Approach to the Patient with Endocrine Disorders

2016 ◽  
Author(s):  
Graham T McMahon ◽  
Robert G. Dluhy
Keyword(s):  
Chronic Care ◽  
Adrenal Incidentaloma ◽  
Hormone Deficiency ◽  
Patient Specific ◽  
Endocrine Disorders ◽  
Endocrine Disease ◽  
Endocrine Diseases ◽  
Characteristic Sets ◽  
Patients Experience

The distribution of hormones throughout the human body results in presentations of endocrine disease that are diffuse and variable. Although some endocrine syndromes result in characteristic sets of symptoms and features, most patients experience a limited number of components of the syndrome and may note symptoms that are not typically syndromic. This review discusses presentations of endocrine diseases and the endocrine patient. Specific attention is given to endocrine testing, which can be achieved by measuring the hormone itself, stimulating or suppressing a hormone feedback loop, or measuring peripheral hormone receptor function. The chronic care relationship is explored as many patients with endocrine diseases require extended chronic care to achieve control of abnormal hormonal systems. The dependency on chronic care necessitates that endocrinologists develop particular expertise in managing illnesses over the long term. Tables list hormones and their associated syndromes, clusters of contrasting symptoms and signs of over- and underactivity of the thyroid and adrenal glands, approaches to endocrine testing and treatment, and variability in selected hormone concentrations over time. Figures show diagnostic criteria related to hypercalcemia, growth hormone deficiency, acromegaly, and adrenal incidentaloma. The chronic care model is also represented. This review contains 4 highly rendered figures, 4 tables, and 12 references.

Prevalence of childhood growth hormone deficiency in survivors of pediatric intracranial germ cell tumors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22526-e22526
Author(s):  
Diana Lone ◽  
Karim Thomas Sadak ◽  
Bradley S Miller ◽  
Michelle Roesler ◽  
Jenny N Poynter
Keyword(s):  
Growth Hormone ◽  
Germ Cell ◽  
Growth Hormone Deficiency ◽  
Late Effects ◽  
Germ Cell Tumors ◽  
Hormone Deficiency ◽  
Endocrine Disorders ◽  
Intracranial Germ Cell Tumors

e22526 Background: Survival rates for childhood cancer continue to rise, and there are now greater than 420,000 survivors in the United States. However, high cure rates come at the cost of short and long-term treatment-related toxicities. Endocrine disorders are among the most common late effects and are associated with poor health outcomes and lower quality of life. Survivors of pediatric intracranial germ cell tumors (iGCTs) are at high risk for endocrine disorders, particularly for growth hormone deficiency (GHD), due to their exposures to cranial radiation, chemotherapy, and brain surgery. To date, no long-term follow-up studies have explored the late effects experienced by survivors of iGCTs. Methods: Study participants were enrolled in the Germ Cell Tumor Epidemiology Study, which is a case-parent triad study conducted using the resources of the Children’s Oncology Group’s Childhood Cancer Research Network. Eligibility criteria included diagnosis with a germ cell tumor in any location at age 0-19 years in the years 2008-2015. The study population included 233 cases with a diagnosis of iGCT. We are currently following the cohort to evaluate outcomes and late effects of treatment, including medical record review to extract data on treatment characteristics and hormone deficiencies. This interim analysis includes chart review for 57 iGCT cases. Results: Of the 57 cases reviewed, there was a male predominance (73.7%) with the highest prevalence in non-Hispanic whites (80.4%). Cases of iGCTs can be subdivided into two main histologic subtypes, germinomas (36 cases) and non-germinomatous GCTs (NGGCT, 21 cases). The median age at diagnosis was 14.6 years for the germinomas and 10.5 years for NGGCTs. Data on growth hormone deficiency (GHD) was available for 42 of the 57 cases with a median follow-up of 7.4 years. Twenty-eight of the 42 cases (66.7%) had GHD; 19 in the germinoma group and 9 in the NGGCT group (p = 0.47). 17 of those with GHD were males (p = 0.10). There was no significant difference in prevalence of GHD by age of tumor diagnosis (p = 0.20). Conclusions: Survivors of iGCTs are at high risk for growth hormone deficiency. Identifying specific risk factors for developing GHD amongst these survivors can enhance the current guidelines for screening and management.

scholarly journals An Investigation of Hearing (250–20,000 Hz) in Children with Endocrine Diseases and Evaluation of Tinnitus and Vertigo Symptoms

2020 ◽  
Vol 24 (02) ◽  
pp. e198-e205
Author(s):  
Murat Kocyigit ◽  
Selin Ustun Bezgin ◽  
Taliye Cakabay ◽  
Safiye Giran Ortekin ◽  
Melek Yıldız ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Patient Group ◽  
Metabolic Diseases ◽  
Hormone Deficiency ◽  
Control Group ◽  
Healthy Children ◽  
Endocrine Disease ◽  
High Frequencies ◽  
Endocrine Diseases

Abstract Introduction Despite much advancement in medicine, endocrine and metabolic diseases remain an important cause of morbidity and even mortality in children. Objective The present study was planned to investigate the evaluation of hearing that also includes high frequencies, and the presence and degree of vertigo and tinnitus symptoms in pediatric patients diagnosed with endocrine diseases such as type 1 diabetes mellitus (DM), growth hormone deficiency (GHD), obesity, idiopathic short stature, and precocious puberty Methods The present study included a patient group of 207 children patients diagnosed with endocrine disease (95 males, 112 females; mean age 9.71 years old [range 6–16 years old]) and a control group including 55 healthy children who do not have any kind of chronic disease (26 males, 29 females; mean age 9.33 years old [range 6–16 years old]). The subjects underwent a hearing test with frequencies between 250 and 20,000 Hz. The vestibular and tinnitus symptoms were evaluated with the Pediatric Vestibular Symptom Questionnaire. Results Out of 207 patients in the patient group, 5 (2.4%) had hearing loss in pure tones, 10 (4.8%) had it in high frequencies, 40 (19.3%) had tinnitus symptoms, and 18 (8.7%) had vertigo symptoms. A total of 4 out of 207 patients in the study group (1.9%), 2 out of 59 with type 1 DM patients (3.4%), 1 out of 46 with GHD (2.2%), and 1 out of 43 obesity patients (2.3%) had hearing loss, vertigo, and tinnitus symptoms. Conclusions Our results suggest that some childhood endocrine diseases can cause some changes in the inner ear, although the exact cause is unknown. Perhaps, a detailed hearing and balance examination should be a routine in a child diagnosed with an endocrine disease. We think it is necessary to work on more comprehensive patient groups and tests in the future.

New Frontiers in the Therapeutic Approach of Patients with Cardiovascular and Endocrine Diseases

2019 ◽  
Vol 19 (5) ◽  
pp. 605-621 ◽  
Author(s):  
Dario Grande ◽  
Paola Terlizzese ◽  
Margherita I. Gioia ◽  
Giuseppe Parisi ◽  
Vito A. Giagulli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Replacement Therapy ◽  
Subclinical Hypothyroidism ◽  
Cardiovascular Events ◽  
Poor Prognosis ◽  
Randomized Clinical Trials ◽  
Hormone Deficiency ◽  
Endocrine Disorders ◽  
Endocrine Diseases

Background and Objective: Cardiovascular disease is the most important cause of morbidity and mortality worldwide, with a significant economic burden, which is expected to increase in the next years. Alongside the management of cardiac manifestations and major risk factors for atherosclerosis, great attention has been paid to the role of comorbidities in initiating and worsening cardiac conditions. Discussion: The cardiovascular impact of a broad spectrum of endocrine disorders has been evaluated, with particular regard to their effects on cardiac function and cardiovascular prognosis in affected patients. Among the different endocrine conditions considered, the association between subclinical hypothyroidism and cardiovascular events is still uncertain. A number of observational studies have linked subclinical hypothyroidism (in particular severe elevation of TSH levels) with incident cardiovascular disease and poor prognosis, however thyroid replacement therapy is still controversial, especially in the elderly, due to the lack of evidence coming from randomized controlled trials. With regards to testosterone deficiency, even though it has been associated with metabolic abnormalities and poor prognosis in patients affected by cardiovascular diseases, the cardiac safety of replacement therapy has still to be completely clarified. Similarly, growth hormone deficiency showed detrimental effects on cardiovascular events and risk factors which seem to be reverted by replacement therapy, even if unequivocal evidence from randomized clinical trials is still lacking Another relevant chapter in cardiovascular disease management is about the cardiovascular outcomes of diabetes medical treatments. In recent years, a growing interest has been developed around the cardiovascular safety of antidiabetic medications which has led to a great number of publications addressing this issue for the different classes of antidiabetic drugs. Interestingly, the recently approved classes, i.e. incretins and SGLT-2 inhibitors, have additionally demonstrated a protective effect against major cardiovascular events, shedding new light on the management of diabetes in patients affected by cardiovascular disease. Conclusion: Important controversies still exist regarding the cardiac implications of the therapies adopted in endocrine diseases. Owing the large prevalence of these conditions, particularly in the cardiovascular population, further research is awaited in order to clarify the potential advantage and the possible cardiac risk related to treatment of the endocrine comorbidities.

Unresolved Problems in Optimal Therapy of Pubertal Disorders in Oncological and Bone Marrow Transplanted Patients

2001 ◽  
Vol 14 (s2) ◽  
Author(s):  
M. Bozzola ◽  
A. Albanese ◽  
G.E. Butler ◽  
V. Cherubini ◽  
A. Cicognani ◽  
...  
Keyword(s):  
Pubertal Development ◽  
Young Patients ◽  
Hormone Deficiency ◽  
Endocrine Disorders ◽  
Consensus Guidelines ◽  
Close Collaboration ◽  
Cranial Radiotherapy ◽  
Long Term Follow Up

AbstractSpecialised clinics for the long-term follow-up of survivors from childhood cancer have developed over recent years. The problems encountered among patients who received multiple chemotherapy and radiotherapy can be challenging and require high expertise and close collaboration among different professionals (e.g. oncologists, endocrinologists, radiotherapists, psychologists). Endocrine disorders are often seen, particularly among those who received cranial radiotherapy or gonadotoxic chemotherapy; puberty can be affected and the spectrum of disorders may range from precocious or accelerated puberty to delayed, arrested or even absent pubertal development. Growth impairment can be multifactorial and growth hormone deficiency is an important but probably not the only factor involved. Many questions remain about the optimal management of this group of young patients. In the consensus guidelines that follow the overview an attempt is made to help optimise patients’ growth and puberty by suggesting practical clinical approaches to some of the most challenging issues.

scholarly journals Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline

2020 ◽  
Vol 105 (12) ◽  
pp. 3613-3682
Author(s):  
Connie B Newman ◽  
Michael J Blaha ◽  
Jeffrey B Boord ◽  
Bertrand Cariou ◽  
Alan Chait ◽  
...  
Keyword(s):  
Endocrine Disorders ◽  
Atherosclerotic Cardiovascular Disease ◽  
Endocrine Society ◽  
Endocrine Disease ◽  
Lipid Management ◽  
Endocrine Disorder ◽  
Endocrine Diseases ◽  
Assessment And Treatment ◽  
Ascvd Risk ◽  
Lipid Abnormalities

Abstract Objective This guideline will provide the practicing endocrinologist with an approach to the assessment and treatment of dyslipidemia in patients with endocrine diseases, with the objective of preventing cardiovascular (CV) events and triglyceride-induced pancreatitis. The guideline reviews data on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with endocrine disorders and discusses the evidence for the correction of dyslipidemia by treatment of the endocrine disease. The guideline also addresses whether treatment of the endocrine disease reduces ASCVD risk. Conclusion This guideline focuses on lipid and lipoprotein abnormalities associated with endocrine diseases, including diabetes mellitus, and whether treatment of the endocrine disorder improves not only the lipid abnormalities, but also CV outcomes. Based on the available evidence, recommendations are made for the assessment and management of dyslipidemia in patients with endocrine diseases.

PITUITARY-ADRENAL RECOVERY FOLLOWING LONG-TERM CORTICOSTEROID THERAPY

1966 ◽  
Vol 51 (1) ◽  
pp. 63-70 ◽  
Author(s):  
P. F. Roe ◽  
D. M. Mitchell ◽  
G. W. Pennington
Keyword(s):  
Corticosteroid Therapy ◽  
Adrenocortical Function ◽  
Endocrine Disorders ◽  
Marked Rise ◽  
Underlying Condition ◽  
Normal Limits ◽  
Small Rise ◽  
The Mean ◽  
Corticosteroid Drugs

ABSTRACT Adrenocortical function was assessed in 20 patients receiving long-term corticosteroid drugs for a variety of non-endocrine disorders. In all cases plasma 17-hydroxycorticosteroids (17-OHCS) levels were within or above normal limits 48 hours after abruptly stopping their drugs and a further marked rise occurred in 7 patients given metyrapone for 24 h. Urinary 17-OHCS excretion did not show a parallel rise. Taking the group as a whole, a small rise in the mean output occurred 48 hours after stopping therapy, and a further slightly greater rise followed metyrapone. 3 patients had a relapse of their underlying condition during the test in spite of normal plasma and urinary 17-OHCS levels.

Effects of long-term growth hormone replacemente therapy on body composition in adult patients with growth hormone deficiency

2020 ◽  
Author(s):  
García Moreno Rosa María ◽  
Ramírez Paola Parra ◽  
Saiz Gonzalo Baonza ◽  
Rojas-Marcos Patricia Martin ◽  
Beatriz Lecumberri ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Body Composition ◽  
Growth Hormone Deficiency ◽  
Adult Patients ◽  
Hormone Deficiency

scholarly journals Vitamin D Deficiency in Testicular Cancer Survivors: A Systematic Review

2021 ◽  
Vol 22 (10) ◽  
pp. 5145
Author(s):  
Giuseppe Schepisi ◽  
Caterina Gianni ◽  
Sara Bleve ◽  
Silvia De Padova ◽  
Cecilia Menna ◽  
...  
Keyword(s):  
Vitamin D ◽  
Testicular Cancer ◽  
Vitamin D Deficiency ◽  
Molecular Mechanisms ◽  
Hypovitaminosis D ◽  
Young Males ◽  
Report Data ◽  
Testicular Cancer Survivors ◽  
Patients Experience

Testicular cancer (TC) is the most frequent tumor in young males. In the vast majority of cases, it is a curable disease; therefore, very often patients experience a long survival, also due to their young age at diagnosis. In the last decades, the role of the vitamin D deficiency related to orchiectomy has become an increasingly debated topic. Indeed, vitamin D is essential in bone metabolism and many other metabolic pathways, so its deficiency could lead to various metabolic disorders especially in long-term TC survivors. In our article, we report data from studies that evaluated the incidence of hypovitaminosis D in TC survivors compared with cohorts of healthy peers and we discuss molecular mechanisms and clinical implications.

scholarly journals On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mehran Ashrafi ◽  
Farzan Ghalichi ◽  
Behnam Mirzakouchaki ◽  
Manuel Doblare
Keyword(s):  
Mathematical Model ◽  
Bone Density ◽  
Bone Remodeling ◽  
Dental Implants ◽  
Implant Design ◽  
Patient Specific ◽  
Dental Implantation ◽  
Antiresorptive Agents ◽  
Antiresorptive Drugs

AbstractBone remodeling identifies the process of permanent bone change with new bone formation and old bone resorption. Understanding this process is essential in many applications, such as optimizing the treatment of diseases like osteoporosis, maintaining bone density in long-term periods of disuse, or assessing the long-term evolution of the bone surrounding prostheses after implantation. A particular case of study is the bone remodeling process after dental implantation. Despite the overall success of this type of implants, the increasing life expectancy in developed countries has boosted the demand for dental implants in patients with osteoporosis. Although several studies demonstrate a high success rate of dental implants in osteoporotic patients, it is also known that the healing time and the failure rate increase, necessitating the adoption of pharmacological measures to improve bone quality in those patients. However, the general efficacy of these antiresorptive drugs for osteoporotic patients is still controversial, requiring more experimental and clinical studies. In this work, we investigate the effect of different doses of several drugs, used nowadays in osteoporotic patients, on the evolution of bone density after dental implantation. With this aim, we use a pharmacokinetic–pharmacodynamic (PK/PD) mathematical model that includes the effect of antiresorptive drugs on the RANK/RANK-L/OPG pathway, as well as the mechano-chemical coupling with external mechanical loads. This mechano-PK/PD model is then used to analyze the evolution of bone in normal and osteoporotic mandibles after dental implantation with different drug dosages. We show that using antiresorptive agents such as bisphosphonates or denosumab increases bone density and the associated mechanical properties, but at the same time, it also increases bone brittleness. We conclude that, despite the many limitations of these very complex models, the one presented here is capable of predicting qualitatively the evolution of some of the main biological and chemical variables associated with the process of bone remodeling in patients receiving drugs for osteoporosis, so it could be used to optimize dental implant design and coating for osteoporotic patients, as well as the drug dosage protocol for patient-specific treatments.

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