How to Approach Endocrine Assessment in Severe Obesity?
How to Approach Endocrine Assessment in Severe Obesity?
The increasing numbers of severely obese patients (body mass index BMI >40 kg/m) 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.
High levels of obesity pose challenges to healthcare providers worldwide because of the associated complications such as diabetes, cardiovascular disease, cancers and sleep-related breathing disorders that increase morbidity and mortality. Adults with a body mass index (BMI) of 40 kg/m or more are considered to have severe (previously termed 'morbid') obesity (Class III obesity by WHO classification). In the USA, the estimated prevalence of severe obesity is approximately 5·1%; in England, 3·8% of females and 1·6% of males are affected. These patients increasingly present in clinical practice, and questions concerning endocrine testing and interpretation may arise. It is known that changes in neuroendocrine function are associated with severe obesity. However, the effects of these changes may be subtle or symptoms experienced attributed solely to the presence of obesity per se, with potential for delayed identification and investigation. In this article, an approach to this clinical question is discussed. Additionally, it is important to highlight potential considerations that should be borne in mind when requesting imaging investigations for these patients.
Abstract and Introduction
Abstract
The increasing numbers of severely obese patients (body mass index BMI >40 kg/m) 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.
Introduction
High levels of obesity pose challenges to healthcare providers worldwide because of the associated complications such as diabetes, cardiovascular disease, cancers and sleep-related breathing disorders that increase morbidity and mortality. Adults with a body mass index (BMI) of 40 kg/m or more are considered to have severe (previously termed 'morbid') obesity (Class III obesity by WHO classification). In the USA, the estimated prevalence of severe obesity is approximately 5·1%; in England, 3·8% of females and 1·6% of males are affected. These patients increasingly present in clinical practice, and questions concerning endocrine testing and interpretation may arise. It is known that changes in neuroendocrine function are associated with severe obesity. However, the effects of these changes may be subtle or symptoms experienced attributed solely to the presence of obesity per se, with potential for delayed identification and investigation. In this article, an approach to this clinical question is discussed. Additionally, it is important to highlight potential considerations that should be borne in mind when requesting imaging investigations for these patients.