Medicine (Abingdon, England : UK ed.)最新文献_第3页

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.008

Ines Harper, Ashley S Shaw, HK Cheow

引用次数: 0

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.004

Alan Kelsall, John Newell-Price

{"title":"Cushing's syndrome","authors":"Alan Kelsall, John Newell-Price","doi":"10.1016/j.mpmed.2025.06.004","DOIUrl":"10.1016/j.mpmed.2025.06.004","url":null,"abstract":"<div><div>Endogenous Cushing's syndrome results from prolonged, excessive concentrations of circulating cortisol. Cushing's syndrome should be considered in individuals with features unusual for their age, multiple and progressive features or adrenal incidentalomas, and children with decreasing height percentile and increasing weight. Endogenous Cushing's syndrome is more common in women than men. Adrenocorticotropic hormone (ACTH)-dependent causes account for around 80% of cases. Of the ACTH-dependent cases, 80% result from pituitary adenomas (Cushing's disease) and the remainder from ectopic ACTH secretion. Non-ACTH-dependent Cushing's syndrome is caused by benign adrenal adenomas in 60% and carcinomas in 40%. Specialist assessment and treatment warrants referral to major centres. Diagnostically, the most discriminating clinical features are thin skin, easy bruising and proximal myopathy. There should be a high index of clinical suspicion before instigating investigations. Biochemical diagnosis is by a combination of dexamethasone suppression tests, assessment for loss of circadian rhythm and measurement of urinary free cortisol. When differentiating pituitary and non-pituitary sources of ACTH, reliance should be placed on biochemical evaluation. Medical therapy is used to lower plasma cortisol, before surgery or after incomplete surgical treatment. Trans-sphenoidal surgery is the treatment of choice for Cushing's disease; laparoscopic bilateral adrenalectomy can be used in refractory cases.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 579-584"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypothyroidism 甲状腺功能减退

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.015

Sri Ramya Ganti , Suhani Bahl , Ornrapee Kiticharoensak, Peter Taylor

{"title":"Hypothyroidism","authors":"Sri Ramya Ganti , Suhani Bahl , Ornrapee Kiticharoensak, Peter Taylor","doi":"10.1016/j.mpmed.2025.06.015","DOIUrl":"10.1016/j.mpmed.2025.06.015","url":null,"abstract":"<div><div>Hypothyroidism is a common endocrine disorder resulting from deficient thyroid hormone production. It presents on a clinical spectrum ranging from asymptomatic to severe manifestations such as myxoedema coma. Primary hypothyroidism, accounting for >99% of cases, typically results from autoimmune thyroiditis (e.g. Hashimoto's thyroiditis) or iatrogenic causes. Central and extrathyroidal forms are rare. Diagnosis primarily relies on elevated serum thyroid-stimulating hormone (TSH) concentrations and reduced free thyroxine (FT4) concentrations. Levothyroxine remains the cornerstone of treatment, aiming to return TSH concentrations to normal and alleviate symptoms. However, a proportion of patients remain symptomatic despite biochemical correction, leading to continuing debate about alternative therapies including liothyronine or desiccated thyroid extract. Subclinical hypothyroidism, with elevated TSH and normal FT4 concentrations, poses a treatment dilemma, although therapy is often considered in younger individuals, those with symptoms or women planning pregnancy. Key management principles include dose individualization, awareness of drug interactions and the importance of the correct timing of administration to optimize absorption. Special considerations apply to populations such as pregnant women, elderly individuals and patients with myxoedema coma. Updated guidance supports a tailored approach to diagnosis and treatment to prevent both under- and overtreatment.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 613-616"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acromegaly 肢端肥大症

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.009

Craig E Stiles, Belayet Hossain, Willliam M Drake

{"title":"Acromegaly","authors":"Craig E Stiles, Belayet Hossain, Willliam M Drake","doi":"10.1016/j.mpmed.2025.06.009","DOIUrl":"10.1016/j.mpmed.2025.06.009","url":null,"abstract":"<div><div>Acromegaly is a rare, chronic, debilitating condition. Untreated, it causes significant morbidity and reduces life expectancy by about 10 years. The disease process is insidious, and early presenting features can be non-specific (e.g. sweating, fatigue). Physicians, dentists and surgeons should consider this diagnosis if any of the classically recognized features are present (e.g. dental malocclusion, carpal tunnel syndrome, sleep apnoea, type 2 diabetes mellitus without a family history). Timely diagnosis is important because surgery can be curative. Surgical outcomes vary widely depending on adenoma size (≥90% for pituitary microadenomas versus 40–45% for macroadenomas; lower for locally invasive tumours); this is in turn related to disease duration. Diagnosis is based on three key findings: clinical features, elevated age-adjusted serum insulin-like growth factor 1 and a serum growth hormone nadir >0.3 micrograms/litre after an oral glucose challenge. Once biochemically confirmed, magnetic resonance imaging of the pituitary is performed to assess the size and regional anatomy in anticipation of future surgery. Medical control of acromegaly has improved, with the introduction of long-acting somatostatin analogues and the growth hormone receptor antagonist pegvisomant. Radiation therapy is a potential adjuvant therapy for individuals with residual disease, but can take 5–10 years to have full effect.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 585-588"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosis of pituitary disease 垂体疾病的诊断

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.006

Cristina Guillén Morote, Athanasios Fountas, Niki Karavitaki

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Presentation of endocrine disease 内分泌疾病的表现

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.007

Amy E Morrison, Miles J Levy

{"title":"Presentation of endocrine disease","authors":"Amy E Morrison, Miles J Levy","doi":"10.1016/j.mpmed.2025.06.007","DOIUrl":"10.1016/j.mpmed.2025.06.007","url":null,"abstract":"<div><div>Endocrine glands produce biologically active hormones, which exert their action throughout the body, at sites distant from their origin. The main glands comprising the endocrine system are the pituitary, adrenals, gonads, thyroid, parathyroids and pancreas. Symptoms can present because of gland hypofunction (hormone deficiency) or gland hyperfunction (hormone excess). Widespread sites of hormone action throughout the body result in symptoms that are often generalized, diffuse and non-specific, presenting diagnostic challenges. A thorough yet focused clinical history is key to guide optimal investigation. A detailed family history is important to identify genetic endocrine disease, and medication can cause endocrine hypo- or hyperfunction. Endocrine disease may be first diagnosed by a new clinician with a fresh pair of eyes who stands back and notices an endocrine syndrome or puts together a constellation of different aspects of a presentation to make a unifying endocrine diagnosis. Increased access to imaging means that incidental thyroid, pituitary and adrenal lesions are often the initial reason for endocrine referral. Endocrine emergencies are common, particularly electrolyte imbalances and acute presentations of thyroid, pituitary and adrenal disease. Insulin, corticosteroids and desmopressin are life-sustaining medications; omitting them can lead to harm or death.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 551-554"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Congenital adrenal hyperplasia 先天性肾上腺增生

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.016

Sophie A Clarke, Ieuan A Hughes

{"title":"Congenital adrenal hyperplasia","authors":"Sophie A Clarke, Ieuan A Hughes","doi":"10.1016/j.mpmed.2025.06.016","DOIUrl":"10.1016/j.mpmed.2025.06.016","url":null,"abstract":"<div><div>Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder of adrenal corticosteroid biosynthesis affecting 1/10,000–1/15,000 live births. The most common form is 21-hydroxylase deficiency caused by variants in <em>CYP21A2</em>. CAH classically presents at birth with atypical genitalia in an affected girl. Salt loss, which can be life-threatening, is the only sign in an affected newborn boy. An adolescent girl with CAH has a syndrome of hirsutism, acne and irregular periods. Treatment aims to replace adequate amounts of glucocorticoid and mineralocorticoid hormones, but avoid adverse effects such as growth suppression in childhood, and obesity and adverse metabolic profile in adult life. Serum 17OH-progesterone and adrenal androgens are increased in CAH because of 21-hydroxylase deficiency and can be useful markers to monitor treatment. Genital surgery has typically been performed around 12–18 months of age if a reduction in clitoral size is needed. However, this can damage nerves and affect later sexual function and there is concern about consent. Vaginoplasty can be deferred until puberty. Prenatal diagnosis has been refined by early non-invasive genetic testing but dexamethasone to prevent virilization of an affected female fetus is now seldom used because of concerns about long-term adverse effects.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 607-612"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prolactin disorders 催乳激素紊乱

