Endocrine Abstracts

Introduction: The management of childhood obesity is complex and requires intensive input from a multidisciplinary team. Pharmaceutical interventions may be required in addition to lifestyle modifications to treat morbid obesity. In a double blind randomised controlled trial, liraglutide, a glucagon-like peptide 1 (GLP-1) agonist along with dietary and lifestyle interventions showed beneficial BMI reduction in children and adolescents. We present a morbidly obese adolescent with life threating obstructive hypoventilation who had a dramatic weight loss of 45.3 kg in a 12 month period following treatment with liraglutide.

Case: A 15year old boy with morbid obesity, 184.5 kg (BMI 56.6 kg/m², (SDS +3.23) presented with symptoms of severe sleep apnoea. The sleep study showed average oxygen saturation of 87% with an oxygen desaturation index of 56.4 consistent with significant obstructive sleep apnoea. He was established on non-invasive ventilator support [overnight continuous positive airway pressure] and was referred to the obesity team. The clinical history was not suggestive of an underlying monogenic cause of obesity. His clinical examination showed generalised obesity, without dysmorphism, signs of insulin resistance or cushingoid features. His investigations showed normal HbA1C (36 mmol/mol), liver function, thyroid function and oral glucose tolerance test. An echo cardiogram showed no evidence of pulmonary hypertension. A Calorie restricted diet (1800 kcal/day) was advised along with goal setting exercise. He was commenced on orlistat but stopped due to side effects. He was referred for bariatric surgery. Liraglutide was commenced in order to buy time before the bariatric surgery. He was commenced at a dose of 0.6 mg which was increased to 1.8 mg over a 12 month period. A further increase in the dose (maximum recommended dose 3.0 mg) was withheld due to the gastrointestinal side effects. A significant reduction of weight from 183.5 kg to 139.2 kg was observed in a 12month period with a 25% reduction in BMI from 56.6 kg/m² (SDS +3.23) to 42.5 kg/m²(SDS +2.87) and a reduction in BMI SDS score of -0.36.

Conclusion: Evidence from clinical trials supports the use of liraglutide in adolescents with severe obesity and should be considered as a potential treatment option, especially in motivated adolescents.