A 10-year-old boy with short stature and obesity (page 1/3)
Prepared by...
Oranee Sanmaneechai, M.D.
Prapai Dejkhamron,M.D
Kevalee Unachak, M.D
* Department of Pediatrics, Chiang Mai University
Patient: A 10-year-old boy Address: -
CC: short stature and obesity for 4 years
Present Illness:
  The patient's mother notices that her son has short stature compared to his friends of the same age.
He has been progressively obese since 6 years of age.
He usually has three meals a day with two dishes each meal. He also enjoys junk food and soft drink as well. He exercises occasionally, once a week.
He occasionally snores during sleep, but no sleep disturbance nor sleep apnea. He seldom falls asleep during the day time. His school performance is in good grade.
Perinatal History:

 

 Normal ANC, no history of intrauterine infection, Caesarian section due to CPD,
Birth weight was 3,940 g. He is the only child in this family
Past Medical History:

 

 No history of chronic illness
Development:

 

 Appropriate for age
Famillyl History:

 

 His father's and mother's height are164 and 165 cm, respectively.
No family history of obesity, diabetes mellitus, hypertension nor short stature
No parental consanguinity and stillborn child
Physical examination:

 

 GA: An obese boy, normal consciousness
BW 54.8 kg (+3.1 SD)HT 116 cm (-3.9 SD) Midparental height (MPH)is 171 cm (at the 50th percentile).
BMI 40.7 kg/m2 Weight for height 267.3 %
  Upper: lower segment (U/L) ratio = 1.5:1 (normal U/L ratio = 1:1) Arm span 116 cm. (normal)
Vital signs: T 37oC RR 36 /min PR 76/min BP 110/60 mmHg.
HEENT: OFC 59 cm, midfacial hypoplasia, not pale, no jaundice,
no thyroid gland enlargement, acanthosis nigricans
Lymph nodes: no lymphadenopathy
Chest: no rachitic rosary
Heart: normal S1, S2, no murmur.
Lungs: clear, no adventitious sound
Abdomen: soft, normal bowel sound, liver and spleen not palpable
Neurological exam: normal neurological sign
Genitalia: normal male genitalia, Sexual Maturity Rating stage 1
Extremities: short extremities (proximal shorter than distal), bowed legs, no joint enlargement
Skin: no hyperpigmentation
Click for Patient's Photographs
Problem list:
1.
 Short stature with infantile skeletal proportion
Macrocephaly with midfacial hypoplasia
Short limb, especially proximal segment (Rhizomelia)
Bow legs

2.

 Obesity
Acanthosis nigricans
Snoring
Presumptive diagnosis
1.
 Disproportionate short stature
2.
 Obesity with insulin resistance
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