A study of patients <25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose
averaging 115 mg/dL is performed. They have adipose tissue abnormalities including: increased non-esterified fatty acid
release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished
peroxisome proliferator-activated receptor gamma (PPARgamma) function. Which of the following is the best therapeutic
intervention for these patients?
A. Adrenalectomy B. Caloric restriction C. Insulin injection D. L-thyroxine E. Liposuction F. Thiazolidinedione
Caloric restriction-(b) the findings are those of insulin resistance from obesity with metabolic syndrome. insulin resistance drives celldysfunction, but other factors such as the tcf7l2 gene play a role in eventual development of overt type 2 diabetesmellitus. lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid inreversing the insulin resistance so that no drug therapy is needed to control hyperglycemia. cushing syndrome may occurfrom acth-independent adrenal cortical lesions such as primary hyperplasia, adenoma, or carcinoma and lead tosecondary diabetes from glucocorticoid-induced insulin resistance, but primary adrenal lesions are less common thanmetabolic syndrome from obesity alone, and the study patients lack additional features of cushing syndrome such ashirsuitism, osteoporosis, and easy bruisability. the absolute decrease of insulin with type 1 diabetes mellitus must betreated with insulin injections. there is modest weight gain with hypothyroidism, but without abnormalities of adipocytesleading to insulin resistance. liposuction is a plastic surgery technique used for body contouring, not weight reduction.metformin and thiazolidinediones are used as oral agents to treat overt type 2 diabetes mellitus.bp7 645647bp8 778780pbd7 11951196pbd8 11361137