SUN-668 A Severe Case of Pica Resolved With GLP-1 Agonist Therapy

Abstract Disclosure: B.R. Bedell: None. J. Katz: None. Background: GLP-1 receptor agonist prescriptions have dramatically increased in popularity over the last few years, predominantly due to their weight-loss and antihyperglycemic effects. It has been hypothesized that this class of medications may impact the reward system pathway via GLP-1 receptors in the brain, thereby impacting behavior surrounding appetite and craving (1). As research continues to progress towards understanding the full impact of this medication class, unintended effects are being discovered due to the large prescribing volume. There have been case reports of GLP-1 agonists reducing intake of various other substances with addiction and craving potential in animal models, such as alcohol (2). We present a case of severe pica incidentally eliminated after the initiation of a GLP-1 agonist. Clinical Case: The patient was a 50-year-old female with a history of obesity and anxiety who presented for weight management. At her initial visit, she also endorsed eating one pound of cornstarch daily for over twenty years. Despite a long-standing history of iron deficiency, prior trials of iron supplementation had failed to eliminate her cravings. Medications at time of visit included omeprazole and escitalopram. Notable labs included a hemoglobin of 7.4 gm/dL (11.7 - 16.0gm/dL), iron of 25 mcg/dL (35 - 170 mcg/dL), transferrin level of 386 mg/dL (200 - 400 mg/dL), total iron binding capacity of 540 mcg/dL (250 - 450 mcg/dL), and a transferrin saturation of 5% (20 - 50%). Her Zinc was 70.3 ug/dL (60.0 - 120.0 ug/dL). Her hemoglobin A1C was 5.8%. She was started on semaglutide for weight management and titrated to 2.4 mg weekly. She was prescribed iron supplementation, but reports that she did not continue this due to side-effects. At a follow-up visit five months after starting semaglutide, she reported 34 pounds of weight loss. Remarkably, the patient noted that the initiation of semaglutide had eliminated the cravings for corn starch completely, and she had not eaten cornstarch since titration of semaglutide to the maximum dose. Conclusion: In this case, initiation of a GLP-1 completely eliminated a longstanding case of severe pica without additional iron supplementation, thereby suggesting a medication driven effect on appetite and craving. This supports the theory of the GLP-1 impact on human reward system pathways. Further research is needed to determine the potential role of these medications in disorders of craving. 2 References: 1)Eren-Yazicioglu CY, Yigit A, Dogruoz RE, Yapici-Eser H. Can GLP-1 Be a Target for Reward System Related Disorders? A Qualitative Synthesis and Systematic Review Analysis of Studies on Palatable Food, Drugs of Abuse, and Alcohol. Front Behav Neurosci. 2021 Jan 18;14:614884. 2)Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A. The role of glucagon-like peptide 1 (GLP-1) in addictive disorders. Br J Pharmacol. 2022 Feb;179(4):625-641. Presentation: Sunday, July 13, 2025