No abstract available.
Memory

Male climacteric syndrome is a clinical and biochemical syndrome characterized by the decline in serum concentration of biologically active forms of testosterone with aging in men which may result in detrimental effect on the quality of life(QOL) and adversely affect the function of multiple organ systems. Androgen replacement therapy may have favorable effect in QOL, body composition, cardiovascular disease, sexual dysfunction and osteoporosis. Controversy in defining the clinical syndrome and in long-term effect of androgen replacement therapy continues. An international consensus document was recently published and provides guidance on the diagnosis, treatment and monitoring of late-onset hypogonadism (LOH) in males. The diagnosis of LOH requires biochemical and clinical components. Any clinical intervention testosterone treatment should be judged on a balance of risk versus benefit. There have been potential concerns regarding the effects of testosterone on prostate disease and polycythemia. The available treatment methods have increased in recent years with the availability of a number of testosterone preparations which can reliably produce physiological serum concentrations. Periodic physician's evaluations is required to assess the clinical response and to avoid potential adverse events and must be tailored individually.
Aging ; Body Composition ; Cardiovascular Diseases ; Climacteric ; Consensus ; Humans ; Hypogonadism ; Male ; Osteoporosis ; Polycythemia ; Prostate ; Testosterone

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

Diabetic insipidus may first present before, during or immediately after pregnancy. Pregnancy serves as a physiologic provocation test that unmasks latent diabetes insipidus. It may explain the very rare first occurrence of diabetes insipidus in the pureperium. Central diabetes insipidus occurring after delivery associated with a catastrophic delivery and postpartum hypopituitarism is more frequent entity. We recently experienced central diabetes insipidus patient, aggrevated polyuria and polydipsia after total hysterectomy due to cervical carcinoma, who had interesting past history of severe polyuria and polydipsia developed during puerperium of 1st pregnancy, 14 years ago. She have had quiet normal pregnancy and there was no definite postpartum complication of pregnancy at that time. There were no change of polyuria and polydipsia during and after second pregnancy and 2 another pregnancy terminated artificially compare to puerperium of 1st delivery. She has intact anterior pituitary gland functinally and anatomically, but the posterior pituitary hyperintense signal with pre-enhance Tl-weighted imaging was absent on MRI.
Diabetes Insipidus ; Diabetes Insipidus, Neurogenic* ; Humans ; Hypopituitarism ; Hysterectomy ; Magnetic Resonance Imaging ; Pituitary Gland, Anterior ; Polydipsia ; Polyuria ; Postpartum Period* ; Pregnancy

Pheochromocytomas are rare neuroendocrine tumours with a highly variable and heterogeneous clinical manifestation. With a noticeable progress in genetics, biochemical diagnosis and tumour imaging techniques, modifications of the traditional "rule of tens" for pheochromocytomas are inevitable consequence. Diagnosis of pheochromocytoma depends on biochemical evidence of catecholamine production by the tumor. Plasma free metanephrines provide the best test for excluding or confirming pheochromocytoma and should be used as an initial screening tool, but if it is not available, urinary fractionated metanephrines could be used as an alternative method. Different anatomical and functional imaging modalities are used to localize biochemically proven pheochromocytomas. These include computed tomography, magnetic resonance imaging, single-photon emission computed tomography (SPECT) using 123/131I-metaiodobenzylguanidine (MIBG) or 111In-DTPA-pentetreotide and positron emission tomography (PET). Timely laparoscopic tumour removal in combination with appropriate pre-and intraoperative management of the effects of secreted catecholamines are essential components for excellent prognosis.
Adrenalectomy ; Catecholamines ; Magnetic Resonance Imaging ; Mass Screening ; Molecular Biology ; Pheochromocytoma ; Plasma ; Positron-Emission Tomography ; Prognosis ; Tomography, Emission-Computed

No abstract available.
Humans ; Insulin Resistance* ; Insulin*

No abstract available.
Pheochromocytoma

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.
Clinical Medicine ; Demeclocycline ; Diagnosis ; Exanthema* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Lung Diseases ; Middle Aged ; Myalgia ; Seizures ; Skin ; Sodium

No abstract available.
Arachnoid* ; Arachnoiditis* ; Magnetic Resonance Imaging* ; Tuberculosis*

No abstract available.
Arachnoid* ; Arachnoiditis* ; Magnetic Resonance Imaging* ; Tuberculosis*