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Corticotropin Stimulation Test

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181. The UK guidelines for management and surveillance of Tuberous Sclerosis Complex Full Text available with Trip Pro

, or cognitive or neurological function are not explained by a standard EEG. Parents should be taught to recognise epileptic spasms and focal seizures in infants, and EEG should be repeated urgently if there is suspicion of seizures. Paediatric neurologists should be involved in their care. Families and patients should be counselled about Sudden Unexpected Death in Epilepsy (SUDEP). Vigabatrin is the recommended first-line therapy for epileptic spasms in infancy. Hormonal therapies (oral prednisolone or ACTH (...) different TSC-causing mutations in the TSC1 and TSC2 genes have been identified. A significant fraction (approximately 15%) of TSC patients have no mutation identified by conventional genetic testing. Therefore, a normal result does not exclude a diagnosis of TSC. Genetics – recommendations and results of consensus Delphi consensus There was consensus to offer a genetic test at baseline in those with definite or probable TSC. Testing may clarify the diagnosis of TSC in cases that do not fulfil clinical

2018 Tuberous Sclerosis Association

182. Review of Prader-Willi syndrome: the endocrine approach Full Text available with Trip Pro

studied ( ). Reasons for such discrepancy in prevalence of GHD is likely due to variation in the testing methods used, differences in growth hormone (GH) assays, and age of patients at time of testing. The exact pathogenesis of GHD in PWS is not entirely clear. PWS children demonstrate decreased spontaneous 24-hour GH secretion, in addition to inadequate response to GH stimulation testing ( ). Serum IGF-1 levels are universally noted to be sub-normal as well. It is likely that there is a combination (...) ( , ). Treatment with levothyroxine at typical replacement doses based on age and weight should be used if thyroid function is indicative of hypothyroidism. Central adrenal insufficiency Individuals with PWS are at risk for CAI due to known hypothalamic dysfunction. However, the true prevalence of CAI in the PWS population is unclear. Several studies using different testing methods including insulin tolerance test (ITT), low dose/high dose ACTH stimulation, glucagon stimulation and overnight metyrapone tests

2017 Pediatric Endocrine Society

183. Insulin tolerance test Full Text available with Trip Pro

. Other provocation tests which cause much less release of growth hormone include the use of , and . Contents Side effects [ ] Side effects include sweating, palpitations, loss of consciousness and rarely convulsions due to severe hypoglycemia which may cause coma. If extreme symptoms are present, glucose should be given . In subjects with no adrenal reserve an may occur. For cortisol stimulation, the has much less risk. Contraindications [ ] This test should not be performed on children outside (...) Insulin tolerance test Insulin tolerance test - Wikipedia Insulin tolerance test From Wikipedia, the free encyclopedia Insulin tolerance test Purpose assess pituitary function/ adrenal function An insulin tolerance test ( ITT ) is a medical diagnostic procedure during which is injected into a patient's vein, after which blood glucose is measured at regular intervals. This procedure is performed to assess function, function, and sometimes for other purposes. An ITT is usually ordered

2012 Wikipedia

184. Odefsey (emtricitabine / rilpivirine / tenofovir alafenamide) - HIV-1

transcriptase inhibitor NRTI nucleoside reverse transcriptase inhibitor NtRTI nucleotide reverse transcriptase inhibitor OATP organic anion transporting polypeptide P1NP procollagen type 1 N-terminal propeptide PBMC peripheral blood mononuclear cell PD pharmacodynamic(s) P-gp P-glycoprotein PI protease inhibitor PRT proximal renal tubulopathy PSP Pediatric Study Plan PTH parathyroid hormone Q1, Q3 first quartile, third quartile RBP retinol binding protein rNTP ribonucleoside triphosphate RPV rilpivirine RT (...) sections 4.2, 4.4 and 5.1). The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that tenofovir alafenamide was considered to be a new active substance. The application submitted is composed of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. Information

2016 European Medicines Agency - EPARs

185. Neofordex - dexamethasone. To treat adults with multiple myeloma

II, or give the monohydrate. Form I, the more stable form, can only be generated from Form II at high temperature, but not from the hydrated forms. Intrinsic Dissolution Rates (IDR) of the different polymorphs were studied. The morphology of the active substance produced by the active ingredient manufacturer is determined and controlled by an XRPD method with a test and control limits included within the specification for the active substance. Specification The control tests comply (...) with the specification and test methods of the Ph. Eur. Monograph for dexamethasone acetate and additional test mentioned in the CEP. Additional specifications have also been set for particle size (laser diffraction) and polymorphism (XRPD). All additional methods have been adequately validated and described according to ICH Q2. Control limits for particle size distribution and morphology are justified in view of the characteristics of the batch of active substance used for the bioequivalence study. Batch analysis

2016 European Medicines Agency - EPARs

186. Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guidelines

is unknown. Patients may present with different complaints. Headache and visual disturbances require immediate evaluation and differenti- ation between cerebral metastasis, leptomeningeal disease, cere- brovascular disease and hypophysitis. On brain MRI, a swollen or enlarged pituitary gland may be visible. Frequently, simultaneous low blood levels of TSH, adrenocorticotropic hormone and/or follicle-stimulating hormone/luteinizing hormone (FSH/LH) point towards hypophysitis as the most likely diagnosis (...) about the pathogenesis of thyroid disorders following ICPis. It is thought to be mediated by T cells and not by B cell autoimmunity. Recently, a cohort of 51 NSCLC patients treated with pembrolizu- mab in the Keynote-001 study was prospectively followed by thyroid-stimulating hormone (TSH), triiodothyronine and thyro- xine (FT3, FT4) and anti-thyroid antibodies (Abs) measurement [28]. The incidence of thyroid dysfunction requiring thyroid hor- mone replacement was 21% (in 80% of these patients, anti

2017 European Society for Medical Oncology

187. Epilepsies: diagnosis and management

for complex or refractory epilepsy 37 1.11 Psychological interventions 39 1.12 Ketogenic diet 39 1.13 Vagus nerve stimulation (VNS) 40 1.14 Prolonged or repeated seizures and convulsive status epilepticus 40 1.15 Women and girls with epilepsy 43 1.16 Children, young people and adults with learning disabilities (see also sections 1.15 and 1.17) 48 Epilepsies: diagnosis and management (CG137) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice (...) (CG137) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 17 of 981.6 Investigations 1.6.1 Information should be provided to children, young people and adults and families and/or carers as appropriate on the reasons for tests, their results and meaning, the requirements of specific investigations, and the logistics of obtaining them. [2004] [2004] 1.6.2 All investigations for children should be performed in a child

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

188. Xadago - safinamide

107 Assessment report EMA/CHMP/393951/2014 Page 4/118 2.9. Pharmacovigilance 107 2.10. Risk Management Plan 107 2.11. Product information 112 2.11.1. User consultation 112 3. Benefit-Risk Balance 113 4. Recommendations 117 Assessment report EMA/CHMP/393951/2014 Page 5/118 List of abbreviations AADC Aromatic L-amino-acid decarboxylase ACTH Adrenocorticotrophic hormone ADL Activities of Daily Living A:G Albumin:Globulin ALDH Aldehyde dehydrogenase ASMF Active substance master file AUC Area under (...) , and ? A stable dose of L-dopa alone or in combination with other PD medications in mid- to late-stage fluctuating patients The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that safinamide was considered to be a new active substance. The application submitted is composed of administrative information, complete quality data, non-clinical and clinical data based on applicants’ own tests and studies

2015 European Medicines Agency - EPARs

189. Cariprazine HCl (Vraylar)

the following: 1. If DPP makes a final determination for approval, the division should consider labeling the possibility of adrenal hypofunction. 2. Consideration should be given to postmarketing enhanced pharmacovigilance of adrenal insufficiency. 3. If the cariprazine is approved, a post-marketing study should include baseline and periodic online adrenal function evaluations. In an ideal situation, the test of choice at baseline includes a 250 mcg ACTH stimulation test along with a morning, fasting ACTH (...) level, electrolyte panel and plasma rennin activity in all patients. If this is not feasible in a large trial, another option would be checking a morning fasting cortisol instead of conducting an ACTH stimulation test. In this scenario, all participants with a morning, fasting cortisol level = 3 mcg/dL should undergo the ACTH stimulation test to confirm the diagnosis of adrenal insufficiency. Participants with a morning, fasting, cortisol level of = 18 mcg/dl are adrenally sufficient and do not need

2015 FDA - Drug Approval Package

190. Corluxin - mifepristone

overview and discussion 8 3.1. Quality aspects 8 3.2. Non clinical aspects 8 3.3. Clinical aspects 13 4. Orphan medicinal products 36 5. Benefit risk assessment 36 Corluxin Withdrawal assessment report EMA/235012/2015 Page 3/42 LIST OF ABBREVIATIONS ??QTcI QTc based on an individual correction AAG a1-acid glycoprotein ACTH Adrenocorticotropic hormone ADR Adverse Drug Reactions AE Adverse Event ALT Alanine Aminotransferase AST Aspartate Aminotransferase AUC Area Under Curve BCRP Breast cancer resistant (...) chemistry, and urinalysis) and electrocardiograms (ECGs). Thyroid status was evaluated by thyroid stimulating hormone (TSH) and free thyroxine (T4). ACTH, serum cortisol, nocturnal salivary cortisol, and 24- hour urinary free cortisol (UFC) were measured throughout the study. Subjects with pituitary- based disease had magnetic resonance imaging (MRI) to monitor for the development of pituitary enlargement. Women with an intact uterus underwent transvaginal ultrasound and endometrial biopsies (biopsies

2015 European Medicines Agency - EPARs

191. Guideline on the management of premature ovarian insufficiency

) antibodies should be performed in women with POI of unknown cause or if an immune disorder is suspected. In patients with a positive TPO-Ab test, thyroid stimulating hormone (TSH) should be measured every year. C 10 There is insufficient evidence to recommend routinely screening POI women for diabetes. D There is no indication for infection screening in women with POI. D The possibility of POI being a consequence of a medical or surgical intervention should be discussed with women as part (...) Interventions for improving quality of life in women with POI 87 10. Sexual and genito-urinary function in women with POI 91 10.1 POI and consequences for sexuality 91 10.2 Interventions for sexuality in POI 93 10.3 Genito-urinary symptoms in POI 95 11. Neurological function in women with POI 99 11.1 POI and consequences for neurological function 99 11.2 Interventions for improving neurological function in POI 101 12. Hormone replacement therapy 107 12.1. Indications for HRT 107 12.2 Risks of HRT 109 12.2

2015 European Society of Human Reproduction and Embryology

192. Acute pain management: scientific evidence (3rd Edition)

obtained from case series, either post-test or pre-test and post-test Clinical practice points ? Recommended best practice based on clinical experience and expert opinion Key messages Key messages for each topic are given with the highest level of evidence available to support them, or with a symbol indicating that they are based on clinical experience or expert opinion. In the key messages, Level I evidence from the Cochrane Database is identified. Levels of evidence were documented according (...) anaesthetics 204 7.5.5 Safety 205 References 208 8. NON-PHARMACOLOGICAL TECHNIQUES 225 8.1 Psychological interventions 225 8.1.1 Provision of information 225 8.1.2 Stress and tension reduction 226 8.1.3 Attentional techniques 227 8.1.4 Cognitiv e-behavioural interventions 228 8.2 Transcutaneous electrical nerve stimulation 230 8.3 Acupuncture 231 8.4 Other physical therapies 232 8.4.1 Manual and massage therapies 232 8.4.2 Heat and cold 232 8.4.3 Other therapies 232 References 233 Acute Pain Management

2015 National Health and Medical Research Council

193. Clinical and biochemical factors to predict biochemical adrenal insufficiency in hospitalized patients with indeterminate cortisol levels: a retrospective study. Full Text available with Trip Pro

Clinical and biochemical factors to predict biochemical adrenal insufficiency in hospitalized patients with indeterminate cortisol levels: a retrospective study. Adrenal insufficiency (AI) in hospitalized patients is a fatal condition if left undiagnosed. Most patients may require an adrenocorticotropic hormone (ACTH) stimulation test to facilitate AI diagnosis. We aim to identify simple biochemical and clinical factors and derive a predictive model to help identify hospitalized patients (...) with biochemical AI who have indeterminate 0800 h serum cortisol levels.A seven-year retrospective study was performed in a tertiary care medical center. We identified 128 inpatients who had undergone low-dose or high-dose ACTH stimulation tests. The association between biochemical AI and other factors was evaluated using a logistic regression model clustering by ACTH dose. Stepwise regression analysis was used to demonstrate the predictive model. Diagnostic performance was evaluated using ROC analysis.Of

2020 BMC Endocrine Disorders

194. Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report. Full Text available with Trip Pro

/follicle-stimulating hormone, and growth hormone, and magnetic resonance imaging showed an empty sella turcica. However, secretion ability of adrenocorticotropic hormone was retained. At 63 years of age, respiratory function tests confirmed a markedly restricted ventilation disorder (vital capacity, 0.54 L; percentage predicted vital capacity, 26.9%). Renal function had also decreased (eGFR, 25.0 mL/min/1.73 m2). Furthermore, she was diagnosed with hypothalamic secondary hypoadrenocorticism (...) to development of other anterior pituitary hormone deficiencies have been reported to be 6.4-9.4 years. On the other hand, adult patients affected by childhood-onset GHD reportedly develop impaired ventilation function due to reduced lung volumes and respiratory pressures, probably due to reductions in respiratory muscle strength. In addition, GH is known to play a role in stimulating the glomerular filtration rate (GFR), and the estimated GFR (eGFR) is decreased in patients with GHD.This case involved a 65

2020 BMC Endocrine Disorders

195. Pregnancy-induced Cushing's syndrome with an adrenocortical adenoma overexpressing LH/hCG receptors: a case report. Full Text available with Trip Pro

clinical features. Adrenocorticotropic hormone (ACTH)-independent CS was diagnosed based on undetectable ACTH and unsuppressed cortisol levels by dexamethasone. Magnetic resonance imaging (MRI) scanning without contrast revealed a left adrenal nodule while pituitary MRI scanning was normal. A conservative treatment strategy of controlling Cushingoid comorbidities was conducted. At 36 weeks GA, a caesarean operation was performed and a live female infant was delivered. At 8 weeks after parturition, our (...) patient achieved normalization of blood pressure, blood glucose, serum potassium, and urinary cortisol level spontaneously. During non-pregnancy period, stimulation testing with exogenous hCG significantly evoked a cortisol increase. The woman underwent resection of the adrenal tumor at 6 months after parturition. Immunohistochemistry (IHC) showed the tumor tissue that stained positive for luteinizing hormone (LH)/human choriogonadotropin (hCG) receptor (LHCGR), whereas negative for both melanocortin

2020 BMC Endocrine Disorders

196. A case report and literature review: Identification of a novel AIRE gene mutation associated with Autoimmune Polyendocrine Syndrome Type 1 in East Asians. Full Text available with Trip Pro

revealed a novel homozygous mutation c.47C>G (p.T16R) in exon 1 in the autoimmune regulator (AIRE) gene.This patient underwent replacement therapy of glucocorticoids, corticosteroid, and levothyroxine, as well as calcium and calcitriol supplementation.He continues to do well 4 years after his hospitalization. During his last follow-up, he had serum thyroid-stimulating hormone level of 3.07 μIU/mL, free triiodothyronine level of 1.92 pg/mL, and free thyroxine level of 13.95 pg/mL. His serum cortisol (...) admitted due to a 1-month history of intermittent fatigue, nausea, vomiting, and diarrhea. His symptom became worse accompanied with chest tightness 4 days before admission. On physical examination, his temperature was 38.5°C, blood pressure was 75/38 mm Hg, and pulse was 98/min. He was a thin boy with mild hyperpigmentation and xanthochromia.After abdominal computed technology and laboratory tests, his diagnosis was APS-1 accompanied with adrenal crisis. Further investigation on whole-exome sequencing

2020 Medicine

197. Adrenal Insufficiency in Children With Eosinophilic Esophagitis Treated With Topical Corticosteroids. (Abstract)

1, a survey about screening practices for AI in children with EoE on TCS was sent to gastroenterologists belonging to a PedsGI listserv and to EoE consortia. In part 2, children with EoE on TCS for ≥6 months were prospectively screened for AI with MSC levels. For subjects with a MSC level of <10 μg/dL, a repeat MSC level and/or confirmatory adrenocorticotropic hormone (ACTH) stimulation testing was offered. AI was defined by peak serum cortisol level <18 μg/dL. In part 3, DHEA-S levels were (...) drawn with MSC levels.Seven percent (16/238) of gastroenterologists screened for AI. Providers in EoE consortia were more likely to screen than nonconsortia providers [9/21(43%) vs 7/217(3%); P = 0.0001]. Thirty-seven children were prospectively screened for AI, and 51% (19/37) had a low MSC level. Ten patients had a low-dose ACTH stimulation test (LDST) after 1 or more low MSC levels. Five percent (2/37) of patients were diagnosed with AI. DHEA-S and MSC levels had a moderate correlation (rs = 0.44

2020 Journal of Pediatric Gastroenterology and Nutrition

198. Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ®): Health Professional Version

secretin stimulation testing and/or intraoperative ultrasonography may also be useful.[ , ] Preoperative assessment using a combination of various biochemical and imaging modalities, intraoperative assessment of tumor burden, and resolution of hormonal hyper-secretion are critical and, in some series, have been associated with higher cure rates and longer disease-free intervals.[ - ] In the current era of effective treatment for hyperfunctional hormone excess states, most MEN1-related deaths are due (...) genes. Surveillance recommendations include regular screening for both endocrine and nonendocrine manifestations of disease. Surgical management of and in MEN1 is based on disease presentation and management of symptoms of the organ. Surgical management of of MEN1 is more specific to preventing disease progression. The decision to operate on is based on hormonal hypersecretion and symptomatology. has been shown to reduce the incidence of persistent or recurrent disease in MEN2 patients who had

2018 PDQ - NCI's Comprehensive Cancer Database

199. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

. Inherent tissue sensitivities and capacity for normal tissue repair. Hormonal milieu. Function of organs not affected by cancer treatment. Socioeconomic status. Health habits. Resources to Support Survivor Care Risk-based screening The need for long-term follow-up for childhood cancer survivors is supported by the American Society of Pediatric Hematology/Oncology, the International Society of Pediatric Oncology, the American Academy of Pediatrics, the Children’s Oncology Group (COG), and the Institute (...) receiving care that focused on their previous cancer (survivor-focused care).[ ] 17.8% reported receiving survivor-focused care that included advice about risk reduction and discussion or ordering of screening tests.[ ] Surveillance for new cases of cancer was very low in survivors at the highest risk of colon, breast, or skin cancer, suggesting that survivors and their physicians need education about the risk of subsequent neoplasms and recommended surveillance.[ ] Sociodemographic factors have been

2018 PDQ - NCI's Comprehensive Cancer Database

200. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

Evaluation Initial evaluation of a child or adolescent with a thyroid nodule includes the following: Ultrasound of the thyroid. Serum thyroid-stimulating hormone (TSH) level. Serum thyroglobulin level. Tests of thyroid function are usually normal, but thyroglobulin can be elevated. Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[ ] Treatment of Papillary and Follicular Thyroid Carcinoma Treatment (...) , further evaluation and treatment with radioactive iodine may need to be delayed for 2 to 3 months until total body iodine burden decreases. Chest imaging (x-ray or CT) may be considered for patients with substantial cervical lymph node disease. Thyroid nuclear scintigraphy should be pursued only if the patient presents with a suppressed thyroid-stimulating hormone (TSH). The routine use of bone scan or fluorine F 18-fludeoxyglucose positron emission tomography (PET) is not recommended. Surgery

2018 PDQ - NCI's Comprehensive Cancer Database

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