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Cushing Response

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181. Testosterone Testing - Protocol

for the investigation and diagnosis of female hyperandrogenism is beyond the scope of this document. Indications for urgent or non-urgent referral are outlined in Table 2 below. Monitoring Response to Treatment in Women Women receiving treatment for hyperandrogenism: Response to treatment of hyperandrogenism in women is clinical. Therefore, testing serum total testosterone and cBAT in patients treated for hyperandrogenism is not recommended unless a concrete cause has been identified, such as non-classical (...) . Men Women , Confirmed or suspected: Hypothalamic/pituitary tumour* Hyperprolactinemia* Hemochromatosis Idiopathic hypogonadotropic hypogonadism Cryptorchidism, anorchia Genetic conditions including Klinefelter syndrome, Kallmann syndrome, myotonic dystrophy Male factor infertility Confirmed or suspected: Rapid virilisation/rapid hair loss* Symptoms consistent androgen-secreting tumour of adrenal or ovarian origin* Cushing syndrome* Acromegaly* Congenital adrenal hyperplasia (CAH) Polycystic ovary

2019 Clinical Practice Guidelines and Protocols in British Columbia

182. Covid-19: Clinical guide to surgical prioritisation during the coronavirus pandemic

/mandib ular trauma not responsive to conservative Rx (reduction and IR) Dental Sepsis - not responding to conservative Rx and threatening life/ airway/sight/ brain. Orbital Compartment Syndrome/Mus cle Entrapment - threatening sight Jaw Dislocation - not responding to conservative Rx Reconstructive plastic surgery including burns and hands Major burns - Airway management/ resuscitation/ escharotomies/ amputations/To xic Shock Chemical burns - especially Eye/ Hydrofluoric acid >2%/ Necrotising (...) Major limb trauma reconstruction unsuitable for conservative Rx Urology Upper urinary tract obstruction Renal stones - pain/ impairment not responsive to conservative Rx Penile fracture Infected prosthesis - penile/testicular/ stent T & O Unstable articular fractures that will result in severe disability with conservative Rx Pelvis fractures- unstable Tibial fracture - high energy/displaced, unstable shaft. Fractures - pathological Lower limb frailty fractures (non-hip) - requiring fixation

2020 NHS England

183. Opioid Treatments for Chronic Pain

The purpose of this review is to update the 2014 AHRQ report 7 on opioids for chronic pain. This update includes new evidence for questions covered in the 2014 AHRQ report, including efficacy and harms, comparisons with nonopioid therapies, dosing strategies, dose-response relationships, risk mitigation strategies, discontinuation and tapering of opioid therapy, and population differences. This review is one of three concurrent AHRQ systematic reviews on treating chronic pain; the other reviews address (...) , et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American college of physicians clinical practice guideline. Ann Intern Med. 2017 Apr 04;166(7):480- 92. doi: https://dx.doi.org/10.7326/M16- 2458. PMID: 28192790. 20. Escobar A, Quintana JM, Bilbao A, et al. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007 Mar;15(3):273-80. doi: 10.1016/j.joca.2006.09.001. PMID: 17052924. 21

2020 Effective Health Care Program (AHRQ)

184. American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases

Michael D. Lockshin, 1 Wendy Marder, 6 Gordon Guyatt, 7 D. Ware Branch, 8 Jill Buyon, 9 Lisa Christopher-Stine, 10 Rachelle Crow-Hercher, 11 John Cush, 12 Maurice Druzin, 13 Arthur Kavanaugh, 4 Carl A. Laskin, 14 Lauren Plante, 15 Jane Salmon, 1 Julia Simard, 13 Emily C. Somers, 6 Virginia Steen, 16 Sara K. Tedeschi, 17 Evelyne Vinet, 18 C. Whitney White, 19 Jinoos Yazdany, 20 Medha Barbhaiya, 1 Brittany Bettendorf, 21 Amanda Eudy, 5 Arundathi Jayatilleke, 15 Amit Aakash Shah, 22 Nancy Sullivan, 23 (...) of Medicine, New York, New York; 10 Lisa Christopher-Stine, MD, MPH: John Hopkins Medicine, Baltimore, Maryland; 11 Rachelle Crow-Hercher, MEd: Shelby Township, Michigan; 12 John Cush, MD: Baylor Research Institute, Dallas, Texas; 13 Maurice Druzin, MD, Julia Simard, ScD: Stanford Medicine, Stanford, California; 14 Carl A. Laskin, MD: University of Toronto, Toronto, Ontario, Canada; 15 Lauren Plante, MD, MPH, Arundathi Jayatilleke, MD, MS: Drexel University College of Medicine, Philadelphia, Pennsylvania

