First one with correct answer with justification win.

 

[size=20px]A fifteen-year old female with longstanding obesity and a body mass index (BMI) of 55 presents to your multidisciplinary weight loss center interested in weight loss surgery. Your team endocrinologist performs a metabolic evaluation.

 

A contraindication to a weight loss surgery would be

 

A increased serum leptin.

 

B absent serum leptin.

 

C increased ghrelin.

 

D absent ghrelin.

 

E decreased gastrointestinal peptide levels.[/size]

E

think again my friend

D absent ghrelin.

think again my friend

C increased ghrelin

think again my dear

B absent serum leptin?

B absent serum leptin?

correct

 

Leptin and ghrelin are two hormones that have been recognized to have a major influence on energy balance. Leptin is secreted by adipose tissue and is a mediator of long term regulation of energy balance, suppressing food intake and thereby inducing weight loss. Ghrelin is secreted by the stomach and is a fast acting hormone which is orexigenic or promoting for food intake. The plasma level constantly rises until it peaks just prior to a meal and then sharply returns to baseline. In obese subjects the circulating level of the anorexigenic hormone leptin is increased.

 

It is now established that obese patients are leptin resistant and leptin decreases with weight loss surgery. A small number of severely obese children have a mutation in the leptin gene and can be treated for their obesity with recombinant leptin. Ghrelin on the other hand is slightly suppressed in obese patients; however, the pattern of sharp rise and fall associated with hunger and meal initiation is not affected. Surgery has had an impact in the overall level being suppressed and in the loss of the normal cyclical pattern.

 

Gastrointestinal peptide has been shown to be inhibited in obese patients. Nothing is reported as to the levels of this hormone following obesity surgery.