Secondary obesity

Introduction Secondary obesity refers to obese people who also have another disease, called primary disease, and obesity is caused by this primary disease. Continuing obesity is pathological obesity. It is caused by abnormal endocrine metabolism, and most of the obese people have a special posture, and the symptoms are more obvious than simple obesity. Endocrine diseases that cause secondary obesity in adults are mainly hypercortisolism and hypothyroidism. In children, secondary obesity is mainly caused by hypothalamic diseases, such as the growth of tumors in the thalamus.

Cause

The main reasons are:

(1) Neuroendocrine obesity, a type of obesity caused by neuro-endocrine diseases, which is actually the result of endocrine diseases. Endocrine diseases that cause secondary obesity in adults are mainly hypercortisolism and hypothyroidism. In children, secondary obesity is mainly caused by hypothalamic diseases, such as the tumor in the thalamus, and so on. There is a disease called insulinoma. The patient has a tumor in the pancreas and secretly secretes insulin. This type of patient is often in a state of hypoglycemia, and has to eat frequently and in large quantities, which can also cause obesity. Some early diabetic patients have the same situation. They have hyperinsulinemia in their bodies. They always feel hungry and have to eat more and cause obesity. These are all neuroendocrine obesity.

(2) Genetic syndrome with obesity: Some clinical manifestations are often accompanied by simultaneous occurrence, and the cause is unknown. This condition is usually referred to as a certain syndrome. Some syndromes are often obese, such as muscle tone mental retardation - sexual dysfunction - obesity syndrome (Prader - Willi syndrome) and retinitis pigmentosa - sexual dysfunction - polymorphism syndrome (Laurence-Moon-Biedl syndrome) Patients are often accompanied by obesity. In addition to obesity, these genetic syndromes are accompanied by other abnormalities such as stunting, sexual dysfunction, limb malformation, and mental retardation.

(3) Iatrogenic obesity: Some patients have neither the primary disease causing obesity nor simple obesity. Their obesity is caused by taking certain drugs. Generally, this type of obesity is called iatrogenic obesity. Drugs that cause iatrogenic obesity include glucocorticoids (prednisone or dexamethasone, etc.), phenothiazines, tricyclic antidepressants, and insulin. In addition, if the brain surgery affects the hypothalamus, it can also cause obesity. Because the cause of iatrogenic obesity is clear, some people also attribute iatrogenic obesity to secondary obesity.

an examination

Related inspection

Endocrine function test brain CT examination

Obesity is only one of the important symptoms of this type of patients, and there are other various clinical manifestations, which are manifested in:

a, hypercortisolism.

b, hypothyroidism.

c, islet beta cell tumor.

d, hypogonadism.

e, polycystic ovary syndrome.

f, intracranial plate hyperplasia and other diseases.

Differential diagnosis

(1) Simple obesity: Obesity is the main manifestation in the clinic. There is no obvious changes in the morphology and function of the nervous and endocrine systems, but it is accompanied by disorders in the regulation of fat and glucose metabolism. This type of obesity is the most common.

1. Constitutional obesity: It is caused by hypertrophy of fat cells and is related to overnutrition before the age of 25. Mostly have a familial genetic history. Overweight children are often overweight adults. According to reports, among those who were overweight at the age of 0 to 13, 42% of women and 18% of men became obese at the age of 31. In the 30th week of the fetus period and 1 year and a half after birth, the fat cells have an extremely active proliferative phase, called the "sensitive period." In this period, if the nutrition is excessive, it can lead to an increase in fat cells. Therefore, it is very important to maintain normal weight during childhood, especially within 10 years of age.

2, nutritional obesity: also known as acquired (exogenous) obesity, mostly due to over-nutrition after 20 to 25 years old, intake of calories exceeds the body's various metabolic activities, or due to too little physical activity or for some reason Need to stay in bed for a longer period of time, less calorie consumption and cause obesity. This type of obesity is mainly caused by fat cell hypertrophy and fat cell proliferation. Physical obesity can also regain acquired obesity and become a mixed type.

The above two types of obesity are collectively referred to as simple obesity, especially in women aged 20 to 30 in urban areas. After middle age, men and women also have a tendency to spontaneous obesity, and menopausal women are more likely to occur.

(B), water, sodium retention obesity: also known as idiopathic edema. This type of obesity is more common in reproductive and menopausal women. Its occurrence may be related to increased capillary permeability, increased aldosterone secretion and slowing of venous return due to increased estrogen. The fat is unevenly distributed, mainly in the calf, thigh, hip, abdomen and breast. The weight gain is rapid, and it is closely related to the body position. The tiredness and standing weight increase, and the rest and lying down are relieved. In the morning and evening, the normal weight change is 0.4 kg, and the patient's weight changes in the morning and evening are more than 1 kg. The edema of the disease is often cyclical, morning face, eyelid edema, activity after getting up, lower limbs, trunk gradually edema, weight before dinner increased by 1.2 ~ 4.5 kg before breakfast, an average of 2.4 ± 0.7 kg. The vertical position water test showed that the patient had water and sodium retention.

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