The dangers inherent in marked obesity have prompted physiciansto advocate more aggressive strategies for weight reduction.One current strategy is the prescription of fenfluramine,1,2either alone or in combination with phentermine, with the knowledgethat the risks of the drugs must be balanced against the risksof continued obesity.
Pulmonary hypertension in adults has several causes that canbe identified pathologically. In the case of pulmonary hypertensionthat develops with hypoxia during the course of chronic obstructiveor interstitial fibrosing disease of the lung, the pulmonaryvessels are characterized by intimal and medial hyperplasiaand luminal stenosis. Thromboembolic pulmonary . . . [Full Text of this Article]
Case Report
Clinical Findings
Pathological Findings
Discussion
Source Information
From the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School (E.J.M., H.T.C.), and the Office of the Chief Medical Examiner, Commonwealth of Massachusetts (E.J.M., E.D.P., R.J.E., S.C.K.) all in Boston.
Address reprint requests to Dr. Mark at the Department of Pathology, Massachusetts General Hospital, 55 Fruit St., Warren Bldg. 219, Boston, MA 02114-2696.
References
This article has been cited by other articles:
2006 WRITING COMMITTEE MEMBERS, , Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S.
(2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation
118: e523-e661
[Full Text]
Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., O'Rourke, R. A., Shah, P. M.
(2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol
52: e1-e142
[Full Text]
Borer, J. S., Pouleur, H., Abadie, E., Follath, F., Wittes, J., Pfeffer, M. A., Pitt, B., Zannad, F.
(2007). Cardiovascular safety of drugs not intended for cardiovascular use: need for a new conceptual basis for assessment and approval. Eur Heart J
28: 1904-1909
[Abstract][Full Text]
Said, S. I.
(2006). Mediators and modulators of pulmonary arterial hypertension. Am. J. Physiol. Lung Cell. Mol. Physiol.
291: L547-L558
[Abstract][Full Text]
Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B.
(2006). ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol
48: e1-e148
[Full Text]
Witzenrath, M., Ahrens, B., Kube, S. M., Hocke, A. C., Rosseau, S., Hamelmann, E., Suttorp, N., Schutte, H.
(2006). Allergic lung inflammation induces pulmonary vascular hyperresponsiveness. Eur Respir J
28: 370-377
[Abstract][Full Text]
Lynch, M. J., Burns, R. G., Holcomb, J. E.
(2005). Food for Thought: An Investigation of Food and Drug Administration Reporting Practices, 1995-1999. Criminal Justice Review
30: 293-311
[Abstract]
Farber, H. W., Loscalzo, J.
(2004). Pulmonary Arterial Hypertension. NEJM
351: 1655-1665
[Full Text]
Weigle, D. S.
(2003). Pharmacological Therapy of Obesity: Past, Present, and Future. J. Clin. Endocrinol. Metab.
88: 2462-2469
[Full Text]
Mitani, Y., Mutlu, A., Russell, J. C., Brindley, D. N., DeAlmeida, J., Rabinovitch, M.
(2002). Dexfenfluramine protects against pulmonary hypertension in rats. J. Appl. Physiol.
93: 1770-1778
[Abstract][Full Text]
Humbert, M., Deng, Z., Simonneau, G., Barst, R.J., Sitbon, O., Wolf, M., Cuervo, N., Moore, K.J., Hodge, S.E., Knowles, J.A., Morse, J.H.
(2002). BMPR2 germline mutations in pulmonary hypertension associated with fenfluramine derivatives. Eur Respir J
20: 518-523
[Abstract][Full Text]
Tomita, T., Zhao, Q.
(2002). Autopsy Findings of Heart and Lungs in a Patient With Primary Pulmonary Hypertension Associated With Use of Fenfluramine and Phentermine. Chest
121: 649-652
[Abstract][Full Text]
Appelbaum, L., Yigla, M., Bendayan, D., Reichart, N., Fink, G., Priel, I., Schwartz, Y., Richman, P., Picard, E., Goldman, S., Kramer, M. R.
(2001). Primary Pulmonary Hypertension In Israel : A National Survey. Chest
119: 1801-1806
[Abstract][Full Text]
Archer, S., Rich, S.
(2000). Primary Pulmonary Hypertension : A Vascular Biology and Translational Research "Work in Progress". Circulation
102: 2781-2791
[Abstract][Full Text]
YI, E. S., KIM, H., AHN, H., STROTHER, J., MORRIS, T., MASLIAH, E., HANSEN, L. A., PARK, K., FRIEDMAN, P. J.
(2000). Distribution of Obstructive Intimal Lesions and Their Cellular Phenotypes in Chronic Pulmonary Hypertension . A Morphometric and Immunohistochemical Study. Am. J. Respir. Crit. Care Med.
