ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The concurrent clinical events of pregnancy and untreated Cushing's syndrome are rare, with fewer than 100 affected patients documented in the medical literature since 1953. When these conditions coexist, maternal and perinatal morbidity and mortality rates are substantial. Therapy to relieve hypercortisolism has been instituted in one-third of reported pregnancies. Such therapy includes pituitary and adrenal surgery, chemotherapy, and pituitary irradiation. The impact of definitive therapy on maternal outcome is unclear, but perinatal outcome appears to be little affected by directed therapy.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The roles of androgen and estrogen in pubertal growth, epiphyseal maturation, and accretion of bone mass have generally been perceived to be overlapping. Described in this article are three recently published novel case reports that reveal important new concepts regarding the relative roles of these two classes of hormones. A woman and a man with aromatase deficiency and a man with estrogen resistance secondary to an estrogen-receptor mutation are described. The details of their phenotypes reveal that although androgens have direct growth-stimulating actions on the epiphysis, the final phase of skeletal maturation associated with epiphyseal closure seems to be primarily an estrogen-dependent phenomenon in men and women. In addition, bone mass accrued during puberty is primarily induced by estrogen in both sexes.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The use of growth hormone (GH) has expanded from the treatment of short stature due to GH deficiency (GHD) in children with open epiphyses to include growth failure due to chronic renal insufficiency (CRI) and Turner's syndrome (TS) as well as adults with GHD. The safety considerations in using GH differ somewhat in these diagnostic groups, and the physician caring for these patients will need to keep this in mind when monitoring patients receiving GH.Peripheral edema and carpal tunnel syndrome have been reported as side effects more frequently in adults than in children treated with GH. Idiopathic intracranial hypertension has been reported most frequently in children with CRI (31.1 cases per 1000 patient-years [pt-yrs]), although children with GHD and TS also have an increased incidence (1.6 and 3.7 cases per 1000 pt-yrs, respectively). The greatest risk is at the beginning of treatment, and complaints of headache or visual disturbance at this time should prompt careful neurologic and ophthalmologic examination.The risk of leukemia and nonleukemic extracranial neoplasms in children treated with GH seems to be confined to those with identifiable risk factors. Although numerous studies have failed to show an increased risk of brain tumor recurrence associated with GH treatment, children with a history of such tumors should have completed tumor therapy and have brain imaging studies before beginning GH.Children with CRI, GHD, and TS have an increased risk of developing slipped capital femoral epiphysis. Complaints of limping or hip or knee pain need to be evaluated with radiographic studies if there is limited hip movement. Although there is no evidence that treatment with GH causes scoliosis, children with pre-existing scoliosis should be observed for rapid progression after starting GH treatment.Most studies of the effect of GH on carbohydrate metabolism show only transient changes in insulin sensitivity. Nevertheless, patients with an increased risk of diabetes should be encouraged to modify their diet and exercise habits.Gynecomastia is a common side effect in adults receiving GH, and self-limited gynecomastia has been reported in prepubertal boys during GH treatment.Older preparations of pituitary GH contained GH oligomers and were frequently associated with high titers of GH antibodies and growth deceleration. Except for patients with GH gene deletions, antibodies are rarely a cause of poor response to GH. Other causes of poor growth should be investigated in a child who fails to respond to prescribed GH as expected.Specific recommendations for managing patients in different diagnostic categories who are treated with GH are reviewed.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A recent study measuring body height and weight in a random sample of several thousand men and women in the United States found the prevalence of overweight, 28% in the 1970s, had risen to 33% [1], Not only are more Americans overweight but also the average weight has increased an astonishing 8 lb in the last 10 years. This average gain in weight translates to a 1–2 unit increase in body mass index (BMI; kg/m2). BMI, in turn, is a simple criterion established by National Institutes of Health Consensus Conference to guide physicians regarding the relative importance of intervention [2] (Table 1)Whereas the medical complications of obesity-glucose intolerance, hypertension, dyslipi-demia, coronary artery disease, gallstones, arthritis, etc-are well established [3], an effective treatment program for obesity-weight loss-is not well established [4]. This article reviews how effective commonly used treatments of obesity are at producing weight loss.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although endometriosis remains an enigmatic disease, recent pharmacologic and surgical ad' vances have dramatically improved our ability to deal with endometriosis-associated pain, infertility, and pelvic masses. This article summarizes the nature, presentation, and diagnosis of endometriosis and reviews the current medical and surgical treatment options. Prospective, con- trolled studies and meta-analyses provide an understanding of how best to utilize these new technologies. A rational, objective, and usually effective algorithm for management of this potentially debilitating disease can be implemented for most patients.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The concept that “slow metabolism” might contribute to obesity, coupled with the idea that thyroid dysfunction is a common cause of “slow metabolism,” has led to exploration of the relationship between obesity, nutrition, and thyroid function, the topic of this review. Some obese animals have low serum T3 concentrations; conversely, some studies of obese humans have revealed high serum T3 concentrations. Exaggerated responses of serum TSH following thyrotropin-releasing hormone (TRH) stimulation have also been noted in some human studies, possibly suggestive of thyroid hormone resistance. Thyroid function in humans and animals depends in a complex way on dietary content and composition. Hypothyroid individuals may have transient increases in body weight related to changes in fluid balance rather than adi- pose mass; long-term treatment of hypothyroidism with thyroid replacement in physiologic dosage has little effect on body weight. Hypothyroidism does not seem more common in the obese population than in the general population. In obese individuals, supplementation of weight reduction regimens with exogenous T3 may accelerate body weight loss at the expense of excessive loss of lean body mass and other possible side effects. In conclusion, abnormalities of thyroid function that are noted in obese individuals are of uncertain clinical significance. Hypothyroidism is not a significant etiology of idiopathic obesity, and treatment of obesity with exogenous thyroid hormones is fraught with significant problems.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A 10.5-year-old boy was evaluated for a history of severe hypertension that was unresponsive to combined antihypertensive medication. A laboratory work-up revealed hypokalemia, suppressed plasma renin activity, and a high serum aldosterone level. A conventional abdominal computed tomographic scan was normal. An NP-59 iodonorcholesterol (131I-6-β-iodomethyl-nor-cholesterol) scan was performed under dexamethasone suppression for the differential diagnosis of primary hyperaldosteronism. The scan revealed an asymmetrical uptake of the radiotracer, with greater activity on the right side. Adrenal venous sampling demonstrated significantly increased aldosterone secretion from the right adrenal gland, with suppression on the left side. A preoperative spiral computed tomographic scan clearly showed a right adrenal tumor that measured 1 cm in diameter. The right adrenal gland was surgically removed, along with a 1.2-cm aldosteronoma; the hypertension of the patient resolved immediately after the operation. An aldosterone-producing adenoma is a rare but curable cause of primary hyperaldosteronism in children. Recently available spiral computed tomography seems to be a promising, noninvasive, diagnostic aid in such patients.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The term hirsutism dose not adequately describe the plight of women who see themselves as excessively hairy; the distinction between affliction and suffering is ignored. The usual “laundry list” diagnostic approach to the hirsute patient unnecessarily complicates evaluation and management. We suggest an alternative schema based on a concept of overlapping pathophysiological entities of increasing severity. Based on this schema we suggest that 1) a minimal clinical and laboratory evaluation suffices for most individuals, and that 2) four simple principles of therapy (compassion, time, beauty care, and medication to reduce the androgenic milieu of the skin) can effectively reduce the woman's suffering.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID