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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is associated with insulin resistance and some reproductive abnormalities. Circulating FFAs are often elevated in obese subjects and are also closely linked to insulin resistance. In this study, we demonstrated that saturated FFAs, such as palmitic acid and stearic acid, markedly suppressed the granulosa cell survival in a time- and dose-dependent manner. Polyunsaturated FFA, arachidonic acid, had no effect on the cell survival, even at supraphysiological concentrations. The suppressive effect of saturated FFAs on cell survival was caused by apoptosis, as evidenced by DNA ladder formation and annexin V-EGFP/propidium iodide staining of the cells. The apoptotic effects of palmitic acid and stearic acid were unrelated to the increase of ceramide generation or nitric oxide production and were also completely blocked by Triacsin C, an inhibitor of acylcoenzyme A synthetase. In addition, acylcoenzyme A, pamitoylcoenzyme A, and stearylcoenzyme A markedly suppressed granulosa cell survival, whereas arachidonoylcoenzyme A had no such effect, and this finding was consistent with the effect of the respective FFA form. Surprisingly, arachidonic acid instead showed a protective effect on palmitic acid- and stearic acid-induced cell apoptosis. A Western blot analysis showed the apoptosis of the granulosa cells induced by palmitic acid to be accompanied by the down-regulation of an apoptosis inhibitor, Bcl-2, and the up-regulation of an apoptosis effector, Bax. These results indicate that saturated FFAs induce apoptosis in human granulosa cells caused by the metabolism of the respective acylcoenzyme A form, and the actual composition of circulating FFAs may thus play a critical role in the apoptotic events of human granulosa cells. These effects of FFAs on granulosa cell survival may be a possible mechanism for reproductive abnormalities, such as amenorrhea, which is frequently observed in obese women.
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PMID:Saturated FFAs, palmitic acid and stearic acid, induce apoptosis in human granulosa cells. 1145 7

In humans, the skin is a target tissue for androgen action; hair growth and sebum secretion are under active androgen control. An increased production or metabolism of testosterone, the main active androgen, shows up clinically in dermatological symptoms such as hirsutism, hyperseborrheic acne and alopecia. Polycystic ovary syndrome (PCOS) is the most frequent androgen disorder of ovarian function. PCOS patients have amenorrhea or severe oligomenorrhea, increased testosterone levels and most often enlarged polycystic ovaries on ultrasound examination. In addition, many PCOS patients have a tendency to accumulate abdominal fat and/or to develop obesity. Some also display a particular metabolic pattern including an atherogenic lipid profile, glucose intolerance and an increased fasting insulin level, which is known to be closely linked with an insulin resistant state. Several studies have now reported that PCOS patients show increased incidence of type 2 diabetes and cardiovascular disease. In addition to being a target for androgens the skin has abundant insulin receptors on the keratinocyte surface membrane and acanthosis nigricans is a common symptom of severe insulin resistance among patients with insulin receptor disorders. However, acanthosis nigricans could also be present in PCOS women given evidence of the intensity of their insulin resistance. This presentation will review the mutual relationship between hyperandrogenia and insulin resistance, with particular attention paid to: (1) insulin secretion and insulin sensitivity in PCOS; (2) the complexity of the molecular mechanisms involved in insulin resistance; (3) the paradoxical relationship between insulin resistance and hyperandrogenia; (4) the current genetic studies; and (5) new avenues for long-term treatment of PCOS women.
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PMID:Association of insulin resistance with hyperandrogenia in women. 1159 27

The paper concerns the treatment results of 113 women with PCO-S by laparoscopic (102) and microlaparoscopic (11) ovarian electrocautery. All of them were qualified for operation on the basis of the following criteria: menstrual cycle disturbances (oligo-/amenorrhoea), anovulation, hirsutism, obesity, LH/FSH ratio > 2 and when more than 10 follicles of < 8 mm diameter are seen in the ovary under theca albuginea in USG examination. During the one year after operation these women were observed. In the first group (patients after laparoscopy) ovulation occurred in 86 (84%) and pregnancy in 54 (53%); accordingly in the second group (women after microlaparoscopy) ovulation occurred in 9 (83%) and pregnancy in 4 (45%). The treatment results by microlaparoscopic and laparoscopic ovarian electrocautery are similar, but the method by microlaparoscopy is easier to carry out in selected cases.
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PMID:[The effects of micro-laparoscopic ovarian electrocautery as a method of polycystic ovary syndrome treatment]. 1159 50

