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Author: Edward R. Laws Jr Publisher: Academic Press ISBN: 0128043903 Category : Medical Languages : en Pages : 238
Book Description
Cushing’s Disease: An Often Misdiagnosed and Not So Rare Disorder reviews the epidemiology of Cushing’s, including statistics on the incidence and prevalence of this disease. There are discussions of the signs and symptoms and the most common co-morbidities, such as diabetes mellitus, hypertension, osteoporosis, amenorrhea, and infertility. Surgical, medical, and radiotherapeutic treatments, including indications, results, risks, and complications, are reviewed. Also featured is a chapter on the patient’s perspective, coping with Cushing’s, quality of life, and psychosomatic issues. This book is essential reading for the wide range of physicians who treat patients with Cushing’s disease symptoms, as well as biomedical researchers who investigate the etiology and mechanisms of rare genetic diseases, in particular rare endocrine disorders. Reviews the basics of Cushing’s disease and its interrelation with hormones, the brain, and bodily functions Includes chapters on diagnosis, surgical, medical, and radiotherapeutic treatments, and variations in presentation, including cyclical disease Presents the cognitive and emotional aspects of Cushing’s and the long-term sequelae Offers an important resource for physicians who are accustomed to treating individual symptoms rather than a disease complex Reviews multidisciplinary management, and post-treatment management of Cushing’s, including recommendations for Cushing’s Centers of Excellence
Author: Edward R. Laws Jr Publisher: Academic Press ISBN: 0128043903 Category : Medical Languages : en Pages : 238
Book Description
Cushing’s Disease: An Often Misdiagnosed and Not So Rare Disorder reviews the epidemiology of Cushing’s, including statistics on the incidence and prevalence of this disease. There are discussions of the signs and symptoms and the most common co-morbidities, such as diabetes mellitus, hypertension, osteoporosis, amenorrhea, and infertility. Surgical, medical, and radiotherapeutic treatments, including indications, results, risks, and complications, are reviewed. Also featured is a chapter on the patient’s perspective, coping with Cushing’s, quality of life, and psychosomatic issues. This book is essential reading for the wide range of physicians who treat patients with Cushing’s disease symptoms, as well as biomedical researchers who investigate the etiology and mechanisms of rare genetic diseases, in particular rare endocrine disorders. Reviews the basics of Cushing’s disease and its interrelation with hormones, the brain, and bodily functions Includes chapters on diagnosis, surgical, medical, and radiotherapeutic treatments, and variations in presentation, including cyclical disease Presents the cognitive and emotional aspects of Cushing’s and the long-term sequelae Offers an important resource for physicians who are accustomed to treating individual symptoms rather than a disease complex Reviews multidisciplinary management, and post-treatment management of Cushing’s, including recommendations for Cushing’s Centers of Excellence
Author: Marcello D. Bronstein Publisher: Springer Science & Business Media ISBN: 1603274499 Category : Medical Languages : en Pages : 304
Book Description
Cushing ́s syndrome is a relatively rare clinical disorder that is associated with many co-morbidities such as systemic hypertension, diabetes, osteoporosis, impaired immune function and growth impairment in children, all of which severely reduce quality of life and life expectancy. Cushing’s Syndrome: Pathophysiology, Diagnosis and Treatment reviews the difficulties in distinguishing Cushing’s syndrome from these and other common conditions, such as central obesity, menstrual irregularity and depression. It also provides state-of-the-art information on various strategies to establish the diagnosis of Cushing’s syndrome and the differential diagnosis among its diverse etiologies, as well as therapeutic approaches. Additionally, a range of conditions that represent challenges for the diagnosis and treatment--such as renal failure, pediatric age, cyclic hypercortisolism, and pregnancy--are covered in detail. A valuable resource not only for endocrinologists but also internal medicine physicians, gynecologists, pediatricians, , pituitary surgeons and urologists, Cushing’s Syndrome: Pathophysiology, Diagnosis and Treatment provides insights by experts that will help all physicians dealing with Cushing ́s syndrome to expand their knowledge about the condition and provide targeted, comprehensive care.
Author: Brooke Swearingen Publisher: Springer Science & Business Media ISBN: 9781461400110 Category : Medical Languages : en Pages : 264
Book Description
In Cushing’s Disease, leading authorities in the field offer a thorough review of the pathogenesis, diagnostic algorithm and treatment options for this complex disease. Beginning with a fascinating history of Cushing's disease that outlines its historical significance to both endocrinology and neurosurgery, the book goes onto to cover the full range of important issues, including the molecular pathogenesis of Cushing’s, anatomic pathology, the diagnosis of Cushing's syndrome, the differential of pseudo-Cushing's syndromes, hypercortisolemia, surgical removal of the corticotroph adenoma, post-operative management and assessment of remission, radiotherapeutic options, and the exciting developments in medical therapy. In addition, the book also addresses Cushing's disease in the pediatric population, given that its clinical manifestations and impact on growth can be severe; silent corticotroph adenomas as a distinct clinical entity; diagnosis and management of Cushing's disease during pregnancy, bilateral adrenalectomy, and, finally, the long-term psychological manifestations of hypercortisolemia. Comprehensive and an invaluable addition the literature, Cushing’s Disease is an essential reference for enhancing diagnosis and treatment of this debilitating disorder.
