Pickwickian Syndrome

Definition

A group of symptoms that generally accompany massive obesity.

Description

Pickwickian syndrome is a complex of symptoms that primarily affect patients with extreme obesity. The syndrome is named after a character in a Charles Dickens novel, The Pickwick Papers, who seemed to show some of the traits of this disease.

The major health problem that occurs in patients with this disease is sleep apnea. This is caused in part by the excess amounts of fatty tissue surrounding the chest muscles. This excess fat places a strain on the heart, lungs, and diaphragm of the patient, making it difficult to breathe.

Causes and symptoms

The major cause of Pickwickian syndrome is extreme obesity. This obesity places an excessive load on the pulmonary system. The role of genetics is also being studied. Symptoms of Pickwickian syndrome include excessive daytime sleepiness, shortness of breath due to elevated blood carbon dioxide pressure, disturbed sleep at night, and flushed face. The skin can also have a bluish tint, and the patient may have high blood pressure, an enlarged liver, and an abnormally high red blood cell count.

Diagnosis

Some tests that can be used to diagnose this condition include echocardiography to determine heart enlargement or pulmonary hypertension. Giving the patient multiple sleep latency tests can help give an objective measurement of daytime sleepiness. Magnetic resonance imaging (MRI), computed tomography (CT) scans, or fiberoptic evaluation of the upper airway may also be used.

Treatment

The primary treatment for Pickwickian syndrome is focused on weight loss and increased physical activity. Also, medroxyprogesterone may help improve the condition.

Prognosis

Pickwickian sydnrome is entirely reversible if it is diagnosed and treated properly. If the problem goes undiagnosed, the outcome can be fatal.

Prevention

Prevention of Pickwickian syndrome can be achieved by maintaining a healthy body weight and getting the proper amount of exercise. For prevention of the sleep apnea that generally accompanies Pickwickian syndrome, there are several possible treatments. If the sleep apnea is only present when the patient is flat on their back, a tennis ball can be sewn into the sleep clothes to remind the patient not to sleep on their back. For more severe cases of sleep apnea, a tonsillectomy or the use of dental appliances may be recommended.

BOOKS

Dambro, Mark R. The 5-Minute Clinical Consult. Baltimore: Williams & Wilkins, 2001.

Dictionary of Medical Syndromes. Philadelphia: Lippincott-Raven, 4th ed., 1997.

Tierney, Lawrence, et. al. Current Medical Diagnosis and Treatment. Los Altos: Lange Medical Publications, 2001.

PERIODICALS

"'Apples' and 'Pears': Defining the Shape of the Problem." FP Report 6 (November 2000).

Kushner, Robert F. and Roland L. Weinsier. "Evlauation of the Obese Patient." Medical Clinics of North America 84 (March 2000)

Kim Sharp, M.Ln.

KEY TERMS

Latency—The period of inactivity between the time a stimulus is provided and the time a response occurs.

Obesity—Exceeding one's normal weight by 20%. A person suffering from extreme obesity would exceed their normal weight by a much higher percentage.

Pulmonary system—Lungs and respiratory system of the body.