Hormonal disorders underlying obesity

Debljina ili pretilost definira se kao prekomjerna količina masnog tkiva u organizmu. Prema WHO, u 2016. godini više od 1,9 milijardi odraslih osoba imalo je prekomjernu tjelesnu težinu, a od toga je oko 650 milijuna bilo pretilo. Debljina može biti primarna, zbog prekomjernog unosa i smanjenog korištenja energije, i sekundarna, kao posljedica drugih bolesti. Najčešći hormonski poremećaji koji mogu uzrokovati pretilost su nedostatak hormona štitnjače (hipotireoza), hiperkortizolizam (Cushingova bolest), sindrom policističnih jajnika (PCOS) i hipogonadizam u muškaraca te određeni poremećaji na razini hipotalamusa i hipofize. Ovisno o kojem endokrinološkom poremećaju se radi, u podlozi debljine se nalazi poremećena hormonska regulacija metabolizma ugljikohidrata, masti i/ili proteina, te narušen sustav za korištenje i/ili pohranu energije. Apetit i sitost su regulirani neurohormonskim procesima koji uključuju masno tkivo, endokrine organe, gastroenteralne peptide i središnji živčani sustav, a do pretilosti dolazi kada se ta povratna sprega iz bilo kojeg razloga prekine. S druge strane, masno tkivo je važan regulator energetske homeostaze i ako ga ima u suvišku, može dovesti do endokrine disregulacije i inzulinske rezistencije koju gotovo redovno vidimo u pretilosti. Iz toga proizlazi i strategija za liječenje pretilosti u endokrinološkim bolestima: osim liječenja uzročnog hormonskog poremećaja, određeni napori se trebaju uložiti u gubitak tjelesne mase, kroz prilagodbu prehrane, fizičku aktivnost, uz pomoć farmakoterapije za liječenje pretilosti ili u krajnjem slučaju pomoću barijatrijske kirurgije.Overweight or obesity is defined as an excessive amount of adipose tissue in the body. According to the WHO, in 2016, more than 1.9 billion adults were overweight, of which about 650 million were obese. Obesity can be primary, due to excessive energy intake and reduced energy consumption, and secondary, as a consequence of other disorders. The most common hormonal disorders that can cause obesity are thyroid hormone deficiency (hypothyroidism), hypercortisolism (Cushing's disease), polycystic ovary syndrome (PCOS), hypogonadism in men and certain disorders of the hypothalamus and pituitary gland. Depending on the endocrinological disorder, the underlying cause of obesity is disrupted hormonal regulation of carbohydrates, fats and / or protein metabolism, and a disrupted systems of energy consumption and storage. Appetite and satiety are regulated by neurohormonal processes involving adipose tissue, endocrine organs, gastroenteral peptides, and the central nervous system, and obesity occurs when this feedback is broken for any reason. On the other hand, adipose tissue is an important regulator of energy homeostasis and if it is found in excess, it can lead to endocrine dysregulation and insulin resistance, which we see almost regularly in obesity. Hence the strategy for treating obesity in endocrinological diseases is as follows: in addition to treating the causative hormonal disorder, certain efforts should be made considering weight loss, through dietary adjustments, physical activity, pharmacotherapy for obesity or, ultimately, bariatric surgery