Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis which is predominantly due to long-term glucocorticoid treatment or by pituitary disease. Primary adrenal failure is a rare disease that is life-threatening when overlooked whle adrenal failure secondary to hypothalamo-pituitary disease is a common clinical problem that has serious impact on the quality of life. Recent data suggests that the health-related quality of life in many patients with adrenal insufficiency is more severely impaired than previously thought and that current hormone replacement strategies are insufficient to prevent increased morbidity and mortality due to the disease. Therefore, the optimization and careful monitoring of glucocorticoid and mineralocorticoid replacement therapy remains one of the most challenging tasks in endocrinology. Leaving treatment aside, diagnosis of adrenal insufficiency is also challenging, because the main presenting symptoms such as fatigue, anorexia, and weight loss are non-specifically associated with many other common ailments, delaying a correct diagnosis. Some pitfalls in diagnostic work-up, particularly in the identification of secondary adrenal insufficiency, make the diagnosis even more difficult. Despite the difficulties, the complications associated with adrenal insufficiency make the rapid diagnosis and proper management of adrenal failure are important tasks for all physicians. We review here current standards for clinical assessment, diagnosis and treatment of adrenal insufficiency in light of recent research findings.
Addison Disease ; Adrenal Cortex Function Tests ; Adrenal Insufficiency ; Anorexia ; Endocrinology ; Fatigue ; Glucocorticoids ; Humans ; Light ; Pituitary Diseases ; Quality of Life ; Rare Diseases ; Weight Loss ; Axis, Cervical Vertebra

The level of blood sugar is an improtant indicator used in the diagnosis and management of diabetes mellitus. In this respect, polarimeter and blood sugar detector were conventionally and generally used in hospitals; However, the former one is already obsolete; the latter one is invasive. In this paper, the development of a novel noninvasive blood-sugar detector is described. The experiment indicate that this detector is nonivasive, safe, fast, and easy to operate, and it can be of wide application.
Blood Glucose ; analysis ; Diabetes Mellitus ; blood ; Diagnostic Techniques, Endocrine ; instrumentation ; Humans ; Saliva ; chemistry

Post-therapy whole body imaging with I-131 is not routinely done in the Philippines. This added cast of this procedure limits its diagnostic value for those patients who cannot afford it. This study was undertaken to evaluate the diagnostic relevance of I-131 whole body scan following therapeutic doses and its implication in further treatment and follow-up. This study included 61 patients treated in our institutions during a three-year period. Comparison of their-pre- and post-therapy who body scans was done. There were 10 males (16%) and 51 (84%) females with a mean age of 45 years + 15 (range, 17-77). Thirty three patients (54%) have corresponding pre-therapy serum thyroglobulin determination, which also guided the clinicians in the administration of appropriate therapeutic doses. The post-therapy studies were performed prior to hospital discharge . The mean interval between administration of therapy dose and imaging was 4 days (range, 2-10 days). About 34 patients (56% did not have any significant change between their pre- and post-therapy whole body scans. In 27 cases (44%), additional findings indicative of local and/or distant thyroid cancer metastasis were noted. Unsuspected cervical nodes were appreciated in 15(24%) of these cases. Seven (7) cases (11%) presented with increased metastatic deposits in the affected area. New areas of metastases were evident in 5 cases (8%). Our present data suggests that the incorporation of post-therapy whole body scans in the clinical evaluation of patients with well-differentiated thyroid cancer may help in the optimum therapeutic management and future follow-up of patients.
Human ; Male ; Female ; Middle Aged ; WHOLE BODY IMAGING ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING ; THYROID NEOPLASMS ; NEOPLASMS ; NEOPLASMS BY SITE ; ENDOCRINE GLAND NEOPLASMS

OBJECTIVETo compare the applicability of the three diagnostic criteria for metabolic syndrome (MS) proposed by the International Diabetes Federation (IDF) in 2005, Adult Treatment Panel III of National Cholesterol Education Program (NCEP-ATP III) in 2005 and Chinese Diabetes Socie (CDS) in 2004.

METHODSBased on the findings of cohort study of multiple metabolic disorders and metabolic syndrome (1971 cases) in Jiangsu province, MS was diagnosed according to these three definitions respectively, and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases (CVD) and type 2 diabetes mellitus (T2DM). While, through Cox regression analysis, to compare their relative risk (RR) and 95% confidential interval (CI) was wade.

