Hypoglycemia is a clinical syndrome that has diverse causes and is characterized by episodes of low blood glucose and typically marked by autonomic and neuroglycopenic manifestations. This review discusses the classification, etiology, and diagnosis for hypoglycemia, including the Whipple triad, and the classic diagnostic test, the prolonged (72-hour) fast. Specific attention is given to the conditions that cause hypoglycemia, including insulinomas, factitious hypoglycemia, insulin autoimmune hypoglycemia, and post–gastric bypass hypoglycemia, as well as the diagnosis and management of these conditions. This review contains 2 figures, 6 figures, and 43 figures. Keywords: Blood glucose, hypoglycemia, neuroglycopenic manifestations, Whipple triad, 72-hour fast, insulinoma, post-gastric bypass, factitious hypoglycemia
{"title":"Hypoglycemia","authors":"F. Service, A. Vella","doi":"10.2310/fm.1112","DOIUrl":"https://doi.org/10.2310/fm.1112","url":null,"abstract":"Hypoglycemia is a clinical syndrome that has diverse causes and is characterized by episodes of low blood glucose and typically marked by autonomic and neuroglycopenic manifestations. This review discusses the classification, etiology, and diagnosis for hypoglycemia, including the Whipple triad, and the classic diagnostic test, the prolonged (72-hour) fast. Specific attention is given to the conditions that cause hypoglycemia, including insulinomas, factitious hypoglycemia, insulin autoimmune hypoglycemia, and post–gastric bypass hypoglycemia, as well as the diagnosis and management of these conditions. \u0000This review contains 2 figures, 6 figures, and 43 figures. \u0000Keywords: Blood glucose, hypoglycemia, neuroglycopenic manifestations, Whipple triad, 72-hour fast, insulinoma, post-gastric bypass, factitious hypoglycemia","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81282342","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}
Pemphigus disorders are characterized by acantholysis, whereas pemphigoid disorders are characterized by a dermal-epidermal split. Diagnosis of pemphigus or pemphigoid relies on a combination of positive anti-desmoglein or anti-collagen XVII serology, confirmatory direct immunofluorescence, and clinical features. Treatment for immunobullous disease revolves around various immunosuppressants, most often some combination of rituximab, prednisone, and IVIg. Paraneoplastic pemphigus is characterized by hemorrhagic crusting of the lips with positive indirect immunofluorescence on rat bladder epithelium, which should prompt a search for malignancy. Hailey-Hailey disease is a genetically mediated pemphigus that typically occurs in skin folds and responds to a number of agents including botulinum toxin, topical steroids, and other anecdotal therapies. This review contains 17 figures, 2 tables, and 109 references. Keywords: blister, pemphigus, bullous, rituximab, bullae, prednisone
{"title":"Pemphigus and Bullous Pemphigoid","authors":"Aakaash Varma, A. Czernik, J. Levitt","doi":"10.2310/FM.1122","DOIUrl":"https://doi.org/10.2310/FM.1122","url":null,"abstract":"Pemphigus disorders are characterized by acantholysis, whereas pemphigoid disorders are characterized by a dermal-epidermal split. Diagnosis of pemphigus or pemphigoid relies on a combination of positive anti-desmoglein or anti-collagen XVII serology, confirmatory direct immunofluorescence, and clinical features. Treatment for immunobullous disease revolves around various immunosuppressants, most often some combination of rituximab, prednisone, and IVIg. Paraneoplastic pemphigus is characterized by hemorrhagic crusting of the lips with positive indirect immunofluorescence on rat bladder epithelium, which should prompt a search for malignancy. Hailey-Hailey disease is a genetically mediated pemphigus that typically occurs in skin folds and responds to a number of agents including botulinum toxin, topical steroids, and other anecdotal therapies.\u0000This review contains 17 figures, 2 tables, and 109 references.\u0000Keywords: blister, pemphigus, bullous, rituximab, bullae, prednisone","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88137193","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}
Vulvar lesions are a common complaint for which pediatric patients seek medical attention. Please refer to the chapter on Prepubertal Vulvovaginitis for more details. A careful history and physical exam, including full skin exam should be performed when pediatric and adolescent patients present with vulvar complaints. The chief complaint and chronicity of the symptoms can narrow the differential. The chronicity and areas of dermatologic involvement can also be key to diagnosing a systemic condition versus a primary vulvar dermatosis. When the latter is assumed, a referral to an appropriate specialist such as a Pediatric and Adolescent Gynecologist or Dermatologist should be considered. Treatment for vulvar dermatoses should be etiology dependent with consideration of systemic treatment as appropriately indicated. Vulvar hygiene should be considered in all patients as restoring the skin barrier and removing potential irritants is imperative to healing and preventing further irritation. This review contains 1 figure, 2 tables, and 25 references. Keywords: vulva, vulva dermatosis, vulvovaginitis, lichen sclerosus, atopic dermatitis, psoriasis, streptococcus vulvovaginitis, irritant dermatitis, contact dermatitis
{"title":"Vulvar Lesions in the Pediatric Patient","authors":"Michele Troutman, Hong-Thao Thieu","doi":"10.2310/OBG.19108","DOIUrl":"https://doi.org/10.2310/OBG.19108","url":null,"abstract":"Vulvar lesions are a common complaint for which pediatric patients seek medical attention. Please refer to the chapter on Prepubertal Vulvovaginitis for more details. A careful history and physical exam, including full skin exam should be performed when pediatric and adolescent patients present with vulvar complaints. The chief complaint and chronicity of the symptoms can narrow the differential. The chronicity and areas of dermatologic involvement can also be key to diagnosing a systemic condition versus a primary vulvar dermatosis. When the latter is assumed, a referral to an appropriate specialist such as a Pediatric and Adolescent Gynecologist or Dermatologist should be considered. Treatment for vulvar dermatoses should be etiology dependent with consideration of systemic treatment as appropriately indicated. Vulvar hygiene should be considered in all patients as restoring the skin barrier and removing potential irritants is imperative to healing and preventing further irritation.\u0000This review contains 1 figure, 2 tables, and 25 references.\u0000Keywords: vulva, vulva dermatosis, vulvovaginitis, lichen sclerosus, atopic dermatitis, psoriasis, streptococcus vulvovaginitis, irritant dermatitis, contact dermatitis","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87844780","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}
{"title":"Invasive Diagnostic and Therapeutic Techniques in Lung Disease","authors":"R. Bueno, A. White","doi":"10.2310/surg.1258","DOIUrl":"https://doi.org/10.2310/surg.1258","url":null,"abstract":"<jats:p />","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76038581","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}
{"title":"Testes and Testicular Disorders","authors":"E. Nabel","doi":"10.2310/FM.1111","DOIUrl":"https://doi.org/10.2310/FM.1111","url":null,"abstract":"<jats:p />","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85871509","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}
Sexuality is important to women of all ages. Although changes in sexual function occur with aging, hormonal transitions, illness, the use of medications, and disability, many women can maintain a satisfying sex life by making appropriate adaptations. Clinicians who take the time to obtain a complete and careful sexual history and perform a pertinent physical examination can help the majority of women who present with sexual complaints. Effective treatment must address the contribution of psychological, relationship, and biologic factors and often requires the collaboration of physicians and psychotherapists, as well as sex and physical therapists in many circumstances. Simply initiating a discussion about sexual concerns is frequently the most valuable aspect of treatment for women and their partners. Also useful are provision of basic education about normal female genital anatomy and sexual function across the lifespan; permission to explore masturbation, erotica, and versatile sexual techniques, as well as nongenital pleasuring; information about lubricants; and the prescription of estrogen in the setting of vulvovaginal atrophy. There are as yet no approved agents to treat the biologic component of hypoactive sexual desire. However, it may be appropriate to consider using androgen supplementation in patients with surgical menopause, as well as the addition of bupropion in patients taking selective serotonin reuptake inhibitors (SSRIs). This review discusses the epidemiology of female sexual disorders, the female sexual response and sexual behavior, and the diagnosis and management of specific sexual disorders, including desire, arousal, orgasm, and sexual-pain problems. This review contains 4 figures, 41 tables, and 96 references. Keywords: Sexual dysfunction disorder, arousal, orgasm, desire, dyspareunia, vulvodynia, vestibulitis, vaginismus
{"title":"Female Sexuality: Assessing Satisfaction and Addressing Problems","authors":"J. Potter","doi":"10.2310/FM.1254","DOIUrl":"https://doi.org/10.2310/FM.1254","url":null,"abstract":"Sexuality is important to women of all ages. Although changes in sexual function occur with aging, hormonal transitions, illness, the use of medications, and disability, many women can maintain a satisfying sex life by making appropriate adaptations. Clinicians who take the time to obtain a complete and careful sexual history and perform a pertinent physical examination can help the majority of women who present with sexual complaints. Effective treatment must address the contribution of psychological, relationship, and biologic factors and often requires the collaboration of physicians and psychotherapists, as well as sex and physical therapists in many circumstances. Simply initiating a discussion about sexual concerns is frequently the most valuable aspect of treatment for women and their partners. Also useful are provision of basic education about normal female genital anatomy and sexual function across the lifespan; permission to explore masturbation, erotica, and versatile sexual techniques, as well as nongenital pleasuring; information about lubricants; and the prescription of estrogen in the setting of vulvovaginal atrophy. There are as yet no approved agents to treat the biologic component of hypoactive sexual desire. However, it may be appropriate to consider using androgen supplementation in patients with surgical menopause, as well as the addition of bupropion in patients taking selective serotonin reuptake inhibitors (SSRIs). This review discusses the epidemiology of female sexual disorders, the female sexual response and sexual behavior, and the diagnosis and management of specific sexual disorders, including desire, arousal, orgasm, and sexual-pain problems. \u0000This review contains 4 figures, 41 tables, and 96 references.\u0000Keywords: Sexual dysfunction disorder, arousal, orgasm, desire, dyspareunia, vulvodynia, vestibulitis, vaginismus","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79645918","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}
Marfan syndrome is an autosomal dominant syndrome that affects various connective tissues including the aorta and skeletal system. It represent a major cause of aortic dissection in individuals with seemingly unremarkable past medical history, and is the most common cause of aortic dissection in pregnancy. Prompt and accurate diagnosis can be lifesaving. Careful physical examination and detailed personal and family history is vital for clinical evaluation. Genetic testing is often needed for accurate diagnosis but result interpretation might be challenging and genetic counseling is always required. Established guidelines can help navigate the challenges in obstetric management, which may include major surgical interventions during or after pregnancy. This review contains 6 figures, 4 tables, and 40 references. Keywords: Marfan syndrome, FBN1, aortic dissection, dilatation, connective tissue, ectopia lentis, pectus, systemic score, Ghent diagnostic criteria, genetic testing.
