Breaking the vicious circle of obesity: the metabolic syndrome and low testosterone by administration of testosterone to a young man with morbid obesity / Quebrando o círculo vicioso da obesidade: síndrome metabólica e baixos níveis de testosterona pela administração de testosterona a um homem jovem com obesidade mórbida

OBJECTIVE: The metabolic syndrome (MS) is associated with low serum testosterone levels. Conversely, low testosterone levels induce MS. These operational mechanisms reinforce one another and induce a vicious cycle. This is a report on a morbid obesity 42 year-old man with the MS and serum testosterone of 5.0 nmol/L (N: 12.0-33.0), who was resistant to treatment with diet and exercise. He was treated with testosterone undecanoate for 16 months. METHODS: Anthropological and laboratory variables were measured before and during testosterone administration. Also the Aging Male Symptom Scale (AMS), the International Index of Erectile Function (IIEF) and Beck's Depression Inventory were assessed. RESULTS: After 16 months, there was a weight loss of 50 kg and a decrease in waist circumference of 36.5 cm. Blood pressure normalized and laboratory variables returned to the normal range. The patient did not meet the criteria for the MS anymore. There were improvements on the AMS, the IIEF and Beck's Depression Inventory. CONCLUSIONS: Normalizing testosterone in men with morbid obesity in combination with diet and exercise, with the MS and low testosterone levels, may rescue them from the MS, improving their mood and their stamina to follow a diet and to exercise.

OBJETIVO: A síndrome metabólica (SM) está associada a baixos níveis séricos de testosterona. Inversamente, baixos níveis de testosterona induzem a SM. Esses mecanismos operacionais se reforçam mutuamente e levam a um círculo vicioso. Este é o relato de um homem de 42 anos, obesidade mórbida com SM e testosterona sérica de 5,0 nmol/L (N: 12,0-33,5), resistente ao tratamento com dieta e exercícios. Ele foi tratado com undecanoato de testosterona por 16 meses. MÉTODOS: Variáveis antropológicas e laboratoriais foram medidas antes e durante a administração de testosterona. Também foram avaliados a Escala de Envelhecimento Masculino (AMS), o Índice Internacional de Função Erétil (IIEF) e a Escala de Beck para Depressão. RESULTADOS: Após 16 meses, houve uma perda de peso de 50 kg e diminuição de 36,5 cm da circunferência abdominal. A pressão arterial foi normalizada e as variáveis laboratoriais também retornaram para os limites de normalidade. O paciente não preenchia mais os critérios para SM. Houve melhoras da AMS, do IIEF e da Escala de Beck para Depressão. CONCLUSÕES: A normalização da testosterona em homens com obesidade mórbida, combinada à dieta e a exercícios, com SM e baixos níveis de testosterona, pode livrá-los da SM, melhorando o humor e o vigor para seguir uma dieta e exercícios.

Alteration in the activities of the membrane-integrated enzymes of polymorphonuclear leukocytes in obesity.

Oubain sensitive and insensitive adenosine triphosphatase showed decrease in their activities in the polymorphonuclear leukocytes of obese patients while the activity of acetylcholinesterase was found to be increased significantly. The contents of sodium, potassium and magnesium were found to be significantly decreased in polymorphonuclear leukocytes of obese patients. Polymorphonuclear leukocytes obtained from treated obese patients showed considerable restoration.

Mejoría de la insulinosensibilidad asociada al uso prolongado de acipimox en un obeso mórbido / Improvement of insulin sensitivity associated to the large use of acipimox in a morbidly obese patient

Insulin sensitivity was estimated in a morbidity obese, insulin-resistant, glucose-intolerant patient before and after 4 weeks of treatment with acipimox (250 mg t.i.d), an orally-administred, long-acting antilypolitic drug. The ensuing fall in circulating levels of fasting free fatty acids was associated with a clear amelioration of insulin resistance, as assessed by a minimal model analysis of a frequently sampled intravenous glucose tolerance test as well as by an oral glucose tolerance test. Similarly, this treatment brought about a reappearence of GH response to oral stimulation with clonidine. The evidence showing acipimox-induced amelioration of insulin resistance in this patient without diet, exercise or weight loss should encourage exploring the potential utility of this drug in this type of patient