ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;The physical and hormonal events that occur at the time of normal development of sex hair growth during childhood are referred to as the adrenarche. Appearance of pubic or axillary hair before age 8 in girls or age 9 in boys characterizes the syndrome of premature adrenarche; its hormonal concomitant is comparably early activation of adrenal androgenesis. In most clinical situations, this condition is simply a normal variant of early puberty and has minimal significance. On rare occasions, adrenal neoplasms or late‐onset congenital adrenal hyperplasia may cause increased adrenal androgenesis and onset of hair growth. The regulation of androgen synthesis in the adrenal zona reticularis is poorly understood. Long‐term follow up of these patients has generally not revealed clinical abnormalities, but there may be an increased incidence of functional ovarian hyper‐androgenism or polycystic ovarian disease that appears in late teenage years.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Insulinomas are rare tumors that may present a diagnostic dilemma to the clinician. The classic diagnostic test for this disorder is the supervised 72‐hour fast. The presence of inappropriately elevated plasma insulin and plasma C‐peptide levels at the time of symptomatic hypoglycemia in a sulfonylurea‐negative patient establishes the diagnosis. In most cases of insulinoma the results of the 72‐hour supervised fast are unequivocal. When beta cell polypeptide levels are inconclusive, however, determination of markers of insulin action, such as plasma &bgr;‐hydroxybutyrate and plasma glucose response to intravenous glucagon at the end of the fast, may provide additional diagnostic information. The cases described herein highlight some of the difficulties that may be encountered during the evaluation of suspected and the management of biochemically confirmed insulinoma and provide clues that lead to a correct diagnosis and therapy.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;A growing body of medical evidence substantiates the popular notion that androgens regulate several aspects of behavior in men; in addition, recent studies suggest that androgens modulate certain behaviors in women as well. In hypogonadal men, androgen replacement leads to improved libido and other behaviors, but erectile responses to erotic stimuli do not seem to be affected. Similarly, in normal men, suppression of endogenous androgens to very low levels leads to decreases in a variety of sexual behaviors. Sexual function, however, may be maintained with lower androgen levels than are required for other target tissues. Although higher androgen levels lead to increased aggressive behaviors in animals, this relationship is probably not valid in men. In women, correlations between levels of circulating androgens and sexual behaviors are variable. In some naturally menopausal women with decreased libido, androgen replacement may be effective when estrogen replacement has failed, but few studies have examined this question. In contrast, several studies suggest that in some surgically menopausal women, replacement of estrogen and androgens may lead to better psychological and sexual functioning than replacement of estrogen alone. However, more data are needed before this approach can be recommended to every surgically menopausal woman.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Epithelial ovarian cancer occurs primarily in postmenopausal women, and most cases are thought to be due to acquired alterations in oncogenes and tumor suppressor genes. In contrast, approximately 5–10% of ovarian cancers arise in women who carry inherited mutations in a cancer susceptibility gene. It is thought that more than 90% of hereditary ovarian cancer is due to inherited mutations in the BRCA1 breast/ovarian cancer susceptibility gene on chromosome 17q. BRCA1 mutational analysis is being performed in several academic medical centers on a research basis and also now is commercially available. With the ability to identify mutations in BRCA1, prophylactic oophorectomy and other interventions intended to decrease ovarian cancer mortality can be offered specifically to women who carry a mutation, but the optimal strategy for the clinical management of these families has not yet been determined.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Luteinizing hormone/human chorionic gonadotropin (LH/hCG) receptors are present in human implantation sites that contain intermediate trophoblasts, decidual cells, and blood vessels. These receptors also are in human endometrial stromal cells, endometrial glands, myometrial smooth muscle, and T lymphocytes. Highly purified exogenous hCG and LH can promote the differentiation of stromal cells into decidua, increase the levels of cyclooxygenase‐2 (COX‐2) in glandular epithelial cells, decrease the resistance index, increase prostacyclin, decrease thromboxane B2synthesis in uterine arteries, and inhibit contractions of the uterus. These changes are required for the successful implantation of the blastocyst. Thus, it is likely that LH and hCG directly promote implantation in humans and possibly in other species.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;The association between radiation exposure and subsequent thyroid cancer has been demonstrated conclusively in epidemiological studies of children receiving external head and neck x‐ray irradiation and in survivors of the atomic bomb exposures in Japan. Previous studies, however, have failed to demonstrate any causal association between diagnostic or therapeutic131I administration and thyroid cancer risk, although data regarding the pediatric population are scarce. New evidence emerging since the Chernobyl accident suggests that exposure to131I can cause thyroid cancer in children and adolescents, but further epidemiological studies are required to prove this hypothesis conclusively. Until the question is settled definitively, clinicians are urged to exercise due caution when considering the use of131I for diagnostic applications or when treating hyperthyroid states in individuals younger than age 20.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Chronic glucocorticoid excess leads to the constellation of symptoms and physical features known as Cushing's syndrome. The most useful screening test for this disease is the measurement of 24‐hour urine‐free cortisol. Depression, chronic alcohol abuse, and psychological or physical stress all can increase urine‐free cortisol excretion and result in a false‐positive study. Drugs such as phenytoin, phenobarbitone, and primidone can interfere with the dexamethasone suppression test, but urine‐free cortisol usually is normal. Carbamazepine (CBZ) is reported to increase 24‐hour urine‐free cortisol. To our knowledge, there is no report of CBZ interfering with a urine‐free cortisol assay by high‐performance liquid chromatography (HPLC). We report the case of a 17‐year‐old woman with partial complex seizure disorder treated with CBZ, 150 mg TID, who was evaluated for Cushing's syndrome because of obesity, hypertension, and hirsutism. She had no other signs of Cushing's syndrome. An overnight dexamethasone suppression test (1 mg) was abnormal (serum cortisol 11 mcg/dL at 8:00 a.m.) The 24‐hour urine‐free cortisol, by HPLC, was elevated on two occasions: 194 mcg/24h, and 14,744 mcg/24h (<50 mcg/24h). Repeat measurements of the second sample by radioimmunoassay showed a 24‐hour urine‐free cortisol of 128 mcg/24h. The interfering substance with HPLC assay has not been identified. It seems likely that it is a CBZ metabolite. Midnight serum cortisol level was normal at 9.9 mcg/dL, and serum corticosterone (&bgr;) showed adequate suppression (<20 ng/dL) after an overnight hydrocortisone suppression test. This is the first case report of CBZ interfering with a urine‐free cortisol assay by HPLC method. Careful interpretation of 24‐hour urine‐free cortisol measurement is required in patients taking CBZ.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Symptomatic primary hyperparathyroidism is still very frequent in Brazil. Unfortunately, the correct diagnosis is usually made late in the course of the disease, and many patients with this disorder present with evident bone disease. After successful parathyroidectomy, these patients usually recover bone mass, but this improvement can be variable. We present the case of a patient with primary hyperparathyroidism whose clinical presentation was heralded by a single right ischio‐pubic lytic lesion. Rapid recovery of bone mass was seen in this patient.

ISSN:1051-2144    

出版商:OVID    

年代:1997

数据来源: OVID