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Question:

From Pennsylvania, USA:

My daughter has dark skin on her neck, stretch marks on her stomach and mood swings. She developed under arm smell at age five, was always petite until she started to gain weight with no change in eating habits.She had one test with high cortisol levels, but the next was not high, so nothing more was done. They just said she was overweight, the neck indicated insulin resistance, there was nothing to be done for her and it was probably hereditary. Can something be done? Should she be tested some more? I've just kind of given up to the fact that my daughter just isn't the little girl she used to be.

Answer:

These are good questions. The darkening of the skin that you describe is probably Acanthosis Nigricans, which often occurs with insulin resistance.

The key is to limit the weight gain. You didn't indicate the age of the child, but in younger children often we try to "maintain" weight, while in an older child/teen, weight loss may be more appropriate. In my view, simply limiting calories does not lead to good weight loss. Increasing activity, also does not frequently lead to good weight loss. The combination of the two are important. The various weight loss inducing medications were not extensively FDA tested in children. Some medical specialists might consider a medication called Glucophage [metformin] as an adjunct medication to indirectly help decrease the insulin production.

The stretch marks are probably simply that, but the high cortisol level concern was a good idea. I think that a better test for excessive cortisol is not simply a blood test, but rather to see how much cortisol is excreted in the urine during a specified 24 hour time frame.

With the early underarm odor, this suggests a form (probably mild) of precocious puberty. Some of these can lead to excess male hormone production, and in teenage girls or adult women, might lead to a condition called Polycystic Ovary Syndrome. The ovaries, while working hard to produce hormones, can develop several small "bubbles" or cysts on them, and it often leads to further increased male hormone production. This condition, in of itself, may lead to additional insulin resistance.

My advice? Seek a referral to an endocrinologist.

DS

DTQ-20011025001625
Original posting 26 Oct 2001
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:26
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