ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

An early diagnosis of functioning adrenocortical carcinoma depends ou die physiuan's ability to recognize the clinical manifestations of excessive steroid hormone production by the tumor. Definition of the biochemical abnormality can be obtained with specific measurements of cortisol, aldosterone, and androgen or estrogen levels. Computerized tomography or magnetic resonance imaging can help localize the tumor and define die presence or absence of local and distant metastases. For non-functioning tumors, detection is frequently incidental to the investigation of nonspecific abdominal complaints. [131I]6-β-iodomethyl-19-norcholesterol will image most benign tumors but is rarely taken up by malignant tumors. Surgical resection of the primary tumor or its recurrence and visible hepatic and pulmonary metastases increases life expectancy. Other methods of treatment, including radiation therapy and chemotherapy, are less effective. Mitotane extends survival for patients with adrenal carcinoma, particularly when it is administered early as adjuvant therapy or combined with repeated debulking resections of recurrent tumor. The toxicity associated with mitotane administration limits the use of larger and probably more effective doses. The synthesis of analogs of mitotane with reduced toxicity may provide better tools for the management of this cancer.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Although the accurate diagnosis of most metabolic bone diseases is possible with noninvasive studies, a transiliac bone biopsy can provide information about rates of bone turnover and mineralization that cannot be obtained by any other means. On occasion, it is necessary to integrate the histologie findings with the clinical presentation to establish a diagnosis and/or initiate appropriate therapy. This short review will attempt to provide the practicing endocrinologist with an understanding of tech' niques of a bone biopsy, the special tools employed by the histopathologist to prepare and examine the biopsy specimen, the relevant information that can be derived from a bone section, and, most importantly, the usefulness of this information in the diagnosis and management of metabolic bone disorders.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 38-year-old man with a previously unrecognized macroprolactinoma presented with an acute and severe headache in association with transient diplopia and ptosis. Computerized tomography revealed erosion of bony sellar margins and a mass in the sellar region containing air bubbles, suggesting the presence of an intrasellar infection. Non-surgical treatment with dexamethasone, antibiotics, and bromocriptine resulted in resolution of the neurological and hormonal abnormalities. Serial imaging studies showed resolution of signs of infection and shrinkage of the tumor. The literature on pituitary abscess is reviewed. Awareness of this condition may improve early recognition and appropriate treatment.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Factitial hypoglycemia occurs as a result of the inappropriate use of a hypoglycemic agent, either through surreptitious self-administration, malicious administration to others, or innocent compliance with a prescription wrongly dispensed. The most common form of factitial hypoglycemia is the covert self-administration of a hypoglycemic agent by a patient without diabetes. A close second is the inappropriate manipulation of doses of hypoglycemic agents by patients with diabetes. These patients are commonly women in the third and fourth decades of life and, among non-diabetic persons, are likely to have health' related occupations. Diagnosis in persons without diabetes requires simultaneous determination of plasma glucose, insulin, C-peptide, and sulfonylurea during an episode of hypoglycemia. Sulfonylurea factitial hypoglycemia is characterized by non-suppressed levels of plasma insulin and C-peptide and the presence of sulfonylurea in urine or blood. Insulin factitial hypoglycemia is characterized by non- he suppressed levels of insulin, suppressed levels of C-peptide, and the absence of sulfonylurea. Assessment of factitial hypoglycemia in a person with diabetes requires close observation under controlled conditions.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

X-linked adrenoleukodystrophy (ALD), char' acterized by the presence of adrenal insufficiency and demyelination, has recently been recognized to be an important cause of primary adrenal insufficiency in males. This disease has a broad clinical expression with four major presentations. The most common phenotypic group is the severe cerebral form of ALD, which is seen most frequently in childhood. In this form, demyelination advances rapidly over several years and the disease is uniformly fatal. A second common phenotype is the adrenomyeloneuropathy form, which usually has its onset in adulthood and exhibits a slow neurological progression dominated by spastic paraparesis. The third phenotype is isolated Addison disease with no neurological involvement. Asymptomatic and presymptomatic patients comprise the fourth phenotypic group. ALD males can develop adrenal disease long before neurological symptoms arise. The diagnosis of ALD is readily made by measuring plasma levels of saturated very long chain fatty acids, which are elevated in affected patients due to an enzymatic defect in their oxidation. All males with isolated adrenal insufficiency should be tested for ALD because of the potential for therapy and the genetic implications for the family.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The craniopharyngioma is one of the most common destructive lesions of the hypothalamus and pituitary gland. It is also one of the most difficult to treat effectively. Complete surgical resection is often impossible and, when done, associated with frequent recurrence. Current therapy focuses on a combination of surgical decompression, medical, and radiotherapy. This article reviews the clinical features of the craniopharyngioma and the several surgical approaches to its treatment. Overall therapeutic strategies for the most common presentations of this tumor are discussed.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Menopausal hormone replacement therapy has evolved into a long-term preventive measure because of its notable benefits on osteoporosis and cardiovascular disease. This has raised the concern that prolonged use of hormones may increase the risk of breast cancer. Numerous studies over the past 15 years have failed to show a strong and consistent increase in the risk of breast cancer among women using unopposed estrogen therapy. However, the evidence does suggest that women with a family history of breast cancer or women who are long-term users may be at higher risk. Hormone replacement therapy consisting of an estrogen and progestin is a relatively recent practice and few studies have been able to evaluate its effect on breast cancer. Those epidemiologic studies that have examined the risk of breast cancer related to estrogen and progestin use have had limited power to detect an effect, and results have been inconsistent. Like-wise, biologic mechanisms have been proposed that favor alternately a protective or deleterious effect of progestins on the risk of breast cancer. Therefore, conclusions about the effect of combination estrogen and progestin menopausal replacement therapy must await the completion of additional epidemiologic studies

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Goiters extending into the mediastinum are a commonly encountered medical problem for which treatment is controversial. The frequency of mediastinal goiters increases with age and is more common in women. The predominant causes are benign multinodular goiter and colloid adenoma. Twelve percent of patients with multinodular goiter have some degree of substernal extension. The majority of these patients have symptoms. The most common symptoms are dyspnea, choking, dysphagia, cough, and upper chest pressure. These are generally due to compression of surrounding structures as the goiter passes through the thoracic inlet. Acute respiratory compromise and superior vena cava obstruction have been reported but are usually euthyroid; the incidence of hyperthyroidism is less than 5%. The diagnosis can usually be made by physical examination. Computerized tomography is the most sensitive diagnostic procedure. Mediastinal goiters have a low risk of malignancy. We believe optimal treatment for symptomatic patients is surgical. There is a role, however, for thyroid hormone and radioactive iodine therapy in asymptomatic patients and those who do not desire surgery.

ISSN:1051-2144    

出版商:OVID    

年代:1992

数据来源: OVID