Which endocrine disorder should be considered in the differential diagnosis of pediatric obesity?

• A. Growth hormone deficiency
• B. Cushing syndrome
• C. Medication-induced weight gain
• D. Hypothyroidism

Answer: (D)

Pediatric obesity can be a sign of an underlying endocrine issue, so it’s important to consider disorders that slow metabolism or alter growth. Hypothyroidism fits this pattern because low thyroid hormone reduces metabolic rate and energy expenditure, which can lead to weight gain in children. In addition, kids with hypothyroidism may have slowed growth or delayed bone age, and they might experience fatigue, constipation, dry skin, or cold intolerance—clues that point toward an endocrine cause rather than purely lifestyle factors.

Growth hormone deficiency can contribute to increased fat mass, but the hallmark is poor linear growth and short stature rather than obesity as the primary feature. Cushing syndrome can cause obesity, especially central fat accumulation, but it’s less common and typically comes with other signs like facial rounding, proximal muscle weakness, easy bruising, or hypertension. Medication-induced weight gain depends on exposure to certain drugs and isn’t an intrinsic endocrine disorder in the child.

Because hypothyroidism is a common, reversible endocrine cause of weight gain in children, it should be included in the differential and prompted thyroid screening when clinically suspected.