Obesity-caused reproductive and endocrine dysfunction syndrome

　　I. Etiology

　　Pituitary tumors, craniopharyngiomas compressing the hypothalamus are one of the common causes, with the most common cause being tumors or inflammation in the hypothalamic region. Encephalitis, meningitis, brain abscess, intracranial tuberculosis, and craniocerebral trauma can also cause it. Some patients, even after various examinations and even pathological anatomy, have not been found to have organic lesions, which may be primary hypothalamic-pituitary dysfunction.

　　II. Pathogenesis

　　The hypogonadism in obesity reproductive dysfunction syndrome is of hypothalamic origin. Due to various reasons, the secretion of luteinizing hormone-releasing hormone (LHRH) in the hypothalamus is disturbed, leading to reduced secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), resulting in secondary hypogonadism. Animal experiments have confirmed that when the median eminence is involved, the secretion of gonadotropin-releasing hormone (GnRH) is low, leading to incomplete sexual function and atrophy of the reproductive organs. As for the cause of obesity, it is not due to a lack of some pituitary hormone, but due to damage to the hypothalamus. Animal experiments have shown that damage to the ventromedial nucleus and median eminence of the hypothalamus causes a loss of satiety in patients, leading to overeating and obesity. When the ventromedial nucleus is involved, insulin secretion is increased, leading to increased appetite, overeating, and obesity.

　　This syndrome can sometimes be accompanied by skeletal growth disorders, which are related to insufficient secretion of hypothalamic growth hormone-releasing factor and/or pituitary growth hormone.

　　Diabetes insipidus is a major complication of the disease, manifested as: large amounts of low-specific gravity urine, urine output exceeding 3L/d, and specific gravity below 1.006. Excessive thirst and drinking, especially for cold drinks, apart from fatigue, weakness, and affecting sleep, generally do not affect growth and development. Depending on the severity of the condition, it can be divided into partial diabetes insipidus and complete diabetes insipidus. If the tumor, trauma, or surgery in the sellar region also affects the function of the anterior pituitary, it can be accompanied by partial or complete hypopituitarism. Congenital diabetes insipidus, as well as trauma, surgery, or sellar region tumor, can affect the thirst center, causing polyuria without thirst in patients, leading to dehydration and the occurrence of hypernatremia and hyperosmotic state. At this time, it can be accompanied by fever, convulsions, or even cerebrovascular accidents.

　　The incidence of this syndrome is similar in males and females, with onset more common before puberty and characterized by the following features:

　　1. Obesity:Patients have an unevenly obese body, with the neck, trunk, and proximal parts of the limbs being most prominent, especially in the breast area, around the pelvis, and the pubic symphysis. Due to the abnormal distribution of fat, the pelvis appears wider, the limbs are relatively slender, and boys often have breast development, so male patients have a female body shape.

　　2. Physical characteristics:The nose, mouth, and hands of patients are often smaller, the fingers and toes are slender, the nails are small, and there may be varying degrees of genu varum. Muscle tone is reduced, causing the joints to be excessively extended. The skin is often pale, soft, and dry. After a certain age, the skin may show fine wrinkles. There are often white atrophic stripes on the sides of the abdomen and around the hips. The growth of height can be normal, delayed, or even faster than normal. Ossification is delayed, and epiphyses do not fuse, so when growth hormone secretion is normal, the stature can be higher than normal.

　　3. Incomplete sexual development:By the age of development, the penis, scrotum, and testes of males still do not develop. Sometimes the testes descend, boys have small testes, small penis, or cryptorchidism. There are no secondary sexual characteristics. Since the reproductive organs are陷 in the fat in the pubic area, they appear even smaller. Before the age of development, it is very difficult to determine whether there is incomplete sexual development, because normal boys do not develop reproductive organs before the age of development. However, sometimes it is found that the development of the reproductive organs is particularly slow. Girls do not have incomplete sexual development before development, and it is not found until the age of development that there is no menstrual period. The vagina and uterus do not develop. Whether boys or girls, there is no growth of pubic hair and armpit hair. Boys do not grow facial hair, and the pitch does not change. If the disease occurs in adulthood, pubic hair and armpit hair may fall out. Male patients have decreased sexual function, and female patients have amenorrhea.

