Pituitary form of obesity. What is hypothalamic obesity. Medical treatment of obesity

Hypothalamic-pituitary obesity occurs when the hypothalamus is damaged and is accompanied by a violation of the hypothalamic and pituitary functions, which cause the clinical manifestations of the disease.

Etiology.

Damage to the hypothalamus, leading to hypothalamic-pituitary obesity, can cause

• - Infections;
• - Intoxication;
• - Metastases of malignant tumors;
• - Traumatic brain injury;
• - Tumors.

Pathogenesis.

• - Damage to the nuclei of the posterior part of the hypothalamus (ventromedial and ventrolateral), which regulate appetite;
• - Hyperinsulinemia and insulin resistance lead to increased appetite;
• - An increase in the level of opioid peptides leads to an increase in appetite;
• - Violation of hypothalamic and pituitary functions, a change in the neurohumoral regulation of gastrointestinal hormones mobilizes carbohydrates, promotes glucose utilization, inhibits lipolysis, activates lipogenesis.

Separate forms of hypothalamic obesity.

• - Adiposo-genital dystrophy (Pechkranz-Babinski-Frelich disease). Deposition of fat according to the "female type", hypogenitalism; sometimes signs of diffuse or focal lesions of the central nervous system, flat feet, transient diabetes.
• - Progressive lipodystrophy (Barraquer-Symonds disease). Excessive or normal deposition of fat in the lower part of the body, atrophy of the upper part.
• - Laurence-Moon-Barde-Biedl syndrome. Obesity, hypogenitalism, growth retardation, polydactyly, retinitis pigmentosa.
• - Morgagni-Morel-Stuart syndrome. Obesity, hirsutism, hyperglycemia, arterial hypertension, thickening of the internal plate of the frontal bone.
• - Painful lipomatosis (Derkum's disease). The presence of painful fatty nodes against the background of generalized obesity, or against the background of normal weight.

The frequency of clinical signs in obese patients.

Neuroendocrine (hypothalamic) obesity

Excessive deposition of fat in adipose tissue is obesity. It develops due to three main pathogenetic factors, such as:

1) increased intake of food (carbohydrates, fat) with energy consumption of fat that does not correspond to this intake (alimentary obesity);

2) excessive formation of fat from carbohydrates;

3) insufficient use (mobilization) of fat as an energy source (metabolic obesity).

The food center regulates the intake of food, including fat and carbohydrates. It is a functional association of nerve centers located in the cerebral cortex and underlying sections of the subcortex and brain stem.

One of the manifestations of the activity of this center is a feeling of appetite and hunger.

An important role in this process is played by nerve formations in the posterior hypothalamus - ventrolateral and ventromedial nuclei. Electrolytic destruction of the first causes lack of appetite, anorexia - refusal of food up to death from starvation. From the ventromedial nuclei ("centers of satiety"), inhibitory impulses arrive to the ventrolateral ones.

Electrolytic destruction of the ventromedial nuclei due to the loss of inhibitory impulses causes prolonged alimentary excitation and pronounced hyperphagia, followed by the development of obesity.

With the introduction of autoglucose to experimental animals, the development of obesity is observed. At the same time, edema, pycnosis of the nucleus, and degenerative changes occur in the ventromedial nuclei.

Autoglucose obesity is hypothalamic, but is caused not by electrolytic damage to the corresponding centers, but by chemical. Experimental hypothalamic and autoglucose obesity is analogous to diencephalic obesity.

In all types of obesity, insufficient energy utilization of fat and inhibition of fat mobilization from its depot are observed. The latter is connected, apparently, with an increase in the content of glycogen in the liver.

Changes in the functions of the endocrine glands, accompanied by a tendency to hypoglycemia, may cause an increase in appetite and thus contribute to obesity.

In this respect certain value has an increase in the function of the insular apparatus. A certain role in this regard can be played by both hypofunction of the pituitary gland and hypothyroidism, in which hypoglycemia is observed.

In adipose tissue, the processes of synthesis and breakdown of triglycerides, hydrogenation of fatty acids, protein synthesis and breakdown, glucose metabolism along the glycolytic and phosphogluconate pathways, and the formation of higher fatty acids from the products of carbohydrate and protein metabolism are constantly going on.

The deposition of fat in adipose tissue occurs not so much with an excess of fat, but due to the neoformation of fat from carbohydrates.

The common product of the metabolism of monosaccharides and glycogenic amino acids - pyruvic acid - is decarboxylated with the subsequent formation of acetylcoenzyme A. The latter, with the participation of ATP, condenses through a series of stages into higher fatty acids.

Varying degree of formation and deposition of fat in different places adipose tissue is associated with unequal expression of glucose metabolism in them.

Glucose is a source of alpha-glycerophosphate, which delivers glycerol to form triglycerides (neutral fat). Adipose tissue itself without glucose does not have the ability to phosphorylate free glycerol and use it for the synthesis of triglycerides. Thus, the activation of glucose metabolism leads to the formation of fat from carbohydrates.

Of the hormonal factors influencing this process, insulin has the greatest effect.

It activates the absorption of glucose by adipose tissue and stimulates its metabolism through the glycolytic cycle. In the process of stimulating the glycolytic cycle, the formation of alpha phosphate increases, which increases the synthesis of triglycerides (neutral fat) from newly formed higher fatty acids. Insulin causes in isolated adipose tissue the processes of fat capture by adipose tissue cells.

Stimulation of the transition of carbohydrates into fats occurs under the influence of prolactin. Observed obesity in women during lactation is due to excessive production of prolactin. If the hyperfunction of this hormone persists even after the cessation of lactation, then this can stabilize obesity.

Thus, excessive secretion of insulin and prolactin, as well as impaired metabolism of estrogen and, possibly, glucocorticoids and testosterone, play a significant role in the etiology of obesity due to increased conversion of carbohydrates into fats.

Pituitary hormones have a great influence on the processes of fat mobilization.

Excessive secretion of thyroxine and triiodothyronine activates the mobilization of fat as a result of excitation of the sympathetic nervous system, which, in turn, is due to the fact that thyroxine, by blocking amine oxidase, potentiates the action of adrenaline and norepinephrine. With insufficient secretion of TSH, as well as secondary and primary insufficiency of the thyroid gland, the mobilization of fat from its depot is inhibited and prerequisites for obesity are created.

A number of polypeptide hormones of the pituitary gland have a fat-mobilizing effect.

It is assumed that it is due to a fragment of a polypeptide molecule common to all organs. Apparently, the fragment is the fatty hormone.

Based on data from many research work endocrinologists believe that in the etiology of obesity, a change in the functions of the anterior pituitary gland is important, leading to a disruption in the biosynthesis of that fragment of the compensatory molecule of pituitary hormones that is related to the activation and mobilization of fat.

The effect of glucocorticoids on fat mobilization is complex. By increasing the glycogen content in the liver and slightly raising the blood sugar level (due to the activation of gluconeogenesis), they are able to have an inhibitory effect on fat mobilization. The same effect may occur due to the inhibitory effect of glucocorticoids on GH secretion and its biological activity, as well as the suppression of ATH secretion with its extra-adrenal lipolysis-activating action. On the other hand, glucocorticoids have a permissive and potentiating effect on the fat mobilizing activity of adrenaline and noradrenaline.

Excessive secretion of glucocorticoids does not always have the same effect on fat deposition.

Androgens and estrogens activate fat mobilization. According to I. G. Kovaleva and other endocrinologists, estrogens (sinestrol) inhibit the fat-mobilizing effect of growth hormone.

Insulin also has an inhibitory effect. An increase in glycogen content in the liver slows down the release of fat from adipose tissue. Glucagon enhances the lipolytic activity of adipose tissue.

Be that as it may, the endocrine glands are involved in the implementation of pathogenetic factors leading to the development of obesity.

The participation of the central nervous system - the cerebral cortex, subcortical formations, sympathetic and parasympathetic innervation - in the regulation of fat metabolism, fat deposition in fat depots, in complex enzymatic processes in fat cells is beyond doubt.

Obesity predisposes to the development of a number of diseases of the cardiovascular system, various types of metabolic disorders, hormonal dysfunctions (atherosclerosis, diabetes mellitus, cholecystohepatitis, cholelithiasis, menstrual disorders, decreased libido and potency), worsens the condition of the supporting apparatus, reduces resistance to various infections .

In recent decades, an increase in the number of patients with obesity has become noticeable, in accordance with which the number of comorbidities and complications has also increased.

