Endocrine Abstracts

Introduction: As the incidence of pediatric obesity is gaining pandemic levels, with children and teenagers developing obesity complications similar to the adult population, a rapid evaluation and treatment is necessary. We present such a case.Case reportA 12-year-old male with a medical history of binge eating, treated by Topiramate, since the age of 11 and 3rd degree obesity, complicated with JNC stage II hypertension, NASH and dyslipidemia was referred to our clinic for nutritional assessment and treatment. He was referred by a colleague endocrinologist that evaluated his obesity for endocrinological causes, which were excluded. The clinical examination:Showed normal pubertal Tanner stage (P1G2), BMI 37.3 kg/m², height of 155 cm (75th centile), 51.4%fat, 205% obesity degree from the 95th centile, normal muscle mass of 23.7 kg, BP 150/90 mmHg and a waist circumference of 120 cm.

Laboratory: Dyslipidemia with HDL= 30 mg/dl, TG= 133 mg/dl:, insulin resistance HOMA-IR: 6, blood glucose= 82.5 mg/dl, an inflammatory status with a VSH=21, fibrinogen = 357, 25-OH vitamin D of 17 ng/ml, TSH of 2,71, normal salivary cortisol, IGF1, FSH, LH < 0.3, testosterone of 0.16 nmol/l and a prolactin of 293 mcUI/ml. The abdominal ultrasound showed liver steatosis. The basal metabolic rate (indirect calorimetry) - low of 1600 kcal (85%), correlated with the low muscle mass. The cardiology consult found normal ECG, JNC stage II hypertension, septal left ventricular hypertrophy and indicated treatment with Lisinopril 10 mg per day. We began a hypocaloric Mediterranean diet (400 calories daily deficit), moderate physical activity (45-60 minutes), low sodium intake, but the patient didn’t lose weight for the first month of nutritional monitoring, so Liraglutide was introduced, with a 0.6 mg /day regimen, with dose titration every 2 weeks to avoid adverse effects, to a dose of 2.4 mg per day. He received Omega 3(2000 mg) and 2000 UI vitamin D per day. After 1 month of diet and Liraglutide, the binge eating improved, he lost 2% of body fat and the BP normalized. Also, the eating disorder improved. ConclusionThe metabolic syndrome that complicates obesity is a frequent condition in adults with increasing incidence in children. As more and more children develop severe complicated obesity, before the age for bariatric surgery, more pharmacological treatment is needed and clear and standardized cut-offs for the metabolic syndrome definition is necessary.