Transvaginal ultrasound is currently the gold standard for diagnosing polycystic ovaries. The results of studies using ultrasound suggest a prevalence in young women of at least 20%. Between 5% and 10% of these women with polycystic ovaries shown on ultrasound will have the classical symptoms of polycystic ovary syndrome such as infertility, amenorrhoea or signs of hirsutism and obesity, as originally described by Stein and Leventhal in 1935. However, the significance of polycystic ovaries in asymptomatic women is still under investigation, as is the role of Doppler (pulsed and colour) and three-dimensional ultrasound. Ultrasound has also contributed to our understanding of the local and systemic haemodynamic changes associated with polycystic ovaries, although the relationship of these changes to morbidity and mortality is unknown.
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PMID:Polycystic ovaries. 1180 52

Clinical characteristics of PCOS Syndrome Two fundamental characteristics: hyperandrogenism and anovulation which lead to hirsutism and oligo-or amenorrhea. Other features include obesity, acanthosis nigricans, and metabolic disruption (insulin resistance with hyperinsulinemia, glucose intolerance, or type II diabetes mellitus). Complementary tests Serum testosterone and DHEA-S levels: to exclude androgen-producing tumors. Serum 17-hydroxyprogesterone level: to exclude congenital adrenal hyperplasia, 21-hydroxylase deficiency. Ultrasound: increased size of the ovaries and central stroma with presence of peripheral follicular cysts (8-10) measuring about 8 mm in diameter. Pathophysiology Therapeutic approaches Therapeutic approaches
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PMID:[Polycystic ovaries in 2001: physiology and treatment]. 1198 85

This study was performed to determine whether the sisters of women with polycystic ovary syndrome (PCOS) have evidence for insulin resistance. Three hundred and thirty-six women with PCOS, 307 sisters of these probands, and 47 control women were studied. The sisters were grouped by phenotypes: PCOS [hyperandrogenemia (HA) with chronic oligo- or amenorrhea, n = 39], HA with regular menses (n = 36), unaffected (UA; n = 122), and unknown (n = 110). The analyses were adjusted for age and body mass index. PCOS and HA sisters of women with PCOS had similar and significantly elevated fasting insulin levels (P = 0.001) as well as similar and significantly decreased fasting glucose/insulin ratios (P < 0.001) suggestive of insulin resistance compared with UA sisters and control women. Markers of insulin resistance were associated with hyperandrogenemia and not with menstrual irregularity. PCOS sisters also had decreased levels of SHBG (P = 0.02) suggestive of higher ambient insulin levels. PCOS sisters had increased levels of proinsulin (P = 0.04) compared with control women, which suggested pancreatic beta-cell dysfunction in this group of sisters. The magnitude of obesity also differed significantly among the groups of sisters. The PCOS sisters were significantly more obese than all the other groups, and the HA sisters were more obese than the UA sisters. We conclude that markers of insulin resistance are associated with hyperandrogenemia rather than menstrual irregularity in the sisters of women with PCOS. Menstrual irregularity may be related to the magnitude of insulin sensitivity or insulin secretion or to other factors associated with obesity.
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PMID:Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenemia rather than menstrual irregularity. 1199 52

The relationship between the body weight and the function of hypothalamopituitary-ovarian axis was longtime studied. Frisch and Ravell (1971) have proposed the hypothesis that the onset of menarche is strong related to the achievement of a critical body weight. These authors observed that, despite the decrease in the last 120 years of the menarche age from 16.5 to 12.5 year-old, the body weight at which the menarche appears remains unchanged, 47.5 +/- 0.5 Kg. Many studies show the importance of both, body weight and fat mass percentage, in the appearance of menarche at puberty, or in the restoration of menses after the weight loss amenorrhea. Primary or secondary underweight amenorrhea can be associated to an eating disorder (anorexia nervosa, bulimia nervosa, or the alternation of these to clinical conditions), to severe exercise (athletes, gymnasts, dancers) or to malnutrition. The connected signal between metabolic status and reproductive function may be represented by the substances like: insulin, amino acids, IGFPB-I, leptin. The low levels of leptin were found in underweight female with oligo or amenorrhea. By the other hand, obesity is not a primary factor causing chronic anovulation. However, obesity may aggravate an already existing subtle defect in some women and result in amenorrhea.
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PMID:[The influence of body weight upon the function of ovarian axis]. 1209 75

A 23-year-old patient who was examined in 1910 by Harvey Cushing triggered his lifelong interest in the syndrome that bears his name. "Minnie G.," as she became historically known, presented with a "...syndrome of painful obesity, hypertrichosis, and amenorrhea with overdevelopment of secondary sexual characteristics accompanying a low grade of hydrocephalus and increased cerebral tension." This case stimulated Harvey Cushing's inquisitive mind and sparked an interest that 20 years later culminated in his seminal report, "The basophil adenomas of the pituitary gland and their clinical manifestations (pituitary basophilism)." In this classic work, Cushing reported in detail the cases of two patients encountered from his own practice and 10 similar cases collected from the literature. Minnie G. was the first case that Cushing reported. The clinical course of that case is briefly reviewed in this article.
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PMID:Cushing's case XLV: Minnie G. 1213 25

This study included 125 women with specific complaints following tubal ligation. In most instances the ligations had been done 7 years previously, mostly for multiparity. 92% had been ligated by the abdominal route 88.8% had symptoms including menstrual irregularities, chronic pain, obesity, psychoses, intermittent acute retention of urine, ventral hernia, and 2 cases of sterilization failure. Average age at time of tubectomy had been 31 years; average parity, 3-4. There was a shift towards right in mean maturation index of cervical cells soon after sterilization. This shift then decreased for a year, then gradually rose, stabilizing at 12 years. Amenorrhea was present in 5 cases with high mean maturation levels. 17 cases of oligomenorrhea all showed ahigh estrogenic activtiy. Of 27 cases of menorrhagia endometrial biopsies were taken in 13. 12 showed the proliferative phase and 1 the secretory phase. These findings correlated with cytological findings, but cervical mucus in 3 cases did not coincide. Of the 27 cases 21 were anovular. In all the karyopyknotic index was high. 2 cases showed clinical evidence of inflammation. Of 10 cases of dysmenorrhea, 3 were ovulatory; inflammation was present in 3. In 12 cases of polymenorrhea 7 showed high estrogenic activities. In 1 a polyp had caused the irregular bleeding. The observed shifts of maturation index of cervical cells toward the right are considered indicative of hyperovarian activity. Results show that ovarian activity after sterilization by tubectomy was normal or increased. The increased activity was considered either psychological,neurovascular, or caused by inflammation. Of the 10 cases with inflammation, 9 were associated with menstrual disorders.
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PMID:Menstrual disorders after sterilization with special reference to ovarian activity. 1225 47

Obesity is a risk factor for women in both pregnancy and contraception. Obesity per se does not cause sterility, but problems in gonadotropic function can arise during periods of rapid weight gain in bulimic episodes. Dysovulation is more common in such cases than amenorrhea. In established obesity, anovulation may occur, as demonstrated by the temperature curve and hormonal levels, but it is usually due to other factors such as ovarian polycystic syndrome or Cushing's syndrome. The main problems of obesity during pregnancy are carbohydrate metabolic disorders and hypertension. In 1 study, hypertension was found in 42.4% of pregnancies of obese women vs. 5.84% in controls; 22% of cases were severe, with blood pressure over 160/100. Carbohydrate metabolic difficulties were found in 11.8% of obese subjects vs. 1.2% of controls. The main consequence of maternal obesity on the child is macrosomy; occurring in 21.3% of births vs. 5.8% in controls. 5.1% of births to obese women are postmature vs. .7% in controls. The rate of cesareans for obese women is high. Improved fetal prognosis in pregnancies of obese women requires increased clinical surveillance for signs of hypertension or excessive weight gain and laboratory monitoring of glucose metabolism every month or even every 2 weeks. A sonogram should be done to detect macrosomy. A careful diet of 1200-1500 calories per day is recommended. 40% should be protein and 30% lipid. Rapid-absorption sugars should be excluded. Oral contraceptives appear to cause weight gain because estrogen stimulates the appetite and progestins have an anabolizing action. If weight gain exceeds 3 kg, a low dose pill and a restrictive diet should be recommended. OCs should be terminated if weight gain continues, and anomalies of glucose or lipid metabolism should be ruled out. Obesity constitutes a relative contraindication for use of combined OCs. Combined OCs may aggravate the obesity. Obesity on the other hand is a risk factor for cardiovascular accidents in OC users. IUDs are preferred for multiparous obese women. Nulliparas and multiparas with absolute contraindications to IUDs can use low-dose OCs if there are no other cardiovascular risk factors, no weight gain, and blood pressure and lipid and glucose metabolism are checked every 6 months. If these conditions cannot be met, the use of condoms or spermicides is recommended.
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PMID:[The obese woman: pregnancy and contraception]. 1228 89


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