ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Hypothalamic germinoma presenting with central diabetes mellitus and extreme hypernatremia is rare. The authors describe a 38-year-old woman with hypothalamic germinoma that manifested as recurrent attacks of nonketotic hyperosmolar hyperglycemia and extreme hypernatremia. Magnetic resonance imaging of the brain showed a hypothalamic tumor and a normal pituitary gland. Examination of endocrine function revealed hypogonadism and hyperprolactinemia. DDAVP test showed central diabetes insipidus. She was treated with tumor debulking and radiotherapy. The glucose level became normal and no more hypoglycemic agent was needed. However, hyperglycemia was noted again 2 months after discharge, with recurrent nonketotic hyperosmolar hyperglycemia and associated hypernatremia. She died at home suddenly 11 months after the diagnosis. Although the survival rate of hypothalamic germinoma is 87.5% over the course of 10 years, symptoms of central diabetes mellitus and extreme hypernatremia may represent a poor prognosis.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors describe the case of an adrenaldeficient woman who required high doses of mineralocorticoid replacement in sequential pregnancies. A 22-year-old woman with surgical removal of her adrenals in childhood, on stable mineralocorticoid and glucocorticoid replacement, increased her need for mineralocorticoid during pregnancy. Her requirements increased from 0.3 mg of Fludrocortisone daily to 1.2 mg and 1.4 mg daily in sequential pregnancies based on serum renin activity levels and presence or absence of postural hypotension. To our knowledge, this is the first published case report of the need for high dose mineralocorticoid replacement in a pregnant patient with primary adrenal insufficiency.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors present the case history as well as laboratory, radiological, and pathologic findings of the current case. Relevant reports from the literature are reviewed. A 65-year-old woman with chronic hypertension presented with nasal congestion and was found to have a mass narrowing her oropharynx and hypo-pharynx. Computed tomography showed a tumor arising at the bifurcation of the carotid artery. Her 24-hour urine collection showed elevated metanephrines. The patient was managed preoperatively with phenoxybenzamine and atenolol. Arteriography revealed a highly vascular tumor with vascular feeding from a branch of the external carotid artery. Embolectomy was performed 48 hours later by surgical removal and was without complications. Subsequently, urinary metanephrine levels normalized but hypertension remained. Inter-carotid paragangliomas occasionally produce an excess of circulating catecholamines but otherwise are clinically silent. A low threshold to rule out this possibility should exist during the evaluation of intercarotid paragangliomas.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Adult growth hormone deficiency (AGHD) is associated with a reduction in lean body and muscle mass, an increased risk for cardiovascular morbidity and mortality, reduced muscle strength and impaired physical fitness, and decreased bone mass. These physical changes are often accompanied by impairment in psychological well-being. Growth hormone (GH) replacement therapy has proven to be beneficial in increasing lean body and muscle mass. Importantly, GH replacement therapy has significant positive effects on lipid profiles and central adiposity, two major cardiovascular risk factors. Improvements in bone mineral density are also often seen with replacement therapy.The diagnosis of AGHD should be considered in adults with a history of a mass lesion in the sella or hypothalamus, cranial irradiation, or documented childhood-onset GH deficiency. Adults with a history of head trauma should also be considered for this diagnosis. The traditional provocative test used for the diagnosis is the insulin tolerance test (ITT). However, the complexity and inherent risks associated with the ITT have resulted in many clinicians using arginine alone or in combination with GH-releasing hormone as the provocative test of choice. Growth hormone therapy should be individualized, with dose adjustments based on clinical and biochemical response. Serum insulin-like growth factor I concentrations are used to evaluate the effectiveness of therapy, with the goal of therapy to return these levels to the upper one-half of the normal age-adjusted and sex-adjusted normal ranges. Adverse effects of GH replacement therapy are minor and are minimized by individualizing therapy based on clinical response.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

For patients with diabetes, a major goal is achieving good glycemic control to prevent the development of end organ complications. Statistical Pro-cess Control (SPC) is a method of data display and analysis that can provide enhanced information for patients and physicians to facilitate good glycemic control. Individual patient data are used to explain control chart selection, control limit calculation, and the appropriateness of recalculating control limits. Examples of how to analyze and chart different types of data are provided, and practical implications and use of control charts for enhancing patient care are discussed.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Cortisol and growth hormone (GH) are released in response to a variety of pharmacologic and physiologic stimuli. Secretion of cortisol and GH are influenced by age, gender, time of day, nutrition, sleep, body composition, and fitness level. Exercise is one of the most potent stimulators for release of these hormones. A single session of exercise of sufficient intensity will result in dramatic increases in cortisol and GH concentrations in most individuals and may take a few hours to recover back to baseline levels. Cortisol and GH are necessary for optimal exercise performance, which is most evident in chronic cortisol and GH deficiency. In deficient individuals, replacement therapy with cortisol or GH restores normal exercise performance. Exercise training can substantially alter the degree of perturbation of the hypothalamic-pituitary axis. The cortisol response pattern to exercise has been considered to be predictive of an individual’s adaptation to other forms of stress. This review discusses the cortisol and GH responses to exercise, the factors affecting these responses, the mechanisms of hormone release, and the clinical implications of these physiological observations.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID