch AZ, Stavrakos JE. Awareness and comfort in treating the Female Athlete Triad: are we failing our athletes?. WMJ : official publication of the State Medical Society of Wisconsin 2006. link 10 Papanek PE. The female athlete triad: an emerging role for physical therapy. The Journal of orthopaedic and sports physical therapy 2003. link 11 Eliás P, Zizka J, Balícek P. Currarino triad: concurrent US and MRI diagnosis in the fetus and the mother. Prenatal diagnosis 2002. link 12 Samuel M, Hosie G, Holmes K. Currarino triad--diagnostic dilemma and a combined surgical approach. Journal of pediatric surgery 2000. link 13 Tander B, Baskin D, Bulut M. A case of incomplete Currarino triad with malignant transformation. Pediatric surgery international 1999. link

Carney triad