{"title":"Common Maternal Genetic Syndromes II: Marfan Syndrome","authors":"Ali Al-Beshri, N. Robin","doi":"10.2310/fm.19143","DOIUrl":"https://doi.org/10.2310/fm.19143","url":null,"abstract":"Marfan syndrome is an autosomal dominant syndrome that affects various connective tissues including the aorta and skeletal system. It represent a major cause of aortic dissection in individuals with seemingly unremarkable past medical history, and is the most common cause of aortic dissection in pregnancy. Prompt and accurate diagnosis can be lifesaving. Careful physical examination and detailed personal and family history is vital for clinical evaluation. Genetic testing is often needed for accurate diagnosis but result interpretation might be challenging and genetic counseling is always required. Established guidelines can help navigate the challenges in obstetric management, which may include major surgical interventions during or after pregnancy.\u0000This review contains 6 figures, 4 tables, and 40 references.\u0000Keywords: Marfan syndrome, FBN1, aortic dissection, dilatation, connective tissue, ectopia lentis, pectus, systemic score, Ghent diagnostic criteria, genetic testing.","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80957515","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}
Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility, interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis
{"title":"Fibromyalgia","authors":"D. Clauw","doi":"10.2310/fm.1215","DOIUrl":"https://doi.org/10.2310/fm.1215","url":null,"abstract":"Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM.\u0000This review contains 6 figures, 9 tables, and 78 references.\u0000Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility, interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72688441","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}
Attention-deficit/hyperactivity disorder (ADHD) is the most common and thoroughly researched neuropsychiatric disorder affecting children and adolescents. The prevalence of ADHD ranges from 8 to 12% in school-age children, and 70% of these individuals continue to meet DSM-5 criteria for the disorder in adolescence. ADHD is more commonly diagnosed in boys compared with girls. ADHD is chronic, with prominent symptoms and impairment in family, social, and academic functioning. ADHD is often associated with comorbid disorders, including disruptive, mood, and anxiety disorders, and can increase the risk of developing substance use disorders. The diagnosis of ADHD requires a comprehensive clinical assessment, including a detailed history, clinical interview, and collateral information, and is clinically established by review of symptoms and impairment and having established a developmental history of the symptoms. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. Treatment should attend to developmental milestones of the child and include family and individual psychosocial interventions. Psychosocial interventions in combination with medication are helpful for ADHD and comorbid problems. Pharmacotherapy, including psychostimulants, noradrenergic agents, alpha agonists, and antidepressants, plays a fundamental role in the treatment and management of ADHD. This review contains 2 figures, 9 tables, and 114 references. Key words: attention, attention-deficit/hyperactivity disorder, comorbidity, hyperactivity, impulsivity, learning, nonstimulants, psychosocial, psychostimulants, treatment
{"title":"Attention-Deficit/Hyperactivity Disorder in Children and Adolescents","authors":"S. Delgado","doi":"10.2310/fm.13007","DOIUrl":"https://doi.org/10.2310/fm.13007","url":null,"abstract":"Attention-deficit/hyperactivity disorder (ADHD) is the most common and thoroughly researched neuropsychiatric disorder affecting children and adolescents. The prevalence of ADHD ranges from 8 to 12% in school-age children, and 70% of these individuals continue to meet DSM-5 criteria for the disorder in adolescence. ADHD is more commonly diagnosed in boys compared with girls. ADHD is chronic, with prominent symptoms and impairment in family, social, and academic functioning. ADHD is often associated with comorbid disorders, including disruptive, mood, and anxiety disorders, and can increase the risk of developing substance use disorders. The diagnosis of ADHD requires a comprehensive clinical assessment, including a detailed history, clinical interview, and collateral information, and is clinically established by review of symptoms and impairment and having established a developmental history of the symptoms. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. Treatment should attend to developmental milestones of the child and include family and individual psychosocial interventions. Psychosocial interventions in combination with medication are helpful for ADHD and comorbid problems. Pharmacotherapy, including psychostimulants, noradrenergic agents, alpha agonists, and antidepressants, plays a fundamental role in the treatment and management of ADHD.\u0000This review contains 2 figures, 9 tables, and 114 references.\u0000Key words: attention, attention-deficit/hyperactivity disorder, comorbidity, hyperactivity, impulsivity, learning, nonstimulants, psychosocial, psychostimulants, treatment","PeriodicalId":10989,"journal":{"name":"DeckerMed Family Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85662634","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}
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