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

Carcinoma of the endometrium is the most common gynecologic malignancy, expected to account for 33,000 new cases and 6,000 deaths in 1995. Most endometrial cancers occur in postmenopausal women and produce abnormal vaginal bleeding. Some women exhibit the premalignant changes of atypical endometrial hyperplasia before developing an overt carcinoma. Identified epidemiologic risk factors include obesity, diabetes mellitus, use of unopposed exogenous estrogens, estrogen-secreting tumors, and a reproductive history characterized by prolonged estrogenic predominance. Diagnosis can be readily established by outpatient endometrial biopsy. Because clinical estimates of disease extent and spread are subject to substantial error, endometrial cancer is now a surgically staged neoplasm. A well-defined set of surgicopathologic risk factors have been incorporated into the staging scheme. Women with extrauterine disease comprise about 20% of cases and are at greatest risk for tumor recurrence and death from disease. Within the much larger group of women whose tumors are limited to the uterus, recurrence risk can be stratified by cytologic grade, cell type, depth of myometrial invasion, and extension to the cervix. About two-thirds of women have low-risk disease confined to the uterus when these criteria are employed, while the remaining one-third have high-risk subtypes. Recent areas of investigation have focused on molecular and genetic markers. Two clinical observations currently being examined are the poorer survival of Black women with uterine cancer and the apparent association of endometrial lesions with chronic tamoxifen suppression in women with breast carcinomas.
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PMID:Clinical aspects of risk in women with endometrial carcinoma. 874 87

Women at risk of uterine cancer include those with one or more of the following characteristics: obesity, nulliparity, late menopause, diabetes mellitus, prolonged unopposed estrogen use, and tamoxifen therapy. Risk is additionally increased by the presence of endometrial hyperplasia. The incorporation of biomarkers into the selection criteria of cohort groups at risk for developing endometrial cancer offers an innovative approach to the clinical design of chemoprevention trials of endometrial adenocarcinoma. Biomarkers that may be useful in cohort selection include nuclear morphometry, specific genetic abnormalities, and markers of proliferation and differentiation.
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PMID:Potential criteria for cohort selection in chemoprevention trials of uterine adenocarcinoma. 874 95

Endoscopic techniques were used to ovariohysterectomize two hybrid Asian lions (Panthera leo) in order to reduce the risk of postoperative wound complications associated with standard surgical techniques. One of the lions was aged, overweight, and considered an anesthetic risk. The animals were anesthetized, intubated, catheterized intravenously, and placed in dorsal recumbency with the head lower (Trendelenburg position). Ventilation was assisted mechanically. Following abdominal insufflation, a surgical trocar was placed in the abdominal cavity. Two additional 12-mm surgical trocars were placed under direct visualization using a videoscope. The ovaries and uterus were removed endoscopically, and the abdominal cavity was inspected for hemorrhage under decreased insufflation pressure before closure. The surgery was complicated by obesity, by uterine enlargement from cystic endometrial hyperplasia and endometrial polyps, and by ovarian enlargement and fragility because of bilateral cystic rete ovarii. The procedure and anesthetic recovery were uneventful. Postsurgical recovery time and convalescence lasted less than 3 days, and the animals were reintroduced to an exhibit mate and placed on exhibit within 8 days. The technique is appropriate for use in lions, even those with pathologic reproductive changes, in zoos.
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PMID:Endoscopic ovariohysterectomy in two lions (Panthera leo). 936 42

