The Obese Child With Acanthosis Nigricans

▸ Children with knee or hip pain and x-ray findings suggestive of slipped capital femoral epiphysis or Blount's disease (tibia vara) may need orthopedic evaluation.

▸ Children with abdominal pain may require referral to a pediatric gastroenterologist for evaluation of obesity-associated liver or gallbladder disease.

Regular monitoring of the overweight child with acanthosis nigricans is recommended. If initial screening is negative for type 2 diabetes or insulin resistance, the American Diabetes Association recommends repeating the screening every 2 years for at-risk children. Follow-up screening can also include thyroid studies to evaluate for hypothyroidism and dehydroepiandrosterone sulfate, free testosterone, and a luteinizing hormone to follicle-stimulating hormone (LH:FSH) ratio to screen for hyperandrogenism.