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

摘要:

Cushing's syndrome with bilateral adrenal hyperplasia usually is caused by chronic adrenocorticotropic hormone (ACTH) stimulation of the adrenal cortex. Until recently, the existence of ACTH-independent bilateral adrenal hyperplasia has not been firmly established. Evidence that such disorders do exist has accumulated, and in some instances, the mechanism is understood. Bilateral adrenalectomy is most often the appropriate therapy. Activation of the adrenocortical adenylate cyclase system by ACTH-independent mechanisms will cause ACTH-independent Cushing's syndrome with bilateral adrenal hyperplasia. Increased cAMP activates downstream signaling and subsequently cell division and Cortisol production. In food-dependent Cushing's syndrome there is functional evidence for ectopic gastric-inhibitory peptide receptor expression in the adrenal cortex. Food ingestion stimulates gastric-inhibitory peptide release and activates the adrenal adenylate cyclase system. ACTH-independent Cushing's syndrome with bilateral hyperplasia may be the initial presentation of the McCune-Albright syndrome. A R201C or R201H substitution in the alpha subunit of Gs constitutively activates adenylate cyclase. In other variants of ACTH-independent adrenal hyperplasia, the mechanisms are less defined. Primary pigmented nodular adrenocortical disease may occur sporadically or in a familial form, and activating adrenal antibodies have been postulated in its etiology. ACTH-independent bilateral macronodular adrenal hyperplasia is characterized by marked adrenal gland enlargement with multiple large nodules. Its etiology is unknown.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A man was given spironolactone and other drugs intermittently for control of hypertension. He developed gynecomastia bilaterally; spironolactone was stopped. Three years later, fatal infiltrating ductal adenocarcinoma of the breast supervened. This sequence of events raises suspicion that spironolactone therapy led to lethal breast carcinoma.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Skeletal cells synthesize growth factors with important effects on the replication and differentiated function of cells of the osteoblast and osteoclast lineage. Growth factors can be regulated at the level of synthesis, activation, receptor binding, and binding proteins. Changes in growth factor levels or activity may play a role in the pathogenesis of metabolic bone disorders. Growth factors could be used topically for the treatment of fractures. Their systemic use for the treatment of metabolic bone disorders has been postulated, and it may be practical for short periods of time. Growth factors also can be used indirectly in the treatment of osteoporosis by developing agents that modify their synthesis or activity in the bone microenvironment.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Inherent defects in white cell function in combination with local complications of diabetes mellitus place the diabetic patient at higher risk for infection. A spectrum of rare but serious infections is seen primarily in diabetics. Mucormycosis is an aggressive fungal infection; rhinocerebral disease is most commonly seen in diabetics. Necrotizing fasciitis is a severe, often rapidly progressive soft tissue infection due to multiple aerobic and anaerobic microorganisms. Malignant external otitis is an indolent infection with serious sequelae, including osteomyelitis and cranial neuropathies. Emphysematous pyelonephritis is a destructive renal infection, usually requiring nephrectomy for adequate treatment. Despite the diversity of these infections, they have at least one feature in common: all require prompt and aggressive surgical debridement for optimal outcome. The clinical presentation, diagnosis, and management of these four infectious processes are discussed in this review.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The fastest growing segment of our population is the elderly. By the turn of the century, 13% of the population in the United States will be more than 65 years of age. A prime goal of geriatric medicine is to compress the morbidities of aging into as small a period as possible at the extreme end of life. It has been postulated that restoration of a “growth hormone axis” more akin to that which exists in youth may play an important role in this effort. We review the data, pro and con, that bear on this hypothesis.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Programs to control dyslipoproteinemia (DLP) in childhood have been controversial because of the need for prolonged treatment during phases of rapid psychological and somatic development. The clinical challenge is to detect and provide intense, safe, and effective interventions for a small group of children with DLP. This program should complement changes in lifestyle for the entire population of children over the age of 2 years that limits dietary total fat, saturated fatty acids and cholesterol, although increasing physical activity and preventing smoking. The National Cholesterol Education Program has recommended selective screening with serum total cholesterol in children with parental history of total cholesterol ≥240 mg/dL or with serum lipoproteins in children with parental or grandparental history of premature (≤55 years of age) cardiovascular disease (CVD). Incomplete family history information and the young age of many parents diminishes the sensitivity and feasibility of this approach. We recommend universal screening by measuring total cholesterol in all children and lipoproteins in those children with a history of parental premature CVD. This approach should increase the salience of CVD prevention to the children, parents, child health providers, and school authorities. Decreasing dietary fat, saturated fatty acids and cholesterol for these DLP children is safe, effective, and well tolerated. Bile acid binding resins are reserved for older, high cardiovascular risk children with low-density lipoproteins ≥160 mg/dL after diet therapy. Treatment of childhood DLP has significant potential to decrease later risk of CVD by delaying the initiation and rate of progression of atherosclerosis.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Historically, women with androgen excess are often ignored and their complaints not taken seriously. We now know that many of these women have insulin resistance that can be aggravated by other cardiovascular risk factors. The insulin resistance is often accompanied by lower HDL cholesterol and higher triglycerides and LDL cholesterol. Evidence is accumulating that these women develop premature atherosclerotic vascular disease, often associated with diabetes. The stigmata of androgen excess often are the only marker of this metabolic aberration. Recognition can permit early institution of preventive measures that include exercise, diet, weight loss, and medications to control hypertension, glucose intolerance, and dyslipidemia.The syndrome of androgen excess is prevalent. Awareness of the range of phenotypic expression will facilitate diagnosis and the cooperation necessary for the behavior modification that is essential for the prevention of subsequent cardiovascular morbidity.

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Serum thyreoglobulin (TG) levels continue to play a critical role in the diagnosis and management of a variety of thyroid disorders. In no situation is this more evident than in the management of patients afflicted with thyroid cancer. The ability to measure serum TG has not only significantly improved the management of these patients, but has also raised a number of new, clinically relevant questions. The intent of this article is to review the clinical utility of serum TG in a variety of thyroid disorders, with particular emphasis on the management of differentiated thyroid cancer. Assay limitations and potential solutions to these difficulties will be discussed

ISSN:1051-2144    

出版商:OVID    

年代:1996

数据来源: OVID