Adiposogenital dystrophy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD

Overview

Adiposogenital dystrophy must be differentiated from other diseases that cause polyphagia, obesity, and a delayed puberty such as Prader-Willi syndrome, Bardet-Biedl syndrome, Borjeson syndrome and Klinefelter's syndrome.

Differentiating Adiposogenital Dystrophy from Other Diseases

Disease/Condition	Clinical presentation	Demographics/History	Diagnosis	Treatment
Adiposogenital Dystrophy	Partial destruction of hypothalamic nuclei resulting in hormonal dysfunction with obesity, growth retardation, and hypogonadism. Deep brain stimulation may also cause symptoms similar to adiposogenital syndrome .	Prevalence is unknown, but it is more common in males	Diagnosis is based on visual field tests, hormonal assays, CT, MRI, autoimmune assays	Diet and exercise Radiation Surgery, thermoablation, radiosurgery Hormone replacement
Prader-Willi Syndrome	It presents with hyperphagia, hypogonadism, truncal obesity, intellectual disability, growth delay, hypotonia, almond-shaped palpebral fissures, narrow frontal diameter, thin upper vermilion with downturned corners of the mouth behavioral problems such as anxiety and temper outbursts	Prader Willi Syndrome has a prevalence of 1 in every 1 in 20000 to 1 in 30000 births. Females and males can be equally affected, and there is no difference between races and ethnicities. Most cases of Prader Willi syndrome are sporadic, but familial cases can present when the paternal genes carry a microdeletion in the imprinting center inherited from his mother.	Molecular testing for DNA methylation Fluorescence In Situ Hybridization to investigate 15q11-q13 Chromosomal microarray to determine presence of maternal disomy.	Hormone replacement Cognitive and behavioral therapy
Bardet-Biedl Syndrome	Visual impairment Polydactyly, brachydactyly or syndactyly Obesity Renal and genital abnormalities Neurological and mental deficits such as learning difficulties developmental delay, speech deficit, ataxia Diabetes mellitus Congenital heart disease	It is a rare autosomal recessive genetic disorder. . Males and females are affected equally	Hair pull test followed by trichogram reveals numerous clubbed-shaped hairs; telogen count must exceed 20% for diagnosis.	It could be an acute self-limiting form triggered by stressors such as crash diets, childbirth, febrile illness, or psychological stress. It may be chronic and present in association with female pattern hair loss.
Borjeson Syndrome	Hair loss at regions of the scalp exposed to tension on hair follicles for a prolonged period of time in people who make tight hairstyles.	Traction alopecia is more commonly seen among black populations with females being affected more often than males at a rate of about 31,000-32,000 per 100,000 women compared to about 2,300 per 100,000 men. Traction alopecia is seen in about 18,000 per 100,000 girls between the ages of 5.4 to 14.3 years based on a study of African-American girls.	Mostly a clinical diagnosis based on hair loss at areas of the scalp where tension on the hair is highest.	Early detection and switching to more loose hairstyles may reverse the condition, however, with prolonged tension on the scalp destruction of the hair follicles will occur, causing the condition to become irreversible.
Klinefelter Syndrome	Presents in diverse ways such as ordinary scaling without any obvious hair loss which is considered to be a seborrheic form, a crusted or pustular form that may be localized or diffuse, a ‘black dot’ type that is characterized by tiny black dots within regions of alopecia, an inflammatory mass called kerion, and a round, bald, scaly patch where the follicular ostia are filled with keratinous debris. A unique feature of tinea capitas is the presence of post-auricular and cervical lymphadenopathy.	It is more common in the pediatric population.	Potassium hydroxide preparation can be added to skin scrapings of affected areas in order to diagnose the condition. Wood's light can also be used in diagnosis as majority of Microsporum spp will appear bluish-green, occasionally dull yellow (Microsporum gypseum) and dull blue (Trichophyton schoenleinii).	In the U.S., under 5% of cases will show fluorescence. Possible complications of tinea capitas are kerion, an abscess in the scalp, or favus, another inflammatory form in which there is honeycomb destruction of the hair shaft. Both are severe forms of the disease and can cause permanent scarring.