- Short stature or a reduced rate of linear growth in a child with obesity suggests the possibility of growth hormone deficiency, hypothyroidism, cortisol excess, pseudohypoparathyroidism, or a genetic syndrome such as Prader-Willi syndrome.
- A history of dry skin, constipation, intolerance to cold, or fatigability suggests hypothyroidism.
- Polyuria and polydipsia may be noted if the adolescent with obesity develops overt diabetes.
- A history of damage to the central nervous system (CNS) (eg, infection, trauma, hemorrhage, radiation therapy, seizures) suggests hypothalamic obesity with or without pituitary growth hormone deficiency or pituitary hypothyroidism. A history of morning headaches, vomiting, visual disturbances, and excessive urination or drinking also suggests that the obesity may be caused by a tumor or mass in the hypothalamus.
- Selective accumulation of fat in the neck, trunk, and purple striae suggest an excess of cortisol, particularly if the rate of linear growth has declined.
- The appearance of signs of sexual development at an early age suggests that the weight gain is caused by precocious puberty. However, excessive facial hair, acne, and irregular periods in a teenage girl suggest that the weight gain may be caused by cortisol excess or polycystic ovary syndrome (PCOS). Obesity itself may be accompanied by facial hair, irregular menses, and hypertension.
Clinical clues that suggest a hormonal etiology for childhood obesity include the following:
- Weight gain out of character for the family
- Obesity in a short child
- Progressive weight gain without a comparable increase in linear growth
- Dry skin, constipation, intolerance to cold, and fatigability
- History of central nervous system (CNS) damage (eg, trauma, hemorrhage, infection, radiation, seizures)
- Accumulation of fat in the neck and trunk but not in the arms or legs
- Purple striae (stretch marks)
- Inappropriate sexual development at an early age
- Excess facial hair, acne, and/or irregular menses in a teenage girl
- Headaches, vomiting, visual disturbances, or excessive urination and drinking
- Treatment with certain drugs or medications