female obesity

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction According to the statistics of the incidence of obesity among domestic scholars and experts over 20 years old, the total number of obese people is 21.7%, of which 46.1% are men and 53.9% are women. In the general population, the number of obese women is significantly higher than that of men.

Cause

Cause

There are several reasons why women are more obese than men:

1. More fat cells than men. Relatively speaking, women are more likely to be fat than men.

2. Estrogen is related to the anabolism of fat. Women who are maternal and long-term oral female contraceptives are more likely to gain weight, mainly due to elevated estrogen levels, which promotes increased fat synthesis.

3. Women's activity is generally less than that of men, with less calorie consumption and increased fat accumulation, which is prone to obesity.

4. Women basically have a process of pregnancy and childbirth. The traditional eating habit is to make up for and supplement the food for the health of the fetus. This can easily lead to overnutrition. Pregnant women can not exercise too much and participate in physical exercise, so that energy accumulates and translates into Fat is accumulated in the body, so the pregnancy process is also an important factor leading to female obesity.

5. The proportion of obesity among middle-aged and older women is significantly higher than that of males. It is because with the increase of age, female hormones gradually decrease, appetite begins to increase, and concerns about whether the body is slim or not are also less. The thicker, the result goes into the ranks of obesity.

Examine

an examination

Related inspection

Sex hormones six tests triglyceride growth hormone renal function test body mass index

First, the characteristics of obesity in all stages of women

Women's growth and development have their own laws, and obesity formed by the accumulation of female fat also has its own characteristics.

Adolescent obesity

Adolescence is a stage in which female reproductive system development tends to mature. From the perspective of menstruation as an indicator of ovarian function, adult obesity is associated with menstrual abnormalities, while adolescents with high obesity have an early stage. The amount of body fat is closely related to menarche, and there must be a certain amount of body fat in the menarche period. Some scholars have conducted a survey of 24,115 middle school students and high school students, and found that the body fat of 9-15 years old, the body fat accounted for 21% to 24% of body weight; on the contrary, the future menstruation of people over 12 years old, the body fat is lower than the tide .

Adolescent women are very afraid of being fat and eager to have a slim figure. From the point of view of obesity, some are only overweight, they are very shy, artificially dieting and controlling weight gain. Once the normal weight gain is wrong, it is considered obesity to carry out unnecessary weight loss, which will not only lead to excessive weight loss, but also delay in menarche, weight loss without menstruation or anorexia nervosa, and some people also cause uterine development. Bad, one of the reasons for the formation of future infertility. Therefore, for adolescent obesity, in the absence of abnormal ovarian function, it should be guided to control it to no longer increase the degree of obesity, blindly to lose weight more harm than good.

2. Adult obesity

Almost the majority of women in adulthood are obese due to pregnancy. Pregnancy itself has a tendency to accumulate fat and obesity, and it has the greatest relationship with obesity. Obesity in women during lactation and lactation is mainly related to eating a high-fat diet, and is also associated with a long period of confinement. If the economic conditions are not good or general, the obesity of this period will return to normal with the recovery of breastfeeding and labor; and the economic conditions will improve, and the unreasonable diet structure will make more women obese.

(1) the danger of obesity during pregnancy

1 Increased risk of pregnancy toxemia. Some people have analyzed 50 patients with toxemia in pregnancy and found that their average weight during the first trimester was 61.8 kg, which was higher than that of normal pregnant women (58.5 kg).

2 causes the occurrence of pregnancy-induced hypertension.

3 Pregnant women have increased chances of miscarriage, dystocia, and cesarean section. For example, the normal pregnancy abortion rate was 2.1%, while the obesity pregnancy abortion rate was 8.1%.

4 infant mortality increased. Obesity has a great impact on the fetus. According to statistics, if the weight gain is 7.5-9.1 kg in the 20th to 30th week of pregnancy, the fetal mortality rate can be doubled. If the body weight is increased above 9.1 kg, the fetal mortality rate can be increased by 3 times.

5 complications increased during pregnancy and childbirth. In addition, obese women are prone to linear atrophy, wrinkles and rough skin. Excessive obesity also often makes couples alienated and cold.

(2) How to avoid getting fat during pregnancy

Many people think that eating well during pregnancy and being nutritious can ensure the normal development of the fetus and produce healthy, lively and intelligent fat dolls in the future. Therefore, a large number of foods, such as eggs, sugars, fats, etc., and the amount of activity during pregnancy are greatly reduced, so it is very easy to be obese. Because pregnancy obesity has many side effects, women should try to avoid obesity after pregnancy. The main methods are as follows.

1 measure your weight at the right time. Under normal circumstances, the first three months of pregnancy, monthly weight gain o.75 - 1. 5kg, 3-7 months monthly weight gain of 1 - 1.2kg, the normal weight increase of about 12kg in normal months. If you exceed this indicator, try to control your weight.

2 Control the intake of fat and sugar foods. Avoid high-calorie foods during pregnancy, instead of high-fat foods with lean meat, fish, eggs, fruits, and vegetables, so that pregnant women can take protein, vitamins, and minerals from these foods, paying particular attention to calcium. Supplement.

3 appropriate exercise. Appropriate exercise is especially important for pregnant women and an important means of preventing obesity in pregnancy. It is important to note that it is not advisable to exercise vigorously during pregnancy to prevent miscarriage.

3. Menopausal obesity

As the activity decreases with age, the body's energy consumption will also decrease; eating habits such as eating sweets will easily lead to overnutrition; ovarian dysfunction, changes in hormone metabolism, resulting in changes in fat metabolism, and the formation of hypertension. Under the combined effect of the above factors, almost all menopausal and menopausal women have varying degrees of obesity. Obesity, which continues to develop from menopause, accounts for the vast majority, and after entering menopause, obesity accounts for about 8% of female obesity. The increase of age has a great impact on obesity. Obese middle-aged and elderly women are often prone to movement disorders, joint lesions and low back pain. Limited exercise, reduced calorie consumption, and some of them become highly obese, resulting in fatty liver, hypertension and so on. There are also a small number of women with breast and uterine body cancer. Although many women often want to lose weight because of the social environment, this period of women's weight loss is often not as good as young people, step by step to lose weight for menopause. And menopausal women's weight loss is beneficial.

Second, postpartum obesity

China's tradition pays special attention to "confinement", and believes that women should eat a lot of supplements before and after childbirth, resulting in excessive intake of calories. In addition, after the postpartum does not strengthen the exercise, the abdominal muscles will relax, so that the fat is deposited too much in the abdomen, affecting the beauty of the body.

Diagnosis

Differential diagnosis

First, simple obesity

(1) Constitutional obesity (young onset obesity)

From childhood obesity to adulthood, there is a family history of obesity, good appetite, uniform distribution of body fat, hypertrophy of fat cells, poor diet and enhanced exercise, and less sensitive to insulin. No obesity can be found.

(2) Acquired obesity

(Adult onset obesity) more than 20 to 25 years old, due to overnutrition, decreased activity and genetic factors, obesity, fat cell hypertrophy without hyperplasia, diet control and exercise weight loss better, weight loss after insulin Sensitivity can be restored.

Second, secondary obesity

(a) hypothalamic obesity

Hypothalamic syndrome

A variety of causes involve diseases caused by the hypothalamus.

(1) Cause:

1 tumors are the most common, and there are 53 cases of tumors in 70 cases in China, including the most common craniopharyngioma (25 cases), followed by pineal tumors (11 cases), thalamic tumors in 6 cases, and third ventricle tumors 4 There were 2 cases of ependymoma, 1 case of olfactory meningioma, gray nodule tumor, ectopic pineal tumor, saddle tumor and astrocytoma. There are reports of leukemia, metastatic cancer, hemangioma, adenoma, hamartoma, teratoma, plasmacytoma neurofibroma, ganglion cell, medulloblastoma, and sarcoma. Malignant hemangioendothelioma and the like.

2 infection and inflammation: tuberculous or purulent meningitis, viral encephalitis, epidemic encephalitis, meningitis, smallpox, measles, chickenpox, rabies vaccination, histoplasmosis, etc., 70 cases in China 6 cases of inflammation;

3 brain trauma, surgery and radiation therapy.

4 vascular lesions such as cerebral arteriosclerosis, cerebral hemangioma, systemic lupus erythematosus and other causes of vasculitis;

5 granuloma and degeneration become tuberculoma. Sarcoidosis, reticuloendotheliosis, eosinophilic granuloma. Chronic multiple xanthoma, nodular sclerosis, brain softening and gliosis.

