scholarly journals Nature Reviews Endocrinology: Acromegaly

2018 ◽  
Vol 2 (2) ◽  
pp. 01-02
Author(s):  
Chike Obi ◽  
Claudio Achebe
Keyword(s):  
Growth Hormone ◽  
Health Care Professionals ◽  
Early Identification ◽  
Treatment Initiation ◽  
Pituitary Surgery ◽  
Primary Treatment ◽  
Disease Awareness ◽  
Prompt Treatment ◽  
Insidious Onset ◽  
Surgical Cure

Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure

scholarly journals Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

2013 ◽  
Vol 169 (3) ◽  
pp. 329-337 ◽  
Author(s):  
M A E M Wagenmakers ◽  
H D Boogaarts ◽  
S H P P Roerink ◽  
H J L M Timmers ◽  
N M M L Stikkelbroeck ◽  
...  
Keyword(s):  
Treatment Option ◽  
Cushing’S Disease ◽  
Remission Rate ◽  
Pituitary Surgery ◽  
Primary Treatment ◽  
Endoscopic Technique ◽  
Cushing's Disease ◽  
Recurrence Rates ◽  
Transsphenoidal Pituitary Surgery

ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.ObjectiveTo gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas.DesignRetrospective cohort study.Patients and methodsThe medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and follow-up were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level ≤50 nmol/l either basal or after 1 mg dexamethasone.ResultsThe remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (n=20), 83% in microadenomas (n=35), 94% in noninvasive macroadenomas (n=16), and 40% in macroadenomas that invaded the cavernous sinus (n=15). The recurrence rate was 16% after 71±39 months of follow-up (mean±s.d., range 10–165 months).ConclusionsEndoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.

Early identification of hepatic encephalopathy improves outcomes

2020 ◽  
Vol 29 (Sup17) ◽  
pp. S10-S13
Author(s):  
Richard Parker
Keyword(s):  
Hepatic Encephalopathy ◽  
Early Identification ◽  
Signs And Symptoms ◽  
Prompt Treatment ◽  
Overt Form

Early identification and prompt treatment of hepatic encephalopathy can help reduce its progression into its overt form. As the initial signs and symptoms of this complication can be extremely subtle, diagnosis can be difficult, particularly for non-specialists. This article describes how the use of simple and widely available tests can help facilitate this

Discordance between growth hormone and insulin-like growth factor-1 after pituitary surgery for acromegaly: a stepwise approach and management

Pituitary ◽  
2014 ◽  
Vol 18 (1) ◽  
pp. 48-59 ◽  
Author(s):  
Mehdi Zeinalizadeh ◽  
Zohreh Habibi ◽  
Juan C. Fernandez-Miranda ◽  
Paul A. Gardner ◽  
Steven P. Hodak ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Pituitary Surgery ◽  
Insulin Like Growth Factor ◽  
Stepwise Approach

scholarly journals Mobilising community networks for early identification of tuberculosis and treatment initiation in Cambodia: an evaluation of a seed-and-recruit model

2020 ◽  
Vol 6 (2) ◽  
pp. 00368-2019
Author(s):  
Alvin Kuo Jing Teo ◽  
Kiesha Prem ◽  
Sovannary Tuot ◽  
Chetra Ork ◽  
Sothearith Eng ◽  
...  
Keyword(s):  
Early Identification ◽  
Proportional Hazards ◽  
Treatment Initiation ◽  
Prevalence Ratio ◽  
Cox Proportional Hazards ◽  
Case Finding ◽  
Community Networks ◽  
Community Based ◽  
Time To Treatment ◽  
Time To Treatment Initiation

Background and objectivesThe effects of active case finding (ACF) models that mobilise community networks for early identification and treatment of tuberculosis (TB) remain unknown. We investigated and compared the effect of community-based ACF using a seed-and-recruit model with one-off roving ACF and passive case finding (PCF) on the time to treatment initiation and identification of bacteriologically confirmed TB.MethodsIn this retrospective cohort study conducted in 12 operational districts in Cambodia, we assessed relationships between ACF models and: 1) the time to treatment initiation using Cox proportional hazards regression; and 2) the identification of bacteriologically confirmed TB using modified Poisson regression with robust sandwich variance.ResultsWe included 728 adults with TB, of whom 36% were identified via the community-based ACF using a seed-and-recruit model. We found community-based ACF using a seed-and-recruit model was associated with shorter delay to treatment initiation compared to one-off roving ACF (hazard ratio 0.81, 95% CI 0.68–0.96). Compared to one-off roving ACF and PCF, community-based ACF using a seed-and-recruit model was 45% (prevalence ratio (PR) 1.45, 95% CI 1.19–1.78) and 39% (PR 1.39, 95% CI 0.99–1.94) more likely to find and detect bacteriologically confirmed TB, respectively.ConclusionMobilising community networks to find TB cases was associated with early initiation of TB treatment in Cambodia. This approach was more likely to find bacteriologically confirmed TB cases, contributing to the reduction of risk of transmission within the community.

Soluble delta-like 1 homolog decreases in patients with acromegaly following pituitary surgery: A potential mediator of adipogenesis suppression by growth hormone?

2019 ◽  
Vol 45 ◽  
pp. 20-24
Author(s):  
Lisa Sze ◽  
Oliver Tschopp ◽  
Marian C. Neidert ◽  
René L. Bernays ◽  
Claudia Ghirlanda ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Surgery ◽  
Potential Mediator

Serum somatotropin concentrations in Holstein heifers administered growth hormone-releasing factor and somatostatin

1998 ◽  
Vol 66 (3) ◽  
pp. 551-556 ◽  
Author(s):  
G. W. Kazmer ◽  
S. A. Zinn
Keyword(s):  
Growth Hormone ◽  
Body Weight ◽  
Early Identification ◽  
Response Curve ◽  
Dairy Calves ◽  
Production Traits ◽  
Individual Animal ◽  
Milk Production Traits ◽  
Serum Growth Hormone ◽  
Blood Samples

AbstractDose-response experiments were designed to determine the dosage of somatostatin (SRIF) necessary to alter serum growth hormone (GH) response to administration of GH-releasing factor (1·44; GRF) in cattle. The objective of this experimentation was to develop a GRF/SRIF challenge model that might be useful in early identification of animals which are genetically superior for milk production traits. In experiment 1, calves received either 0, 5 or 10 /JLg GRF per 100 kg body weight (BW) or GRF 1·29 at 1 ug per 100 kg BW. Both the 5 and 10 ug GRF per 100 kg BW dosages increased GH concentrations (P < 0·05). In experiment 2, animals received 3 ug GRF per 100 kg BW concurrent with administration of 0, 0·5, 1 or 2 ug SRIF per 100 kg BW at 0 min, with second dosage of GRF at +120 min. Administration of SRIF in those dosages did not alter GH response to GRF. In experiment 3, animals received 5 ug SRIF per 100 kg BW at -2, -1, 0 or +1 min relative to 3 ug GRF per 100 kg BW, with a second GRF injection at +120 min. No differences (P < 0·05) were found in response due to timing of SRIF administration. In experiment 4, animals were administered 0, 5, 10 or 20 Xg SRIF per 100 kg BW concurrent with 3 ug GRF per 100 kg BW. SRIF delayed (P < 0·05) the occurrence of maximum GH concentrations but did not affect the maximum concentration nor the area under the GH response curve (AUC) following either the first or second GRF injection. Utilizing data from experiment 4, individual animal response to GRF was reasonably consistent, as repeatabilities of AUCs for 1 h following first and second GRF injections were 0·80 and 0·65, respectively. Furthermore, sufficient among-animal variation existed so that animals could be distinguished from each other. Thus we conclude the method described herein might be useful in identifying superior dairy calves but accuracy would potentially be enhanced by collecting blood samples more frequently during the 20 min immediately after GRF injection.

Does Adenotonsillectomy Cure Pediatric Sleep Apnea?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P63-P64
Author(s):  
Michael Friedman ◽  
Rohit Soans ◽  
Ziya Bozkurt ◽  
Hsin-Ching Lin ◽  
Ninos J Joseph
Keyword(s):  
Sleep Apnea ◽  
Meta Analysis ◽  
Treatment Success ◽  
Primary Treatment ◽  
Inclusion Criteria ◽  
Cure Rate ◽  
Effect Measure ◽  
Surgical Cure ◽  
Pediatric Sleep

Objective 1) Perform an updated meta-analysis to determine the cure rate of adenotonsillectomy for pediatric sleep apnea. 2) Report the findings of 5 years of experience with standardized coblation intracapsular tonsillectomy for the treatment of pediatric sleep apnea. Methods A thorough literature search of multiple databases was performed. Inclusion criteria for studies were: 1) Adenotonsillectomy as the primary treatment of sleep apnea (age<18). 2) Pre-and postoperative polysomnography data was included. 20 studies fit the inclusion criteria and a metaanalysis was performed to determine the overall success. A 5–year retrospective analysis of coblation tonsillectomy performed by a single surgeon for sleep apnea was also performed. Results The meta-analysis included 904 subjects with average follow-up time of 21.6 weeks. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k= 20 studies) with T/A based on pre-and postoperative PSG data. Random-effects model estimated the treatment success of adenotonsillectomy was 61.1%. When “cure” was defined as an AHI of <1, the cure rate was 53.8%. 200 adenotonsillectomy cases performed with coblation technique were reviewed. The mean preoperative was AHI 28.3 and mean postoperative AHI was 3.8. Surgical cure, as defined as a postoperative AHI <1, was achieved in 51.7% of patients. Conclusions 1) Contrary to popular belief, meta-analysis of current literature and a review of 200 cases demonstrates that pediatric sleep apnea is often not cured by adenotonsillectomy. 2) Although complete resolution is not achieved in most cases, adenotonsillectomy still offers significant improvements in AHI.

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