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1.
Reprod Sci ; 27(10): 1839-1847, 2020 10.
Article in English | MEDLINE | ID: mdl-32572832

ABSTRACT

Some chronic pain conditions and comorbidities suppress the hypothalamic-pituitary-adrenal (HPA) axis and response to dynamic testing. We measured HPA axis responses to corticotropin-releasing hormone (CRH) administration in relation to chronic pelvic pain and endometriosis. In a cross-sectional study of women (n = 54) with endometriosis-associated chronic pelvic pain (n = 22), chronic pelvic pain alone (n = 12), or healthy volunteers (n = 20), adrenocorticotropic-releasing hormone (ACTH) and cortisol levels were measured at 0, 15, 30, and 45 min after intravenous ovine CRH administration. ACTH and cortisol delta (peak-baseline) and area under the curve (AUC) were compared by study group and assessed for association with race and menstrual and non-menstrual pain severity. HPA axis responses did not differ among the racially diverse groups or in those with pain compared with healthy volunteers. However, when stratified by race, ACTH delta (129.9 ± 130.7 vs. 52.5 ± 66.0 pg/mL; p = 0.003), ACTH AUC (4813 ± 4707 vs. 2290 ± 2900 min*pg/mL; p = 0.013), and cortisol delta (26.3 ± 21.5 vs. 13.2 ± 9.7 µg/mL; p = 0.005) were significantly higher in black (n = 10) than predominately white (non-black) subjects (n = 44; 39/44 white). In analyses among primarily white (non-black) women, greater menstrual pain severity was associated with blunted ACTH delta (p = 0.015) and cortisol delta (p = 0.023), and greater non-menstrual pain severity with blunted cortisol delta (p = 0.017). Neuroendocrine abnormalities in women with chronic pelvic pain may differ by pain manifestations and may vary by race. The higher HPA axis response in black women merits investigation in pelvic pain studies stratified by race. In white (non-black) women experiencing pain, a blunted response was related to pain severity suggesting pain affects women independently of endometriosis lesions.


Subject(s)
Adrenocorticotropic Hormone/blood , Chronic Pain/blood , Endometriosis/blood , Hydrocortisone/blood , Hypothalamo-Hypophyseal System/physiopathology , Pelvic Pain/blood , Pituitary-Adrenal System/physiopathology , Adult , Chronic Pain/etiology , Chronic Pain/physiopathology , Corticotropin-Releasing Hormone/pharmacology , Cross-Sectional Studies , Endometriosis/complications , Endometriosis/physiopathology , Female , Humans , Hypothalamo-Hypophyseal System/drug effects , Middle Aged , Pelvic Pain/etiology , Pelvic Pain/physiopathology , Pituitary-Adrenal System/drug effects , Young Adult
2.
J Fam Pract ; 68(6): 334-340, 2019.
Article in English | MEDLINE | ID: mdl-31381621

ABSTRACT

Failure to control these dermatologic changes can lead to lower dosages of cancer agents or an interrupted course of Tx. These steps can help you to head off trouble.


Subject(s)
Antineoplastic Agents/adverse effects , Drug Eruptions/etiology , Molecular Targeted Therapy/adverse effects , Drug Eruptions/complications , Drug Eruptions/therapy , ErbB Receptors/antagonists & inhibitors , Humans , Neoplasms/drug therapy , Stomatitis/chemically induced , Stomatitis/complications , Stomatitis/therapy
3.
Pediatr Diabetes ; 12(1): 50-7, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20456085

ABSTRACT

Type 2 diabetes in youth was almost unheard of only two decades ago. However, tracking the recent dramatic rise in childhood obesity, type 2 diabetes has become increasingly prevalent. Thus, there is an urgent need for high-quality clinical trials to increase in-depth knowledge about pathophysiology, optimal treatment, and prevention. We therefore systematically reviewed published and ongoing clinical trials of type 2 diabetes in children and adolescents. The results demonstrate that (i) few randomized clinical trials have been completed and published in children with type 2 diabetes; (ii) ongoing trials in type 1 diabetes clearly outnumber trials in type 2 diabetes; and (iii) recruitment and enrollment into the latter trials are challenging, however once achieved, drop-out rates are not excessively high. We conclude that type 2 diabetes in youth is an important but difficult new field of clinical research, and we discuss the existing barriers to successful recruitment, conduct, and support of these clinical trials.


Subject(s)
Clinical Trials as Topic , Diabetes Mellitus, Type 2/drug therapy , Adolescent , Child , Humans , Patient Selection , Risk Factors
4.
Fertil Steril ; 94(5): 1627-31, 2010 Oct.
Article in English | MEDLINE | ID: mdl-19945097

ABSTRACT

OBJECTIVE: To assess the prevalence of patient-reported, physician-diagnosed comorbid conditions in women with endometriosis. DESIGN: Cross-sectional study of self-reported survey data. SETTING: Academic research. PATIENT(S): Four thousand three hundred thirty-one Endometriosis Association (EA) members reporting surgically diagnosed endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Self-reported, physician-diagnosed infectious diseases, cancers, and endocrine diseases. RESULT(S): Nearly two-thirds of women reported one or more of the assessed conditions. Recurrent upper respiratory infections and recurrent vaginal infections were common and more likely in women responding to the EA survey. Melanoma was reported by 0.7% (n=29), breast cancer by 0.4% (n=16), and ovarian cancer by 0.2% (n=10). While ovarian cancer and melanoma were significantly more common than in the general population, breast cancer was surprisingly less common. Addison's disease and Cushing's syndrome were rare (0.2% and 0.1%, respectively). CONCLUSION(S): Respondents reported a higher prevalence of recurrent upper respiratory or vaginal infections, melanoma, and ovarian cancer than the general population. These findings document other potential associations related to the immune system, which may help focus future research into this disease.


Subject(s)
Endocrine System Diseases/epidemiology , Endometriosis/epidemiology , Melanoma/epidemiology , Ovarian Neoplasms/epidemiology , Respiratory Tract Infections/epidemiology , Uterine Diseases/epidemiology , Vaginal Diseases/epidemiology , Addison Disease/epidemiology , Adolescent , Adult , Aged , Comorbidity , Congenital Abnormalities/epidemiology , Cross-Sectional Studies , Cushing Syndrome/epidemiology , Endometriosis/surgery , Female , Humans , Middle Aged , Mitral Valve Prolapse/epidemiology , Prevalence , Recurrence , Self Disclosure , Skin Neoplasms/epidemiology , Uterine Diseases/surgery , Young Adult
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