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.003

Niamh Martin

{"title":"Prolactin disorders","authors":"Niamh Martin","doi":"10.1016/j.mpmed.2025.06.003","DOIUrl":"10.1016/j.mpmed.2025.06.003","url":null,"abstract":"<div><div>Hyperprolactinaemia can be physiological, pathological or drug induced. Elevated serum prolactin concentrations can cause secondary hypogonadism via inhibition of hypothalamic gonadotropin-releasing hormone and pituitary gonadotropins. Therefore, it is important to determine the pathological causes of hyperprolactinaemia, particularly prolactinoma. Female patients can present with galactorrhoea, menstrual irregularity and infertility, whereas male patients can present with symptoms of secondary hypogonadism. Notably, postmenopausal women and men often present with mass effects secondary to a large macroprolactinoma. Macroprolactin, representing <5% of circulating prolactin, is a polymeric form of prolactin with limited bioavailability and bioactivity. Macroprolactinaemia should be suspected in individuals with a raised prolactin concentration who lack typical features of hyperprolactinaemia. After confirming an elevated serum prolactin and excluding other physiological and pathological causes, pituitary magnetic resonance imaging should be performed to investigate the presence of a prolactinoma or non-prolactinoma pituitary tumour. Bromocriptine and cabergoline are the two dopamine agonists most commonly used to correct abnormal serum prolactin concentrations. Both cause tumour shrinkage in prolactinomas and restore gonadal function and fertility, but cabergoline is preferred as it is more effective and better tolerated. Although there are more safety data for bromocriptine than cabergoline, both are considered to be safe in pregnancy.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 589-592"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The endocrine laboratory 内分泌实验室

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.005

David S Church, David J Halsall

引用次数: 0

Thyrotoxicosis 甲状腺毒症

Medicine (Abingdon, England : UK ed.) Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.012

Peter Novodvorsky, Amit Allahabadia

{"title":"Thyrotoxicosis","authors":"Peter Novodvorsky, Amit Allahabadia","doi":"10.1016/j.mpmed.2025.06.012","DOIUrl":"10.1016/j.mpmed.2025.06.012","url":null,"abstract":"<div><div>Thyrotoxicosis refers to symptoms and signs that arise from excess quantities of circulating thyroid hormones. It can be caused by hyperthyroidism – hyperfunction of the thyroid gland – or by other mechanisms, such as the destruction of thyroid follicles with release of thyroid hormones (thyroiditis) or excessive ingestion of thyroid hormones (thyrotoxicosis factitia). There are several causes of thyrotoxicosis, the most common being Graves' disease, followed by toxic nodular thyroid disease (toxic multinodular goitre, toxic adenoma) and thyroiditis of any aetiology. Establishing the underlying cause of thyrotoxicosis is essential for its management. Diagnosis relies on clinical observation, sensitive hormonal and immunological assays and the occasional use of thyroid scintigraphy. Management of thyrotoxicosis includes the use of anti-thyroid medication, β-adrenoceptor blocking agents, radioiodine, thyroid surgery or a combination of these. Management of thyrotoxicosis in pregnancy and the postpartum period requires special attention and expertise as the correct diagnosis and treatment can significantly influence the outcome of pregnancy and the well-being of the mother and the fetus or newborn.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 617-623"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0