Pub Date : 2018-01-01DOI: 10.17925/USE.2018.14.2.67
G. Mariani, J. Bellver
Polycystic ovary syndrome (PCOS) is a heterogenous condition affecting 5–10% of women at reproductive age. It is the most common cause of anovulatory infertility, characterized by hyperandrogenism and arrested follicle development, and is frequently associated with metabolic features such as insulin resistance and obesity. The diagnosis of PCOS, based on the Rotterdam criteria (2003), can be made when at least two of the following three main features are met: oligo-ovulation and/or anovulation, hyperandrogenism (clinical and/or biochemical), and polycystic ovarian morphology at ultrasound examination. Several approaches to ovulation induction have been proposed in women with PCOS. These approaches vary in efficacy, treatment duration, cost, and patient compliance. Management includes lifestyle changes, pharmacotherapy (metformin, clomiphene citrate, letrozole, gonadotropins, inositol), laparoscopic surgery (ovarian drilling), and assisted reproductive techniques, usually in vitro fertilization (see Figure 1). Clinical decisions in PCOS anovulatory patients are currently supported by a recently published international evidence-based guideline that provides 166 recommendations to help clinicians in the diagnosis and management of PCOS and to guide clinical practice.
{"title":"Management Options for Infertile Women with Polycystic Ovary Syndrome","authors":"G. Mariani, J. Bellver","doi":"10.17925/USE.2018.14.2.67","DOIUrl":"https://doi.org/10.17925/USE.2018.14.2.67","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a heterogenous condition affecting 5–10% of women at reproductive age. It is the most common cause of anovulatory infertility, characterized by hyperandrogenism and arrested follicle development, and is frequently associated with metabolic features such as insulin resistance and obesity. The diagnosis of PCOS, based on the Rotterdam criteria (2003), can be made when at least two of the following three main features are met: oligo-ovulation and/or anovulation, hyperandrogenism (clinical and/or biochemical), and polycystic ovarian morphology at ultrasound examination. Several approaches to ovulation induction have been proposed in women with PCOS. These approaches vary in efficacy, treatment duration, cost, and patient compliance. Management includes lifestyle changes, pharmacotherapy (metformin, clomiphene citrate, letrozole, gonadotropins, inositol), laparoscopic surgery (ovarian drilling), and assisted reproductive techniques, usually in vitro fertilization (see Figure 1). Clinical decisions in PCOS anovulatory patients are currently supported by a recently published international evidence-based guideline that provides 166 recommendations to help clinicians in the diagnosis and management of PCOS and to guide clinical practice.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603664","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 : 2018-01-01DOI: 10.17925/USE.2018.14.2.73
Neesha Ramchandani
Emerging adults with type 1 diabetes (T1D) often find it challenging to manage their diabetes well due to the many competing priorities they are juggling during this time. The majority of emerging adults (72%) are already looking for health information online, so telemedicine may be an avenue to explore with them. Telemedicine services for individuals with T1D are becoming increasingly popular and have been found to be beneficial for those who use them. However, there are very few multi-component telemedicine services available for individuals with T1D, and none of them provide a comprehensive technology-based system. Additionally, while these multi-component T1D telemedicine systems often included emerging adults in the group under study, the average age of the study subjects was usually above the age range of emerging adulthood. This suggests that specific developmental needs of emerging adults are not being addressed by these telemedicine systems, nor are the issues faced by diverse populations. More research needs to be done to address which telemedicine services, if any, would be beneficial for this especially vulnerable population.
