Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0168
Siew S. Lim, A. Mousa, S. Shorakae, L. Moran
Undernutrition adversely affects fertility. A low body weight is associated with delayed conception. When conception does occur, undernutrition could also adversely affect pregnancy outcomes. Low prepregnancy BMI (<18.5 kg/m2) is associated with increased risk of early miscarriage, preterm labour, anaemia, insufficient weight gain, and impaired intrauterine fetal growth. On the other hand, overweight and obesity are associated with increased risk of gestational diabetes, pre-eclampsia, and other complications during pregnancy and delivery. Weight loss through energy restriction, with or without exercise, improves reproductive function in overweight or obese women. Aside from body weight and energy status, maternal macronutrient, and micronutrient intakes before and during pregnancy would also influence pregnancy outcomes. Studies in mostly nutritionally at-risk women reported that balanced energy/protein supplementation (<25% energy from protein) is associated with higher birth weights but high protein supplementation (> 25% energy from protein) may increase the risk of small-for-gestational-age (SGA) infants. Reducing glycaemic index or glycaemic load of maternal diet may reduce the risk of large-for-gestational-age (LGA) births or gestational diabetes. In terms of micronutrients, current evidence supports folic acid supplementation (at least 400 µg/day) to reduce the risk of fetal abnormalities, iodine supplementation for women at risk of iodine deficiency to prevent complications in fetal physical and mental development, and iron supplementation to reduce the risk of maternal anaemia where required.
{"title":"Exogenous Factors and Female Reproductive Health","authors":"Siew S. Lim, A. Mousa, S. Shorakae, L. Moran","doi":"10.1093/med/9780198870197.003.0168","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0168","url":null,"abstract":"Undernutrition adversely affects fertility. A low body weight is associated with delayed conception. When conception does occur, undernutrition could also adversely affect pregnancy outcomes. Low prepregnancy BMI (<18.5 kg/m2) is associated with increased risk of early miscarriage, preterm labour, anaemia, insufficient weight gain, and impaired intrauterine fetal growth. On the other hand, overweight and obesity are associated with increased risk of gestational diabetes, pre-eclampsia, and other complications during pregnancy and delivery. Weight loss through energy restriction, with or without exercise, improves reproductive function in overweight or obese women. Aside from body weight and energy status, maternal macronutrient, and micronutrient intakes before and during pregnancy would also influence pregnancy outcomes. Studies in mostly nutritionally at-risk women reported that balanced energy/protein supplementation (<25% energy from protein) is associated with higher birth weights but high protein supplementation (> 25% energy from protein) may increase the risk of small-for-gestational-age (SGA) infants. Reducing glycaemic index or glycaemic load of maternal diet may reduce the risk of large-for-gestational-age (LGA) births or gestational diabetes. In terms of micronutrients, current evidence supports folic acid supplementation (at least 400 µg/day) to reduce the risk of fetal abnormalities, iodine supplementation for women at risk of iodine deficiency to prevent complications in fetal physical and mental development, and iron supplementation to reduce the risk of maternal anaemia where required.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"1 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":"129904289","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/9780198870197.003.0061
N. Perrier, O. Clark, S. Fisher
Antithyroid medications, radioactive iodine, or thyroidectomy are viable therapeutic options for the patient with thyrotoxicosis, with relative pros and cons for each modality varying with patient comorbidities and preferences, and the expertise of the treating physicians. Of the three modalities, surgery is the most invasive but also the most definitive, and is favoured for patients with symptomatic compression, concomitant documented/suspected malignancy, or coexisting hyperparathyroidism requiring surgical intervention. Thyroidectomy for treatment of thyrotoxicosis is also advantageous for women who are pregnant, lactating, or planning pregnancy, for patients with moderate to severe Graves’ orbitopathy, or when immediate control of symptoms is necessary. In experienced hands, thyroidectomy is performed with minimal morbidity and should be considered in the patient who places more relative emphasis on prompt and definitive control of symptoms with avoidance of radioactive therapy and/or medications, with less concerns regarding operative risks and/or need for lifelong thyroid hormone replacement.
{"title":"Surgery for Thyrotoxicosis","authors":"N. Perrier, O. Clark, S. Fisher","doi":"10.1093/med/9780198870197.003.0061","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0061","url":null,"abstract":"Antithyroid medications, radioactive iodine, or thyroidectomy are viable therapeutic options for the patient with thyrotoxicosis, with relative pros and cons for each modality varying with patient comorbidities and preferences, and the expertise of the treating physicians. Of the three modalities, surgery is the most invasive but also the most definitive, and is favoured for patients with symptomatic compression, concomitant documented/suspected malignancy, or coexisting hyperparathyroidism requiring surgical intervention. Thyroidectomy for treatment of thyrotoxicosis is also advantageous for women who are pregnant, lactating, or planning pregnancy, for patients with moderate to severe Graves’ orbitopathy, or when immediate control of symptoms is necessary. In experienced hands, thyroidectomy is performed with minimal morbidity and should be considered in the patient who places more relative emphasis on prompt and definitive control of symptoms with avoidance of radioactive therapy and/or medications, with less concerns regarding operative risks and/or need for lifelong thyroid hormone replacement.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"7 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":"122477238","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/9780198870197.003.0012
R. Ross
The aim of hormone replacement is to replace the missing physiological effects of a deficient hormone. The last century identified most of the endocrine hormones, which can now be replaced when deficient; however, the challenge of the twenty-first century is to optimize replacement. The guiding principle in hormone replacement is replicating the natural levels and rhythms of hormones at different ages but this requires a good understanding of physiology. There is a need for better biomarkers of hormone actions and using these to develop new ways to deliver hormone replacement tailored to the individual. This chapter discusses current approaches to this problem.
{"title":"Principles of Hormone Replacement","authors":"R. Ross","doi":"10.1093/med/9780198870197.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0012","url":null,"abstract":"The aim of hormone replacement is to replace the missing physiological effects of a deficient hormone. The last century identified most of the endocrine hormones, which can now be replaced when deficient; however, the challenge of the twenty-first century is to optimize replacement. The guiding principle in hormone replacement is replicating the natural levels and rhythms of hormones at different ages but this requires a good understanding of physiology. There is a need for better biomarkers of hormone actions and using these to develop new ways to deliver hormone replacement tailored to the individual. This chapter discusses current approaches to this problem.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"32 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":"121337434","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/9780198870197.003.0171
K. Poppe, F. Veltri, D. Unuane
Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be considered as a therapeutic option. Prior to an ART treatment, an ovarian hyperstimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating thyroid hormone supplements (LT4) before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic infertility have a higher prevalence of TAI. Women with a known hypothyroidism before pregnancy and treated with LT4 should have a serum TSH <2.5 mIU/L, both in case of assisted and spontaneous pregnancies. Women with Graves’ disease desiring pregnancy should be advised of the increased risk of maternal and fetal complications and about the possible side effects of antithyroid drugs. If necessary, pregnancy must be postponed until euthyroidism is reached and confirmed. With the exception of women planning ART or those known to have TAI, at present there are no recommendations regarding universal screening for thyroid function in the preconception phase.
{"title":"Management of Thyroid Disorders Before Assisted and Spontaneous Pregnancies","authors":"K. Poppe, F. Veltri, D. Unuane","doi":"10.1093/med/9780198870197.003.0171","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0171","url":null,"abstract":"Severe thyroid dysfunction may lead to menstrual disorders and infertility. Fertility problems may persist even after restoring normal thyroid function, and then an assisted reproductive technology (ART) may be considered as a therapeutic option. Prior to an ART treatment, an ovarian hyperstimulation is performed, leading to high oestradiol levels, which may lead to hypothyroidism in women with thyroid autoimmunity (TAI), necessitating thyroid hormone supplements (LT4) before pregnancy. Moreover, women with the polycystic ovarian syndrome and idiopathic infertility have a higher prevalence of TAI. Women with a known hypothyroidism before pregnancy and treated with LT4 should have a serum TSH <2.5 mIU/L, both in case of assisted and spontaneous pregnancies. Women with Graves’ disease desiring pregnancy should be advised of the increased risk of maternal and fetal complications and about the possible side effects of antithyroid drugs. If necessary, pregnancy must be postponed until euthyroidism is reached and confirmed. With the exception of women planning ART or those known to have TAI, at present there are no recommendations regarding universal screening for thyroid function in the preconception phase.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"1 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":"122369522","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/9780198870197.003.0166
Jennifer Chin, B. Kaneshiro
The birth control pill, the first hormonal contraceptive method widely available to the public, transformed the way society viewed childbearing and sexuality. Since the 1960s, many different types of hormonal contraceptives have been developed and are now available to women. There are two main categories of hormonal contraceptives, combined hormonal contraceptives, which consist of oestrogen and progestin, and progestin-only contraceptives. Within each category, various methods and formulations exist, each with a different mechanism of action, efficacy, and side effect profile. Emergency contraception offers a post-coital method that can be used in cases where women did not use contraception at the time of intercourse or had a method failure (i.e. condom breakage). Several contraceptive methods have non-contraceptive benefits. Most methods decrease the risk of endometrial cancer and combined hormonal contraceptives decrease the risk of ovarian cancer. Many methods have been used in the treatment of abnormal uterine bleeding, dysmenorrhoea, premenstrual syndrome, and acne.