162: 1577-1586
[Abstract][Full Text]
Kereveur, A., Callebert, J., Humbert, M., Herve, P., Simonneau, G., Launay, J.-M., Drouet, L.
(2000). High Plasma Serotonin Levels in Primary Pulmonary Hypertension : Effect of Long-Term Epoprostenol (Prostacyclin) Therapy. Arterioscler. Thromb. Vasc. Bio.
20: 2233-2239
[Abstract][Full Text]
Rich, S., Rubin, L., Walker, A. M., Schneeweiss, S., Abenhaim, L.
(2000). Anorexigens and Pulmonary Hypertension in the United States: Results From the Surveillance of North American Pulmonary Hypertension. Chest
117: 870-874
[Abstract][Full Text]
Bray, G. A., Greenway, F. L.
(1999). Current and Potential Drugs for Treatment of Obesity. Endocr. Rev.
20: 805-875
[Abstract][Full Text]
Salvi, S. S.
(1999). {alpha}1-Adrenergic Hypothesis for Pulmonary Hypertension. Chest
115: 1708-1719
[Abstract][Full Text]
Grewal, J. S., Mukhin, Y. V., Garnovskaya, M. N., Raymond, J. R., Greene, E. L.
(1999). Serotonin 5-HT2A receptor induces TGF-beta 1 expression in mesangial cells via ERK: proliferative and fibrotic signals. Am. J. Physiol. Renal Physiol.
276: F922-F930
[Abstract][Full Text]
Friedman, M. A., Woodcock, J., Lumpkin, M. M., Shuren, J. E., Hass, A. E., Thompson, L. J.
(1999). The Safety of Newly Approved Medicines: Do Recent Market Removals Mean There Is a Problem?. JAMA
281: 1728-1734
[Abstract][Full Text]
Wojnicki, F. H. E., Rothman, R. B., Rice, K. C., Glowa, J. R.
(1999). Effects of Phentermine on Responding Maintained under Multiple Fixed-Ratio Schedules of Food and Cocaine Presentation in the Rhesus Monkey. J. Pharmacol. Exp. Ther.
288: 550-560
[Abstract][Full Text]
Fishman, A. P.
(1999). Aminorex to Fen/Phen : An Epidemic Foretold. Circulation
99: 156-161
[Full Text]
TUDER, R. M., RADISAVLJEVIC, Z., SHROYER, K. R., POLAK, J. M., VOELKEL, N. F.
(1998). Monoclonal Endothelial Cells in Appetite Suppressant-associated Pulmonary Hypertension. Am. J. Respir. Crit. Care Med.
158: 1999-2001
[Abstract][Full Text]
Haworth, S. G
(1998). Primary pulmonary hypertension in childhood. Arch. Dis. Child.
79: 452-455
[Full Text]
ARCHER, S. L., DJABALLAH, K., HUMBERT, M., KENNETH WEIR, E., FARTOUKH, M., DALL'AVA-SANTUCCI, J., MERCIER, J.-C., SIMONNEAU, G., TUAN DINH-XUAN, A.
(1998). Nitric Oxide Deficiency in Fenfluramine- and Dexfenfluramine-induced Pulmonary Hypertension. Am. J. Respir. Crit. Care Med.
158: 1061-1067
[Abstract][Full Text]
Martin, A., State, M., Koenig, K., Schultz, R., Dykens, E. M., Cassidy, S. B., Leckman, J. F.
(1998). Prader-Willi Syndrome. Am. J. Psychiatry
155: 1265-1273
[Full Text]
KANEKO, F. T., ARROLIGA, A. C., DWEIK, R. A., COMHAIR, S. A., LASKOWSKI, D., OPPEDISANO, R., THOMASSEN, M. J., ERZURUM, S. C.
(1998). Biochemical Reaction Products of Nitric Oxide as Quantitative Markers of Primary Pulmonary Hypertension. Am. J. Respir. Crit. Care Med.
158: 917-923
[Abstract][Full Text]
Kassirer, J. P., Angell, M.
(1998). Losing Weight -- An Ill-Fated New Year's Resolution. NEJM
338: 52-54
[Full Text]
(1997). Weight Loss Medications: More Lost Than Gained. JWatch Psychiatry
1997: 18-18
[Full Text]
(1997). More Reason for Caution with Diet Pills. Journal Watch Cardiology
1997: 2-2
[Full Text]
(1997). MORE ON DIET PILLS AND VALVULAR DISEASE. JWatch General
1997: 1-1
[Full Text]
Curfman, G. D.
(1997). Diet Pills Redux. NEJM
337: 629-630
[Full Text]