Classify different forms of obesity.

Alimentary-constitutional obesity is caused by overeating (sometimes from the first years of life), when food intake exceeds the body's energy costs.

Hypothalamic (diencephalic, interstitial-pituitary, neuroendocrine) obesity is caused by damage to the hypothalamic metabolic centers with the involvement of various parts of the neurohormonal regulatory system in the pathological process.

Diffuse-cerebral (multilevel) obesity is associated with a gross organic cerebral process (tumor, encephalitis) that affects the hypothalamic nuclei and other brain structures (cortex, subcortical and stem formations), and the peripheral nervous system.

Endocrine-metabolic obesity is caused by damage to the endocrine glands (insuloma, corticosteroma, post-castration syndrome).

Clinic of hypothalamic obesity.

Obesity is the main symptom of the disease. The disease affects mainly young people. Violations of fat metabolism are usually preceded by infections, intoxication, trauma (viral encephalitis, general somatic infections, tonsillitis, chronic tonsillitis).

In the early stages of the disease, headaches, fatigue, insomnia, and thirst are disturbing. Weight gain progresses regardless of the increase or decrease in the diet. Fat is deposited on the chest, abdomen, thighs. Blue-purple or pink stretch marks appear on the skin. Obesity begins to be combined with diabetes insipidus or diabetes mellitus, edema may occur. In the neurological status - absent-mindedness.

In cases of neuroviral etiology, vegetative-vascular disorders are observed with disturbances in the activity of the heart, respiration, chills with trembling of the whole body.

Forms of hypothalamic obesity are divided into:

1) the type of Itsenko-Cushing's disease;

2) type of adino-genital dystrophy;

3) the type of Barraquer-Simons disease;

4) by mixed type.

Obesity according to the type of Itsenko-Cushing's disease is manifested by excessive deposition of fat in the face, trunk, abdomen, neck with relatively thin limbs. The skin in this disease is dry, rough, with the presence of stretch marks. There is a violation of the vegetative-vascular regulation, marbling of the skin, a rapid change in color. skin, arterial hypertension.

The hypothalamic type of obesity is observed in persons from 12 years to 35.

The basis of metabolic and hormonal shifts is an increase in the production of gonadotropic, somatotropic and adrenocorticotropic hormones during the period of sexual restructuring of the body, with their subsequent effect on an increase in protein and fat body mass. Increases the function of the adrenal cortex. In particular, increased secretion of glucocorticoids.

Preceding factors are tonsillitis, rheumatism, general somatic infections: measles, mumps, scarlet fever. Overweight in patients with early age does not disturb parents until puberty, while weight gain progresses, and health worsens.

Obesity according to the type of adino-genital dystrophy is more common in boys. Universal obesity and a lag in the formation of the reproductive apparatus are noted. The basis of adinose-genital dystrophy is an organic process localized in the pituitary gland or other parts of the brain with a severe organic lesion.

In adults, this form of hypothalamic obesity is associated with pathology of the birth period (bleeding, sepsis). Sometimes the disease of adults is preceded by a skull injury.

Dysplastic obesity of the Barraquer-Simons type is more common in adolescent girls and young women with rheumatic brain damage.

Characterized by excessive deposition of fat in the lower parts of the body - in the thighs, abdomen. The upper body is normal and without stretch marks on the skin.

The mixed type of obesity is manifested by a uniform distribution of the subcutaneous fat layer with an advantage in the pelvis, abdomen and chest. Stretch bands are clearly visible. There is a tendency to water retention in the tissues with a decrease in diuresis (up to 400–600 ml per day).

Violation of the water balance causes swelling. There are signs of increased functional activity of the insular apparatus. The content of glycogen in the blood of obese patients is increased. With pathological obesity, the transition of dietary carbohydrates to glycogen is activated, which weakens the impulses to mobilize fat. Glucocorticoid function of the adrenal cortex is increased. Violated function of the sex glands. Puberty is delayed.

Adolescents with hypothalamic obesity show signs of body disproportion. Decreased muscle strength. Poorly developed secondary sexual characteristics - facial hair. Changes in the thyroid cartilage of the larynx. The high timbre of the voice is preserved. The size of the penis is small, the scrotum is underdeveloped, the testicles are small.

In girls, there is a violation of the menstrual cycle, but the muscular system of the shoulder girdle is well developed and a large number of acne (blackheads) on the skin of the face, chest, hirsutism phenomena.

As obesity progresses, functions suffer internal organs: increased blood pressure. The liver is especially affected.

Even in the early stages of the disease, it is possible to establish a violation of carbohydrate, protein, prothrombin-educational, antitoxic and other functions of the liver. In the future, angiocholitis, cholecystohepatitis develops. On the part of the gastrointestinal tract, there is a tendency to constipation, flatulence, increased acidity of gastric juice. The function of the urinary system is not noticeably affected.

The treatment of obesity is associated with serious difficulties and must be comprehensive. For any type of clinical course of the disease and the degree of obesity, it is necessary to observe a diet during treatment. The emphasis is on reducing the excitability of the food center. For this purpose, they switch to fractional meals (5-6 times a day). Foods rich in fiber (cabbage, carrots, beets) are introduced into the diet.

Preferred fresh vegetables and herbs containing tartronic acid, which prevents the transition of carbohydrates into fats.

To mobilize fat from the fat depot, the calorie content of food is reduced at the expense of carbohydrates, the amount of fat, but the amount of animal proteins is increased. It is advisable to use cottage cheese, cheese containing lipotropic factors. Salt is limited, spices, seasonings, extractives, alcoholic beverages are excluded.

Daily calorie intake: 1200-1800 (20 calories per 1 kg of estimated weight). Appointed fasting days: kefir, fish, vegetable, fruit. The mode of enhanced physical activity is established (physiotherapy exercises, walking, running). Useful water procedures(shower, swimming, rubdown).

With progressive forms of obesity, dosed fasting is introduced into the treatment in compliance with correct technique exit from hunger and dosed physical activity. Treatment with hunger is carried out in a hospital.

Lipotropic drugs, calcium pantothenate, vasodilators and other drugs are prescribed.

Anabolic steroids and glutamic acid are used to improve protein metabolism and prevent the breakdown of tissue proteins.

Along with diet therapy, a complex of dehydration, desensitizing and resolving therapy is prescribed (intramuscular injections of magnesium sulfate, calcium gluconate, diuretics, antihistamines). With severe symptoms of CSF hypertension, dehydration therapy is indicated.

Cholesterol-reducing agents are used (lipocaine, methionine, lipoic acid, clofibrate, linetol, petamifen), B vitamins.

Hormonal cyclic therapy (estrogens, progesterone, choriogonin) are prescribed in cases of sexual infantilism or reverse development of the reproductive apparatus, and established hormonal deficiency.

Boys with mild hypogonadism are treated with choriogonin (from 10–12 years of age). With pronounced hypogenitalism, cryptorchidism, the use of choriogonin begins at the age of 6–8 years. Synthetic analogues or male sex hormones are prescribed from the age of 12.

Adults with a decrease in libido and potency are also prescribed sex hormones, in parallel - general tonic and restorative drugs.

In cases of decreased functional activity of the thyroid gland, thyroid therapy is prescribed.

The use of anorexigenic drugs is excluded, since they contribute to short-term weight loss, entail side effects, namely, persistent violations of vascular regulation, menstrual irregularities.

Long-term use of diuretics and laxatives is dangerous. This contributes to the deterioration of metabolic processes (electrolyte metabolism is disturbed, colitis develops, kidney failure due to vasospasm caused by hypokalemia, possible headache, collaptoid state).

It should be borne in mind the hyperglycemic effect of thiazide compounds.

Diet is crucial. Constantly ongoing psychotherapeutic measures - explaining the dangers of overeating and mandatory dieting - is important condition treatment of neuroendocrine forms of obesity.

Hypothalamic obesity is a pathology in which body fat occurs due to a malfunction of the hypothalamus. The disease is diagnosed in different ages even in children. Fat deposits appear in the thighs, abdomen and chest.

Hypothalamic obesity occurs due to hormonal disorders in the pituitary gland and hypothalamus.

The following factors provoke the development of the disease:

1. Neoplasms in the brain.
2. Viral pathologies.
3. infectious diseases.
4. Traumatic brain injury.
5. Body poisoning.
6. Irrational nutrition.
7. Bleeding in brain tissues.

