title: Successful treatment with atomoxetine of an adolescent boy with attention deficit/hyperactivity disorder, extreme obesity, and reduced melanocortin 4 receptor function.
abstract: OBJECTIVE
  Recent case reports suggest a link between reduced melanocortinergic tone and both obesity and attention deficit / hyperactivity disorder (ADHD). We present the case of a 13-year-old, male, obese MC4R mutation carrier with ADHD.
  
  
  METHODS
  The boy carries a heterozygous mutation in the melanocortin 4 receptor gene (MC4R; Met281Val), that leads to a reduced receptor function. Dominant mutations of this type represent major gene effects for obesity. He participated in a lifestyle intervention program for obesity and received treatment with the selective norepinephrine re-uptake inhibitor atomoxetine for 31 months. The boy markedly reduced his BMI from 47.2 to 29.6 kg/m².
  
  
  CONCLUSIONS
  Atomoxetine proved to efficiently reduce weight in a severely obese MC4R mutation carrier with ADHD. We briefly discuss possible mechanisms for our observation, including evidence for the functional connectivity between melanocortinergic, dopaminergic, and norepinephrinergic brain circuitries.
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human Medicine, Philipps-University Marburg, Germany. Wilfried.Pott@t-online.de
authors.forename: Wilfried
authors.initials: W
authors.lastname: Pott
authors.forename: Ozgür
authors.initials: O
authors.lastname: Albayrak
authors.forename: Anke
authors.initials: A
authors.lastname: Hinney
authors.forename: Johannes
authors.initials: J
authors.lastname: Hebebrand
authors.forename: Ursula
authors.initials: U
authors.lastname: Pauli-Pott
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D004252:DNA Mutational Analysis; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D009154:Mutation; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D010641:Phenotype; D011437:Propylamines / Q000627:therapeutic use*; D044105:Receptor, Melanocortin, Type 4 / Q000235:genetics / Q000378:metabolism*; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects
chemical_list: D018759:Adrenergic Uptake Inhibitors; C470072:MC4R protein, human; D011437:Propylamines; D044105:Receptor, Melanocortin, Type 4; D000069445:Atomoxetine Hydrochloride