Polyphagia
Polyphagia, or hyperphagia, refers to the excessive consumption of food or display of food-seeking behavior. Obesity does not necessarily occur.
Differential Diagnosis
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Exogenous obesity
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Bulimia
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Depression
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Anxiety
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Diabetes mellitus
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Hypoglycemia
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Diabetes insipidus in infants
–On breast milk or formula diet, excessive drinking is misinterpreted as excessive eating
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Hyperthyroidism or Graves disease
–Increased metabolic rate, increased appetite, and increased oral intake as well as increased stool output
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Medications
–Corticosteroids
–Cyproheptadine
–Tricyclic antidepressants
–Valproic acid
–Tetrahydrocannabinol
–Neuroleptics
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Hypothalamic lesions (hypothalamic –Tumors (e.g., craniopharyngioma)
–Inflammation/autoimmune
–Central nervous system infection
–Head trauma
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Genetic syndromes
–Prader-Willi syndrome
–Laurence-Moon-Bardet-Biedl syndrome
–Kleine-Levin syndrome
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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
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Physical exam: Height and weight, visual fields, optic disks, visual acuity (brain tumor), proptosis, goiter, lid lag (Graves), syndromic features
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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
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MRI of the brain and pituitary
Treatment
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Insulin therapy for diabetes mellitus
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Graves disease is treated with antithyroid medication, thyroid radioablation, or surgical thyroidectomy
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Stop offending medications or substances if possible
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Psychiatric conditions require treatment directed at the specific cause
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Lesions of the hypothalamus require treatment directed to the specific cause
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Syndromes such as Prader-Willi and Laurence-MoonBardet-Biedl require multidisciplinary treatment from endocrinology, nutrition, and other subspecialities
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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.
Other Book Chapters Related to Excessive hunger
Read excerpts from these other book chapters related to Excessive hunger:
Medical Books Excerpts
- POLYPHAGIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Polyphagia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Excessive hunger
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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
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» Next page: POLYPHAGIA (Differential Diagnosis in Primary Care)
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