Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0276
P. Scanlon
Diabetic retinopathy is the leading cause of blindness in the working age population of most developed countries but has been shown to no longer be the leading cause in England and Wales. The introduction of the national screening programmes has been considered to be a major contributor to this achievement. The people with diabetes who still lose vision are often non-attenders who present late in the disease when treatment is more difficult. Tightening of control of glycaemia and blood pressure can slow the disease progression. When sight threatening retinopathy is detected, laser treatment and vascular endothelial growth factor (VEGF) inhibitor treatments reduce the risk of visual loss. When advanced retinopathy is detected, vitrectomy results have improved considerably over the last 20 years and a reasonable level of vision is often retained.
{"title":"Retinopathy","authors":"P. Scanlon","doi":"10.1093/med/9780198870197.003.0276","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0276","url":null,"abstract":"Diabetic retinopathy is the leading cause of blindness in the working age population of most developed countries but has been shown to no longer be the leading cause in England and Wales. The introduction of the national screening programmes has been considered to be a major contributor to this achievement. The people with diabetes who still lose vision are often non-attenders who present late in the disease when treatment is more difficult. Tightening of control of glycaemia and blood pressure can slow the disease progression. When sight threatening retinopathy is detected, laser treatment and vascular endothelial growth factor (VEGF) inhibitor treatments reduce the risk of visual loss. When advanced retinopathy is detected, vitrectomy results have improved considerably over the last 20 years and a reasonable level of vision is often retained.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126603347","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0286
P. Clarke, Tom W. C. Lung
There is an ever-increasing demand for healthcare. While clinical studies determine an intervention’s efficacy or effectiveness, limited resources mean that choices need to be made when deciding which healthcare interventions should be funded. Health economics focuses on how to make these choices to fund healthcare interventions that will maximize health benefits. This chapter introduces the ideas of key drivers in healthcare costs and issues around sustainability of funding for diabetes-specific programmes. It will then focus on the concept and different types of economic evaluation, measuring quality-adjusted life-years, and its use in identifying diabetes interventions that provide value for money, providing specific examples.
{"title":"Health Economics of Diabetes Care and Prevention","authors":"P. Clarke, Tom W. C. Lung","doi":"10.1093/med/9780198870197.003.0286","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0286","url":null,"abstract":"There is an ever-increasing demand for healthcare. While clinical studies determine an intervention’s efficacy or effectiveness, limited resources mean that choices need to be made when deciding which healthcare interventions should be funded. Health economics focuses on how to make these choices to fund healthcare interventions that will maximize health benefits. This chapter introduces the ideas of key drivers in healthcare costs and issues around sustainability of funding for diabetes-specific programmes. It will then focus on the concept and different types of economic evaluation, measuring quality-adjusted life-years, and its use in identifying diabetes interventions that provide value for money, providing specific examples.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114090234","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0387
G. Rastrelli, M. Maggi, G. Corona
Several therapeutic options are available in the treatment of adult hypogonadism, the choice of which depend on the clinical situation, availability/costs of medications, patient expectations, and preferences. The induction or restoration of both fertility and testosterone (T) production are potentially achievable, in patients with secondary hypogonadism, whereas only T substitution is effective when the testes are damaged (i.e. primary hypogonadism). When fertility is desired, the use of gonadotrophins in secondary hypogonadism is the most appropriate treatment allowing sperm production to be achieved in about 50% of cases. In all other patients, T substitution is the treatment of choice as it is cheaper and easier to administer when compared to gonadotropins. The use of transdermal T preparations and long-acting injectable T undecanoate are currently the most popular forms of the treatment worldwide. They generally achieve a high level of efficacy with limited side effects.
{"title":"Types of Treatment","authors":"G. Rastrelli, M. Maggi, G. Corona","doi":"10.1093/med/9780198870197.003.0387","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0387","url":null,"abstract":"Several therapeutic options are available in the treatment of adult hypogonadism, the choice of which depend on the clinical situation, availability/costs of medications, patient expectations, and preferences. The induction or restoration of both fertility and testosterone (T) production are potentially achievable, in patients with secondary hypogonadism, whereas only T substitution is effective when the testes are damaged (i.e. primary hypogonadism). When fertility is desired, the use of gonadotrophins in secondary hypogonadism is the most appropriate treatment allowing sperm production to be achieved in about 50% of cases. In all other patients, T substitution is the treatment of choice as it is cheaper and easier to administer when compared to gonadotropins. The use of transdermal T preparations and long-acting injectable T undecanoate are currently the most popular forms of the treatment worldwide. They generally achieve a high level of efficacy with limited side effects.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"318 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114129256","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0072
B. Nygaard
The goals for treatment of primary hypothyroidism are to restore euthyroidism with normalization of serum thyroid-stimulating hormone (TSH) and fT4 concentrations and to eliminate symptoms. Thyroxine, as levothyroxine sodium (L-T4), is the therapy of choice, and its use in most patients’ treatment is straightforward. In a minor patient group, persistent symptoms are present although thyroid function parameters are normalized. In these patients, it is pertinent to search for alternative explanations for the symptoms other than thyroid disease. A possible effect of a combination of L-T4 and L-T3 is disputed. Overtreatment with suppressed serum TSH must be avoided due to risks of cardiovascular disease, osteoporosis, and dementia.
{"title":"Treatment of Hypothyroidism","authors":"B. Nygaard","doi":"10.1093/med/9780198870197.003.0072","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0072","url":null,"abstract":"The goals for treatment of primary hypothyroidism are to restore euthyroidism with normalization of serum thyroid-stimulating hormone (TSH) and fT4 concentrations and to eliminate symptoms. Thyroxine, as levothyroxine sodium (L-T4), is the therapy of choice, and its use in most patients’ treatment is straightforward. In a minor patient group, persistent symptoms are present although thyroid function parameters are normalized. In these patients, it is pertinent to search for alternative explanations for the symptoms other than thyroid disease. A possible effect of a combination of L-T4 and L-T3 is disputed. Overtreatment with suppressed serum TSH must be avoided due to risks of cardiovascular disease, osteoporosis, and dementia.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"425 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115251057","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0021
M. Levy, R. Bhake, N. Reddy
Hypopituitarism is the consequence of diseases or interventions resulting in deficiency of pituitary hormones. Pituitary hormone replacement is one of the most frequent clinical interventions in pituitary disease, yet is rarely been the subject of rigorous scientific evaluation. With the exception of growth hormone, anterior pituitary hormones are replaced with target hormones (sex steroids, cortisol, and thyroxine), in preference to pituitary trophic hormones, as the former have longer half-lives allowing for oral administration. The precise reason for increased morbidity and mortality associated with hypopituitarism is unclear, but underlines the importance of replacing hormones close to physiological patterns. In an era of ‘evidence-based’ medicine, recommendations are frequently based on clinical experience, consensus guidelines, and retrospective reviews rather than on randomized trials. Within these limitations, this chapter will attempt to give a balanced view on current best practice for replacement therapy in adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and gonadotrophin deficiency.
