MedWorm: Addison's Disease

Cardiac dysfunction in cirrhosis – does adrenal function play a role? A hypothesis

Liver International — Tue, 31 Jan 2012 05:00:00 +0100

AbstractCirrhotic cardiomyopathy (CCM), a condition of unknown pathogenesis, is characterized by suboptimal ventricular contractile response to stress, diastolic dysfunction and QT interval prolongation. It is most often found in patients with advanced cirrhosis. It is clinically relevant during stressful conditions, such as sepsis, bleeding and surgery. CCM reverses after liver transplantation and potentially has a role in the pathogenesis of hepatorenal syndrome. In adrenal insufficiency (AI), cardiac dysfunction is a feature with low ejection fraction, decreased left ventricular chamber size and electrocardiographic abnormalities, including QT interval prolongation. With optimal diagnostic tests, AI is present in approximately 10% of patients with cirrhosis, particularly in those with a...

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Adrenal insufficiency in children with sepsis

Revista Brasileira de Terapia Intensiva — Fri, 27 Jan 2012 15:57:11 +0100

CONCLUSION: This study determined the frequency of adrenal insufficiency in children with sepsis and its relationship to increased mortality within the first 28 post-admission days. No statistically significant association was found between adrenal insufficiency and mechanical ventilation time or the use of vasoactive drugs. (Source: Revista Brasileira de Terapia Intensiva)

Fludrocortisone/prednisolone/psyllium interaction: Adrenal insufficiency crisis (first report for fludrocortisone and psyllium): case report

Reactions — Mon, 23 Jan 2012 18:35:21 +0100

(Source: Reactions)

Exogenous adrenal insufficiency

About.com Eating Disorders — Fri, 20 Jan 2012 05:00:00 +0100

is a condition of low levels of hormones released by the adrenal glands, caused by factors other than problems with the glands themselves. See for information on adrenal deficiency caused by problems within these glands. (Source: About.com Eating Disorders)

Nocturnal Hypoglycemia Identified by a Continuous Glucose Monitoring System in Patients with Primary Adrenal Insufficiency (Addison's Disease)

Diabetes Technology — Thu, 19 Jan 2012 04:04:40 +0100

Diabetes Technology & Therapeutics , Vol. 0, No. 0. (Source: Diabetes Technology)

Adrenal Insufficiency as a Possible Contributor to Pain in Adults With Sickle Cell Disease (SCD) (413-B)

Journal of Pain and Symptom Management — Thu, 19 Jan 2012 03:24:50 +0100

Recognize the relationship between adrenal insufficiency and pain. (Source: Journal of Pain and Symptom Management)

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Diagnostic Value of Salivary Cortisol in the CRH Stimulation Test in Premature Infants.

The Journal of Clinical Endocrinology and Metabolism — Wed, 18 Jan 2012 05:00:00 +0100

Conclusion:This study indicated that using salivary cortisol measurements for the CRH test could be a reliable method for evaluating the hypothalamic-pituitary-adrenal axis in VLBWI with gestational age of less than 29 wk. PMID: 22259060 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Vanishing white matter disease caused by EIF2B2 mutation with the presentation of an adrenoleukodystrophy phenotype.

Gene — Tue, 17 Jan 2012 05:00:00 +0100

This report widens the clinical spectrum of VWMD and raises the possibility of an allele-specific association with adrenal insufficiency. PMID: 22285377 [PubMed - as supplied by publisher] (Source: Gene)

Lipodystrophy and adrenal insufficiency: Potential mediators of peripheral neuropathy in HIV infection?

Medical Hypotheses — Mon, 16 Jan 2012 05:00:00 +0100

Abstract: The mechanisms behind certain co-morbid conditions associated with chronic HIV disease still remain elusive. HIV-associated peripheral neuropathy is one among those rarely studied manifestations in HIV-1 infection. Numerous underlying factors associated with peripheral neuropathy have been described in HIV disease. Herein, we hypothesized certain heretofore undescribed potential mechanisms that lead to HIV associated neuropathy. Being a multifactoral manifestation, HIV-associated neuropathy is presumed to have an association with physiological factors namely, adrenal inadequacy/steroid resistance and lipodystrophy-induced cushion-effect loss in peripheral nerves. Therefore, management of the adrenals with steroids at the time-point of high inflammatory burden thereby preventing l...

Nocturnal Hypoglycemia Identified by a Continuous Glucose Monitoring System in Patients with Primary Adrenal Insufficiency (Addison's Disease)

Diabetes Technology — Sat, 14 Jan 2012 04:05:09 +0100

Diabetes Technology & Therapeutics , Vol. 0, No. 0. (Source: Diabetes Technology)

Busulfan/cyclophosphamide: Adrenal insufficiency in a child: case report

Reactions — Fri, 13 Jan 2012 23:22:43 +0100

(Source: Reactions)

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Adrenocortical dysfunction in liver disease: A systematic review

Hepatology — Wed, 11 Jan 2012 05:00:00 +0100

AbstractIn patients with cirrhosis adrenal insufficiency (AI) is reported during sepsis and septic shock, and is associated with increased mortality. Consequently, the term “hepato‐adrenal syndrome” was proposed. Some studies have shown that AI is frequent in stable cirrhosis, and in cirrhosis associated with decompensation other than sepsis, such as bleeding and ascites. Moreover, other studies showed a high prevalence in liver transplant recipients, immediately after or some time after liver transplantation. The effect of corticosteroid therapy in critically ill patients with liver disease has been evaluated in some studies, but the results remain controversial.The 250 µg ACTH stimulation test to diagnose AI in critically ill adult patients is recommended by an international task ...

Developing an algorithm for pulse oximetry derived respiratory rate (RRoxi): a healthy volunteer study

Journal of Clinical Monitoring and Computing — Mon, 09 Jan 2012 19:34:28 +0100

Conclusions These data indicate that RRoxi represents a viable technology for the measurement of respiratory rate of healthy individuals. Content Type Journal ArticlePages 1-7DOI 10.1007/s10877-011-9332-yAuthors Paul S. Addison, Advanced Research Group, Covidien Respiratory and Monitoring Solutions, Technopole Centre, Edinburgh, EH26 0PJ UKJames N. Watson, Advanced Research Group, Covidien Respiratory and Monitoring Solutions, Technopole Centre, Edinburgh, EH26 0PJ UKMichael L. Mestek, Covidien Respiratory and Monitoring Solutions, Boulder, CO, USARoger S. Mecca, Department of Anesthesiology, University of California, Irvine, USA Journal Journal of Clinical Monitoring and ComputingOnline ISSN 1573-2614Print ISSN 1387-1307 (Source: Journal of Clinical Monitoring and Computin...

Long-term Management for Primary Adrenal InsufficiencyLong-term Management for Primary Adrenal Insufficiency

Medscape Today Headlines — Wed, 04 Jan 2012 04:00:00 +0100

Learn about glucocorticoid replacement for special situations such as pregnancy and hypertension. Clinical Endocrinology (Source: Medscape Today Headlines)

Salivary Cortisol as a Diagnostic Tool for Cushing's Syndrome and Adrenal Insufficiency: Improved Screening by an Automatic Immunoassay.

European Journal of Endocrinology — Tue, 03 Jan 2012 05:00:00 +0100

Conclusions: The newly established thresholds facilitated initial screening for secondary adrenal insufficiency and allowed excellent identification of hypercortisolism. Measurement by an automated immunoassay will allow broader use of salivary cortisol as a diagnostic tool. PMID: 22214924 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Loss of Function Thrombospondin-1 Mutations in Familial Pulmonary Hypertension.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Fri, 23 Dec 2011 05:00:00 +0100

Authors: Maloney JP, Stearman RS, Bull TM, Calabrese DW, Tripp-Addison ML, Wick MJ, Broeckel U, Robbins IM, Wheeler LA, Cogan JD, Loyd JE Abstract Most patients with familial pulmonary arterial hypertension (FPAH) carry mutations in the bone morphogenic protein receptor 2 gene (BMPR2). Yet carriers have only a 20% risk of disease, suggesting that other factors influence penetrance. Thrombospondin-1 (TSP1) regulates activation of TGF-β and inhibits endothelial and smooth muscle cell proliferation - pathways coincidentally altered in PAH. To determine if a subset of FPAH patients also have mutations in the TSP1 gene (THBS1) we resequenced the type I repeats of THBS1 encoding the TGF-β regulation and cell growth inhibition domains in 60 FPAH probands, 70 nonfamilial PAH subjects, an...

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Improved bonding of zirconia substructures to resin using a “glaze-on” technique

Journal of Dentistry — Thu, 22 Dec 2011 02:16:38 +0100

ConclusionThe glazing techniques used in the current investigation resulted in a significantly enhanced shear bond stress to the resin based cement when compared with the current ‘gold standard’–tribochemical coating. (Source: Journal of Dentistry)

Discordant growth hormone and IGF-1 levels post pituitary surgery in patients with acromegaly naïve to medical therapy and radiation: what to follow, GH or IGF-1 values?

Pituitary — Mon, 19 Dec 2011 16:51:07 +0100

Abstract New criteria that define acromegaly remission are more stringent: normal (age/sex-adjusted) insulin-like growth factor type 1 (IGF-1), growth hormone (GH) random (GHr) <1 μg/L, and a GH nadir (GHn) during oral glucose tolerance test (OGTT) of <0.4 μg/L. Discordance between GH and IGF-1 values is often attributed to somatostatin receptor ligands (SRLs) or radiation. The purpose of this study was to evaluate rates of discordant IGF-1 and GH levels in patients with GH secreting adenomas (after pituitary surgery), who were naïve to any other treatment. We retrospectively analyzed data over a 5 year time period (2006–2010), in post-surgery acromegaly patients who had elevated IGF-1 but normal GH levels (per the new cure criteria). Symptoms of a...

Suppression of the HPA axis during extrahepatic biliary obstruction induces cholangiocyte proliferation in the rat

AJP: Gastrointestinal and Liver Physiology — Mon, 19 Dec 2011 05:00:00 +0100

Cholestatic patients often present with clinical features suggestive of adrenal insufficiency. In the bile duct-ligated (BDL) model of cholestasis, the hypothalamic-pituitary-adrenal (HPA) axis is suppressed. The consequences of this suppression on cholangiocyte proliferation are unknown. We evaluated 1) HPA axis activity in various rat models of cholestasis and 2) effects of HPA axis modulation on cholangiocyte proliferation. Expression of regulatory molecules of the HPA axis was determined after BDL, partial BDL, and α-naphthylisothiocyanate (ANIT) intoxication. The HPA axis was suppressed by inhibition of hypothalamic corticotropin-releasing hormone (CRH) expression by central administration of CRH-specific Vivo-morpholinos or by adrenalectomy. After BDL, the HPA axis was reactiva...

What Causes a Black Colored Tongue?

PediatricEducation.org — Mon, 19 Dec 2011 00:29:33 +0100

Discussion Although dental caries, strep throat and oral candidiasis are some of the most common oral pathology. The tongue itself can be a source of potential pathology. Geographic tongue, oral candidiasis, and lingual ulcerations are common problems. Most discolorations of the tongue are because of food, drink or medications that are ingested and are self-limited. However discoloration can be a sign of more significant problems. Hairy tongue, often colored black, is a relatively uncommon problem in the US but has a higher incidence reported in Turkey and Iran. It is more common in adults than children but has been reported in a child 2 months of age. It is also called lingua villosa nigra and is a benign condition caused by keratin accumulation usually in the setting of poor oral hygiene...

The 1,8-Bis(2′-pyridyl)-3,6-dithiaoctane Complex of Rhodium(III)

Journal of Chemical Crystallography — Sat, 17 Dec 2011 16:41:59 +0100

Abstract The tetradentate ligand 1,8-bis(2′-pyridyl)-3,6-dithiaoctane (Pdto) forms a pseudooctahedral structure with rhodium(III). The yellow racemic [Rh(Pdto)Cl2](CF3SO3) compound belongs to the Pbca space group with a = 13.566(15), b = 15.6588(16), c = 21.473(2) Å, and Z = 8. The Rh–S bonds are shorter than is usual, while the pyridine rings are mutually trans and form an interplanar angle of 24°. Graphical Abstract The yellow racemic Rh(III) complex [Rh(Pdto)Cl2]+ possesses a pseudooctahedral structure with relatively short Rh–S bonds, in which the pyridine rings are mutually trans and form an interplanar angle of 24°. Content Type Journal ArticleCategory NotePages 1-4DOI 10.1007/s10870-01...

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Manchester United fan 'made unwell by watching matchers' (BBC News Online, 16 December 2011)

Society for Endocrinology — Fri, 16 Dec 2011 12:00:00 +0100

A report in BMJ tells the case of a patient tested for and diagnosed with Addison's disease after she described the symptoms she experienced during Manchester United matches. Full article (Source: Society for Endocrinology)

Manchester United fan 'made unwell by watching matches' (BBC News Online, 16 December 2011)

Society for Endocrinology — Fri, 16 Dec 2011 12:00:00 +0100

Successful management of cryptococcosis of the bilateral adrenal glands and liver by unilateral adrenalectomy with antifungal agents: a case report

BMC Infectious Diseases — Wed, 14 Dec 2011 05:00:00 +0100

Conclusions: This is the first report describing adrenal cryptococcosis with adrenal insufficiency and liver invasion without central nervous system involvement. Adrenal cryptococcosis should be considered in the differential diagnosis for patients with bilateral adrenal masses with primary adrenal deficiency. Unilateral adrenalectomy was quite effective in controlling the cryptococcosis in this case. Even in patients with bilateral adrenal cryptococcosis, unilateral adrenalectomy should be an option for treatment of disseminated cryptococcosis. (Source: BMC Infectious Diseases)

[131I]Iodometomidate for Targeted Radionuclide Therapy of Advanced Adrenocortical Carcinoma.

The Journal of Clinical Endocrinology and Metabolism — Wed, 14 Dec 2011 05:00:00 +0100

Conclusions:Radionuclide therapy with [(131)I]IMTO is a promising treatment option for selected patients with ACC, deserving evaluation in prospective clinical trials. PMID: 22170726 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

What is the best long‐term management strategy for patients with primary adrenal insufficiency?

Clinical Endocrinology — Wed, 07 Dec 2011 22:06:23 +0100

This article provides answers to the important daily clinical questions, such as correct dose finding, dose adaptation in special situations, e g, pregnancy, improvement of quality of life and measures for protection from adrenal crisis. Other important aspects discussed are side effects of glucocortiocid replacement therapy and interactions with other drugs. (Source: Clinical Endocrinology)

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Genotype-Phenotype Analysis in Congenital Adrenal Hyperplasia due to P450 Oxidoreductase Deficiency.

The Journal of Clinical Endocrinology and Metabolism — Wed, 07 Dec 2011 05:00:00 +0100

Conclusions:We report clinical, biochemical, and genetic findings in a large PORD cohort and show that MLPA is a useful addition to POR mutation analysis. Homozygosity for the most frequent mutation in Caucasians, p.A287P, allows for prediction of genital phenotype and moderate malformations. Adrenal insufficiency is frequent, easily overlooked, but readily detected by cosyntropin testing. PMID: 22162478 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Serum and salivary cortisol in the diagnosis of adrenal insufficiency and as a predictor of the outcome in patients with severe sepsis

Arquivos Brasileiros de Endocrinologia e Metabologia — Sun, 04 Dec 2011 08:16:21 +0100

CONCLUSIONS: Salivary cortisol in critically ill patients may be a better laboratory indicator of cortisol levels than serum total cortisol.OBJETIVOS: Comparar cortisol salivar com sérico total em pacientes com sepse grave, em pós-operatório e controles normais. MATERIAIS E MÉTODOS: Cortisol sérico total foi determinado por imunoensaio quimioluminescente e cortisol salivar por imunoensaio enzimático. RESULTADOS: Em pacientes com sepse grave, a mediana do cortisol salivar foi 14,0 e 2,6 vezes maior que dos pacientes em pós-operatório e saudáveis. Nos pacientes em pós-operatório, cortisol salivar foi 5,4 vezes maior que o controle. Cortisol sérico total também foi maior em pacientes com sepse grave que nos saudáveis e pós-operatórios, porém, esse incremento foi bem menor (2,...

Stage-dependent differential expression of microRNAs in colorectal cancer: potential role as markers of metastatic disease

Clinical and Experimental Metastasis — Fri, 25 Nov 2011 17:57:09 +0100

Abstract MicroRNAs (miRs) are short non-coding RNAs that bind complementary sequences in mRNA resulting in translation repression and/or mRNA degradation. We investigated expression of the reported metastasis-associated miRs-335, 206, 135a, 146a, 146b, 10b, 21, let7a and let7b in normal mucosa, non-metastatic and metastatic colorectal cancer (CRC). Expression of target miRs in micro-dissected paraffin embedded tissues was evaluated in 15 primary tumours with adjacent normal tissue from patients that were disease-free at 4 years (cohort A) and 19 paired primary tumours with corresponding liver metastases (cohort B) by quantitative real-time PCR. Increased expression of miR-21, mir-135a and miR-335 was associated with clinical progression of CRC, while miR-206 demonstrat...

Adrenal disease in pregnancy

Best Practice and Research. Clinical Endocrinology and Metabolism — Fri, 25 Nov 2011 08:02:59 +0100

Adrenal disorders in pregnancy are relatively rare, yet can lead to significant maternal and fetal morbidity. Making a diagnosis is challenging as pregnancy may alter the manifestation of disease, many signs and symptoms associated with pregnancy are also seen in adrenal disease, and the fetal-placental unit alters the maternal endocrine metabolism and hormonal feedback mechanisms. The most common cause of Cushing’s syndrome in pregnancy is an adrenal adenoma, followed by pituitary etiology, adrenal carcinoma, and other exceedingly rare causes. Medical therapy of Cushing’s syndrome includes metyrapone and ketoconazole, but generally surgical treatment is more effective. Exogenous corticosteroid administration is the most common cause of adrenal insufficiency, followed by the endogenous...

SfE awards second Public Engagement Grant

Society for Endocrinology — Thu, 24 Nov 2011 12:00:00 +0100

Dr Niki Karavitaki, Consultant Endocrinologist, Oxford, will deliver two ?Steroid replacement study days’ to educate patients with adrenal insufficiency and their family members/carers about their condition and medication. These events are sponsored by SfE through a Public Engagement Grant awarded to Dr Karavitaki. The study days will take place at the Oxford Centre for Diabetes, Endocrinology & Metabolism. Dr Karavitaki will be joined by Specialty Registrars and an Endocrine Nurse team to deliver educational talks and a practical demonstration of the emergency steroid jabs. Previous study days have received excellent feedback and have improved attendees’ confidence in giving the emergency steroid jab. The events will take place from 17:00-18:30 on Monday 5 March 2012, and...

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Structure-Guided Evolution of Potent and Selective CHK1 Inhibitors through Scaffold Morphing

Journal of Medicinal Chemistry — Wed, 23 Nov 2011 14:55:55 +0100

Journal of Medicinal ChemistryDOI: 10.1021/jm2007326 (Source: Journal of Medicinal Chemistry)

Improved Cortisol Exposure-Time Profile and Outcome in Patients with Adrenal Insufficiency: A Prospective Randomized Trial of a Novel Hydrocortisone Dual-Release Formulation.

The Journal of Clinical Endocrinology and Metabolism — Wed, 23 Nov 2011 05:00:00 +0100

Conclusion:The OD dual-release tablet provided a more circadian-based serum cortisol profile. Reduced body weight, reduced blood pressure, and improved glucose metabolism were observed during OD treatment. In particular, glucose metabolism improved in patients with concomitant DM. PMID: 22112807 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Hyponatremia and antidiuresis syndrome.

Annales d'Endocrinologie — Wed, 23 Nov 2011 05:00:00 +0100

Authors: Vantyghem MC, Balavoine AS, Wémeau JL, Douillard C Abstract Antidiuretic hormone (ADH), or arginine vasopressin (AVP), is primarily regulated through plasma osmolarity, as well as non-osmotic stimuli including blood volume and stress. Links between water-electrolyte and carbohydrate metabolism have also been recently demonstrated. AVP acts via the intermediary of three types of receptors: V1a, or V1, which exerts vasoconstrictive effects; pituitary gland V1b, or V3, which participates in the secretion of ACTH; and renal V2, which reduces the excretion of pure water by combining with water channels (aquaporin 2). Antidiuresis syndrome is a form of euvolaemic, hypoosmolar hyponatraemia, which is characterised by a negative free water clearance with inappropriate urine osmol...

Adrenal Failure due to Adrenal Metastasis of Lung Cancer: A Case Report

Infectious Diseases in Obstetrics and Gynecology — Tue, 22 Nov 2011 15:56:52 +0100

We report a case of a patient with adrenal failure due to bilateral adrenal metastasis of lung cancer. This is a rare presentation of lung cancer. We review the differential diagnosis of weight loss and how to make diagnosis of adrenal insufficiency. (Source: Infectious Diseases in Obstetrics and Gynecology)

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β1 integrin is required for anchorage-independent growth and invasion of tumor cells in a context dependent manner

Cancer Letters — Fri, 18 Nov 2011 05:00:00 +0100

Abstract: Recent studies suggest that extracellular matrix (ECM) components within the tumor microenvironment can influence malignant progression, thus we investigated the influence of the ECM binding receptor β1 integrin, on the hallmark properties of tumorigenesis. Small interfering (si) or short hairpin (sh) RNA approaches were used to deplete β1 integrin in cancer cell lines. β1 integrin-depleted cells were then assessed for their growth and invasive capabilities using 2-dimensional (2D) or 3D culture conditions. Depletion of β1 integrin expression did not impact cell growth in 2D assay systems; however, β1 integrin and its ligand fibronectin were required for growth in 3D. β1 integrin-depleted cells also had reduced invasive capabilities, in part due to increased tissue inhibito...

Cardiovascular instability after patent ductus arteriosus ligation in preterm infants: the role of hydrocortisone

Journal of Perinatology — Thu, 17 Nov 2011 05:00:00 +0100

Authors: M D Satpute, P K Donohue, L Vricella & S W Aucott (Source: Journal of Perinatology)

Limited contribution of NR5A1 (SF-1) mutations in women with primary ovarian insufficiency (POI)

Fertility and Sterility — Thu, 17 Nov 2011 05:00:00 +0100

Conclusion(s): The current study demonstrates that mutations in the NR5A1 gene are rare in women with POI. Primary ovarian insufficiency remains unexplained in the great majority of patients; therefore, continued efforts are needed to elucidate its underlying genetic factors. (Source: Fertility and Sterility)

Quality of Life in European Patients with Addison's Disease: Validity of the Disease-Specific Questionnaire AddiQoL.

The Journal of Clinical Endocrinology and Metabolism — Wed, 16 Nov 2011 05:00:00 +0100

Conclusion:The validation process resulted in a revised 30-item AddiQoL questionnaire and an eight-item AddiQoL short version with good psychometric properties and high reliability. PMID: 22090270 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Did Jane Austen die of arsenic poisoning?

The Poison Review — Tue, 15 Nov 2011 04:09:52 +0100

Jane Austen The novelist Jane Austen (1775-1817) died at the early age of 41, after a chronic illness that caused progressive deterioration over a year or more. Although the cause of death has not been definitely established, previous literary historians have speculated about a wide range of diagnoses, including Addison’s Disease, lupus, Hodgkin’s lymphoma, tuberculosis, and Brill-Zinsser disease (re-activated typhus). As The Guardian (U.K.) reports today, mystery writer Lindsay Ashford has recently suggested another possibility: arsenic toxicity. While researching a new book, Ashford noted a sentence in a letter Austen wrote several months before she died: I am considerably better now and am recovering my looks a little, which have been bad enough, black and white and ever...

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Congenital lipoid adrenal hyperplasia (a rare form of adrenal insufficiency and ambiguous genitalia) caused by a novel mutation of the steroidogenic acute regulatory protein gene

European Journal of Pediatrics — Mon, 14 Nov 2011 16:53:27 +0100

Conclusion: There is significant phenotypic variability among patients with lipoid CAH. While splice site mutations in the StAR gene lead to premature translational termination, resulting in truncated and non-functional proteins, there is phenotypic variability among patients with such mutations. Our patient appears to have the more atypical phenotype compared to reported patients with similar mutations. The molecular mechanism underlying this heterogeneity remains unclear. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00431-011-1620-5Authors Oksana Lekarev, Department of Pediatrics, Mount Sinai School of Medicine, Box 1198, One Gustave L. Levy Place, New York, NY 10029, USADelphine Mallet, Molecular Endocrinology and Rare Diseases, Hospices Civils de Ly...

DuoCort Plenadren drug receives European approval

Pharmaceutical Technology — Thu, 10 Nov 2011 19:36:23 +0100

The European Commission has granted a European Marketing Authorisation for DuoCort Pharma's Plenadren, an orphan drug used to treat adrenal insufficiency in adults.Post to:Delicious Digg reddit Facebook StumbleUpon (Source: Pharmaceutical Technology)

Atazanavir/ritonavir/triamcinolone interaction: Cushing syndrome with secondary adrenal insufficiency: case report

Reactions — Thu, 10 Nov 2011 08:03:53 +0100

(Source: Reactions)

Plenadren® (modified release hydrocortisone tablet) approved in the EU for adrenal insufficiency

NeLM - News — Tue, 08 Nov 2011 05:00:00 +0100

Source: PharmaLive Area: News According to a PharmaLive report, the European Commission has granted a European Marketing Authorisation for Plenadren® (hydrocortisone, modified release tablet), an orphan drug for treatment of adrenal insufficiency in adults. This product is a dual release tablet given once daily - an outer layer releases hydrocortisone immediately and an inner core releases the rest of the drug more slowly during the day. It has been designed to better mimic the normal physiological cortisol profile, in order to improve outcomes for patients suffering from adrenal insufficiency. (Source: NeLM - News)

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Is there a real adrenal axis dysfunction in patients with amyloidosis associated with familial Mediterranean fever?

Rheumatology International — Sat, 05 Nov 2011 17:07:51 +0100

Abstract Systemic amyloidosis with AA-type amyloid deposition is the major complication of FMF, leading to end stage renal disease. There is no clear data on the prevalence of adrenal involvement in patients with FMF amyloidosis. The aim of this study is to determine the adrenal axis function in patients FMF with amyloidosis. Twenty patients with FMF with amyloidosis (F/M: 10/10, mean age; 38 ± 11 SD years), twenty without amyloidosis (F/M: 14/6, mean age 32 ± 10 years), and healthy controls (F/M: 12/8, mean age: 30 ± 7.6 SD years) were recruited. A dose of 250 mg tetracosactide (Synacthen) was then administered intravenously and further blood samples collected 30 and 60 min later. Blood samples were separated and collected at...

Glucocorticoid-induced diabetes and adrenal suppression: How to detect and manage them

Cleveland Clinic Journal of Medicine — Wed, 02 Nov 2011 04:00:00 +0100

Glucocorticoids, commonly used to treat multiple inflammatory processes, can cause hyperglycemia, Cushing syndrome, adrenal suppression, and, when they are discontinued, adrenal insufficiency. Physicians must be aware of these adverse effects and be equipped to manage them. (Source: Cleveland Clinic Journal of Medicine)

Sir Samuel Wilks (1824-1911): brilliant observer who 'rediscovered' Hodgkin's disease.

British Journal of Hospital Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Ellis H Abstract Guy's Hospital and its medical school rejoiced in a remarkable group of physicians in the 19th century. These included Richard Bright, a pioneer in the study of chronic nephritis, Thomas Addison, who described two diseases that bear his name (Addison's disease of the suprarenals and Addison's, or pernicious, anaemia), Thomas Hodgkin, who gave the first clear account of lymphadenoma and Sir William Gull, who documented myxoedema, its relationship to the thyroid and its resemblance to cretinism in children. PMID: 22083012 [PubMed - in process] (Source: British Journal of Hospital Medicine)

Focal adhesion kinase inhibitors are potent anti-angiogenic agents

Molecular Oncology — Wed, 26 Oct 2011 04:00:00 +0100

Abstract: Focal adhesion kinase (FAK), a cytoplasmic tyrosine kinase and scaffold protein localized to focal adhesions, is uniquely positioned at the convergence point of integrin and receptor tyrosine kinase signal transduction pathways. FAK is overexpressed in many tumor cells, hence various inhibitors targeting its activity have been tested for anti-tumor activity. However, the direct effects of these pharmacologic agents on the endothelial cells of the vasculature have not been examined. Using primary human umbilical vein endothelial cells (HUVEC), we characterized the effects of two FAK inhibitors, PF-573,228 and FAK Inhibitor 14 on essential processes for angiogenesis, such as migration, proliferation, viability and endothelial cell tube formation. We observed that treatment with eit...

Barriers and facilitators to the use of computer-based intensive insulin therapy

International Journal of Medical Informatics — Mon, 24 Oct 2011 04:00:00 +0100

Conclusion: This analysis revealed sociotechnical interactions affecting IIT CDSS that previous studies have not addressed. These issues may influence protocol performance at other institutions. Findings have implications for IIT CDSS user interface design and alerts, and may contribute to nascent general CDSS theory. (Source: International Journal of Medical Informatics)

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Decoding Complex Chemical Mixtures with a Physical Model of a Sensor Array

PLoS Computational Biology — Thu, 20 Oct 2011 04:00:00 +0100

by Julia Tsitron, Addison D. Ault, James R. Broach, Alexandre V. Morozov Combinatorial sensor arrays, such as the olfactory system, can detect a large number of analytes using a relatively small number of receptors. However, the complex pattern of receptor responses to even a single analyte, coupled with the non-linearity of responses to mixtures of analytes, makes quantitative prediction of compound concentrations in a mixture a challenging task. Here we develop a physical model that explicitly takes receptor-ligand interactions into account, and apply it to infer concentrations of highly related sugar nucleotides from the output of four engineered G-protein-coupled receptors. We also derive design principles that enable accurate mixture discrimination with cross-specific sensor arra...

Predicting Solvent Stability in Aprotic Electrolyte Li–Air Batteries: Nucleophilic Substitution by the Superoxide Anion Radical (O2•–)

Journal of Physical Chemistry A — Tue, 18 Oct 2011 04:51:38 +0100

The Journal of Physical Chemistry ADOI: 10.1021/jp2073914 (Source: Journal of Physical Chemistry A)

[Diagnosis of congenital endocrinological disease in newborns with prolonged jaundice and hypoglycaemia.]

Anales de Pediatria — Tue, 18 Oct 2011 04:00:00 +0100

CONCLUSIONS: Prolonged or cholestatic jaundice associated with neonatal hypoglycaemia is highly likely to be due to pituitary hormone deficiency or primary adrenal insufficiency. Early diagnosis and treatment of these children reverts the prolonged jaundice and prevents morbidity and mortality due to recurrent hypoglycaemia and hormone deficiencies. PMID: 22015010 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Bone Mineral Density Is Not Significantly Reduced in Adult Patients on Low-Dose Glucocorticoid Replacement Therapy.

The Journal of Clinical Endocrinology and Metabolism — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions:Adult PAI and CAH patients on low glucocorticoid doses showed normal BMD within the normal reference range. The use of longer acting prednisolone resulted in significantly lower BMD in PAI. In addition, DHEA treatment may have a beneficial effect on bone in Addison's women. PMID: 21994966 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Adrenal function in Smith–Lemli–Opitz syndrome

American Journal of Medical Genetics Part A — Tue, 11 Oct 2011 04:00:00 +0100

This article is a U.S. Government work and is in the public domain in the USA. (Source: American Journal of Medical Genetics Part A)

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Suppression of the HPA axis during extrahepatic biliary obstruction induces cholangiocyte proliferation in the rat.

American Journal of Physiology. Gastrointestinal and Liver Physiology — Thu, 06 Oct 2011 04:00:00 +0100

CONCLUSION: Suppression of the HPA axis is an early event following BDL and induces cholangiocyte proliferation. Knowledge of the role of the HPA axis during cholestasis may lead to the development of innovative treatment paradigms for chronic liver disease. PMID: 21979757 [PubMed - as supplied by publisher] (Source: American Journal of Physiology. Gastrointestinal and Liver Physiology)

Fluconazole/fluticasone propionate interaction: First report of an interaction, leading to adrenal insufficiency and Cushing syndrome in a child: case report

Reactions — Mon, 03 Oct 2011 06:00:13 +0100

(Source: Reactions)

Tramadol: First report of adrenal insufficiency: case report

Reactions — Mon, 03 Oct 2011 06:00:13 +0100

(Source: Reactions)

Mechanisms and Models of Immune Tolerance Breakdown in the Ovary

Seminars in Reproductive Medicine — Mon, 03 Oct 2011 04:00:00 +0100

Semin Reprod Med 2011; 29: 308-316DOI: 10.1055/s-0031-1280916ABSTRACTOvarian autoimmunity is increasingly implicated in the etiology of primary ovarian insufficiency (POI), previously termed premature ovarian failure or premature menopause. Links to autoimmunity in human POI have long been noted due to the close association of POI with several autoimmune diseases and syndromes such as Addison's disease and Autoimmune polyglandular syndrome 1. However, diagnosis of autoimmune-mediated POI (aPOI) remains challenging because of the lack of sensitive or specific markers of disease. Autoimmunity can arise from the breakdown of immunological tolerance in several ways. How then may we discern what constitutes a relevant target and what represents a downstream phenomenon? The answer lies in the st...

Reply

Clinical Gastroenterology and Hepatology — Mon, 03 Oct 2011 04:00:00 +0100

We report no significant difference in prevalence of AI among variceal bleeders with serum albumin levels below or above 2.5 g/dl. (Source: Clinical Gastroenterology and Hepatology)

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Three different clinical manifestations of oral and systemic paracoccidioidomycosis

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Paracoccidioidomycosis (South America blastomycosis) is a deep mycosis caused by the Paracoccidioides brasiliensis, that has been considered the most frequent systemic mycosis in Latin America. Mulberry-like ulcers on the oral mucous membranes are one of the earliest manifestations of the disease. The infection may remain subclinical, localized or may occasionally disseminate. Hematogenous dissemination of paracoccidioidomycosis to abdominal lymph nodes, spleen, liver, adrenal glands, skin, or brain can result in life-threatening complications. When the disease manifests with signs and systemic symptoms without its classics features, a initial confusion may occur among clinicians, leading to delayed diagnosis and treatment of the disease and its associated comorbidities. The aim of this st...

Multiple Loci in the HLA Complex Are Associated with Addison's Disease.

The Journal of Clinical Endocrinology and Metabolism — Sat, 01 Oct 2011 04:00:00 +0100

Conclusions: The major histocompatibility complex harbors multiple risk loci for AAD, in which DRB1 appears to represent the main risk factor. PMID: 21816777 [PubMed - in process] (Source: The Journal of Clinical Endocrinology and Metabolism)

Incidence of Adrenal Insufficiency and Impact of Corticosteroid Supplementation in Critically Ill Children with Systemic Inflammatory Syndrome and Vasopressor-Dependent Shock: Hebbar KB, Stockwell JA, Leong T, Fortenberry JD. Crit Care Med 2011;39:1145–50.

The Journal of Emergency Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study was a retrospective review of 78 patients with a median age of 84 months, who were treated at the Atlanta Pediatric Intensive Care Unit (PICU) with a protocol for steroid supplementation in patients meeting SIRS criteria. The primary outcome was decrease in vasopressor requirements after initiation of steroid treatment. All PICU patients requiring intravenous fluids and vasopressors for treatment of shock were tested for adrenal insufficiency with a standardized corticotrophin stimulation test. Patients were then classified as having absolute adrenal insufficiency (AAI) if a basal cortisol level < 18 mg/dL was measured vs. relative adrenal insufficiency (RAI) if the corticotrophin stimulation test induced a change in measured cortisol levels. Of the initial 78 patients, 44 (56%)...

[Bright's disease is mentioned in an official Hungarian medical document in the 19th century].

Orvosi Hetilap — Fri, 30 Sep 2011 21:10:33 +0100

Authors: Kiss I Abstract The World Kidney Day was announced for the fifth time in 2011, that calls attention to chronic renal failure as it attains the title of endemic. Richard Bright (1789-1858), a British doctor was the first to recognize and describe the uremic state and the kidney diseases leading to it. There are many aspects that the readers should remember him about especially in connection with the World Kidney Day. During his European study tour's stage in Hungary, he was not so much interested in the country's medical and health conditions, rather in its economic and cultural life, natural history and geography. He travelled to Hungary on two occasions and recorded his experiences in a personal travel documentation illustrated with his own drawings. He finally establishe...

The Use of Oral Budesonide in Adolescents and Adults With Protein-Losing Enteropathy After the Fontan Operation [ORIGINAL ARTICLES: PEDIATRIC CARDIAC]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

Conclusions CR-budesonide can be used to treat PLE in certain patients, but careful assessment of hepatic function should be performed before initiation of therapy as systemic side effects can limit treatment. Normal serum liver function tests do not preclude hepatic dysfunction in the Fontan patient, and it is important to perform radiographic assessments as well. (Source: The Annals of Thoracic Surgery)

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Low‐dose hydrocortisone treatment for patients with septic shock: A pilot study comparing 3 days with 7 days

Respirology — Mon, 26 Sep 2011 14:32:00 +0100

Conclusions: This pilot study showed that in patients with septic shock and relative adrenal insufficiency, 28‐day mortality did not differ between those treated with low‐dose hydrocortisone for 3 or 7 days. (Source: Respirology)

The use of steroids in the treatment of severe sepsis and septic shock

Best Practice and Research. Clinical Endocrinology and Metabolism — Thu, 22 Sep 2011 09:06:57 +0100

Sepsis and septic shock remain major causes of mortality and morbidity worldwide. Previously, high dose corticosteroids were used to dampen the inflammatory response but studies and meta-analyses showed this to be of no benefit and possibly detrimental. Subsequently, low dose corticosteroids were used in the treatment of sepsis and septic shock with the hypothesis that these conditions are associated with relative adrenal insufficiency. Although some studies showed promising results larger studies and meta-analyses have failed to reproduce these effects and the use of corticosteroids in the treatment of sepsis and septic shock remains controversial.We review the current literature and guidelines regarding low dose corticosteroid use in the management of sepsis and septic shock. (Source: Be...

Prednisolone: Adrenal insufficiency in paediatric patients: 4 case reports

Reactions — Thu, 22 Sep 2011 07:55:36 +0100

(Source: Reactions)

Severe intestinal pseudo-obstruction following withdrawal from over-the-counter steroid abuse

Journal of Postgraduate Medicine — Thu, 22 Sep 2011 04:00:00 +0100

We report a case of a 59-year-old man who presented with diverticular bleeding and developed prolonged ileus postoperatively. After observing arthritic joints on examination, further questioning revealed long-term, high-dose steroid use for analgesic effect. Failure to produce an effective cortisol response was due to adrenal suppression from continuous steroid use. Immediate improvement of his ileus was seen after steroid replacement. Unreported self-medication is a frequent problem encountered in developing countries. RAI can be easily missed and requires a high index of suspicion in any patient who fails to respond to conventional treatment or with long-term steroid use. (Source: Journal of Postgraduate Medicine)

Synthesis, structure and magnetic properties of Nd3+ and Pr3+ 2D polymers with tetrafluoro-p-phthalate

RSC - Dalton Trans. latest articles — Mon, 19 Sep 2011 20:37:28 +0100

Dalton Trans., 2011, Advance ArticleDOI: 10.1039/C1DT11237F, PaperElena A. Mikhalyova, Sergey V. Kolotilov, Matthias Zeller, Laurence K. Thompson, Anthony W. Addison, Vitaly V. Pavlishchuk, Allen D. HunterTwo lanthanide tetrafluoro-p-phthalate (L2-) complexes, Ln(L)1.5[middle dot]DMF[middle dot]H2O (Ln = Pr3+ (1), Nd3+ (2)) were prepared. A general classification of structural types for lanthanide p-phthalates is proposed, and a comparison of extant models for magnetic data analysis of lanthanide compounds is made.To cite this article before page numbers are assigned, use the DOI form of citation above.The content of this RSS Feed (c) The Royal Society of Chemistry (Source: RSC - Dalton Trans. latest articles)

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The Alfred Potter memorial medical research award

Society for Endocrinology — Mon, 19 Sep 2011 12:00:00 +0100

The Addison's Disease Self Help Group (ADSHG) Alfred Potter memorial medical research award offers an annual award of up to £5,000 to support medical research projects that will advance good clinical practice in the management of Addison’s disease. The trustees of the ADSHG established the Alfred Potter memorial research grant in 2010, when Alfred Potter bequeathed a legacy of £5,000 to the group. The award is intended to assist medical researchers with the costs of equipment, laboratory charges or other running costs. The ADSHG is open to applications from researchers who are facing unanticipated cost overuns on research projects that are already underway, as well as from researchers who are in the planning stages of their project. The ADSHG is open to applications fro...

Iatrogenic Cushing syndrome after a single intramuscular corticosteroid injection and concomitant protease inhibitor therapy

Journal of the American Academy of Dermatology — Sun, 18 Sep 2011 01:35:52 +0100

We describe a 41-year-old HIV-positive woman on a regimen of lamivudine, tenofovir, atazanavir, and ritonavir who developed a diffuse, pruritic, nonspecific dermatitis that was unresponsive to medium-potency topical corticosteroids who was treated with a single intramuscular (IM) injection of 60 mg triamcinolone acetonide (TAC). After missing her follow-up appointment, the patient presented at 3 months with resolution of her eruption, weight gain of 7 kg, round facies, and increased density of coarse hairs on the face. She had lower than baseline blood pressure of 92/50 mm Hg, adrenocorticotropic hormone level less than 5 pg/mL (normal 7-50 pg/mL), and endogenous cortisol level 2.2 μg/dL (normal 5-23 μg/mL), with normal testosterone, dehydroepiandrosterone, and thyroid-stimulating hormon...

Oral symptoms of systemic diseases - what to suspect?

Clinical Cases and Images — Mon, 12 Sep 2011 13:37:00 +0100

Examination of the oral cavity (mouth) may reveal findings pointing to an underlying systemic condition, and allow for early diagnosis and treatment. Oral examination should include evaluation for: - mucosal changes- periodontal inflammation and bleeding- condition of the teeth Examples of lesions: - Oral findings of anemia may include mucosal pallor, atrophic glossitis, and candidiasis. - Oral ulceration may be found in patients with lupus erythematosus (SLE), pemphigus vulgaris, or Crohn disease. Oral manifestations of lupus erythematosus may include honeycomb plaques (silvery white, scarred plaques); raised keratotic plaques (verrucous lupus erythematosus); erythema, purpura, petechiae, and cheilitis. Oral findings in patients with Crohn disease may include diffuse mucosal swelling, ...

Haemodynamic consequences of etomidate administration in elective cardiac surgery: a randomized double-blinded study

British Journal of Anaesthesia — Thu, 08 Sep 2011 04:00:00 +0100

Conclusions A single bolus of etomidate blunts the hypothalamic–pituitary–adrenal axis response for more than 24 h in patients undergoing elective cardiac surgery, but this was not associated with an increase in vasopressor requirements. (Source: British Journal of Anaesthesia)

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Challenges in Management of Primary Hypoparathyroidism Associated with Autoimmune Polyglandular Syndrome Type 1

Infectious Diseases in Obstetrics and Gynecology — Wed, 07 Sep 2011 23:58:45 +0100

We report a case of autoimmune polyglandular syndrome type 1 (APS1) complicated by severe vascular insufficiency due to diffuse vascular calcification. APS1 is characterised clinically by multiple autoimmune conditions and development of at least two components of the triad of mucocutaneous candidiasis, hypoparathyroidism, and autoimmune adrenal insufficiency. We highlight the problems in current serum calcium monitoring methods and suggest that fluctuations in serum calcium concentrations due to difficulties treating hypoparathyroidism may have contributed to the vascular calcification seen in this case. (Source: Infectious Diseases in Obstetrics and Gynecology)

Grapefruit juice and liquorice increase cortisol availability in patients with Addison's disease.

European Journal of Endocrinology — Tue, 06 Sep 2011 04:00:00 +0100

Conclusion: Liquorice and in particular GFJ increased cortisol available to tissues in the hours following oral CA administration. Both patients and physicians should be aware of these interactions, and we recommend that circulating levels of cortisol should be monitored in habitual users. PMID: 21896619 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Diagnosis of adrenal failure in critically ill patients

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 03 Sep 2011 15:39:34 +0100

In the last two decades there was important evolution on the knowledge of the function of the hypothalamic-pituitary-adrenal axis. In the last decade, the expression "relative adrenal insufficiency" (RAI) was created, and more recently "critical illness-related corticosteroid insufficiency" (CIRCI) was used to designate those patients in which cortisol production was not sufficiently increased in stress situations. Patients with CIRCI have elevated hospital morbidity and mortality. Currently, there is a wide discussion about diagnostic criteria for this dysfunction. Besides basal cortisol, some publications now study the role of other tests, such as cortrosyn test - either in low (1 μg) or high doses (250 μg); free cortisol, salivary cortisol, metyrapone test and others. With this review...

Review of Molecular Driving Forces: Statistical Thermodynamics in Biology, Chemistry, Physics, and Nanoscience, 2nd edition

Journal of Chemical Education — Fri, 02 Sep 2011 13:59:57 +0100

Journal of Chemical EducationDOI: 10.1021/ed2005328 (Source: Journal of Chemical Education)

A case of adrenal insufficiency secondary to syphilis and difficulties in the diagnostic work‐up

Australasian Journal of Dermatology — Thu, 01 Sep 2011 23:00:00 +0100

We report a case of Addison's disease presumed to be secondary to syphilis. The patient presented with adrenal failure and a maculopapular rash on his trunk and palms. Syphilis was suspected but the non‐treponemal serological test used (the rapid plasma reagin test (RPR)) was falsely negative due to the prozone phenomenon. Treatment with benzathine penicillin resulted in normalization of adrenal function and resolution of the cutaneous findings. Repeat testing of the previously obtained serum sample showed the RPR to be positive on increasing dilutions of serum, consistent with the prozone effect. (Source: Australasian Journal of Dermatology)

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F605 a 12-month analysis of factors limiting adequate epidural analgesia, following major surgery

European Journal of Pain Supplements — Thu, 01 Sep 2011 04:00:00 +0100

(Source: European Journal of Pain Supplements)

Variceal Bleeding in Cirrhotic Patients Is Associated With Adrenal Dysfunction: What Is the Evidence?

Clinical Gastroenterology and Hepatology — Thu, 01 Sep 2011 04:00:00 +0100

We read the article by Triantos and colleagues with great interest. The authors prospectively assessed adrenal function in 20 patients with variceal bleeding and 60 nonbleeding cirrhotic patients with a low-dose short synacthen test (LD-SST; 1 μg) and/or a standard-dose (250 μg) short synacthen test. Their crude conclusion was that adrenal insufficiency in bleeding patients using well-defined serum total cortisol thresholds was common, mainly using the low-dose short synacthen test (60% vs 48% in nonbleeding patients). The authors also found no significant difference in albumin concentrations between bleeding patients with and without adrenal insufficiency. These interesting results deserve comment because nearly 80% of circulating cortisol in serum is bound to corticosteroid-binding glo...

A Novel Entity of Clinically Isolated Adrenal Insufficiency Caused by a Partially Inactivating Mutation of the Gene Encoding for P450 Side Chain Cleavage Enzyme (CYP11A1).

The Journal of Clinical Endocrinology and Metabolism — Tue, 30 Aug 2011 23:00:00 +0100

Conclusions:We provide the first evidence that partial CYP11A1 deficiency has to be considered as a differential diagnosis in clinically isolated adrenal insufficiency. Our assays demonstrate a tighter genotype-phenotype correlation in CYP11A1 deficiency than previous in vitro studies. PMID: 21880796 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Woodridge Task Force to Tackle Childhood Obesity

RWJF News Digest - Childhood Obesity — Tue, 30 Aug 2011 04:49:40 +0100

[Health department] staff studied the communities’ strengths and barriers to promoting health and well-being. The municipalities were then challenged to target three areas to make change. Downers Grove decided on improvements to public transportation and sidewalks and bike paths, increasing opportunities for non-competitive athletes such as intramurals and providing a farmers stand during the week. The Indian Boundary YMCA currently organizes a farmers market every Saturday in downtown Downers Grove. Now FORWARD wants to focus on lower socioeconomic communities and has begun work this summer in Woodridge, Aurora, Addison, Villa Park and West Chicago. (Source: RWJF News Digest - Childhood Obesity)

What Causes Increased Body Hair?

PediatricEducation.org — Mon, 29 Aug 2011 00:21:30 +0100

Discussion Body hair, including its amount and distribution, have cultural norms and social implications that vary according to the group and individual. There are entire industries which cater to removing hair in certain body parts (i.e. underarms and legs for western women) and adding hair in other locations (i.e. head for western men). Excessive body hair (relatively) is usually often due to normal physiologic process (such as puberty) or genetic. Two definitions which are often confused are: Hypertrichosis – excessive, non-androgen induced hair growth in a localized or generalized pattern distribution in males or females. Hirsuitism – excessive, androgen-induced hair growth in a male pattern distribution in children and women. Learning Point The differential diagnosis of ...

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Adrenal hemorrhage in newborns: a retrospective study.

World Journal of Pediatrics : WJP — Fri, 26 Aug 2011 23:00:00 +0100

CONCLUSIONS: AH occurs in the newborns with unexplained jaundice. Adrenal insufficiency is more frequent in preterm than in mature infants. Abdominal USG is required to determine AH in a newborn with swelling and bluish discoloration of the scrotum. Serial USG is the best modality for monitoring AH to prevent unnecessary surgery. PMID: 21874621 [PubMed - as supplied by publisher] (Source: World Journal of Pediatrics : WJP)

Cutaneous signs of systemic disease

Clinics in Dermatology — Sat, 20 Aug 2011 15:44:23 +0100

Abstract: Commonly used dermatologic eponyms and characteristic skin signs are enormously helpful in guiding a diagnosis, even though they may not be pathonemonic. They include, on the nails, Aldrich-Mees' lines (syn.: Mees' lines), Beau's lines, Muehrcke's lines, Terry's nails, and half and half nails, often associated, respectively, with arsenic poisoning, acute stress or systemic illness, severe hypertension, liver disease and uremia, and, around the nails, Braverman's sign, associated with collagen-vascular disease. Elsewhere, one may see the Asboe-Hansen and Nikolsky's signs, indicative of the pemphigus group of diseases, Auspitz's sign, a classic finding in psoriasis, Borsieri's and Pasita's signs, seen in early scarlet fever, the butterfly rash, indicative of systemic lupus erythema...

A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

Supportive Care in Cancer — Thu, 18 Aug 2011 06:03:23 +0100

Conclusions We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00520-011-1248-zAuthors Hye-Suk Han, Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Seongbong-ro, Heungduk-gu, Cheongju 361-711, South KoreaYoung Kwang Shim, Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Seongbong-ro, Heungduk-gu, Cheongju 361-711, South KoreaJeong Eun Kim, Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Seongbong-ro, Heungduk-gu, Cheongju 361-711, South KoreaHyun-Jung Jeon, Department of Internal Medicine, Ch...

Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness

Intensive Care Medicine — Thu, 18 Aug 2011 06:01:09 +0100

Conclusions Although the biologically active free cortisol fraction depends on binding proteins, total cortisol correlates to free cortisol in treatment-insensitive hypotension during critical illness. In sepsis, albumin is not an important binding molecule. Subnormal increments in total cortisol upon ACTH suffice in assessing relative adrenal insufficiency, particularly in sepsis. Content Type Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2342-xAuthors Nienke Molenaar, Department of Intensive Care, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsA. B. Johan Groeneveld, Department of Intensive Care, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsHilde M. Dijstelbloem, ...

Genome-wide copy number variation (CNV) in patients with autoimmune Addison's disease

BMC Medical Genetics - Latest articles — Wed, 17 Aug 2011 23:00:00 +0100

Conclusions: We have identified two novel CNV associations to ADAM3A and UGT2B28 in AD. The mechanism by which this susceptibility is conferred is at present unclear, but may involve steroid inactivation (UGT2B28) and T cell maturation (ADAM3A). Characterization of these proteins may unravel novel information on the pathogenesis of autoimmunity. (Source: BMC Medical Genetics - Latest articles)

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Biodiversity of active and inactive bacteria in the gut of wood-feeding huhu beetle larvae (Prionoplus reticularis).

Applied and Environmental Microbiology — Thu, 11 Aug 2011 23:00:00 +0100

This study provides new information on the diversity and activity of gut-associated microorganisms that are essential for the digestion of the nutritionally poor diet consumed by wood-feeding larvae. Many huhu gut phylotypes affiliated with insect symbionts, or bacteria present in acidic environments or associated with fungi. PMID: 21841025 [PubMed - as supplied by publisher] (Source: Applied and Environmental Microbiology)

The pituitary stalk transection syndrome: multifaceted presentation in adulthood

Pituitary — Mon, 08 Aug 2011 19:53:14 +0100

We present 4 cases of stalk transection syndrome diagnosed by the adult endocrinologist that reflect its pleiotropic manifestations. In all cases, MRI showed pathognomonic findings with small anterior pituitary, diminutive or absent infundibulum and ectopic posterior pituitary at the median eminence. Clinical presentation occurred in childhood or the second decade of life. The hormonal deficits were variable in severity and onset, with adrenal insufficiency diagnosed in the second and forth decade in three patients, and absent in another. Growth hormone deficiency was diagnosed before age 10 in three cases and at age 20 in one case with normal spontaneous linear growth. Hypothyroidism had onset in the first or second decade of life and hypogonadism was diagnosed during work-up for l...

Breast Enlargement With Prednisone Treatment.

The American Journal of the Medical Sciences — Tue, 02 Aug 2011 23:00:00 +0100

Authors: Pishdad GR, Pishdad P, Pishdad R A 17-year-old boy sought endocrine advice for an unusual gynecomastia that inexplicably recurred whenever he was treated with prednisone. This began at the age of 14, when the patient was diagnosed as having Addison's disease and was first treated with prednisone. An ensuing breast enlargement caused him to stop the medication and a regression of the gynecomastia was observed. Breast enlargement reappeared each time prednisone treatment resumed. Review of this problem led to the final diagnosis of congenital adrenal hyperplasia in a teenager who was genetically female but phenotypically male. PMID: 21817886 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

Air Methods closes on buy of Omniflight Helicopters parent

bizjournals.com Health Care:Biotechnology headlines — Mon, 01 Aug 2011 20:50:42 +0100

Air Methods Corp. said Monday it has closed on its acquisition of OF Air Holdings Corp. and its subsidiaries, including Omniflight Helicopters Inc., in a $200 million deal. Air Methods (Nasdaq: AIRM), is the largest air medical transportation company in the world. Omniflight, based in Addison, Texas, has a fleet of about 100 helicopters and fixed-wing aircraft with operations in 18 states with 75 base operations. Omniflight is to become a wholly owned subsidiary of Air Methods. Omniflight generated unaudited consolidated revenue of $172 million for the fiscal year ended March 31... (Source: bizjournals.com Health Care:Biotechnology headlines)

Air Methods Corporation Closes Acquisition of Omniflight Helicopters, Inc.

Medical News (via PRIMEZONE) — Mon, 01 Aug 2011 20:01:00 +0100

DENVER, Aug. 1, 2011 (GLOBE NEWSWIRE) -- Air Methods Corporation (Nasdaq:AIRM), the largest air medical transportation company in the world, announced today that it has successfully completed its acquisition of OF Air Holdings Corporation and its subsidiaries, including Omniflight Helicopters, Inc. (together, Omniflight). Omniflight provides air medical transport services throughout the United States and provides these services under both the community-based and hospital-based service delivery models, utilizing a fleet of approximately 100 helicopters and fixed-wing aircraft. Omniflight is headquartered in Addison, Texas, with operations in 18 states involving over 75 base locations. (Source: Medical News (via PRIMEZONE))

Activation of the masseter muscle during normal smile production and the implications for dynamic reanimation surgery for facial paralysis

Journal of Plastic, Reconstructive and Aesthetic Surgery — Fri, 29 Jul 2011 04:00:00 +0100

Conclusions: Natural contraction of the Masseter muscle during normal smile production helps to explain the high rate of spontaneous smile development in subjects with facial paralysis who have undergone a free muscle reanimation procedure powered by the nerve to the Masseter muscle. (Source: Journal of Plastic, Reconstructive and Aesthetic Surgery)

Nonsegmental Vitiligo and Autoimmune Mechanism

Advances in Pharmacological Sciences — Tue, 26 Jul 2011 17:23:32 +0100

Nonsegmental vitiligo is a depigmented skin disorder showing acquired, progressive, and depigmented lesions of the skin, mucosa, and hair. It is believed to be caused mainly by the autoimmune loss of melanocytes from the involved areas. It is frequently associated with other autoimmune diseases, particularly autoimmune thyroid diseases including Hashimoto's thyroiditis and Graves' disease, rheumatoid arthritis, type 1 diabetes, psoriasis, pernicious anemia, systemic lupus erythematosus, Addison's disease, and alopecia areata. This indicates the presence of genetically determined susceptibility to not only vitiligo but also to other autoimmune disorders. Here, we summarize current understanding of autoimmune pathogenesis in non-segmental vitiligo. (Source: Advances in Pharmacolo...

Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 18-21 July 2011 (European Medicines Agency press release, 22 July 2011)

Society for Endocrinology — Mon, 25 Jul 2011 12:00:00 +0100

Highlights of the latest meeting of the European Medicines Agency Committee for Medicinal Products for Human Use are now available online, including a conclusion of their review into the benefit-risk profile of pioglitazone, approval of marketing authorisation for a new drug for adrenal insufficiency, and a note on the current supply shortage of Thyrogen. Full press release (Source: Society for Endocrinology)

The Use of Oral Budesonide in Adolescents and Adults With Protein-Losing Enteropathy After the Fontan Operation.

The Annals of Thoracic Surgery — Thu, 21 Jul 2011 23:00:00 +0100

CONCLUSIONS: CR-budesonide can be used to treat PLE in certain patients, but careful assessment of hepatic function should be performed before initiation of therapy as systemic side effects can limit treatment. Normal serum liver function tests do not preclude hepatic dysfunction in the Fontan patient, and it is important to perform radiographic assessments as well. PMID: 21784410 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)

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Clinical approach to adrenal insufficiency in hospitalised patients

International Journal of Clinical Practice — Thu, 21 Jul 2011 21:50:41 +0100

This article extensively reviews various aetiologies and management of adrenal insufficiency. (Source: International Journal of Clinical Practice)

Pseudotumor cerebri during Cushing's disease treatment with ketoconazole

Arquivos Brasileiros de Endocrinologia e Metabologia — Sat, 16 Jul 2011 16:49:17 +0100

We describe here the case of a 12-year old girl with CD who developed benign intracranial hypertension during treatment with ketoconazole. She presented headache, vomiting, a black spot on her right temporal visual field, and signs of elevated intracranial pressure. Pituitary image was normal on magnetic resonance image (MRI), and all symptoms improved after treatment with acetazolamide. We call attention to the diagnosis of this disorder in CD patients, especially children on ketoconazole treatment, because it could be confounded with adrenal insufficiency and lead to definitive severe visual impairment.Hipertensão intracraniana benigna (Pseudotumor cerebral) tem sido descrita relacionada à redução dos níveis de esteroides séricos na doença de Cushing (DC), especialmente após a re...

Endothelial dysfunction: a critical determinant in inflammation‐associated adrenal insufficiency?

European Journal of Clinical Investigation — Thu, 14 Jul 2011 06:45:49 +0100

(Source: European Journal of Clinical Investigation)

Methylprednisolone/opioid analgesics: Central adrenal insufficiency: case report

Reactions — Wed, 13 Jul 2011 16:51:36 +0100

(Source: Reactions)

Valproic acid: Adrenal insufficiency: case report

Reactions — Wed, 13 Jul 2011 16:51:36 +0100

(Source: Reactions)

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Lopinavir-Ritonavir May Alter Adrenal Function in NeonatesLopinavir-Ritonavir May Alter Adrenal Function in Neonates

Medscape Hiv-Aids Headlines — Thu, 07 Jul 2011 01:47:54 +0100

Treatment of newborns with the protease inhibitor lopinavir-ritonavir may lead to adrenal dysfunction, including life-threatening adrenal insufficiency in premature infants, researchers report. Reuters Health Information (Source: Medscape Hiv-Aids Headlines)

Association of Prenatal and Postnatal Exposure to Lopinavir-Ritonavir and Adrenal Dysfunction Among Uninfected Infants of HIV-Infected Mothers [Preliminary Communication]

JAMA — Mon, 04 Jul 2011 23:00:00 +0100

Conclusion Among newborn children of HIV-1–infected mothers exposed in utero to lopinavir-ritonavir, postnatal treatment with a lopinavir-ritonavir–based regimen, compared with a zidovudine-based regimen, was associated with transient adrenal dysfunction. (Source: JAMA)

Lopinavir-ritonavir may alter adrenal function in neonates

Modern Medicine — Mon, 04 Jul 2011 23:00:00 +0100

NEW YORK (Reuters Health) - Treatment of newborns with the protease inhibitor lopinavir-ritonavir may lead to adrenal dysfunction, including life-threatening adrenal insufficiency in premature infants, researchers report. (Source: Modern Medicine)

Triamcinolone: Adrenal insufficiency following epidural administration: case report

Reactions — Sun, 03 Jul 2011 18:34:01 +0100

(Source: Reactions)

Puppy power.

Nursing Standard — Fri, 01 Jul 2011 23:00:00 +0100

Authors: Knight J Abstract Dogs have been used for many years to help people who are blind or have hearing loss. Now they are being trained to help people with medical conditions such as cancer, diabetes, seizures, Addison's disease and narcolepsy. PMID: 21888098 [PubMed - in process] (Source: Nursing Standard)

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Low dose hydrocortisone treatment for patients with septic shock: a pilot study comparing three days with seven days

Respirology — Thu, 30 Jun 2011 23:00:00 +0100

Outcomes of Etomidate in Severe Sepsis and Septic Shock: Dmello D, Taylor S, O'Brien J, et al. Chest 2010;138:1327–32.

The Journal of Emergency Medicine — Thu, 30 Jun 2011 23:00:00 +0100

The discussion over transient adrenal suppression caused by single-dose etomidate has been heated in recent years. The aim of this study was to evaluate the effect of single-dose etomidate in patients with severe sepsis and septic shock. This was a retrospective cohort study conducted in a 56-bed medical/surgical intensive care unit (ICU) at St. John's Mercy Medical Center in St. Louis, Missouri. The study evaluated 224 consecutive patients who had severe sepsis or septic shock and required intubation and mechanical ventilation comparing those patients who had received etomidate to those who had not. Outcome measures were not explicitly defined, but data recorded included Acute Physiology and Chronic Health Evaluation (APACHE) II and Mortality Probability Model at zero hour (MPM-II0) scor...

Hydrocortisone Therapy for Patients with Multiple Trauma: The Randomized Controlled HYPOLYTE Study: Roquilly A, Mahe PJ, Seguin P, et al. JAMA 2011;305:1201–9.

The Journal of Emergency Medicine — Thu, 30 Jun 2011 23:00:00 +0100

Stress-related adrenal insufficiency associated with polytrauma has been postulated as a factor in the development of hospital-acquired infections. This multicenter, randomized, double-blind, parallel, placebo-controlled study conducted in seven separate intensive care units (ICUs) in France from November 15, 2006 to August 4, 2009 was designed to test the idea that steroid treatment could reduce the prevalence of hospital-acquired pneumonia in trauma patients. All multiple-trauma patients, defined as having two or more traumatic injuries and injury severity score>15, aged>15 years who were expected to require mechanical ventilation for more than 48h, were included. All patients were tested for corticosteroid insufficiency with a corticotropin test. Upon completion of this test, patients w...

Angiotensin Receptor Blockers: Pharmacology, Efficacy, and Safety

The Journal of Clinical Hypertension — Thu, 30 Jun 2011 23:00:00 +0100

J Clin Hypertens (Greenwich).Key Points and Practical Recommendations• The angiotensin receptor blockers are highly effective antihypertensive agents that are also particularly well tolerated.• There are no major differences in efficacy or other clinical characteristics among older drugs in this class, although some of the newer agents may more effectively reduce blood pressure than older agents.• Major randomized clinical trials have demonstrated that angiotensin receptor blockers provide significant outcomes benefits in conditions such as diabetic nephropathy, chronic heart failure or heart failure following myocardial infarction, hypertension with left ventricular hypertrophy and in patients whose histories of previous events or complicated diabetes puts them at high cardiov...

Official Positions for FRAX® Clinical Regarding Glucocorticoids: The impact of the Use of Glucocorticoids on the Estimate by FRAX® of the 10 Year Risk of Fracture: From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®

Journal of Clinical Densitometry — Thu, 30 Jun 2011 23:00:00 +0100

Abstract: Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization’s Fracture Risk Assessment Tool (FRAX®). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Soc...

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Structural trends in a series of isostructural lanthanide–copper metallacrown sulfates (LnIII = Pr, Nd, Sm, Eu, Gd, Dy and Ho): hexaaquapentakis[μ3-glycinehydroxamato(2−)]sulfatopentacopper(II)lanthanide(III) heptaaquapentakis[μ3-glycinehydroxamato(2−)]sulfatopentacopper(II)lanthanide(III) sulfate hexahydrate

Acta Crystallographica Section C — Tue, 28 Jun 2011 23:00:00 +0100

The seven isostructural complexes, [Cu5Ln(C2H4N2O2)5(SO4)(H2O)6.5]2(SO4)·6H2O, where LnIII = Pr, Nd, Sm, Eu, Gd, Dy and Ho, are representatives of the 15-metallacrown-5 family. Each dianion of glycinehydroxamic acid (GlyHA) links two CuII cations forming a cyclic [CuGlyHA]5 frame. The LnIII cations are located at the centre of the [CuGlyHA]5 rings and are bound by the five hydroxamate O atoms in the equatorial plane. Five water molecules are coordinated to CuII cations, and one further water molecule, located close to an inversion centre between two adjacent [Cu5Ln(GlyHA)5]2+ cations, is disordered around this inversion centre and coordinated to a CuII cation of either the first or second metallacrown ether. Another water molecule and one of the two crystallographically independent sulfat...

Endoscopic Transsphenoidal Surgery for Acromegaly: Remission Using Modern Criteria, Complications, and Predictors of Outcome.

The Journal of Clinical Endocrinology and Metabolism — Tue, 28 Jun 2011 23:00:00 +0100

Conclusions: ETSS for GH adenomas is associated with high rates of remission and a low incidence of new endocrinopathy. Despite the panoramic views offered by the endoscope, invasive tumors continue to have lower rates of remission. PMID: 21715544 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Rapid Onset of Iatrogenic Adrenal Insufficiency in a Patient with Cystic Fibrosis-Related Liver Disease Treated with Inhaled Corticosteroids and a Moderate CYP3A4 Inhibitor (July/August).

The Annals of Pharmacotherapy — Mon, 27 Jun 2011 23:00:00 +0100

CONCLUSIONS CYP3A4-mediated drug interactions represent a significant risk in patients treated with long-term inhaled corticosteroids. The presence of clinically significant CF-related liver disease may enhance this risk. PMID: 21712512 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

Adrenocorticotropic hormone and cortisol response to corticotropin releasing hormone in the critically ill—a novel assessment of the hypothalamic-pituitary-adrenal axis

American Journal of Surgery — Fri, 17 Jun 2011 04:00:00 +0100

Conclusions: ACTH responsiveness was increased in nonsurvivors and may predict mortality. (Source: American Journal of Surgery)

Premature Ovarian Failure in Patients with Autoimmune Addison's Disease: Clinical, Genetic, and Immunological Evaluation.

The Journal of Clinical Endocrinology and Metabolism — Tue, 14 Jun 2011 23:00:00 +0100

Conclusions: This study indicates that AD is frequently associated with POF and that steroidogenic antibodies are markers of patients with POF. Steroidogenic autoantibodies are predictive markers of POF in patients with AD. PMID: 21677034 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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Should we screen children with type 1 diabetes for Addison's disease?

Archives of Disease in Childhood — Sat, 11 Jun 2011 23:00:00 +0100

Children with type 1 diabetes mellitus (T1DM) are at a higher risk of developing other autoimmune diseases. The National Institute of Clinical Excellence guidance in 2009 included recommendations about screening for thyroid disease (TD) and coeliac disease (CD) in children with T1DM, but there was no guidance regarding screening for autoimmune Addison's disease (AD).1 Symptoms of AD in children with T1DM include recurrent hypoglycaemia with falling insulin requirements and/or salt craving. Eight per cent of patients with AD require annual hospital treatment for adrenal crisis.2 This risk is increased when diabetes is concomitantly present with AD.3 This suggests the importance of screening for AD in patients with T1DM. However, there are contradicting views in the literature about this scr...

Neurological features in adult Triple-A (Allgrove) syndrome

Journal of Neurology — Thu, 09 Jun 2011 05:48:31 +0100

Abstract Triple-A or Allgrove syndrome is a rare multisystem disease classically associated with esophageal achalasia, adrenal insufficiency and alacrima. Here, we describe the poorly understood neurological characteristics often associated with this condition, through the clinical and electrophysiological analysis of eight patients. All patients were genetically confirmed and had a mutation in the ALADIN gene. They all displayed a classical picture of Triple-A syndrome: all suffered from achalasia and alacrima and half of them from adrenal insufficiency. However, all harbored a neurological picture characterized by a recognizable pattern of peripheral neuropathy. Other neurological features included cognitive deficits, pyramidal syndrome, cerebellar dysfunction, dysautono...

A Dog with Pseudo-Addison Disease Associated with Trichuris vulpis Infection

Infectious Diseases in Obstetrics and Gynecology — Wed, 08 Jun 2011 16:01:00 +0100

A female Rottweiler dog was presented with a history of intermittent vomiting and diarrhoea, dysorexia, weakness, and weight loss. Haemocytometry and biochemistry values were within normal ranges except for electrolyte analyses, that demonstrated hyponatremia and hyperkalemia with a decreased sodium/potassium ratio. A diagnosis of hypoadrenocorticism was suspected. Basal and post-ACTH stimulation cortisolemia were within the normal values. Electrocardiography was normal, and thoracic radiography showed no significant modifications. On abdominal ultrasonography, adrenal glands appeared normal, while the bowel was distended, and several thin linear hyperechoic objects floating in the lumen were observed. Two adult female whipworms (Trichuris vulpis) were collected following bowel irrigation....

Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis

Clinical and Developmental Immunology — Tue, 07 Jun 2011 13:59:59 +0100

This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease wit...

Low prevalence of hypopituitarism after traumatic brain injury - a multi-center study.

European Journal of Endocrinology — Sun, 05 Jun 2011 23:00:00 +0100

Conclusion: In this study, the prevalence of hypopituitarism during long-term follow-up after TBI was low. Prospective studies are urgently needed to find reliable predictive tools for the identification of patients with a significant pre-test likelihood for hypopituitarism after TBI. PMID: 21646286 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

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Partial Deletion of the NR5A1 (SF1) Gene Detected by Synthetic Probe MLPA in a Patient with XY Gonadal Disorder of Sex Development.

Thu, 02 Jun 2011 23:00:00 +0100

Authors: Barbaro M, Cools M, Looijenga LH, Drop SL, Wedell A Steroidogenic factor 1 (SF1, officially NR5A1) is a nuclear receptor involved in adrenal and gonadal development. NR5A1 mutations have been identified in patients with various forms of 46,XY disorders of sex development (DSD), including complete gonadal dysgenesis with or without adrenal insufficiency, mild testicular dysgenesis with ambiguous external genitalia or female external genitalia with clitoromegaly, and penoscrotal hypospadias. We developed a synthetic probe set for MLPA analysis of the NR5A1 gene covering its 7 exons and analyzed 20 patients with 46,XY gonadal DSD in whom analyses failed to identify a genetic cause. We identified a partial NR5A1 deletion affecting exons 2 and 3, leading to NR5A1 haploinsufficiency...

Functional effects of DAX-1 mutations identified in patients with X-linked adrenal hypoplasia congenita

Metabolism - Clinical and Experimental — Wed, 01 Jun 2011 04:00:00 +0100

In this study, we investigated the functional defects of DAX-1 caused by mutations identified in 3 unrelated Korean patients with adrenal hypoplasia congenita. The DAX-1 gene was directly sequenced using genomic DNA isolated from peripheral blood leukocytes. The functional defects of DAX-1 caused by mutations were evaluated using an in vitro promoter assay. After mutagenesis of DAX-1 complementary DNA in the pcDNA3.1 vector, steroidogenic factor 1 and the promoter region of steroidogenic acute regulatory protein (StAR) genes in pGL4.10[luc2] were transiently cotransfected into human embryonic kidney 293 cells, followed by luminometry measurements of the luciferase activity of StAR. Mutation analysis of 3 patients revealed p.L386delfsX2, p.W105X, and p.Q252X mutations of the DAX-1 gene. The...

Adrenocortical cell transplantation reverses a murine model of adrenal failure

Journal of Pediatric Surgery — Tue, 31 May 2011 23:00:00 +0100

Conclusion: Cells transplantation restored the adrenocortical function in these mice. Further optimization of this technique could bring a curative therapy to patients with adrenal insufficiency. (Source: Journal of Pediatric Surgery)

Congenital Adrenal Hyperplasia

Journal of Pediatric and Adolescent Gynecology — Wed, 25 May 2011 16:45:28 +0100

This article will review key aspects regarding pathophysiology, diagnosis, and treatment of CAH. (Source: Journal of Pediatric and Adolescent Gynecology)

Implementing electronic patient handover in a district general hospital

Clinical Risk — Mon, 23 May 2011 23:00:00 +0100

This paper discusses how we have improved patient handover by implementing an electronic system for weekend handover. We discuss the process of changing handover methods and the results of an audit comparing our old paper based book versus our new ‘e-handover’ system. (Source: Clinical Risk)

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Strategies for Insulin Delivery in a Patient With Type 2 Autoimmune Polyglandular Syndrome (APS-2): Type 1 Diabetes Mellitus, Addison's Disease, and Hashimoto's Thyroiditis

Journal of Pediatric Nursing — Fri, 20 May 2011 20:14:32 +0100

B.L. is a 15-year-old Native American/Caucasian female diagnosed with type 2 autoimmune polyglandular syndrome (APS-2). B.L., a patient with known type 1 diabetes, presented at age 12 years with increased skin pigmentation on sun exposure. An increased adrenocorticotropic hormone (ACTH) Level l (3,024 ng/ml) and elevated thyroid-stimulating hormone (10.16 mIU/ml); low free T4 (0.94 ng/ml) revealed diagnosis of Addison's disease and Hashimoto's thyroiditis, respectively. She was prescribed hydrocortisone 12 mg/m2 per day (25 mg in divided doses), fludrocortisone 0.1 mg daily, and levothyroxine 100 μg daily. (Source: Journal of Pediatric Nursing)

An 18-Year-Old Male Newly Diagnosed With Addison's Disease That Masked Type 1 Diabetes Mellitus

Journal of Pediatric Nursing — Fri, 20 May 2011 20:14:32 +0100

The patient is an 18-year-old Caucasian male. C.M. was admitted to the hospital with persistent nausea, abdominal pain, and hyponatremia. Pediatric endocrinology was consulted for concerns of Addison's disease. He was diagnosed with Addison's disease and being at risk for diabetes in the hospital. (Source: Journal of Pediatric Nursing)

Natural Killer T-Cell Lymphoma Presenting As Adrenal Mass and Partial Adrenal Insufficiency Followed by CNS Involvement [DIAGNOSIS IN ONCOLOGY]

Journal of Clinical Oncology — Tue, 17 May 2011 23:00:00 +0100

(Source: Journal of Clinical Oncology)

Pediatric Adrenal Trauma in the 21st Century: Children's Hospital of Atlanta Experience

The Journal of Urology — Sun, 15 May 2011 23:00:00 +0100

Conclusions: Adrenal trauma in children is rare. Although typically associated with high morbidity, this outcome is likely from related injuries as an isolated adrenal injury generally portends a benign course. (Source: The Journal of Urology)

Dominant Suppression of Addison's Disease Associated with HLA-B15.

The Journal of Clinical Endocrinology and Metabolism — Tue, 10 May 2011 23:00:00 +0100

Conclusions: HLA-B15 is not associated with protection from 21OH-AA formation but is associated with protection from progression to AD in 21OH-AA-positive individuals. To our knowledge, this is one of the most dramatic examples of genetic disease suppression in individuals who already have developed autoantibodies and of novel dominant suppression of an autoimmune disease by a class I HLA allele. PMID: 21565792 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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Medical Management of Patients With Brain Tumors

Current Treatment Options in Neurology — Tue, 10 May 2011 05:56:59 +0100

Opinion statement Patients with brain tumors require meticulous attention to medical issues resulting from their disease or its therapy. The following specific issues are the ones most frequently arising in the purview of neurologists: (1) Vasogenic edema: Corticosteroids should be used in divided doses in the minimum amount required to control symptoms and should be tapered as quickly as possible. Some patients may require long-term steroid supplementation, and symptoms of adrenal insufficiency should be investigated with 8 am cortisol measurement and treated with appropriate repletion. (2) Seizures: Patients with brain tumors should receive antiepileptic drugs only if they have had seizures, and the drugs should be chosen to minimize cognitive effects and interactions wi...

Adrenal Insufficiency with Gingival Mass—An Unusual Presentation of Hepatocellular Carcinoma

Journal of Oral and Maxillofacial Surgery — Sun, 08 May 2011 23:00:00 +0100

We report a case with clinical, radiologic, biochemical, and histopathologic evidence of metastases of HCC, with the initial presentation a solitary gingival mass. Subsequent examination revealed adrenal insufficiency. A complete workup confirmed the presence of multiple organ involvement, including metastasis to the adrenal glands. (Source: Journal of Oral and Maxillofacial Surgery)

Growth Hormone Deficiency, Short Stature, and Juvenile Rheumatoid Arthritis in a Patient with Autoimmune Polyglandular Syndrome Type 1: Case Report and Brief Review of the Literature

Journal of Oncology — Thu, 05 May 2011 14:35:30 +0100

We report the chronological history of a female patient who presented with features most consistent with APS type 1, along with growth hormone deficiency and juvenile rheumatoid arthritis (JRA). In terms of her autoimmune diagnoses, she first presented with JRA at three years of age, then hypocalcemia and hypoparathyroidism at five years of age, type 1 diabetes (DM 1) at age eleven years, adrenal insufficiency at age fourteen years, recurrent mucocutaneous candidiasis as a teenager, growth hormone deficiency at age fourteen years leading to significant short stature, primary amenorrhoea, and hypogonadism, and finally alopecia at age twenty-six years. In addition to this, she has suffered other nonautoimmune medical problems including a Tetralogy of Fallot with a surgical repair at age six ...

Adrenal insufficiency uncommon after transsphenoidal surgery for acromegaly

Modern Medicine — Tue, 03 May 2011 23:00:00 +0100

NEW YORK (Reuters Health) - Long-term rates of adrenal insufficiency are low after transsphenoidal surgery for growth hormone-secreting pituitary adenomas, researchers from the Netherlands report in the April 6th online issue of The Journal of Clinical Endocrinology & Metabolism. (Source: Modern Medicine)

Love: Are We The Witless Pawns Of Cupid's Arrows?

Psychology Today Relationships Center — Tue, 03 May 2011 15:52:52 +0100

As adults, nothing impacts our development quite like the person we love.read more (Source: Psychology Today Relationships Center)

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Greater awareness needed on risks that Addison's disease poses to patients (Medical News Today, 3 May 2011)

Society for Endocrinology — Tue, 03 May 2011 12:00:00 +0100

Two studies presented at the European Congress of Endocrinology in Rotterdam show that adrenal crises in Addison's disease may have a higher incidence than previously thought, and that the risk of infections (which can precipitate adrenal crises) may be greater in those with Addison's disease. The studies call for greater awareness of the life-threatening nature of adrenal crises and the appropriate medical action. Full article (Source: Society for Endocrinology)

Greater Awareness Needed On Risks That Addison's Disease Poses To Patients

Health News from Medical News Today — Tue, 03 May 2011 07:00:00 +0100

Two new studies presented at the European Congress of Endocrinology in Rotterdam show the possible dangers facing patients with Addison's disease are higher than previously thought. The new research shows that Addison's patients, who have low levels of cortisol produced by the adrenal glands, are more likely to get infections which may provoke life-threatening adrenal crises. Addison's disease is caused by low levels of the hormone cortisol, produced by the adrenal glands. Without treatment, the condition can be fatal... (Source: Health News from Medical News Today)

Phase II Trial of Saracatinib (AZD0530), an Oral SRC-inhibitor for the Treatment of Patients with Hormone Receptor-negative Metastatic Breast Cancer.

Clinical Genitourinary Cancer — Mon, 02 May 2011 23:00:00 +0100

CONCLUSIONS: These efficacy results were not sufficiently promising to justify continued accrual to this study. Based on this series, saracatinib does not appear to have significant single-agent activity for the treatment of patients with ER(-)/PR(-) MBC. PMID: 21729667 [PubMed - as supplied by publisher] (Source: Clinical Genitourinary Cancer)

Relative Adrenal Insufficiency in the Critical Care Setting: Debunking the Classic Myth

World Journal of Surgery — Sun, 01 May 2011 15:32:25 +0100

Conclusion Hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia do not predominate in RAI and laboratory values are of minimal value in predicting patients with RAI. Content Type Journal ArticlePages 1-6DOI 10.1007/s00268-011-1126-3Authors Fatuma Kromah, Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Ave., El Paso, TX 79905, USAAlan Tyroch, Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Ave., El Paso, TX 79905, USASusan McLean, Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Ave., El Paso, TX 79905, USAHarold Hughes, Department of Internal Medicine, Texas...

Hormonal disturbances in visceral leishmaniasis (kala-azar).

The American Journal of Tropical Medicine and Hygiene — Sat, 30 Apr 2011 23:00:00 +0100

This study presents a cross-sectional analysis of the hormonal alterations of patients with visceral leishmaniasis. The diagnosis was established by the bone marrow aspiration and polymerase chain reaction test. Primary adrenal insufficiency was observed in 45.8% of patients; low aldosterone/renin plasma ratio in 69.4%; low daily urinary aldosterone excretion in 61.1%; and low transtubular potassium gradient in 68.0%. All patients had normal plasma antidiuretic hormone (ADH) concentrations, hyponatremia, and high urinary osmolality. Plasma parathyroid hormone was low in 63%; hypomagnesemia was present in 46.4%, and increased Mg(++)(EF) in 100%. Primary thyroid insufficiency was observed in 24.6%, and secondary thyroid insufficiency in 14.1%. Normal follicle-stimulating hormone plasma level...

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Adrenal Imaging: From Addison to Algorithms

Radiologic Clinics of North America — Sat, 30 Apr 2011 23:00:00 +0100

This article, outlines the range of possible abnormalities encountered in the adrenal gland, the imaging modalities and specialized techniques used to detect and characterize them, the principles based on which these techniques are used, and finally a working imaging algorithm that can be readily used in daily practice. (Source: Radiologic Clinics of North America)

When Normal Is Abnormal: Keys to Laboratory Diagnosis of Hidden Endocrine Disease

Topics in Companion Animal Medicine — Sat, 30 Apr 2011 23:00:00 +0100

Although veterinary clinicians commonly rely on panels of laboratory tests with individual results flagged when abnormal, care should be taken in interpreting normal test results as well. There are several examples of this in evaluating patients with endocrine disease. The finding of a normal leukogram (absence of a stress leukogram) can be indicative of adrenal insufficiency in dogs, and this disorder can be especially elusive when there are no overt indicators of mineralocorticoid deficiency. Cats with hyperthyroidism can have normal serum thyroid hormone concentrations, normal hematocrits, and normal serum concentrations of creatinine despite the presence of disease that affects these parameters. A normal serum phosphorus concentration, in the face of azotemia, isosthenuria, and hyperte...

Adrenal imaging: from addison to algorithms.

Radiologic Clinics of North America — Sat, 30 Apr 2011 23:00:00 +0100

Measuring adrenal autoantibody response: Interlaboratory concordance in the first international serum exchange for the determination of 21-hydroxylase autoantibodies.

Clinical Immunology — Wed, 27 Apr 2011 23:00:00 +0100

Authors: Falorni A, Chen S, Zanchetta R, Yu L, Tiberti C, Bacosi ML, Furmaniak J, Bini V, Dotta F, Eisenbarth GS, Rees Smith B, Betterle C 21-hydroxylase autoantibodies (21OHAb) are the gold standard immune marker to identify patients with clinical or subclinical autoimmune Addison's disease (AAD). No assessment of interlaboratory concordance has been made for 21OHAb measurement. Serum samples from 267 patients with primary adrenal insufficiency and from 83 healthy control subjects were distributed to four independent laboratories that determined presence and titer of 21OHAb, by using radiobinding assays with either in vitro translated (35)S-radiolabelled or (125)I-radiolabelled autoantigen. Cohen's κ of inter-rater agreement ranged from 0.857 to 0.983, showing a very good concordance...