　　4. Manifestations of primary disease:If the primary disease is a tumor, it can cause binasal hemianopia due to compression of the optic chiasm, and may have headaches. In the late stage, the symptoms of increased intracranial pressure may appear, the fundus may change, and X-ray examination may show damage or enlargement of the sella turcica.

　　5. Manifestations of hypothalamic syndrome:Due to hypothalamic damage, polyuria, unstable body temperature, and drowsiness may occur. Intelligence is mostly normal, but may also decrease.

　　1. It is necessary to fully taste the food and chew, which can convey the signal that food has been eaten to the brain. Therefore, it is very important to develop the habit of chewing each mouthful 20 times.

　　2. Determining the rules and correct meal time, eating before going to bed is a cause of obesity. An important point is to eat at the beginning of activity. Especially breakfast should be eaten more, dinner less, and eating before going to bed is prohibited.

　　3. It is common to see overweight people buying a large variety of foods at one time. The situation where the refrigerator is always full must be changed.

　　1. Hormone examination:The concentration of urinary gonadotropin and sex hormone concentration decreases.

　　2. Glucose tolerance test:It is often shown that glucose tolerance is reduced.

　　3. Pathological examination:Testicular biopsy shows obvious atrophy of seminiferous tubules, interstitial fibrosis, no mature sperm, all of which are helpful for diagnosis.

　　4. Chromosome examination:Chromosomes show no abnormalities.

　　5. CT and other examinations:Displacement lesions can be found.

　　6. Fundus examination:There is papilledema of the optic nerve.

　　7. Skull X-ray examination:Show saddle injury and calcification, patient with optic nerve crossing glioma, in addition to obesity and reproductive dysfunction, X-ray examination can see the signs of optic nerve foramen enlargement.

　　First, dietary therapy for obesity and reproductive dysfunction syndrome

　　1. Braised kelp and black fungus:250g of fresh kelp, 20g of black fungus, and 100g of celery are stir-fried in the pot, and 12ml of vinegar and seasonings are added when they are almost cooked to make a dish.

　　2. Salted three skins:Peel the wax-like outer skin of the watermelon rind, peel the hair-like outer skin of the winter melon rind, and remove the core of the cucumber. Cook them separately with different degrees of heat. Wait until cool, cut into strips, put them in a container, and marinate with salt and monosodium glutamate for 12 hours before eating.

　　3. Weight loss slimming formula:Black and white cowhorns each 10 to 30g, fried cassia seed, alisma, and atractylodes each 10g, hawthorn and prepared rhubarb each 20g. Grind the above medicine into fine powder, refine it into pills with honey, as big as the seeds of a wutong tree. Swallow 20 to 30 pills twice a day, accompanied by light diet and appropriate exercise.

　　4. Radish soup:Carrots and white radishes each 250g, ginger 10g, all cut into pieces, boiled in water, seasoned with salt. Drink the soup and eat the radishes.

　　5. Fish soup:Pickled mustard greens 100g, fish slices 200g, 1 egg, 25g peanut oil.

　　(1) Mince the fish into fish mince, mix with eggs; wash the mustard greens, cut them into fine ends, wash them with cold water twice, and drain for later use.

　　(2) Heat the peanut oil in the pot, stir-fry the fish mince and eggs, add a little water, add the shredded mustard greens, and boil until it has a fragrance.

　　6. Beef soup:Beef bone 1 root, half an onion, half a carrot, half a white radish, 1 scallion, a small piece of ginger, 1 star anise, 2000 milliliters of water. 1 teaspoon of rock sugar, 2 tablespoons of rice wine. Salt to taste.