{"title":"Hormonal Contraception","authors":"Jennifer Chin, B. Kaneshiro","doi":"10.1093/med/9780198870197.003.0166","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0166","url":null,"abstract":"The birth control pill, the first hormonal contraceptive method widely available to the public, transformed the way society viewed childbearing and sexuality. Since the 1960s, many different types of hormonal contraceptives have been developed and are now available to women. There are two main categories of hormonal contraceptives, combined hormonal contraceptives, which consist of oestrogen and progestin, and progestin-only contraceptives. Within each category, various methods and formulations exist, each with a different mechanism of action, efficacy, and side effect profile. Emergency contraception offers a post-coital method that can be used in cases where women did not use contraception at the time of intercourse or had a method failure (i.e. condom breakage). Several contraceptive methods have non-contraceptive benefits. Most methods decrease the risk of endometrial cancer and combined hormonal contraceptives decrease the risk of ovarian cancer. Many methods have been used in the treatment of abnormal uterine bleeding, dysmenorrhoea, premenstrual syndrome, and acne.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"182 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":"121025684","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/9780198870197.003.0177
D. Torpy, M. O’Reilly, S. M. D. De Sousa
Diagnosis of adrenal gland dysfunction in pregnancy is complex, and confounded by physiological gestational changes in maternal adrenal hormone metabolism. Management of newly diagnosed or pre-existing adrenal disease in pregnant women requires intensive input from the endocrinologist, and close collaboration with the obstetrician or fetal medicine specialist. Maternal adrenal gland dysfunction during pregnancy encompasses adrenocortical disorders resulting in glucocorticoid and mineralocorticoid deficiency or excess, and medullary disease resulting in catecholamine excess. The aim of this chapter is to review clinical aspects of the most common adrenal disorders in pregnancy, and to discuss approaches to diagnosis and management. Both benign and malignant diseases of the adrenal cortex and medulla will also be discussed.
{"title":"Adrenal Disease in Pregnancy","authors":"D. Torpy, M. O’Reilly, S. M. D. De Sousa","doi":"10.1093/med/9780198870197.003.0177","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0177","url":null,"abstract":"Diagnosis of adrenal gland dysfunction in pregnancy is complex, and confounded by physiological gestational changes in maternal adrenal hormone metabolism. Management of newly diagnosed or pre-existing adrenal disease in pregnant women requires intensive input from the endocrinologist, and close collaboration with the obstetrician or fetal medicine specialist. Maternal adrenal gland dysfunction during pregnancy encompasses adrenocortical disorders resulting in glucocorticoid and mineralocorticoid deficiency or excess, and medullary disease resulting in catecholamine excess. The aim of this chapter is to review clinical aspects of the most common adrenal disorders in pregnancy, and to discuss approaches to diagnosis and management. Both benign and malignant diseases of the adrenal cortex and medulla will also be discussed.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"68 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":"128767724","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/9780198870197.003.0071
C. Moran, M. Gurnell, K. Chatterjee
Disorders of cellular uptake, metabolism, or action of thyroid hormones comprise syndromes of resistance to thyroid hormone. Reduced entry of thyroid hormones into the central nervous system via a membrane transporter mediates severe mental and psychomotor retardation associated with peripheral hyperthyroidism. Failure of selenocysteine incorporation into 25 different proteins results in a multisystem, selenoprotein deficiency, disorder associated with abnormal thyroid function due to impaired activity of deiodinase selenoenzymes. Resistance to Thyroid Hormone β, due to thyroid hormone β receptor mutations, is characterized by elevated circulating thyroid hormones, impaired feedback inhibition of thyroid-stimulating hormone (TSH) secretion and variable hormone resistance in peripheral tissues. Thyroid hormone receptor α defects cause resistance to thyroid hormone α, characterized by features of hypothyroidism in specific tissues but paradoxically associated with near-normal thyroid hormone levels. We describe the genetic basis, clinical features, pathogenesis, and management of these disorders.
