Browse the corpus

©2013 UpToDate ® Print Email Additional assessment for weight-related comorbidities to be considered for selected children with obesity Condition Tests Reason Note Cardiac disease Lipid profile Hyperlipidemia, hypertriglyceridemia, cardiovascular disease risk Fasting sample preferred Hypertension Repeat BP measurements on several occasions Required to diagnose or exclude hypertension Use appropriately sized cuffs and age-appropriate norms 24-hour ambulatory BP monitoring Evaluate for "masked" hypertension; rule out "white coat" hypertension Suggested if the diagnosis is unclear from random office measurements CBC, metabolic panel, renin assay, urinalysis, renal ultrasound Exclude other causes of hypertension Suggested if hypertension is confirmed Fatty liver disease Liver ultrasound; α-1-antitrypsin, ceruloplasmin, ANA, hepatitis antibodies Determine cause of elevated transaminases Persistent elevation of AST, ALT for >6 months warrants further investigation Liver biopsy Determine cause of elevated transaminases, assess degree of hepatitis Imaging cannot accurately determine inflammation and fibrosis Type 2 diabetes mellitus or impaired glucose tolerance Fasting glucose, oral glucose tolerance test, HbA1c, urinary microalbumin Assess for insulin resistance, renal involvement Fasting glucose ≥126 mg/dL or HbA1c ≥6.5 percent indicates diabetes. Fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4 percent considered pre-diabetes. Sleep apnea Polysomnogram (sleep study) Evaluate sleep related breathing disorders Polysomnogram also may detect disordered sleep pattern Orthopedic disease Hip x-rays Evaluate for SCFE Use frog-leg positioning for radiograph Knee x-rays Evaluate for Blount disease Polycystic ovary syndrome 17-hydroxyprogesterone, DHEAS, androstenedione, free testosterone (or total testosterone and SHBG), LH, FSH, possibly pelvic ultrasound To confirm whether hyperandrogenemia is present, and exclude other causes of hyperandrogenemia Precocious puberty LH, FSH, testosterone or estradiol, DHEAS Early onset of obesity Physical exam often is sufficient to evaluate Pseudotumor cerebri Fundoscopic exam, lumbar puncture Increased intracranial pressure suggested by papilledema, and confirmed by lumbar puncture

To confirm whether hyperandrogenemia is present, and exclude other causes of hyperandrogenemia Precocious puberty LH, FSH, testosterone or estradiol, DHEAS Early onset of obesity Physical exam often is sufficient to evaluate Pseudotumor cerebri Fundoscopic exam, lumbar puncture Increased intracranial pressure suggested by papilledema, and confirmed by lumbar puncture BP: blood pressure; CBC: complete blood count; AST: aspartate aminotransferase; ALT: alanine aminotransferase; ANA: antinuclear antibodies; HbA1c: hemoglobin A1c; SCFE: slipped capital femoral epiphysis; DHEAS: dehydroepiandrosterone sulfate; SHBG: sex hormone binding globulin; LH: luteinizing hormone; FSH: follicle-stimulating hormone. Adapted from: Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007 Dec; 120 Suppl 4:S164-92. Krebs NF, et al. Assessment of child and adolescent overweight and obesity. Pediatrics. 2007 Dec; 120 Suppl 4:S193-228.