4. Metabolic and Endocrine Physiology in Obesity

  1. Ali A. El Solh MD, MPH4,5,6
  1. Paula Alvarez-Castro MD1,
  2. Susana Sangiao-Alvarellos PhD2 and
  3. Fernando Cordido PhD3

Published Online: 19 APR 2012

DOI: 10.1002/9781119962083.ch4

Critical Care Management of the Obese Patient

Critical Care Management of the Obese Patient

How to Cite

Alvarez-Castro, P., Sangiao-Alvarellos, S. and Cordido, F. (2012) Metabolic and Endocrine Physiology in Obesity, in Critical Care Management of the Obese Patient (ed A. A. El Solh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119962083.ch4

Editor Information

  1. 4

    Division of Pulmonary, Critical Care & Sleep Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, USA

  2. 5

    Critical Care Western New York Healthcare System, USA

  3. 6

    Western New York Respiratory Research Center Buffalo, NY, USA

Author Information

  1. 1

    Xeral Lugo Hospital, Lugo, Spain

  2. 2

    Investigation Department, University Hospital A Coruña, University of A Coruña, A Coruña, Spain

  3. 3

    Endocrine Department, University Hospital A Coruña, University of A Coruña, A Coruña, Spain

Publication History

  1. Published Online: 19 APR 2012
  2. Published Print: 16 APR 2012

ISBN Information

Print ISBN: 9780470655900

Online ISBN: 9781119962083

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Keywords:

  • Obesity;
  • Physiology;
  • Hyperinsulinemia;
  • Growth hormone hyposecretion;
  • Decreased ghrelin;
  • Hyperleptinemia

Summary

Obesity is associated with important disturbances in metabolic and endocrine function. Hyperinsulinemia and insulin resistance are the most well known alterations in obesity, although their mechanisms and clinical significance are not clearly established. In obesity there is a decreased GH secretion; the altered somatotroph function of obesity is functional as it can be reversed in different situations. The pathophysiological mechanism responsible for the GH hyposecretion of obesity is probably multifactorial. In women, abdominal obesity is associated with hyperandrogenism and low sex hormone-binding globulin levels. Obese men have low testosterone and gonadotropin concentrations. Obesity is associated with increasing cortisol production rate, which is balanced by enhanced cortisol clearance, resulting in plasma free cortisol levels that are invariant to increasing body size. Ghrelin, the recently discovered gastrointestinal hormone, is the only known circulating orexigenic factor, and has been found in reduced levels in obese humans. The metabolic syndrome is a cluster of metabolic abnormalities including obesity (particularly central adiposity), hyperglycemia, dyslipidemia, and hypertension. These interrelated alterations confer risk for cardiovascular disease and diabetes.