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

A random sample of 281 men, aged 30 through 69, resident in the community of Tecumseh, Mich, was studied with the use of standard glucose tolerance tests, including serum insulin assays and fasting serum lipid concentrations. Diagnoses of diabetes and probable diabetes were made according to a modification of the criteria of Fajans and Conn. Prevalence of diabetes and probable diabetes was considerably higher among men aged 40 through 49 than among those aged 30 through 39, but it increased little in the 50-through-59 and 60-through-69 age groups. Lean nondiabetics and probable diabetics had similar mean systolic blood pressures and similar mean levels of serum cholesterol, serum triglycerides, and serum insulin, but fat probable diabetics had much higher mean serum lipid and serum insulin concentrations that fat nondiabetics. Adiposity grouping discriminated by variable levels less well between diabetics and nondiabetics.
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PMID:Diabetes among men in a general population. Prevalence and associated physiological findings. 126 49

Adrenal myelolipoma is an uncommon benign tumor usually discovered by chance in patients with hypertension, obesity, arteriosclerosis or cancer. The association with adrenocortical endocrine dysfunctions is rare. We report herein an unusual case, the second in the literature to the best of our knowledge, of combined adrenal adenoma and myelolipoma in a patient with Conn syndrome.
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PMID:Combined adrenal adenoma and myelolipoma in a patient with Conn syndrome. Case report. 129 51

The etiology of several specific types of hypertension are described in order of increasing difficulty of diagnosis: glycyrrhizine poisoning, oral contraceptives, coarctation of the aorta, pheochromocytoma, Conn syndrone, Cushing syndrome, parenchymal nephropathy, unilateral renal atrophy, and renovascular hypertension. Glycerryyzine and oral contraceptive etiologies can be diagnosed by questioning the patient and improved by eliminating their intake. Coarctation of the aorta is easily identified by clinical signs, but surgical repair is probably mor e risky than drug treatment. A pheochromocytoma is signaled clinically and by catecholamine excretion. Conn syndrome has characteristic clinical signs, particularly hypokalemia during intake of diuretics. Cushing syndrome is recognized by corticosteroid excretion as well as peculiear obesity, acne, erythrosis, and diabetes. Bilateral nephropathy is common (25% of hypertensions) and rather difficult to dia gnose and treat. Unilateral renal atrophy can be demonstated by renal arteriography and cystography, but predicting the outcome of nephrectomy is problematic. Renovascular hypertension due to occlusion of the renal artery requires the most sophisticated tests and care for an effective treatment. A table and an outline of diagnostic tests to differentiate these disorders are included.
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PMID:[Etiologic survey of arterial hypertension. Its justifications and practical modalities]. 549 42

Most patients with hypertension in the United States have essential (primary) hypertension (95%), the cause of which is unknown. The remaining 5% of adults with hypertension have the secondary form of hypertension, the cause and pathophysiologic process of which are known. Internists and other primary care physicians refer to this as treatable or curable hypertension, because the hypertension can be managed or even controlled with medications. Similarly, the condition is called surgical hypertension by surgeons in the belief that once the cause is determined and identified, surgical intervention will result in cure of hypertension. Secondary causes of hypertension include renal parenchymal disease, renovascular diseases, coarctation of the aorta, Cushing's syndrome, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism, and hyperparathyroidism. Occasionally included in this category are alcohol- and oral contraceptive-induced hypertension and hypothyroidism, but these conditions are not discussed herein. The evaluation of secondary hypertension is of interest and can bring together different facets of anatomy, physiology, pharmacology, and radiology in the medical and surgical treatment of these disorders. Despite enthusiasm that can be generated in the evaluation of these conditions, evaluation can be expensive and should not be conducted for all patients with hypertension. Features that aid in the diagnosis of secondary hypertension include the following: 1. Onset of hypertension before the age of 20 or after the age of 50 years. The presence of hypertension at a young age may suggest coarctation of the aorta, fibromuscular dysplasia, or an endocrine disorder. Hypertension found for the first time after the age of 50 years may suggest the presence of renovascular hypertension caused by atherosclerosis. 2. Markedly elevated blood pressure or hypertension with severe end-organ damage, as in grade III or IV retinopathy. These findings suggest the presence of renovascular hypertension or pheochromocytoma. 3. Specific body habitus and ancillary physical findings. For example, truncal obesity and purple striae occur with hypercortisolism, and exophthalmos is associated with hyperthyroidism. 4. Resistant or refractory hypertension (poor response to medical therapy usually necessitating use of more than three antihypertensive medications from three different classes). 5. Specific biochemical test that suggest the existence of certain disorders, such as hypercalcemia in hyperparathyroidism, hyperglycemia in Cushing's syndrome and pheochromocytoma, and unprovoked hypokalemia with renin-producing tumors, primary hyperaldosteronism, or renin-mediated renovascular hypertension. 6. Other characteristics that may suggest secondary hypertension such as abdominal diastolic bruits (renovascular hypertension), decreased femoral pulses (coarctation of the aorta), or bitemporal hemianopias (Cushing's disease). A combination of a good history and physical examination, astute observation, and accurate interpretation of available data usually are helpful in the diagnosis of a specific causation.
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PMID:Secondary hypertension: evaluation and treatment. 894 19

