1,721,273 research outputs found
Response to Letter to the Editor from Candemir et al: "Prevalence and Incidence of Atrial Fibrillation in a Large Cohort of Adrenal Incidentalomas: A Long-Term Study"
No full textEffect of captopril on aldosterone response to potassium infusion in primary aldosteronism
No full text
Testosterone in ageing men
No full textA progressive decline in androgen levels is a common Finding in men after middle age. The resulting clinical picture may br characterised by alterations in the physical and psychological domains, which have been demonstrated to correlate positively with testosterone serum levels. This clinical picture closely resembles the features of primary or secondary hypogonadism. Testosterone is the more convenient hormone fur substitution therapy in classic hypogonadism as well as in age-related hypoandrogenism. Different choices of testosterone preparations are currently available. which are characterised by different routes of administration and by various pharmacokinetic profiles. Two major achievements urgently need to be investigated in the near future: the ability of the nem formulations to reach more physiological and sustained hormone levels with tl-le concomitant amelioration of their tolerability and the evidence of long-term prospective studies aimed at demonstrating the benefits and thtr possible complications of this therapy
Biomediators in polycystic ovary syndrome and cardiovascular risk
Full text linkPolycystic ovary syndrome (PCOS) is extremely heterogeneous in terms of clinical manifestations. The variability of the syndrome’s phenotype is derived from the genetic and molecular heterogeneity, with a great deal of environmental factors that may have long-term health consequences, such as metabolic and cardiovascular (CV) diseases. There is no doubt that women with PCOS suffer from metabolic complications more than their age-matched counterparts in the general population and at an earlier age. Obesity, low steroid hormone-binding globulin (SHBG), hyperandrogenemia, insulin resistance, and compensatory hyperinsulinemia are biomediators and early predictors of metabolic complications in PCOS. Doubts remain about the real risk of CV diseases in PCOS and the molecular mechanisms at the basis of CV complications. Based on that assumption, this review will present the available evidence on the potential implications of some biomediators, in particular, hyperandrogenism, estrogen-progesterone imbalance, insulin resistance, and low SHBG, in the processes leading to CV disease in PCOS, with the final aim to propose a more accurate CV risk assessment
Predictors of weight loss and maintenance in patients treated with antiobesity drugs
Full text linkFederica Guaraldi1, Uberto Pagotto2, Renato Pasquali21Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Division of Endocrinology, Department of Clinical Medicine, S Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, ItalyBackground: The prevalence of obesity and related diseases has increased enormously in the last few decades, becoming a very important medical and social issue. Because of the increasing number of people who need weight loss therapies and the high costs associated with these, the search for reliable predictors of success for weight loss and weight maintenance treatments has become a priority.Objective: A literature review was undertaken to identify possible predictors of outcome of weight loss and weight maintenance in patients treated with antiobesity drugs.Results: For the majority of variables, published data are not sufficient to define their role on final outcomes. Among all considered factors, only early response to treatment appeared to be a reliable positive predictor, and diabetes a negative predictor of weight loss and maintenance.Conclusion: To date, no definitive results have been obtained. Due to the great benefits of reliable predictors of outcome associated to currently available antiobesity drugs and those under development, identifying these predictors has to be supported and encouraged.Keywords: obesity, weight loss predictors, pharmacological treatmen
Case Report: An Atypical Form of Familial Partial Lipodystrophy Type 2 Due to Mutation in the Rod Domain of Lamin A/C
Full text linkPurpose: Familial partial lipodystrophy type 2 (FPLD2) patients generally develop a wide variety of severe metabolic complications. However, they are not usually affected by primary cardiomyopathy and conduction system disturbances, although a few cases of FPLD2 and cardiomyopathy have been reported in the literature. These were all due to amino-terminal heterozygous lamin A/C mutations, which are considered as new forms of overlapping syndromes. Methods and Results: Here we report the identification of a female patient with FPLD2 due to a heterozygous missense variant c.604G>A in the exon 3 of the LMNA gene, leading to amino acid substitution (p.Glu202Lys) in the central alpha-helical rod domain of lamin A/C with a high propensity to form coiled-coil dimers. The patient’s cardiac evaluations that followed the genetic diagnosis revealed cardiac rhythm disturbances which were promptly treated pharmacologically. Conclusions: This report supports the idea that there are “atypical forms” of FPLD2 with cardiomyopathy, especially when a pathogenic variant affects the lamin A/C head or alpha-helical rod domain. It also highlights how increased understanding of the genotype-phenotype correlation could help clinicians to schedule personalized monitoring of the lipodystrophic patient, in order to prevent uncommon but possible devastating manifestations, including arrhythmias and sudden death
Obesity and the polycystic ovary syndrome
No full textThe polycystic ovary syndrome (PCOS) is a condition characterized by hyperandrogenism and chronic oligo-anovulation. However, many features of the metabolic syndrome are inconsistently present in the majority of women with PCOS. Approximately 50% of PCOS women are overweight or obese and most of them have the abdominal phenotype. Obesity may play a pathogenetic role in the development of the syndrome in susceptible individuals. In fact, insulin possesses true gonadotrophic function and an increased insulin availability at the level of ovarian tissue may favour excess androgen synthesis. Obesity, particularly the abdominal phenotype, may be partly responsible for insulin resistance and associated hyperinsulinemia in women with PCOS. Therefore, obesity-related hyperinsulinemia may play a key role in favouring hyperandrogenism in these women. Other factors such as increased estrogen production rate, increased activity of the opioid system and of the hypothalamic-pituitary-ad renal axis, decreased sex hormone binding globulin synthesis and, possibly, high dietary lipid intake, may be additional mechanisms by which obesity favours the development of hyperandrogenism in PCOS. Irrespective of the pathogenetic mechanism involved, obese PCOS women have more severe hyperandrogenism and related clinical features (such as hirsutism, menstrual abnormalities and anovulation) than normal-weight PCOS women. This picture tends to be more pronounced in obese PCOS women with the abdominal phenotype.Body weight loss is associated with beneficial effects on hormones, metabolism and clinical features. A further clinical and endocrinological improvement can also be achieved by adding insulin-sensitizing agents and/or antiandrogens to weight reduction programmes. These obviously emphasize the role of obesity in the pathophysiology of PCOS
La presa in carico del paziente con diabete: sintomi depressivi, distress diabete correlato e controllo glicemico
No full textINTRODUZIONE
Circa il 30% dei pazienti con diabete riporta la presenza di sintomi depressivi e di distress correlato al diabete
(diabetes distress syndrome, DDS).
Sebbene la relazione fra diabete e depressione in termini di causa (fattore di rischio) - effetto (complicanza),
rimanga attualmente irrisolta, è invece dimostrata l’associazione fra depressione ed autogestione efficace del
diabete.
Scopo dello studio è esplorare, nei pazienti con diabete, la relazione tra depressione, DDS e autoefficacia,
utilizzando come outcome il controllo glicemico.
MATERIALI E METODI
Ai pazienti adulti con diabete di tipo 1 (DM1) e 2 (DM2) afferenti all’U.O. di Diabetologia sono state
somministrate 3 scale psicometriche: PHQ-9 (sintomi depressivi), PAID-5 (DDS) e IT-DMSES (autoefficacia
percepita nella gestione del diabete). Sono stati inoltre rilevati i risultati di tre determinazioni di emoglobina
glicata (HbA1c) nell’anno precedente.
I pazienti sono stati successivamente classificati in 4 gruppi in base all’andamento temporale dell’HbA1c:
sempre a target, sempre sopra il target, sono arrivati a target e non sono arrivati a target nell’ultima
determinazione. È stata inoltre effettuata un’analisi di correlazione tra i punteggi delle scale psicometriche per
tipo di diabete per indagare sulla relazione tra sintomi depressivi, distress ed autoefficacia.
RISULTATI
242 pazienti in totale (DM1=103; DM2=139).
La prevalenza di sintomi depressivi e DDS era rispettivamente del 32,3% e 48,5% nel DM1 e 37,2% e 42,4%
nel DM2.
Il confronto dei punteggi mediani delle scale psicometriche nei 4 gruppi di pazienti ha rilevato una differenza
statisticamente significativa esclusivamente per lo score PHQ-9. In particolare, nei pazienti con DM1 si
evidenziavano punteggi più bassi al PHQ-9 nel gruppo sempre a target rispetto a quello sempre sopra il
target terapeutico.
I punteggi di PHQ-9 e PAID-5 risultavano correlati positivamente tra loro e negativamente con IT-DMSES
per cui ad alti livelli di depressione corrispondevano alti livelli di distress e ad alti livelli di autoefficacia
corrispondevano bassi livelli di depressione e distress e vice versa.
CONCLUSIONI
Il nostro studio mostra che il benessere psicologico nel diabete rappresenta un importante determinante di
salute. In particolare l’autoefficacia percepita nella gestione della malattia è correlata alla presenza di distress
e sintomi depressivi. Questi ultimi a loro volta sono strettamente legati alla stabilità del controllo glicemico.
Pertanto, come suggerito dalle principali linee guida, la presa in carico del paziente con diabete dovrebbe
prevedere la valutazione degli aspetti psicosociali
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