The Psychosomatic Practice.

There is increasing awareness of the limitations of the disease-oriented approach in medical care. The primary goal of psychosomatic medicine is to correct this inadequacy by incorporation of innovative operational strategies into clinical practice. Psychosomatic practice can be recognized by 2 distinctive features: the holistic approach to patient management (encompassing psychosocial factors) and the clinical model of reasoning (which reflects a multifactorial frame of reference). A basic psychosomatic assumption is the consideration of patients as partners in managing disease. The partnership paradigm includes collaborative care (a patient-physician relationship in which physicians and patients make health decisions together) and implementation of self-management (a plan that provides patients with problem-solving skills to enhance their self-efficacy). Pointing to strategies that focus on individual needs may improve patient quality of life and final outcomes

Diagnosis and Complications of Cushing's Syndrome: A Consensus Statement

In October 2002, a workshop was held in Ancona, Italy, to reach a Consensus on the management of Cushing's syndrome. The workshop was organized by the University of Ancona and sponsored by the Pituitary Society, the European Neuroendocrine Association, and the Italian Society of Endocrinology. Invited international participants included almost 50 leading endocrinologists with specific expertise in the management of Cushing's syndrome. The consensus statement on diagnostic criteria and the diagnosis and treatment of complications of this syndrome reached at the workshop is hereby summarized

The pattern of growth hormone secretion during the menstrual cycle in normal and depressed women

Objective Major depression is associated to altered hypothalamic pituitary function. Stress is linked to elevated cortisol as well as menstrual cycle disturbance; however, there is no known relationship between depression and menstrual cycle disruption. The aim of this study was to investigate changes of growth hormone (GH) secretion during the menstrual cycle in normal and depressed women. Design Case-control study. Patients and methods Nineteen women affected with depression and 24 normal controls were included. The two groups had comparable body mass index (BMI), and age (29·4 ±9·8 vs. 28·6 ± 9·7 years). Nine depressed and 10 controls were studied in the follicular phase, while 10 depressed and 14 controls were studied in the luteal phase of the cycle. GH was sampled every 10 min for 24 h, and the data were analysed by the cluster pulse detection method. Results There was no difference in 24-h mean GH concentrations between depressed and control subjects (P =0·93), even after accounting for menstrual cycle phase (P = 0·38). GH pulse frequency was higher during the follicular phase of the cycle (P =0·032), and nocturnal GH was higher in the follicular phase of the cycle (P =0·05, and after adjusting for 24-h GH, P= 0·0138) regardless of whether thesubjects were depressed or healthy. Conclusions In studies of GH secretion in women with or without depression, it is necessary to control for the phase of menstrual cycle.NIMH MH 50030 NICHD K12HD01438Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49486/2/KasaVubuYoung.pd

Prolactinomas, Cushing's disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas

Pituitary adenomas are associated with a variety of clinical manifestations resulting from excessive hormone secretion and tumor mass effects, and require a multidisciplinary management approach. This article discusses the treatment modalities for the management of patients with a prolactinoma, Cushing's disease and acromegaly, and summarizes the options for medical therapy in these patients