{"title":"Telemedicine Services for Emerging Adults with Type 1 Diabetes","authors":"Neesha Ramchandani","doi":"10.17925/USE.2018.14.2.73","DOIUrl":"https://doi.org/10.17925/USE.2018.14.2.73","url":null,"abstract":"Emerging adults with type 1 diabetes (T1D) often find it challenging to manage their diabetes well due to the many competing priorities they are juggling during this time. The majority of emerging adults (72%) are already looking for health information online, so telemedicine may be an avenue to explore with them. Telemedicine services for individuals with T1D are becoming increasingly popular and have been found to be beneficial for those who use them. However, there are very few multi-component telemedicine services available for individuals with T1D, and none of them provide a comprehensive technology-based system. Additionally, while these multi-component T1D telemedicine systems often included emerging adults in the group under study, the average age of the study subjects was usually above the age range of emerging adulthood. This suggests that specific developmental needs of emerging adults are not being addressed by these telemedicine systems, nor are the issues faced by diverse populations. More research needs to be done to address which telemedicine services, if any, would be beneficial for this especially vulnerable population.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603671","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 : 2018-01-01DOI: 10.17925/USE.2018.14.1.11
M. Marcovecchio
{"title":"Letter from the Journal","authors":"M. Marcovecchio","doi":"10.17925/USE.2018.14.1.11","DOIUrl":"https://doi.org/10.17925/USE.2018.14.1.11","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80643268","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 : 2017-01-01DOI: 10.17925/USE.2017.13.01.10
L. Siminerio
Received: March 20, 2017 Published Online: May 8, 2017 Citation: US Endocrinology, 2017;13(1):Epub ahead of print Corresponding Author: Linda Siminerio, Professor of Medicine and Nursing, University of Pittsburgh, Falk Medical Building, Room 570, 3601 Fifth Avenue, Pittsburgh PA 15213, US. E: simineriol@upmc.edu D iabetes self-management education and support provides the foundation for helping people with diabetes to be able to navigate decisions and activities related to managing their life-long disease. Here, Linda Siminerio of the School of Medicine and Nursing, University of Pittsburgh, Pennsylvania, US discusses psychological factors affecting people with diabetes, self-management and the multiple benefits of ongoing education and support.
收稿日期:2017年3月20日发布在线日期:2017年5月8日引用来源:美国内分泌学杂志，2017;13(1):Epub预印通讯作者:Linda Siminerio，匹兹堡大学医学与护理学教授，福克医疗大楼，570室，3601 Fifth Avenue, Pittsburgh PA 15213, US。E: simineriol@upmc.edu糖尿病自我管理教育和支持为帮助糖尿病患者能够做出与管理其终生疾病相关的决定和活动提供了基础。在这里，美国宾夕法尼亚州匹兹堡大学医学与护理学院的Linda Siminerio讨论了影响糖尿病患者的心理因素、自我管理以及持续教育和支持的多重好处。
{"title":"The New Psychosocial Position Statement from the American Diabetes Association","authors":"L. Siminerio","doi":"10.17925/USE.2017.13.01.10","DOIUrl":"https://doi.org/10.17925/USE.2017.13.01.10","url":null,"abstract":"Received: March 20, 2017 Published Online: May 8, 2017 Citation: US Endocrinology, 2017;13(1):Epub ahead of print Corresponding Author: Linda Siminerio, Professor of Medicine and Nursing, University of Pittsburgh, Falk Medical Building, Room 570, 3601 Fifth Avenue, Pittsburgh PA 15213, US. E: simineriol@upmc.edu D iabetes self-management education and support provides the foundation for helping people with diabetes to be able to navigate decisions and activities related to managing their life-long disease. Here, Linda Siminerio of the School of Medicine and Nursing, University of Pittsburgh, Pennsylvania, US discusses psychological factors affecting people with diabetes, self-management and the multiple benefits of ongoing education and support.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603043","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 : 2017-01-01DOI: 10.17925/USE.2017.13.02.51
J. Yardley
Managing training and competition with type 1 diabetes is complicated, but not impossible. Athletes, and their diabetes care providers, should be aware of everything that might impact blood glucose responses to exercise. These factors include the type, timing, intensity and duration of exercise, as well as the timing and size of insulin dosage adjustments and carbohydrate intake. Due to differences in physiology (age, sex, fitness levels, etc.) there is no "one size fits all" solution, however, with careful planning and record-keeping, athletes with type 1 diabetes have the same opportunities for success in their sport as everyone else.
{"title":"Type 1 Diabetes in Athletes","authors":"J. Yardley","doi":"10.17925/USE.2017.13.02.51","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.51","url":null,"abstract":"Managing training and competition with type 1 diabetes is complicated, but not impossible. Athletes, and their diabetes care providers, should be aware of everything that might impact blood glucose responses to exercise. These factors include the type, timing, intensity and duration of exercise, as well as the timing and size of insulin dosage adjustments and carbohydrate intake. Due to differences in physiology (age, sex, fitness levels, etc.) there is no \"one size fits all\" solution, however, with careful planning and record-keeping, athletes with type 1 diabetes have the same opportunities for success in their sport as everyone else.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603370","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 : 2017-01-01DOI: 10.17925/USE.2017.13.02.74
L. Talman, Binit B. Shah
T he use of surgical treatments for movement disorders has been well established for several decades, with a strong focus, in the past, on ablative lesioning procedures and, more recently, deep brain stimulation. Magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) is emerging as a newly recognized surgical technique for the treatment of various movement disorders. The most robust data, demonstrating safety and efficacy of MRgFUS, have been published in trials directed at treatment of essential tremor (ET); however, many trials are underway to define its role in other movement disorders, such as Parkinson’s disease with preliminary results echoing those from studies in ET. The full potential for use of MRgFUS, both in the field of movement disorders and beyond, is only beginning to be explored.
