ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Inferior petrosal sinus sampling is highly accurate in distinguishing pituitary from ectopic sources of ACTH in Cushing's syndrome. However, this test may give misleading results in several clinical situations. These include patients in whom hypercortisolism is the result of a pseudo-Cushing state, patients who have ACTH-independent Cushing's syndrome, patients with episodic or mild hypercortisolism that is insufficient to suppress ACTH secretion of the normal pituitary corticotrophs, and patients who have disparate results between inferior petrosal sinus sampling and the noninvasive tests used to distinguish Cushing's disease from the ectopic ACTH syndrome.Due to these limitations, petrosal sinus sampling should be reserved for patients with clear clinical and biochemical evidence of ACTH-dependent Cushing's syndrome, and must be interpreted cautiously whenever the results conflict with those of the noninvasive tests of differential diagnosis.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Osteoporosis has traditionally been a disorder almost synonymously associated with women, and as a result our understanding of osteoporosis in men is rudimentary. Nevertheless, there is an emerging recognition of the impact of osteoporosis in men. Attention is now being focused on elucidating the causes of age-related bone loss and delineating the clinical character and pathophysiologic processes responsible for idiopathic male osteoporosis. Of particular importance are efforts to understand the basic nature of the sexual differences in skeletal development and maturation, with the aim of identifying gender-specific aspects of male skeletal metabolism. Recognition of the factors responsible for the fracture protection inherent in the male skeletal phenotype may afford new therapeutic approaches for both male and female osteoporotic patients. The purpose of this review is to summarize our current understanding of osteoporotic bone disease in men and provide a framework for diagnostic and therapeutic approaches to this disorder.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Insulin pump therapy has come a long way in the last 15 years and is now a very practical way of maximizing glycemic control in the person with insulin-dependent diabetes. Any patient with insulin-dependent diabetes is a candidate for insulin pump therapy. Insulin pump therapy, at least in the long term, seems to be superior to multiple injection therapy in achieving glycemic control and provides a better quality of life. Disadvantages include an increased incidence of diabetic ketoacidosis and, perhaps, severe hypoglycemia, needle site infections, weight gain, expense, and potential worsening of retinopathy in an occasional patient. Early diabetic retinopadiy, nephropadiy, and neuropathy are improved on insulin pump therapy. Expense and third-party reimbursement remain the major hurdles to initiation of insulin pump therapy. Success of insulin pump therapy is dependent upon careful selection of patients and training of the pump patient by a team that is experienced in this form of treatment. Implantable pump therapy offers no advantage and has several disadvantages compared with external insulin pump therapy. In the future, only the development of nontoxic immunosuppression or an implantable glucose sensor will outdate external insulin pump therapy.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Newly developed, ultrasensitive immunoassays have allowed a more accurate assessment of the gonadotropin changes that occur during the pubertal transition. Difficulties still remain, however, and controversial data exist regarding circadian secretion, sex differences, and the pulsatile secretory mode of FSH and LH in the pediatric age groups. How and when to employ the more sensitive assays, GnRH stimulation, sex steroid measurements, or urine concentrates are not settled topics. Many avail' able techniques, such as the assessment of pulsatile LH secretion, lend themselves more to research investigations than to routine patient evaluation. In particular, any useful gonadotropin testing method will require repeated sequential evaluation in a process such as puberty. Requirements for clinical diagnosis and treatment encompass adequate sensitivity, specificity, and simplicity of the assay method. The LH and FSH radioimmunoassay of short-term urine concentrates meets such needs and constitutes a useful technique applicable to the management of children with disorders of sexual maturation.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Estrogens and androgens have opposing effects on lipoprotein lipids. Progestins fall in between depending on their androgenicity. Estrogens raise plasma triglyceride concentrations but lower remnant and LDL and raise HDL levels while progestins and androgens lower triglyceride concentrations, raise LDL and lower HDL concentrations. Apoprotein B and A-I levels change in parallel with alterations in LDL and HDL, respectively. An exception is Lp(a), which decreases with estrogen or androgen. There are numerous examples of these effects. Male puberty is associated with a testosterone-induced reduction in HDL. Estrogen appears to explain the lower LDL levels experienced by women premenopausally. Oral contraceptive effects reflect estrogen-progestin potency and progestin androgenicity. Lipoprotein changes in pregnancy are generally an estrogen dominant effect while in oral contraceptive use the lipoprotein changes are a balance of the estrogenic and progestogenic effects of the given formulation. The hypertriglyceridemia of pregnancy may be severe enough to cause pancreatitis and require treatment with low fat diet and fish oil. Postmenopausally, use of estrogens alone or with a low-dose low-andro-genic progestin such as medroxyprogesterone acetate reveal a predominantly estrogenic effect and beneficial effects on LDL and HDL. Advantage can be taken of these hormonal effects to manage hypercholesterolemia and Type HI hyperlipidemia (“remnant removal disease”). Rarely, androgens may be useful in treating intractable hypertriglyceridemia. Pending the outcome of ongoing studies, the prevention of coronary artery disease in women with estrogen may be feasible through favorable effects on lipid and carbohydrate metabolism and the artery wall.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The enzyme steroid 5α-reductase converts testosterone to the more potent androgen dihydrotestosterone. An inherited deficiency of the enzyme results in a deficiency of dihydrotestos-terone (DHT) and the clinical syndrome of 5α-reductase deficiency. The syndrome is characterized by male pseudohermaphroditism. Affected males have pseudovaginal perineoscrotal hypospadias and ambiguous genitalia at birth. Many are raised as girls; however, at puberty there is virilization, with deepening of die voice, enlargement of the phallus, hyper-pigmentation of the scrotum and increased muscle mass. A change in gender role and gender identity frequently occurs at this time in many affected individuals, and this phenomenon is detailed in the Dominican and the New Guinean kindreds. Affected adult subjects have small, nonpalpable prostates, decreased facial hair and no evidence of male pattern baldness, attesting to the DHT dependency of these phenomena. The diagnostic criteria and characteristic biochemical profile of 5α-reductase deficiency are described. The mode of inheritance of the condition has been clearly demonstrated to be autosomal recessive, and carrier detection, both biochemical and genetic, is discussed. Recently two isoforms of the enzyme, 5α-reductase 1 and 5α-reductase 2, and their corresponding genes have been characterized. The clinical syndrome of 5α-reductase deficiency (5αRD) is due to a defect in die 5α-reductase 2 gene. The specific mutations found in the Dominican and New Guinean kindreds are reviewed. Medical therapy for male pseudohermaphroditism and issues related to surgical correction of the perineoscrotal hypospadias are discussed. The use of 5α-reductase inhibition as therapy for benign prostatic hyperplasia and possible dierapy for male pattern baldness, hirsutism and acne are discussed.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID