ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Adrenal hemorrhage, found in about 1% of autopsies, is not rare but is commonly overlooked and often fatal. Severe stress (perhaps mediated by ACTH action), physical trauma, and/or anticoagulant therapy are usually responsible. Abdominal pain from adrenal capsular distension and fever are present, followed by weakness, fatigue, hypotension, and other features of rapidly advancing adrenal insufficiency. In severely traumatized patients, the possibly adrenal origin of these relatively nonspecific manifestations is frequently overlooked antemortem. If adrenal hemorrhage is considered, it is easily diagnosed by ultrasound, CT, or MR imaging and confirmed by fine-needle aspiration, which may even confer therapeutic benefit by reducing intra-adrenal pressure. Low serum Cortisol measurements and subnormal responses to IV cosyntropin (ACTH), preceded by dexamethasone administration to avoid continuing clinical deterioration, indicate adrenal insufficiency. Therapy includes continuous IV hydrocortisone infusion at about 300 mg/day in normal saline, with oral fludrocortisone when vomiting stops and tapering of dosage to maintenance levels as improvement occurs. Because adrenal necrosis is often incomplete at autopsy, adrenocortical regeneration can occur, followed by complete recovery provided that rapid diagnosis and vigorous therapy have been instituted without delay. The importance of considering the possible presence of adrenal hemorrhage in severely stressed, traumatized, and/or anticoagulated patients is obvious.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although glucagon-producing tumors are rare, they are of special clinical interest because patients with these tumors present with characteristic manifestations of glucagonoma syndrome. The features of this syndrome include the typical rash of necrolytic migratory erythema, diabetes, weight loss, anemia, and hypoaminoacidemia. Almost all glucagon-producing tumors arise from alpha cells of the pancreas. The majority of these tumors are malignant and usually patients present with liver metastases. In malignant glucagon-producing tumors, other hormonal syndromes may be present initially or may develop later in the course of the disease. Hyperglucagonemia can also occur in the absence of necrolytic migratory anemia or diabetes. Surgical cure is occasionally possible when the tumor is benign or if a malignant tumor is detected early. Characteristically, malignant tumors and metastases grow slowly. Thus, palliative therapies, e.g., surgical debulking, hepatic artery embolization, partial hepatectomy, octreotide therapy, and chemotherapy, significantly add to the length and quality of life.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Our understanding of the hormonal control of growth during the fetal period is incomplete, and it is inapparent how the short stature associated with intrauterine growth retardation (IUGR) might be prevented or treated. There is evidence that insulin-like growth factors (IGFs) play important roles in the regulation of perinatal growth. Rodents genetically engineered to lack either IGFs or IGF receptors display prenatal and postnatal growth retardation, depending on the specific gene affected. Humans with IUGR frequently have low concentrations of IGF-I. Because some patients with IUGR-associated short stature may have relatively decreased growth hormone (GH) secretion, GH treatment could be beneficial. Recent reports show gains in height for some patients when GH treatment is continuous and at a moderately high dosage. Patients with laboratory evidence for relatively lower GH secretion seem to respond better. These published studies, however, lack untreated controls and evaluate a paucity of patients treated to final height. Challenges for the future include the development of better methods of predicting who may respond to GH therapy, increasing our understanding of the mechanisms that control human growth in the perinatal period, and conducting well-controlled studies that will determine whether GH treatment of patients with IUGR-associated short stature will produce meaningful gains in adult height.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Endocrinologists are increasingly confronted by central diabetes insipidus (DI) in children who have had neurosurgical procedures or head injuries. The severity of the disorder depends on the anatomic level of the injury, the degree of hypo-thalamic-pituitary gland damage, and the number and distribution of residual magnocellular neurons that secrete vasopressin. The course of DI may be transient or permanent. The “triphasic” pattern is the most complex and potentially the most dangerous, because the diagnosis can be delayed or even missed. Before diagnosing DI, it is important to evaluate all of the other possible causes of postoperative and post-traumatic polyuria, including fluid overload, osmotic diuresis, hyperglycemia, hypokalemia, and hypercalcemia. The treatment of DI is especially difficult when consciousness is impaired, the thirst mechanism is not intact, or the child is very young. In the patient without an intact thirst mechanism, a daily fluid prescription and frequent checks on serum sodium levels are needed for appropriate home therapy. l-Desamino-8-D-arginine vasopressin is the preferred antidiuretic agent, with the subcutaneous route suggested by us in children younger than 3 years. This article focuses on the pathophysiology, presentation, and diagnosis of postoperative and post-traumatic DI and suggests guidelines for the management of this condition in children.