{"title":"The Use of Magnetic Resonance Imaging-guided Focused Ultrasound in Movement Disorders—A Review","authors":"L. Talman, Binit B. Shah","doi":"10.17925/USE.2017.13.02.74","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.74","url":null,"abstract":"T he use of surgical treatments for movement disorders has been well established for several decades, with a strong focus, in the past, on ablative lesioning procedures and, more recently, deep brain stimulation. Magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) is emerging as a newly recognized surgical technique for the treatment of various movement disorders. The most robust data, demonstrating safety and efficacy of MRgFUS, have been published in trials directed at treatment of essential tremor (ET); however, many trials are underway to define its role in other movement disorders, such as Parkinson’s disease with preliminary results echoing those from studies in ET. The full potential for use of MRgFUS, both in the field of movement disorders and beyond, is only beginning to be explored.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603186","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 : 2017-01-01DOI: 10.17925/USE.2017.13.02.94
Kourosh Kahkeshani, Huma U. Sheikh
{"title":"Headache in the Emergency Room","authors":"Kourosh Kahkeshani, Huma U. Sheikh","doi":"10.17925/USE.2017.13.02.94","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.94","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603240","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 : 2017-01-01DOI: 10.17925/USE.2017.13.02.69
D. Khandelwal, S. Birla, Arundhati Sharma, R. Khadgawat
M elanocortin-4 receptor (MC4R; OMIM#155541) encodes a 332-amino acids protein possessing typical G-protein-coupled receptors' (GPCRs) structural design having three intact and functional domains, mutations which lead to the most recurrent type of monogenic obesity. Methods: We report here a case of a 5-year-old boy from Iraq who presented to the clinic for evaluation of progressive weight gain since he was 6 months of age. There were no symptoms of hypothalamic dysfunction except increase in appetite. His height was 120 cm (97th centile of the Centers for Disease Control and Prevention [CDC] growth chart, mid parental height was 50th centile), weight was 57 kg (>97th centile on CDC chart) and body mass index was 39.6 kg/m2 (>97th centile on CDC chart). A monogenic cause of obesity was strongly suspected in view of early onset severe childhood obesity. Results: Mutation screening of MC4R revealed a homozygous isoleucine by arginie at codon 69 (I69R) mutation in the patient, while his father was heterozygous for this mutation. Conclusion: We describe a monogenic form of obesity with characteristic presentation due to I69R MC4R mutation inherited as an autosomal recessive condition. The finding is different from previous reports which have documented this mutation to be inherited in a dominant manner. The findings of the present study reiterate the complex nature of obesity with possible involvement of modifier genes and/or genetic heterogeneity in its causation.