A 44-year-old morbidly obese and hypertensive woman had been diagnosed with idiopathic cardiomyopathy seven years previously. She was referred for consideration for heart transplantation because of progression of symptoms to class IV. Massive obesity and pulmonary hypertension were strong relative contraindications to transplantation. During outpatient evaluation, the patient developed pulmonary edema, was hospitalized, and became intensive care unit-bound and immobile. Exercise radionuclide angiocardiography revealed left ventricular ejection fraction of 17%, and left ventricular end-diastolic volume of 408 mL. A reduction ventriculoplasty procedure was performed by resection of the lateral wall of the left ventricle. The patient did very well, and was discharged on postoperative day nine. Two weeks after the procedure, exercise radionuclide angiocardiography demonstrated left ventricular ejection fraction of 30% (76% increase) and left ventricular end-diastolic volume of 293 mL (28% decrease). The patient remains in stable New York Heart Association class II, now three months postprocedure. This initial positive experience in New England encourages-continued investigation of the reduction ventriculoplasty procedure, either as a bridge or as an alternative to heart transplantation in patients with dilated cardiomyopathy.
Conn Med 1997 Mar
PMID:Reduction ventriculoplasty for the cardiomyopathic heart: a case report. 909 83

Adrenal myelolipoma is an uncommon benign tumor usually discovered by chance in patients with hypertension, obesity, atherosclerosis, cancer or endocrine disorders. The association with adrenal endocrine dysfunctions appears to be the most frequent. Myelolipoma has been found in patients affected by Cushing's syndrome, hyperaldosteronism, Addison's disease, virilization. We report herein a case of association, based on clinical and radiological signs, between myelolipoma and adrenal adenoma in a patient with Conn's disease. The myelolipoma was localized in the opposite adrenal gland to that of adenoma, at difference with the other cases described.
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PMID:[Adrenal adenoma and myelolipoma in an elderly patient with Conn's syndrome]. 1076 42

Obstructive sleep apnea is a state-dependent syndrome. It is characterized by repeated collapse of the upper airway as the result of the loss of waking neuromuscular drive as the brain changes from wakefulness to sleep. This produces a state-dependent decrease in muscle tone, which, together with other predisposing factors such as obesity and anatomical narrowing of the upper airway, results in the spectrum of sleep disordered breathing. Sleep-disordered breathing describes the continuum from simple snoring (pharyngeal vibration), to flow limitation (hypopnea), to complete cessation of breathing (apnea). Obstructive sleep apnea (OSA) is the common description of what is now appreciated as the sleep apnea/hypopnea syndrome. The cardinal symptoms are snoring, observed apneas, and excessive daytime sleepiness. The immediate physical consequences are hypoxia, repeated sympathetic discharges, increased cardiac load, and repeated brain arousals. The repetitive arousals are required to restore airway patency, resulting in severely fragmented sleep and consequent sleep deprivation. The syndrome, untreated, produces significant cognitive and cardiorespiratory morbidity, and potential mortality. Compared to matched controls, patients with undiagnosed sleep apnea use twice the health resources and spend double the health-care dollars in the 10 years prior to diagnosis. Both trends are reversed by successful treatment. It is by definition a sleep-related illness and can be observed and evaluated only when the patient is asleep. Polysomnography is the laboratory procedure to study sleep and its protean dysfunctions. Multiple physiologic parameters are required to document the various types of sleep disorders as well as to establish the origin of pathologic sleep fragmentation. Complete polysomnography includes (but is not limited to) electroencephalogram (EEG), electrooculogram ((EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory effort, air flow, and oxygen saturation. Treatment options for obstructive sleep apnea include continuous positive airway pressure (CPAP), oral appliances, uvulopalatal and/or maxillomandibular surgery, positional control, and weight loss. The efficacy of each depends on the individual anatomy and the severity of the sleep-disordered breathing. CPAP is accepted as the most reliable treatment regardless of anatomy and severity. It is currently the only treatment modality which can be titrated during sleep and requires simultaneous polysomnography.
Conn Med 2000 Aug
PMID:Obstructive sleep apnea, polysomnography, and split-night studies: consensus statement of the Connecticut Thoracic Society and the Connecticut Neurological Society. 1098 71

