Pickweckian syndrome

Introduction Occasionally, the weight of extremely obese children is 4 to 5 times of the standard weight. Due to excessive fat, the movement of the thoracic and diaphragm muscles is restricted, resulting in rapid breathing, reduced alveolar ventilation, hypoxemia, and polycythemia. There is purpura, enlarged heart and congestive heart failure, known as Pickweckian syndrome. Eat more, rest too much, lack of exercise, genetic factors, neuropsychiatric disorders and other causes can induce the disease. Controlling the diet, increasing the amount of exercise, and controlling the body weight within a certain range can prevent the disease from occurring.

Cause

The cause of Pickweckian syndrome

1. Eat more: The main cause of obesity is overeating. The intake of human heat exceeds the consumption, so the remaining heat is converted into fat accumulation in the body. Children with obese parents often have the same trend. Members of a family are often accustomed to eating abundance. Members of a family are often accustomed to eating abundance food. Children have developed eating habits since childhood, and obesity occurs over time.

2. Too much rest, lack of exercise, lack of proper activities and physical exercise are also important factors for obesity. Children who are overweight children do not like sports. Among the obese children we observed, the vast majority were simple obesity with less movement and more food. During the recovery of hepatitis or other diseases, there are often too many rests and too little exercise, so that the weight increases day by day, and the heavier the more difficult it is, the vicious circle is formed.

3. Genetic factors: Parents of obese children tend to be fat. If both parents are significantly more than normal, about two-thirds of the offspring are obese. If one of the shuangguan is obese, the offspring show that the obese person is about 40%.

4. Neuropsychiatric disorders: Occasionally, obesity occurs after encephalitis. Obesity can also occur after hypothalamic disease or frontal lobe resection. Obesity can sometimes occur in children with emotional trauma (such as death or death of a loved one) or psychological abnormalities.

an examination

Related inspection

Insulin blood test

Examination of Pickweckian syndrome

[clinical manifestations]

Severe obesity is more common in older children and adolescents, and is rare in infants and young children. Children's appetite is particularly strong, and the food intake exceeds that of ordinary children. They all prefer starch and oily foods and do not like vegetables. Some sick children eat less when they are seeking medical treatment, but they must eat too much before they start to gain weight. The accumulation of fat in children is marked by milk, abdomen, hip and shoulder. The pink skin is often seen in the abdomen, and the limbs are hypertrophied, especially in the upper arms and thighs. The boy's external genital tract is covered by the pubic pharyngeal skin, which looks small and actually falls within the normal range. The bone age is normal or exceeds the same age. Good intelligence. Sexual development is normal or earlier. Inconvenient activities, very little exercise.

Occasionally, the weight of extremely obese children is 4 to 5 times of the standard weight. Due to excessive fat, the movement of the thoracic and diaphragm muscles is restricted, resulting in rapid breathing, reduced alveolar ventilation, hypoxemia, and polycythemia. Purpura, heart enlargement, and congestive heart failure, known as Pickweckian syndrome, can cause death.

[Auxiliary inspection]

1. Serum triglyceride, cholesterol, low density lipoprotein, very low density lipoprotein, apolipoprotein B were mostly elevated, while high density lipoprotein and apolipoprotein A1 were normal.

2. The serum insulin level is increased, and the blood insulin concentration can be restored to normal after the child loses weight.

3. The secretion rate of adrenal cortex hormones increases, but the catabolism of corticosteroids in peripheral tissues also accelerates. Therefore, the plasma total cortisol concentration is normal, but the metabolites in urine increase, and the urinary 17-hydroxycorticosteroids tend to increase significantly.

4. Dexamethasone inhibition screening test: the secretion of cortisol in children can be significantly inhibited.

Differential diagnosis

Symptoms of susceptibility to Pickweckian syndrome

[Differential diagnosis]

Simple obese children should cover up the external genitalia because of excessive body fat, so that the wrong development of the external genitalia should be noted. It is often suspected that fat children are caused by endocrine abnormalities. In fact, obesity caused by endocrine system diseases is relatively rare, and other symptoms can be identified.

Pituitary and hypothalamic lesions can cause obesity, called obesity reproductive incompetence, but its body fat has a special distribution, the neck, underarm, breast, hip and thigh upper part is most obvious, the finger is sharp, and there are intracranial lesions. And gonadal developmental delay. General obesity can also occur due to interbrain damage caused by craniocerebral trauma, but there are urine collapse, sexual dysfunction and other autonomic symptoms.

When thyroid function declines, body fat accumulation mainly in the face and neck, often accompanied by mucous edema, growth and development is significantly lower, basal metabolic rate and appetite are low.

Adrenal cortical tumors and long-term use of adrenocortical hormone can cause Cushing's syndrome, including cheeks, more fat under the armpits, a specific face, thicker chest and back body fat, often accompanied by high blood pressure, skin redness Purple, hair plus and genital precocity. The abdomen sometimes touches the mass, and the X-abdominal plain film shows calcified shadows. Obesity is also observed in some diabetic children and ovarian dysfunction such as Stein-Leventhal syndrome.

The accumulation of glycogen in the liver can be seen as a fat face, especially in the lower abdomen and pubic area. Prader-Willi syndrome is another congenital metabolic disease, starting from the late stage of infantile obesity, as well as low muscle tone, short body, small hands and feet, mental retardation and hypogonadism, strabismus and other symptoms, often to adolescents with diabetes. Lauience-Moon-Biedl syndrome is a multiple malformation, including finger toe deformity, obesity, visual impairment, and mental retardation.

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