2020 American College of Rheumatology

185. Overview of brain tumours

, is the most common cause of Cushing's syndrome and is responsible for the majority of cases. Diagnosis is by demonstration of unsuppressed ACTH and subsequent cranial MRI. First-line therapy is generally transsphenoidal surgical resection. Benign prolactin-expressing and secreting pituitary adenoma. It is more frequent in women, mainly during the childbearing years. Gillam MP, Molitch ME, Lombardi G, et al. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27:485-534. http (...) . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697616/?tool=pubmed http://www.ncbi.nlm.nih.gov/pubmed/18226732?tool=bestpractice.com Espinosa de los Monteros AL, Carrasco CA, Albarrán AA, et al. The role of primary pharmacological therapy in acromegaly. Pituitary. 2014;17(suppl 1):4-10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906545/ http://www.ncbi.nlm.nih.gov/pubmed/24166706?tool=bestpractice.com Cushing's disease, which is hypercortisolism caused by an ACTH-secreting pituitary adenoma

2018 BMJ Best Practice

186. Adrenal suppression

endogenous glucocorticoid excess (e.g., Cushing's syndrome after treatment). Even locally administered glucocorticoids may result in adrenal suppression. The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression. Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency. Preventive measures include minimising corticosteroid dose and duration when possible (...) responses to exogenous corticotropin-releasing hormone. N Engl J Med. 1992 Jan 23;326(4):226-30. http://www.nejm.org/doi/full/10.1056/NEJM199201233260403#t=article http://www.ncbi.nlm.nih.gov/pubmed/1309389?tool=bestpractice.com History and exam presence of risk factors sudden cessation or rapid tapering of glucocorticoids hx of weight gain and increased appetite hx of depression, agitation, or sleep disorders hx of easy bruising fatigue, anorexia, or weight loss nausea or vomiting dizziness

2018 BMJ Best Practice

187. Assessment of metabolic alkalosis

alkalosis. This is usually compensated by the kidneys with normal function by renal excretion of bicarbonate. Severe circulating volume contraction. This leads to loss of extracellular fluid and relative increase in bicarbonate concentration. Metabolic alkalosis generally requires an initiation factor that starts the process and a maintenance factor that continues the imbalance by preventing renal excretion of excess HCO3. Sometimes, the same factor may be responsible for both initiation and maintenance (...) administration Milk-alkali syndrome Primary hyperaldosteronism Secondary hyperaldosteronism Renal artery stenosis Cushing's syndrome Liquorice ingestion Tobacco chewing Apparent mineralocorticoid excess Liddle's syndrome Bartter's syndrome Gitelman's syndrome Profound potassium depletion Hypercalcaemia of non-hyperparathyroid aetiology Post-starvation refeeding syndrome Transfusion of blood products (sodium citrate) Villous adenoma Chloride diarrhoea Cystic fibrosis Contributors Authors Professor of Medicine

2018 BMJ Best Practice

188. Assessment of hypokalaemia

. Differentials Vomiting Severe diarrhoea Laxative and bowel cleansing agent use Bulimia nervosa Anorexia nervosa Drug-induced Alcoholism Diabetic ketoacidosis Non-ketotic hyperglycaemia Renal tubular acidosis (RTA) Exercising in a hot climate Stress response in critical illness Villous adenoma VIPoma Ileal loop/conduit with ureteric implants Dialysis or plasmapheresis Primary aldosteronism Apparent mineralocorticoid excess Cushing's syndrome Hypomagnesaemia Hypokalaemic periodic paralysis Central diabetes

2018 BMJ Best Practice

189. Assessment of hypernatraemia

of osmotic equilibrium, intracellular fluid (ICF) becomes volume contracted. The appropriate responses are increased water intake stimulated by thirst, and the excretion of the minimal amount of maximally concentrated urine. Infants and adults with cognitive impairment are most commonly affected because of their inability to express thirst and limited access to water. Hypernatraemia is often the result of several disease processes, and the underlying cause needs to be elicited to correct the sodium (...) is diagnosed in males and females in equal numbers. Differentials Central diabetes insipidus Hyperosmolar hyperglycaemic state (HHS) Nephrogenic diabetes insipidus Severe diarrhoea Vomiting Limited access to water Primary hypodipsia Cushing's syndrome Primary aldosteronism Post-obstructive diuresis Laxative and bowel cleansing agent use Enteric fistulae Diuretics Heat exposure Exercise Fever Severe burns Inadequate breastfeeding of infants Salt ingestion High-protein diet Use of intravenous sodium chloride

2018 BMJ Best Practice

190. Overview of brain tumours

, is the most common cause of Cushing's syndrome and is responsible for the majority of cases. Diagnosis is by demonstration of unsuppressed ACTH and subsequent cranial MRI. First-line therapy is generally transsphenoidal surgical resection. Benign prolactin-expressing and secreting pituitary adenoma. It is more frequent in women, mainly during the childbearing years. Gillam MP, Molitch ME, Lombardi G, et al. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27:485-534. http (...) . http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697616/?tool=pubmed http://www.ncbi.nlm.nih.gov/pubmed/18226732?tool=bestpractice.com Espinosa de los Monteros AL, Carrasco CA, Albarrán AA, et al. The role of primary pharmacological therapy in acromegaly. Pituitary. 2014;17(suppl 1):4-10. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906545/ http://www.ncbi.nlm.nih.gov/pubmed/24166706?tool=bestpractice.com Cushing's disease, which is hypercortisolism caused by an ACTH-secreting pituitary adenoma

2018 BMJ Best Practice

191. Assessment of hirsutism

=bestpractice.com Hair response to androgens varies from person to person and includes increase in follicle size, fibre diameter, and the amount of time spent in anagen (the growth-cycle phase). Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med. 2005 Dec 15;353(24):2578-88. http://www.ncbi.nlm.nih.gov/pubmed/16354894?tool=bestpractice.com Messenger AG. The control of hair growth: an overview. J Invest Dermatol. 1993 Jul;101(suppl 1):4S-9S. http://www.ncbi.nlm.nih.gov/pubmed/8326154?tool=bestpractice.com (...) , Bartolucci AA, et al. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab. 2006 Apr;91(4):1345-50. http://jcem.endojournals.org/cgi/content/full/91/4/1345 http://www.ncbi.nlm.nih.gov/pubmed/16449347?tool=bestpractice.com Differentials Polycystic ovary syndrome Idiopathic hirsutism Hyperprolactinaemia Non-classic congenital adrenal hyperplasia Cushing's syndrome (benign) Androgenic medications Androgen

2018 BMJ Best Practice

192. Assessment of hirsutism

=bestpractice.com Hair response to androgens varies from person to person and includes increase in follicle size, fibre diameter, and the amount of time spent in anagen (the growth-cycle phase). Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med. 2005 Dec 15;353(24):2578-88. http://www.ncbi.nlm.nih.gov/pubmed/16354894?tool=bestpractice.com Messenger AG. The control of hair growth: an overview. J Invest Dermatol. 1993 Jul;101(suppl 1):4S-9S. http://www.ncbi.nlm.nih.gov/pubmed/8326154?tool=bestpractice.com (...) , Bartolucci AA, et al. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab. 2006 Apr;91(4):1345-50. http://jcem.endojournals.org/cgi/content/full/91/4/1345 http://www.ncbi.nlm.nih.gov/pubmed/16449347?tool=bestpractice.com Differentials Polycystic ovary syndrome Idiopathic hirsutism Hyperprolactinaemia Non-classic congenital adrenal hyperplasia Cushing's syndrome (benign) Androgenic medications Androgen

2018 BMJ Best Practice

193. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

to get better instantly. Their most acute need is appropriate reas- surance that their disorder has been recognised and that help will be forthcoming. Initial treatment should be selected in collaboration with the patient, based on the severity of the disorder, previous response to treatment, availability and the person’s preference. It will usually take 4–6 weeks to see improvement, whether cognitive–behavioural therapy (CBT) or an antide- pressant is used, and most people can tolerate this. Only (...) . Overview of the management of anxiety disorders. CBT: cognitive–behavioural therapy. CBT can be delivered face-to-face by an experienced clinician or as guided digital CBT. dCBT: guided digital CBT (CBT accessed by computer, tablet or smartphone application). §Watchful waiting includes monitoring response to psychoeducation and lifestyle measures. *For the purpose of initial treatment choice, mild, moderate and severe are defined pragmatically, according to effect on function, as inability to perform

2018 Royal Australian and New Zealand College of Psychiatrists

194. Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

, with further evaluation in patients with amenorrhea and more severe clinical features including consideration of hypogonadotropic hypogonadism, Cushing disease or androgen-producing tumours. The guideline recognises that PCOS is an insulin-resistant and metabolic disorder; tests for insulin resistance, however, lack accuracy and should not be incorporated into the diagnostic criteria for PCOS at this time. Anti-Müllerian hormone is likewise not recommended for diagnosis at this time. Complication screening (...) . Ngaanyatjarra Health Service, Dec 2006. (viewed Aug 2018). Kildea S, Bowden FJ. Reproductive health, infertility and sexually transmitted infections in Indigenous women in a remote community in the Northern Territory. Aust N Z J Public Health 2000; 24: 382-386. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted. Author Salutation First Name Middle Name Last Name

2018 MJA Clinical Guidelines

195. ESC/ESH Management of Arterial Hypertension Full Text available with Trip Pro

Vascular endothelial growth factor WUCH White-coat uncontrolled hypertension 1 Preamble Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health (...) and coordinates the preparation of new Guidelines. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts, and in this case by ESH -appointed experts. After appropriate revisions the Guidelines are approved by all the experts involved in the Task Force. The finalized document is approved by the CPG and ESH for publication in the European Heart Journal and in the Journal of Hypertension as well as Blood

2018 European Society of Cardiology

196. International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

pharmacological agents 97 4.7 Inositol 99 Chapter Five Assessment and treatment of infertility 100 5.1a Assessment of factors that may affect fertility, treatment response or pregnancy outcomes 101 5.1b Tubal patency testing 103 5.2 Ovulation induction principles 104 5.3 Letrozole 105 5.4 Clomiphene citrate and/or metformin 107 5.5 Gonadotrophins 110 5.6 Anti-obesity agents 112 5.7 Laparoscopic ovarian surgery 113 5.8 Bariatric surgery 115 5.9a In-vitro fertilisation 117 5.9b Gonadotropin releasing hormone (...) with amenorrhea and more severe clinical features including consideration of hypogonadotropic hypogonadism, Cushing’s disease, or androgen producing tumours. We acknowledge the challenges in defining specific diagnostic features, including around menarche and menopause, where diagnostic features naturally evolve. The guideline aims to facilitate timely and appropriate diagnosis for women with PCOS, whilst avoiding over diagnosis, especially in adolescents. Specific recommendations of relevance here include

