ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In the past decade there has been an increased awareness of the association between chronic illnesses of the alimentary tract and alterations of bone metabolism. The advent of dual x-ray absorptiometry has made it possible to measure bone mineral density in these patients reproducibly with low doses of radiation. In many of these diseases, the basic mechanisms that alter bone metabolism have not been fully elucidated. Most of these diseases can potentially affect bone function in several ways, including malabsorption of key nutrients like calcium and vitamin D, delayed sexual development, inactivity, and corticosteroid use. However, even in gastrointestinal and liver diseases associated with malabsorption, which would be expected to cause osteomalacia or rickets, decreased bone mass may be more common for reasons that are incompletely understood. This review presents examples of gastrointestinal and liver disorders associated with alterations in bone metabolism.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Diabetes is a condition that easily lends itself to a disease management approach. It is characterized by easily measurable and quantifiable outcomes and process measures. When implemented, diabetes disease management programs can significantly improve outcomes, whether compared with the American Diabetes Association standards [1] or when assessed based on economic models [2,3]. Despite this, on a population level, the data for patients with diabetes shows that targets are rarely reached [4–6]. This means that these programs are not uniformly available and/or they are implemented poorly. This review covers the history of diabetes disease management, its current application, and goals for the future.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Autoimmune polyglandular syndromes include involvement of multiple endocrine glands. In patients with these syndromes, hypofunction of multiple endocrine glands is induced by autoimmunity and occurs in well-described patterns. Features of type I autoimmune polyglandular syndrome include hypoparathyroidism, recurrent mucocutaneous candidiasis, and adrenal insufficiency. Major features of type II autoimmune polyglandular syndrome are type 1 diabetes mellitus, adrenocortical insufficiency, and primary hypothyroidism. Commonly, patients present with one component of the syndrome and the other components do not become evident clinically for a number of years.We report the case of a 39-year-old woman with type II autoimmune polyglandular syndrome. This patient presented with simultaneous onset of all three major features of this syndrome: type 1 diabetes mellitus, adrenocortical insufficiency, and hypothyroidism. We review literature and describe current classification of polyglandular syndromes. Consequences of untreated adrenocortical insufficiency can be dire. Detection of autoantibodies and or measurement of elevated tropic hormones can help us diagnose hypofunction of a variety of endocrine glands at an asymptomatic stage. When a clinician diagnoses one or more features of autoimmune polyglandular syndrome, she/he should be on the look out for deficiencies of other endocrine glands in the preclinical or clinical stage.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cobalamin (Cbl), or vitamin B12, is required for activity of the mitochondrial enzyme, methylmalonyl-CoA mutase, and the cytoplasmic enzyme, methionine synthase. A number of inborn errors affecting ability to absorb dietary cobalamin or to convert exogenous cobalamin to its active coenzyme derivatives have been recognized. Intrinsic factor deficiency and Imerslund-Gräsbeck syndrome result in inability to absorb dietary cobalamin from the gut. Transcobalamin II deficiency results in decreased levels of the blood cobalamin-binding protein that facilitates cellular cobalamin uptake. The inborn errors of cobalamin metabolism, the CblA– CblH disorders, result in inability to synthesize one or both of the cobalamin coenzyme derivatives, adenosylcobalamin and methylcobalamin, resulting in methylmalonic aciduria or hyperhomocystinemia and hypomethioninemia, or both.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Elevated serum levels of prolactin are identified less frequently in men than in women, in part because in men the recognition of symptoms, including reproductive dysfunction, is delayed. The majority of prolactin secreting tumors in men are macroadenomas, and patients often present with headache and visual field abnormalities as chief complaints. Abnormalities in pulsatile gonadotropin secretion result in hypogonadism, and both sexual and reproductive dysfunctions are commonly present at the time of diagnosis. Serum prolactin levels typically correlate with tumor size. In the absence of other explanations for an elevated prolactin level, such as medication, primary hypothyroidism, or pituitary stalk compression, a prolactin secreting pituitary tumor is the most likely diagnosis. A magnetic resonance imaging scan of the pituitary is critical in the diagnosis of a prolactinoma. Medical management with dopamine agonists is the first line of treatment. Bromocriptine or newer agents, such as cabergoline and quinagolide, normalize prolactin levels and decrease tumor size in the majority of patients, independent of initial tumor size. Overall, approximately 80% of men with prolactinomas will normalize serum prolactin levels with dopamine agonist therapy alone. Adjunctive therapy with testosterone for hypogonadism and sexual dysfunction is often necessary due to per manent gonadotroph destruction in macroadenomas or failure to normalize prolactin levels in both macro and microadenomas. Transsphenoidal surgical resection of the tumor should be used only when dopamine agonist therapy fails or cannot be tolerated. Increased recognition of the syndrome of hypogonadism in men in recent years may lead to earlier diagnosis of prolactin secreting tumors in men.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Insulin infusion pumps, or continuous subcutaneous insulin infusion, have been an increasingly popular choice of management for type 1 diabetes in children and adolescents. Real advantages and manageable risks make this method a good option in selected patients and families. Prepump education and preparation are important.Basal and bolus functions of the pump allow flexible and individualized therapy. Adaptations for sports, holidays, and other schedule variations can be handled sensibly. Certain special situations, such as pregnancy, surgery, and sick days are well handled with pump therapy.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Care of infants with intersex must consider the changing understanding of determination of sex and gender. Although most intersex infants are either females with relatively mild virilization (clitoromegaly with some posterior labial fusion) or males with incomplete virilization (varying degrees of hypospadias), a small portion of intersex patients have genital ambiguity to the extent that the sex of rearing is not obvious on initial assessment. Guidelines for the traditional approach have compared anatomic potential for fertility, sexual function, and endogenous gonadal hormone production. Inherent in the care is disclosure to the parents, and later, progressively to the patients. Counseling should include available information concerning diagnosis, medical and surgical therapy, as well as updated information regarding determinants of sexual and gender roles and behavior.Because these guidelines have not been fully used or because adequate outcome information is unavailable, some intersex patients have expressed dissatisfaction with their care. This, plus increasing understanding of gender and sexual roles, has demanded a reassessment of the approach to the child with intersex. More outcome information is needed to recommend the best guidelines and to formalize the best approach.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Long-acting contraceptives offer couples the ability to increase compliance with a reliable method by decreasing its repetitive use. Though surgical sterilization is part of this group of contraceptive options, a number of reversible agents have been approved by the FDA over the past 15 years that have demonstrated a high degree of efficacy and patient tolerability. These include preparations or devices that can be administered either intramuscularly, subdermally, or inserted in the uterus.

ISSN:1051-2144    

出版商:OVID    

年代:2001

数据来源: OVID