Sialadenosis with Eating Disorders

Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder

  • Associated with diabetes, hypothyroidism, alcoholism, malnutrition, anorexia nervosa, bulimia, excessive starch digestion and refeeding after starvation (1,2)
  • Enlargement usually occurs 2-6 days after a binge eating (1) and purging (5) episode has stopped
  • Both the size of the glands and the salivary amylase  level generally normalize on their own after vomiting is stopped, but parotitis can take up  to a year to resolve (6)
    • Similar to smoker’s cough, parotitis may acutely worsen when the patient
  • Severe malnutrition, excessive starch digestion and refeeding after starvation have been described with bilateral partoid enlargement (1)
  • incidence and size of the swellings are directly proportional to the frequency of vomiting (3)

Theories:

  • cholinergic stimulus associated with frequent vomiting activates the salivary glands as evidenced by the increased salivary flow during an emetic episode (3)
    • chronic work hypertrophy leads to bilateral parotid swelling
  • Patients with bulimia develop an autonomic neuropathy that leads to enlarged acinar cells from zymogen granule engorgement (3)
    • granule congestion results from a dysregulation in granule production and/or a lengthening of zymogen granule storage time
  • hypertrophy due to binge eating and the relationship between rapid consumption and massive quantities of food (4)
    • autonomic stimulation of the glands by activation of the taste buds

References:

  1. berke_et_al-1985-parotid-hypertrophy
  2. coleman_et_al-1998-sialadenosis-a-presenting-sign-in-bulimia
  3. bilateral-parotid-swelling-review_2002
  4. eating-disorders-part-i-psychiatric-diagnosis-and-dental-implications-2008
  5. medical-complications-of-self-induced-vomiting-2013
  6. recognizing-managing-medical-conseuqences-of-eating-disorders-in-primary-care-2014
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