Cardiorespiratory Syndrome of Obesity (Pickwickian Syndrome) in Children

The clinical, pulmonary and hemodynamic findings in two boys with the Pickwickian syndrome are presented. In contrast to adults with this syndrome, all four children thus far reported have been mentally retarded. Both of our cases were cyanotic, lethargic and in congestive heart failure at the time of admission. They both exhibited polycythemia, cardiac enlargement, electrocardiographic evidence of right atrial and right ventricular hypertrophy, decreased pulmonary function without evidence of obstructive pulmonary disease and pulmonary arterial hypertension. Symptoms of cardiorespiratory disease subsided following weight reduction. The pathophysiologic mechanisms of alveolar hypoventilation, pulmonary arterial hypertension, and congestive heart failure in patients with this disease complex are discussed. The clinical recognition of this syndrome is of practical importance because: 1) it is a preventable disease, 2) the changes are reversible following weight reduction and 3) because of the dangers of oxygen administration.