{"title":"Hypopituitarism","authors":"M. Levy, R. Bhake, N. Reddy","doi":"10.1093/med/9780198870197.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0021","url":null,"abstract":"Hypopituitarism is the consequence of diseases or interventions resulting in deficiency of pituitary hormones. Pituitary hormone replacement is one of the most frequent clinical interventions in pituitary disease, yet is rarely been the subject of rigorous scientific evaluation. With the exception of growth hormone, anterior pituitary hormones are replaced with target hormones (sex steroids, cortisol, and thyroxine), in preference to pituitary trophic hormones, as the former have longer half-lives allowing for oral administration. The precise reason for increased morbidity and mortality associated with hypopituitarism is unclear, but underlines the importance of replacing hormones close to physiological patterns. In an era of ‘evidence-based’ medicine, recommendations are frequently based on clinical experience, consensus guidelines, and retrospective reviews rather than on randomized trials. Within these limitations, this chapter will attempt to give a balanced view on current best practice for replacement therapy in adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and gonadotrophin deficiency.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131233635","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0273
K. Ismail, Christopher J. Garrett, M. Stadler
There is a consistent pattern of association of several psychiatric disorders and type 1 diabetes (T1D) including depression, anxiety, eating disorders, and personality disorders. The presumption is that most psychiatric morbidity is accrued from the psychological burden per se of T1D or that individuals with subclinical pre-existing mental health difficulties are tipped into an overt psychiatric diagnosis. Elements of the T1D regime, namely the acute focus on food and the energy it contains, as well as heightened requirements of self-control can predispose to eating disorders, while others find the unrelenting requirements profoundly depressing, leading to clinical depression. Others acquire diabetes-specific anxieties, such as fear of hypoglycaemia or preoccupation with long-term complications. Psychiatric disorders impact diabetes self-management and there is an established association with acute and long-term complications including increased mortality. An underlying mental health problem should be a primary differential in certain clinical scenarios. such as persistent high HbA1c (>80 mmol/mol IFCC), particularly with recurrent diabetic ketoacidosis (rDKA) and also those with recurrent severe hypoglycaemia. This is particularly important in rDKA where subsequent all-cause mortality is in excess of 15% and closely linked to mental health disorders. Early recognition of psychiatric disorders is therefore vital for prognosis for both physical and mental health and diabetes clinicians should routinely monitor for psychiatric disorders.
{"title":"Type 1 Diabetes and Psychiatry","authors":"K. Ismail, Christopher J. Garrett, M. Stadler","doi":"10.1093/med/9780198870197.003.0273","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0273","url":null,"abstract":"There is a consistent pattern of association of several psychiatric disorders and type 1 diabetes (T1D) including depression, anxiety, eating disorders, and personality disorders. The presumption is that most psychiatric morbidity is accrued from the psychological burden per se of T1D or that individuals with subclinical pre-existing mental health difficulties are tipped into an overt psychiatric diagnosis. Elements of the T1D regime, namely the acute focus on food and the energy it contains, as well as heightened requirements of self-control can predispose to eating disorders, while others find the unrelenting requirements profoundly depressing, leading to clinical depression. Others acquire diabetes-specific anxieties, such as fear of hypoglycaemia or preoccupation with long-term complications. Psychiatric disorders impact diabetes self-management and there is an established association with acute and long-term complications including increased mortality. An underlying mental health problem should be a primary differential in certain clinical scenarios. such as persistent high HbA1c (>80 mmol/mol IFCC), particularly with recurrent diabetic ketoacidosis (rDKA) and also those with recurrent severe hypoglycaemia. This is particularly important in rDKA where subsequent all-cause mortality is in excess of 15% and closely linked to mental health disorders. Early recognition of psychiatric disorders is therefore vital for prognosis for both physical and mental health and diabetes clinicians should routinely monitor for psychiatric disorders.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133631842","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0108
D. Clement, R. Srirajaskanthan, M. Caplin
Carcinoid syndrome occurs in approximately 20% of patients with neuroendocrine tumours. Its pathophysiology is not completely understood; however, it is thought to arise from secretion of serotonin and kinins from the neuroendocrine tumour cells. In patients with liver metastases these hormones are not metabolized by the liver and consequently lead to the symptoms of carcinoid syndrome. The most common symptoms are diarrhoea, flushing, abdominal pain, and wheezing. Management of carcinoid syndrome is centred around control of tumour growth and symptoms. First line treatment is with somatostatin analogues, more recently Telotristat ethyl has been licensed for refractory syndrome. A number of complications can arise secondary to serotonin and kinin secretion these include nutritional deficiency, mesenteric fibrosis, and carcinoid heart disease. Carcinoid crisis which comprises of severe haemodynamic instability can occur during times of stress or surgery. Careful preoperative management needs to be considered prior to surgery in this cohort of patients.
{"title":"Carcinoid Syndrome","authors":"D. Clement, R. Srirajaskanthan, M. Caplin","doi":"10.1093/med/9780198870197.003.0108","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0108","url":null,"abstract":"Carcinoid syndrome occurs in approximately 20% of patients with neuroendocrine tumours. Its pathophysiology is not completely understood; however, it is thought to arise from secretion of serotonin and kinins from the neuroendocrine tumour cells. In patients with liver metastases these hormones are not metabolized by the liver and consequently lead to the symptoms of carcinoid syndrome. The most common symptoms are diarrhoea, flushing, abdominal pain, and wheezing. Management of carcinoid syndrome is centred around control of tumour growth and symptoms. First line treatment is with somatostatin analogues, more recently Telotristat ethyl has been licensed for refractory syndrome. A number of complications can arise secondary to serotonin and kinin secretion these include nutritional deficiency, mesenteric fibrosis, and carcinoid heart disease. Carcinoid crisis which comprises of severe haemodynamic instability can occur during times of stress or surgery. Careful preoperative management needs to be considered prior to surgery in this cohort of patients.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133981962","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0111
C. Toumpanakis, M. Caplin
Gastrinomas are functional neuroendocrine tumours, characterized by autonomous release of gastrin by the tumour cells, which results in symptoms not only due to the tumour growth per se, but also due to gastric acid hypersecretion. Gastrinomas can either be sporadic or can be associated with multiple endocrine neoplasia type 1 (MEN-1) syndrome in 25% of cases. The duodenum (especially the first and the second part) is the most common location for both sporadic and MEN-1 associated gastrinomas. Most of the symptoms in patients with gastrinomas include peptic ulcers resistant to treatment, erosive oesophagitis, and chronic diarrhoea. Fasting serum gastrin levels of >10-fold the upper normal limit in the presence of gastric p H<2 or basal acid output (BAO)>15 mmol/h confirm the clinical suspicion, of a gastrinoma. Precise localization of primary tumour as well as metastatic deposits can be achieved through the new molecular imaging studies (68Ga-DOTA PET) in combination with good quality cross-sectional imaging studies and endoscopic ultrasound. Once the diagnosis is established, it is important to control gastric acid hypersecretion and prevent its complications, by using high-doses proton pump inhibitors. The aim of surgery in patients with sporadic gastrinomas is curative resection, in order to decrease the risk of development of distant metastases, as well as to completely control the hormonal symptoms. The benefit of surgery in gastrinomas associated with MEN-1 syndrome is controversial. All patients with advanced and inoperable disease should have systemic antitumour treatment (somatostatin analogues, molecular targeted agents, chemotherapy, peptide receptor radionuclide therapy) in order to prolong the survival rates.
{"title":"Gastrinoma","authors":"C. Toumpanakis, M. Caplin","doi":"10.1093/med/9780198870197.003.0111","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0111","url":null,"abstract":"Gastrinomas are functional neuroendocrine tumours, characterized by autonomous release of gastrin by the tumour cells, which results in symptoms not only due to the tumour growth per se, but also due to gastric acid hypersecretion. Gastrinomas can either be sporadic or can be associated with multiple endocrine neoplasia type 1 (MEN-1) syndrome in 25% of cases. The duodenum (especially the first and the second part) is the most common location for both sporadic and MEN-1 associated gastrinomas. Most of the symptoms in patients with gastrinomas include peptic ulcers resistant to treatment, erosive oesophagitis, and chronic diarrhoea. Fasting serum gastrin levels of >10-fold the upper normal limit in the presence of gastric p H<2 or basal acid output (BAO)>15 mmol/h confirm the clinical suspicion, of a gastrinoma. Precise localization of primary tumour as well as metastatic deposits can be achieved through the new molecular imaging studies (68Ga-DOTA PET) in combination with good quality cross-sectional imaging studies and endoscopic ultrasound. Once the diagnosis is established, it is important to control gastric acid hypersecretion and prevent its complications, by using high-doses proton pump inhibitors. The aim of surgery in patients with sporadic gastrinomas is curative resection, in order to decrease the risk of development of distant metastases, as well as to completely control the hormonal symptoms. The benefit of surgery in gastrinomas associated with MEN-1 syndrome is controversial. All patients with advanced and inoperable disease should have systemic antitumour treatment (somatostatin analogues, molecular targeted agents, chemotherapy, peptide receptor radionuclide therapy) in order to prolong the survival rates.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124243982","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0211
E. Armeni, A. Grossman, B. Khoo
Endogenous opioids and opioid receptors play key neuroendocrinological roles in regulating the body’s response to stress and pain. As part of this function, endogenous opioids regulate the hypothalamo–pituitary–adrenal (HPA), hypothalamo—pituitary–gonadal axes (HPG) axes and posterior pituitary function. Exogenous opioids have been used from ancient times as analgesics but have a well-known addictive potential. Opiate dependency is now a widespread global problem, driven by the easy availability of both prescribed and illegal opiates. As a consequence, the endocrine complications from opiates are becoming more common and chronic opiate users are at high risk of developing hypoadrenalism and hypogonadism. A robust screening protocol for these endocrinopathies, in collaboration between pain specialists and endocrinologists, is essential for appropriate replacement treatment and the prevention of morbidities and possibly mortality, especially from hypoadrenalism.
