title: Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome.
abstract: OBJECTIVE
  We report that intractable early childhood obesity may be associated with severe insulin resistance syndromes (pseudo-Cushing's syndrome and pseudo-acromegaly) and precede polycystic ovary syndrome (PCOS).
  
  
  RESULTS
  Patient 1 had prepubertal obesity followed by early puberty and was diagnosed with pseudo-Cushing's syndrome and insulin resistance at 10.3 years. Oligomenorrhea, androgen excess, and type 2 diabetes mellitus (DM2) emerged at 13.5 years. Patient 2 developed intractable prepubertal obesity followed by atypical true sexual precocity and pseudo-Cushing's syndrome in early childhood. By 11.3 years, oligomenorrhea, androgen excess, and DM2 had appeared. Patient 3 had prepubertal overgrowth in weight and height and was diagnosed with pseudo-acromegaly, menstrual irregularity, androgen excess, and impaired glucose tolerance at 14.3 years of age. Patient 4 had prepubertal overgrowth that evolved into pseudo-acromegaly, insulin resistance, secondary amenorrhea, and androgen excess at 15.6 years.
  
  
  CONCLUSIONS
  Intractable prepubertal obesity was recognized to culminate in early childhood pseudo-Cushing's syndrome or pseudo-acromegaly, which are manifestations of insulin-resistant hyperinsulinism, and to herald adolescent PCOS.
authors.affiliation: University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Section of Pediatric Endocrinology, 5841 S. Maryland Avenue, IL 60637, USA. ebaumann@peds.bsd.uchicago.edu
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Littlejohn
authors.forename: Roy E
authors.initials: RE
authors.lastname: Weiss
authors.forename: Dianne
authors.initials: D
authors.lastname: Deplewski
authors.forename: Deborah V
authors.initials: DV
authors.lastname: Edidin
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenfield
mesh_terms: D000293:Adolescent; D002648:Child; D003480:Cushing Syndrome / Q000473:pathology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000209:etiology*; D007333:Insulin Resistance; D009765:Obesity / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis / Q000209:etiology*; D011629:Puberty, Precocious / Q000473:pathology; D013997:Time Factors