Department of Obesity and Endocrinology, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
Clin Endocrinol (Oxf). 2013 Aug;79(2):163-7. doi: 10.1111/cen.12256.
The increasing numbers of severely obese patients (body mass index BMI >40 kg/m(2) ) represent a significant management challenge. These patients are at risk of obesity-related complications that may be driven by changes in endocrine function. Their care may potentially be complex at times, and therefore, an appropriate assessment strategy will be relevant to timely diagnosis and management. In this article, we discuss an approach to the endocrine assessment of the severely obese patient. We consider the clinical question in three categories that may also represent different complexities in terms of subsequent management: (i) obesity as a consequence of structural lesions at the hypothalamic-pituitary region; (ii) obesity as a consequence of inherited and genetic syndromes; and (iii) functional neuroendocrine hormone abnormalities relating to obesity. The first two categories are associated with hypothalamic dysfunction, of which hypothalamic obesity is a consequence. Additionally, the implications and difficulties associated with imaging severely obese patients are discussed from an endocrinological perspective and we provide practical guidance on which to base practice.
越来越多的重度肥胖患者（体重指数 BMI＞40kg/m2）给管理带来了巨大挑战。这些患者存在肥胖相关并发症的风险，这些并发症可能是由内分泌功能改变引起的。他们的治疗有时可能很复杂，因此，一个适当的评估策略对于及时诊断和管理是相关的。在本文中，我们讨论了一种针对重度肥胖患者内分泌评估的方法。我们考虑了三类临床问题，这些问题在后续管理方面也可能具有不同的复杂性：（i）由于下丘脑-垂体区域的结构性病变而导致的肥胖；（ii）由于遗传和基因综合征而导致的肥胖；以及（iii）与肥胖相关的功能性神经内分泌激素异常。前两类与下丘脑功能障碍有关，其中下丘脑性肥胖是其后果。此外，还从内分泌学的角度讨论了对重度肥胖患者进行影像学检查的相关影响和困难，并提供了基于实践的实用指导。
