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1.
Cureus ; 14(2): e22322, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35317040

RESUMO

Graves' disease accounts for one of the most common causes of thyrotoxicosis. Most patients with Graves' disease present with classic signs and symptoms of hyperthyroidism. Psychosis and mood symptoms secondary to hyperthyroidism are rare. Here we report the case of a 37-year-old male with a history of Graves' disease with poor medication adherence who presented to the emergency department with psychotic features and hyperexcitability. He had excessive agitation, paranoia, and hyperactivity requiring restraints. He also endorsed insomnia and weight loss. He was admitted to the inpatient unit, and laboratory investigations were significant for a low thyroid-stimulating hormone, and elevated T3, T4, thyroid-stimulating antibodies, and thyroid peroxidase antibodies. The initial assessment was a primary psychiatric illness. The patient never had a personal or family history of psychiatric illness. Psychiatry and endocrinology were consulted for further recommendations. The patient was started on methimazole 30 mg, propranolol 100 mg, and hydrocortisone 100 mg, which resolved his symptoms.

2.
Cureus ; 13(4): e14543, 2021 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-34017658

RESUMO

Introduction The primary receptor for SARS-CoV-2 infection, angiotensin-converting enzyme-2 (ACE-2), is expressed in the gastrointestinal tract and liver parenchyma. The involvement of the gastrointestinal tract with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has remained unclear. The following study retrospectively reviews gastrointestinal symptoms and liver function tests at the time of hospital admission to identify patient outcomes including prolonged hospital stay, the requirement for intensive care, and all-cause in-hospital 30-day mortality. Methods A retrospective review of patient charts at the Woodhull Medical and Mental Health Center (WMC) was conducted at the time of hospital admission, using a pre-determined selection criterion. All adult patients, both inpatient and outpatient, were included from March 2020 till May 2020. A 95% confidence interval was used to estimate the odds ratio (OR) for patient outcomes. Results Of the 520 patients, gastrointestinal symptoms including nausea (OR = 0.375, p = 0.015), and nausea and vomiting in combination (OR = 0.400, p = 0.016) had an inverse protective relationship with all-cause in-hospital 30-day mortality among COVID-19 patients. Gastrointestinal symptoms including diarrhea (OR = 1.008, p < 0.001), and nausea and vomiting (OR = 1.291, p = 0.043) had a mild impact on the length of hospital stay. Conclusion Elevated liver transaminases including alanine transaminase (ALT) and aspartate transaminase (AST) at the time of hospital admission can predict critical care requirement and all-cause 30-day hospital mortality in patients with COVID-19 infection. Presence of gastrointestinal symptoms is associated with worsened outcomes.

3.
Curr Diab Rep ; 19(10): 101, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506836

RESUMO

PURPOSE OF REVIEW: There is a growing, largely inconsistent, literature on the role of vitamin D in association with type 2 diabetes, insulin resistance/insulin secretion, glycemic indices, and complications of type 2 diabetes. Pathophysiologic, bystander, preventive, and treatment roles of vitamin D have all been proposed. In this focused review, we attempt to organize and clarify our current information in this area. RECENT FINDINGS: Clinical study interpretation is difficult because of variability in dosage, dosage form, study duration, and populations studied, as well as recently reported normal human polymorphisms in vitamin D synthesis and catabolism, vitamin D-binding protein, and vitamin D receptors in addition to a host of potential epigenetic confounders. Low vitamin D status appears to be associated with type 2 diabetes and most other insulin resistance disorders reported to date. The extraskeletal benefits of supplementation/repletion in these disorders in our species, with a few highlighted exceptions, remain to be established. This focused review attempts to summarize our current knowledge in this burgeoning area through a review of key meta-analyses, observational studies, randomized control trials, and Mendelian randomization studies and will hopefully serve as a guide to indicate future research directions and current best practice.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Resistência à Insulina/fisiologia , Deficiência de Vitamina D/fisiopatologia , Vitamina D/fisiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/mortalidade , Humanos , Insulina , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/mortalidade
4.
Curr Diab Rep ; 18(10): 92, 2018 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-30171481