Fat deposits will accumulate faster if the patient leads a sedentary lifestyle, smokes, drinks alcohol. Also, doctors do not exclude a genetic predisposition from the list of causes.

Varieties

Purpose effective treatment hypothalamic obesity is impossible without determining its type. There are several forms of pathology. These include obesity by the type of Itsenko-Cushing's disease. It occurs in patients aged 12-35 years.

The following disorders are observed in the body:

1. Fat deposits accumulate in the face, abdomen, neck. At the same time, the legs remain thin.
2. The skin becomes dry, acquires a marble shade.
3. There are violations of the vegetative-vascular system.
4. The blood pressure rises.

The development of obesity according to the type of adiposogenital dystrophy occurs as a result of trauma to the skull and brain. With this form, there are serious disturbances in the work of the pituitary gland, damage to the brain tissues, and a malfunction in the reproductive system.

Another type of obesity is the type of Barraquer-Simons disease. It occurs in most cases in girls in adolescence or in adult women who suffer from rheumatic brain lesions.

It is also possible to develop a mixed type of hypothalamic obesity.

In this case, the following manifestations occur:

1. Increase in the volume of the pelvis, abdomen and chest.
2. Deterioration of the skin.
3. The occurrence of stretch marks.
4. Water balance failure.

Each form is treated in its own way, so determining the type of obesity is an important part of diagnosing a patient.

Symptoms

With hypothalamic obesity, clinical signs do not begin to manifest themselves immediately.

On early stages the patient does not feel the development of the disease, but over time, the disease causes the following manifestations:

1. A set of body weight that is distinguished by swiftness and does not depend on food intake.
2. Fast fatiguability.
3. General weakness.
4. Headache.
5. Increased anxiety.
6. Depression.
7. Sleep problems.
8. The appearance of striae in the abdomen, thighs, chest.
9. Profuse sweating.
10. Increase in blood pressure.
11. The appearance of pigmentation on the skin.

With the active development of obesity, internal organs suffer. The hypothalamic type of pathology negatively affects the work of the adrenal glands. This leads to the fact that a hormonal failure occurs, which entails many other consequences.

The functioning of the pancreas is also impaired, which causes insulin imbalance, threatens the development of diabetes mellitus. There is also a high likelihood of disorders in the work of the heart and respiratory organs.

Hypothalamic obesity also adversely affects the activity of the reproductive system. If the disease develops in a teenager, then there is a risk of disruption of the testicles or ovaries, failure of puberty.

Boys often show signs that are characteristic of girls, for example, the absence of facial hair, a high voice, and an increase in the mammary glands.

Diagnostics

An examination is required to detect hypothalamic obesity. First of all, an external examination is carried out, during which the doctor checks the body weight, measures the pressure, and listens to the heart.

Then the doctor prescribes laboratory blood tests, checking the state of hormones, cholesterol and sugar levels. With lesions of internal organs, instrumental diagnostic methods are used.

Therapeutic measures

Pituitary obesity occurs due to hormonal failure, therefore, treatment is mainly aimed at normalizing hormone levels. Concomitant diseases are also subject to therapy, measures are taken to eliminate symptoms, lose excess body weight.

Preparations

With hypothalamic obesity, different groups of medications are prescribed to restore the work of the hypothalamus, pituitary gland, as well as other internal organs that have affected the disease.

The following types of drugs are used:

1. Hormonal agents. They help to restore the balance of hormones, support the work of the pituitary gland, hypothalamus, thyroid gland, reproductive system.
2. Anabolic steroids, glutamic acid. These drugs stabilize the metabolism of proteins, help prevent their destruction.
3. Medications for cholesterol. With excess weight, blood vessels often suffer, the risk of plaque formation increases, so normalization of cholesterol levels is required.
4. Means that restore blood circulation.
5. Vitamin complexes. Group B is especially important, as it helps to speed up the metabolism of substances and provide cell nutrition.

What medications should be taken, in what dosage and for how long, the attending physician decides.

Diet

Obesity diet is indispensable. No need to be afraid of dietary adjustments, you can eat delicious healthy food. No aggressive methods, let alone fasting, will be required. The main thing to do is to minimize the consumption of fat and carbohydrates.

To do this, you need to abandon the following products:

1. Confectionery.
2. Bakery.
3. Fatty meat and fish.
4. Dairy products with a high percentage of fat.
5. Fast food, for example, chips, pizza, hamburger.
6. Smoked dishes.
7. Canned food.
8. Sweets.

It is recommended to enrich the diet with plant foods containing only useful components. It includes fruits, vegetables, berries, herbs, dried fruits. From meat, fish, dairy products, you need to choose low-fat varieties. Cereals are better to eat whole grains.

Cooking is recommended in any way except frying. In the process of frying in oil, carcinogens are formed, which greatly harm the body and contribute to weight gain. The ideal option is food that is steamed, boiled or stewed.

Eating is required 5-6 times a day in small portions and do not forget to drink about 2 liters of water per day.

Radiation therapy

Irradiation is used when a patient is diagnosed with obesity by the type of Itsenko-Cushing's disease, which is accompanied by metabolic disorders and hormonal balance.

The patient is placed in a hospital until a positive trend is observed.

Radiation therapy gives a good effect only in this type of pathology, in other cases its use is inappropriate.

Prevention

Obesity of any type is dangerous for human health and life, so you need to know how to prevent it.

Doctors advise the following:

1. Exercise.
2. Do morning exercises daily.
3. Eat properly.
4. Monitor the hormonal background of the body.
5. Beware of traumatic brain injury.
6. Do not take uncontrolled drugs.
7. To refuse from bad habits.
8. Timely treat pathologies that can lead to weight gain.

Hypothalamic and pituitary obesity are serious conditions that require urgent treatment.

Hypothalamic-pituitary obesity is observed in one third of patients with pathological obesity and is associated with damage to the hypothalamus.

ETIOLOGY. Among the causes of the disease indicate a viral or chronic infection, intoxication, trauma to the skull, a brain tumor, hemorrhage, as well as a genetic predisposition.

PATHOGENESIS. The development of the disease is associated with damage to the nuclei of the hypothalamus, which regulate appetite. It has been experimentally established that damage to the ventromedial nuclei of the hypothalamus is accompanied by a sharp increase in appetite and the development of obesity. Primary damage to the hypothalamus also leads to an increase in appetite, resulting in excessive deposition of fat, increased formation of fat and carbohydrates.

Other endocrine glands are also involved in the progression of the disease. obese patients are characterized by hyperinsulinism, elevated blood levels and accelerated urinary excretion of corticosteroids. The level of somatotropin in the blood decreases and the level of corticotropin increases. A decrease in the secretion of somatotropin involved in lipogenesis may be important in the genesis of obesity. The reaction of hormones to functional tests is disturbed. The gonadotropic function of the pituitary gland decreases, resulting in hypofunction of the gonads with a clinic of hypogonadism.

In addition to endocrine, obese patients are characterized by metabolic disorders (persistent hyperlipidemia, changes in electrolyte metabolism). Consequently, obesity develops a number of endocrine-metabolic disorders characteristic of such metabolic diseases as diabetes mellitus and atherosclerosis. In special studies, it is revealed that in obese people, the glucose tolerance test is violated 7-10 times more often than in people with normal body weight. That is why obesity is now regarded as a risk factor for the development of diabetes and atherosclerosis. The consequence of violation of the hypothalamic regulation and the listed hormonal disorders is an imbalance between lipogenesis and lipolysis in the direction of the predominance of lipogenesis processes.

PATHOMORPHOLOGY. There is a uniform deposition of fat in the subcutaneous tissue, omentum, perirenal tissue, in the heart, liver, pancreas. Fatty infiltration of the liver and other parenchymal organs develops. In some forms of obesity, there may be selective deposition of fat in the form of lipomas. The histological feature of adipose tissue in obesity is an increase in the size and number of adipocyte fat cells, consisting mainly of triglycerides.

CLASSIFICATION. There are the following forms of obesity:

Alimentary-constitutional;

Hypothalamo-pituitary;

Endocrine-exchange;

Cerebral.

Alimentary-constitutional obesity often has a family character. It includes the majority of cases of obesity (70%). At the heart of its development is overeating, lack of physical activity, hereditary predisposition.

Hypothalamic-pituitary obesity includes, in addition to the form described below, separate varieties: Barraquer-Simmonds disease, Derkum's disease (generalized lipomatosis), Pehkrantz-Babinski-Frelich syndrome. This group also includes cerebral obesity due to CNS damage.