Endometrial hyperplasia is thought to be caused by the prolonged, unopposed oestrogenic stimulation of the endometrium. The regression of hyperplastic back to normal endometrium is the main purpose of any conservative treatment in order to prevent development of adenocarcinoma. The aim of this study was to evaluate the regression of hyperplastic to normal endometrium in patients with various forms of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue (GnRHa) triptorelin for 6 months. Fifty-six patients with endometrial hyperplasia were enrolled in this trial; 39 patients (group I) presented simple hyperplasia, 14 (group II) complex hyperplasia and three (group III) atypical complex hyperplasia. All patients were treated with triptorelin for 6 months. Bleeding control during treatment was excellent. A post-treatment curettage for estimation of endometrial histology was performed on 54 out of 56 patients 100.1 +/- 44.7 days after the last triptorelin dose, following the restoration of pituitary function. Regression of hyperplastic to normal endometrium was observed in 32 (86.5%) out of 37 patients in group I and in 12 (85.7%) out of 14 in group II. Persistence of simple hyperplasia was found in five (14.5%) out of 37 patients in group I. Persistence of complex hyperplasia was found in 1 (7.1%) out of 14 patients and progression to atypical complex hyperplasia in another one (7.1%) woman in group II. In some of these cases, the presence of risk factors such as obesity, diabetes mellitus and ovulatory disturbances may contribute to the disease persistence despite therapy. On the other hand, in group III, none of the three patients had normal post-treatment endometrial histology. It seems, therefore, that in cases of endometrial hyperplasia without atypia, the administration of the GnRHa triptorelin is associated with high regression rates to normal endometrium. Conversely, the presence of atypia seems to be a poor prognostic factor. Treatment tolerance and bleeding control during therapy is excellent.
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PMID:Regression of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue triptorelin: a prospective study. 1009 98

Many adolescents present with hirsutism and irregular menses. The challenge for the clinician is to distinguish physiologic anovulatory cycles from true menstrual disorders such as PCOS, and to differentiate PCOS from other causes of hyperandrogenism in hirsute adolescents. Common clinical features seen in adolescents with PCOS include hirsutism, acne, menstrual irregularity, and obesity. Biochemical abnormalities include hyperandrogenism, acyclic estrogen production, LH hypersecretion, decreased levels of SHBG, and hyperinsulinemia. Management strategies for a patient with PCOS include treatment of features which may cause distress to the adolescent, such as hirsutism, acne, and irregular menses, and prevention of long-term sequelae. Oral contraceptive pills, antiandrogens, and cosmetic treatments are used to treat hirsutism, acne, and menstrual irregularity. Oral contraceptive pills or medroxyprogesterone acetate are given to prevent endometrial hyperplasia and carcinoma. Counseling about weight loss and nutrition are essential, as weight loss may improve signs of hyperandrogenism and menstrual irregularity and may prevent NIDDM and cardiovascular disease. Insulin-sensitizing agents show promise in terms of decreasing hyperandrogenism, restoring ovulatory cycles, treating infertility, and preventing long-term sequelae. Finally, it is important to recognize that adolescents with PCOS may experience psychological distress because of the clinical manifestations of hyperandrogenism or when confronted with the information that they have a chronic illness. Psychological support should be available for these young women. Future research is likely to further elucidate the pathophysiology of PCOS, identify candidate genes, and clarify which adolescents are at risk for long-term sequelae. Prospective studies are needed to identify which therapies could potentially reduce the risk of infertility, diabetes, cardiovascular disease, and endometrial carcinoma in young women with PCOS.
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PMID:Polycystic ovary syndrome. 1037 Jul 13

Anorexia nervosa is a complex psychiatric disorder with endocrinologic manifestations primarily affecting adolescent females. The classic triad of presenting symptoms is weight loss in excess of 15% of ideal body weight, behavioral changes and amenorrhea (secondary or primary). The menstrual irregularities may cause the patient or family to seek gynecologic consultation before the diagnosis of primary psychiatric disorder has been made. Bulimia is a separate disease entity characterized by compulsive overeating binges followed by compensatory purging behavior to maintain a desired weight. Depending on the degree of psychiatric disturbance, purging, and ultimate body weight, such patients may or may not present with menstrual abnormalities. Hypoestrogenic hypothalamic amenorrhea in both types of patients may result in osteoporosis, stress fractures, and infertility. Obese women, in contrast to the above, most often have abnormally heavy bleeding patterns secondary to chronic anovulation. Their-short term gynecologic concerns may be cycle control or infertility, but over the long term they are at increased risk for endometrial hyperplasia and cancer.
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PMID:Managing adolescents with eating disorders. 1043 10

We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), using data from a case-control study. One hundred twenty nine women aged 35-73 (median 51 years) with histologically confirmed complex endometrial hyperplasia without atypies identified at the University of Milan during the period 1990-99 were examined. Controls were 258 non hysterectomized women aged 36-74 (median 52 years), admitted to a network of hospitals covering the same area where cases had been identified for conditions other than gynecological, malignant, or hormone-related. Cases with EH were more educated than controls (OR > 12 years of education vs. < 7: 2.8, 95% CI 1.7-4.8), more frequently obese (OR 2.7, 95% CI 1.5-5.0) and diabetic (OR 2.4, 95% CI 0.8-6.9). Parous women (OR 1.8) and women reporting induced abortions (OR 1.6) showed an increased risk of EH, but the associations were not statistically significant. Compared to premenopausal women, the OR of EH was 0.2 (95% 0.1-0.5) for postmenopausal ones. Compared to women reporting menopause at age 50 or less, the OR of endometrial hyperplasia was 1.5 (95% CI 0.6-3.5) and 2.2 (95%CI 0.7-6.7), respectively, in women with menopause at age 50-52 and > or = 53. Considering postmenopausal women only the OR was 3.1 (95% CI 1.1-9.3) for use of hormonal replacement therapy (HRT). We conclude that this study indicates that high education, obesity, diabetes, and HRT use increase the risk of endometrial hyperplasia.
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PMID:Risk factors for endometrial hyperplasia: results from a case-control study. 1206 Apr 46

A carefully taken history and clinical examination are necessary for assessing the relative benefits and risks of estrogen replacement therapy for an individual patient. The patient's weight, blood pressure and urine need to be checked. Benefits of estrogen replacement are seen in relation to vasomotor symptoms, atrophy of the genital tract, bone metabolism, psychological symptoms, libido, skin, and cardiovascular effects. Estrogens are contraindicated with a history of previous deep vein thrombosis, ischemic heart disease or carcinoma of the breast. Care needs to be taken with liver disease, hyperlipidemias, diabetes, gallbladder disease, gross obesity, or in heavy smokers. Progesterones should always be administered if the uterus is present to prevent endometrial hyperplasia and adenocarcinoma. When properly selected and carefully monitored, many women may be relieved of unnecessary suffering due to menopause.
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PMID:Estrogen replacement therapy: its benefits and risks. 1227 83

The question is whether the administration of estrogenic substances to the human female causes cancer of the endometrium. Current data seems to indicate that in predisposed individuals the unopposed action of estrogenic substances for a considerable period of time will result in endometrial adenomatous hyperplasia, carcinoma in situ (atypical adenomatous hyperplasia), and eventually carcinoma. The relationship of estrogenic substances to the development of endometrial hyperplasia of all degrees is clear, but the relationship of these substances to invasive endometrial cancer is blurred by assumptions based on individual case reports, retrospective reasoning, and uncontrolled experimentation. 4 published reports reviewed here have compared the use of exogenous estrogen by patients with endometrial cancer to that by controls. These studies have not been comprehensive and they raise more questions than they answer. If a physician chooses to use estrogen for the treatment of symptoms or signs of estrogen insufficiency, the selection of patients is crucial. Obesity, hypertension, diabetes, and infertility associated with oligo-ovulation are predisposing factors in the development of endometrial cancer, and patients with these conditions should have endometrial biopsy or uterine aspiration before the institution of therapy. There are 2 therapeutic regimens which can be used to prevent or even reverse the endometrial hyperplasia that may otherwise result from excessive and continuous estrogen administration.
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PMID:Estrogen controversy updated. 1233 9

The antiestrogen drug tamoxifen, which is widely used in adjuvant hormone therapy of breast cancer, presents certain risk of causing hyperplasia and endometrial carcinoma. Our clinical data on 1,969 breast cancer patients (stage I-III) (tamoxifen--947; control--1,022) showed a double rise in endometrial carcinoma risk in cases receiving hormone therapy. Endometrial carcinoma incidence in tamoxifen-treated patients was 3% while in the untreated ones--1.6% (p < 0.05). According to the endometrial tissue study in 439 breast cancer patients, proliferative effect of tamoxifen in the form of endometrial hyperplasia was 5--6 times in tamoxifen users. Meanwhile, endometrial carcinoma and hyperplasia risk increased during a much longer exposure to tamoxifen and in combination with such factors as obesity, diabetes mellitus, uterine myoma and estrogen-type colpocytological response. Hence, breast cancer patients need to undergo dynamic follow-up of the endometrium including ultrasonic examination of the small-pelvis organs and cytological study of ecto- and endocervical smears and endometrial aspirates.
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PMID:[Risk of endometrial hyperplasia and carcinoma in breast cancer patients receiving adjuvant tamoxifen]. 1278 5


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