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Query: UMLS:C0028754 (obesity)
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The presenting signs, symptoms, roentgenographic findings, endocrine evaluations, treatment, and results in 68 cases of presumed pituitary adenomas treated over an 18-year period are discussed. The most common symptoms were headache, acromegalic changes, visual symptoms, and amenorrhea. Most common physical findings were obesity, acromegaly, and visual field defects, usually bitemporal hemianopsia. Roentgenographic evidence of sellar erosion was almost universal but angiography and pneumoencephalography were required to evaluate suprasellar extension. Brain scan was not considered a particularly useful diagnostic tool. Endocrine status was best evaluated by a battery of tests including 17-OH, 17-KS, T3, T4, PBI, ACTH stimulation, and FSH and STH levels. (Prolactin levels are currently being obtained, also). Surgical specimens were obtained in 29 patients, with subsequent diagnoses of 22 chromophobe adenomas, five eosinophilie adenomas, one cystic adenoma, and one necrotic tumor. All five eosinophilic tumors came from acromegalic patients. Patients treated by operation alone or operation followed by radiotherapy generally had less "medical morbidity" than did patients who received radiotherapy alone.
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PMID:Review of 18 years' experience with pituitary tumors. 19 48

Results of a study involving dynamic testing of hypothalamic-pituitary function in 26 patients attending the Gynecologic Reproductive Endocrine Service at John Hopkins University are presented. Patients included women with primary amenorrhea and few if any secondary sex characteristics (Group 1), primary amenorrhea with secondary sexual development (Group 2), secondary amenorrhea (Group 3), and amenorrhea with pituitary or supracellar tumors (Group 4). Subjects received a combined luteinizing hormone-releasing hormone (LH-RH)-clomiphene test and an estrogen provocation test. 100 mcg LH-RH was administered and blood samples obtained at 15, 30, and 45 minutes and at 1, 1 1/2, 2, 2 1/2, and 3 hours. 100 mg of clomiphene citrate was given daily for 7 days (the dosage of clomiphene varied somewhat with history of preexisting conditions). Blood was assayed for serum LH and follicle stimulating hormone (FSH) In the provocation test, 1 mg of estradiol was given and blood samples drawn 48, 72, and 96 hours thereafter. In Group 1, 3 patients were unresponsive to LH-RH stimulation and were without change in the baseline after either clomiphene or Enovid suppression. 3 other patients in this group had a fairly normal delta percent peak LH response to LH-RH. However, baseline or the delta percent peak LH response to LH-RH remained unchanged after clomiphene. The 7th patient in Group 1 has an immature hypothalamus. Group 2 consisted of 3 patients. 2 were found to have elevated baseline values of LH with normal FSH levels. 1 had a poor but mature response to clomiphene of the negative estrogen feedbacK. LH peak remained unchanged in response to LH-RH after clomiphene and estrogen response was negative. 2 of these patients conceived and 1 was diagnosed as able to conceive. In Group 3, 2 patients with massive obesity showed elevated serum LH values, 2 patients were infertile after oral contraceptives and were stimulated with human chorionic gonadotropin and clomiphene, 7 had anorexia and were diagnosed with the aestrogen provocation test. The patients in Group 4 were all studied in an effort to assess the pituitary gonadotropin reserve. These tests can be useful in this regard but must be considered in light of the patient's history and physical findings. Thus initial diagnoses were further subdivided by this method of dynamic testing. It helps establish areas of further testing.
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PMID:Dynamic testing of hypothalamic-pituitary function in abnormalities of ovulation. 34 92

Breast milk is a complete food for the first 4-6 months of life. It helps prevent diarrhea and obesity, and discourages the development of allergies. It is extremely difficult to put in economic terms the value of breastfeeding. Some of its benefits can be quantified in nonmonetary terms, such as morbidity, mortality, and population growth, while psychological benefits cannot be quantified. The authors of this article, however, attempt to estimate the economic value of breastfeeding in Ghana, and in the Ivory Coast. Calculated on a basis of a 2 year period, the cost of artificial feeding amounted to 310 U.S. dollars, to which another 210 should be added for the cost of the time spent in breastfeeding. This sum would be almost 3 times higher than that for breastfeeding in the same countries. Other economic implications must include the health-producing effects of breastfeeding, and the fact that lactation amenorrhea plays a crucial role in birth spacing, especially in developing countries.
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PMID:Economic importance of breastfeeding. 54 Jun 68

Daily plasma hormones, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrone (E1), estradiol (E2), progesterone, androstenedione, and testosterone (T), were measured in 16 anovulatory patients for a span of 3 to 4 weeks. The clinical diagnoses in this group of patients included the following: anovulation-eumenorrhea (n = 5), anovulation-polymenorrhea (n = 1), anovulation-oligomenorrhea (n = 3), congenital adrenal hyperplasia (n = 1), polycystic ovarian disease (n = 4), severe hypothalamic amenorrhea (n = 1), and postpartum amenorrhea-galactorrhea (n = 1). Follicular activity was evident in polymenorrheic and oligomenorrheic patients, and menstruation occurred in these patients following estrogen withdrawal. No follicular maturation was noted in the group of patients with anovulation-eumenorrhea, and menstruation in these patients was considered breakthrough bleeding. Low FSH levels were observed in anovulatory patients with eumenorrhea, polymenorrhea, and oligomenorrhea. Significantly high LH values were noted in both classic and non-classic polycystic ovarian disease. Extremely low E1 and E2 levels were found in patients with severe hypothalamic amenorrhea and postpartum amenorrhea-galactorrhea. Slightly elevated progesterone levels were observed in polymenorrheic and oligomenorrheic patients prior to menstruation; this was frequently associated with an LH surge or elevation. Elevated T levels were consistently associated with hirsutism but not with obesity.
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PMID:Plasma hormone profile in anovulation. 57 58

A massively obese, amenorrheic young woman had elevated levels of plasma androgens which could be reduced either acutely by dexamethasone administration or chronically by weight loss. Normalization of plasma androgen levels in both instances led to resumption of ovulation, suggesting that weight-related hyperandrogenism is a cause of amenorrhea in obesity.
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PMID:Secondary amenorrhea in obesity: etiologic role of weight-related androgen excess. 68 Feb 2

Ignoring of emaciation (IE), fear of any weight recovery (Dalpha), and dismorphophobias (DPP) represent the central problem of AN, with different incidence. Fundamental need of being lean expresses, at lesss in girls, distress of personality insufficiently prepared to autonomous adult life, with its responsabilities. Obesity-DPP may correspond to projection upon the body of the obsessing conviction of being inferior, with regard to social and publicitary patterns, and get an active play in starting and management of weight loss. So AN is either an attempt to accomodate this critic situation, trying to incarnate actual female archetype, either, in the more severe cases, a renouncing with an obstinate physical and psychological recession to the state of a protected child. It seems to correspond to an attempt of negation of morbid character of this situation, so that it may be perpetuated and so that feeling of culpability can be decreased in front of familial recrimination. Constancy of these symptoms, and their relation with deep meaning of this illness, justify their introduction into a new definition of AN, diagnosed by association of at less 2 out of 3 major criterious (loss of weight superior to 10% premorbid weight, feed restrictions and Dalpha) and one out of 2 minor criterions (amenorrhea and IE).
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PMID:[Dysperception of body image and dysmorphophobias in mental anorexia. Apropos of 115 cases involving both sexes. III. Physiopathogenic deductions and introduction of a novel definition of the disease]. 72 18

During pregnancy estrogen-medicated augmented prolactin secretion is presumably responsible for a 10-20 fold increase in circulating plasma prolactin; significant differences in basal levels between nursing and nonnursing women persist into the puerperium, reflecting the influence of sucking on maternal plasma prolactin. The release of prolactin is induced via a neurogenic pathway from nipple to hypothalamus and it is proportionate to the length of nursing and to the intensity of the stimulus. There is evidence supporting catecholamine/serotonin control of prolactin release, and the influence of changes in hypothalamic dopamine turnover. The composition of human milk is dependent on various factors; overall, fat composition is 2-5% and protein 9% at 3 weeks and 5% thereafter; milk delivers 20-25 calories per ounce; total fluid and nutritional requirements of the newborn can be met by breastfeeding up to 6 months postpartum. Maternal malnutrition negatively affects lactation; gestational, rather than progestational, food intake influences lactation. Immunity in the newborn is provided also by breast milk through immunoglobulins, thus enhancing the child's protection against internal pathogens. The incidence of gastrointestinal disorders is 1.5/1000 in breastfed infants, and 84.7/1000 in bottle fed infants; the incidence of respiratory infection is .4/1000 and 48/1000, respectively. Prolactin may exert an inhibitory influence on ovarian steroidogenesis, and gonadotropin secretion is disrupted by nipple stimuation; this may account for the low percentage of ovulation among nursing mothers. Lactational amenorrhea has been proven to have great demographic impact; dramatic variations in fertility on the basis of variations in lactational amenorrhea have been described in rural areas of Latin America, Asia, and Africa. Reduction of lactational amenorrhea results not only from changes in sociocultural patterns, but from improved maternal nutrition, often through nutrition programs. When nursing has to be interrupted because of complications full lactation may be restored by oral administration of thyrotropin-releasing hormone. Breastfeeding is possible in 99% of women; the denial of lactation may cause the retention of unwanted weight, which can be compounded by the use of oral contraceptives. Moreover, infantile obesity may stem from the lack of a satiety signal in bottle fed newborns.
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PMID:Mechanisms of puerperal lactation. 83 86

The case of a 35-year-old woman who demonstrated androgenic obesity, absence of ovulation, and amenorrhea is examined. This patient showed arterial hypertension, diabetes mellitus, hirsutism, and anovulatory cycles. A very high concentration of estrone was noted in the urine, originating in the adrenal glands. These indications are generally considered during evaluation of breast or uterine cancer threat. Administration of dexamethasone led to a decrease in urinary estrone to insignificant levels. Stimulation with human chorionic gonadotropin caused an increase in ovarian activity. The disruptions this patient suffered were attributed to hormonal imbalances attributed to her obesity, primarily in regard to estrogen metabolism.
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PMID:[Uncommonly high concentration of estrone of adrenal origin in a case of androgenic obesity, anovulation and amenorrhea]. 90 13

Cyclophosphamide and other alkylating agents suppress ovarian function in pre-menopausal women. However, endocrine details remain unknown regarding the influence of patients' age and obesity on CMF-induced hormonal changes. We studied changes in endocrine profile due to chemotherapy (CMF) in 70 pre-menopausal patients with axillary node positive, stage II and/or III breast carcinoma. Plasma levels of estrone (E1), estradiol (E2), androstenedione (A2), luteinizing hormone (LH), and prolactin (PRL) were determined on day 1 and 8 of each chemocycle for 12 cycles. After receiving therapy, 23% of the women continued to have regular menstrual cycles (non-amenorrheic group). In the remaining 77%, ovarian function was suppressed, as evidenced by the onset of amenorrhea within 0-11 months (amenorrheic group). The mean time to amenorrhea was 2.83 +/- 0.33 months (SE). The time required to develop amenorrhea inversely correlated to the patient's age. Both incidence of amenorrhea and time to amenorrhea remained unaffected by either patient's obesity or the timing of chemotherapy initiation in relation to menstrual cycle phase (progestational, follicular). Plasma hormone levels fluctuated widely in both groups during the first three chemocycles. During chemocycle months 4 to 10, in the amenorrheic group, plasma E1, E2, and P declined to their baseline levels with a concomitant rise in LH levels. At this time, E1, E2, and P levels were significantly lower in amenorrheics, despite menstrual cycle associated fluctuations in the non-amenorrheic group. Estrogens (E1 and E2) gradually declined further following the onset of amenorrhea in subsequent months. Further data analysis suggests that host age or obesity did not influence CMF-induced changes in the plasma endocrine profile.
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PMID:Endocrine profile in breast cancer patients receiving chemotherapy. 155 88

The authors report a very rare case of pituitary adenoma producing both GH and ACTH. A 29-year-old female was admitted with obesity, amenorrhea, acromegaly, hirsutism, excessive pigmentation, acne, and diabetes mellitus. Computed tomography revealed an intrasellar tumor 16 mm in height, with a destroyed sellar floor. The blood concentrations of GH, ACTH and cortisol were increased (GH: 92 ng/ml, ACTH: 94 pg/ml, cortisol: 18.3 micrograms/dl). No diurnal variation in the amount of cortisol was observed. The urinary 17-OHCS was suppressed by 8 mg but not by 2 mg of dexamethasone. A subtotal adenomectomy was then performed through the transsphenoidal approach, which led to a sufficient reduction of both blood GH and ACTH (cortisol). Histologically the tumor was an acidophilic pituitary adenoma. Immunoperoxidase staining showed diffuse GH and sporadic ACTH producing cells, but failed to show any cells producing both hormones. The electron micrograms of neoplastic cells showed the ultrastructural characteristics of respective GH and ACTH cells. Another increase in both GH and cortisol, which occurred 19 months after the operation, has been controlled by bromocriptine administration. This case may be the first reported case of a pituitary adenoma producing both GH and ACTH, not accompanied by prolactin (PRL) hypersecretion, which has been fully confirmed endocrinologically and histopathologically.
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PMID:A case of pituitary adenoma producing both growth hormone (GH) and adrenocorticotropic hormone (ACTH). 166 12


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