Simple upper body weight loss type

Introduction Simple weight loss includes constitutional wasting and exogenous wasting. Institutional wasting is mainly non-gradual weight loss and has certain heritability. Exogenous wasting is usually affected by various factors such as diet, lifestyle and psychology. Insufficient food intake, partial eclipse, anorexia, missing meals, irregular life and lack of exercise, eating habits and work stress, mental stress and excessive fatigue are the causes of exogenous wasting. Simple upper body weight loss is a manifestation of progressive lipodystrophy. Progressive lipodystrophy is a rare autonomic nervous system disorder characterized by adipose tissue metabolic disorders. The clinical and histological features are slowly progressive bilateral distribution with substantially symmetrical, well-defined, subcutaneous adipose tissue atrophy or Disappeared, sometimes combined with limited adipose tissue hyperplasia, hypertrophy.

Cause

(1) Causes of the disease

The cause is unknown. Due to damage to the midbrain and the diencephalon, the anterior pituitary hormone secretion is increased or the mesodermal interstitial function is disordered. Sissons found that some patients had glomerulonephritis and low complement (C3)emia. A small number of patients have a family history.

(two) pathogenesis

Mainly associated with hypothalamic lesions and post-ganglionic sympathetic neuropathy in parallel with the spinal nerve. The hypothalamus plays a regulatory role in gonadotropins, thyroid stimulating hormones and other endocrine glands, and is closely related to the post-ganglionic sympathetic nerve fibers. There seems to be a boundary between the disappearance zone of adipose tissue of the progressive lipodystrophy and the normal zone or the obese zone. This boundary has a certain relationship with the segment of the spinal cord. Usually, the body is divided into the upper body and the lower body with the waist 1 to 2 as the boundary. Two parts.

Another study suggests that the hypothalamic and pituitary constitute a metabolic regulation control system, and fat loss is related to the promotion of fat transfer factors produced by the system. Before the onset, there may be a history of acute fever and endocrine defects, such as hyperthyroidism, hypopituitarism and encephalitis. Injury, mental factors, early menstruation and pregnancy may all be incentives. At present, the view on the role of genetic factors has not been unified. .

an examination

Related inspection

Electromyography thyroid-binding globulin (TBG)

Progressive lipodystrophy is a rare autonomic nervous system disorder characterized by adipose tissue metabolic disorders. The clinical and histological features are slowly progressive bilateral distribution with substantially symmetrical, well-defined, subcutaneous adipose tissue atrophy or Disappeared, sometimes combined with limited adipose tissue hyperplasia, hypertrophy.

Because of the range of fat atrophy, it can be divided into localized lipodystrophy (Simons disease or head and chest fat malnutrition) and systemic lipodystrophy (Seip-Laurence syndrome).

1. Most patients start from 5 to 10 years old, women are more common, and the onset and progress are slower. At the beginning of the disease, the facial tissue or upper extremity adipose tissue disappeared, and then expanded downward, involving the buttocks and thighs, showing a roughly symmetrical distribution. The course of the disease lasts for 2 to 6 years and can be stopped by itself. The patient's facial expression is concave on both sides of the cheeks and ankles, the skin is slack, and the normal elasticity is lost. The disappearance of fat around the cheeks and eyelids gives the patient a special face. Some patients may have obvious subcutaneous tissue hyperplasia and hypertrophy in the buttocks and hips, but the hands and feet are often unaffected.

2. The patient can express the disappearance of adipose tissue, special obesity and normal adipose tissue, and combine the basic characteristics of cost disease in different ways. According to different combinations, it can be expressed as the following types: 1 upper body is normal, lower body is obese. 2 The upper body is thin and the lower body is obese. 3 simple upper body weight loss type. 4 upper body obese. 5 lower body is thin. 6 body weight loss type. 7 half-length obese.

3. Patients may have autonomic dysfunction such as skin moisture change, sweating abnormality, polyuria, impaired glucose tolerance, tachycardia, unstable vascular movement, vascular headache, abdominal pain, vomiting, skin and nail nutritional disorders, etc. Cases may be associated with endocrine dysfunction, such as genital dysplasia, thyroid dysfunction, acromegaly, and menstrual disorders. Symptoms tend to be stable within 5 to 10 years after onset.

4. The patient's muscles, bones, hair, breast and sweat glands are normal, no muscle disorders, most of the patients' physical strength is not affected, and the physical and mental development during the course of the disease is not affected. Recently reported that Hodgkin's disease and scleroderma can be complicated.

5. Neonatal or infant patients have congenital systemic and multiple organ lesions, in addition to the body, subcutaneous and visceral fat tissue involving the head, face, neck, trunk and limbs, may also be associated with high Blood lipids, diabetes, hepatosplenomegaly, skin pigmentation, heart and muscle hypertrophy.

According to the disappearance of subcutaneous adipose tissue, normal muscle and bone, disappearance of adipose tissue in living tissue examination, and the disappearance, increase and normalization of subcutaneous fat can be confirmed by combining in different ways.

Differential diagnosis

The disease should be distinguished from the following diseases:

1. Facial lateral atrophy: progressive atrophy of one side of the face, skin, subcutaneous tissue and bone are all involved.

2. Localized muscular dystrophy: such as face-shoulder-sputum type, manifested as facial muscle wasting with weak muscle strength, EMG suggests muscle damage, subcutaneous fat remains.

3. Excessive weight loss: Most cases of excessive weight loss caused by various causes can detect the cause, such as malignant tumors, chronic infections and long-term gastrointestinal dysfunction.

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