What metabolic and hormonal disorders develop in obesity

Obesity − is a condition that plays a central role in the development of noncommunicable diseases such as:

• diabetes mellitus (DM);
• hyperlipidemia;
• arterial hypertension (AH);
• cardiovascular disease;
• cancer.

In connection with the close relationship between obesity and type 2 diabetes, the neologism diabesity (diabetes + obesity) was created, which introduces the concept of "DM caused by overweight", that is, the condition of a person with existing DM and overweight.

After that, the problem of obesity became an integral part of medicine and, as a result, multidisciplinary European recommendations for the management of patients with obesity were issued, which you can read in this article on estet-portal.com.

• Sex hormone dysfunction in obesity
• Correction of insulin resistance in obesity
• Rationale for vitamin D supplementation in obesity
• Impaired concentration of male sex hormones in obeseii

Sex hormone dysfunction in obesity

Obesity is associated with impaired fertility and an increased risk of miscarriage, even in the absence of a diagnosis of PCOS. If there is a violation of the menstrual cycle, infertility, further studies are recommended to confirm or exclude hyperandrogenism, anovulation, PCOS.

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In case of excessive androgen levels, it is recommended to exclude other possible diagnoses such as adrenal hyperplasia, insulin resistance, adrenal dysfunction and iatrogenic factors, and in the presence of menstrual irregularities or infertility − evaluation should include hyperprolactinemia, thyroid dysfunction, and hypercortisolism.

One of the most important tests for evaluating gonadal function is determining the levels of LH, FSH, total testosterone; globulin that binds sex hormones; androstenedione, estradiol, 17-hydroprogesterone and prolactin.

In case of obesity and concomitant dysfunction of the genital organs, it is recommended to determine hormones in the early follicular phase of the menstrual cycle (1-5th day of the menstrual cycle). In the presence of amenorrhea, the determination can be carried out at any time.

For the diagnosis of anovulation, the determination of LH, FSH, estradiol, progesterone and prolactin is recommended. These studies will help to distinguish primary ovarian failure from central hypogonadism, as well as secondary hormonal disorders, which is associated with an additional depot of estrogen in adipose tissue in obese ii.

Correction of insulin resistance in obesity

Obesity polycystic ovary syndrome is often associated with insulin resistance and an increased risk of T2DM. Therefore, it is recommended to perform fasting glucose and glucose tolerance testing in all obese patients.

 

 

Metformin is often used in medical practice to manage insulin resistance by increasing insulin sensitivity in the liver, muscle, and adipose tissue, thus improving cardiometabolic risk factors, menstrual irregularities, and fertility.

Provided that insulin resistance plays an important role in hyperandrogenism, which has various dermatological and hormonal manifestations, metformin can be used in a therapeutic approach to restore hormonal imbalance in patients with obesity and gonadal dysfunction, with the additional effect of improving the metabolic profile of the patient. At the same time, it is not recommended to prescribe Metformin for the sole purpose of – decrease in body weightla.

Rationale for vitamin D supplementation in obesity

Vitamin D deficiency is a common (55-97%) comorbid problem in obesity. An association of vitamin D deficiency with obesity, diabetes mellitus, and insulin resistance is considered likely, as vitamin D receptors are common in all tissues, suggesting its multiple functions. Therefore, vitamin D plays an indirect but important role in carbohydrate and fat metabolism.

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The ESE does not recommend vitamin D supplementation for the sole purpose of − help reduce body weight and reduce the risk of comorbidities in obesityii.

Impaired concentration of male sex hormones in obesity

In case of obesity and the often occurring in this case clinical signs of hypogonadism, the definition of:

• total and free testosterone;
• sex hormone-binding globulin;
• follicle stimulating hormone (FSH);
• luteinizing hormone (LH).

The initial test is the determination of total plasma testosterone concentration.

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Because there is a circadian rhythm to testosterone secretion, the test should be taken in the morning at 7-11 am or within 3 hours of waking up. Once low testosterone concentrations have been determined, FSH and LH measurements are needed to differentiate between primary and secondary hypogonadism.

 

 

Before making a diagnosis of obesity-related hypogonadism, it is recommended that other causes be excluded:

• hyperprolactinemia;
• leptin abnormalities;
• syndromic obesity;
• hypothalamic obesity.

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