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Ugeskrift For Laeger May 2019In this review, we discuss pituitary adenomas (PA), which account for 10-25% of the intracranial tumours. Despite their benign nature, PA often show invasive growth.... (Review)
Review
In this review, we discuss pituitary adenomas (PA), which account for 10-25% of the intracranial tumours. Despite their benign nature, PA often show invasive growth. Pressure on neighbouring structures may cause hypopituitarism or vision field impairment. For PA, except prolactinomas, surgical treatment is first choice. The primary surgical technique is transsphenoidal surgery. Pituitary function, vision and post-operative magnetic resonance imaging scan is evaluated in a multidisciplinary team of neurosurgeons and endocrinologist 6-8 weeks post-operatively. Follow-up and treatment of pituitary adenomas is highly specialised and requires a team of dedicated endocrinologists and neurosurgeons.
Topics: Adenoma; Humans; Magnetic Resonance Imaging; Pituitary Neoplasms; Treatment Outcome
PubMed: 31124446
DOI: No ID Found -
The American Journal of Managed Care Dec 2022Two guidelines-one by the American College of Cardiology (ACC)/American Heart Association (AHA)/The Obesity Society (TOS), and the other by the American Association of... (Review)
Review
Two guidelines-one by the American College of Cardiology (ACC)/American Heart Association (AHA)/The Obesity Society (TOS), and the other by the American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)-remain the standard of care in the management of overweight and obesity in adults. However, since the publication of the ACC/AHA/TOS document, several relevant pharmacotherapies have been approved by the FDA, a medication was withdrawn from the market, and several procedures and device types for weight loss have been recommended or FDA-approved. Simultaneously, research in obesity treatment has advanced, and leaders in the field have issued complementary guidance. This article summarizes and synthesizes the 2013 ACC/AHA/TOS and the 2016 AACE/ACE guidelines and includes updates from more recent professional association guidance. Measurement of body mass index is recommended to initiate evaluation for overweight and obesity and determine disease classification. To stage disease severity, weight-related conditions should be assessed. Although lifestyle therapy remains the cornerstone of treatment for this disease, both pharmacotherapy and metabolic and bariatric surgery produce greater and more sustained weight loss in treatment-approved populations as compared with lifestyle modifications alone. An ongoing partnership between the patient and clinician is highly recommended to manage this serious, progressive, chronic disease.
Topics: Adult; United States; Humans; Overweight; Obesity; Endocrinologists; Body Mass Index; Weight Loss
PubMed: 36525676
DOI: 10.37765/ajmc.2022.89292 -
The Journal of Clinical Endocrinology... May 2019The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults.
OBJECTIVE
The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults.
CONCLUSIONS
Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.
Topics: Accidental Falls; Aged; Aged, 80 and over; Atherosclerosis; Continuity of Patient Care; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Neuropathies; Diabetic Retinopathy; Disease Management; Endocrinologists; Heart Failure; Humans; Hyperlipidemias; Hypertension; Hypoglycemic Agents; Life Style; Mass Screening; Physician's Role; Prediabetic State; Renal Insufficiency, Chronic
PubMed: 30903688
DOI: 10.1210/jc.2019-00198 -
The Journal of Clinical Endocrinology... Jan 2022The burden of cirrhosis from nonalcoholic fatty liver disease (NAFLD) is reaching epidemic proportions in the United States. This calls for greater awareness among... (Review)
Review
CONTEXT
The burden of cirrhosis from nonalcoholic fatty liver disease (NAFLD) is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP-1RAs) are beneficial vs nonalcoholic steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH.
EVIDENCE ACQUISITION
Evidence from observational studies, randomized controlled trials, and meta-analyses.
EVIDENCE SYNTHESIS
Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (ie, people with obesity, prediabetes, or T2D). With no US Food and Drug Administration (FDA)-approved agents, weight loss is central to successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently, the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management.
CONCLUSION
A paradigm change is developing between the endocrinologist's greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.
