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:

Alcohol-induced pseudo-Cushing's syndrome (APS) refers to a reversible physiologic change of the hypothalamic-pituitary-adrenal axis resulting in hypercortisolism and caused by the consumption of excess alcohol. Other causes of pseudo-Cushing's syndrome include depression and anorexia nervosa. These latter two syndromes, however, are not associated with the clinical features of excess Cortisol secretion. The physical changes we associate with true Cushing's syndrome also occur when alcohol consumption is severe. The mechanisms that differentiate alcoholic pseudo-Cushing's syndrome from the other causes of pseudo-Cushing's syndrome are outlined in this short review.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Procedures to evaluate the bone status in a noninvasive way comprise absorptiometric methods such as single photon absorptiometry (SPA) or dual x-ray absorptiometry (DXA), and computer tomographic methods of the axial skeleton (axial QCT) and the peripheral skeleton (pQCT). This report focuses on the metfiodology and the application of peripheral quantitative computed tomography. pQCT is a low risk procedure with the potential to perform precise bone density determinations separately for trabecular bone and compact bone. Long-term reproducibility of 0.3% in patient examinations is achievable with a special multislice technique. Due to its low dose and its high precision, pQCT is particularly suitable for serial examinations. It is most useful in detecting “high risk” patients in the early postmenopause and for optimizing treatment procedures. In the early postmenopause, approximately one-third of otherwise healthy women suffer from an excessive bone loss that can be prevented by estrogen substitution; we give the example of a controlled, randomized study with transdermally applied estradiol. The concept of “fast bone losers” and “slow bone losers” appears to be generally applicable and may be the basis of a tailored treatment scheme. Bisphosphonates, calcitonin, and estrogens are substances able to stop a high bone loss. Fluorides, having the potential to increase bone mass, should be used only in slow bone losers to avoid treatment induced fractures. While trabecular bone and cortical bone are affected in synchrony in the early postmenopause, differential effects on trabecular and cortical bone can be observed in hyperparadiy-roidism, corticosteroid or fluoride treatment. The high spatial resolution provided by pQCT permits a “compartmental” analysis of bone structure. Research under way should allow a quantitative evaluation of the three-dimensional bone architecture at the same sites where the bone density is measured. The combination of bone density and structural analysis provides an improved fracture risk prediction and a refined understanding of the bone remodelling processes during disease and therapy

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report a patient who first developed ACTH-dependent Cushing's syndrome in early 1963 and, because the source of ACTH could not be found, was adrenalectomized in September 1963. He thed suddenly in 1989 at age 70, after suffering brief chest pain. In the 26-year interval, histologically benign ACTH-producing carcinoid tumors were removed from his thymus (1964), pancreas (1981), cauda equina (1984, recurrence in 1986), and prostate (1986). Plasma ACTH concentrations ranged from 50–3600 pg/mL (normal < 85 pg/mL) during this interval, with pigmentation varying directly with plasma ACTH. At autopsy, multiple ACTH-contain-ing carcinoid tumors were found in the walls of his left and right cardiac ventricles and another in his pancreas. The benign histology and extremely long intervals between the appearance of the tumors reflect an extraordinarily protracted course, most likely resulting from an unusually indolent malignant thymic carcinoid with pancreatic, cauda equina, prostatic, and myocardial metastases, especially since the microscopic appearance and functional nature (ACTH production) were essentially identical at all sites. The possibility that some of the rumors arose independendy cannot be excluded by the studies available.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 35-year-old man presented with an apparently short history and clinical features of hypopituitarism. The diagnosis was confirmed by the following investigations: random plasma Cortisol 79 mmol/L (normal = 200–770 mmol/L), total thyroxine 47 nmol/L (normal = 60–154 nmol/L), plasma testosterone 3.5 nmol/L (normal = 9–32 nmol/L), FSH 2.2, LH 2.0 IU/L (normal = 2–20 IU/L), and no significant rise of Cortisol and growth hormone to insulin hypoglycemia. There was no abnormality of the pituitary on CT examination. He had a good response to replacement therapy but 3 years later ceased all hormone replacement, felt well, and basal plasma Cortisol, thyroxine, FSH, LH, and testosterone were normal. A combined pituitary function test 8 years after presentation was normal. Fourteen years later he is clinically well with normal basal Cortisol, thyroxine, TSH, FSH, LH, ACTH, and testosterone; and MRI examination showed that the anterior pituitary gland and stalk were of normal dimensions but the right two-thirds of the pituitary appeared nonfunctional.It is believed that there has been spontaneous regeneration of anterior pituitary tissue after destruction, probably by infarction severe enough to produce panhypopituitarism. The relation of this event to a severe illness with headache and prostration 7 years before presentation is doubtful because of his fertility during this time.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Diet is often the most difficult aspect of any diabetes treatment program. A primary dietary goal for patients with type I diabetes receiving conventional treatment is consistent day-to-day caloric and carbohydrate intake. The best way to achieve this consistency is with the Exchange Lists for Meal Planning. Dietary consistency is less important for type I diabetic patients receiving intensive therapy as such patients can be taught to adjust premeal insulin doses to compensate for departures from their meal plan. A primary dietary goal for most patients with type II diabetes is weight loss, but no effective dietary method to accomplish this objective has been established. Secondary issues pertaining to the dietary treatment of diabetes include: (1) the possibility that diets relatively high in monounsaturated fat have beneficial metabolic effects when compared with high carbohydrate diets; (2) the potential benefit of low protein diets in patients with nephropathy; (3) the lack of evidence that dietary sucrose aggravates hyperglycemia; (4) the potential utility of glycemic indexing of foods; and (5) the beneficial effects of soluble fiber on serum cholesterol levels.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although persistent hyperinsulinism is a rare cause of neonatal hypoglycemia, its neurological effects can be devastating, including permanent brain damage and mental retardation. The current mainstay of medical therapy is treatment with diazoxide. More recently, the somatostatin analog, octreotide, has also been used to suppress insulin secretion. Because oc-treotide and diazoxide are not always successful, aggressive surgical intervention is often indicated. The procedure of choice is a total or near-total pancreatectomy.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Treating the hypertensive diabetic presents several special considerations that bear on the selection of antihypertensive agents and monitoring their effect. Most important in this regard are the increased likelihood of dyslipide-mia, renal disease, micro- and macrovascular disease, and autonomic neuropadiy. This short review will examine the therapeutic options available.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

No discrete event marks a transition to male reproductive senescence; however, a number of investigations have suggested that male fertility and reproductive hormone secretion decrease with age, giving rise to the term male menopause. Nearly all studies of seminiferous tubular function and morphology have found evidence of an age-related deterioration including anatomical lesions, reduced semen quality, elevated serum levels of inhibin, and diminished fertility. The question of altered androgen secretion remains controversial with evidence both for and against age-related reductions in testosterone (T), free T, and/or DHT in multiple investigations. Much of this controversy probably stems from noncompar-able populations, especially with regard to confounding variables such as stress, illness, and medication use. Published findings to date agree that in healthy aging men there is a small but significant increase in basal levels of LH and a diminished T response to exogenous gonadotropin, suggesting an intrinsic loss of Leydig cell reserve. Moreover, there is evidence of a gradual loss of function of the hypodialamic/pituitary gonadotropic axis as well. Despite these changes, healthy aging men appear to maintain normal circulating total and free T and DHT levels, despite modest increases in sex hormone binding globulin (SHBG) and an small downward trend in serum androgens. Whether there are metabolic consequences such as altered body composition, muscle strengdi, and lipid profiles in the portion of the aging male population with larger androgen decrements requires further investigation.

ISSN:1051-2144    

出版商:OVID    

年代:1994

数据来源: OVID