Differential diagnosis of obesity:

Differential diagnosis of obesity:
A simple obesity



(A) of the constitution of obesity (early-onset obesity)



Adult obesity at an early age until there is a family history of obesity appetite good body fat distribution of fat proliferation of mast cells were restricted diet and exercise to strengthen the efficacy of the poor are less sensitive to insulin without cause obesity available



(B) Acquired obesity (adult-onset obesity) more than 20 to 25-year-old due to the onset of excessive nutrition activities and to reduce the amount of genetic factors in obesity and non-proliferation of mast cells in fat diet and exercise to lose weight after weight loss better Insulin sensitivity to resume



Second secondary obesity



(A) of the hypothalamus and obesity



1. Hypothalamus syndrome involving a variety of causes of diseases caused by the hypothalamus



(1) cause: ① tumor up to 70 cases of domestic see this disease in 53 cases in which the tumor attached to a maximum of craniopharyngioma (25 cases) followed by the pineal gland tumors (11 cases), 6 cases of hypothalamic tumors of the third ventricle tumor 4 Cases of ependymoma 2 olfactory groove meningioma tumor nodules gray saddle ectopic pineal tumor astrocytoma tumor on the reported 1 case of leukemia still metastatic cancer tumor blood vessels and environmental hamartoma tumor teratoma Plasmacytoma neurofibromatosis by the middle section of tumor medulloblastoma sarcoma malignant skin tumors, such as vascular endothelial ② infection and inflammation: tuberculosis or purulent meningitis and viral encephalitis epidemic cerebrospinal meningitis encephalitis measles, chicken pox smallpox rabies Vaccination histoplasmosis, and other domestic 70 cases of the disease in 6 cases of inflammation; ③ traumatic brain surgery and radiation therapy ④ cerebral vascular diseases such as tumors and cerebrovascular atherosclerosis in systemic lupus erythematosus and other reasons caused by TAO; ⑤ granulation Swelling and degeneration as tuberculoma sarcoidosis reticuloendothelial cells hyperplasia multiple chronic eosinophilic granuloma yellow tuberous sclerosis brain tumor softened by the middle gliosis ⑥ such as Gap acute attack of blood carbon dioxide narcotic oral disease Ye Lin Chloro-Propionibacterium contraceptives reserpine-induced amenorrhea syndrome ⑦ galactorrhea a trauma-induced environmental changes, such as functional barriers



(2) clinical features: the hypothalamus due to the small and functional damage to a number of complex diseases often involving nuclear groups and a number of physical conditioning for the central performance of the complex clinical syndrome: ① more food due to obesity and disease involving ventral medial hypothalamus or nuclear Nodules in the vicinity of the Department of often caused by genital dysplasia (obesity, said that reproductive incompetence dystrophy syndrome frohlich performance of the majority of the people of drowsiness or lethargy strong fresh attack disease (Kleine-tevlll syndrome in patients who can not control the performance of paroxysmal Hours of sleep for several days to wake up after overeating due to obesity ② endocrine dysfunction due to one or more of the hypothalamic-releasing hormone anterior pituitary hormone secretion, or endocrine disorder caused by hyperthyroidism or decreased as precocious puberty or sexual dysfunction Amenorrhea male obese women of reproductive incompetence of the loss of the sense of smell and hypoplasia syndrome; galactorrhea amenorrhea a Hypercortisolism hypothyroidism acromegaly gigantism diabetes insipidus, such as fever or hypothermia ③ ④ mental disorders such as disorientation and volatile Kuxiao Pina and hallucinations Dengzheng ⑤ hypothalamus epilepsy headache pain or hyperhidrosis Khan, hand-foot-fat group closed sphincter dysfunction visually impaired vision 'Pianmang defect and blood pressure fluctuations (fluctuated people mydriasis or both sides of the narrow range) based on the diagnosis ① in the history of how eating a variety of fat drowsiness endocrine dysfunction abnormal regulation of body temperature abnormal secretion of sweat ② head CTMRIJ ray angiography, and so on in order to check showed intracranial lesion and the nature of the anterior pituitary hormone ③ ④ determination of adrenal function and Gonadal function of the thyroid function tests ⑤ islet function test ③ hypothalamic-pituitary dysfunction may be given to patients' IRHLRH excited to observe the examination of cerebrospinal fluid test ① intracranial pressure and interleukin (inflammation increased when people leukocyte ③ EEG



(B) of the pituitary obesity



Empty sella syndrome as a result of saddle or saddle next to the tumor by radiation therapy after surgery or for secondary non-empty sella syndrome after surgery or radiation therapy for primary empty sella syndrome of unknown etiology Internal report to the saddle area are mostly caused by arachnoid adhesion (about 50% of the saddle area of the local people so that the adhesion of cerebrospinal fluid drainage impeded the normal pulsatile cerebrospinal fluid pressure under the impact of its settlement thinning saddle every other open (defect) arachnoid Under the chamber and the third ventricle of the lower part of the former can saddle people with defects caused by the expansion of pituitary sella pressure arising from a series of clinical pregnancy several times during pregnancy were pituitary physiological hypertrophy (which can increase the number of times the human pituitary after pregnancy-induced increases Saddle and every hole is greater than birth pituitary fossa up gradually after the pituitary saddle back so that every hole and the pituitary fossa left more room for the saddle people with spinal defects in pituitary damage caused by pituitary tumors or cystic change occurred craniopharyngioma Subarachnoid space capsule with the traffic caused by the breakdown of empty sella or spontaneous pituitary tumor necrosis can be caused by empty sella * Women are often found in the bed headache vision loss increased intracranial pressure and visual field defect with some of the fat patients were light Sex and degree of hypothyroidism but pituitrin normal diagnosis based on multi-functional: the skull X-ray film showing the expansion of sella spherical or oval have Sella bone absorption; head CT shows the expansion of pituitary fossa shrink pituitary fossa The brain is full of low-density fluid; MRI showed pituitary organizations close to flatten under pressure in the saddle at the end of saddle-like signal in the water is full of material under the saddle depression



2. Pituitary adenoma or hyperplasia growth hormone secretion of growth hormone (GH) caused by excessive body bone and soft tissue hypertrophy and hyperplasia of the internal organs associated with endocrine metabolic disorder clinic in order to face crudely hand-foot skin mast crassa sella headache dizziness before the onset of puberty, such as the expansion of For gigantism after the onset of puberty for plastic side hypertrophy before the onset of puberty and lasting until puberty Buyu after the performance of acromegaly as the tremendous weight of non-treatment of this disease lipomatosis



3. Pituitary adrenocorticotropic hormone (ACTH) for most of the micro-cell adenoma adenoma adenoma excessive secretion of ACTH to promote bilateral adrenal hyperplasia excessive secretion of cortisol lead to fat protein metabolism of sugar to the clinical manifestations of heart fat full moon face buffalo skin back the Philippines Bo Wen Zi Jing acne high blood pressure urine disease osteoporosis, and other groups



4. Prolactin pituitary tumor in the pituitary tumor to see more of a mostly female adenoma due to excessive secretion of prolactin (PRL) due to hyperprolactinemia clinical performance galactorrhea amenorrhea, or menstrual disorder infertility obesity edema vision Decline, and so on; male patients with a rare performance of the anti-impotence headache vision loss or vision impairment based on the diagnosis; ① history; ② PRL determination of the continued general than 4.55 nmol / L and normal female 0.046 ~ 1.14 Nmol / L for men 0.046-0.97 0.97nmol / L such as the PRL> 0.046 ~ 1.14nmol / L contribute to the diagnosis of the disease; ③ exciting test: TRHO.5mg intravenous or oral metoclopramide (metoclopramide) 10mg Perphenazine 8 mg chlorpromazine 25 mg spray after the peak response to the PRL are <2 times the value of the base; ④ skull X-ray film CTMRI help diagnosis



(C) Cushing syndrome (also known as Cushing's syndrome)



