Drug-induced obesity

Introduction Obesity is a pathological condition in which the number of fat cells in the body is increased or the cell body weight is approximately 20% of the standard body weight. Patients with mental illness and certain diseases have long-term use of chloropropene, insulin, protein synthesis, and glucocorticoids. Drugs such as Shismin make the patient's appetite, eat more and become obese. Caused by side effects of drugs, such as caused by adrenocortical hormone drugs. Patients with allergic diseases, rheumatoid diseases, and asthma. All antipsychotics (AP) can cause varying degrees of weight gain.

Cause

The cause of drug-induced obesity:

Caused by side effects of drugs, such as caused by adrenocortical hormone drugs. Patients with allergic diseases, rheumatoid diseases, and asthma. All antipsychotics (AP) can cause varying degrees of weight gain. Allison (1999)'s meta-analysis of AP-induced weight gain suggests that clozapine and olanzapine are ranked first and second in APs that cause weight gain, followed by thioridazine, sulphur, and chloropropion. Oxazine, risperidone, haloperidol, fluphenazine. Ziprasidone has little effect on body weight, while acetophenone can reduce weight. According to statistics, about two-thirds of patients have significant weight gain after long-term use of AP, and gain weight over time.

an examination

Related inspection

Body mass index urinary follicle-stimulating hormone

Physical examination:

1. Measure the patient's height (m), weight (kg), body temperature, blood pressure, abdominal circumference and hip circumference. To understand whether the patient is obese or not, whether there is abnormal temperature regulation (hypothermia during hypothalamic syndrome) and elevated blood pressure.

2. Observe the body shape and fat distribution: in patients with simple obesity, male fat is distributed in the neck and head. The trunk is the main part; the female is mainly the abdomen, lower abdomen, chest breasts and buttocks. Secondary obesity varies with different diseases, such as heart-to-heart obesity, full moon face, buffalo back, multi-blood appearance, purple pattern. Acne is characteristic of hypercortisolism; females are obese and hairy. Amenorrhea infertility may be caused by polycystic ovary. Obesity, facial swelling, dry and rough skin, and unresponsiveness are characteristic of hypothyroidism. The extremities of the extremities are fat and the face is ugly and characterized by acromegaly.

3. Vision and visual field examination: hypothalamic and pituitary obesity, especially in this part of the tumor can cause visual impairment, hemianopia and so on. Detailed physical examination is the main clue for the diagnosis of the cause of secondary obesity.

Buy a laboratory check:

(1) Laboratory testing of hypothalamic and pituitary functions:

1. Hormone determination ACTH, FSH, LH, TSH, GH, PRL measurement, in order to understand the hypothalamic and pituitary function, the diagnosis of hypothalamic and pituitary obesity.

2. TRH, LH-RH excitation test:

(1) TRH stimulation test: Intravenous injection of TRH200~500 g in the morning, and TSH levels were measured before injection and at 15, 30, 60, and 90 min after injection. Serum TSH peaked in normal people 30 min after injection, reaching 10~30 g /L. There is no increase in TSH in hyperthyroidism (no response). The baseline value of serum TSH is increased in primary hypothyroidism. The TSH value is significantly increased after intravenous injection of TRH (significant excitability); secondary hypothyroidism such as lesions in the hypothalamus, TRH TSH was significantly increased after stimulation; if the lesion was in the pituitary gland after TRH stimulation, TS H did not increase. Pituitary tumor, Xihan syndrome, advanced acromegaly and other pituitary diseases caused insufficient secretion of TSH, serum TSH levels were low, and the response after TRH stimulation was poor, suggesting that the pituitary TSH reserve function was poor.

(2) LH-RN (LRH) stimulation test: differential hypogonadism is primary or secondary. At 8 o'clock in the morning, LRH 100 g was injected intravenously, and LH was taken before injection and at 15, 30, 60 min after injection; then, LRH 100 g was intravenously injected (or intramuscularly) every other day for 3 times, and the above test was repeated. In normal women, the peak of LH appeared 15 minutes after injection, which increased to more than 3 times of the baseline value, and the absolute value increased by 7.5 nmol/L or more, which was twice as low as that of females. In patients with low primary dysfunction, the LH base value is increased. The peak value of LH after injection of LRH is 4-5 times higher than the baseline value. (The reaction is obvious in humans with pituitary lesions. The LH base value is low. After LRH injection, the response is poor or no reaction. In the thalamus, the LH has a low baseline value and a normal or delayed response after injection of LRH (peak occurs 60 or 9 min after LRH injection).

(B) Determination of peripheral gland hormones:

1. Determination of thyroid hormone: TT3, TT4, FT3, FT4 were measured to understand thyroid function.

2. Determination of adrenocortical hormone: blood cortisol, 24h urine 17-hydroxysteroids and 17-ketosteroids, 24 h urinary free cortisol determination, the diagnosis of cortisol-induced obesity. In the early stage of hypercortisolism and simple obesity identified by the above-mentioned tests, a small dose of dexamethasone (2mg / d) inhibition test should be performed, the former is not inhibited.