RESUMO

PURPOSE OF REVIEW: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have positive effects on weight loss, blood pressure, hyperlipidemia, and glycemic control. They exhibit a broad range of effects on the cardiovascular system that are independent of changes in blood glucose. Cardiovascular outcome trials have demonstrated safety of GLP-1 RAs but results for cardiovascular efficacy were varied. The aim of the present review is the assessment of the effects of GLP-1 RAs on cardiovascular risk factors, and major cardiovascular events. RECENT FINDINGS: Use of GLP-1 RAs was associated with relative risk reduction in cardiovascular mortality and all-cause mortality with no significant differences for the incidence of severe hypoglycemia, pancreatitis, pancreatic cancer, or medullary thyroid cancer when compared to placebo. Although there are differences between individual medications with respect to their effects on cardiovascular events, GLP-1 RAs offer a favorable risk-benefit profile. The present review confirms the cardiovascular safety and efficacy vs placebo of GLP-1 RAs in patients with type 2 diabetes at moderate-to-high atherosclerotic cardiovascular risk without significant side effects. Although professional guidelines recommend metformin as the sole first-line agent, GLP-1 RAs can be used as first-line therapy in individuals with type 2 diabetes who either are intolerant to metformin or have high cardiovascular risk factors.


Assuntos
Sistema Cardiovascular/patologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Biomarcadores/metabolismo , Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Humanos , Fatores de Risco
5.
Case Rep Endocrinol ; 2017: 1869560, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28713602

RESUMO

An elderly woman presented with acne and male pattern alopecia, which upon diagnostic evaluation was found to be due to nonclassic 11-hydroxylase deficiency. We previously reported that Ashwagandha root ameliorates nonclassic 3-ß-ol dehydrogenase and aldosterone synthase deficiencies. This is the first report of its use being associated with amelioration of nonclassic 11-hydroxylase deficiency, where its apparent effects appear to be dose-related.

6.
Curr Diab Rep ; 16(11): 116, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27730517

RESUMO

Heart failure (HF) is a major cardiovascular complication of diabetes mellitus (DM). The greatest risk factor for HF is age, and data indicate that 6 to 10 % of individuals over the age of 65 years suffer from HF. Patients with DM have a 2.5-fold increased risk for developing HF than individuals without DM. The 25 to 40 % of patients with HF who have DM have worse outcome (death from cardiovascular disease or hospitalization for worsening HF) than patients without DM. Hyperglycemia is a risk factor for the development of HF with an increase in incidence of HF rising from 10 % at hemoglobin A1c (HbA1c) 8.0 to 9.0 % to 71 % at a HbA1c > 10 %. Patients with DM and HF are equally distributed between those with low ejection fractions and those with normal ejection fractions. The HF treatment regimens for patients with HF and DM (blockade of angiotensin II synthesis or action, cardioselective ß-adrenergic blockade, mineralocorticoid receptor blockade, and diuretics) are the same as for HF patients without DM, though the benefit on clinical outcomes is not as great. The new angiotensin-neprilysin inhibitors appear to provide increase outcome benefits in both HF patients with or without DM. Glycemic control impacts the clinical outcomes in patients with HF and DM in a U-shaped relationship with poorer survival at low and high mean HbA1c levels. The optimal chronic glycemic control occurs at an HbA1c of 7.5 to 8.0 % for patients with DM who have symptoms of HF.


Assuntos
Complicações do Diabetes/etiologia , Insuficiência Cardíaca/etiologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Hemoglobinas Glicadas/análise , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperglicemia/tratamento farmacológico , Renina/antagonistas & inibidores
7.
BMJ Case Rep ; 20152015 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-26698199

RESUMO

Cortisol production by hepatocellular carcinoma (HCC) has not been previously reported and dehydroepiandrosterone (DHEA) secretion by HCC is rare. We report a case of a 53-year-old woman admitted with dyspnoea and headache. Serum cortisol by immunoassay (IA) was 42.3 µg/dL, urine free cortisol (UFC) by liquid chromatography mass spectrometry (LC/MS/MS) was 106.1 µg/24 h, serum DHEA by LC/MS/MS was 4886 ng/mL, serum DHEA-S by LC/MS/MS was 4477 ng/mL and plasma adrenocorticotrophic hormone (ACTH) by IA was 10 pg/mL. CT showed likely HCC metastatic to the left adrenal gland, brain and lungs. Liver and adrenal gland biopsies confirmed HCC. ACTH tumour staining was negative. High serum and UFC levels and high serum DHEA and DHEA-S with low-normal plasma ACTH and negative tumour ACTH staining suggested ACTH-independent ectopic Cushing's syndrome (CS); cortisol and DHEA being likely secreted by the HCC. To the best of our knowledge, this is the first reported case of HCC associated with CS.


Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Glândulas Suprarrenais/metabolismo , Carcinoma Hepatocelular/metabolismo , Síndrome de Cushing/etiologia , Desidroepiandrosterona/metabolismo , Hidrocortisona/metabolismo , Neoplasias Hepáticas/complicações , Síndrome de ACTH Ectópico/complicações , Neoplasias das Glândulas Suprarrenais/metabolismo , Glândulas Suprarrenais/patologia , Hormônio Adrenocorticotrópico/metabolismo , Biópsia , Neoplasias Encefálicas/secundário , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Cromatografia Líquida , Síndrome de Cushing/sangue , Desidroepiandrosterona/sangue , Feminino , Humanos , Hidrocortisona/sangue , Fígado/patologia , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Espectrometria de Massas em Tandem
9.
Maturitas ; 81(2): 282-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25911245

RESUMO

The rates of long-term diabetes related complications have declined substantially over the past decade. On the contrary, the growth in the incidence of prediabetes is note-worthy - especially in the population 60 years and above. As a result, the focus is now shifting toward early identification and prevention of diabetes. Prediabetes is a high risk state in the continuum of glycemic progression and beta cell dysfunction toward the development of diabetes mellitus. Observational studies have shown association of prediabetes with increased incidence of vascular complications. Long-term prospective randomized clinical trials across the globe have demonstrated a reduction in progression of prediabetes when lifestyle modifications are adopted and these effects can last up to 20 years beyond the period of intervention. While there has been recent interest in using pharmacotherapy for diabetes prevention, they have not been shown to be superior to lifestyle changes. This review hopes to provide a concise summary for the interested reader.


Assuntos
Diabetes Mellitus/prevenção & controle , Estado Pré-Diabético/diagnóstico , Custos e Análise de Custo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Humanos , Estado Pré-Diabético/economia , Estado Pré-Diabético/epidemiologia , Risco
10.
BMJ Case Rep ; 20152015 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-25666246

RESUMO

A 71-year-old woman with type 2 diabetes mellitus, chronic kidney disease stage IV, primary hypothyroidism and osteoarthritis, whose prescribed treatment included miglitol 50 mg thrice daily with the first bite of meals, reported that she suffered visual hallucinations while taking miglitol, which resolved within a few days of stopping the drug. When she resumed miglitol, hallucinations recurred within a few days and again resolved within a few days of stopping the drug. To our knowledge, this is the first reported case of hallucinations associated with the use of an α-glucosidase inhibitor and highlights a previously unappreciated risk associated with the use of this generally quite benign drug class.


Assuntos
1-Desoxinojirimicina/análogos & derivados , Diabetes Mellitus Tipo 2/tratamento farmacológico , Alucinações/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Hipotireoidismo/complicações , Insuficiência Renal Crônica/complicações , 1-Desoxinojirimicina/efeitos adversos , Idoso , Diagnóstico Diferencial , Feminino , Inibidores de Glicosídeo Hidrolases/efeitos adversos , Humanos
11.
Maturitas ; 76(3): 253-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23628280

RESUMO

The increasing prevalence of diabetes especially type 2 diabetes worldwide is indisputable. Diabetics suffer increased morbidity and mortality, compared to their non-diabetic counterparts, not only because of vascular complications, but also because of an increased fracture incidence. Both types 1 and 2 diabetes and some medications used to treat it are associated with osteoporotic fractures. The responsible mechanisms remain incompletely elucidated. In this review, we evaluate the role of glycemic control in bone health, and the effect of anti-diabetic medications such as thiazolidinediones, sulfonylureas, DPP-4 inhibitors, and GLP-1 agonists. In addition, we examine the possible role of insulin and metformin as anabolic agents for bone. Lastly, we identify the current and future screening tools that help evaluate bone health in diabetics and their limitations. In this way we can offer individualized treatment, to the at-risk diabetic population.


