Patient case (clinical description): A 9-year-old girl is brought to the office for evaluation of short stature and overweight body habitus. The patient's mother and father are 170 cm and 181 cm tall, respectively.  On physical examination, the patient's height is in the 5th percentile of her age.  Other findings include low-set ears, a high arched palate, a webbed neck, and cubitus valgus.  Chromosomal analysis reveals a 45, XO karyotype.

Patient's own account: I took my 9-year-old daughter to the doctor because my mother-in-law kept saying she seemed small and overweight. My husband and I are 170 cm and 181 cm tall, respectively. The physical health highlighted that she is in the 5th percentile of her age. The doctor said that she has low-set ears, a high-arched palate, a webbed neck, and cubitus valgus. She also did a chromosomal analysis, which revealed a 45, XO karyotype.

Clinical trial: Safety and Efficacy of Xenical in Children and Adolescents With Obesity-Related Diseases

Eligibility criteria:
-  INCLUSION CRITERIA:

        Good general health. Individuals taking medications for obesity-related comorbid conditions
        will not be excluded.

        Obesity: body mass index for age and triceps skinfold above the 95th percentile (determined
        by NHANES I age-, sex-, and race- specific data). All subjects will be required to be over
        60 kg in body weight.

        Evidence for a quantifiable obesity-related comorbidity. Examples include: systolic or
        diastolic hypertension (determined by age-specific charts); frank Type 2 diabetes, impaired
        glucose tolerance assessed by oral glucose tolerance testing; hyperinsulinemia (defined as
        a fasting insulin greater than 15 mIU/mL); significant hyperlipidemia (total cholesterol
        greater than 200 mg/dL, LDL cholesterol greater than 129 mg/dL or fasting triglycerides
        greater than 200 mg/dL); hepatic steatosis (SGPT or SGOT above normal range with negative
        hepatitis studies) or sleep apnea documented by a sleep study.

        Age 12 to 17 years at the start of the study.

        For girls with childbearing potential, a negative pregnancy test before taking and while
        taking study medication. Sexually active females must be using an effective form of birth
        control. These methods include total abstinence (no sex), oral contraceptives ("the pill"),
        an intrauterine device (IUD), levonogestrol implants (Norplant), or medroxyprogesterone
        acetate injections (Depo-provera shots). If one of these cannot be used, contraceptive foam
        with a condom is recommended.

        Race of all four grandparents self-identified as either all Caucasian or all African
        American.

        EXCLUSION CRITERIA:

        Volunteers will be excluded (and referred to non-experimental treatment programs) for the
        following reasons:

        Presence of renal, hepatic (other than obesity-related steatosis), gastrointestinal, most
        endocrinologic (e.g., Cushing syndrome), or pulmonary disorders (other than either asthma
        not requiring continuous medication or sleep apnea-related disorders);

        Adolescent girls who are pregnant, who are currently nursing an infant, or who are having
        unprotected intercourse;

        Individuals who have, or whose parent or guardians have, current substance abuse or a
        psychiatric disorder or other condition which, in the opinion of the investigators, would
        impede competence or compliance or possibly hinder completion of the study;

        Subjects who regularly use prescription medications unrelated to the complications of
        obesity. Oral contraceptive use will be permitted, provided the contraceptive has been used
        for at least two months before starting study medication. The use of over-the-counter and
        prescription medications will be reviewed on a case-by-case basis; depending on the
        medication, subjects who have continued to take prescription medication for at least 3
        months prior to study entry may be eligible;

        Recent use (within six months) of anorexiant medications for the purpose of weight
        reduction;

        Inability to undergo MRI (e.g., volunteers with metal within their bodies including cardiac
        pacemakers, neural pacemakers, aneurysmal clips, shrapnel, ocular foreign bodies, cochlear
        implants, non-detachable electronic or electromechanical devices such as infusion pumps,
        nerve stimulators, bone growth stimulators, etc. that are contraindications).

        For pilot study participants, hypersensitivity or allergy to methylene blue. Individuals
        with documented G6PD deficiency will be excluded.

        INCLUSION CRITERIA: HEALTHY CONTROL CHILDREN AND ADOLESCENTS:

        Volunteers will qualify for inclusion if they meet the following criteria:

          1. Good general health.

          2. Age 12-17 years at study entry.

          3. Body mass index (BMI) for age above the 5th percentile and below 85th percentile,
             which is considered normal weight by CDC growth chart standards.

          4. For females with childbearing potential, a negative pregnancy test at initial
             evaluation.

          5. Race of all four grandparents self-identified as either all Caucasian or all African
             American.

        EXCLUSION CRITERIA: HEALTHY CONTROL CHILDREN AND ADOLESCENTS:

        Volunteers will be excluded for the following reasons:

          1. Presence of past or present medical problems which would impair performance during the
             exercise tests;

          2. Females who are pregnant, or who are currently nursing an infant;

          3. Individuals who have, or whose parent or guardian has, current substance abuse or a
             psychiatric disorder or other condition that in the opinion of the investigators would
             impede competence or possibly hinder completion of the study;

          4. Recent weight change of more than 3% of body weight in the past two months;

          5. Recent use (within six months) of anorexiant medications for the purpose of weight
             reduction;

          6. Physical impairments that would prevent completion of either the walk/run test or the
             cycle test.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 12 Years old.
Subject must be at most 17 Years

Eligibility (NLI label): Contradiction