Brief Answer:
About obesity in children:

Detailed Answer:
Hello XXXX,

The VAST majority of obese kids have simple nutritional obesity.

I would like to summarize causal categories of childhood obesity from a Pediatric-Endocrinologist's perspective:

1. Common multi-factorial obesity-- Growth curve shows accentuated adiposity rebound and smooth gain at excessive rate throughout childhood, with patient above average height at onset of adolescent. Usually several fat relatives. This is certainly the most common.

2. Treatable endocrinopathy, like hypothyroidism, Cushings, insulinoma, ROHAD syndrome, leptin deficiency. These are the ones we don't want to miss because there is a specific treatment. The first two usually present as growth failure rather than weight gain.

3. Syndromic obesity-- Prader-Willi is the one you have heard of, but there are over a dozen obesity syndromes with multisystem abnormalities, like the G protein forms of pseudohypoparathyroidism. Nearly all involve developmental delay and/or early hypotonia. Many include hypogonadism and sensory or limb anomalies.

4. Monogenic obesity-- MC4R mutations are most common. POMC mutations have red hair. Because these are single gene effects they don't have the multisystem abnormalities that the syndromes carry. However, in most cases the major feature distinguishing them from common multi-factorial obesity is the onset in infancy, rather than with the adiposity rebound. Unfortunately, none of these have specific interventions.

5. Hypothalamic obesity-- This category overlaps with the syndromic in mechanism, but usually involve acquired hypothalamic injuries rather than multiple organ abnormalities. Most common example is post-craniopharyngioma resection.

6. Iatrogenic obesity-- Tube feedings without adjustment. Medications like Risperdal, steroids, etc.
So after a detailed clinical examination and history you will manage to classify your patient in one of these groups.

Regarding to high testosterone , in these levels is suggestive for precocious puberty.
So a more complete picture can often be obtained by performing other tests at the same time, including an LH or FSH test.

Hope the information will help.

Kind Regards,
Dr.Mirjeta

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Brief Answer:
Thanks for asking!

Detailed Answer:
It was a pleasure to help you.
All the best,
Dr.Mirjeta

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