Suggest Treatment For Loss Of Appetite And Weight Loss

Posted on Wed, 10 Sep 2014

Question: My 12 year old son has lost his appetite. He had Mono a year & a half ago with an enlarged spleen & liver. He recovered, but has since lost 35 lbs in one year. He says he just is not hungry. He has no other complaints, does not need naps nor does he complain of headaches or joint pain ect.. His doctor became concerned because he was in the 98% for height & weight up to this point & now is in the 50% for height & 10% for weight. He does not excuse himself after dinner & there is no indication that he throws up after eating, he is simply "not that hungry". His electrolytes, CBC with Diff, HgbA1C, thyroid, albumin & pre-albumin levels all came back normal. The only abnormal value was he was spilling protein in his urine. We have an appointment with a pediatric urologist, but I am not sure this is the problem. I am a nurse so certainly have an excellent medical background. Really would like your opinion as to what our next move should be? Thanks in advance.

Answered by Dr. Eric Goldstein (2 hours later)

Brief Answer:
Weight loss

Detailed Answer:
Hello. I just read through your question and I am sorry about what is going on with your son. It clearly has you upset. I am not convinced this is a urology issue either.
I know his thyroid and A1C came back normal but I would consider consulting with an endocrinologist anyway. There could be an issue with his satiety point that an endocrinologist could treat. I'm assuming a bone age has already been done.
Also, consider consulting with a gastroenterologist. This could be a malabsorption issue. And make sure whatever little he is eating is loaded with calories.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Eric Goldstein (10 hours later)

Thank you Dr. Goldstein for your suggestions. I just needed to ask a few follow-up questions. Could you please give some examples of problems that could be effecting his satiety point (I am assuming you mean his hypothalmus?) and their possible treatments so when I speak with his pediatrician I sound intelligent. Also, can you please clarify what you mean by bone age. That test has not been done. What is it & what information would we obtain from it?

Thank you so much for your time, Ms. Hutton

P.S. I have been giving him protein shakes with ice cream every afternoon with frozen peaches and half a banana, which he loves. He gained 6 lbs since the end of May. At least it is a step in the right direction, though I was hoping for more of a weight gain and he has not grown in height.

Answered by Dr. Eric Goldstein (3 hours later)

Brief Answer:
Follow Up

Detailed Answer:
Thank you for the follow up question.
satiety point could be affected by the hypothalamus or the pituitary. I believe an endocrinologist would want to check hypothalamic and pituitary hormones.
Bone age is calculated based on an x-ray of the hand. It is typically ordered by an endocrinologist. The radiologist can look at it and determine one of three things;
1. The patient's bone age is more than his chronologic age, in which case there is not much vertical growth left.
2. The bone age is less than chronologic age (this is usually good), and he still has plenty of vertical growth left.
3. The bone age is equal to chronologic age (this is also good), and he will continue to grow vertically.

It is very encouraging that he is gaining weight with the high calorie foods. I would continue with that diet until you get some more answers.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar