Differentials

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Obesitas bij kinderenPublished by: Domus Medica | SSMGLast published: 2008Obésité chez l'enfantPublished by: Domus Medica | SSMGLast published: 2008
SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Fatigue.

Attenuated growth.

Cold intolerance.

Constipation.

Declining school performance.

Dry skin.

Coarse hair.

Goiter.

INVESTIGATIONS

Free T4 will be low for age.

Thyroid-stimulating hormone (TSH, also known as thyrotropin) will be elevated for age.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Fatigue.

Poor growth.

Cold intolerance.

Constipation.

Dry skin.

Coarse hair.

INVESTIGATIONS

Free T4 will be low for age.

Thyroid-stimulating hormone (TSH, also known as thyrotropin) will be low or normal for age.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Attenuated growth.

Violaceous striae.

Buffalo hump.

Central adiposity.

Moon facies.

Hirsutism.

Hypertension.

Diabetes.

INVESTIGATIONS

The 24-hour urinary free cortisol or midnight salivary cortisol is elevated for age.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Short stature.

Small hands and feet.

Almond-shaped eyes.

Picking on skin.

Delayed puberty.

Developmental delay.

Hyperphagia.

History of poor feeding and hypotonia as infant.

INVESTIGATIONS

Genetic testing shows imprinting error on chromosome 15q11-q13.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Dysmorphic extremities.

Retinitis pigmentosa.

Developmental delay.

Hypogonadism.

Renal defects.

INVESTIGATIONS

Mutations in several different genes have been linked to Bardet-Biedl syndrome.[81]

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Short stature.

Round face.

Short metacarpals.

Developmental delay.

Basal ganglia calcification.

INVESTIGATIONS

Serum calcium levels show hypocalcemia.

Serum phosphate levels show hyperphosphatemia.

Serum parathyroid hormone level is elevated.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Severe, early-onset obesity.

Usually associated with disruption of normal appetite control mechanisms.

INVESTIGATIONS

Genetic testing identifies gene mutation in candidate genes such as leptin, ghrelin, adiponectin, peptide YY(3-36), and melanocortin 4 receptor (MC4-R).[3]​​[82]

Mutations in MC4-R are the most common cause in children, occurring in approximately 5% of cases.[83]

The obesity gene map database and the National Institutes of Health and Centers for Disease Control and Prevention database of association studies can be used as a source of candidate genes: National Institute on Aging: genetic association database Opens in new window

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Severe obesity following treatment for intracranial lesions such as craniopharyngioma or other tumors in the hypothalamic-pituitary region.

Excessive appetite.

INVESTIGATIONS

Abnormal hypothalamopituitary testing.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Several classes of drugs can be associated with weight gain, including neuropsychiatric drugs (e.g., risperidone, olanzapine, clozapine), anticonvulsants (e.g., sodium valproate), insulin, corticosteroids, antibiotics, and acid-suppressing drugs.[32][33][64]

INVESTIGATIONS

Discontinuation of drug as a therapeutic trial.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lipedema is a condition characterized by swelling and enlargement of the lower limbs due to abnormal deposition of subcutaneous fat often dismissed as simple obesity. In addition, easy bruising and pain with soft tissue pressure, as well as the step-off at the ankles are hallmark symptoms.[84] Disease onset is usually at or soon after puberty but can develop at other times of hormonal change (such as pregnancy or even menopause).[85]

INVESTIGATIONS

Lipedema is diagnosed based on the symptoms and clinical examination. Imaging studies, such as CT and MRI may be useful in clinical examination. Patients with lipedema demonstrate diffuse fatty hypertrophy throughout the bilateral lower extremities without skin abnormalities on MRI and CT imaging. NIH: Genetic and Rare Diseases Information Center: Lipedema Opens in new window[86]

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