Assuntos
Osso e Ossos/efeitos dos fármacos , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/efeitos adversos , Osteoporose/etiologia , Fraturas por Osteoporose/etiologia , Densidade Óssea/efeitos dos fármacos , Humanos , Insulina/farmacologia , Insulina/uso terapêutico , Metformina/farmacologia , Metformina/uso terapêutico , Osteoporose/prevenção & controle , Fraturas por Osteoporose/prevenção & controle
12.
BMJ Case Rep ; 20132013 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-23513016

RESUMO

Non-classic adrenal hyperplasia (NCAH) has been associated with insulin resistance (IR). Therapies such as metformin, thiazolidinediones and lifestyle alterations improve IR and also ameliorate the biochemical and clinical abnormalities of NCAH, much as they do in polycystic ovarian syndrome (PCOS). More recently, bariatric surgery, such as Roux-en-Y gastric bypass (RYGBP), has also been associated with improvement in IR and amelioration of PCOS and may, therefore, be beneficial in NCAH. We report a case of a 39-year-old, deaf-mute, obese woman with NCAH due to 11-hydroxylase deficiency who underwent RYGBP followed by improvement of NCAH manifestations. She was initially treated with metformin and pioglitazone, which lowered serum 11-deoxycortisol from 198 ng/dl (<51) to 26 ng/dl. Five weeks after undergoing RYGBP her body mass index fell from 44.18 kg/m(2) to 39.54 kg/m(2) and, despite not taking metformin or pioglitazone, serum 11-deoxycortisol remained normal at <40 ng/dl. Concurrently and subsequently, her NCAH symptoms, for example, alopecia, hirsutism and irregular menses normalised as well. We conclude that RYGBP, like other interventions that reduce IR, may be another way of treating non-classic 11-hydroxylase deficiency in selected patients.


Assuntos
Hiperplasia Suprarrenal Congênita/cirurgia , Derivação Gástrica , Adulto , Feminino , Humanos
13.
BMJ Case Rep ; 20122012 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-22987912

RESUMO

Congenital adrenal hyperplasia (CAH) is a well-characterised family of disorders of the adrenal cortices, resulting in varying degrees of cortisol, aldosterone and androgen deficiency or androgen excess, depending on the enzyme(s) affected and the degree of quantitative or functional enzyme deficit. Withania somnifera (WS), commonly known as Ashwagandha, is a medicinal plant that has been employed for centuries in ayurvedic medicine. Preclinical studies have shown that WS increases circulating cortisol levels and improves insulin sensitivity. We report the case of a 57-year-old woman with non-classical adrenal hyperplasia due to both 3-ß-ol dehydrogenase deficiency and aldosterone synthase deficiency who was self-treated with WS for 6 months. After 6 months of treatment her serum 18-OH-hydroxycorticoserone, 17-OH-pregnenolone, corticosterone and 11-deoxycortisol decreased by 31%, 66%, 69% and 55%, respectively. The biochemical improvement was accompanied by a noticeable reduction in scalp hair loss.


Assuntos
Hiperplasia Suprarrenal Congênita/tratamento farmacológico , Fitoterapia/métodos , Raízes de Plantas , Withania , 17-alfa-Hidroxipregnenolona/sangue , Hiperplasia Suprarrenal Congênita/sangue , Hiperplasia Suprarrenal Congênita/diagnóstico , Corticosterona/sangue , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Extratos Vegetais
14.
BMJ Case Rep ; 20122012 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-22891006

RESUMO

A 37-year-old woman presented with a history of reactive hypoglycaemia, non-classic adrenal hyperplasia (NCAH), osteopenia and fibromyalgia. After several months of palpitations, postural orthostatic tachycardia syndrome (POTS) was diagnosed by tilt table studies. Her heart rate (HR) reached 191 bpm at 60 degrees from horizontal. Investigation suggested increase in epinephrine and norepinephrine levels in response to tilt table. Her 25(OH) vitamin D level measured by immunoextraction radioimmunoassay was 35 pg/ ml (normal 9-54 pg/ml) while her 1,25(OH)(2) vitamin D3 level was 24 pg/ml (normal 30-67 pg/ml). Accordingly, she was started on calcitriol 0.25 mcg orally daily. At her next visit after 5 months, she reported remarkable improvement in her palpitations and had been working full time for the past 4 months. HR both seated and upright was 72 bpm. After 3 months, her 1,25(OH)(2) vitamin D3 level on calcitriol was 40 pg/ml. The authors suggest that 1-α hydroxylation defects should be sought and treated, if present, with calcitriol in patients with POTS.


Assuntos
Calcitriol/deficiência , Calcitriol/uso terapêutico , Síndrome da Taquicardia Postural Ortostática/tratamento farmacológico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico , Adulto , Calcitriol/sangue , Feminino , Humanos , Síndrome da Taquicardia Postural Ortostática/sangue , Síndrome da Taquicardia Postural Ortostática/etiologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicações
15.
BMJ Case Rep ; 20122012 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-22707693

RESUMO

The authors report a patient whose polycystic ovarian syndrome (PCOS) and increased calcitriol level were associated with neurocysticercosis (NCC), for which she refused standard therapy. Based upon a report on treatment with tamoxifen in murine cysticercosis,1 she was offered raloxifene. She began raloxifene 60 mg/day on 21 January 2010. On 17 March 2010 she was pregnant, and was terminated on 14 April 2010. MRI 26 April 2010 showed diminution in size, shrinkage and loss of viability in a number of the cysts. Total lesions fell from 37 to 33, 10 lesions shrunk, 5 resolved, 18 were unchanged, 4 enlarged and 1 new lesion developed. Concomitantly serum calcitriol fell from 81 to 41 pg/ml while 25-OH-vitamin D level fell from 34 to 30 ng/ml. Alteration of the hormonal milieu may reduce cestode burden in human NCC. The pregnancy on raloxifene, though unfortunate, supports the concept that NCC caused the PCOS. Serum calcitriol may be a useful biomarker for assessing disease activity in NCC.


Assuntos
Encéfalo/patologia , Neurocisticercose/tratamento farmacológico , Cloridrato de Raloxifeno/uso terapêutico , Administração Oral , Adulto , Animais , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Neurocisticercose/diagnóstico , Cloridrato de Raloxifeno/administração & dosagem , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico
16.
Maturitas ; 70(2): 151-9, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21890292

RESUMO

AIM: To provide evidence based recommendations for optimal care diabetes care in the elderly. BACKGROUND: Diabetes affects approximately 25% of the population ≥65 years, and that percentage is increasing rapidly, particularly in minorities who represent an important fraction of the uninsured/underinsured. Diabetes is an important cause of hospital admissions and a co-morbidity in as high as 50% of hospital inpatients. It impacts mortality and quality of life. While tools have become available to improve glycemic control, enthusiasm for their application must be tempered with the sober realization of the risks involved in intensification of glycemic control, chiefly hypoglycemia. METHODS: Weighted review from PubMed and other literature search tools in descending order of randomized control trials, observational studies, pilot studies, published guidelines, the authors' clinical experience, and expert opinion. RESULTS/CONCLUSIONS: • HbA1c targets should be stratified according to the frailty of the elderly diabetic patient: <7.0% in the generally well elderly and < 8.0% in the frail elderly. • Therapies are available that achieve glycemic goals, while minimizing the risk of hypoglycemia, taking into consideration such factors as cognitive function, renal and hepatic function, bone density, fall risk, and hypoglycemia unawareness. • When insulin is used determir or glargine are safer choices than NPH. • Ultra-short acting prandial insulins are safer than regular insulin. • Pen devices for insulin delivery significantly reduce dosing errors and the risk of hypoglycemia. • Sudden managed care formulary changes that disrupt patients' diabetes treatment should be prevented through national policy initiatives. • Up to date home medication lists help prevent dangerous medication errors. • Widespread adoption of telehealth approaches can significantly improve glycemic control and render it safer.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas/metabolismo , Guias como Assunto , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Idoso , Idoso Fragilizado , Humanos
18.
Endocr Pract ; 14(7): 889-91, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18996819

