ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Primary cortisol resistance is a disorder of generalized target cell resistance to cortisol caused by a functionally abnormal glucocorticoid receptor (GluR) and characterized by hypercortisolism without other manifestations of glucocorticoid excess. Pituitary resistance to cortisol causes increased release of adrenocorticotropic hormone (ACTH), which stimulates the adrenal gland to produce cortisol, adrenal androgens, and mineralocorticoids in greater than normal amounts. The hypothalamicpituitary-adrenal axis is intact, but hormone concentrations are high. Since there is peripheral resistance to cortisol, the hypercortisolism does not produce the expected features of glucocorticoid excess. The increased production of non-glucocorticoid adrenal steroids may cause hypertension, hypokalemia, virilization, and sexual precocity, which bring the patient to medical attention. Primary cortisol resistance must be distinguished from Cushing's syndrome and other causes of hypercortisolism. ACTH concentrations are normal to high, the cortisol response to insulin-induced hypoglycemia is normal, there is a diurnal variation of cortisol secretion, and hypercortisolism is often familial. Confirmation of the diagnosis is dependent upon demonstrasting a glucocorticoid receptor abnormality. Qualitative and quantitative abnormalities of the GluR have been reported, suggesting that this disorder is receptor-mediated and that the molecular basis is heterogeneous. In studies of two different kindreds, two different point mutations have been identified in the GluR binding domain. These may be responsible for the cortisol resistance. Affected subjects with clinical evidence of mineralocorticoid and adrenal androgen excess may require therapy. Dexamethasone in carefully titrated doses will suppress ACTH stimulation of the adrenal glands without causing Cushingoid features.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In this review, the efficacy of bisphosphonates for the control of endocrine- and malignancy-related hypercalcemia is addressed. The bisphosphonates are an important group of bone-active compounds with a great affinity for bone surfaces. They are potent inhibitors of bone resorption and, for this reason, have been utilized in clinical states where increased bone resorption is a major pathogenic factor. Etid-ronate, clodronate, and pamidronate have been administered to patients with primary hyperparathyroidism and hypercalcemia of malignancy since 1977. Because high doses of etidronate may induce a mineralization defect in bone, this agent is more suitable for shortterm use. The bisphosphonates are effective in correcting the component of hypercalcemia that is due to increased bone resorption. Because increased renal tubular reabsorption of calcium contributes to the degree of hypercalcemia in patients with primary hyperparathyroidism and in many patients with malignancies, restoration of serum calcium levels to the mid-normal range is not always achieved except with the adjunctive use of intravenous saline. In patients with multiple myeloma or solid tumors, presumably not secreting parathyroid hormone-related protein, restoration of normocalcemia is more readily accomplished.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Patients with poorly controlled diabetes mellitus have a number of abnormalities in polymorphonuclear leukocyte (PMN) function and metabolism that are reversible with insulin treatment. Since host defense mechanisms in general have a great deal of reserve capacity, these defects alone do not appear to predispose diabetics to infection. However, when neuropathy and, particularly, arterial vascular disease are present, certain life-threatening microbial infections, almost unique to diabetes, may involve soft tissues and fasciae of the lower extremities, the external auditory canal, gall bladder, and sinuses. Even though the involved sites are anatomically diverse, all of these uncommon infections are associated with tissue ischemia and necrosis and require prompt surgical debridement and antimicrobial therapy. A second common infection in diabetes is candidiasis. Hyperglycemia contributes to the high frequency ofCandidainfection in two ways: 1) by glycosylating the active site on complement (C3), inhibiting the opsonization of bacteria; and 2) by inducing the production of a protein inCandidathat is structurally and functionally homologous to the PMN complement receptor, thus interrupting the normal complement-PMN interaction. These two mechanisms likely contribute to the persistence ofCandidainfections in poorly controlled diabetic patients. Since these abnormalities are reversible, improved glycemic control is essential for the successful treatment of this common yeast infection. In light of the fact that the serious life-threatening infections in diabetes are associated with underlying macro and microvascular disease, their elimination would appear to ultimately depend on our success in preventing the arterial vascular complications of diabetes.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Central precocious puberty is associated with both psychological and physical sequelae. Long-acting gonadotropin-releasing hormone analogs are currently used as the therapy of choice for central precocious puberty. The current diagnostic and therapeutic approaches to management of precocious puberty are summarized, and controversial issues that require future study are discussed.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The use of very low energy diets has been through several phases. The first phase was consumer driven, not medically supervised, and proved to be unsafe. The second phase involved modifications to render these diets safe and the institution of programs to ensure proper monitoring and to provide organized behavioral modification programs. While the popularity of very low energy diets grew in these supervised programs, not enough attention was paid to long-term results and many patients regained their weight. This has led us to the current phase of very low energy diets with proper attention to maintenance and to the appropriate use of very low energy diets to treat uncomplicated and complicated obesity. There is definitely an important role for very low energy diets in the treatment of obesity, a chronic illness associated with significant health hazards.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Postoperative central diabetes insipidus is a recognized complication following certain neurosurgical procedures in the region of the hypothalamus and pituitary. Depending on the type and extent of surgery, central diabetes insipidus can occur transiently in 10–20% of tumors resected using a transsphenoidal approach. It can be permanent in 60–80% of procedures necessitating palliative total hypo-physectomy. Managing central diabetes insipidus in the immediate postoperative period can be complicated due to fluctuating levels of consciousness and alterations in thirst-regulating mechanisms. Central diabetes insipidus generally manifests itself in three patterns in the postoperative period: transient diabetes insipidus, permanent diabetes insipidus, and a triphasic pattern marked by an intermediate period of antidiuresis. Making the diagnosis of diabetes insipidus is usually not complicated; other possible causes of polyuria, however, should be eliminated. Similarly, anterior pituitary insufficiency may prevent polyuria and impair the ability to make the diagnosis. The goals of therapy are aimed at maintaining normal electrolytes and maintaining sufficient in-travascular volume without inducing water overload. This is accomplished with careful fluid replacement supplemented by the judicious use of antidiuretic agents. This article will review the pathogenesis, diagnosis, and current treatment options available in managing postoperative central diabetes insipidus.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The pulsatile administration of gonadotropin-releasing hormone (GnRH) is emerging as an attractive approach for ovulation induction in certain women. Ideal candidates for therapy are women with abnormalities of the GnRH pulse generator. These women have the diagnosis of primary hypothalamic amenorrhea or clomiphene-unresponsive secondary hypothalamic amenorrhea. GnRH can be administered intravenously or subcutaneously. The routes are equivalent in terms of inducing ovulation and pregnancy. The advantages and disadvantages of each route can dictate which will be most suitable for a given patient. Current recommendations suggest that GnRH be initiated at 5 μg/pulse given at 90-minute intervals by an automated mini-pump. The dose should be increased at specified intervals if ovulation does not occur. Patients require minimal monitoring, but surveillance of follicular development with ovarian ultrasound is useful during the initial cycle. The corpus luteum can be supported with continued pulsatile GnRH therapy or with human chorionic gonadotropin. The rate of ovulation approaches 80–100%. Pregnancy occurs in 25–62% of treatment cycles. Although minor adverse side effects occur, ovarian hyperstimulation is rare. Multiple pregnancy (usually twins) occurs in 7–12% of pregnancies. Given the physiologic rationale, safety, and associated ovulation/pregnancy rates, ovulation induction using GnRH is the preferred therapy for many patients.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thyroid fine needle aspiration biopsy has become an important tool in the diagnostic armamentarium of the endocrinologist. It is the safest, most cost-effective means for detecting thyroid cancer. Surgical intervention rates can be lowered by almost 50% by using fine-needle aspiration to identify nodules most likely to be malignant. In addition, the incidence of cancer in excised nodules can approach 50% when surgery is planned with the help of fine needle aspiration biopsy. This short review will examine the utility of fine needle aspiration biopsy in the differential diagnosis of the thyroid nodule, examine its accuracy with the most common neoplasms, and assess its role in the contemporary evaluation of the thyroid gland.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The reviewers here are an expert on hypertension with an extensive background in endocrinology and an academic nephrologist who takes an active interest in hypertensive patients. Their views reasonably coincide. (ed.).

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID