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1.
Minerva Endocrinol ; 40(1): 37-51, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25411807

ABSTRACT

Obesity is now a major international health concern. It is increasingly common in young women with reproductive, metabolic and psychological health impacts. Reproductive health impacts are often poorly appreciated and include polycystic ovary syndrome (PCOS), infertility and pregnancy complications. PCOS is the most common endocrine condition in women and is underpinned by hormonal disturbances including insulin resistance and hyperandrogenism. Obesity exacerbates hormonal and clinical features of PCOS and women with PCOS appear at higher risk of obesity, with multiple underlying mechanisms linking the conditions. Lifestyle intervention is first line in management of PCOS to both prevent weight gain and induce weight loss; however improved engagement and sustainability remain challenges with the need for more research. Medications like metformin, orlistat, GLP1 agonists and bariatric surgery have been used with the need for large scale randomised clinical trials to define their roles.


Subject(s)
Obesity/complications , Polycystic Ovary Syndrome/complications , Adipokines/physiology , Bariatric Surgery , Combined Modality Therapy , Comorbidity , Diet, Reducing , Exercise Therapy , Female , Glucagon-Like Peptide 1/agonists , Gonadal Steroid Hormones/physiology , Humans , Hyperandrogenism/etiology , Hyperandrogenism/physiopathology , Inflammation , Insulin Resistance , Lactones/therapeutic use , Life Style , Metformin/therapeutic use , Models, Biological , Motivation , Obesity/epidemiology , Obesity/physiopathology , Obesity/psychology , Obesity/surgery , Obesity/therapy , Obesity, Abdominal/physiopathology , Orlistat , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/epidemiology , Polycystic Ovary Syndrome/physiopathology , Polycystic Ovary Syndrome/psychology , Prevalence , Sympathetic Nervous System/physiopathology , Weight Loss
2.
BMJ Case Rep ; 20142014 Oct 19.
Article in English | MEDLINE | ID: mdl-25331146

ABSTRACT

A 90-year-old man was transferred to a geriatric evaluation and management (GEM) unit for management of hypoactive delirium following a pneumonia and acute myocardial infarction complicated by septic shock. He was found to have central hypothyroidism and hypoadrenalism leading to the diagnosis of hypopituitarism. Cerebral imaging confirmed this was secondary to a pituitary haemorrhage. This case illustrates the complexity of assessment of delirium and its aetiologies. Hypoactive forms of delirium in particular can be difficult to detect and therefore remain undiagnosed. While this patient's delirium was likely multifactorial, his hypopituitary state explained much of his hypoactivity. His drowsiness, bradycardia, hypotension and electrolyte imbalance provided clinical clues to the diagnosis.


Subject(s)
Delirium/etiology , Hypopituitarism/complications , Hypopituitarism/diagnosis , Adrenal Insufficiency/drug therapy , Adrenal Insufficiency/etiology , Aged, 80 and over , Hormone Replacement Therapy , Humans , Hypopituitarism/drug therapy , Hypothyroidism/drug therapy , Hypothyroidism/etiology , Male , Pituitary Hormones/therapeutic use , Thyroid Hormones/therapeutic use
3.
Intern Med J ; 44(8): 720-6, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24909750

ABSTRACT

Polycystic ovary syndrome (PCOS) is a prevalent, chronic and heterogeneous endocrine condition, with reproductive, metabolic and psychological features. Insulin resistance and hyperandrogenaemia are the key pathophysiological hormonal abnormalities. Insulin resistance is a significant contributor to the reproductive and metabolic complications of PCOS, both independently and in the setting of excess bodyweight. While the diagnostic criteria are now internationally uniformly accepted, individual components of the criteria are ill-defined, making diagnosis challenging. This, along with low awareness of PCOS, has resulted in a significant proportion of women remaining undiagnosed. While reproductive features are best recognised in PCOS and form the basis of the diagnostic criteria, awareness of psychological and metabolic features, recommended screening protocols, and management strategies to prevent metabolic complications are important. In this review, we focus on diagnostic criteria, and reproductive, metabolic and psychological features of PCOS, as well as recommended screening and management strategies suggested by national and international evidence-based guidelines.


Subject(s)
Clinical Competence , Insulin Resistance , Metabolic Syndrome/complications , Polycystic Ovary Syndrome , Female , Global Health , Humans , Metabolic Syndrome/metabolism , Polycystic Ovary Syndrome/epidemiology , Polycystic Ovary Syndrome/etiology , Polycystic Ovary Syndrome/metabolism , Prevalence
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