1. Etiology



(1) bilateral adrenal hyperplasia (Cushing's disease): this accounts for 70% of the total number of disease due to pituitary tumor, or ACTH hypothalamic-pituitary dysfunction excessive secretion of ACTH stimulation of bilateral adrenal hyperplasia and secretion cortex Zuiguo Multi-induced



(2) of the adrenal adenoma cancer or its secretion cortisol secretion of a large number of mostly functional autonomy from the pituitary tumors secrete ACTH regulation of a large number of cortisol feedback inhibition caused by the release of ACTH in tumor tissue than the same side or opposite often adrenal atrophy



2. Cortisol rise to a large number of clinical manifestations of fat and protein metabolism of sugar multiple organ dysfunction mainly how the quality of blood face the full moon face buffalo back concentric pattern of fat purple skin acne hairy high blood pressure diabetes mellitus groups, such as osteoporosis



3. Diagnosis based on the



(1) clinical presentation: a typical clinical course of disease but often Yiwangerzhi early often do not rely typical laboratory



(2) laboratory: ① 24 h urinary 17-hydroxy corticosteroids (17-hydroxy corticosteroids (17-OH CS)> 55.2 mol/24 h,> 69mol/24h a greater significance when the diagnosis (13.8 to 41.9 of the normal male mol/24h that is 5 ~ 15 mg of women 11 ~ 27.6mol/24h 24 h urine of a 17-corticosteroids (17, a 17-to-one)> 69.4 mol/24h, such as Japan 20mg significantly higher cancer may prompt regular ② 24h urine Free cortisol> 3036nmol/24h, the normal 28 ~ 276nmol/24 (10 ~ 100mg/24h) ③ plasma cortisol and normal adults as early as 8:00 for the average 442 ± 276 (16 ± μg / dl), 16:00 average for the 221 ± 166 nmol / L (8 ± 6μg/dl), the lowest midnight this morning when the disease increased plasma concentration of midnight, when no significant circadian rhythm to reduce the disappearance ④ low-dose dexamethasone suppression test (2mg / d) will not be simple obese suppression ⑤ midnight inhibition can be a single dose dexamethasone suppression test: Night at 23:30 am service lmg dexamethasone in the previous month after the morning service 8:00 measured blood plasma cortisol simple obesity and normal plasma cortisol suppression was to control the value of More than 50% of the disease and those who are not inhibited ⑥ determination of plasma ACTH normal as early as 8:00 for the average 1.1-11pmol / (5 ~ 50 pg / mL), pituitary tumor or hypothalamic-pituitary disorders are caused by adrenal hyperplasia Slightly higher concentrations of plasma ACTH adrenal tumor while reducing ectopic ACTH syndrome was significantly higher when



(3) inspection equipment: B-mode X-ray film scanning, and so on CTMRI adrenal Cushing's syndrome diagnosis help



(D) disease of obesity Islet



1. Insulinoma B, also known as islet cell tumor because of a large number of tumors secrete insulin-induced hypoglycemia repeated attack as a result of eating more fat and more than hypoglycemia morning attack on an empty stomach or after exercise when blood sugar attack <2.76mmol / L for the alleviating of sugar quickly after diagnosis See Section IV of this chapter based on the "hypoglycemia"



2. Diabetes mellitus (NIDDM) diabetes is obesity early symptoms of hypertrophy of fat cells to insulin sensitivity in patients with non-fasting and postprandial increase in fasting insulin levels when up to 30 min / L up to 200 ~ 300 Mu / L caused by eating more fat and Fasting blood glucose to normal after meal blood sugar can often ≥ 11.1mmol / L (200mg/dl), or reduce the tolerance in accordance with the clinical diagnosis of diabetes: Diabetes: any time blood glucose ≥ 11.1mmol / L and fasting plasma glucose ≥ 7.8mmol / L or 2 h after meal Blood sugar) ≥ 11.1mmol / L or 75g glucose tolerance test (OGTT): fasting blood glucose ≥ 7.8 mmol/L2 h ≥ 11.1mmol / L / impaired glucose tolerance: 2h postprandial blood glucose> 7.8 ~ <11.1mmol / L



