help

[dddizzy66]

I have a 15yr old whom at age 14 started experiencing severe mood changes, depression, cutting on himself, failing in school and a large weight gain (130 lb increase in less than a year).  He is finally doing  better, he was diagnosed with bi-polar.  I am not too sure that I agree with this but since he is doing better than we will go with it.  He is on prozac, trileptal and concerta(dx at age 10 with AD/HD-he was on 60mg of adderal until this year).  I am extremely concerned with the weight gain.  He went to an endocrinologist whom recommended a dietation.  The only thing he checked was the cholesteral and the urine for cushings(at my request).  My son went from 170 to 300 lbs in a year.  The dr does not feel he has cushings because his stretch marks are not wide enough and because it is very rare.  I have two rare autoimmune diseases so I know that anything is possible.  I also have a sister whom at age 12/13 went through a 75 lb increase in a short time and a complete personality change.  Even though there is 9yrs between them their behavioral changes and weight gain is very similar.  I really feel there is something that everyone is missing, can you offer any suggestions on something that the doctors may be missing

[Deanna L Aftab Guy, MD]

Cushing's Disease is very rare in children, not nonexistent but rare, he has a very clear psychiatric history and the medications are very likely contributing to the weight gain along with some unfair metabolism and increased eating and lack of activity related to depression and mood problems. I would work very closely with the psychiatrist, they can test thyroid, first thing to look at, next 24 hour urine for free cortisol done on 3 separate occasions will help with your concern for Cushing's, this is indeed a big weight gain but you have some very strong influences also that have to be addressed, mood, genetic tendency to have rapid weight gain, pubertal hormones that change the metabolism on top of genetics. Have a dietician also look at things, there has to be some help nutritionally as well as medically. Talk with his psychiatrist and also work with his pediatrician if not get an adolescent pediatrician to see him. The weight gain may be a symptom not necessarily the problem of his overall concerns. I hope this gives you a start. This will not correct overnight but needs addressed as well as the other concerns