Use of obesity medications in a young pediatric patient with optic nerve hypoplasia and severe early-onset obesity: A case report.

Introduction: Pediatric obesity presents complex challenges in children with underlying endocrine disorders. In patients with optic nerve hypoplasia (ONH) and hypothalamic-pituitary dysfunction, lifestyle changes alone are often ineffective for obesity treatment. This case report describes targeted pharmacologic interventions for severe early-onset obesity in a child with ONH and multiple pituitary hormone deficiencies. Case presentation: A Hispanic female was diagnosed at 45 days of life with ONH and central arginine vasopressin deficiency, central hypothyroidism, secondary adrenal insufficiency, and growth hormone deficiency. Despite early interventions, her weight-for-length percentile rose from the 65th to >97th by nine months, with continued acceleration to body mass index (BMI) of 52 kg/m Discussion: This case highlights the potential role and therapeutic benefit of early, targeted pharmacologic intervention in managing severe obesity in pediatric patients with hypothalamic dysfunction and ONH. In a setting where lifestyle modifications alone are insufficient, the use of combination obesity medications resulted in substantial and sustained BMI reduction, alongside resolution of obesity-related comorbidities. These findings underscore the need for proactive, individualized treatment strategies in complex pediatric obesity.