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Adrenal Mass

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3501. Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. (Abstract)

Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. The aim of this study was to assess the benefits and disadvantages of robot-assisted laparoscopic surgery for disorders of the adrenal gland in terms of feasibility, safety, and length of hospitalization.Twenty consecutive patients with benign lesions of adrenal gland were randomized into two groups: Patients in the laparoscopic group underwent traditional laparoscopic adrenalectomy (LAP), whereas those (...) in the robotic group underwent robot-assisted adrenalectomy (ROBOT) using the da Vinci robotic system.There was no significant difference between the groups in terms of age, sex, body mass index, and size or locations of lesions. Operative times were significant longer in the ROBOT group (total operative time, 169.2 min [range, 136-215] vs 115.3 min (range, 95-155) p < 0.001. Skin-to-skin time was 107 m (range, 77-154) vs 82.1 min (range, 55-120) (p < 0.001). There were no conversions to open surgery

2004 Surgical endoscopy Controlled trial quality: uncertain

3502. Enhanced circadian ACTH release in obese premenopausal women: reversal by short-term acipimox treatment. Full Text available with Trip Pro

Enhanced circadian ACTH release in obese premenopausal women: reversal by short-term acipimox treatment. Several studies suggest that the hypothalamo-pituitary-adrenal (HPA) axis is exceedingly active in obese individuals. Experimental studies show that circulating free fatty acids (FFAs) promote the secretory activity of the HPA axis and that human obesity is associated with high circulating FFAs. We hypothesized that HPA axis activity is enhanced and that lowering of circulating FFAs (...) by acipimox would reduce spontaneous secretion of the HPA hormonal ensemble in obese humans. To evaluate these hypotheses, diurnal ACTH and cortisol secretion was studied in 11 obese and 9 lean premenopausal women (body mass index: obese 33.5 +/- 0.9 vs. lean 21.2 +/- 0.6 kg/m(2), P < 0.001) in the early follicular stage of their menstrual cycle. Obese women were randomly assigned to treatment with either acipimox (inhibitor of lipolysis, 250 mg orally four times daily) or placebo in a double-blind

2004 American journal of physiology. Endocrinology and metabolism Controlled trial quality: uncertain

3503. Evidence of increased visceral obesity and reduced physical fitness in healthy insulin-resistant first-degree relatives of type 2 diabetic patients. (Abstract)

to their insulin resistance.We measured fat distribution in 20 FDR and 14 age-, gender- and body mass index (BMI)-matched controls employing dual energy X-ray absorbtiometry (DEXA)- and computed tomography (CT)-scanning. Insulin-stimulated glucose uptake (ISGU) was determined by a hyperinsulinemic clamp and maximal aerobic work capacity (VO2 max) by a bicycle ergometer test. Baseline lipolysis was measured using [3H]palmitate. The activity level of the hypothalamic-pituitary-adrenal axis was assessed as the 24 (...) h urinary (u)-cortisol/creatinine ratio.All subjects had a normal oral glucose tolerance test (OGTT), but FDR were insulin resistant (ISGU: 6.64+/-0.48 vs 9.12+/-0.98 mg/kg ffm/min, P=0.01). Despite similar BMI (25.2+/-0.5 vs 24.8+/-0.7 kg/m2, P=0.61) and overall fat mass (26.4+/-1.6 vs 24.2+/-2.1%, P=0.41) in FDR vs controls, the amount of visceral adipose tissue was substantially increased (65.9+/-10.0 vs 40.1+/-11.3 cm2, P<0.05) and VO2 max was reduced (52.2+/-3.1 vs 63.3+/-3.9 ml/kg ffm/min

2004 European journal of endocrinology / European Federation of Endocrine Societies Controlled trial quality: uncertain

3504. The impact of fasting and treatment omission on susceptibility to hypoglycaemia in children and adolescents with GH and cortisol insufficiency. (Abstract)

) including GH deficiency (GHD). Of the 14 patients, seven were ACTH sufficient (PHDC+) and seven ACTH deficient (PHDC-). Six had primary adrenal failure (PAF). Subjects administered or omitted their normal dose of evening GH and/or morning hydrocortisone. Glucose, insulin, GH, cortisol, ketones and catecholamines were measured at 04.00 h and regularly from 07.00 to 12.00 h. Insulin sensitivity was assessed by HOMA and hypoglycaemia defined as a blood glucose (BG) mass index on treatment but no subject became hypoglycaemic on or off therapy prior to 07.00 h. Five children (aged 3, 4, 7, 8 and 11 years) were hypoglycaemic between 07.00 and 12.00 h off treatment. There was a positive relationship between GH AUC and minimum BG in patients with PHD on treatment (r(2) = 0.45, P = 0.012) with increased insulin sensitivity off treatment. Increased cortisol levels were seen in PHDC+ patients off GH (P < 0.001). A negative relationship was observed between

2008 Clinical endocrinology Controlled trial quality: uncertain

3505. No effect of 5-day treatment with acetylsalicylic acid (aspirin) or the beta-blocker propranolol (Inderal) on free cortisol responses to acute psychosocial stress: a randomized double-blind, placebo-controlled study. (Abstract)

No effect of 5-day treatment with acetylsalicylic acid (aspirin) or the beta-blocker propranolol (Inderal) on free cortisol responses to acute psychosocial stress: a randomized double-blind, placebo-controlled study. The characterization of an individual's hypothalamic-pituitary-adrenal axis stress response is a main research topic in neuropsychobiology since alterations have been causally linked to several disease states. Over the last years, several studies focused on the identification (...) a significant cortisol increase after stress (p < 0.0001). The four treatment groups did not differ in their cortisol responses (group effect p > 0.44; interaction p > 0.97). Additionally, controlling for gender, age, smoking status, body mass index, mean arterial blood pressure or pre-stress cortisol levels yielded similar results in the total sample as well as in the male or female subgroups, respectively.Neither short-term treatment with aspirin nor propranolol altered the acute free cortisol response

2007 Neuropsychobiology Controlled trial quality: uncertain

3506. Effects of inhaled glucocorticoids on bone density in premenopausal women. (Abstract)

Effects of inhaled glucocorticoids on bone density in premenopausal women. Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term therapy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we examined the relation between the dose of inhaled glucocorticoids and the rate of bone loss in premenopausal women with asthma.We studied 109 (...) the decline in bone density and the number of puffs per year of use. Serum and urinary markers of bone turnover or adrenal function did not predict the degree of bone loss.Inhaled glucocorticoids lead to a dose-related loss of bone at the hip in premenopausal women.

2001 NEJM

3507. The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. (Abstract)

The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency. In a double-blind, placebo-controlled trial, we studied the effects of six months of growth hormone replacement in 24 adults with growth hormone deficiency. Most of the patients had acquired growth hormone deficiency during adulthood as a consequence of treatment for pituitary tumors, and all were receiving appropriate thyroid, adrenal, and gonadal hormone (...) replacement. The daily dose of recombinant human growth hormone (rhGH) was 0.07 U per kilogram of body weight, given subcutaneously at bedtime. The mean (+/- SE) plasma concentration of insulin-like growth factor I increased from 0.41 +/- 0.05 to 1.53 +/- 0.16 U per liter during rhGH treatment. Treatment with rhGH had no effect on body weight. The mean lean body mass, however, increased by 5.5 +/- 1.1 kg (P less than 0.0001), and the fat mass decreased by 5.7 +/- 0.9 kg (P less than 0.0001) in the group

1989 NEJM Controlled trial quality: uncertain

3508. Hypopituitarism

; decreased muscle mass, osteoporosis, anaemia. Children: . Growth hormone deficiency: . Decreased muscle mass and strength, visceral obesity, fatigue, decreased quality of life, impairment of attention and memory. Dyslipidaemia, premature atherosclerosis. Children: growth restriction. : Polyuria, polydipsia. Decreased urine osmolality, hypernatraemia. May also present with features attributable to the underlying cause: : headaches or visual field deficits. Large lesions involving the hypothalamus (...) be restored after successful surgical or medical removal of the lesion. Medical care consists of hormone replacement as appropriate and treatment of the underlying cause [ ] . Glucocorticoids are required if the ACTH-adrenal axis is impaired, especially in acute presentations. Increased doses of glucocorticoids are required following any form of emotional or physical stress (eg, during an infection) to prevent acute decompensation. Secondary hypothyroidism: thyroid hormone replacement. Gonadotrophin

