Polyphagia

Polyphagia: Excerpt from In A Page: Pediatric Signs and Symptoms

Polyphagia, or hyperphagia, refers to the excessive consumption of food or display of food-seeking behavior. Obesity does not necessarily occur.

Differential Diagnosis

• Exogenous obesity
• Bulimia
• Depression
• Anxiety
• Diabetes mellitus
• Hypoglycemia
• Diabetes insipidus in infants
  –On breast milk or formula diet, excessive drinking is misinterpreted as excessive eating
• Hyperthyroidism or Graves disease
  –Increased metabolic rate, increased appetite, and increased oral intake as well as increased stool output
• Medications
  –Corticosteroids
  –Cyproheptadine
  –Tricyclic antidepressants
  –Valproic acid
  –Tetrahydrocannabinol
  –Neuroleptics
  • Hypothalamic lesions (hypothalamic –Tumors (e.g., craniopharyngioma)
    –Inflammation/autoimmune
    –Central nervous system infection
    –Head trauma
• Genetic syndromes
  –Prader-Willi syndrome
  –Laurence-Moon-Bardet-Biedl syndrome
  –Kleine-Levin syndrome
• Cystic fibrosis
  –Malabsorption results in chronic malnutrition, especially of fat

Workup and Diagnosis

• History
  –Nutritional history/diet recall for 24–72 hour
  –Onset (age, life events) of change in eating behaviors
  –Symptoms of depression, anxiety, eating disorders, or other psychiatric illness
  –Symptoms of diabetes: Polyuria, polydipsia, wt loss
  –Symptoms of hyperthyroidism or Graves disease: Palpitations, proximal muscle weakness, heat intolerance, ocular symptoms, difficulty concentrating, tremulousness
  –Past medical history, medications
  –Symptoms of brain tumor or infection/injury to CNS: Headaches, visual changes, fever, trauma, mental status changes
  –A history of poor feeding and hypotonia at birth, developmental delay, hypogonadism, and hyperphagia with subsequent obesity suggests Prader-Willi syndrome

• Physical exam: Height and weight, visual fields, optic disks, visual acuity (brain tumor), proptosis, goiter, lid lag (Graves), syndromic features
• Labs/studies: Blood glucose; TSH, T4, T3, thyroid stimulating immunoglobulin; genetic testing for Prader-Willi or Laurence-Moon-Bardet-Biedl syndrome; simultaneous serum and urine osmolalities may indicate DI; often requires formal water deprivation test
• MRI of the brain and pituitary

Treatment

• Insulin therapy for diabetes mellitus
• Graves disease is treated with antithyroid medication, thyroid radioablation, or surgical thyroidectomy
• Stop offending medications or substances if possible
• Psychiatric conditions require treatment directed at the specific cause
• Lesions of the hypothalamus require treatment directed to the specific cause
• Syndromes such as Prader-Willi and Laurence-MoonBardet-Biedl require multidisciplinary treatment from endocrinology, nutrition, and other subspecialities
• Diabetes insipidus
  –Free water replacement while on formula
  –DDAVP when older

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Eating Disorder not Otherwise Specified (ENDOS)

• Back to disease: Eating Disorder not Otherwise Specified (ENDOS): Introduction
• Next Book Extract About Eating Disorder not Otherwise Specified (ENDOS): ANOREXIA (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Eating Disorder not Otherwise Specified (ENDOS)

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: ANOREXIA (Differential Diagnosis in Primary Care)

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