Morbid Obesity with Severe Hypertension: A Clinical Challenge

Abstract

Background: Morbid obesity is a growing concern among children and adolescents, and is complicated by multitude of morbidities such as diabetes, hypertension, metabolic syndrome, and sleep disturbances. Obesity-related hypertension is a distinct phenotype in children and adolescents and needs extensive evaluation to look for underlying etiology. Clinical Description: We report a case of acute nephritic syndrome who presented in hypertensive emergency, was found to have morbid obesity, evaluated and diagnosed as Prader–Willi syndrome with metabolic syndrome and obstructive sleep apnea (OSA). After initial stabilization, relevant blood investigations and urinalysis confirmed the diagnosis of poststreptococcal glomerulonephritis. A carefully planned evaluation identified multiple morbidities of severe obesity and determinants for the chronic hypertension. Management: The morbid obesity necessitated a thorough evaluation for etiology and complications. The child was managed for hypertensive emergency and started on multiple anti-hypertensives. The identification and management of OSA led to better control of hypertension. A holistic plan was formulated to address other medical issues including the metabolic syndrome, deranged lipid profile, impaired social cognition, and behavioral issues. Conclusion: Obesity-related chronic hypertension was unveiled in our patient by an acute hypertensive emergency. This case underscores the importance of screening for hypertension in chronic conditions such as obesity and sleep-disordered breathing at every clinical encounter and also the need for a holistic multidisciplinary approach for managing morbid obesity.

Keywords

• morbid obesity
• obstructive sleep apnea
• poststreptococcal glomerulonephritis
• prader–willi syndrome