{"title":"MC4R Mutation in Early-onset Severe Childhood Obesity—Genotype–phenotype Correlation","authors":"D. Khandelwal, S. Birla, Arundhati Sharma, R. Khadgawat","doi":"10.17925/USE.2017.13.02.69","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.69","url":null,"abstract":"M elanocortin-4 receptor (MC4R; OMIM#155541) encodes a 332-amino acids protein possessing typical G-protein-coupled receptors' (GPCRs) structural design having three intact and functional domains, mutations which lead to the most recurrent type of monogenic obesity. Methods: We report here a case of a 5-year-old boy from Iraq who presented to the clinic for evaluation of progressive weight gain since he was 6 months of age. There were no symptoms of hypothalamic dysfunction except increase in appetite. His height was 120 cm (97th centile of the Centers for Disease Control and Prevention [CDC] growth chart, mid parental height was 50th centile), weight was 57 kg (>97th centile on CDC chart) and body mass index was 39.6 kg/m2 (>97th centile on CDC chart). A monogenic cause of obesity was strongly suspected in view of early onset severe childhood obesity. Results: Mutation screening of MC4R revealed a homozygous isoleucine by arginie at codon 69 (I69R) mutation in the patient, while his father was heterozygous for this mutation. Conclusion: We describe a monogenic form of obesity with characteristic presentation due to I69R MC4R mutation inherited as an autosomal recessive condition. The finding is different from previous reports which have documented this mutation to be inherited in a dominant manner. The findings of the present study reiterate the complex nature of obesity with possible involvement of modifier genes and/or genetic heterogeneity in its causation.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603596","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 : 2017-01-01DOI: 10.17925/USE.2017.13.01.01
Umal Azmat, J. Phay, T. Teknos, J. Bekeny, F. Nabhan
L ingual thyroid and thyroid hemiagenesis are rare thyroid developmental abnormalities. These conditions can be present with other thyroid diseases, whether functional ones involving abnormal thyroid hormone levels, or structural ones such as presence of thyroid nodules, however the association with thyroid cancer and lingual thyroid or thyroid hemiagenesis is rare. In addition to that, when thyroid hemiagenesis is present, it is usually in the left lobe. We describe here a pregnant patient who presented with metastatic cervical nodes from thyroid cancer who was found on imaging to have right thyroid hemiagenesis. After she underwent an initial surgery for thyroid cancer and metastatic nodal disease, she was then later discovered to have a lingual thyroid. In this case we report this extremely rare combination and also discuss the potential implications of this association on the diagnosis and management of these patients particularly initial surgery and imaging studies needed for the thyroid cancer.
{"title":"A Case of a Rare Association Between Right Thyroid Hemiagenesis, Lingual Thyroid, and Papillary Thyroid Cancer","authors":"Umal Azmat, J. Phay, T. Teknos, J. Bekeny, F. Nabhan","doi":"10.17925/USE.2017.13.01.01","DOIUrl":"https://doi.org/10.17925/USE.2017.13.01.01","url":null,"abstract":"L ingual thyroid and thyroid hemiagenesis are rare thyroid developmental abnormalities. These conditions can be present with other thyroid diseases, whether functional ones involving abnormal thyroid hormone levels, or structural ones such as presence of thyroid nodules, however the association with thyroid cancer and lingual thyroid or thyroid hemiagenesis is rare. In addition to that, when thyroid hemiagenesis is present, it is usually in the left lobe. We describe here a pregnant patient who presented with metastatic cervical nodes from thyroid cancer who was found on imaging to have right thyroid hemiagenesis. After she underwent an initial surgery for thyroid cancer and metastatic nodal disease, she was then later discovered to have a lingual thyroid. In this case we report this extremely rare combination and also discuss the potential implications of this association on the diagnosis and management of these patients particularly initial surgery and imaging studies needed for the thyroid cancer.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67602995","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 : 2017-01-01DOI: 10.17925/USE.2017.13.01.12
C. Lardinois
I ndividuals with chronic kidney disease (CKD) are at high risk of coronary heart disease (CHD), and roughly half die of CHD without developing end-stage renal disease. Two key kidney measurements: estimated glomerular filtration rate (eGFR) and albuminuria, are consistently associated with high CHD risk. An eGFR greater than 105 ml/min per 1.73m2 (hyperfiltration) and an albumin-to-creatinine ratio (ACR) greater than 5 mg/g are both independently associated with an increased risk of CHD. Therefore, eGFR and ACR should be taken into account for cardiovascular prediction.
{"title":"Hyperfiltration and Albuminuria—A Deadly Combination","authors":"C. Lardinois","doi":"10.17925/USE.2017.13.01.12","DOIUrl":"https://doi.org/10.17925/USE.2017.13.01.12","url":null,"abstract":"I ndividuals with chronic kidney disease (CKD) are at high risk of coronary heart disease (CHD), and roughly half die of CHD without developing end-stage renal disease. Two key kidney measurements: estimated glomerular filtration rate (eGFR) and albuminuria, are consistently associated with high CHD risk. An eGFR greater than 105 ml/min per 1.73m2 (hyperfiltration) and an albumin-to-creatinine ratio (ACR) greater than 5 mg/g are both independently associated with an increased risk of CHD. Therefore, eGFR and ACR should be taken into account for cardiovascular prediction.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603054","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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