ACTH-dependent Hypercortisolemia in a Patient with a Pituitary Microadenoma and an Atypical Carcinoid Tumour of the Thymus.
This study presents a case of a 31 year-old man with diabetes, hypertension, rosacea, purple stretch marks and hypokalemia. Findings of diagnostic procedures include high concentrations of cortisol and ACTH, pituitary microadenoma and a tumour in the anterior mediastinum. Dynamic hormone tests determined the source of excess hormone secretion and ectopic ACTH-dependent CS was diagnosed. Due to increasing symptoms of superior vena cava syndrome, an emergency resection of almost the whole tumour was performed, with only a small part of the upper pole left because of the proximity of large vessels and a risk of damaging them. On the basis of histopathological tests, an atypical carcinoid tumour of the thymus was identified. Immediately after the surgical procedure, there was a significant reduction of clinical and laboratory traits of hypercortisolemia, yet, during the 46 weeks of postoperative observation, despite chemotherapy, the progression of residual masses of the tumour occurred with metastases and increased hormone indices. The presented case shows and discusses the differentiation of ACTH-dependent hypercortisolemia and its causes, difficulties in surgical therapy and chemotherapy, as well as prognosis for atypical carcinoid of the thymus, which is a rare disease. PMID: 31783507 [PubMed - in process]
Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if possible. Sometimes, these efforts are successful and sometimes they fail. Antipsychotic medications have many side effects, including sedation, diabetes, hyperlipidemia, weight gain, motor rigidity, impaired gait, and falls. Monitoring of blood glucose, lipids, and extrapyramidal symptoms is mandatory.
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime).
Authors: Lee YM, Park SH, Lee DH Abstract OBJECTIVE: The aim of this paper is to propose a new hypothesis for the role of lipophilic chemical mixtures stored in adipose tissue in the development of dementia. Specifically, we present how the dynamics of these chemicals can explain the unexpected findings from the Action for Health in Diabetes (Look AHEAD) study, which failed to show long-term benefits of intentional weight loss on cognition, despite substantial improvements in many known risk factors for dementia. Moreover, we discuss how the role of obesity in the risk of dementia can change depending on the dynami...
Publication date: Available online 25 February 2020Source: Actas Urológicas Españolas (English Edition)Author(s): G. del Pozo Jiménez, F. Herranz Amo, J.A. Arranz Arija, E. Rodríguez Fernández, D. Subirá Ríos, E. Lledó García, G. Bueno Chomón, M.J. Cancho Gil, J. Carballido Rodríguez, C. Hernández Fernández
Authors: El-Demiry NM, Maged AM, Gaafar HM, ElAnwary S, Shaltout A, Ibrahim S, El-Didy HM, Elsherbini MM Abstract Objective: To evaluate the diagnostic performance of Doppler sonography of umbilical artery (UA), fetal middle cerebral artery (MCA), ductus venosus (DV) &umbilical vein (UV) for prediction of adverse perinatal outcome.Material and Methods: A prospective cohort study conducted on 60 women diagnosed with preeclampsia with severe features divided into two groups based on adverse perinatal outcome.Results: Statistically Significant differences were demonstrated UA PI (1.28 ± 0.23 vs. 0.96 ± 0.21, P
Conclusion: These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC. PMID: 32093463 [PubMed - in process]
Authors: Medeiros MC, Rocha N, Bandeira E, Dantas I, Chaves C, Oliveira M, Bandeira F Abstract Sclerostin (Scl) is an osteoblast-inhibiting glycoprotein that is secreted mainly by osteocytes and is regulated by hormonal changes and skeletal loading. Decreased physical function and high serum Scl concentrations have been reported in chronic renal failure patients but little is known to date about the differences between diabetic and non-diabetic patients on hemodialysis who are susceptible to both sarcopenia and bone fragility. Objective.To determine the prevalence of sarcopenia and its association with serum Scl co...
Publication date: March 2020Source: The Lancet Haematology, Volume 7, Issue 3Author(s): The Lancet Haematology
Publication date: Available online 25 February 2020Source: The Lancet Diabetes &EndocrinologyAuthor(s): Ida Pernicova, Stephen Kelly, Sharon Ajodha, Anju Sahdev, Jonathan P Bestwick, Plamena Gabrovska, Olufunso Akanle, Ramzi Ajjan, Blerina Kola, Marietta Stadler, William Fraser, Mirjam Christ-Crain, Ashley B Grossman, Costantino Pitzalis, Márta Korbonits