RESUMO

OBJECTIVE: To study the effect of adding metformin to standard steroid replacement therapy in a patient with classic salt-losing congenital adrenal hyperplasia due to 21-hydroxylase deficiency with suboptimal biochemical and clinical control. METHODS: We present the clinical and laboratory findings before and after the addition of metformin to the therapeutic regimen of the study patient. RESULTS: A 17-year-old girl had been diagnosed as a neonate with classic salt-losing congenital adrenal hyperplasia caused by 21-hydroxylase deficiency (CYP21A2 deficiency). She was treated with hydrocortisone, 20 mg in the morning and 10 mg at bedtime, and fludrocortisone, 50 mcg daily. While on steroid replacement, she maintained normal serum electrolytes, glucose, blood pressure, and external genitalia, but she continued to express clinical features of obesity, hirsutism, amenorrhea, and acanthosis nigricans. Elevated laboratory measurements included the following: fasting 17-hydroxyprogesterone, 3410 ng/dL; total testosterone, 326 ng/dL; and androstenedione, 390 ng/dL. She was initiated on metformin, 500 mg twice daily after meals. After 3 months, the patient lost 2 kg, amenorrhea resolved, 17-hydroxyprogesterone decreased to 1539 ng/dL, total testosterone decreased to 163 ng/dL, and androstenedione levels remained unchanged. CONCLUSIONS: Metformin, an agent known to reduce insulin resistance, further suppressed the 17-hydroxyprogesterone concentration in a patient with classic congenital adrenal hyperplasia on steroid replacement therapy. Metformin may improve clinical and biochemical outcomes in classic congenital adrenal hyperplasia without the risk of iatrogenic Cushing syndrome.


Assuntos
Hiperplasia Suprarrenal Congênita/tratamento farmacológico , Hiperplasia Suprarrenal Congênita/genética , Metformina/uso terapêutico , Esteroide 21-Hidroxilase/genética , Adolescente , Hiperplasia Suprarrenal Congênita/patologia , Feminino , Humanos
19.
Endocr Pract ; 13(6): 601-8, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17954415

RESUMO

OBJECTIVE: To ascertain an association between the a priori known insulin resistance caused by antipsychotic agents and divalproex and adrenal hyperandrogenism and to determine whether the associated hyperandrogenism is reversible with insulin sensitizers. METHODS: We studied 26 consecutive psychiatric inpatients (22 women and 4 men) receiving the aforementioned medications, who were referred to us for a consultation. They ranged in age from 19 to 79 years and had a mean body mass index (SEM) of 32.35 +/- 1.26 kg/m2. Between 8 AM and 9 AM, blood samples were collected for 17-hydroxyprogesterone, 17-hydroxypregnenolone, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate, 11-deoxycortisol, luteinizing hormone and follicle-stimulating hormone (in reproductive age women), estrone, estradiol (in reproductive age women), free testosterone (in women), deoxycorticosterone, and sex hormone-binding globulin (SHBG), which were measured by radioimmunoassay, after chromatography if necessary. For intact, premenopausal women, measurement of the abnormal steroid metabolite or SHBG level was repeated during prednisone therapy (5 mg at bedtime) to document the likely adrenal origin of the abnormality. Men, women who had undergone bilateral oophorectomy, and postmenopausal women had hyperandrogenism of adrenal origin by default. Clinical features included central obesity, acanthosis, hirsutism, alopecia, type 2 diabetes mellitus, and oligomenorrhea. RESULTS: We found reversed estrone/estradiol ratios in 4 patients, decreased SHBG in 4, increased 17-hydroxy-pregnenolone in 8, increased 17-hydroxyprogesterone in 2, increased deoxycorticosterone in 2, increased DHEA sulfate in 1, increased 11-deoxycortisol in 4, increased androstenedione in 1, and reversed ratios of luteinizin hormone to follicle-stimulating hormone in 2. The bio-chemical abnormalities were corrected in 8 of 8 patients receiving metformin and in 2 of 2 patients receiving rosiglitazone. CONCLUSION: Insulin resistance caused by antipsychotic agents and divalproex is associated with adrenal hyperandrogenism. Metformin and rosiglitazone correct the biochemical abnormalities detected without compromising their psychotropic effect. Adrenal androgen synthesis may be increased by hyperinsulinemia-induced hyperphosphorylation of P450c17 alpha, resulting in an increase in its 17,20-lyase activity, which magnifies the effects of any distal steroidogenic enzyme defects. Treatment with metformin or rosiglitazone prevents excess adrenal androgen synthesis.