6 acute interstitial hemoptysis, carbon dioxide anesthesia, oral contraceptives, chloropropionate reserpine caused by galactorrhea amenorrhea syndrome.

7 Mental trauma, functional disorders caused by environmental changes, etc.

(2) Clinical manifestations: Due to the small size and complex function of the hypothalamus, lesions often damage multiple nuclear groups and involve multiple physiological regulatory centers, which are characterized by complex clinical syndromes:

1 more food and obesity, due to lesions involving the hypothalamic ventromedial nucleus or nodules near, often accompanied by genital dysplasia (called obesity reproductive incompetent malnutrition, that is, frohlich syndrome, most people show drowsiness, even episodes of sleepiness Symptoms (Kleine-tevlll syndrome in patients with uncontrollable narcolepsy, can last for hours to days, wake up after overeating and obesity.

2 endocrine dysfunction, due to one or several hypothalamic release hormone or anterior pituitary hormone secretion disorder caused by hypersecretion or decline, such as sexual precocity or sexual dysfunction, female amenorrhea, male obesity, reproductive incompetence, sexual dysplasia and Olfactory loss syndrome; galactorrhea amenorrhea, hypercortisolism, hypothyroidism, acromegaly, giant disease, diabetes insipidus.

3 fever or hypothermia.

4 mental disorders such as crying and laughing, disorientation, hallucinations and paralysis.

5 hypothalamic epilepsy, headache, sweating or sweating, hand and foot hair group, sphincter dysfunction, vision loss, visual field 'deficiency and hemianopia, blood pressure fluctuations (suddenly high and low dilated pupil dilated. .

Diagnose based on

1 In the history of the disease, there are more food, fat sleepiness, a variety of endocrine dysfunction, abnormal temperature regulation, abnormal secretion of sweat.

2 skull CT, MRIJ line film, cerebral angiography and other examinations to show the location and nature of intracranial lesions.

3 Pituitary anterior hormone determination.

4 adrenal function, thyroid function, gonadal function test.

5 islet function check.

6 patients with hypothalamic-pituitary dysfunction may also consider 'IRH. LRH excitement test.

7 cerebrospinal fluid examination to observe intracranial pressure and white blood cells (white blood cells rise when inflammation

8 EEG.

(two) pituitary obesity

Cavitation Sella Syndrome

Patients with intracavitary or parasagittal tumors who have undergone radiation therapy or surgery are secondary vacuolar sella syndrome, and those who are caused by non-surgical or radiotherapy are primary vacuolar sella syndrome. The cause is unknown. Most of the arachnoid adhesions in the sellar region are caused by local adhesions (about 50% of the local adhesions in the saddle area, causing poor drainage of the cerebrospinal fluid, and the impact of the normal pulsating cerebrospinal fluid pressure on the saddle, causing it to sag, thin, open (defect), The subarachnoid space and the anterior lower part of the third ventricle can be smashed into the saddle, causing the sella to enlarge, and the pituitary is compressed to produce a series of clinical manifestations. Multiple pregnancies, the pituitary is physiologically hypertrophic during pregnancy (can increase more than one person) After the second pregnancy, the pituitary enlargement causes the saddle septum and the pituitary fossa to be large. After the delivery, the pituitary gland gradually retracts, leaving a large space for the saddle septum and the pituitary fossa. The subarachnoid space is in the saddle, causing pituitary damage. Cysts of pituitary tumors or craniopharyngioma, cystic rupture and subarachnoid traffic caused by vacuolar saddles, or spontaneous degeneration and necrosis of pituitary tumors can also cause vacuolar saddles * Beds are more common in women, often have headaches, Increased intracranial pressure, vision loss and visual field defects with fat, Patients can be mild gonads and hypothyroidism, but the function of the posterior pituitary is normal. Diagnosis basis: Skull X-ray film shows that the saddle enlargement is spherical or oval, and the saddle bone can be absorbed; the skull CT can display The pituitary fossa is enlarged, the pituitary gland is atrophied, and the fossa is filled with low-density brain effusion; MRI can show that the pituitary tissue is compressed and flattened, closely attached to the saddle bottom, and the saddle is filled with water-like signal material.

2. Pituitary growth hormone cell adenoma or hyperplasia

Excessive secretion of growth hormone (GH), causing hypertrophy of the soft tissues, bones and internal organs of the body with endocrine and metabolic disorders, clinically rough face, hand and foot hypertrophy, thick skin, headache dizziness, enlargement of the saddle. The pre-pubertal onset is a giant disease. The post-pubertal onset is a rubbery hypertrophy. The pre-puberty onset is persistent and unhealed until puberty is characterized by acromegaly. The weight gain of this disease is not fat.

3. Pituitary adrenocorticotropic hormone (ACTH) cell adenoma

Most of them are microadenomas and adenomas secrete excessive ACTH, which promotes bilateral adrenal hyperplasia. Excessive secretion of cortisol leads to disorder of fat, protein and glucose metabolism, and clinical manifestation to cardiac obesity. Full moon face, buffalo back, thin skin, purple lines, hemorrhoids, high blood pressure. A group of semen patients, osteoporosis, etc.

4. Pituitary prolactinoma

It is more common in pituitary tumors, mostly female, and hyperprolactinemia is caused by excessive secretion of prolactin (PRL) from adenomas. Clinical manifestations of galactorrhea, menstrual disorders or amenorrhea, infertility, obesity, edema, vision loss, etc.; male patients are rare, showing impotence, headache, vision loss or visual field defects. Diagnosis basis; 1 history; 2PRL determination generally lasts more than 4.55 nmol/L normal women 0.046~1.14nmol/L, male 0.046-0.97 0.97nmol/L, such as PRL>0.046~1.14nmol/L is helpful for the diagnosis of this disease; Excitatory test: after intravenous injection of TRHO.5mg or oral metoclopramide (metaclopramide) 10mg, perphenazine 8mg, chlorpromide 25mg, the peak of PRL reaction is < 2 times the base value; 4 skull X Line filming, CT, MRI can help diagnose.

Cause

(1) bilateral adrenal hyperplasia (Cushing's disease): people account for about 70% of the total number of diseases. Due to pituitary ACTH cell tumor or hypothalamic-pituitary dysfunction, excessive secretion of ACTH, stimulate bilateral adrenal hyperplasia and secretion of cortical excess.

(2) Adrenal adenoma or cancer secrete a large amount of cortisol, its secretion function is mostly autonomic, and is not regulated by pituitary ACTH. A large amount of cortisol secreted by the tumor inhibits the release of ACTH, resulting in atrophy of the ipsilateral or contralateral adrenal cortex outside the tumor tissue.

2. Clinical manifestations

A large amount of cortisol causes disorders of fat, protein, glucose metabolism and various organ dysfunction. The main performance is more bloody face, full moon face, buffalo back, centripetal obesity. Purple skin, acne, hairy, high blood pressure, diabetes, osteoporosis, etc.

3. Diagnosis basis

(1) Clinical manifestations: Typical clinical manifestations are often known, but the early stages of the disease are often atypical and require laboratory tests.

(2) Laboratory inspection:

124 h urinary 17-hydroxycorticosteroid (17-hydroxyl, corticosteroid (17-OH CS)>55.2 mol/24 h, >69mol/24h, the diagnosis is more significant (normal male 13.8~41.9mol/24h ie 5~ 15 mg female 11 ~ 27.6mol / 24h 24 h urine 17-ketone corticosteroids (17-ketone, 17 times) > 69.4 mol / 24h, if the daily increase of 20mg, often suggest cancer.

224h urinary free cortisol>3036nmol/24h, normal value 28~276nmol/24 (10~100mg/24h).

3 The average age of plasma cortisol in normal adults was 442±276 (16±g/dl) at 8 o'clock, and the mean value at 4:00 pm was 221±166 nmol/L (8±6 g/dl), which was the lowest at midnight. In the morning, the plasma concentration increased, no significant decrease at midnight, and the circadian rhythm disappeared.

4 low-dose dexamethasone inhibition test (2mg / d) is not inhibited, simple obesity can be inhibited.

5 midnight single-dose dexamethasone suppression test: dexamethasone lmg was taken at 23:30 in the evening, plasma cortisol was measured at 8 am after the service, and plasma cortisol was inhibited to normal in normal and simple obesity. More than 50%, and the person with this disease is not inhibited.

6 Plasma ACTH measurement in normal people at 8 o'clock in the early morning, the mean value of 1.1-11pmol / (5 ~ 50 pg / mL), pituitary tumor or hypothalamic pituitary dysfunction caused by adrenal hyperplasia plasma ACTH concentration increased slightly, adrenal cortical tumors Then decreased, the ectopic ACTH syndrome was significantly increased.

(3) Device examination: B-mode ultrasound, X-ray film, CT, MRI, adrenal scanning, etc. are helpful for the diagnosis of Cushing's syndrome.

(4) Islet disease obesity

Insulinoma

Also known as islet B cell tumor, due to the secretion of a large amount of insulin caused by repeated hypoglycemia episodes, due to polyphagia and obesity. Hypoglycemia is more frequent than morning fasting or after exercise. The blood sugar at the time of onset is <2.76mmol/L, which is quickly relieved after sugar supply. The diagnosis is based on the fourth section of this chapter, "hypoglycemia."

Type 2 diabetes (NIDDM)

Obesity is an early symptom of diabetes. Hypertrophic fat cells are not sensitive to insulin, and patients with fasting and postprandial insulin levels increase, up to 30 min / L on fasting, up to 200 ~ 300 Mu / L, resulting in more food and obesity. Fasting blood glucose can be normal, postprandial blood glucose is often 11.1mmol / L (200mg / dl), tolerance or clinical diabetes. Diagnosis: Diabetes: blood glucose 11.1mmol/L at any time and fasting blood glucose 7.8mmol/L or 2h postprandial blood glucose) 11.1mmol/L, or 75g glucose tolerance test (OGTT): fasting blood glucose 7.8 mmol/L 2 h 11.1 mmol/L/glucose tolerance: 2 h after meal, blood glucose>7.8~<11.1 mmol/L.

3. Functional spontaneous hypoglycemia

Often obese due to eating more, more common in middle-aged women. The diagnosis is based on the section on hypoglycemia.

(5) Hypothyroidism obesity

Due to the reduced metabolic rate, the calorie expenditure is reduced, and some are accompanied by obesity. The weight gain of most patients is caused by hydrolytic edema. The existing face of the table is swollen, pale skin, dry and rough skin, cold, loss of appetite, constipation, slow heart rate, slow response. Diagnose based on:

1 The history of primary hypothyroidism is often caused by chronic lymphocytic thyroiditis, may have a history of goiter. Some patients have a history of thyroid surgery or a history of radiation therapy.

2 signs support hypothyroidism.

3 serum T3, T4 increased, thyroid gland 131I second rate increased, and most peaks moved forward, FT3, FT4 increased slightly.

(6) hypogonadal obesity

Polycystic ovary syndrome

May have obesity, hairy, irregular menstruation or amenorrhea, infertility, basal body temperature in a single phase, long-term non-ovulation. The bilateral ovaries increase. Feasible B-mode ultrasound, local CT, laparoscopic diagnosis. Plasma LH levels were increased, hH levels were lower, and LH/ThH ratios were >3.

2. Postmenopausal obesity

Due to the decline of ovarian function, estrogen levels are lowered, and the feedback inhibition of hypothalamus and pituitary is weakened, resulting in mental and autonomic dysfunction, eating more and obesity, and accompanied by abnormal fat metabolism.

3. Men have no testis or dysplasia

Hypogonadism is often accompanied by obesity. Obesity often occurs after removal of the gonads by the gonads or radiation. Autonomic dysfunction caused by loss of gonadal function is the basis of obesity. Because it is accompanied by gonads, it is easier to identify.

(7) Others

Sodium hydrate retention obesity

It is a syndrome of idiopathic edema with simple obesity. Occurs in middle-aged women, edema, activity, standing position and pre-menstrual aggravation, rest, supine, early morning and menstrual period after the reduction, morning and evening weight difference of 1 ~ 1.5kg (normal average of 0.5 kg). Weight gains rapidly, often with less menstruation or amenorrhea, thirst and less urine. Easy to have emotional instability, lethargy, headache, facial and extremity vasomotor dysfunction, orthostatic hypotension. The vertical position water test showed significant water and sodium retention to aid diagnosis.

2. Painful obesity

More common in postmenopausal women, the pain threshold is reduced. It is characterized by obesity, painful subcutaneous fat nodules, more common in the neck, and the nodules can last for many years. Patients often have early arrest and premature aging.

3. Prader-Willi syndrome

Also known as the three low obesity syndrome, mainly manifested in obesity with low muscle tone, mental retardation, hypogonadism. From infancy to early childhood, there is obvious polyphagia, short stature, and the body and thigh are fat and short and fat. Respiratory function due to high obesity. After puberty, there is often impaired glucose tolerance or diabetes. Diagnostic basis: In addition to medical history and clinical manifestations, biopsy of low-tension muscles showed myogenic or neurogenic atrophy.

4. Skull internal plate hyperplasia (Morgagni-Stewart-Morel syndrome)

The disease is rare, almost all women, more common after menopause. About half of the patients have obesity, mainly on the trunk and proximal extremities, often accompanied by severe headache, mental disorders, hairy, less menstruation or amenorrhea. Reduced basal metabolic rate and disorders of glucose metabolism. The skull X-ray film shows the frontal bone and other intracranial plate hyperplasia.

5. Sexual naive retinitis pigmentosa syndrome (Laurence-Moom-Biedl syndrome)

This disease is rare and common among male members of the same family. Mainly manifested as obesity, multi-finger (toe) deformity, pigmented retinal degeneration, short stature, curly hair, long eyebrows and long eyelashes, poor genital development, mental retardation and so on.

(8) Drug-induced obesity

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.

First, medical history

1. Ask the patient's eating habits and exercise situation to roughly calculate the daily calorie intake, too much diet and too little activity is the main external cause of simple obesity.

2. Ask family history Simple obesity patients often have parental obesity. Their brethren and patients themselves are also obese at first age. Family habits are more like sweets, more food intake and frequency, 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.

Second, 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, and whether there is abnormal temperature regulation (hypotial dysregulation during hypothalamic syndrome) And blood pressure is elevated.

2. Observe the body shape and fat distribution. In simple obesity patients, 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

Hypothalamus and pituitary obesity, especially in this part of the tumor, can cause visual impairment, hemianopia, and the like. Detailed physical examination is the main clue for the diagnosis of the cause of secondary obesity.

Third, buy a laboratory inspection

(1) Laboratory testing of hypothalamic and pituitary functions

Hormone determination

ACTH, FSH, LH, TSH, GH, PRL measurement to understand the hypothalamic and pituitary functions, 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 LRH injection (peak occurs 60 or 9 min after LRH injection)

(B) Determination of peripheral gland hormones

1. Thyroid hormone determination TT3, TT4, FT3, FT4 determination 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%.

Fourth, equipment inspection

(1) Inspection of obesity diagnosis methods

1. Diagnosis according to height and weight: firstly find the standard weight according to the patient's age (see the body standard weight scale), or calculate the following formula: standard weight (?) = "height (cm) -100" x 0.9, such as the actual patient An overweight of 20% of the standard weight can be diagnosed as obesity. However, factors due to muscle development or water retention must be excluded.

2. Skin wrinkle calipers measure subcutaneous fat thickness: 25-year-old normal shoulder swelling subcutaneous fat thickness averaged 12.4?, more than 14? for obesity; deltoid muscle sebum thickness male average price. 4mm, female 17.5? (normal person 25 years old value)

3. X-ray soft tissue filming calculation of skin fat thickness, ultrasonic reflection imaging method to estimate subcutaneous fat thickness and other methods (standard with caliper method)

4. Calculate body weight (kg) / body 2 (?) > 24 according to body mass index. World Health Organization standards: men > 27, women > 25 for obesity.

(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-Iodocholinol and computer program for adrenal scanning

Helps with adrenal hyperplasia or tumor diagnosis

First, the characteristics of obesity in all stages of women

Women's growth and development have their own laws, and obesity formed by the accumulation of female fat also has its own characteristics.

Adolescent obesity

2. Adult obesity

(1) the danger of obesity during pregnancy

2 causes the occurrence of pregnancy-induced hypertension.

3 Pregnant women have increased chances of miscarriage, dystocia, and cesarean section. For example, the normal pregnancy abortion rate was 2.1%, while the obesity pregnancy abortion rate was 8.1%.

(2) How to avoid getting fat during pregnancy

2 appropriate exercise. Appropriate exercise is especially important for pregnant women and an important means of preventing obesity in pregnancy. It is important to note that it is not advisable to exercise vigorously during pregnancy to prevent miscarriage.

3. Menopausal obesity

Second, postpartum obesity

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Gynecology

female obesity

Introduction

Cause

Examine

Diagnosis

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