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

Polycystic ovarian disease has a variety of biochemical and clinical features with great individual variation. In our clinical experience, oligo-ovulation, manifested as oligomenorrhea or frank amenorrhea, associated with an acyclic estrogen milieu, is a consistent finding. This may be associated with hyperandrogenemia, hirsutism, inappropriate gonadotropin levels, hyperprolactinemia, obesity, insulin resistance, and ultrasound evidence of multicystic enlarged ovaries. A common presentation is infertility or irregular menstruation secondary to oligo-ovulation and hirsutism secondary to altered androgen metabolism. A challenge in diagnosis is to differentiate polycystic ovarian disease from latent cases of congenital adrenal hyperplasia. Although the precise mechanism in the pathogenesis of polycystic ovarian disease remains undefined, altered function of the hypothalamic-pituitary-ovarian and adrenal axes is both involved and integrated. Results from clinical trials of ovulation induction using different agents have implicated one site or another as the major progenitor of the "vicious cycle" but with no definitive pathway established. Restoring fertility to these patients can be challenging in that not all patients with polycystic ovarian disease respond to clomiphene or do so satisfactorily. The use of glucocorticoid suppression, pituitary suppression with GnRH analogues, or the use of FSH alone may be of benefit in clomiphene treatment failures.
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PMID:Polycystic ovarian disease. 332 31

Serum estradiol (E2) levels were measured in 451 men attending an infertility clinic and 80 fertile men attending for vasectomy. The normal range of E2 levels found in fertile men was 70 to 200 pmol/l. Subfertile men had lower mean E2 levels than fertile men (P less than 0.05), but there was no relationship to obesity, cigarette smoking, age, or the male infertility diagnostic category. E2 levels in the subfertile group gave no prognostic information concerning future fertility. The authors conclude that E2 measurements in male patients are not useful in clinical infertility practice.
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PMID:Estradiol and male fertility. 336 Jan 76

Clinical and pathological studies were performed on 51 cases with endometrial cancer. The results are as follows: The average age was 58.9 years and the range 41 to 80 years. Forty-one (80.4%) patients were postmenopausal and the average menopausal age was 49.1 years. All cases were symptomatic and in 35 (76.5%) cases the postmenopausal bleeding was noted as a chief complaint. The chief complications were obesity (37.5%), hypertension (25.0%), infertility (13.7%) and diabetes mellitus (9.4%). Of 51 cases, 36(70.6%) were in Stage I, 7(13.7%) in Stage II, 6(11.8%) in Stage III and 2(3.9%) in Stage IV. When the depth of the invasion was classified into 3 grades, less than 1/3 of the muscular layer, between 1/3 and 2/3, and over 2/3 in 48 cases examined, they were observed in 20(41.7%), 10(20.8%) and 18 cases (37.5%) respectively. There were 6 cases (15%) with lymph node involvement in 40 cases examined. Those in which the depth of invasion was over 2/3, had a significantly higher incidence of lymph node involvement. The five year cumulative survival rate was 66.7%(14/21) for all cases. The clinical stage and age of the patients had a significant correlation with the prognosis of endometrial cancer, but the histological grades, the depth of invasion, and lymph node involvement did not demonstrate the a significant correlation in prognosis in this study. The five year survival rate for the group treated by modified pan-hysterectomy with pelvic lymphadenectomy was 92.3% which was significantly higher than the 25% of the group treated by simple hysterectomy or than the 0% of non-surgical group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinico-pathological study and appraisal of treatment for endometrial cancer at the Ehime University Hospital]. 355 19

Ninety-five patients diagnosed as having stage I endometrial carcinoma (EC) were divided into two groups, one with associated adenomatous hyperplasia (AH; group 1) and the other without (group 2). Adenomatous hyperplasia results from estrogenic stimulation of the endometrium. Therefore, patients in group 1 are considered to have an estrogen-related EC. Group 1 included 49 patients with an average age of 59; group 2 included 46 patients with an average age of 65. Review of the histologic characteristics of EC showed that group 1 tumors are better differentiated and less invasive and that their morphology is closer to the normal glandular structure of the endometrium. Group 2 tumors are less well differentiated, more often invade the myometrium, and include histologic variants such as papillary, clear cell, and anaplastic carcinoma that are dissimilar from the glandular structure of the normal endometrium. Mucinous adenocarcinomas and the presence of stromal foam cells were found to be associated with group 1 EC. Progesterone receptors (PR) were measured in a sample of 30 patients. They were present in all cases of group 1 ranging from 50 to 2,400 fmol/mg protein and absent or very low (30-190 fmol/mg protein) in group 2. All EC with stromal foam cells had high PR (380-2,400 fmol/mg protein). This study confirms that estrogen-related EC is generally a better differentiated and less aggressive tumor and suggests that there are two types of EC. The tumors not related to estrogens, which are histologically more malignant, were seen in an older age group of patients. In addition to the currently accepted methods of clinical evaluation of EC patients, defining the morphologic and biochemical characteristics of two types of EC may contribute to the management of EC, now the most prevalent cancer of the female pelvis. The patients known to be at risk for endometrial carcinoma, identifiable by abnormal hormonal manifestations (obesity, infertility, and other conditions related to hyperestrogenism) as well as those receiving exogenous estrogens are likely to develop a better differentiated and less aggressive form of neoplasia. It would be important to elaborate a system of early detection of EC in the group of elderly patients with no signs of hyperestrogenism prone to develop the less differentiated and biologically more aggressive tumors.
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PMID:Endometrial carcinoma: two diseases? 356 22