Violation of the hypothalamic-pituitary regulation also plays an important role in the origin of endocrine-metabolic obesity. The allocation to a separate group is due to the fact that obesity is a symptom of an endocrine disease. These diseases include the following: Itsenko-Cushing's disease, Lawrence-Moon-Biedl syndrome, Stein-Leventhal syndrome, Morgagni-Stewart-Morel syndrome, obesity with hypothyroidism, hypercortisolism, hypogonadism.

Baranov V.G. all forms of obesity are grouped into two groups:

1 - primary (essential), when the bulk of cases of alimentary-constitutional obesity enters;

2 - secondary (symptomatic) on the basis of any pathological processes.

Hypothalamic obesity (it is also called neuroendocrine, diencephalic), along with alimentary and endocrine, is one of the types of this unpleasant disease. It is manifested by a sudden and aggressive intervention of fat deposits in the abdomen, thighs, buttocks and is due to pathological changes in the hypothalamus and pituitary gland. The first of these organs is responsible for coordinating metabolic processes in the body, and the second regulates the hormonal system.

Different areas of the hypothalamus affect appetite in different ways, and therefore body weight, mutually complementing and compensating each other. If one of the areas is damaged, this balance is disturbed. If the pathology of the lateral section inhibits the desire to eat and in extreme cases can lead to anorexia, then with ventromedial pathologies everything happens exactly the opposite: hyperphagia (irrepressible craving for eating) and obesity begin.

The provoking factors of such negative changes are numerous and not fully understood. In particular, these may be mechanical damage and injuries, malfunctions of the central nervous or endocrine systems, different kind infections, intoxication of the body. An important role is played by the genetic factor.

Clinical picture

The basis of neuroendocrine obesity is hypothalamic syndrome, which most often develops during puberty and in reproductive age. The main external symptoms of this phenomenon:

• active progression of fullness, often independent of the amount of food taken;
• neuropathological signs: fatigue accompanied by headaches, hyperexcitability, anxiety-depressive states, followed by euphoria, sleep disturbances;
• the appearance of striae - characteristic purple-blue stripes in the thighs, abdomen or chest.

In addition, the syndrome is characterized by increased sweating and the appearance of age spots, an increase (occasionally - a decrease) in pressure.

In many ways, the pathogenesis of hypothalamic obesity is caused by an increase in the function of the adrenal glands with an increase in the content of cortisol in the blood. The process is also accompanied by hormonal disruptions, leading to a delay or acceleration of growth, inhibition of the thyroid gland. For example, an additional stimulus to obesity is provided by excessive production of the hormone prolactin, which under normal conditions is characteristic during pregnancy and after childbirth. There are interruptions in metabolic processes related to other important hormones: these are estrogens, testosterone and glucocorticoids.

Pathology does not bypass the pancreas, leading to disorders of the insulin balance in the blood with the threat of development various kinds diabetes. A vital role in fat deposition and developmental disorders of fermentation in fat cells belongs to the central nervous system: the cerebral cortex with subcortical formations, as well as both parts of the autonomic system.

If the root cause of excessive fullness was neuroviral etiology, there is a high risk of vegetative-vascular disorders with cardiac disorders and lesions of the respiratory system.

A separate discussion deserves the disorganization of the reproductive system: in children of puberty, the disease directly affects the work of the gonads, introducing an imbalance into it.

In boys, the muscular constitution is poorly developed, and due to a decrease in the secretion of sex hormones, there is a decrease in libido, underdevelopment of both primary and secondary sexual characteristics with the simultaneous development of signs characteristic of the opposite sex. This manifests itself, in particular, small size penis and testicles, rudimentary scrotum. In men, there is almost no vegetation on the face, instead, the mammary glands are enlarged, the timbre of the voice is high, the Adam's apple is almost not observed.

For girls and girls, hypothalamic obesity is primarily menstrual irregularities, fraught with the threat of gynecological diseases, up to infertility, acne-prone skin, androgenic type hair.

Classification

There are 4 types of hypothalamic obesity.

