Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-2005. A 14-year-old boy with recent slowing of growth and delayed puberty

Drugs used in psychiatry causing an increase in body weight in children-a review

Body weight gain is a prevalent adverse effect observed in psychiatric medication therapy. With the notable increase in mental health diagnoses among children and adolescents over the last decade, exacerbated by the COVID-19 pandemic, the use of medications associated with weight gain poses an additional risk for obesity development. This study aimed to identify psychiatric drugs that may induce weight gain in children as a side effect. Twenty-nine publications were included in this systematic review, investigating the effects of nineteen different drugs on children's weight. The majority of these drugs belonged to atypical antipsychotics and anticonvulsants. Nearly all included articles reported that the examined substances resulted in weight gain in children. As childhood obesity has become a significant problem with various metabolic, psychological and social consequences, it is crucial to carefully consider therapy options. In addition to evaluating effectiveness, it is important to also assess the potential for weight gain. Clinicians and nutrition specialists should individually evaluate patients' nutritional needs, evaluate obesity risk, and provide appropriate dietary guidance to minimalize the risk of weight gain.

Growth and Pubertal Timing in Boys With Adult-diagnosed Celiac Disease: A Population-based Longitudinal Cohort Study

There are few longitudinal data on whether childhood growth and pubertal timing may be impaired by adult-diagnosed celiac disease (CD). Through school health care records and national registers, we retrieved serial growth measurements on 37,672 Swedish boys born in 1945 to 1961, out of whom 72 (0.2%) were clinically diagnosed with CD as adults. Boys with, versus without, adult-diagnosed CD exhibited no appreciable mean differences in body mass index (BMI, kg/m) and height (cm) at ages 8 or 20 to 21 years (childhood BMI, 15.9 [CD] vs 15.7 [comparators]; childhood height, 129.1 [CD] vs 128.6 [comparators]; adult BMI, 21.3 [CD] vs 21.4 [comparators]; adult height, 180.7 [CD] vs 180.4 [comparators]). Neither did we observe any between-group differences in growth development during puberty nor in the timing of pubertal growth spurt (all P values ≥0.30). Conclusively, in this population-based longitudinal study, boys with adult-diagnosed CD had similar growth and pubertal timing as their peers.

Two cases presenting with pubertal delay and diagnosed as Celiac disease

Pubertal delay may be due to underlying chronic diseases and primary endocrine diseases. Celiac disease, one of the common malabsorption disorders of childhood, may progress silently in some cases, and the cases diagnosed late present with growth failure or disturbance of pubertal development. Currently, due to the changing face of celiac disease, patients are being diagnosed in adolescence with atypical symptoms and findings. This study describes 2 patients aged 13 and 16 years who presented with pubertal delay and who were diagnosed with celiac disease, concluding that routine screening of celiac disease in the differential diagnosis of delayed puberty should be recommended.

Population screening for celiac disease: follow up of patients identified by positive serology

BACKGROUND AND AIM

A previous study that evaluated the prevalence of celiac disease (CD) in a cohort of healthy blood donors, found that 3.8% of subjects had positive serology for CD. The aim of the present study was to examine how the screening results and the diagnosis of CD affected these patients' lifestyle and attitude toward CD.

METHODS

All subjects with positive serology for CD (n = 59) found in the previous study of healthy blood donors (n = 1571) were contacted and interviewed. Data collected included current and previous symptoms compatible with CD, medical follow up since being informed of positive serology for CD and adherence to gluten-free diet (GFD). Information was obtained regarding attitude towards the screening for CD, the results of the screening, and the effect of screening on subjects' lifestyle.

RESULTS

Of the 59 subjects, 51 were available for telephone interview, including all 10 subjects diagnosed with CD (positive serology and biopsy), 17/20 with positive serology and normal intestinal mucosa, and 24/29 with positive serology who refused to undergo intestinal biopsy. Of the 10 patients diagnosed with CD, four adhere to GFD. Only 1/17 subjects with normal intestinal mucosa repeated serology. Two of the 24 who initially refused a biopsy, underwent an intestinal biopsy, and one of them was currently diagnosed with CD. Only one patient diagnosed with CD had all his family members screened for CD.

CONCLUSIONS

The data suggest that many of the patients identified in this screened population do not ultimately benefit from the purpose of the screening, which was early identification and treatment of a common disease with potential serious consequences.

Eating disorders and celiac disease: a case report

OBJECTIVE

Although chronic physical illness may be associated coincidentally with an eating disorder, some clinicians may overlook the possibility that another medical illness may coexist and contribute concurrently to symptoms such as peculiar eating behaviors, restrictive eating, and/or vomiting accompanied by body dissatisfaction. We present a 31-year-old single woman initially diagnosed with an atypical eating disorder.

METHOD

After a gastroenterology consultation prompted by the atypical characteristics of her eating disturbance, the diagnosis of celiac disease was established.

RESULTS

Cause-and-effect relationships between anorexia nervosa and celiac disease are unclear, and celiac disease may lead to confusion in the differential diagnosis of anorexia nervosa.

CONCLUSION

Particularly in atypical cases, and in cases where nausea and bloating are prominent complaints, workup for celiac sprue may reveal the presence of this condition. In such instances, patients may achieve additional relief through the implementation of gluten-free diets.

Coeliac disease case finding and diet monitoring by point-of-care testing

BACKGROUND

Immunoglobulin A class transglutaminase autoantibodies are highly predictive markers of active coeliac disease, a disorder difficult to recognize solely on clinical grounds.

AIMS

To develop and evaluate a simple rapid test for point-of-care detection of coeliac autoantibodies.

METHODS

The novel whole blood test utilizes the patient's endogenous transglutaminase in red blood cells for detection of transglutaminase-specific immunoglobulin A antibodies present in the blood sample, with normal plasma immunoglobulin A detection as positive test control. We evaluated 284 patients under suspicion of coeliac disease and undergoing jejunal biopsy, and 263 coeliac patients on a gluten-free diet, 383 being tested prospectively in a point-of-care setting. Results were compared with histology, conventional serum autoantibody results and dietary adherence.

RESULTS

The rapid test showed 97% sensitivity and 97% specificity for untreated coeliac disease, and identified all immunoglobulin A-deficient samples. Point-of-care testing found new coeliac cases as efficiently as antibody tests in laboratory. Coeliac autoantibodies were detected onsite in 21% of treated patients, while endomysial and transglutaminase antibodies were positive in 20% and 19%, respectively. The positivity rate correlated with dietary lapses and decreased on intensified dietary advice given upon positive point-of-care test results.

CONCLUSIONS

Point-of-care testing was accurate in finding new coeliac cases and helped to identify and decrease dietary non-compliance.