{"title":"Effect of Opioids on Adrenal and Reproductive Endocrinology","authors":"E. Armeni, A. Grossman, B. Khoo","doi":"10.1093/med/9780198870197.003.0211","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0211","url":null,"abstract":"Endogenous opioids and opioid receptors play key neuroendocrinological roles in regulating the body’s response to stress and pain. As part of this function, endogenous opioids regulate the hypothalamo–pituitary–adrenal (HPA), hypothalamo—pituitary–gonadal axes (HPG) axes and posterior pituitary function. Exogenous opioids have been used from ancient times as analgesics but have a well-known addictive potential. Opiate dependency is now a widespread global problem, driven by the easy availability of both prescribed and illegal opiates. As a consequence, the endocrine complications from opiates are becoming more common and chronic opiate users are at high risk of developing hypoadrenalism and hypogonadism. A robust screening protocol for these endocrinopathies, in collaboration between pain specialists and endocrinologists, is essential for appropriate replacement treatment and the prevention of morbidities and possibly mortality, especially from hypoadrenalism.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124783233","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0100
W. Drake, Morris J. Brown
Major advances have been made since Jerome Conn first described the meticulous assessment and surgical treatment of a patient with severe primary aldosteronism (PA) more than 60 years ago. Diagnostic criteria, although still imperfect, have been refined; high definition cross-sectional imaging is widely available; adrenal vein sampling (AVS) is practised to a high standard in selected centres; low-morbidity laparoscopic adrenalectomy (replacing open surgery involving rib resection) is now routine; preliminary data are emerging about the utility of radiofrequency ablation of adrenal nodules as an alternative to surgery; and the range of medical therapies, available or in development, is expanding. Despite this, based on current prevalence estimates, it remains the case that under 1% of patients with PA are fully evaluated and treated. Given the evidence that PA is associated with substantial excess cardiometabolic morbidity over and above that conferred by elevated blood pressure alone, this underprovision of clinical care represents a major public health issue. This chapter will describe the current approach to the management of PA (from its initial suspicion, diagnosis, differential diagnosis, treatment, and evaluation of the success of treatment) and highlight areas of particular uncertainty and controversy.
{"title":"Management of Primary Aldosteronism","authors":"W. Drake, Morris J. Brown","doi":"10.1093/med/9780198870197.003.0100","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0100","url":null,"abstract":"Major advances have been made since Jerome Conn first described the meticulous assessment and surgical treatment of a patient with severe primary aldosteronism (PA) more than 60 years ago. Diagnostic criteria, although still imperfect, have been refined; high definition cross-sectional imaging is widely available; adrenal vein sampling (AVS) is practised to a high standard in selected centres; low-morbidity laparoscopic adrenalectomy (replacing open surgery involving rib resection) is now routine; preliminary data are emerging about the utility of radiofrequency ablation of adrenal nodules as an alternative to surgery; and the range of medical therapies, available or in development, is expanding. Despite this, based on current prevalence estimates, it remains the case that under 1% of patients with PA are fully evaluated and treated. Given the evidence that PA is associated with substantial excess cardiometabolic morbidity over and above that conferred by elevated blood pressure alone, this underprovision of clinical care represents a major public health issue. This chapter will describe the current approach to the management of PA (from its initial suspicion, diagnosis, differential diagnosis, treatment, and evaluation of the success of treatment) and highlight areas of particular uncertainty and controversy.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131344203","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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