RESULTSAmong three diagnostic criteria, the specificity by CDS of MS was higher than the other criteria (83.52%, 76.36%, 89.57%; 85.02%, 78.67%, 92.28%), however the sensitivity of CDS of MS was low (40.82%, 29.47%). When using CDS, over 50 percent of diagnosis might be missed. ATP III definition corresponded to the shortest distance in ROC curve, namely, at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum (0.4369; 0.5777). The incidence of CVD [5.59 (2.62 - 11.92) vs 2.90 (1.41 - 5.93)], T2DM [3.36 (1.92 - 5.79) vs 1.97 (1.16 - 3.34)] was significantly higher in cases of ATP III+/IDF-than ATP III+/IDF+, as compared with ATP III-/IDF-.

CONCLUSIONAmong three diagnostic criteria, the ATP III definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.

China ; Diabetes Mellitus, Type 2 ; diagnosis ; Diagnostic Techniques, Endocrine ; standards ; False Negative Reactions ; False Positive Reactions ; Humans ; Hypertension ; diagnosis ; Metabolic Syndrome ; diagnosis ; Reference Standards ; Sensitivity and Specificity

The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves' disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves' disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves' disease. One kind of thionamides and beta-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including beta-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves's disease that is resistant to conventional therapies.
Adrenal Cortex Hormones ; Adult ; Antithyroid Agents ; Cholestyramine Resin* ; Drug Resistance ; Female ; Glycogen Storage Disease Type VI ; Graves Disease* ; Humans ; Hypersensitivity ; Iodine ; Thyroid Function Tests ; Thyroid Gland ; Thyroidectomy* ; Thyrotoxicosis

OBJECTIVETo evaluate the accuracy of continuous glucose monitoring system (CGMS) during oral glucose tolerance test (OGTT) in the detection of blood glucose changes in glucose stress condition.

METHODSForty-nine out-patients with fasting plasma glucose of 3.9-11.0 mmol/L underwent continuous blood glucose monitoring using CGMS for 3 days, and OGTT was conducted on the third day. The venous blood glucose was measured at 0, 30, 60, 90, and 120 min after oral glucose intake, and the accuracy of CGMS during OGTT was evaluated.

RESULTSThe correlation indices between CGMS values and the venous blood glucose values during the entire OGTT and in phases of stable, rapidly rising and falling glucose levels were 0.928, 0.901, 0.924 and 0.902, respectively (P<0.001). Clarke error-grid analysis showed that more than 95% of the measured results fell into the A and B zones.

CONCLUSIONCGMS values show good consistency with venous blood glucose values measured during OGTT. CGMS is accurate in detection of rapidly changing blood glucose during OGTT.

Adult ; Aged ; Blood Glucose ; analysis ; Blood Glucose Self-Monitoring ; methods ; Female ; Glucose Tolerance Test ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Young Adult

For non-invasive blood glucose detection through near-infrared spectroscopy, it is very important to ensure the data quantity and reliability of calibration model. In this paper, the method of sampling blood by tubing pump in OGTT (Oral Glucose Tolerance Test) is used to get reliable and adequate reference data of blood glucose concentration for calibration model, and the non-invasive blood detection system based on the AOTF (Acousto-Optic Tunable Filter) ranging from 1100 nm to 1700 nm is designed. 3 experiments were performed by the above system and method. The results showed that based on the PLS (Partial Least Square) calibration models constructed by analyzing all individual experimental data, the correlation coefficients were 0.986, 0.971 and 0.985, respectively, and the RMSEP (Root Mean Square Error of Prediction) estimated by Full Cross Validation were 0.550 mmol/l, 0.456 mmol/l and 0.520 mmol/l; respectively. The results also showed that the prediction error of the model decreased when the number of effective model data increased.
Adult ; Blood Glucose Self-Monitoring ; methods ; Female ; Glucose Tolerance Test ; methods ; Humans ; Male ; Sensitivity and Specificity ; Spectroscopy, Near-Infrared

To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). A total of 2611 pregnant women with GDM who were examined and delivered in Women's Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all <0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (all <0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (all <0.017), and the incidence of LGA were higher than that in inadequate GWG patients (all <0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (all <0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (=1.66, 95%: 1.10-2.52; =2.20, 95%: 1.07-4.53), and protective factor for LGA (=0.40, 95%: 0.27-0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (=2.15, 95%: 1.35-3.41; =1.80, 95%: 1.20-2.72; =2.18, 95%: 1.10-4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (=0.24, 95%: 0.09-0.67; =0.54, 95%: 0.34-0.86), while excessive GWG was risk factor for premature delivery (=1.98, 95%: 1.23-3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.
Blood Glucose ; Blood Glucose Self-Monitoring ; Body Mass Index ; Diabetes, Gestational/epidemiology* ; Female ; Gestational Weight Gain ; Glucose Tolerance Test ; Humans ; Pregnancy ; Pregnancy Outcome

Hashimoto's encephalopathy (HE) is a rare and underdiagnosed neuropsychiatric illness. We present the case of a 17-year-old girl who was admitted to a tertiary-care psychiatric center with acute onset psychosis and fever. Her psychotic symptoms were characterized by persecutory and referential delusions, as well as tactile and visual hallucinations. Her acute behavioral disturbance warranted admission and treatment in a psychiatric setting (risperidone tablets, 3 mg/day). She had experienced an episode of fever with a unilateral visual acuity defect approximately 3 years before admission, which was resolved with treatment. Focused clinical examination revealed an enlarged thyroid, and baseline blood investigations, including thyroid function test results were normal. Abnormal laboratory investigations revealed elevated anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) levels (anti-TPO of 480 IU/mL; anti-TG of 287 IU/mL). Results of other investigations for infection, including cerebrospinal fluid examination, electroencephalography, and brain magnetic resonance imaging were normal. She was diagnosed with HE and was treated with intravenous corticosteroids (methylprednisolone up to 1 g/day; tapered and discontinued after a month). The patient achieved complete remission of psychotic symptoms and normalization of the anti-thyroid antibody titers. Currently, at the seventh month of follow-up, the patient is doing well. This case highlights the fact that in the absence of well-defined clinical diagnostic criteria, a high index of suspicion is required for early diagnosis of HE. Psychiatrists need to explore for organic etiologies when dealing with acute psychiatric symptoms in a younger age group.
Adolescent ; Adrenal Cortex Hormones ; Brain ; Brain Diseases ; Cerebrospinal Fluid ; Delusions ; Early Diagnosis ; Electroencephalography ; Female ; Fever ; Follow-Up Studies ; Hallucinations ; Humans ; Magnetic Resonance Imaging ; Methylprednisolone ; Peroxidase ; Psychiatry ; Psychotic Disorders ; Risperidone ; Tablets ; Thyroid Function Tests ; Thyroid Gland ; Visual Acuity

Quality control for genetic tests has become more important as testing volume and clinical demands have increased dramatically. The diagnostic genetics subcommittee of Korean Association of External Quality Assessment Service conducted two trials in 2014 based on cytogenetics and molecular genetics surveys. A total of 44 laboratories participated in the chromosome surveys, 33 laboratories participated in the fl uorescence in situ hybridization (FISH) surveys, and 130 laboratories participated in the molecular genetics surveys as a part of these trials. All laboratories showed acceptable results in the chromosome and FISH surveys. The molecular genetics surveys included various tests: Mycobacterium tuberculosis detection, hepatitis B and C virus detection and quantification, human papilloma virus genotyping, gene rearrangement tests for leukaemia and lymphomas, genetic tests for JAK2, FMS-like tyrosine kinase 3, nucleophosmin, cancer-associated genes (KRAS, EGFR, KIT, and BRAF), hereditary breast and ovarian cancer genes (BRCA1 and BRCA2), Li-Fraumeni syndrome (TP53), Wilson disease (ATP7B), achondroplasia (FGFR3), Huntington disease, spinocerebellar ataxia, spinal and bulbar muscular atrophy, mitochondrial encephalopathy with lactic acidosis and stroke like episodes, myoclonic epilepsy ragged red fibre, Prader-Willi/Angelman syndrome, Duchenne muscular dystrophy, spinal muscular atrophy, fragile X syndrome, nonsyndromic hearing loss and deafness (GJB2), multiple endocrine neoplasia 2 (RET), Leber hereditary optic neuropathy (major mutation), apolipoprotein E genotyping, methylenetetrahydrofolate reductase genotyping, ABO genotyping, and DNA sequencing analysis. Molecular genetic surveys showed excellent results for most of the participants. The external quality assessment program for genetic analysis in 2014 proved to be helpful for continuous education and the evaluation of quality improvement.
Achondroplasia ; Acidosis, Lactic ; Apolipoproteins ; Breast ; Cytogenetics ; Deafness ; Education ; Epilepsies, Myoclonic ; fms-Like Tyrosine Kinase 3 ; Fragile X Syndrome ; Gene Rearrangement ; Genetics* ; Hearing Loss ; Hepatitis B ; Hepatolenticular Degeneration ; Humans ; Huntington Disease ; In Situ Hybridization ; Korea ; Li-Fraumeni Syndrome ; Lymphoma ; Methylenetetrahydrofolate Reductase (NADPH2) ; Molecular Biology ; Molecular Diagnostic Techniques ; Multiple Endocrine Neoplasia ; Muscular Atrophy, Spinal ; Muscular Disorders, Atrophic ; Muscular Dystrophy, Duchenne ; Mycobacterium tuberculosis ; Optic Atrophy, Hereditary, Leber ; Ovarian Neoplasms ; Papilloma ; Quality Assurance, Health Care ; Quality Control ; Quality Improvement ; Sequence Analysis, DNA ; Spinocerebellar Ataxias ; Stroke