Endocrine Abstracts

Introduction

As the incidence of pediatric obesity is increasing, so is the incidence of metabolic syndrome in the pediatric population. We present the management of 3 such cases.

Case report

Three 14 (D.D), 15 (C.A.), 16 (C.M) year-old males presented for weight and metabolic management.DD had a medical history weight gain since 2 years old, obesity, dyslipidemia, hyperuricemia. C.A., obese since 2018, with hypertriglyceridemia and insulin resistance (HOMA-IR of 3.71). C.M., obese since 2015, with a Bethesda II 1.5 cm thyroid nodule (right lobe), hyperuricemia since 2017. All three had important first degree antecedents of type 2 diabetes, hypertension and metabolic syndrome. The clinical examination showed in all three boys normal pubertal Tanner stage (P4–5G4), D.D: BMI 35.5, 1.68 m (+2SD), 44% fat, 179% obesity degree, BP 130/80 mmHg and a waist circumference: 113 cm, C.A.: BMI 30.2, 1.82 m (+2.5DS), 22.9% fat, 137% obesity degree, BP 147/78 mmHg, important acanthosis nigricans, waist circumference: 106.5cm and C.M.: BMI 35.4, 1.83 m (+2DS), 38.7%fat, 161% obesity degree, BP 145/88mmHg, waist circumference: 120 cm.

Laboratory

Dyslipidemia with HDL: 35/26/39, TG: 71/250/190, insulin resistance in C.M.-HOMA-IR: 5.8, type 2 diabetes in C.A: HbA1c= 7.4%, blood glucose 135, hepatic cytolysis in C.A. (TGO= 118, TGP= 182) and D.D. (TGP= 48.6, TGO= 26 UI/l, ) 25-OH vitamin D – between 17 and 25 ng/dl and hyperuricemia 10.53 in D.D., 7.4 in C.A. and 8.4 mg/dl in C.M. The abdominal ultrasound: severe liver steatosis, BP monitoring showed 1^st degree hypertension in all three patients. The basal metabolic rate (indirect calorimetry) - low in D.D. (85%), correlated with the low muscle mass, normal in the other 2 boys – 94 and 99%. We began a hypocaloric Mediterranean diet (400 calories daily deficit), moderate physical activity (45–60 minutes), low sodium intake. All three received Omega 3(2000 mg), 2000 UI vitamin D, vitamin E and hepatic protectors for the liver cytolysis. After 1 month of diet and 2% of body fat loss the BP, cytolysis and fasting glucose normalized.

Conclusion

The metabolic syndrome is a frequent condition in adults with increasing prevalence in children and teenagers, but there is no common definition and treatment of the conditions associated with this syndrome. A new guideline for the metabolic syndrome in the pediatric population is needed to manage and monitor the effects of this syndrome and avoid the serious health risks in our children and teenagers.