Assuntos
Antipsicóticos/efeitos adversos , Hiperandrogenismo/prevenção & controle , Metformina/uso terapêutico , Tiazolidinedionas/uso terapêutico , Ácido Valproico/efeitos adversos , 17-alfa-Hidroxiprogesterona/sangue , Adolescente , Glândulas Suprarrenais/efeitos dos fármacos , Glândulas Suprarrenais/metabolismo , Glândulas Suprarrenais/patologia , Adulto , Idoso , Antipsicóticos/uso terapêutico , Cortodoxona/sangue , Desidroepiandrosterona/sangue , Disruptores Endócrinos/efeitos adversos , Estradiol/sangue , Estrona/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hiperandrogenismo/sangue , Hiperandrogenismo/induzido quimicamente , Hipoglicemiantes/uso terapêutico , Resistência à Insulina , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Radioimunoensaio , Rosiglitazona , Testosterona/sangue , Ácido Valproico/uso terapêutico
20.
Nutr Metab (Lond) ; 2(1): 9, 2005 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-15817133

RESUMO

Osteoporosis is a major public health problem with low bone mass affecting nearly half the women aged 50 years or older. Evidence from various studies has shown that higher body mass index (BMI) is a protective factor for bone mineral density (BMD). Most of the evidence, however, is from studies with Caucasian women and it is unclear to what extent ethnicity plays a role in modifying the effect of BMI on BMD.A cross sectional study was performed in which records of postmenopausal women who presented for screening for osteoporosis at 2 urban medical centres were reviewed. Using logistic regression, we examined the interaction of race and BMI after adjusting for age, family history of osteoporosis, maternal fracture, smoking, and sedentary lifestyle on BMD. Low BMD was defined as T-score at the lumbar spine < -1.Among 3,206 patients identified, the mean age of the study population was 58.3 +/- 0.24 (Years +/- SEM) and the BMI was 30.6 kg/m2. 2,417 (75.4%) were African Americans (AA), 441(13.6%) were Whites and 348 (10.9%) were Hispanics. The AA women had lower odds of having low BMD compared to Whites [Odds ratio (OR) = 0.079 (0.03-0.24) (95% CI), p < 0.01]. The odds ratio of low BMD was not statistically significant between White and Hispanic women. We examined the interaction between race and BMD. For White women; as the BMI increases by unity, the odds of low BMD decreases [OR = 0.9 (0.87-0.94), p < 0.01; for every unit increase in BMI]. AA women had slightly but significantly higher odds of low BMD compared to Whites [OR 1.015 (1.007-1.14), p <0.01 for every unit increase in BMI]. This effect was not observed when Hispanic women were compared to Whites.There is thus a race-dependent effect of BMI on BMD. With each unit increase in BMI, BMD increases for White women, while a slight but significant decrease in BMD occurs in African American women.

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