{"title":"Syndromes of Resistance to Thyroid Hormone","authors":"C. Moran, M. Gurnell, K. Chatterjee","doi":"10.1093/med/9780198870197.003.0071","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0071","url":null,"abstract":"Disorders of cellular uptake, metabolism, or action of thyroid hormones comprise syndromes of resistance to thyroid hormone. Reduced entry of thyroid hormones into the central nervous system via a membrane transporter mediates severe mental and psychomotor retardation associated with peripheral hyperthyroidism. Failure of selenocysteine incorporation into 25 different proteins results in a multisystem, selenoprotein deficiency, disorder associated with abnormal thyroid function due to impaired activity of deiodinase selenoenzymes. Resistance to Thyroid Hormone β, due to thyroid hormone β receptor mutations, is characterized by elevated circulating thyroid hormones, impaired feedback inhibition of thyroid-stimulating hormone (TSH) secretion and variable hormone resistance in peripheral tissues. Thyroid hormone receptor α defects cause resistance to thyroid hormone α, characterized by features of hypothyroidism in specific tissues but paradoxically associated with near-normal thyroid hormone levels. We describe the genetic basis, clinical features, pathogenesis, and management of these disorders.","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":"133751199","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/9780198870197.003.0013
J. Valabhji, R. Agha-Jaffar
Changing epidemiology has led to a clear shift in focus in endocrinology disease prevention. Iodine deficiency disorders and congenital hypothyroidism were examples of conditions, which when left untreated had severe consequences including impaired neurological development. However, introduction of appropriate health policies has successfully increased early recognition and treatment, thereby reducing the associated health burden. The epidemic of type 2 diabetes has now superseded these and presents one of the greatest public health challenges. In some countries, national policies are being implemented to tackle the increasing prevalence with strategies focusing on improving the obesogenic environment, a significant modifiable contributor to type 2 diabetes, as well as strategies that aim to prevent high-risk individuals progressing through to type 2 diabetes, such as the National type 2 diabetes Prevention Programme in England. The potential for prevention in other areas including gestational diabetes, type 1 diabetes, and osteoporosis will also be explored in this chapter.
{"title":"Prevention in Endocrinology","authors":"J. Valabhji, R. Agha-Jaffar","doi":"10.1093/med/9780198870197.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0013","url":null,"abstract":"Changing epidemiology has led to a clear shift in focus in endocrinology disease prevention. Iodine deficiency disorders and congenital hypothyroidism were examples of conditions, which when left untreated had severe consequences including impaired neurological development. However, introduction of appropriate health policies has successfully increased early recognition and treatment, thereby reducing the associated health burden. The epidemic of type 2 diabetes has now superseded these and presents one of the greatest public health challenges. In some countries, national policies are being implemented to tackle the increasing prevalence with strategies focusing on improving the obesogenic environment, a significant modifiable contributor to type 2 diabetes, as well as strategies that aim to prevent high-risk individuals progressing through to type 2 diabetes, such as the National type 2 diabetes Prevention Programme in England. The potential for prevention in other areas including gestational diabetes, type 1 diabetes, and osteoporosis will also be explored in this chapter.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"1 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":"130531827","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}
Pub Date : 2021-07-01DOI: 10.1093/med/9780198870197.003.0283
B. Williams
High blood pressure (hypertension) is very common in people with diabetes. There is moreover an association between hypertension and diabetes that tracks through life, while the blood glucose concentration of young non-diabetic individuals has been shown to predict risk of future hypertension. Conversely, people with hypertension are twice as likely to develop type 2 diabetes over their lifetime. High blood pressure (hypertension) is arguably the most important preventable cause of premature microvascular and macrovascular disease and their associated morbidity and mortality in people with diabetes. This chapter will review key aspects of the epidemiology and pathophysiology of hypertension in people with diabetes, as well as recommended approaches to its clinical evaluation and treatment.
{"title":"Hypertension in Diabetes Mellitus","authors":"B. Williams","doi":"10.1093/med/9780198870197.003.0283","DOIUrl":"https://doi.org/10.1093/med/9780198870197.003.0283","url":null,"abstract":"High blood pressure (hypertension) is very common in people with diabetes. There is moreover an association between hypertension and diabetes that tracks through life, while the blood glucose concentration of young non-diabetic individuals has been shown to predict risk of future hypertension. Conversely, people with hypertension are twice as likely to develop type 2 diabetes over their lifetime. High blood pressure (hypertension) is arguably the most important preventable cause of premature microvascular and macrovascular disease and their associated morbidity and mortality in people with diabetes. This chapter will review key aspects of the epidemiology and pathophysiology of hypertension in people with diabetes, as well as recommended approaches to its clinical evaluation and treatment.","PeriodicalId":130301,"journal":{"name":"Oxford Textbook of Endocrinology and Diabetes 3e","volume":"138 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":"133172393","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：