ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Incidentally discovered adrenal masses are commonly found on imaging studies of the adrenal glands performed for other reasons. The evaluation of these “adrenal incidentalomas” requires a synthesis of clinical, biochemical, and imaging data. The most common adrenal incidentaloma is a benign adenoma without detectable biochemical hyperfunction. Recent advances in categorization by the percent washout of intravenous contrast over several minutes on computed tomography scans enable one to distinguish most adenomas from nonadenomas. History, physical examination, laboratory screening, and computed tomography characteristics direct the need for further testing and/or follow-up. Additional valuable techniques include chemical shift magnetic resonance imaging, adrenal cortical scintigraphy, and fine needle aspiration biopsy. Surgical resection is indicated for only a minority of adrenal masses.

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Growth hormone (GH) secretion is impaired in obese children and adults but the physiologic mechanisms for obesity-induced hyposomatotropism remain unclear. Metabolic disturbances that result from obesity and a central accumulation of body fat, such as increased circulating insulin and free-fatty acid concentrations, reduce growth hormone secretion at the level of the pituitary and perhaps the hypothalamus. Leptin is a logical choice as a humoral signal to relay information regarding the body composition and the fat distribution to the hypothalamus and pituitary. Leptin is secreted directly from the adipocytes and leptin receptors are located in the pituitary and the hypothalamus including growth hormone' releasing hormone neurons. Serum leptin concentrations are inversely related to basal and growth hormone releasing hormone-stimulated GH secretion and inversely related to pituitary GH expression. However, correlational studies do not prove causality and the evidence is not yet convincing enough to conclude that leptin plays a role in the modulation of the neuroendocrine GH axis in obesity.

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In recent decades gonadotroph adenomas of the pituitary have been recognized to be more common than previously thought. As they rarely result in a specific clinical syndrome distinct from nonfunctional adenomas, they are usually not discovered until large enough to cause mass-related neurologic or endocrine effects. Visual impairment is the most common and most significant manifestation of these tumors, with headaches and hypopituitarism also occurring frequently. Preoperative diagnosis involves the use of MRI, and the interpretation of basal and TRH-stimulated gonadotropin patterns, although definitive diagnosis often awaits immunohistochemical study of resected tissue. Transsphenoidal surgery is the primary mode of therapy for gonadotroph adenomas. Radiotherapy, especially stereotactic radiosurgery, may also have a role. Medical therapy has been disappointing to date.

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The insulin-like growth factors (IGFs), IGF binding proteins (IGFBPs), and IGFBP proteases regulate somatic growth and cellular proliferation both in vivo and in vitro. IGFs are potent mitogens whose actions are determined by the availability of free IGFs to interact with IGF receptors. IGFBPs comprise a family of six proteins that bind IGFs with high affinity and specificity and thereby regulate IGF-dependent actions. IGFBPs have recently emerged as IGF-independent regulators of cell growth. Cleavage of IGFBPs by specific proteases modulate levels of free IGFs and IGFBPs and, thereby, their actions. IGFBP-related proteins bind IGFs with low affinity and also play important roles in cell growth and differentiation. Future research on IGF axis physiology promises exciting insights into cell biology, as well as therapies for diseases such as cancer, asthma, and diabetes mellitus

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A series of hormonal changes follows the completion of pregnancy. These changes are necessary for the initiation and maintenance of lactation for the survival of the infant and for the prevention of another conception. Hormones involved in this process 'include estrogen, progesterone, insulin, glucocorticoids, thyroid, growth hormone, and human placental lactogenProlactin is a major regulating factor in the immediate postpartum period for the initiation and establishment of lactation. In a non-breastfeeding individual, serum prolactin will drop to nonpregnant levels within 1 week after delivery. In a lactating woman, prolactin levels may remain elevated for up to 80 days postpartum. Despite normalization of prolactin levels after that time interval, milk production and lactation may be sustained, providing that frequent breastfeeding continues. Vigorous breastfeeding patterns and nipple stimulation are factors that sustain lactation while also delaying the resumption of ovulation, even in the presence of normal prolactin levels

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Antithyroid drugs are a mainstay of therapy of hyperthyroidism, especially when it is due to Graves' disease. Although antithyroid agents are generally safe, side effects may limit their useful' ness in some patients. Side effects are classified as minor and major, based on their degree of morbidity. All side effects are more common at higher doses of methimazole (40 mg/day or more), but there is no apparent dose relationship for propylthiouracil (PTU). The most common minor side effects include cutaneous eruptions, arthralgias, and gastrointestinal upset, which develop in up to 5% of patients at usual doses. Hair loss, sialadenitis, myopathy, and abnormalities of taste and smell also have been described. The common major side effects are agranulocytosis (frequency 0.1–0.4%) and frank polyarthritis. Severe systemic vasculitis or drug-induced lupus (often an-tineutrophil cytoplasmic antibody positive) are associated with PTU. Hepatic toxicity with methimazole is cholestatic in nature and not as severe as the potentially life-threatening hepatocellular reactions that are seen with PTU. Hypoprothrombinemia and the insulin autoimmune syndrome are exceedingly rare major side effects

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective: In this paper we analyze our experience in the treatment of a group of predominantly Hispanic patients with type 2 diabetes in South Florida and estimate the yearly per patient cost. Method: Data were collected on all patients with type 2 diabetes seen between February and June 1997. A total of 352 patients (92% Hispanic) were evaluated, of whom 71 were new patients. All patients were evaluated by a diabetes specialist and 64% were referred to the Diabetes Treatment Center at Mercy Hospital, Miami FL. A treatment protocol was developed and followed. Results: Eighty four percent of the patients received diabetes education with a 60–80% compliance rate to the diet, exercise, and home monitoring programs prescribed. Only 15% of the patients were on diet alone. The remaining 85% of the patients were nearly equally divided between oral medication(s) only and insulin therapy. A HbA1cwas reported in 97% of the patients evaluated. The median HbA1cwas 7.23% (normal range 4.1–5.7%). New patients had a median HbA1cof 8.3%. We evaluated all new Hispanic patients with an initial HbA1cabove 8.5% (median 10.2% ± 1.2) (n = 24). After 4 months of follow-up the median HbA1cdecreased to 7.4% ± 1.4 (p < 0.01) (n = 24). After 24 months the median HbA1cfor this group was 7.22% ± 0.94 (p < 0.0001) (n = 15). Eighty percent of the patients had had no hospitalizations in the previous year and only 9% of the patients had visited an emergency room. Cost analysis including all outpatient and inpatient services was 5506.23 per patient per year. Conclusions: The combination of a diabetes specialist and a diabetes treatment team can achieve excellent long-term control of a Hispanic type 2 diabetic population, significantly decrease hospital and emergency room utilization and decrease the expected cost

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 57-year old man with a history of an orthotopic heart transplant presented with fever and neck pain. Sputum cultures produced Aspergillus fumi-gatus, and aspiration of a nodule in the neck also showed branching hyphae consistent with A. fumigatus. Laboratory values were consistent with hyperthyroidism with elevated total thyroxine and suppressed thyrotropin levels, which sug-gest acute hormone release secondary to infection with the fungus. Acute suppurative thyroiditis (AST) due to fungal infection is rare, and associated hyperthyroidism resulting from AST is also extremely uncommon. This case of disseminated A. fumigatus presenting with AST and hyperthyroidism illustrates that although physicians are aware of the unusual infections that can develop in patients who have received solid organ transplants, they must also be cognizant of the atypical presentations with which these infections can manifest.

ISSN:1051-2144    

出版商:OVID    

年代:1999

数据来源: OVID