2008 Mentor

3509. Hyponatraemia

. Plasma hypo-osmolality proportional to hyponatraemia. Inappropriately elevated urine osmolality (>100 mOsmol/kg) commonly > plasma osmolarity. Persistent urine [Na+] >30 mmol/L with normal salt intake. Euvolaemia. Normal thyroid and adrenal function. Extra features include an elevated ADH level and low blood uric acid level. Causes (not exhaustive) Neurological: tumour, trauma, infection, , , intracranial haemorrhage, sinus thrombosis, , . Pulmonary: , , , , , , positive-pressure ventilation. Other (...) . If necessary, repeat the test. Serum potassium . If raised, consider . SIADH needs to be confirmed by results of paired serum and urine samples: serum hypo-osmolality is <275 mOsm/kg, and urine osmolality >100 mOsm/kg and sodium ≥30 mmol/L, in the absence of hypovolaemia, hypervolaemia, adrenal or thyroid dysfunction and use of diuretics. Urine sodium level . If this is >20 mmol/L, a renal cause should be sought. Serum thyroid-stimulating hormone and free thyroxine level . These should be checked

2008 Mentor

3510. Hypertension in Childhood

, sympathomimetics). Mineralocorticoid excess (congenital adrenal hyperplasia, aldosterone-secreting tumours). Obstructive sleep apnoea and sleep disordered breathing [ ] . Phaeochromocytoma. Rheumatological conditions. Essential hypertension (primary hypertension). Presentation [ ] History The condition is usually asymptomatic but may be revealed fortuitously during examination in patients with suspected underlying conditions such as kidney disease or . A very full history is required including: Past medical (...) in the lower limbs. If the amplitude of the pulse is poor this suggests coarctation of the aorta. Look for stigmata of specific diseases: Café au lait spots may suggest . Examination of the abdomen may reveal a mass in and abdominal bruit may suggest coarctation or other vascular abnormalities including in the renal system. Virilisation will point to . Acne, hirsutism, central obesity and striae may suggest Cushing's syndrome. Sweating and tachycardia may indicate medication or illicit substances

2008 Mentor

3511. Is this new treatment any good?

by alternative practitioners if for no other reason than to protect their patients. It must also be acknowledged that within the spectrum of non-mainstream medical tenets, a kernel of truth can sometimes be found, which eventually becomes subsumed into mainstream medicine. Acupuncture is a case in point. The following is a list of common therapies and theories which patients seeking an alternative approach may encounter. Adrenal fatigue [ ] Adrenal fatigue is a term used by alternative practitioners (...) to describe a condition in which long-term mental, emotional or physical stress over-stimulates the adrenal gland, resulting in an eventual reduction in activity. Symptoms include tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving and needing stimulants like caffeine to get through the day. The condition needs to be differentiated from which is a recognised medical disease associated with a number of demonstrable laboratory abnormalities. It is important

2008 Mentor

3512. Lung Malignancy

on CXR): Secondary malignancy. Arteriovenous malformation. Pulmonary hamartoma: Rare, benign tumour. CT scan shows lobulated mass with flecks of calcification. Often excised to exclude malignancy. Bronchial adenoma: Rare, slow-growing tumour. 90% are carcinoid tumours; 10% are cylindromas. Treatment is surgery. Abscesses. Granuloma - eg, tuberculosis. Encysted effusion (fluid, blood, pus). Cyst. Foreign body. Skin tumour (eg, seborrhoeic wart). Referral [ ] Refer urgently (to be seen within two weeks (...) [ ] : Cough Fatigue Shortness of breath Chest pain Weight loss Appetite loss Urgent CXR (to be performed within two weeks) should also be considered for patients aged over 40 years with any of the following: Persistent or recurrent chest infection. Finger clubbing. Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy. Chest signs consistent with lung cancer. Thrombocytosis. Contrast-enhanced chest CT scan: To stage the tumour. The scan should also include the liver and adrenal glands

2008 Mentor

3513. Loin Pain

is gradual in onset and there may be painless haematuria and possibly a mass. The most common forms are clear cell carcinoma in adults and Wilms' tumour in children. Pelvi-ureteric junction (PUJ) obstruction : It usually follows drinking large amounts of fluid, as the diuresis causes distension of the renal pelvis and colic. Renal infarction : This is frequently misdiagnosed, initially as acute renal colic, pyelonephritis, or acute abdomen. [ ] Acute renal infarction affects both kidneys and both sexes (...) . Berger's disease. Acute nephritis. Polycystic kidney disease. Cholecystitis. Adrenal tumours (and haemorrhage). Colon cancer. Splenic infarction. Beware that patients can present with a fictitious story suggestive of renal colic as a ruse to obtain an injection of pethidine. The patient will usually be insistent that only pethidine works and will be very dissatisfied if given intramuscular diclofenac instead. Investigations Urine examination Microscopy may show haematuria with stones, pyuria

2008 Mentor

3514. Hyperprolactinaemia

tumour that prevents dopamine (which inhibits prolactin release) from reaching the normal prolactin-producing cells. Causes of hyperprolactinaemia 'Physiological' causes Pregnancy. Puerperium. Breast stimulation. Stress - physical (including excessive exercise) or psychological - including venepuncture. Macroprolactinaemia: This refers to prolactin of high molecular mass, mostly complexes of monomeric prolactin with immunoglobulins (prolactin autoantibody complexes). These larger molecules have low (...) , Hypogonadism, and Bone Health. World Neurosurg. 2017 Jan97:595-602. doi: 10.1016/j.wneu.2016.10.059. Epub 2016 Oct 20. Prolactinomaand at one time secondary adrenal insufficient and a whole host of other issues. I workout hard and try to eat a healthy diet but it doesnt work... i won't go into all the details but... fendertele84 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 21 December 2017 Next Review 20 December 2022 Document ID

2008 Mentor

3515. Fungal Lung Infections

in immunocompromised patients suspected of having invasive fungal pneumonia can help identify and treat disease early, leading to an improved outcome. [ ] Halo sign: ground-glass opacity surrounding a pulmonary nodule or mass. Most commonly associated with invasive pulmonary aspergillosis. [ ] Reversed halo sign: focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation. Most often associated with pulmonary mucormycosis. [ ] Bronchoscopy - to obtain bronchoalveolar (...) of fungal infection to other sites such as the brain, meninges, skin, liver, kidneys, adrenal glands, heart, eyes, spleen. Progressive . Systemic fungaemia and septic shock. Blood vessel invasion causing massive , pulmonary infarction, myocardial infarction, cerebral infarction/embolism. Associated rheumatological complex/pericarditis with endemic fungal pneumonias. Lung cavitation. Development of mycetoma in a lung cavity. Local pulmonary damage causing bronchopleural or tracheo-oesophageal fistulas

2008 Mentor

3516. Congenital Urogenital Malformations

mass of cysts and usually absent or atretic ureter. Frequently associated with contralateral abnormalities, especially ureteropelvic junction (UPJ) obstruction. 60% of kidneys affected by renal dysplasia have an obstructive component [ ] . Dysplasia of the renal parenchyma is seen with urethral obstruction or reflux present early in pregnancy, or obstructed ureter. Potter's syndrome occurs in sporadic and autosomal recessive forms with an incidence of 1 in 4,000 births. The name describes (...) . As a result of the abnormal anatomy of a horseshoe kidney, imaging and treatment pathways vary substantially from those for the normal kidney [ ] . Children can present with urinary tract infections (UTIs), abdominal mass and haematuria. Ectopic kidney [ ] In simple ectopy, the kidney does not ascend properly and is found in the pelvis or over the brim. The ureter of a pelvic kidney is tortuous. Ureteropelvic junction (UPJ) obstruction occurs in around 30%. The pelvic kidney is prone to obstruction

2008 Mentor

3517. Heart Failure (Diagnosis and Investigation)

, hyperthyroidism, Cushing's syndrome, adrenal insufficiency, excessive growth hormone, phaeochromocytoma. Nutritional - eg, deficiencies of thiamine, selenium, carnitine, and obesity, cachexia. Infiltrative - eg, sarcoidosis, amyloidosis, haemochromatosis, Löffler's eosinophilia, connective tissue disease. Infective - eg, Chagas' disease, HIV. Arrhythmias - tachyarrhythmias or bradyarrhythmias. Conditions where there is increased peripheral demand on the heart - this occurs when cardiac output is normal (...) ). Peribronchial cuffing. Diffuse interstitial or alveolar shadowing - classical perihilar 'bat's wings' or nodular (especially with pre-existing COPD). Fluid in the fissures. Pleural effusions. Kerley B lines. Apart from pulmonary congestion, CXR findings are only predictive of heart failure where there are co-existing typical signs and symptoms. Urinalysis. Lung function tests (peak flow or spirometry). Cardiac magnetic resonance imaging - the gold standard for assessing ventricular volumes, mass and wall

2008 Mentor

3518. Gynaecomastia

. Men with Klinefelter's syndrome have an increased risk of breast cancer and this needs to be considered (risk is increased up to 20 times that of other patients with gynaecomastia). Viral orchitis. Trauma. Castration. Renal disease and dialysis. Increased oestrogen levels : (eg, Leydig's cell tumour) which secrete estradiol. Hermaphroditism. Neoplasms producing human chorionic gonadotrophin (hCG) - eg, : hCG stimulates Leydig's cells to excrete estradiol. Also, , and . Adrenal tumours: these can (...) release oestrogens. (high androgens and oestrogens). Liver disease or . In liver disease there is an increased production of androstenedione by the adrenal glands, increased aromatisation of androstenedione to oestrogen, loss of clearance of adrenal androgens by the liver and a rise in SHBG, resulting in gynaecomastia. Malnourishment and re-feeding syndrome. . Obesity. Extreme stress. Aromatase excess syndrome. Mutation of the aromatase gene causes excess oestrogen levels, prepubertal gynaecomastia

2008 Mentor

3519. Hirsutism and Virilism

. Deepening of voice. Increased libido. Increased muscle mass (primarily shoulder girdle). Loss of breast tissue or normal female body contour. Malodorous perspiration. Infertility. Menstrual dysfunction. Other abnormalities associated with excessive levels of androgen are cardiovascular disease, dyslipidaemia, glucose intolerance/insulin resistance and hypertension. Acanthosis nigricans, a marker for insulin resistance, may also be present. Pelvic mass: ovarian (bimanual vaginal examination) or adrenal (...) in a generalised non-sexual distribution and is unrelated to androgens. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) are the most common causes [ ] . When hirsutism in women is accompanied by other signs of virilism, it may be a manifestation of a more serious underlying disorder causing hyperandrogenism, such as an ovarian tumour or adrenal neoplasm. Epidemiology [ ] Hirsutism is a common disorder affecting between 5% and 15% of women of reproductive age [ ] . It is less common in Asian people

2008 Mentor

3520. Genitourinary History and Examination (Female)

who cannot be pregnant is one who has not been having intercourse). Psychological: look for mood abnormalities. Record BMI (low BMI suggesting anorexia nervosa). Extrinsic hormonal causes: drugs such as the contraceptive pill, and progestogen-only contraceptive methods. Intrinsic hormonal causes: hypothalamic, pituitary, thyroid and adrenal disorders. Ovarian factors: polycystic ovaries, ovarian tumours, ovarian infection, primary ovarian failure. The pattern of the menstrual cycle. Record: First (...) masses arising from the pelvis: Large ovarian cysts, which can be detected by abdominal percussion revealing central dullness. Pregnancy (often used to equate the size of other pelvic tumours): 12 weeks - palpable above the pubic bone. 16 weeks - palpable midway between the pubic bone and umbilicus. 20 weeks - just below the umbilicus. 28 weeks - just midway between the umbilicus and xiphisternum. 34 weeks - just below the xiphisternum. Palpable bladder in urinary retention. Tender bowel loops

2008 Mentor

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