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenic chronic anovulation and is the most common endocrinopathy among reproductive-age women. The syndrome is not to be confused with the presence of polycystic ovaries (PCO), which has a varied etiology and is not specific to the syndrome. PCOS is associated with significant insulin resistance as well as with defects in insulin secretion. A defect in insulin mediated receptor autophosphorylation has been found in a substantial proportion of PCOS women. This defect is unique to PCOS and is not found in other common states of insulin resistance. These abnormalities, combined with obesity, predispose PCOS women to developing non-insulin dependent diabetes mellitus. Another long-term sequelae that may be related to insulin resistance is cardiovascular disease. There is unfortunately no readily available clinical test at present to diagnose insulin resistance in PCOS women. Treatment considerations for improving insulin sensitivity in PCOS women should focus on weight loss regimens and the avoidance of interventions that worsen insulin sensitivity. The initial investigational use of insulin-sensitizing agents in these women has shown favorable responses.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Subclinical hyperthyroidism is one of several causes of low serum thyroid-stimulating hormone (TSH) concentrations. It is most simply denned as low serum TSH and normal serum thyroid hormone concentrations. Other causes of low serum TSH concentrations from which subclinical hyperthyroidism must be distinguished are nonthyroidal illness and secondary hypothyroidism. The most common cause of subclinical hyperthyroidism is excessive thyroid hormone therapy. Other causes are an autonomously functioning thyroid adenoma, multinodular goiter, and Graves' disease. Because many patients have no evident thyroid disease and because serum TSH concentrations may be normal weeks or more later, intervention should not be seriously considered until the biochemical findings are found to persist. The likelihood of progression to overt hyperthyroidism is low. Some patients have minor symptoms and signs of hyperthyroidism, but most do not. Some may also have minor stimulation of cardiac function, an increased risk of atrial fibrillation, or accelerated bone loss. Management should be based on the cause of the subclinical hyperthyroidism and on whether the patient has any clinical manifestations of thyroid hormone excess or underlying problems likely to be worsened by small increases in thyroid secretion.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This 12-month observation studied the clinical epidemiology of the “curbside” consultation process in a three-physician, private (fee-for-ser-vice), endocrinology practice that also provides consultative services to a staff-model HMO on a discounted fee-for-service basis. During the study, there were 559 curbside consultations (23.8% of which resulted in patient referrals) and 2001 formal consultations. The areas addressed most frequently were the thyroid gland, calcium, diabetes mellitus, the adrenal glands, the gonads, and the pituitary gland. Of the 513 curbside consultations by the three endocrinologists, 63.4% were from primary care providers, 8.3% from other endocrinologists, and 15.3% from other subspecialists. Physicians in the HMO accounted for a larger proportion of curbside consultations than of formal patient referrals (22.2% vs. 12.9%; p < 0.00001). The proportion of curb-side consultations resulting in formal referrals (31.6%) was higher for physicians in the HMO than for physicians in fee-for-service practice, although this difference was not statistically significant (p = 0.04). The data suggest that curbside consultations constitute an appreciable workload, that a minority of such consultations result in patient referrals, and that curbside consultation is used to a greater extent in the managed care setting. Questions about the impact of this on resource use and outcomes await further study.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This study gives an overview of glucose sensing strategies for potential use in diabetes therapy. The basis for the most commonly used ampero-metric glucosensors is the Clark electrode which measures oxygen tension. Coupling this sensor with glucose oxidase led to the first specific “biosensor” for glucose measurement. This sensor has been used for more than 20 years in the in vitro artificial pancreas (“Biostator”). The development of implantable glucose sensors has been hampered by the disappointing in vivo behavior of these sensors. Alternative glucose sensing techniques including noninvasive approaches are still experimental. Combining the microdialysis technique for continuous sampling of subcutaneous extracellular fluid with an in vitro on-line amper-ometric glucose oxidase electrode (the “Ulmer Zuckeruhr” or “sugar watch” system), permits continuous glucose sensing for 72 hours. Although there are differences and delays between changes in tissue and blood glucose concentrations, a complete automated feedback-controlled insulin delivery system is possible if fast acting insulin analogs can close the insulin delivery “feedback loop.”

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID