Adolescent and his/her body image. Hidden factors of confusion in diagnosis

Adolescents? worries due to their body image can occasionally drive them to adopt extreme attitudes (diet, exercise, etc.). When the teenagers try to hide these attitudes diagnoses can be very difficult. A Sixteen-year-old adolescent suffered a syncope while he was running. His physical examination showed obesity and hypertension. His blood tests showed increased total creatine kinase and its MB isoenzyme. Further tests ruled out renal and cardiac illness. In following interviews the patient expressed his worry for his physical appearance and that the exercise he did to loose weight was far beyond the healthy limits. An efficient communication during medical interview with the adolescent was the key to get the previous hidden information. We finally proved that the increased creatine kinase clearly correlated with heavy exercise and hypertension with obesity.