Plasma norepinephrine concentrations in a group of malnourished patients with anorexia nervosa were significantly (P less than 0.002) lower than those in an age- and sex-matched group of normal subjects. Platelet total alpha-adrenoceptor densities of these patients significantly (P less than 0.002) exceeded those of the controls. The increased total alpha-adrenoceptor density was due to an increase in the alpha 2-adrenoceptor receptor subtype, which mediates epinephrine-induced platelet aggregation. Accordingly, the aggregation response of the patients' platelets was significantly (P less than 0.002) enhanced after epinephrine challenge. We suggest that the starvation-induced fall in plasma norepinephrine levels is associated with the up-regulation of platelet alpha-adrenoceptors. This, in turn, accounts for exaggerated epinephrine-induced platelet aggregation in anorexic patients.