Linear growth and body mass index in pediatric patients with Cushing's disease or simple obesity.
BACKGROUND
Increasing prevalence of childhood obesity has resulted in an accelerating rate of referrals of overweight patients to pediatric clinics for exclusion of endocrine or metabolic etiologies. The exclusion of Cushing's disease (CD) requires complex and potentially invasive investigations.


OBJECTIVE
To evaluate the sensitivity of accurate measurements of height, weight and body mass index (BMI) in discriminating between simple obesity and CD.


METHODS
Height, weight and BMI were measured at diagnosis in 25 patients with CD; 14 males, 11 females, mean age 12.9 yr (6.4-17.8) and 41 patients with simple obesity (SO), defined as BMI >2.0 SD; 20 males, 21 females, mean age 9.4 yr (3.5-15.6).


RESULTS
Mean (+/-SE) BMI SDS in the CD patients was 2.41+/-0.5 and in the SO patients 3.71+/-1.3. Height SDS in the CD patients was -1.88+/-0.24 and in the SO patients 1.18+/-0.19 (p<0.05). The mean (+/-SE) BMI SDS to height SDS ratio was significantly decreased in the CD compared with the SO patients; -1.81+/-0.54 vs +0.90+/-1.17 (p<0.0001).


CONCLUSIONS
Simple, accurate measurement of height and BMI SDS values provides a quick, and sensitive diagnostic discriminator in pediatric patients with CD or SO, thus potentially avoiding complex investigations.
Greening
J E
JE
Department of Endocrinology, Barts and the London School of Medicine and Dentistry, London, UK.
Storr
H L
HL
McKenzie
S A
SA
Davies
K M
KM
Martin
L
L
Grossman
A B
AB
Savage
M O
MO
D000293:Adolescent; D001827:Body Height / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008297:Male; D009765:Obesity / Q000175:diagnosis* / Q000503:physiopathology*; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D006854:Hydrocortisone