Special Treatment Considerations

Although primary adrenal insufficiency is rare, secondary adrenal insufficiency after withdrawal of supraphysiologic corticosteroid therapy is common, and both are potentially fatal conditions if unrecognized and untreated. With the introduction of glucocorticoid replacement in the late 1940s, the survival of patients with adrenal insufficiency now approaches that of the normal population. However, owing to the lack of cortisol production in response to stress, certain everyday life-type...

Early diagnosis and treatment

The period between the onset of the signs and symptoms of Cushing's syndrome and its definitive diagnosis averages 5 yr (1). Thus, the idea of an early diagnosis is somewhat of an oxymoron. The diagnosis requires a convincing combination of clinical findings and biochemical abnormalities (2-8). The obvious combination is an established clinical picture coupled with some reliable measure of an elevated cortisol production rate. The diagnosis can be made in the absence of evidence for an...

Glucocorticoid Coverage for Stress

In response to acute illness, trauma, or surgical intervention, there is increased secretion of CRH, ACTH, and finally Cortisol. Patients with primary or secondary adrenal insufficiency will not be able to increase cortisol production and require both physiologic and supplemental stress therapy with glucocorticoid. Because of the large variation in cortisol production in healthy patients under stress, it is difficult to predict cortisol needs of patients exactly during stressful conditions. A...

Dysmetabolic Metabolic Syndrome Syndrome X

The original definition of syndrome X, by Reaven (20), emphasized insulin resistance. The dysmetabolic syndrome consists of insulin resistance in association with dyslipidemia, obesity (particularly with excess visceral fat), hypertension, and often IGT or type 2 diabetes. This constellation of abnormalities is associated with an accelerated onset of atherosclerosis (18,122). Patients with syndrome X have a 20-40 incidence of type 2 diabetes and probably an even greater association with IGT...

Testosterone Treatment

Safe and effective androgen replacement therapy (ART) can be provided through the use of intramuscular long-acting testosterone esters, transdermal patches, or transdermal testosterone-containing gel (Table 3). Oral androgen replacement should be avoided because of the consistently deleterious effects of these preparations on LDL and HDL cholesterol levels and (less commonly) hepatic function. Intramuscular T esters (cypionate, or enanthate) are initiated at doses of 200 mg im every 14 d or 100...

Guidelines for the Treatment of Dyslipidemia

With the recent knowledge regarding the efficacy of therapy with statins, the new NCEP recommendations evolved (Table 5). In the highest risk category, the NCEP recommends that both lifestyle modifications and drug therapy be initiated at diagnosis if the baseline LDL-C exceeds130 mg dL. However, LDL-C levels between 100 and 129 mg dL may necessitate either intensification of lifestyle modification and or initiation of drug therapy at the discretion of the provider. Subjects in the...

Impaired glucose tolerance is a disease

The prediabetes state of IGT is associated not only with progression to diabetes but also with increased coronary artery disease mortality therefore, it should be recognized, diagnosed, and treated early (see ref. 1 and Chapter 5 of this book). Moreover, the demonstration that lifestyle intervention can substantially Components of the Metabolic Syndrome Abdominal obesity (waist circumference) > 102 cm (> 40 in.) > 88 cm (> 35 in.) > 150 mg dL High-density lipoprotein cholesterol Men...

Anaplastic Thyroid Cancer

In the past, ATC comprised about 5-10 of thyroid cancers (24) but in recent years has accounted for about 2 of all thyroid cancers (8). In a review of 475 patients with this disease reported in six large studies, the mean age was 65 yr, with only a slight female predominance (24). ATC is almost never seen before age 20 yr. It evolves from well-differentiated tumors (24) which may slowly transform into ATC (25). One report, for example, described a 61-yr-old man who developed follicular cancer...

Anuja Dokras md phd and William I Sivitz md

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The clinical presentation commonly includes infertility, irregular menses, obesity, and hirsutism, and hence women may initially present to the gynecologist or reproductive endocrinologist. However, women with PCOS are also at an increased risk for a number of medical problems including diabetes, hypertension, coronary artery disease, and endometrial cancer and may first present to an...

Chronic Adrenal Insufficiency

The treatment for chronic primary adrenal insufficiency includes replacement of both glucocorticoid and mineralocorticoid. In secondary (pituitary hypo-thalmic) adrenal insufficiency, only glucocorticoid replacement is necessary because the adrenal gland is still intact and can respond directly to hyperkalemia and hypovolemia through the renin angiotension system to stimulate mineralo-corticoid secretion. The glucocorticoid of choice is cortisol (hydrocortisone) dosed at 20 mg in the am and 10...

Hypothyroidism

Belin, md Primary Prevention of Hypothyroidism Secondary Prevention of Hypothyroidism Early Diagnosis and Treatment Tertiary Prevention of Hypothyroidism Early diagnosis and treatment of hypothyroidism is the exception rather than the rule. Despite its high prevalence (1-3) and potential consequences, hypothyroidism is typically diagnosed in clinical settings at an advanced and often longstanding stage or is incidentally detected during a wide-ranging...

Type 2 diabetes and igt

Type 2 diabetes in the United States is increasing at an alarming rate it is predicted that as many as 10 of the country's population will have diabetes by the year 2025 (83). Individuals with type 2 diabetes pass through a stage of IGT prior to diabetes onset (Fig. 1) (84,85). Depending on the criteria used for the diagnosis of IGT, 30-40 million Americans now have IGT, with 20 or more of the elderly being affected (86). This compares with the 16 million individuals who now have type 2...

Who to screen

It is clear that individuals who present with signs and symptoms of thyrotoxi-cosis should have thyroid function tests carried out. However, there has been an ongoing debate about the role of screening in asymptomatic patients. In 1990, American Thyroid Association guidelines recommended against screening of asymptomatic patients, as it was unclear whether early diagnosis conferred any benefit (8). As recently as 1996, the U.S. Preventive Services Task Force recommended against TSH screening...

Fsh and lhomas Pituitary Tumors Secreting Fsh Or Lh

FSH- and LH-secreting tumors are usually clinically silent. Rare cases of tumors presenting with clinical features have been reported. A 28-yr-old Finnish woman presented with oligoamenorrhea and pelvic pain. A detailed assessment revealed elevated FSH and estradiol with an appropriately suppressed LH enlarged ovaries with multiple cysts were seen on pelvic ultrasound examination. Both gonadotropins and the a-subunit exhibited a paradoxic response to TRH, and MRI revealed a pituitary...

Early signs and symptoms

The clinical presentation of overt thyrotoxicosis can be subtle and nonspecific. Some patients may complain of classic symptoms such as nervousness, sweating, fatigue, heat intolerance, weakness, tremor, hyperactivity, changes in weight or appetite, insomnia, exertional dyspnea, hyperdefecation, or palpitations. Oligomenorrhea occurs in about one in four women with thyrotoxicosis (25). Thyrotoxic patients, especially among the elderly, may have higher rates of depression than their euthyroid...

Management of dyslipidemia Rationale

Without a doubt, coronary artery disease is associated with significant morbidity and mortality. Therefore, researchers have spent tremendous amounts of time and resources in arriving at interventions to prevent or delay the onset and retard the progression of this disease. Most of these research efforts have been directed toward lowering LDL levels, since elevated LDL concentrations have been clearly linked to coronary artery disease. Prior to the introduction of statins or HMG CoA-reductase...

Robert G Spanheimer md

Introduction Adrenal Physiology Etiology Clinical Features Diagnostic Evaluation Treatment Conclusions References Although adrenal insufficiency is unusual, its recognition and treatment are life-saving. The prevalence of primary adrenal insufficiency (Addison's disease) is between 110 and 120 cases per million population (1), with a mean age of onset at 40 yr old. Advanced cases are usually easily diagnosed, but the recognition of early phases can be a challenge. In 1855, Thomas Addison...

The Role of Thyroid Radiation in Causing Thyroid Cancer External Irradiation

The only environmental factor known to increase the risk of thyroid cancer is irradiation. The risk of developing papillary thyroid cancer after therapeutic external radiation, used in the past to treat children with benign head and neck conditions, is well known (30). Exposure before the age of 15 yr poses a major risk that becomes progressively larger with increasing doses of radiation between 0.10 Gy (10 rad) and 10 Gy (1000 rad). The incidence of thyroid cancer begins increasing within 5 yr...

Etiologic Classification

As previously stated, the underlying cause of obesity in most cases is the chronic energy imbalance resulting from excessive energy intake relative to energy expenditure. However, this positive energy balance is a consequence of a complex interaction between environmental societal influences (that affect dietary and physical activity) and the biologic genetic milieu. Although the genetic contribution has been estimated from population studies to be as high as 40-70 , genetic factors cannot...

Childhood Obesity

As is the case in adults, increase in energy intake and decrease in physical activity are the primary environmental influences on childhood obesity. A number of studies have documented that the increase in obesity prevalence has paralleled the increased consumption of junk foods snacks and decreased physical activity in this age group (85-87). Incidentally, children are especially vulnerable since most decisions regarding diet and physical activity are beyond their control. For example,...

Primary Disorders of HDL Metabolism

This disorder of HDL metabolism is autosomal recessive and very rare. Patients have a very low HDL level, elevated triglycerides, and low LDL levels. Clinically, the disorder is detected in childhood or early adulthood during a routine physical exam or during assessment of a sore throat because of the typical large orange tonsils. These patients also manifest a peripheral neuropathy, hepatosplenomegaly and premature coronary artery disease (8). This disorder is autosomal dominant and manifests...

Udaya M Kabadi md frcpc facp face

Nonfunctioning Pituitary Tumors TSHoma FSH- and LHomas Pituitary Tumors Secreting FSH or LH References Prolactinoma, an adenoma, is the most common hormone-secreting pituitary tumor. Pituitary tumors arise from the functioning or hormone-producing cells as well as stromal cells. The prevalence of prolactinoma in the general population is unknown. However, autopsy results demonstrate that 23-27 of individuals have pituitary microadenomas without prior clinical evidence, and 40 of these stain...

Treatment of overt hyperthyroidism

Patients with overt hyperthyroidism from Graves' disease or from toxic mul-tinodular goiter should clearly be treated. One therapeutic option for patients with Graves' disease is medical management with methimazole (MMI) or pro-pylthiouracil (PTU), both of which decrease thyroid hormone synthesis. Therapy with one of these drugs will induce long-term remission of Graves' disease in about half of all patients, although those patients with large goiters are less likely to remain euthyroid (70)....

Introduction To Endocrine Disorders

Osteoporosis is a metabolic bone disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced fragility and a consequent increase in fracture risk (1). Clinically, it is defined by evidence of osteopenia associated with a fracture, or history of fractures with minimal trauma. It is defined quantitatively as a bone mineral density (BMD) of less than 2.5 SD below the mean gender-matched maximal bone density (1). Osteoporosis results from an...

Women Not Interested in Fertility

The medical treatment for menstrual regulation and hirsutism is summarized in Table 3. The lack of menstrual regularity predisposes women with PCOS to a threefold risk of endometrial cancer (46). Data from the Cancer and Steroid Hormone study found a fivefold increased risk of endometrial cancer in women with PCOS Odds ratio (OR) 5.4 95 confidence interval (CI) 2.4-12.3 (47). This increased risk is attributed to prolonged periods of unopposed estrogens, resulting in mito-genic stimulation of...

Primary Adrenal Insufficiency Addisons Disease

Suncongentcral Hemorrhage

Primary adrenocorticol insufficiency results from any disease process (Table 1) that damages the entire adrenal cortex, thus resulting in deficiencies of cortisol, aldosterone, and adrenal androgens. Approximately 75-80 of cases are owing to autoimmune adrenalitis (5), a shift from the predominant cause in 1928-1938, which was tuberculous adrenalitis (now only accounting for 10-20 worldwide). Although circulating antibodies to adrenal antigens, predominately 21-hydroxylase (6), are found in 70...

Classification

As stated above, obesity is defined as excessive accumulation of body fat. Since body fat is difficult to measure directly, several attempts have been made to devise or identify clinically useful surrogate measures. Currently, body mass index (BMI body mass in kilograms divided by the square of the height in meters) is an acceptable index of obesity, and has been shown in epidemiologic studies to predict risk of obesity-related morbidity and mortality reasonably. In the guidelines adopted by...

Arthropathy

Arthropathy With Acromegaly

Mono- or polyarticular arthropathy with joint swelling, hypermobility, and cartilaginous thickening (18) is common in acromegaly, affecting 70 of patients, up to half of whom are impaired in the performance of daily activities Local tumor effects Pituitary enlargement Visual field defects Cranial nerve palsy Headache Somatic Thickening of soft tissue of hands and feet Musculoskeletal Prognathism Malocclusion Arthralgias Carpal tunnel syndrome Acroparesthesia Proximal myopathy Hypertrophy of...

FollowUp of MTC

Persistent or recurrent MTC is typically manifest by high postoperative cal-citonin levels, which occurs commonly although survival is usually prolonged. A French study, for example, reported that 57 of 899 patients were not cured (57 ), but that survival was 80 at 5 yr and 70 at 10 yr (96). Reoperation in appropriately selected patients is thus appropriate because it is the only treatment that may reduce calcitonin levels and often results in excellent local disease control. Although the...

Routine Laboratory Findings

Electrolyte disturbances are found in 92 of patients, with hyponatremia the most common (88 ). Without aldosterone there is salt wasting, so urine sodium is inappropriately high combined with the finding of hyponatremia, this may be misdiagnosed as the syndrome of inappropriate antidiuretic hormone (SIADH). The combination of hyponatremia and hyperkalemia owing to loss of mineralo-corticoid effect on sodium potassium exchange should strongly suggest adrenal Early Findings in Adrenal...

Primary Disorders of LDL Metabolism

Familial hypercholesterolemia (FH) is a common disorder occurring in 1 in every 500 people in the United States (2). The clinical manifestations include tendinous xanthomatosis most commonly involving the Achilles, the patellar, and the extensor tendons of the hands. Subjects may also have xanthelasma, arcus corneae, and premature coronary artery disease. The defect in FH involves the LDL receptor. A variety of mutations can occur that lead to the absence of or a functional defect in the LDL...

Adrenal physiology

Each adrenal gland is composed of cortical and medullary areas. The cortex is divided histologically and functionally into three concentric zones the zona glomerulosa, which secretes aldosterone, the fasiculata, which secretes cortisol, and the reticularis, which secretes adrenal androgens. The adrenal medulla secretes catecholamines, principally epinephrine. Cortisol secretion is closely regulated by a negative feedback mechanism, as shown in Fig. 1. Pituitary adrenocorticotropic hormone...

Primary Hypertriglyceridemia

Familial combined hyperlipidemia (FCH) is a common disorder probably inherited in an autosomal dominant fashion. Epidemiologic studies have shown that 1-2 of the general population suffer from this genetic defect and that it accounts for one-half of all cases of familial coronary artery disease (5). Unfortunately, these subjects present with no overt physical manifestations of hyperlipidemia such as xanthomata. The mechanism of this disorder involves the overproduction of apo B-100 with...

Treatment of Hypercalcemia

When deciding on time of therapy initiation for hypercalcemia one needs to consider the underlying cause and the patient's symptoms (43). When the serum calcium is greater than 14 mg dL, therapy should be initiated regardless of symptoms. Moderate hypercalcemia (12-14 mg dL) is treated aggressively if the patient is having clinical signs or symptoms consistent with hypercalcemia. Initially general measures should be instituted, consisting of rehydration with normal saline. Hypercalcemia impairs...

Miscellaneous Causes of Hypercalcemia

Sarcoidosis and Other Granulomatous Diseases Hypercalcemia occurs in about 10 of patients with sarcoidosis, and hypercalciuria is about three times more frequent (41). Kidney stones develop in about 10 of patients and are usually pure calcium oxalate stones (42). Pulmonary macrophages from affected individuals contain 25(OH)D 1-a-hydroxylase activity that is not readily inhibited by calcium or 1,25(OH)2D. Glucocorticoids suppress the 1-a-hydroxylase activity and provide effective treatment for...

Secondary Adrenocorticol Insufficiency

The presentation of secondary adrenal insufficiency is similar to that of primary adrenal insufficiency except that the adrenal glands remain intact and it is either hypothalamic CRH or pituitary ACTH secretion that is deficient. Clinically, this difference is seen as the lack of hyperpigmentation (owing to excess ACTH and MSH secretion in Addison's disease) and absent features of miner-alocorticoid deficiency, since the adrenal glands can still directly respond to Initial testing to rule out...

Endocrine Complications

Thirty percent of acromegalic patients have concomitant elevated serum PRL levels, with or without galactorrhea (15) owing to functional pituitary stalk compression by the adenoma, with interruption of tonic hypothalamic dopamine inhibition (36) or concomitant GH and PRL hypersecretion from mixed GH-cell and PRL-cell plurihormonal adenomas, monomorphous, mammosomatotroph adenomas, and acidophilic stem cell adenomas (9). Because most patients harbor macroadenomas, hypopituitarism develops from...

Cellular response to insulin

In both IGT and type 2 diabetes, defect (s) exist in insulin action and or insulin secretion from the pancreatic P-cell (21,55-60). Although the specific cellular and molecular defects have not yet been defined, the evolving delineation of the complex molecular events in insulin signaling and insulin synthesis secretion has given increasing information on the polygenic diseases that manifest as IGT and type 2 diabetes. The cellular effects of insulin have been generally agreed on for type 2...

Specific Disorders

Vitamin D3 is synthesized in the human skin by photoconversion of 7-dehy-drocholesterol to previtamin D3, which is isomerized to vitamin D3 (100). This form of vitamin D accounts for most vitamin D in a healthy person. Populations that do not have adequate sunlight exposure, such as housebound elderly, inner city children without adequate sunlight exposure, institutionalized patients, and people who wear clothing covering their entire bodies, are at increased risk for vitamin D deficiency. In...

Secondary prevention of hypothyroidism Early Diagnosis And Treatment

Hypothyroid Follow

Hypothyroidism fulfills the criteria for early detection, either through testing prompted by clinical suspicion (case finding) or by routine testing of all individuals in a defined group (screening). First, hypothyroidism is highly prevalent, particularly in clinically identifiable subsets of the population, such as older women. Second, its consequences can be clinically significant whether one considers the morbidity of subsequent myxedema or the long-term vascular effects of associated...

Arna Gudmundsdottir md and Gregory Doelle md

Ninety-nine percent of total body calcium is within bone 1 of this is rapidly exchangeable with extracellular calcium. Extracellular calcium is a substrate for bone mineralization. In the circulation, calcium is bound to proteins, principally albumin however, 50 circulates as ionized calcium. Ionized calcium is biologically active, and its concentration is tightly regulated. Interactions of parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D 1,25(OH)2D precisely regulate ionized calcium...

Tertiary prevention of hypothyroidism Avoiding Complications

Potential complications of recognized hypothyroidism and its treatment are preventable with sustained thyroxine therapy and appropriate clinical and laboratory monitoring. Myxedema coma is a life-threatening syndrome of multisystem organ failure resulting from prolonged profound thyroid hormone deficiency, usually with superimposed sepsis, drug intoxication, or an ischemic vascular event (52). Anecdotally, the hypothyroid patient who is elderly or has a history of previous noncompliance, other...

Diabetes is an atherosclerosis risk equivalent

In contrast to the microvascular complications of diabetes, such as nephropathy and retinopathy, atherosclerosis occurs early in the process of type 2 diabetes. Based on the observation that patients with diabetes without known atherosclerosis have the same 7-yr incidence rate of fatal or nonfatal myocardial infarction (MI) as nondiabetic patients with documented coronary artery disease, the National Cholesterol Education Program (NCEP) has defined diabetes as an atherosclerosis risk equivalent...

Sporadic MTC

Ranging from large bulky tumors to microscopic lesions, sporadic and familial tumors are histologically similar except sporadic MTC is typically unilateral and not associated with other somatic lesions. A wider spectrum of abnormalities is encountered in familial cases, ranging from isolated hypertrophied C-cells to large bilateral multicentric tumors in the superior portions of the thyroid lobes. MTC is typically composed of fusiform or polygonal cells surrounded by irregular masses of amyloid...

Primary prevention of hypothyroidism

Primary prevention of disease focuses on risk factor identification and modification. Risk factors may stem from genetic predispositions and environmental exposures. There is a genetic predisposition to the most common cause of hypothyroidism, autoimmune thyroiditis, which occurs approximately tenfold more frequently in women than men and affects approximately one in seven female children of affected women. However, autoimmune thyroiditis appears to be a polygenic disorder (8) for which there...

Effects of thyrotoxicosis Bone Effects

Postmenopausal women are at high risk for losing bone density. Up to 3 of bone mass is commonly lost within each of the first 5 yr after menopause (37). It is estimated that 30 of Caucasian women in the United States have osteoporosis (38). Concomitant thyrotoxicosis, whether subclinical or overt, has been shown to exacerbate this risk for postmenopausal osteoporosis. In thyrotoxicosis there is an increase in both osteoblast and osteoclast activity. This results in increased bone turnover, as...

Men1 3ps parathyroid pancreas and pituitary tumors

MEN-1 is a rare disorder with an estimated prevalence of 2 in 100,000 persons (4). It is defined by the presence of hypercalcemia secondary to parathyroid hyperplasia, gastrointestinal and pancreatic islet cell tumors, and anterior pituitary tumors. Primary hyperparathyroidism is the most common component of MEN-1 hypercalcemia is the most common initial presentation of the disorder, occurring in 80-100 of patients by age 40 (5). Four-gland parathyroid hyperplasia and or adenomatous tumors...

Pathophysiology

Schematic depiction of factors regulating the production of androgens by the theca cell of the ovary. The conversion of cholesterol into androstenedione and testosterone within the theca cell is regulated by cytochrome p45017a enzymes (17a-hydroxylase and 17,20-lyase). These are further regulated by factors such as hyperinsulinemia and increased free insulin-like growth factor (IGF)-1. Elevated androgens within the theca cell inhibit the actions of aromatase and hence formation of...

Rapid ACTH Stimulation Test

In most patients dynamic testing is recommended, and the rapid ACTH stimulation test is the procedure of choice (14,15). This test should be the initial diagnostic test in either primary or secondary adrenal insufficiency. Corticotropin (250 g) is given intravenously or intramuscularly, and plasma cortisol is measured before and 30 (or preferably) 60 min after the injection. If the patient is hypotensive and possibly not perfusing peripheral tissue, the intravenous route is preferred. Because...

Women Interested in Fertility

Most women with PCOS ovulate intermittently and can present with infertility. However, only a subset have infertility secondary to anovulation, and most respond to ovulation-inducing agents. The current medical treatment strategy for PCOS patients to regulate menstruation and treat infertility includes use of an estrogen receptor agonist antagonist such as clomiphene citrate. Clomiphene is typically administered in the follicular phase of the cycle, starting on d 3-5 for a total of 5 d. The...

Secondary Adrenal Insufficiency

The most common cause of secondary adrenocorticol insufficiency is iatrogenic, caused by withdrawal of therapy from patients who have been treated with pharmocologic doses of glucocorticoids (10). Clinical experience suggests that more than 30 d of supraphysiologic glucocorticoid treatment (e.g., prednisone at doses of > 7.5 mg d) may suppress CRH and ACTH for 3-6 mo an additional 36 mo may then be required for cortisol to respond to ACTH since ACTH is trophic for the adrenal glands. Both...

Approach to therapy

Images Algorithm Hypopituitarism

Several different treatment modalities are available to attain tight control of GH hypersecretion in order to improve morbidity and mortality in patients with acromegaly. Multiple treatment options may be required, and an individualized therapeutic approach is recommended for each patient Fig. 10 . In assessing the role of surgery as primary therapy, the likelihood of cure must be seriously considered. Surgery is the primary treatment for pituitary microadenomas or macroadenomas that have not...

Clinical presentation

Most of the clinical features of pheochromocytoma result from metabolic and hemodynamic actions of norepinephrine and epinephrine secreted by the tumor 1,5,13 . Hypertension is the most common clinical sign. Headache, excessive truncal sweating, and palpitations are the most common symptoms. Although pallor is found only in a small number of patients, the presence of this sign is highly suspicious for pheochromocytoma and, together with hypertension and excessive sweating, provides a high...

Vivien Bonert md and Shlomo Melmed md

Growth Hormone Releasing Factor

Introduction Clinical Features Diagnosis Treatment Approach to Therapy References Acromegaly is a chronic, insidious, disfiguring disorder of adulthood caused by excess circulating growth hormone GH secretion occurring after epiphyseal closure with protean clinical manifestations affecting almost every major organ system. GH hypersecretion stimulates increased hepatic insulin-like growth factor IGF-1 production, and both GH and IGF-1 contribute to the clinical features of hypersomatotrophism....

Biochemical diagnosis

Comt Metanephrines

Diagnosis of a pheochromocytoma depends on biochemical evidence of excessive catecholamine norepinephrine and epinephrine production by the tumor. This is usually achieved by measurements of catecholamines and catecholamine metabolites in plasma or urine. However, catecholamines are normally produced by the sympathetic nervous system and the adrenal medulla and are not specific to pheochromocytoma. Thus, a variety of physiologic conditions involving sympathoadrenomedullary activation cause...

Incidence and death rates of thyroid cancer and lymphoma

About 17,000 new cases of thyroid cancer are diagnosed annually in the United States, making it about 14th in incidence among malignancies 6 . It occurs at all ages but is most common among middle-aged and postmenopausal women Fig. 1 . The lifetime risk of developing thyroid cancer is about 1 0.65 for women and 0.25 for men 7 , and death rates are less than 10 1200 deaths occurred among 135,000 thyroid cancer patients in 1998 6 . However, both the incidence and mortality rates vary...

Polycystic Ovarian Syndrome and Insulin Resistance

The association between insulin resistance and PCOS has been well recognized for almost two decades. Insulin resistance refers to an impairment of insulin-stimulated glucose uptake largely in skeletal muscle and an impairment in insulin-mediated inhibition of hepatic glucose output. In skeletal muscle and fat, insulin initiates several intracellular signals culminating in GLUT 4-mediated glucose uptake. Insulin also has a vasodilator effect on the normal skeletal muscle vasculature mediated by...

Octreotide

Amino acid sequences of the three available somatostatin analogs, compared with endogenous somatostatin-14 SS-14 . Reproduced from van der Lely AJ, Lamberts SWJ. Medical therapy for acromegaly. In Wass J, ed. Handbook of Acromegaly. BioScientifica, Bristol, UK, 2001, p. 52. Fig. 6. Amino acid sequences of the three available somatostatin analogs, compared with endogenous somatostatin-14 SS-14 . Reproduced from van der Lely AJ, Lamberts SWJ. Medical therapy for acromegaly. In Wass J, ed....

Thyroid Lymphoma

The annual incidence of thyroid lymphoma in the United States is less than 1 in 2 million persons 29 . Thus the likelihood that a thyroid nodule is a primary thyroid lymphoma is less than 1 in 1000 it is much more likely to be a manifestation of systemic lymphoma, which affects the thyroid in about 10 of those who die of the disease 29 . However, the incidence of thyroid lymphoma has been rising significantly and now constitutes about 5 of all thyroid malignancies 29 . The reason for this is...