ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 17-year-old girl with chronic abdominal pain had low serum cortisol levels with a subnormal response to adrenocorticotropic hormone (ACTH) stimulation test while receiving opioid analgesics for pain. After discontinuation of the opioid analgesics, the cortisol levels returned to normal and repeated ACTH stimulation tests showed normal response of the hypothalamic-pituitary-adrenal (HPA) axis. A concise review of the literature on the effects of opioids on serum cortisol levels and the HPA axis is presented.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 22-year-old woman had low-grade fever and fatigue for 3 months. Four months before evaluation, she changed jobs, from bank clerk to salesperson. The latter job was stressful for her. Laboratory evaluation revealed no signs of infection, inflammation, or malignant disorders. On admission, serum cortisol level at 8:00am fluctuated between 171 nmol/L and 557 nmol/L by repeated measures, whereas urinary daily free cortisol level was consistently within normal range. During an insulin tolerance test, she did not demonstrate the typical symptoms of hypoglycemia. Secretion of adrenocorticotropic hormone (ACTH), cortisol, adrenaline, and nor-adrenaline in response to the insulin-induced hypoglycemia was markedly impaired. The symptoms of low-grade fever and fatigue were spontaneously relieved during a hospitalization which remained after she started to work at her previous position as a bank clerk. Insulin tolerance test was performed again when she was free of symptoms. At that time, she experienced the symptoms of hypoglycemia, and the response of ACTH, cortisol, adrenaline, and noradrenaline to the insulin-induced hypoglycemia returned to normal. This patient is the first to demonstrate the association of impaired counter-regulation to hypoglycemia with stress.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 53-year-old man was referred to the authors’ hospital with an 8-month history of bilateral gynecomastia and decreased libido for which he was treated with tamoxifen 20 mg/d. Five months later, he experienced abdominal pain accompanied by nausea and headache. He also reported weight loss of approximately 5 kg. An abdominal echogram revealed the presence of a 10-cm mass in contact with the superior pole of the right kidney and partial compression of the inferior vena cava. The hormonal evaluation showed an increased serum estradiol as the only abnormality. Computed tomography scan confirmed the echographic findings. The patient underwent right adrenalectomy and, with the diagnosis of adrenal carcinoma, was treated with mitotane. During treatment, adrenal insufficiency and primary hypogonadism developed. Although he recovered gonadal function after mitotane was discontinued, adrenal insufficiency persisted. There was no clinical evidence of the disease 11 years after the surgical resection of the mass.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Graves disease is rare in childhood and adolescence. Radioactive iodine (RAI, iodine I 131,131I) was the treatment used for these patients with undefined illness. We studied 11 patients, 10 girls and 1 boy, aged 14 to 18 years. All were treated with methimazole (ATD), with levothyroxine added when necessary to maintain euthyroidism. The ATD was administered concomitantly with the first dose of131I. In this group of adolescents, RAI was uniformly successful in treating the disease. We conclude that radioiodine should be considered as a first-line treatment option in older children with Graves–Basedow.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article discusses the pathophysiologic relationship between type 2 diabetes mellitus and obesity and the effect of obesity on the complications of that disease. It is concluded that obesity plays an important role in type 2 diabetes and that modulating body weight can be an important therapeutic modality in treating this illness.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The hip is the most common nonvertebral fracture site in patients with osteoporosis. Because the incidence of hip fracture is expected to increase dramatically as the population ages and osteoporosis becomes more common, interventions that prevent hip fracture and reduce or prevent osteoporosis are important therapeutic steps. A number of prospective, clinical trials have been conducted that evaluated the antifracture efficacy of various drugs and supplements. These include calcium, vitamin D, calcitonin, raloxifene, hormone replacement therapy, and bisphosphonates. A review of these trials leads to the conclusion that a combination regimen of a bisphosphonate with calcium and vitamin D provides the most effective protection against hip fracture. Both risedronate and alendronate have demonstrated efficacy in reducing the incidence of hip fracture. The effectiveness of risedronate was demonstrated in a clinical trial in which hip fracture was the primary efficacy endpoint. For alendronate, a subgroup analysis of a secondary endpoint and a meta-analysis provided evidence of a reduction in hip fracture incidence. In clinical trials, treatment with risedronate plus calcium and vitamin D has demonstrated usefulness in reducing the incidence of nonvertebral fractures.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Recent reports have reinforced the usefulness of salivary cortisol (SAF) in the evaluation of cortisol dynamics and in the diagnosis of Cushing syndrome. However, few data are available on the usefulness of SAF and salivary aldosterone (SAL) in response to corticotrophin (ACTH) stimulus. The aim of the authors’ study was to standardize the response of SAF and SAL to the intramuscular injection of 250 μg of synthetic human β1–24ACTH in healthy patients. This test was performed in 21 healthy adult volunteers. Salivary samples were obtained in baseline conditions and during 30, 60, 90, and 120 minutes after ACTH administration. The results showed that all healthy volunteers achieved SAF and SAL concentrations of at least 40.0 nmol/L and 100.0 pmol/L, respectively, after the stimulus. The clinical usefulness of this test was confirmed when patients with known adrenal dysfunction were studied. In three patients with primary adrenal insufficiency, blunted SAF and SAL responses were obtained. Six patients with secondary adrenal insufficiency demonstrated subnormal or blunted SAF and normal SAL responses after ACTH stimulation.From these data, the authors suggest that corticoadrenal reserve can be easily, noninvasively, and accurately investigated through the simultaneous measurement of salivary cortisol and aldosterone in response to corticotrophin. Salivary aldosterone was helpful in the differential diagnosis of adrenocortical hypofunction.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pituitary metastasis is a rare cause of an intrasellar mass. The authors report a series of 52 patients with intrasellar metastases diagnosed between 1950 and 1996. The patient group included 29 women and 23 men with a mean age of 60 years. Breast and lung carcinomas were the most frequent primary tumors (37% and 23%, respectively). The primary tumor was unknown in 12% of patients. In the patients with a known primary tumor, it was diagnosed after the pituitary metastasis was discovered in 20%. The mode of discovery of pituitary metastases was symptom-based (visual impairment, diabetes insipidus, hypopituitarism) in 75% of patients. Of the patients in whom prolactin was measured, 63% had hyperprolactinemia. Computed tomography and magnetic resonance imaging of the brain, available for 52% and 19% of patients, respectively, showed a pituitary mass in each case. Pituitary surgery and radiotherapy were performed in 42% and 63% of patients, respectively. Mean survival was 17 months (range, 0–240 months). Overall mortality at 1 year was 67%.

ISSN:1051-2144    

出版商:OVID    

年代:2002

数据来源: OVID