2018 European Society of Human Reproduction and Embryology

197. Budesonide (Jorveza) - to treat adults with eosinophilic oesophagitis

38 2.4.5. Conclusions on clinical pharmacology 40 2.5. Clinical efficacy 40 2.5.1. Dose response study 40 2.5.2. Main study(ies) 42 2.5.3. Discussion on clinical efficacy 59 2.5.4. Conclusions on the clinical efficacy 63 2.6. Clinical safety 64 2.6.1. Discussion on clinical safety 70 2.6.2. Conclusions on the clinical safety 72 2.7. Risk Management Plan 73 2.8. Pharmacovigilance 75 Assessment report EMA/774645/2017 Page 4/83 2.9. Product information 75 2.9.1. User consultation 75 3. Benefit-Risk (...) -double blind PPI Proton pump inhibitor PPI-REE Proton pump inhibitor-responsive oesophageal eosinophilia PRA Patient’s Response Assessment PRO Patient reported outcome PT Preferred term QoL Quality of life R Reference dose RCI Repeated confidence interval RH Relative Humidity SAE Serious adverse event SAF Safety set Scr 2 Screening visit 2 SD Standard deviation SmPC Summary of Product Characteristics SOC System Organ Class TAMC Total Aerobic Microbial Count TEAE Treatment-emergent adverse event TLC

2018 European Medicines Agency - EPARs

198. Screening and Management of the Hyperandrogenic Adolescent

before menarche. Once initiated, patients should be coun- seled that it may take 6 months before they see the benefits of treatment. c Any estrogen-containing therapy should be effective at reducing acne, and oral contraceptive pills (OCPs)particularlyareeffectiveforadolescentswho report premenstrual acne flare-ups. c Patients should be assessed at routine intervals (every 3–6 months) for adverse effects and response to treatment until their condition is stable; they then should be monitored annually (...) hyperandrogenism of puberty, idiopathic hyperandrogenism, and PCOS. Other lesscommonpotentialcausesofhyperandrogenisminclude nonclassic congenital adrenal hyperplasia, androgen- secreting tumors, hypothyroidism, Cushing disease, and severe hyperprolactinemia. The diagnosis of hyperandrogenism can be based on clinical symptoms or measurement of serum androgens. In females, androgens originate from three primary sources: (1) the ovarian theca, (2) the adrenal cortex, and (3) within end organs by peripheral

2019 American College of Obstetricians and Gynecologists

199. Sudden Hearing Loss Full Text available with Trip Pro

obtain, or refer to a clinician who can obtain, audiometry as soon as possible (within 14 days of symptom onset) to confirm the diagnosis of sudden sensorineural hearing loss. (KAS 6) Clinicians should evaluate patients with sudden sensorineural hearing loss for retrocochlear pathology by obtaining magnetic resonance imaging or auditory brainstem response. (KAS 10) Clinicians should offer, or refer to a clinician who can offer, intratympanic steroid therapy when patients have incomplete recovery from (...) is emphasized. KAS 5—New studies were added to confirm the lack of benefit of nontargeted laboratory testing in sudden sensorineural hearing loss. KAS 6—Audiometric follow-up is excluded as a reasonable workup for retrocochlear pathology. Magnetic resonance imaging, computerized tomography scan if magnetic resonance imaging cannot be done, and, secondarily, auditory brainstem response evaluation are the modalities recommended. A time frame for such testing is not specified, nor is it specified which

2019 American Academy of Otolaryngology - Head and Neck Surgery

200. Management of Cardiac Disease in Cancer Patients Throughout Oncological Treatment: ESMO Consensus Recommendations

therapy needs to be individualised with multidisciplinary discussion considering the cancer sta- tus, response to prior therapy, severity of cardiotoxicity, regression of toxicity with immunosuppressive therapy and patientpreferenceafterweighingtherisksandbene?ts.IfICI therapy needs to be restarted, monotherapy with an anti- Annals of Oncology G. Curigliano et al. 184 https://doi.org/10.1016/j.annonc.2019.10.023 Volume 31 - Issue 2 - 2020programmedcell death protein 1(anti-PD-1) agent might

2020 European Society for Medical Oncology

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