What are the common causes of secondary obesity in patients with certain diseases

Secondary obesity is common in patients with Cushing's syndrome, polycystic ovary syndrome, hypothyroidism, hypothalamic obesity, insulinoma, and other diseases. Secondary obesity is mainly caused by endocrine and metabolic abnormalities or central nervous system disorders, and has a clear causal association compared to simple obesity.

1. Cushing's syndrome

Patients with Cushing's syndrome experience central obesity due to excessive cortisol secretion, characterized by a full moon face, buffalo back, and abdominal fat accumulation. Long term high cortisol levels can promote fat redistribution, inhibit fat breakdown, and cause protein breakdown and glucose metabolism disorders. This type of patient needs to be diagnosed through blood cortisol rhythm testing and low-dose dexamethasone suppression test. Treatment should choose surgery or medication to control cortisol secretion based on the primary cause.

2. Polycystic ovary syndrome

Patients with polycystic ovary syndrome are prone to abdominal obesity due to insulin resistance and hyperandrogenism, accompanied by symptoms such as menstrual disorders and hirsutism. Insulin resistance leads to an increase in fat synthesis and a decrease in breakdown, while an increase in testosterone further exacerbates abnormal fat distribution. Improving lifestyle is the basic treatment, and if necessary, insulin sensitizers or anti androgen drugs should be used to regulate metabolism.

3. Hypothyroidism

Hypothyroidism patients experience a decrease in basal metabolic rate due to insufficient thyroid hormones, often manifested as weight gain accompanied by myxoedema. Thyroid hormone deficiency can reduce fat mobilization and thermogenesis, leading to decreased energy expenditure. Diagnosis can be confirmed by detecting thyroid stimulating hormone and free thyroxine. It is necessary to take levothyroxine sodium replacement therapy for life and regularly monitor hormone levels.

4. Hypothalamic obesity

Hypothalamic obesity is often caused by tumors, trauma, or inflammation that damage the hypothalamic feeding regulatory center, leading to increased appetite and decreased metabolic rate. Patients often experience uncontrollable hunger accompanied by drowsiness and abnormal temperature regulation. Head MRI examination can clearly identify hypothalamic lesions. Treatment requires addressing the primary cause and strict dietary management, and appetite suppressants may be used if necessary.

5. Insulinoma

Patients with insulinoma experience repeated hypoglycemia due to abnormal secretion of insulin by the tumor, leading to compensatory feeding and weight gain. Frequent consumption of high sugar foods can stimulate fat synthesis, while episodes of hypoglycemia can enhance feeding behavior. Diagnosis can be confirmed through a 72 hour hunger test and pancreatic imaging examination. Surgical resection of the tumor is a curative method, and close monitoring of blood glucose levels is required after surgery. Patients with secondary obesity should regularly monitor their blood pressure, blood sugar, and blood lipid levels, avoid high salt and high-fat diets, and choose low-intensity exercises such as brisk walking and swimming. Daily recording of weight changes and ensuring adequate sleep can help regulate leptin secretion. Individuals with combined metabolic abnormalities should have their liver and kidney function rechecked every three months and strictly follow medical advice to adjust medication dosage. When experiencing unexplained sudden weight gain or accompanied by headaches or changes in vision, it is necessary to promptly investigate intracranial lesions.