29.03.2024

Endocrine obesity: causes, diagnosis and treatment

Obesity is a pathology which is characterized by the appearance of excess fat deposits in various tissues and organs, mainly in the subcutaneous tissue. Metabolic disorder leads to an increase in the weight of the patient by 20% or more relative to the average values, and it is due to fatty tissue.

According to statistical studies, in our country this disease is diagnosed in almost every fourth person of working age.

Cause endocrine obesity are various dysfunctions of the endocrine glands, accompanied by insufficient or excess synthesis of certain hormones.

Obesity greatly increases the risk of serious somatic diseases – atherosclerosis, hypertension, coronary heart disease, diabetes, kidney and liver failure. People with excess weight more often heart attacks and strokes. In addition, excess body fat take patients mental discomfort; often such people are prone to depression.

Hormonal causes of obesity

Identify the following endocrine forms of obesity:

  • pituitary;
  • thyrogenous;
  • sex;
  • pancreatogenic;
  • adrenal;
  • epiphyseal.

Regardless of the type of problem identified violations of the hypothalamic-pituitary system, which can be primary or secondary, i.e. appeared as a result of the pathological process.

In the fairer sex the risk of obesity is much higher.

Obesity develops as a result of the imbalance between nutritional intake of nutrients – sources of energy and the actual energy consumption of the body. Unused calories tend to be transformed into fat, deponeerimise in different areas of the body. Serious metabolic disorders the causes of obesity in only 5% of cases. 90% of patients simply overeat for different reasons.

To eating disorders often have failures on the part of the hypothalamic-pituitary system. With its hyperactive increased biosynthesis of adrenocorticotropic hormone and also increases the rate of production and metabolism of cortisol. This leads to a decrease in the secretion somatotropina responsible for lipolysis (utilization of fat). In the blood of the patient significantly increases the level of produced by the pancreas insulin is a metabolic thyroid hormones (thyroxine and triiodothyronine).

Factors that increase the risk of obesity:

  • overeating (including psychogenic);
  • an excess of “fast” carbohydrates in the diet;

Errors in diet involve not only a large total volume of food consumed, but also the abuse of “fast food”, pastries and sweets. Extra pounds a person can gain, overeating at night. Among the risk factors also include the consumption of alcoholic beverages (especially beer) and sweet sodas.

To increase the volume of adipose tissue endocrine cause such diseases as hyperadrenocorticism syndrome (Cushing’s), insulinoma (hormonally active tumor), hypogonadism (underactive sex glands) and hypothyroidism (decreased levels of thyroid stimulating hormones).

The cause of obesity in some cases is genetically determined decline in the activity of lipolytic enzymes and increased activity of enzymes responsible for lipogenesis (formation of fat).

Pancreatogenic endocrine obesity is caused by hypersecretion of the pancreatic hormone – insulin. At the background level (hyperinsulinemia) is significantly increased appetite that leads to overeating. The hormone slows down lipolysis and promotes the accumulation of fat in so-called depot.

Excessive body weight is often found in people with diabetes (2nd type), characterized by lack of insulin.

On the background of hypogonadism (dysfunction of sex glands), the nervous system is changing, causing changes in diencephalic apparatus. Often diagnosed ovarienne kind of pathology. It is caused by ovarian hypofunction and concomitant deficiency of female sex hormones – estrogens. Obesity is typical for adenomas of the epiphysis.

Classification, degree of obesity

According to the who classification of degrees of obesity are estimated according to body mass index. BMI = weight (kg)/height (m) squared.

Index <18,5 tells about underweight. The norm adopted numbers from 18.5 to 24.9. When BMI 25,0-29,9 talk about the extra weight (the normal).

The degree of obesity according to this index:

  • I – 30,0 – 34,9;
  • II – 35,0 – 39,9;
  • III – IV – 40.0 or higher.

If the BMI is above 30.0 is there is a clear threat to the health of the patient. It requires a comprehensive medical examination; the treatment of the pathologies and diseases that caused its development.

The I degree obesity is the body mass increase of no more than 29%. About II degree say, if the excess weight is in the range of 30-40%. When III degree mass increased by 50-99%. If the weight exceeds the norm by more than twice (i.e. 100% or more) – it is the IV degree.

There is a classification of obesity according to the preferential localization of excess sediments and lipid tissue.

It is customary to consider 3 types:

  • lower or femoral-gluteal;
  • the upper (abdominal, Android);
  • mixed (intermediate).

Bottom type of obesity is characterized by a predominance of fat deposition in the thighs and buttocks. Such obesity is more typical for women. It often develops venous insufficiency (varicose veins of the lower extremities), affected leg joints and intervertebral joints.

At the top type the excess fat localized in the abdominal area and chest. Android obesity is more typical for males. On the background of this pathology develops hypertension and diabetes and greatly increases the risk of life-threatening complications of the cardiovascular system, strokes and heart attacks.

Mixed obesity is a relatively uniform distribution of fat in different areas of the body.

Neuroendocrine obesity tends to progress. The body weight gradually increases, and the volume of deposits of lipid tissue increases. It is also possible stable course, in which certain weights do not change for a long time. The article also considers the residual phase, i.e. the residual after the adoption of measures to reduce weight (weight loss).

Symptoms

The leading clinical manifestation of the disease is excess weight. The patient’s appearance is characteristic changes can appear pseudogynecomastia, fatty “apron” on the abdomen and double chin.

On the background of obesity often develop hernias – inguinal and umbilical, due to the weakness of the muscles, combined with increased load on it.

When I and II degree patients may not show any complaints, in addition to the appearance of an aesthetic deficiency.

On the background of the III-IV affected respiratory, cardiovascular and digestive system.

As the progression of the disease appear the following symptoms:

Diagnosis

The diagnosis is based on measurement of weight and height with the index definition BMI.

In the course of gathering history from the patient figure out how to change its weight after 20 years and suffers from obesity if any of the next of kin. Specified lifestyle (including activity) and dietary habits.

At objective examination revealed a rapid heartbeat (tachycardia), high blood pressure (hypertension). Tones of heart muted. Determined by high standing of diaphragmatic dome, which is a consequence of the development of “pulmonary heart” and respiratory failure.

Due to excess weight high load on the lower limb provokes the appearance of arthritis of large joints – knee and ankle. Also suffer intervertebral articulation, which is manifested pain syndrome in different parts of the spine (often in the lumbar).

Excess fat is deposited in the liver, causing lipid infiltration. Patients with obesity frequently diagnosed comorbidities such as inflammation of the pancreas and gallbladder.

Amid hyperhidrosis appear acne (acne), develop pustular skin lesions (pyoderma), inflammation of hair follicles (furuncles and carbuncles), and eczema.

Rather typical manifestation of endocrine obesity are dry skin and stretch marks – pigmented “stretch” in the abdomen and hips.

In women endocrine obesity can cause menstrual disorders, until the absence of menstrual periods (amenorrhea), and hirsutism (excessive hair growth on the male type) and infertility. In men it may lower the potency, gynecomastia and signs of feminization.

In some cases, diagnosed specific form of obesity – lipomatosis. At growth of fat tissue lipomas are formed from numerous various locations. These growths are painless and are characterized by the symmetry of the arrangement.

To obtain accurate data on the volume and localization of adipose tissue makes use of hardware methods – an ultrasonic scanning and imaging. For the evaluation of bone densitometry is used.

Treatment of endocrine obesity

In endocrine obesity, the patients require the assistance of an endocrinologist, nutritionist, physical therapist and psychologist. In secondary lesions of the joints should consult astrology and orthopedist.

When treating any type of obesity, including endocrine plays an important role in the normalization of the diet and physical activity. Medication is necessary when BMI > 30 or the ineffectiveness of low-calorie diet combined with physical exercise.

To suppress hunger help pharmacological group of amphetamines, but their continued use of the building up a tolerance and drug dependence.

Currently one of the most effective tools against obesity is considered Subitramine; it speeds up satiety. Widely used also the Orlistatto reduce the absorption of lipids in the intestine.

Dysfunction of the endocrine glands additionally requires treatment of the underlying disease and carrying out hormone replacement therapy (HRT).

If diagnosed thyrogenous pathology, good effect helps to achieve directional receiving thyroxine.

Ovarienne endocrine obesity is an indication for the use of preparations of estrogen and progesterone or their synthetic analogues.

If conservative treatment fails to achieve a BMI below 40, surgical treatment is shown. One of the areas of bariatric surgery is to reduce the volume of the stomach; it is achieved through conducting gastroenterology or banding body. The excess fat removed during liposuction.

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