Endocrine Pathophysiology, Second Edition: Medicine & Health Science Books @ aracer.mobi by C. B. Niewoehner (Author). out of 5. Endocrine Pathophysiology, second edition, presents new insight into the immensely complex reactions that allow hormone interactions with receptors; the early. Generally a great book for medical school endocrinology. Very clear and easy to read. However, at times it was too simplistic. I appreciate that the material was.
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The key glands of the endocrine system include the hypothalamus, pituitary, thyroid, parathyroids, . View Full Size|Favorite Figure|Download Slide .ppt). I hope you will find this “quick look” at metabolic and endocrine physiology to be informative, . Primate Menstrual Cycle Neonatal Physiology: I (Endocrine Parameters) Niewoehner CB: Endocrine pathophysiology. . Download pdf. 73 - ST Segment Elevation Acute Myocardial Infarction and Complications of Myocardial Infarction. Jeffrey L. Anderson Dennis E. Niewoehner .. - Endocrine Manifestations of Tumors: “Ectopic” Hormone Production Download PDFs.
In men with an identifiable underlying disorder e. Similarly, if the gynecomastia is believed to be due to a medication or recreational drug, withdrawal of that agent should lead to at least some improvement over a period of a few months.
If the breast enlargement has been present for more than 1 yr, complete regression is less likely, due to the predominance of dense fibrous tissue 13 , Teenage boys with pubertal gynecomastia can usually be observed, with the expectation that the gynecomastia will spontaneously resolve over 1—2 yr in most cases Gynecomastia related to dialysis or refeeding is also generally self-limited, and reassurance may be sufficient treatment 27 , In some men with hypogonadism of short duration, testosterone replacement may lead to the resolution or improvement of associated gynecomastia 29 , However, because testosterone can be aromatized to estradiol, it may worsen the breast enlargement in some cases, and the patient should be warned of this possibility.
Antiestrogens have been increasingly used in recent years to decrease the stimulatory effect of estrogens on the male breast. Tamoxifen and raloxifene, which block the estrogen receptor, and aromatase inhibitors such as anastrozole have all been used with varying degrees of success in the treatment of gynecomastia. Although studies of their effects have been limited, there appears to be reasonable evidence supporting the utility of tamoxifen 31 — 35 and some evidence that raloxifene is approximately as useful as tamoxifen Neither tamoxifen nor raloxifene has been associated with significant side effects in the majority of patients 31 — In contrast, anastrozole was no better than placebo in a randomized, double-blind trial in patients with pubertal gynecomastia Anastrozole was successfully used to reduce the estrogen excess and breast enlargement in a patient with familial aromatase excess 37 , a patient with a feminizing Sertoli cell tumor 38 , and two hypogonadal men with gynecomastia induced by testosterone therapy It should be noted that none of these drugs have been approved for the treatment of gynecomastia.
For men with gynecomastia due to androgen deprivation therapy for prostate cancer, prophylactic radiation therapy directed at the breast has been somewhat successful in preventing new-onset gynecomastia 40 — Tamoxifen has also been used successfully in this situation 43 and appears to be superior to both radiotherapy 44 and anastrozole 45 , Daily administration of tamoxifen was shown to be more efficacious than weekly dosing Surgery to remove the breast tissue has been widely used in the treatment of gynecomastia.
It should probably be performed by highly experienced surgeons to achieve the best cosmetic result. Excision with or without liposuction has been successfully used 48 , Surgical treatment of pubertal gynecomastia should generally be postponed until the completion of puberty to minimize the possibility of postoperative regrowth of breast tissue.
Figure 1 illustrates a suggested scheme for the evaluation and treatment of gynecomastia. Suggested algorithm for the management of gynecomastia. Narula and H. Therefore, universal application of imaging seems unlikely to be cost-effective.
In one study of male breast mammography, all of the men diagnosed with breast cancer also had physical findings that were suspicious for malignancy Curr Opin Endocrinol Diabetes Obes ; 17 3 : It results from either deficiency or impaired action of glucocorticoids.
Typical symptoms of AI include weakness, fatigue, anorexia, abdominal pain, weight loss and salt craving. Addison's disease. Lancet ; ; : On the constitutional and local effects of disease of the supra-renal capsules. London: Samuel Highley. However, Schwartz et al.
Moderate dose inhaled corticosteroid-induced symptomatic adrenal suppression: case report and review of the literature. Clin Pediatr Phila ; 51 12 : The effects of AI may vary from non-specific complaints of fatigue that may go undetected without a high level of clinical suspicion to severe adrenal crises with hypotension and hypoglycaemia [ 16 Arlt W, Allolio B.
Adrenal crises in children treated with high-dose inhaled corticosteroids for asthma.
Med J Aust ; 5 : Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Child ; 87 6 : A rare case of adrenal insufficiency induced by inhaled corticosteroids.
J Am Geriatr Soc ; 61 5 : There are few studies investigating the risk of AI in adults. In the second report, a 38 year old male on high dose budesonide, developed symptoms of AI after decreasing his budesonide dose from 3. This was confirmed by the short tetracosactrin test to be due to adrenal suppression [ 38 Wong J, Black P. Acute adrenal insufficiency associated with high dose inhaled steroids.
BMJ ; : Adrenal insufficiency in an adult on inhaled corticosteroids; recovery of adrenal function with inhaled nedocromil sodium. Ann Allergy Asthma Immunol ; 81 6 : Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate. Eur Respir J ; 19 6 : Hypothalamic-pituitary-adrenal axis suppression associated with the use of inhaled fluticasone propionate. J Allergy Clin Immunol ; 4 Pt 1 : Adrenal insufficiency in a woman secondary to standard-dose inhaled fluticasone propionate therapy.
Endocrinol Diabetes Metab Case Rep ; In addition to these case reports, a survey by Todd et al. In addition, a study by Fardon et al.
Adrenal suppression with dry powder formulations of fluticasone propionate and mometasone furoate. A large case control study by Lapi et al. The use of inhaled corticosteroids and the risk of adrenal insufficiency. Eur Respir J ; 42 1 : It showed the incidence of AI to be 1. A Cohort study by Smith et al. Prevalence of hypothalamic-pituitary-adrenal axis suppression in children treated for asthma with inhaled corticosteroid.
Paediatr Child Health ; 17 5 : e Key points from the study included the fact that children on low to moderate doses of ICS were still at risk of HPA axis suppression. The majority of reports involved high dose fluticasone. Hypoglycemia due to adrenal suppression secondary to high-dose nebulized corticosteroid. Pediatr Pulmonol ; 34 1 :