3. Functional spontaneous hypoglycemia due to eating more and more common in obese middle-aged women based on the diagnosis of hypoglycemia see a



(E) hypothyroidism and obesity



As the metabolic rate to reduce energy consumption caused by lower part of the majority of obese patients with weight gain from the effect of swelling caused by fluid performance of the virtual face swollen skin dry and rough skin pale and cold lack of appetite, constipation, heart rate slow down, and so on the basis of diagnosis: ① In the history of primary hypothyroidism often from chronic lymphocytic thyroiditis may have caused part of the history of goiter patients with history of thyroid surgery or radiation therapy ② signs in support of the history of hypothyroidism ③ T3T4 increased serum thyroid 131I prostate and most of the second rate increase FT3FT4 forward a few high peaks, and so on



(F) gland dysfunction and obesity



1. Polycystic ovary syndrome may have a fat hairy irregular menstruation or amenorrhea sterile body temperature was the basis of single-phase long-term bilateral ovarian increase ovulation does not feasible B-mode local CT laparoscopy confirmed plasma LH levels increased a lower level of hH LH / ThH ratio> 3



2. Postmenopausal obesity because of ovarian failure on lower levels of estrogen in the hypothalamus and pituitary feedback inhibition caused by weakening and autonomic dysfunction and obesity at the same time more food with fat metabolism disorders



3. No male testis or testis disease-free type of sexual dysfunction often have fat removed or gonadal radiation injury after sex workers are often fat loss gonad function of the autonomic dysfunction caused by obesity is occurring at the same time as a result of the basis of sex with disease Make it easier to identify



(G) Other
1. Salt and water retention of obesity is associated with idiopathic edema simple obesity syndrome occurs in middle-aged women standing edema and more activities and the rest Lateral Horizontal increase in the early morning before the menstrual period and sooner or later to reduce body weight difference of 1 ~ 1.5 kg (the normal average of 0.5 kg) over the rapid weight gain often menstruation or amenorrhea less thirsty and easy Niaoshao emotional instability headache drowsiness face and extremities vasomotor dysfunction, orthostatic hypotension, such as water tests Li position Show a clear water can help to stay sodium Lu diagnosis



2. The pain of obesity was particularly prevalent in post-menopausal women to reduce their pain threshold of pain is characterized by obesity subcutaneous fat nodules found in neck axilla in patients with nodular sustainable for many years often been stopped as early as premature sexual function



3.Prader-Willi syndrome, also known as the three low-fat obesity syndrome mainly low muscle tone with mental retardation gonadal function in the lower infancy to childhood obesity have significantly more than feeding the body and the short trunk and legs were fat and more fat tubby Due to a high degree of body fat and respiratory function to the impact of post-adolescent diabetes or impaired glucose tolerance are often based on the diagnosis: In addition to the history and clinical performance of low-tension muscle biopsy so that myogenic or neurogenic atrophy



4. Skull plate with hyperplasia (Morgagni-Stewart-Morel syndrome) disease is rare, almost all more common in women after menopause, about half of the obese patients to the main trunk and proximal extremities are often severe mental disorders, headaches and more hair on after Amenorrhea or less basal metabolic rate of glucose metabolism and reduce barriers to the skull X-ray film show and other frontal skull plate with hyperplasia



5. Childish one of retinitis pigmentosa refers to more than 1 (toe) malformation syndrome (Laurence-Moom-Biedl syndrome) of this rare disease is commonly found in the same family in the male members of the main means there are more obese (toe) and abnormal pigment Retinal degeneration short hair and long eyelashes long eyebrows genital development, such as poor mental retardation



(H) drug-induced obesity



And certain mental disorders in patients with long-term use of chlorpromazine call to promote protein synthesis of insulin preparations glucocorticoid Astemizole making drugs such as loss of appetite in patients with hyperthyroidism and eating more fat.