Author: D. T. Krieger Publisher: Springer Science & Business Media ISBN: 3642816592 Category : Medical Languages : en Pages : 144
Book Description
The unraveling of our knowledge of the functions of the adrenal gland constitutes one exciting development of modern medicine and biochemistry. We owe these advances to the felicitous cooperative efforts of the clinical investigator and the biochemist. Three centuries elapsed between the first recorded anatomical descrip tion of the adrenals and the demonstration by Dr. Addison in the mid-nineteenth century of the fatal results of the destruction of these glands by disease. It became evident from this observation that the adrenals secreted a "factor" or "factors" essential to life. It took approximately 90 years to isolate this elusive vital factor - cortisone - from beef adrenal cortices, independently by both Reichstein and his co-workers in Basle and Kendall and his group in the United States and another 10-15 years before it became more generally available for experimental and clinical use. It is perhaps difficult to believe that as recently as 35-40 years ago, before cortisone and cortisol were clinically available, the surgical removal of a benign adrenal cortical tumor in patients with Cushing's syndrome was associated with a prohibitive postoperative mortality rate. Within 12-36 h after operation, most of such patients developed an intractable state of shock, which was not manifested by significant electrolyte abnormalities or hypoglycemia and was unresponsive to the usual treatment for shock plus the generous use of salt-retaining hormone.
Author: Lewis S. Blevins Publisher: Springer Science & Business Media ISBN: 1461511038 Category : Medical Languages : en Pages : 344
Book Description
Cushing's Syndrome provides the reader with an update on the clinical presentation, diagnosis, and treatment of patients with Cushing's syndrome. Molecular mechanisms of pituitary and adrenal causes of Cushing's syndrome are reviewed in detail. Successful diagnostic and treatment strategies that have been employed by readers in the field are recommended and discussed. Numerous advances in the pathophysiology and diagnosis of Cushing's syndrome speak to the timeliness of this volume that has been penned by experts in the field.
Author: Adriana G. Ioachimescu Publisher: Elsevier Health Sciences ISBN: 0323612946 Category : Medical Languages : en Pages : 225
Book Description
This issue of Endocrinology and Metabolism Clinics, edited by Adriana G. Ioachimescu, will focus on Cushing’s Syndrome. Topics include--but are not limited to--1. Diagnosis of Cushing’s syndrome in the modern era, Gene mutations in patients with Cushing’s syndrome, Morbidity in Cushing’s syndrome and impact of treatment, Localization of ACTH-dependent Cushing’s syndrome, Prognostic factors of long-term remission after surgical treatment of Cushing’s disease, Outcomes of pituitary radiation for Cushing’s disease, New molecular targets in Cushing’s disease, Recent advances in subclinical Cushing’s syndrome, Adrenal surgery for Cushing’s syndrome, Adrenocortical carcinoma with hypercortisolism, Ectopic Cushing’s syndrome, Medical therapy for Cushing’s syndrome in the 21st century, Pregnancy in patients with Cushing’s syndrome, Mortality in patients with Cushing’s syndrome, and Cushing’s syndrome in children and adolescents.
