Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Obes Surg. 2012 Jan;22(1):62-9. doi: 10.1007/s11695-011-0545-4.
Several endocrine abnormalities, including hypothyroidism and Cushing's syndrome (CS), are considered as causative factors of obesity. The aim of this study was to evaluate the prevalence of endocrine disorders and obesity-associated co-morbidities, as well as the impact of substantial weight loss.
Screening was performed in 433 consecutive morbidly obese patients (age 41 ± 12 years; BMI 47 ± 6.9 kg/m(2); women 76%). A 1-mg dexamethasone suppression test (1-mg DST) was conducted to exclude CS, and thyrotropin (TSH) was measured to exclude hypothyroidism. Insulin sensitivity was estimated from oral glucose tolerance tests employing the Clamp-like index. Examinations were carried out at baseline, as well as at 6 and 12 months postoperatively.
The prevalence of CS was below 0.6%. Before surgery, TSH was elevated compared to an age- and sex-matched normal weight control group (2.4 ± 1.2 vs. 1.5 ± 0.7 μU/ml; p < 0.001). The NCEP criteria of metabolic syndrome (MetS) were fulfilled by 39.5% of the patients. Impaired glucose tolerance and diabetes mellitus were observed in 23.5% and 22.6%, respectively. Seventy-two percent were insulin resistant. During follow-up, weight (BMI 47 ± 6.9 vs. 36 ± 6.4 vs. 32 ± 6.6 kg/m(2); p < 0.001) and TSH decreased significantly (2.4 ± 1.2 vs. 1.8 ± 1.0 vs. 1.8 ± 1.0 μU/ml; p < 0.001). Serum cortisol was higher in the MetS(+)-group compared to the MetS(-)-group (15.0 ± 6.3 vs. 13.5 ± 6.3 μg/dl; p = 0.003).
CS appears to be a rare cause of morbid obesity. Normalization of slightly elevated thyrotropin after weight loss suggests that obesity causes TSH elevation rather than the reverse.
一些内分泌异常，包括甲状腺功能减退和库欣综合征（CS），被认为是肥胖的原因。本研究的目的是评估内分泌紊乱和肥胖相关合并症的患病率，以及大量体重减轻的影响。
对 433 例连续的病态肥胖患者（年龄 41 ± 12 岁；BMI 47 ± 6.9kg/m²；女性 76%）进行筛查。进行 1mg 地塞米松抑制试验（1-mg DST）以排除 CS，并测量促甲状腺激素（TSH）以排除甲状腺功能减退。采用钳夹样指数从口服葡萄糖耐量试验中估计胰岛素敏感性。在基线、术后 6 个月和 12 个月进行检查。
CS 的患病率低于 0.6%。手术前，TSH 水平高于年龄和性别匹配的正常体重对照组（2.4 ± 1.2 对 1.5 ± 0.7 μU/ml；p < 0.001）。符合代谢综合征（MetS）NCEP 标准的患者占 39.5%。葡萄糖耐量受损和糖尿病分别为 23.5%和 22.6%。72%的患者存在胰岛素抵抗。随访期间，体重（BMI 47 ± 6.9 对 36 ± 6.4 对 32 ± 6.6kg/m²；p < 0.001）和 TSH 显著下降（2.4 ± 1.2 对 1.8 ± 1.0 对 1.8 ± 1.0 μU/ml；p < 0.001）。MetS（+）组的血清皮质醇高于 MetS（-）组（15.0 ± 6.3 对 13.5 ± 6.3μg/dl；p = 0.003）。
CS 似乎是病态肥胖的罕见原因。体重减轻后略升高的促甲状腺激素恢复正常提示肥胖引起 TSH 升高，而不是相反。