3. Islet function test:

(1) Fasting and postprandial 2h blood glucose measurement: It is necessary to do oral glucose (75 g) tolerance test (OGTT) to help diagnose diabetes (DM) and impaired glucose tolerance (IGT).

(2) Determination of insulin and C peptide: it is helpful for the diagnosis of pancreatic obesity. In particular, the insulin release test can reflect the reserve function of islet B cells (in OGTT) while measuring plasma insulin concentration).

4. Determination of blood lipids.

5. Vertical position water test: shows that the patient has water retention when standing. After urinating in the morning on an empty stomach, the patient drank 1000 ml of water within 20 minutes, and then urinated once every hour for 4 hours to record the urine volume. On the first day, take the lying position (without the pillow), and take the standing position for the next day, such as the activity or the normal person's standing position, the drainage rate is 81.8+ 3.7% of the drinking water, and the urine output in the lying position is equal to the drinking water or even the drinking water. In the case of water retention obesity, the urine volume in the standing position is lower than the urine volume in the lying position by more than 50%.

Device inspection

(1) Examination of the diagnostic method for obesity:

Diagnosis based on height and weight: First, the standard weight is determined according to the age of the patient. If the actual weight of the patient exceeds 20% of the standard weight, it can be diagnosed as obesity. However, factors due to muscle development or water retention must be excluded.

(2) CT, MRI:

Diagnosis of hypothalamic, pituitary tumors, vacuolar sella, adrenal tumors, and insulinoma.

(3) B-mode ultrasound

It is helpful for the diagnosis of adrenal hyperplasia, tumor and islet cell tumor.

(D) 131I-19-Iodinated cholinol and computer program for adrenal scanning, for adrenal hyperplasia or tumor diagnosis.

Differential diagnosis

Identification of symptoms that are confusing for drug-induced obesity :

First, simple obesity:

1. Constitutional obesity:

Reason: Congenital. The metabolism of substances in the body is slow, and the rate of synthesis of matter is greater than the rate of decomposition.

Phenomenon: The fat cells are large and numerous, all over the body, and there is baby fat on the face.

2, acquired obesity:

Cause: Caused by excessive diet. Sweet food, greasy food, and fat are distributed in the torso.

Phenomenon: fat cells are large, but the number does not increase. Puffy physique, a pinch of meat, not tight.

Second, pathological obesity:

1, Cushing Syndrome:

Cause: Adrenal hyperfunction, excessive secretion of cortisol.

Phenomenon: The face, neck and body are hypertrophy, but the limbs are not fat.

2, pancreatic origin:

Cause: Excessive insulin secretion, decreased metabolic rate, decreased fat decomposition and increased synthesis.

Phenomenon: generalized obesity.

3, sexual function reduction:

Cause: Cerebral obesity, accompanied by loss of sexual function, or loss of libido.

Phenomenon: breast, lower abdomen, obesity near the genitals.

4, pituitary:

Cause: Pituitary lesions cause excessive growth hormone secretion in the anterior pituitary.

Phenomenon: whole body bones, soft tissue, visceral tissue hyperplasia and hypertrophy. The bones are large and the stomach muscles are prominent.

5, hypothyroidism

Cause: Hypothyroidism.

Phenomenon: obesity and mucinous edema. The legs are often prone to edema.

6, drug source:

Cause: Caused by side effects of the drug, such as caused by adrenocortical hormone drugs.

Phenomenon: Obesity that occurs after a period of medication, such as some patients with allergic diseases, rheumatoid diseases, and asthma.

7, subcutaneous obesity:

Features: Fat is mainly distributed in the subcutaneous tissue of the abdomen, buttocks and thighs.

8, visceral fat:

Characteristics: Fat is mainly distributed in the peritoneum in the abdominal cavity. There are a lot of meat on the waist and belly.

diagnosis

1. Ask the patient's eating habits and exercise: a rough calculation of the daily intake of calories, too much diet and too little activity is the main external cause of simple obesity.

2. Ask family history: Patients with simple obesity often have parental obesity. Their brethren and patients are also obese at first age. Family habits are more like sweets, more food and more times, and more snacks.

3. Understand personal birth history and physical development status, secondary sexual development and sexual function status. Simple obesity patients have no secondary sexual development disorder, sexual function is more normal, and secondary obesity patients have second. Sexual developmental disorders and sexual dysfunction. In addition, should ask about the past health conditions, with or without meningitis, encephalitis, craniocerebral trauma, history of cancer, because of secondary obesity have a clear cause, obesity is only one of its clinical manifestations, especially pay attention to the presence or absence of nerves History of mental illness, endocrine and metabolic diseases, such as hypothyroidism, hypercortisolism, giant disease and acromegaly, hirsutism, hypothalamic syndrome, and other history.

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