Author: Daniel Bengtsson Publisher: Linköping University Electronic Press ISBN: 9179296521 Category : Languages : en Pages : 89
Book Description
This thesis focuses on clinical and epidemiological aspects of aggressive pituitary tumours/carcinomas and Cushing’s disease. Pituitary carcinomas account for only 0.1-0.2% of the tumours originating from the anterior pituitary gland and are defined solely by the event of distant metastases, whereas aggressive pituitary tumours are defined by their clinical behaviour of rapid/progressive growth despite optimal treatment with surgery, radiotherapy and medical agents. The prognosis for individuals with aggressive tumours/carcinomas has been poor with few treatment options. However, case reports indicated better outcomes after treatment with the alkylating agent temozolomide. In study I and III, we investigated 24 patients (16 aggressive tumours and 8 carcinomas) given treatment with temozolomide. We found an initial response rate (tumour regression ≥30%) in 10/21 evaluable patients, with complete regression in two carcinomas. Favourable response was associated with low tumour expression of the DNA repair protein MGMT; in responders median 9% (range 5-20%) vs non-responders median 93% (50-100%). Our results also indicated a longer survival in patients with low MGMT. Out of 11 patients with MGMT >10%, nine died with an estimated median survival of 26 months (95% CI 14-38), whereas only 1/6 patients with lower MGMT died from tumour progression during a follow-up of median 83 months (range 12-161). One of the patients in study I and III had a corticotroph pituitary carcinoma and in addition, Lynch syndrome (LS), a hereditary cancer-predisposing syndrome caused by germline mutations in DNA mismatch repair (MMR) genes and primarily associated with colon and endometrial carcinomas. In study II, we investigated the characteristics of the pituitary carcinoma and found loss of MSH2 and MSH6 protein expression, consistent with the patient’s germline mutation in MSH2. This was the first published case of a pituitary tumour associated with LS. In addition, we identified all known Swedish patients with LS (n=910) and searched for diagnostic codes consistent with a pituitary tumour in the Swedish national patient register. We found in total three patients with clinically relevant pituitary tumours, the reported prevalence in the background population is around 1:1000. The last two studies in the thesis focused on Cushing’s disease (CD), i.e. an ACTH-secreting pituitary tumour resulting in excess levels of cortisol. CD is associated with multiple comorbidities and increased mortality. The reversibility of comorbidities and mortality risk after remission of cortisol levels have been under debate. Study IV examined psychiatric consequences of CD, measured by the use of psychotropic drugs. 179 patients with CD and a quadrupled matched control group were followed from diagnosis and at 5- and 10-year follow-up. We found that use of antidepressants remained at around 25% of patients with CD, regardless of remission status, at diagnosis and follow-up, whereas drugs for somatic comorbidities decreased. Use of antidepressants, sleeping pills and anxiolytics was higher in patients with CD compared to controls at diagnosis and 5-year follow-up. A cross-sectional analysis of 76 patients in sustained biochemical remission for median 9.3 years showed that 25% were taking antidepressants, a significantly higher use than controls, OR 2.0 (95% CI 1.1-3.8). In addition, patients with CD had a higher use of psychotropic drugs, already in the 5-year period before diagnosis. Study V investigated mortality and causes of death in 371 patients with CD, compared to a quadrupled matched control group. Follow-up was median 10.6 years (IQR 5.7-18.2) after time of diagnosis. Overall mortality was increased in patients with CD, HR 2.1 (95% CI 1.5-2.8) and remained elevated for patients in remission at last follow-up (n=303), HR 1.5 (1.02-2.2). For patients not in remission (n=31), HR was 5.6 (2.7-11.6). Cardiovascular diseases (32/66) and infections (12/66) were overrepresented causes of death in patients with CD. Main conclusions of the thesis: Temozolomide improves outcome in patients with aggressive pituitary tumours/carcinomas and a low MGMT expression in the tumour predicts a favourable outcome. As additional therapies evolve, MGMT may help to tailor the treatment.Germline mutations in MMR genes may contribute to the development and clinical course of pituitary tumours and may be a novel cause of hereditary pituitary tumours.Patients with Cushing’s disease have a high use of psychotropic drugs that remains elevated despite achievement of biochemical remission, suggesting persisting negative effects on mental health and highlighting the need for long-term monitoring of psychiatric symptoms. In addition, psychiatric symptoms may be early and important signs of CD.Efforts to achieve biochemical remission are crucial to reduce mortality in CD. However, patients in remission still have an increased mortality compared to controls. This underscores the need for life-long monitoring and treatment of associated comorbidities in patients with CD.
Author: Adriana G. Ioachimescu Publisher: Elsevier ISBN: 9780323612937 Category : Languages : en Pages :
Book Description
This issue of Endocrinology and Metabolism Clinics, edited by Adriana G. Ioachimescu, will focus on Cushing's Syndrome. Topics include--but are not limited to--1. Diagnosis of Cushing's syndrome in the modern era, Gene mutations in patients with Cushing's syndrome, Morbidity in Cushing's syndrome and impact of treatment, Localization of ACTH-dependent Cushing's syndrome, Prognostic factors of long-term remission after surgical treatment of Cushing's disease, Outcomes of pituitary radiation for Cushing's disease, New molecular targets in Cushing's disease, Recent advances in subclinical Cushing's syndrome, Adrenal surgery for Cushing's syndrome, Adrenocortical carcinoma with hypercortisolism, Ectopic Cushing's syndrome, Medical therapy for Cushing's syndrome in the 21st century, Pregnancy in patients with Cushing's syndrome, Mortality in patients with Cushing's syndrome, and Cushing's syndrome in children and adolescents.
Author: Edward R. Laws Jr
Author: Edward R. Laws Jr
Author: Marcello D. Bronstein
Author: Brooke Swearingen
Author: D. T. Krieger
Author: Lewis S. Blevins
Author: Adriana G. Ioachimescu
Author: Dorothy T. Krieger
Author: Daniel Bengtsson
Author: Adriana G. Ioachimescu
Author: Marcello D. Bronstein