ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

“Primary hyperaldosteronism” is an uncommon but potentially curable disorder. Although hypokalemia is characteristic of autonomous overproduction of aldosterone, it is not always present. Performing a captopril test in all new hypertensive patients is preferable to relying solely on determinations of serum potassium. Those patients with a high plasma aldosterone/plasma renin activity ratio following captopril with or without a low serum potassium should be further evaluated by measuring resting and ambulatory plasma renin activity, plasma aldosterone, plasma cortisol, and plasma 18-hydroxycorticosterone during a sodium intake of 100 to 150 mEq/day. In those patients with equivocal findings for autonomous overproduction of aldosterone, the response of plasma aldosterone to infusion of saline may be helpful. Once a diagnosis of primary aldosteronism has been made, computerized tomography of the adrenal glands and adrenal vein sampling for cortisol and aldosterone will make the distinction between aldosterone-producing adenoma and idiopathic hyperaldosteronism in the majority of patients. Unilateral adrenalectomy is the treatment of choice in most patients with an adenoma; pharmacologic therapy is indicated for those with idiopathic hyperaldosteronism.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Malignancy-associated hypercalcemia (MAH) has long been recognized as a common metabolic complication of cancer. Until the 1980s, its pathophysiology was poorly understood, diagnostic tools were limited, and only a handful of therapeutic options were available. Since then, however, the pathophysiology underlying humoral hypercalcemia of malignancy, local osteolytic hypercalcemia, and a few other causes of malignancy-associated hypercalcemia has been elucidated. The development of sensitive assays for parathyroid hormone, cyclic AMP, vitamin D metabolites, and parathyroid hormone-related protein has made the diagnosis of MAH clinically practical. More effective treatments for MAH, such as the bisphosphonates and gallium nitrate, are now available to augment the therapeutic armamentarium, as well.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Rarely considered in the differential diagnosis of short stature is Fanconi anemia. It is a rare autosomal recessive disorder typically manifest clinically by pancytopenia and phenotypic anomalies, aplasia of the radius, and microcephaly. The availability of precise chromosomal diagnosis has revealed that as many as half of these patients may be hematologically normal, at least in early childhood. This confirms the need for enhanced awareness of this disorder and for modern modalities for diagnosis and treatment.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Effective therapy for obesity would result in an improved quality of life and possibly even an increased life expectancy for many individuals. To understand why current therapy for obesity is inadequate, it is necessary to review what is known about the regulation of body composition. In individuals of normal weight, energy balance is maintained at a body fat content of less than 25% by adjustments in both energy intake and energy expenditure. Obese individuals are able to achieve long-term energy balance only at a higher body fat content. Both obese and normal weight individuals respond to any deviation of body fat content from its customary value with counterregulatory changes in energy expenditure and appetite. This review will elaborate upon these observations both to explain the limitations of current weight loss therapy and to suggest a strategy for targeting available therapy until the physiology of energy balance is better understood.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Eosinophilic granuloma, Hand-Schuller-Christian disease, and Letterer-Siwe syndrome together comprise the entity of Langerhans' cell histiocytosis. The chronic disseminated form, Hand-Schuller-Christian disease, is associated with several endocrine abnormalities including diabetes insipidus, growth retardation due to growth hormone deficiency, hyperprolactine mia, and hypogonadotrophic-hypogonadism. These abnormalities are due to primary hypothalamic dysfunction secondary to hypothalamic and posterior pituitary infiltration by the histiocytic cells.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Symptoms and signs of androgen deficiency in men and in boys with delayed sexual maturation warrant evaluation. The most sensitive means for establishing the diagnosis is to measure serum levels of non-testosterone-binding globulin bound testosterone between 8 and 10 a.m. Androgen replacement should be considered for hypogonadal men and for boys whose sexual development has been delayed. Effective treatment of hypogonadal men may improve libido, potency, and muscle strength and decrease the risk of developing osteoporosis. Replacement therapy for boys with sexual delay should attempt to simulate normal puberty. Enthusiasm for treating older males must be tempered by risks of worsening benign prostatic hyperplasia, prostate cancer, sleep apnea, polycythemia, and dyslipidemia. In the United States, intramuscular administration of testosterone enanthate or testosterone cypionate provides the safest and most effective regimen. Less adequate replacement can be achieved with oral administration of testosterone undecanoate, a preparation only available in other countries. Several new agents are under investigation. If patients are monitored carefully, the benefits of androgen replacement appear to outweigh the risks.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thyrotoxicosis in the pregnant woman presents a diagnostic and therapeutic challenge to the physician. Clinically, the hypermetabolic states of hyperthyroidism and pregnancy can be difficult to differentiate. New biochemical measurements of free thyroxine and sensitive immunometric thyroid-stimulating hormone assays are diagnostic and have obviated the need for thyrotropin-releasing hormone stimulation tests. Graves' disease is the leading cause of thyrotoxicosis in pregnancy, although this autoimmune disease frequently remits as gestation progresses. Hyperemesis gravidarum can be associated with hyperthyroxinemia. This may result from the thyroid-stimulating hormone activity of rising human chorionic gonadotropin levels. More severe elevations in human chorionic gonadotropin, and therefore of thyroxine, can be seen in gestational trophoblastic disease. Propylthiouracil is the mainstay of therapy for hyperthyroidism in pregnancy, although methimazole can also be used. Radioactive iodine is contraindicated in pregnancy, and surgery is rarely necessary. Careful fetal surveillance is required to prevent fetal hypothyroidism and hyperthyroidism. Neonatal thyrotoxicosis, believed to be mediated by thyroid-stimulating immunoglobulins, frequently can be predicted by measuring this maternal antibody during the third trimester in mothers with Graves' or Hashimoto's thyroiditis. Postpartum thyroiditis is common and may have an early transient thyrotoxic stage. Measuring microsomal antibody levels early in pregnancy or following delivery in women at risk is a useful predictor of disease occurrence.

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:1991

数据来源: OVID