In this study, the histological definition of endometrial cancer precursor (ECP) lesions is discussed and a comparison is made of clinical and histological parameters of ECP patients and endometrial cancer (EC) patients. ECP lesions were divided in 3 types: adenomatous hyperplasia, atypical hyperplasia and in situ adenocarcinoma. The following parameters were analyzed: age, menopausal status, gynecological and extragynecological familiar cancer incidence, other cancers in the proband, diabetes, obesity, primary infertility, fertility and previous estrogen therapy. Results give support to the hypothesis of the existence of a common biological pathway between ECP and EC. The high frequency of coexistence of both types of lesions in hysterectomy specimens from EC patients studied by step sections adds a confirmatory supporting argument. Measures for primary and secondary prevention of these lesions are proposed.
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PMID:Endometrial cancer and its precursors: a comparison of histological and clinical features. 357 42

Data from the Cancer and Steroid Hormone study was used to evaluate the effect o cigarette smoking on the risk of developing epithelial ovarian cancer. This multicenter, population-based case-control study of oral contraceptive (OC) use and ovarian, breast, and endometrial cancer enrolled women between December 1, 1980, and December 31, 1982, in 8 geographic areas: Atlanta, Detroit, San Francisco, and Seattle; the states of Connecticut, Iowa, and New Mexico; and the 4 urban counties of Utah. Eligible cases were women 20-54 years old first diagnosed as having ovarian cancer of any histologic type which was ascertained through population-based tumor registries in the above-mentioned areas during the study interval. Interviews were completed with 579 of the eligible cases (71.0%). The study controls were women 20-54 years of age selected by telephoning randomly selected phone numbers of households in the same geographic areas as the cases. 4754 of those selected were interviewed. A standard questionnaire was administered to participants in their homes by trained interviewers. Women who had never smoked a total of 100 cigarettes to be nonsmokers in this analysis. Age, parity, and ever-use of OCs (for 3 or more consecutive months) were considered to be potentially confounding factors because they are known to be associated with smoking. Women with epithelial ovarian cancer were more likely than controls to be white, nulliparous, to have used OCs, and to have had a natural menopause. Women who had ever smoked cigarettes had the same risk of epithelial ovarian cancer as women who had never smoked; this was the case when current smoking and past smoking were considered. There was a slightly reduced risk of ovarian cancer among women who had stopped smoking 10 or more years earlier, but the association was not statistically significant. Cumulative lifetime exposure to cigarette smoking categorized by increasing pack-years showed no statistically significant dose effect. Among smokers, no significant linear trend was present when pack-years was used as a continuous variable. No effect of latency was found. The age that a woman began smoking had no effect on ovarian cancer risk. Stratification of the data according to age, race, education, parity, OC use, infertility, noncontraceptive estrogen use, menopausal status, alcohol use, obesity, and family history of ovarian cancer did not reveal any appreciably different effects of smoking on ovarian cancer risk in different subgroups of women. Likelihood ratio tests revealed no statistically significant interactions.
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PMID:Cigarette smoking and the risk of epithelial ovarian cancer. 359 76

Polycystic ovarian disease represents a poorly defined spectrum of clinical disorders having oligo-ovulation or anovulation as a common feature. There is no single, universally accepted biochemical or clinical definition. Clinical findings usually include anovulation resulting in irregular uterine bleeding and infertility, androgen excess resulting in hirsutism and acne, and obesity. The patho-physiology involves altered functions of the hypothalamus, pituitary, ovary and adrenal glands, resulting in failure of folliculogenesis to regularly proceed to ovulation. The cause of the initiating event in this disease process remains enigmatic. Therapy for the various abnormalities in polycystic ovarian disease is tailored to a patient's needs and may include preventing endometrial hyperplasia, controlling irregular uterine bleeding, controlling hirsutism and inducing ovulation.
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PMID:Polycystic ovarian disease. 392 38

This prospective study determines the presence of a consistent endocrine disturbance in patients with endometrial carcinoma. A major requirement of the study was an unbiased control group matched as to age, race, economic status, and primary reason for referral. All patients with untreated endometrial carcinoma or postmenopausal bleeding were studied and grouped into: 1) endometrial carcinoma (n=56), and 2) atrophic endometrium (n=83), or the "bleeding" controls. Average age of patients with carcinoma was 63.9 years and that of controls, 61.3 years. Factors studied were glucose metabolism, estrogenic activity, gonadotropin excretion, obesity, hypertension, time of climacteric, fertility, and menstrual history. By averaging deviations from ideal weight, cancer patients were found to be 13.1 pounds heavier than the control group (49.8 pounds vs. 36.7 for the controls). Analysis of fertility data showed that age at time of marriage in patients who were parous compared with those who were nulliparous was 20.1 and 26.8 years respectively for the carcinoma group, and 20.4 and 27.5 years for the bleeding controls. Of parous cancer patients, 6.3% used contraception vs. 13% of the controls. These data do not suggest that pregnancy prevention by late marriage or contraception plays a significant role in the later development of endometrial carcinoma. Hypertension, time of menopause, diabetes, estrogenic activity, and gonadotropin excretion did not exhibit significant effects in the development of carcinoma. The findings support those of Corscaden, Fertig, and Gusberg that obesity and infertility are statistical concomitants with endometrial carcinoma but contradict current belief that there is direct evidence of abnormal endocrine state (e.g., glucose metabolism, estrogen stimulation, or anterior pituitary activity).
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PMID:Endocrine factors in endometrial carcinoma. A preliminary report. 601 48

Polycystic ovarian disease (PCOD) was first described as a single disease by Stein and Leventhal in 1935, but now has been separated into several distinct entities, comprising a symptom complex. The most frequent presenting symptoms associated with PCOD are obesity, hirsutism, amenorrhea or anovulation, dysfunctional uterine bleeding, irregular menses, and infertility. The common finding of hirsutism in PCOD patients is a reflection of the hyperandrogenism resulting from elevation of all the androgens, including testosterone, androstenediol, dehydroepiandrostrone sulfate (DHEA-S), and androstenedione. Some patients with all the clinical features of PCOD can be shown, through appropriate testing, to have an attenuated form of classic congenital adrenal hyperplasia (CAH). Serum follicle stimulating hormone (FSH) levels are usually low or in the normal range, and serum luteinizing hormone (LH) levels are usually elevated in patients with PCOD, resulting in an altered LH/FSH ratio. Treatment for PCOD must be based on the needs and desires of the individual patient, and on the pathophysiology of the patient's particular abnormalities. When pregnancy is desired, ovulation induction with clomiphene is indicated. Clomiphene is a weak estrogen that induces a transient rise in serum LH and FSH, followed by a gonadotropic pattern similar to normal cycles. A 72% ovulation rate and a 41.8% conception rate have been reported after treatment with clomiphene. In patients who do not respond to clomiphene, or clomiphene with added human chorionic gonadotropin (hCG), human menopausal gonadotropin (hMG) can be used to induce ovulation, but the patient should be closely monitored for multiple ovulation, multiple pregnancy, or hyperstimulation syndrome. For patients not interested in conception, regular menstrual cyclicity can be restored and hyperandrogenism reduced with oral contraceptives (OCs).
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PMID:Polycystic ovarian disease. 623 74

A 29-year-old woman presented with hirsutism, obesity, oligomenorrhea, and infertility caused by oligoovulation and tubal occlusion. Partial 21-hydroxylase deficiency of the adrenal was suggested by an abnormal adrenocorticotropic hormone (ACTH) stimulation test. The patient subsequently developed bilateral tuboovarian abscesses and underwent abdominal hysterectomy and bilateral salpingo-oophorectomy. Thus, an opportunity was presented to study the adrenal endocrine disorder in the absence of ovaries and to investigate the effect of human chorionic gonadotropin (hCG) on the adrenals. There was no change in the adrenal response to ACTH stimulation after oophorectomy. hCG stimulation resulted in an increase in dehydroepiandrosterone sulfate and 17 beta-estradiol levels, suggesting that hCG had a stimulatory effect on the adrenal. The ovarian-adrenal relationship and effects of adrenal stimulation in the absence of ovaries are discussed.
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PMID:Effect of adrenocorticotropic hormone and human chorionic gonadotropin before and after bilateral oophorectomy in a patient with acquired adult-onset adrenal hyperplasia: a case report. 629 2


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