• First

The first type is based on Itsenko-Cushing's disease, in which there is an obvious disproportion between relatively thin limbs and an excess of body fat. The skin is characterized by roughness and dryness, marble tint, there are signs of arterial hypertension. Pathogenesis - dysfunction of the adrenal glands.

• Second

The second type is characterized by adipose-genital dystrophy and a combination of exorbitant heaviness and obvious signs retardation in sexual development. It occurs only in men. The reason is pathological processes in the pituitary gland or in the surrounding brain tissues. At an older age, traumatic brain injury can become a provocateur.

• Third

On the contrary, the course of the disease according to the type of disease of progressive lipodystrophy caused by general somatic infections, various forms encephalitis, and possibly brain tumors, is more common in adolescent girls and young women. Fat is deposited mainly on lower limbs and on the stomach.

• Fourth

The fourth type is rather mixed, showing all the above signs.

Pathological physiology also distinguishes four degrees of this phenomenon:

• with an excess of mass of less than 30 percent, one can judge about 1 degree of obesity;
• if the difference between the actual weight and the norm is up to 40 percent - about 2 degrees;
• when the excess reaches 99 percent - about 3 degrees;
• at greater difference of these indicators we are dealing with the 4th degree.

Diagnostics

To establish the causes of the disease, differential diagnosis is necessary with an X-ray examination of the skull and spinal column, as well as a small Liddle test to detect excessive production of cortisol.

If there are appropriate indications, a glucose test, examination of the pelvic organs using ultrasound and other diagnostic measures are performed. Clarification of the diagnosis requires an ultrasound or CT scan of the adrenal glands.

Treatment

Treatment of hypothalamic obesity is based on an integrated approach with a combination of drug therapy, exercise and diet. The meaning of treatment, for the most part, comes down to inhibiting the activity of the centers responsible for appetite. It is possible to enter dosed starvation, but only in a hospital and under the supervision of specialists.

Medical therapy

With an increased addiction to food, drugs such as depimon, mazindol, fepranone are prescribed. These anorexigens stimulate the satiety center, suppressing the need for food. The treatment course does not exceed 4-6 weeks due to the risk of addiction.

You can improve protein metabolism through glutamic acid and anabolic steroids. Of the cholesterol-lowering drugs, B-vitamin complexes are recommended in combination with lipoic acid, methionine.

Of the fat-mobilizing drugs, tablets are used, which are based on a substance. Throughout the course, which can last up to 2 years, the patient must be under medical supervision. Another option is a combination of adiposin and, which should be taken for no more than one month due to the presence of side effects.

Actively used absorbable and freeing the body from excess water therapy by intramuscular injection of antihistamines and diuretics.

With sexual infantilism, hormonal treatment is prescribed. Treatment of boys with choriogonin usually begins at the age of ten, however, in obvious cases, therapy can be started as early as 6-8 years. From the age of 12, it is allowed to take male sex hormones or their analogues from synthetics, and older men are also prescribed immunity-strengthening and tonic drugs.

Hormonal treatment of girls includes synthetic estrogen-containing drugs, as well as progesterone, clomiphene citrate. If necessary, antiandrogenic agents are prescribed.

In the first type of disease, the doctor may prescribe radiation therapy. In cases of obesity of the third - fourth degrees, especially in the progression stage, surgical intervention may be the best solution.

diet therapy

Diet is a prerequisite for effective treatment. Meals should be frequent and contain small portions. The ratio of calorie content of food to a kilogram of weight should be kept below 20 kilocalories. The basis of the diet is foods containing fiber. Eating with high content carbohydrates should be reduced to a minimum.

The menu must contain fruits, vegetables, herbs, dairy products, cheeses with a low salt content. Spices, spices, pickles should be limited or completely excluded from the diet - everything that provokes appetite. Organization will be a good help to therapy.

Additional Methods

Of great importance is high physical activity - physical therapy, or just fast. As often as possible, you should take a shower, wipe yourself. No less important is the proper psychotherapeutic preparation of the patient with a mindset for success!

It is impossible to treat hypothalamic obesity on your own! Uncontrolled intake of therapeutic (especially hormonal) drugs or an ill-conceived diet can cause irreparable harm to health. The seeming success in the face of a few kilograms dropped will become a temporary phenomenon, but it can result in hormonal disruption, heart problems and other serious consequences.

Be healthy and do not forget: a dietitian will always come to the rescue!