Topics: Cost of Illness; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Humans; Hypoglycemic Agents; Liver Cirrhosis; Meta-Analysis as Topic; Non-alcoholic Fatty Liver Disease; Obesity; Observational Studies as Topic; Randomized Controlled Trials as Topic; Treatment Outcome; United States; Weight Loss
PubMed: 34406410
DOI: 10.1210/clinem/dgab578 -
Endocrinology and Metabolism Clinics of... Mar 2021Congenital adrenal hyperplasia encompasses a group of autosomal recessive defects in cortisol biosynthesis, and 21-hydroxylase deficiency accounts for 95% of such cases.... (Review)
Review
Congenital adrenal hyperplasia encompasses a group of autosomal recessive defects in cortisol biosynthesis, and 21-hydroxylase deficiency accounts for 95% of such cases. Non-classic 21-hydroxylase deficiency is due to partial enzymatic defects, which present with normal cortisol synthesis, but excessive production of adrenal androgens, including 11-oxygenated androgens. Non-classic 21-hydroxylase deficiency is relatively common, and its phenotype resembles closely that of polycystic ovary syndrome. This review focuses primarily on non-classic 21-hydroxylase deficiency, its clinical features, diagnosis, and management.
Topics: Adrenal Hyperplasia, Congenital; Androgens; Endocrinologists; Female; Humans; Polycystic Ovary Syndrome
PubMed: 33518183
DOI: 10.1016/j.ecl.2020.10.008 -
Frontiers in Endocrinology 2022In the original definition by Klinefelter, Albright and Griswold, the expression "hypothalamic hypoestrogenism" was used to describe functional hypothalamic amenorrhoea... (Review)
Review
In the original definition by Klinefelter, Albright and Griswold, the expression "hypothalamic hypoestrogenism" was used to describe functional hypothalamic amenorrhoea (FHA). Given the well-known effects of estrogens on bone, the physiopathology of skeletal fragility in this condition may appear self-explanatory. Actually, a growing body of evidence has clarified that estrogens are only part of the story. FHA occurs in eating disorders, overtraining, and during psychological or physical stress. Despite some specific characteristics which differentiate these conditions, relative energy deficiency is a common trigger that initiates the metabolic and endocrine derangements contributing to bone loss. Conversely, data on the impact of amenorrhoea on bone density or microarchitecture are controversial, and reduced bone mass is observed even in patients with preserved menstrual cycle. Consistently, oral estrogen-progestin combinations have not proven beneficial on bone density of amenorrheic women. Low bone density is a highly prevalent finding in these patients and entails an increased risk of stress or fragility fractures, and failure to achieve peak bone mass and target height in young girls. Pharmacological treatments have been studied, including androgens, insulin-like growth factor-1, bisphosphonates, denosumab, teriparatide, leptin, but none of them is currently approved for use in FHA. A timely screening for bone complications and a multidisciplinary, customized approach aiming to restore energy balance, ensure adequate protein, calcium and vitamin D intake, and reverse the detrimental metabolic-endocrine changes typical of this condition, should be the preferred approach until further studies are available.
Topics: Humans; Female; Amenorrhea; Bone Density; Hypothalamic Diseases; Endocrinologists; Bone Diseases, Metabolic; Estrogens
PubMed: 36303862
DOI: 10.3389/fendo.2022.946695 -
Thyroid : Official Journal of the... Dec 2022Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being...
Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this consensus statement.
Topics: Humans; Consensus; Graves Ophthalmopathy; Hyperthyroidism; United States; Europe
PubMed: 36480280
DOI: 10.1089/thy.2022.0251 -
Frontiers in Endocrinology 2023Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work... (Review)
Review
Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work independently and interactively as part of the stress response. The scientific stress literature, which spans both animal and human studies, contains heterogeneous findings about the effects of stress on the brain and the body. This review seeks to summarise and integrate literature on the relationships between these systems, examining particularly the roles of physiological and psychosocial stress, the stress hormone cortisol, as controlled by the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of stress on cognitive functioning. Health conditions related to impaired HPA axis functioning and their associated neuropsychiatric symptoms will also be considered. Lastly, this review will provide suggestions of clinical applicability for endocrinologists who are uniquely placed to measure outcomes related to endocrine, nervous and immune system functioning and identify areas of intervention.
Topics: Animals; Humans; Cognition; Hydrocortisone; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Stress, Psychological
PubMed: 36950689
DOI: 10.3389/fendo.2023.1085950