The genetic and histopathological backgrounds of adrenocortical tumorigenesis remain poorly characterized. In other tissues, there is conclusive evidence that hyperplasia and adenomas precede cancer. In the adrenal, there are few clinical cases of either hyperplasia or adenoma associated with later development of cancer, and there are few biological studies that attempt to characterize this process molecularly. Current research focuses on the early lesions of the adrenal cortex because of their possible molecular link with carcinogenesis, and evidence of their frequent association with atypical forms of Cushing's and Conn's syndromes, obesity, hypertension and/or diabetes. These studies indicate a model for oncogenesis that is the same as that in other tissues. The rarity of adrenal cancer compared to benign lesions could be a clue to unique features of adrenocortical cells. It might also highlight the function of genes that are associated with endocrine tumors in the context of which the concept of gene 'conductors' is introduced here.
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PMID:Genetics of adrenocortical tumors: gatekeepers, landscapers and conductors in symphony. 1458 Jul 59

The renin-angiotensin-aldosterone system (RAAS) is characterized by a circadian rhythm (CR) whose acrophase is detectable early in the morning. The prorenin and angiotensin converting enzyme (ACE) show a CR as well. However, while the prorenin is in phase with the RAAS the ACE shows its circadian acrophase in the afternoon suggesting a negative feed-back. The RAAS CR is influenced by many factors. Its mesor is modified by sodium intake. The physical activity and rest affect both the mesor and acrophase. The variations in mesor amplitude and acrophase in aged subjects are conditioned by sex and physical activity. Moreover, the RAAS CR seems to be influenced by the race. In addition, it is abolished by the beta-adrenergic blockade, suggesting the existence of an adrenergic clock. Interestingly, the RAAS CR seems not to be a pacemaker for the blood pressure CR, whose acrophase is early in the afternoon. The RAAS CR is not substantially modified has in essential hypertension. However, the CR of plasma renin activity is disappeared in the low-renin essential hypertension, while the CR of plasma aldosterone is detectable. On the contrary, the aldosterone CR is not detectable in ascitic liver cirrhosis; but, it is restored when the ascites is removed by peritoneal-jugular shunt. No significant variation of the RAAS CR seems to occur in obesity and Cushing's syndrome. The RAAS CR has disappeared in Conn's disease as well as in Bartter's syndrome and Liddle's syndrome. The administration of indomethacine in Bartter's syndrome and of triamterene in Liddle's syndrome is able to restore the RAAS CR. Finally, the RAAS CR is not detectable in the heart or kidney transplanted patients; such a phenomenon could be attributed to cyclosporine and corticosteroids administration and to the denervation of the transplanted organs.
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PMID:[Circadian rhythm of the renin-angiotensin-aldosterone system: a summary of our research studies]. 1555 56

This paper is a review of the literature about adrenal myelolipoma. It is a rare, benign, hormonally inactive tumor of the adrenal gland composed of mature fat tissue and hematopoietic tissue in varying amounts. Adrenal myelolipoma is usually small (< 4 cm), unilateral and causes no clinical disorders. The age range of the affected patients is 20-90 years; most are men in their fourth to sixth decade. This tumour is discovered during autopsy or USG, CT MRI of the abdomen usually by chance and because of that is included in the group of tumors called incidentaloma. Etiology of myelolipoma is unclear. It is usually hormonally inactive but there were several cases in which adrenal myelolipoma coexisted with various endocrine disorders such as Cushing's syndrome, Conn's syndrome, Addison's disease, hirsutism, hermaphroditism, inborn deficiencies of 17- and 21-hydroxylase. It is also more frequent in patients with obesity, hypertension and leading stressful life. Surgical treatment is called for when the diameter of tumor reaches more than 4 cm, tumour shows tendency to fast growth or causes clinical disorders. In cases of small lesions, that show no progression, it is advised to observe the tumor using imaging techniques.
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PMID:[Adrenal myelolipoma]. 1585 62


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