　　(1) First, blanch the beef bone in the soup, clean it and set it aside; peel the carrots and white radishes, clean them, and cut them into pieces; clean the scallions and ginger, cut the scallions into segments, and slice the ginger for later use.

　　(2) Add all the materials and beef bone to the pot with boiling water, add A material and simmer over low heat for 90 minutes, and then add B material to taste.

　　Second, what is good for the body to eat for obesity and reproductive dysfunction syndrome

　　1. Eat more fresh fruits, vegetables, and vegetables.

　　2. You can eat more fish and beef.

　　3. Eat more foods rich in collagen and B vitamins.

　　4. Eat more warm foods and foods rich in fiber, and maintain a diet with high protein and low carbohydrate content.

　　Third, what food should not be eaten for obesity and reproductive dysfunction syndrome

　　1. Limit the intake of foods such as fat, sugar, pastries, and beer.

　　2. Try to avoid eating cold and raw foods as much as possible.

　　3. Eat less greasy and spicy food.

　　First, the traditional Chinese medicine treatment method for obesity and reproductive dysfunction syndrome

　　1. Weight loss and fitness tea:It has the effects of calming the liver and clearing heat, and invigorating the spleen to digest food. It is suitable for patients with hyperactivity of liver yang. For children aged 3 to 6 years, take 2 to 3g each time, and for children over 6 years old, take 3 to 5g each time. Take twice a day, and brew as tea.

　　2. Cholesterol-Lowering and Weight Loss Decoction:It has the effects of invigorating Qi and nourishing Yin, promoting blood circulation and removing dampness and accumulation. It is suitable for patients with deficiency of both Qi and Yin. For children aged 3-6 years, 4-6g per dose, for children over 6 years old, 6-10g per dose, 3 times a day.

　　3. Weight Loss Shengshen Tablets:It has the effects of expelling wind and heat, clearing heat and removing dampness. It is suitable for patients with damp-heat accumulation and phlegm obstruction. For children aged 3-6 years, 2-3 slices per time, for children over 6 years old, 4-6 slices per time, 3 times a day. 30 days as a course.

　　4. Epimedii Tea:It has the effects of resolving phlegm and digestion, diuresis and removing dampness. It is suitable for patients with excessive intake of rich and sweet foods, and abundant sputum and phlegm. For children aged 3-6 years, 1-3g per time, for children over 6 years old, 3-5g per time, infused with boiling water for drinking. Twice a day.

　　Second, Western medical treatment methods for obesity and reproductive dysfunction syndrome

　　1. Treatment

　　Treatment is divided into two aspects: etiological treatment and endocrine disorder treatment:

　　(1) The source of the disease is hypothalamic or pituitary tumors, optic nerve tumors, and consider radiotherapy or surgical treatment according to their nature and whether they cause compression symptoms.

　　(2) Treatment for endocrine disorders: Hypogonadism can be treated with LHRH, HCG, or sex hormone replacement therapy:

　　① Androgen replacement therapy: 30mg of methyltestosterone preparation orally or 25mg of testosterone propionate intramuscularly 3 times a week. Long-acting testosterone preparations such as testosterone enanthate can also be selected, 50mg/time, 1-2 times intramuscularly in the first year, 100mg in the second year, and 200mg in the third year. Androgens can make the voice lower, hair grow, and the external genitalia develop. Female patients can use estrogen replacement therapy.

　　② Gonadotropin treatment: HCG 1000-1500U, injected intramuscularly 3 times a week. The most appropriate method is to use an artificial synthetic GnRH10 peptide pulse-type automatic infusion pump for intermittent infusion treatment, 12.5mg/time, intermittent infusion once every 90 minutes.

　　③ Hypothyroidism can be treated with thyroid hormone preparations.

　　④ Obesity can be controlled by diet and the use of Sibutramine.

　　2. Prognosis

　　The prognosis of this symptom depends on the nature of the primary disease and the timing of radical surgery.