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ENDOCRINOLOGY > Obesity > Flashcards

Obesity Flashcards

1
Q

Define overweight and obesity by BMI percentile (WHO criteria)

A
  • AGE 5-19:
    • Overweight: >85th percentile
    • Obese: 97th percentile
  • AGE <2:
    • Overweight = Weight >97th
    • Obese = Weight >99.9th
  • AGE 2-5:
    • Overweight = BMI >97th
      • Obese = BMI > 99.9th
  • ADULTS
    • Overweight = BMI 25-29.9
    • Obese = BMI >30
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2
Q

What is the prevalence of overweight and obesity in Canadian children?

A
  • Overweight 20%
  • Obese 12%
  • Note: age 5-17
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3
Q

What cells produce leptin? What does it signal?

A

Adipocytes

Satiety signal (long-term)

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4
Q

List 3 clinical features of leptin deficiency

A
  • Severe, early onset obesity
  • Decreased immune function
  • Hypogonadotropic hypogonadism

*Think physiologic signs of starvation

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5
Q

What cells produce Ghrelin? What does it signal?

A
  • Gastric X/A-like cells
  • Stimulated by fasting
  • Stimulates hunger/food intake (decreases after a meal, short-term effect)
  • Acts on hypothalamus
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6
Q

What cells produce cholecystokinin? What does it signal?

A
  • Proximal intestinal I cells
  • Promotes meal termination, reduces meal size, stimulated by duodenal presence of fat and protein (short-term effect)
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7
Q

What cells produce Peptide YY3-36 (PYY)? What does it signal?

A
  • Distal intestinal L cells (ileum and colon)
  • Acts on hypothalamus
  • Stimulated by fat in the lumen, reduces appetite and food intake
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8
Q

What cells produce Glucagon-like peptide 1 (GLP1)? What does it signal?

A
  • Distal intestinal L cells (ileum and colon)
  • Stimulated by presence of nutrients in the lumen
  • Signals short-term inhibition of food intake. half life is 2 minutes
  • Degraded by DPP-4
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9
Q

What cells produce pancreatic polypeptide? What does it signal?

A
  • Pancreatic F cells
  • Released in proportion to calories ingested
  • Reduces appetite and food intake
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10
Q

Describe the neurons in the arcuate nucleus of hypothalamus that impact obesity signaling

A
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11
Q

List 5 syndromes associated with obesity

A
  • Prader Willi: obesity, hypotonia, MR, short stature, hypogonadotropic hypogonadism
  • Barder-Biedl: hypogonadism, pigmentary retinopathy, polydactyly, MR
  • Alstrom: myocardiopathy, sensory deficit (retinopathy, deafness), obesity, dyslipidemia, diabetes
  • Borjeson-Forssman-Lehman: severe MR, epilepsy, hypogonadism, facial dysmorphism
  • Cohen: MR, characteristic facies
  • Carpenter: acrocephalosyndactyly, polydactyly, MR
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12
Q

List 5 monogenic causes of obesity

A
  • Leptin deficiency
  • Leptin receptor deficiency
  • POMC
  • PC-1
  • NTRK2
  • SIM1
  • MC4R
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13
Q

List 5 treatment modalities for hirsutism

A
  1. Cosmetic (laser hair removal, waxing, electrolysis, shaving)
  2. Topical (eflornithine hydrochloride cream- Vaniqa)
  3. OCP
  4. Anti-androgen (cyproterone, spironolactone)
  5. Lifestyle (weight management)
  6. Metformin
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14
Q

List 3 neuroendocrine appetite stimulants

A
  1. Ghrelin
  2. NPY (localized in arcuate nucleus adjacent to POMC)
  3. AgRP (localized in arcuate nucleus adjacent to POMC)
  4. Endocannabinoids (stimulate food intake via CB1 receptor)
  5. Orexins A and B (stimulate NPY releat)
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15
Q

List 2 neuroendocrine appetite suppressants

A
  1. Leptin
  2. Peptide YY 336
  3. Insulin
  4. GLP-1
  5. Cholecystokinin
  6. POMC
  7. Alpha-MSH
  8. CART (hypothalamic neuropeptide)
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16
Q

What is the definition of metabolic syndrome

A
  • NCEP ATP III (Adult): 3 or more of
    • High fasting glucose (>5.6)
    • High triglycerides (>1.7)
    • Low HDL (<1.0 in males, <1.3 in females)
    • High blood pressure (>130/85)
    • High waist circumference (>40 in males, >35 in females)
  • Modified ATP III for pediatrics: 3 or more criteria but no waist circumference
  • IDF: 2 or more criteria
17
Q

List 8 additional features of metabolic syndrome (aside from TG, HDL, WC, BP, FBG)

A
  • Increased FFAs
  • Increased VLDL
  • Increased small dense LDL
  • Increased ApoB
  • Increased inflammatory cytokines (IL-6)
  • Increased CRP
  • Increased plasminogen activator inhibitor (PAI-1)
  • Fatty liver disease, PCOS, sleep-disordered breathing?
18
Q

List 5 features of PWS on history?

5 physical exam features?

A
  • History
    • Prenatal: reduced fetal movement, polyhydramnios, breech
    • Neonatal hypotonia, weak cry
    • Feeding difficulty, poor suck, may have FTT
    • Delayed motor skills
    • Hyperphagia (onset 2-8 years)
    • Behavioural and learning difficulties
    • Mild/mod cognitive impairment
    • Delayed puberty, premature adrenarche
  • Physical exam
    • BMI >95th percentile with decreased lean body mass
    • Depigmentation relative to family
    • Cryptorchidism, small testes
    • Micropenis
    • Almond shaped eyes
    • Small hands and feet
    • Strabismus
    • Scoliosis
    • Short stature
19
Q

List 4 advantages and 3 disadvantages to using BMI as a surrogate marker for adiposity

A
  • Advantages
    • More accurate than weight alone
    • Correlates with body fat and CVD risk
    • Norms are established in children and adults
    • Easy to measure and track
    • Cheap and non-invasive
  • Disadvantages
    • Does not differentiate weight of muscle vs fat
    • Does not differentiate central vs generalized obesity
    • Not useful in pregnancy
    • Not useful in children <age>
      </age><li>Not useful for extremes of height</li>
    </age>
20
Q

List 10 things to assess at a first clinic visit for obesity management

A
  • History
    • Readiness to change, what has she tried in the past
    • Dietary history
    • Screens
    • Physical activity
    • Sleep
    • Mental health review
    • Review of systems: r/o hypothyroidism, Cushing, PCOS, OSA, DM2
    • Family history of obesity, CVD, type 2 diabetes
  • Physical exam
    • BMI
    • Waist circumference
    • Acanthosis nigricans
    • Blood pressure
    • Fundoscopy
    • Signs of dyslipidemia
  • Labs
    • OGTT
    • Lipid profile
    • LFTs
    • Thyroid function
    • Urinalysis
      *
21
Q

List 2 anti-obesity medications approved in Canada and their mechanism of action

A
  1. Orlistat (approved for >12 yo). Prevents absorption of fat from intestine by inhibiting pancreatic lipase.
  2. Metformin. Mechanism is unclear, reduces hepatic glucose production, increases peripheral insulin sensitivity.
  3. Saxenda (liraglutide): GLP1 agonist, approved in adults.

ENDOCRINOLOGY (21 decks)

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