Cushing\u27s Disease: Dilemmas of Diagnosis and Management

Determining the cause of Cushing\u27s disease and correcting the abnormality presents a continuing challenge to the clinician despite remarkable advances in diagnostic and therapeutic techniques. We present seven cases to illustrate 1) the classic disorder cured by pituitary adenomectomy: 2) persistence of the disease after adenomectomy: 3) Cushing\u27s disease manifesting in the puerperium and remitting with dopamine agonist therapy: 4) a patient whose disease relapsed at least five times during 20 years of treatment by adrenalectomy, pituitary radiation, mitotane, and pituitary adenomectomy; 5) the Nelson syndrome; 6) the ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with dexamethasone suppressible urinary cortisol who had a pituitary adenoma which stained positively for ACTH hut who was not cured by total hypophysectomy; and 7) a patient whose ACTH-secreting tumor proved fatal despite repeated surgical, radiologic, and pharmacologic measures

Pregnancy Following Sequential Bromocriptine Therapy in a Hyperprolactinemic Subject

Regular menses were maintained in a 26-year-old woman with a prolactinoma by sequential bromocriptine therapy given for either five or 14 days of the menstrual cycle. She conceived promptly when desired

Hypophyseal Growth Hormone II. Interaction with Other Hormones

Growth hormone (GH) synthesis and release is controlled by hypothalamic GH releasing factor. Thyroid hormones, androgens and estrogens in physiologic concentrations enhance GH secretion but a controlling role for glucagon and vasopressin in GH release is not established. Under stress, ACTH directly facilitates GH release while the similar action of the catecholamines is mediated by the a-adrenergic receptors. Though physiologic doses of glucorticoids and progestins do not affect GH liberation, prolonged administration of medroxyprogesterone acetate or of glucocorticoids in high dosage will decrease blood levels or blunt Gti responsiveness. GH enhances the release of insulin. A shift in adrenal steroid biosynthesis from the glucocorticoid to the androgenic pathway may also be an effect of GH administration. Prolonged elevated GH levels decrease serum thyroid binding globulin but increase the turnover of free thyroxine. Decreased thyroidal iodine uptake is probably secondary to these changes in thyroxine metabolism. In hypothyroidism and severe Cushing\u27s syndrome GH release is blunted. In most cases of acromegaly as well as in hyperthyroidism GH is nonsuppressible, while in diabetes its response to stimuli other than hypoglycemia is exaggerated

The Effectiveness of Oxandrolone in Promoting Linear Growth in Growth Hormone Deficient Children

This two-year study consisted of a comparison of oxandrolone and growth hormone for the treatment of five children with documented growth hormone deficiency. Previously, androgens have been reported to be relatively ineffective in accelerating linear growth In growth hormone deficient children. Oxandrolone was administered for one year. Growth hormone was added in the second six months and then was given as a single agent in the third six months. Growth accelerated markedly in all patients. Only one child showed more rapid growth with the addition of growth hormone while two children actually grew more rapidly under the Influence of oxandrolone alone. Growth was poor and diminished when growth hormone was given as a single agent in the third six-month period for three children but improved when oxandrolone was re-instituted in a fourth six-month treatment period. These results suggest that oxandrolone may prove to be an effective and safe substitute for growth hormone in the management of selected cases of hypopituitarism

Advice from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons on riot control agents in connection to the Chemical Weapons Convention

Compounds that cause powerful sensory irritation to humans were reviewed by the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) in response to requests in 2014 and 2017 by the OPCW Director-General to advise which riot control agents (RCAs) might be subject to declaration under the Chemical Weapons Convention (the Convention). The chemical and toxicological properties of 60 chemicals identified from a survey by the OPCW of RCAs that had been researched or were available for purchase, and additional chemicals recognised by the SAB as having potential RCA applications, were considered. Only 17 of the 60 chemicals met the definition of a RCA under the Convention. These findings were provided to the States Parties of the Convention to inform the implementation of obligations pertaining to RCAs under this international chemical disarmament and non-proliferation treaty.Peer reviewe

Advice on assistance and protection from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons : Part 2. On preventing and treating health effects from acute, prolonged, and repeated nerve agent exposure, and the identification of medical countermeasures able to reduce or eliminate the longer term health effects of nerve agents

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice in relation to the Chemical Weapons Convention on assistance and protection. We present the SAB’s response to a request from the OPCW Director-General in 2014 for information on the best practices for preventing and treating the health effects from acute, prolonged, and repeated organophosphorus nerve agent (NA) exposure. The report summarises pre- and post-exposure treatments, and developments in decontaminants and adsorbing materials, that at the time of the advice, were available for NAs. The updated information provided could assist medics and emergency responders unfamiliar with treatment and decontamination options related to exposure to NAs. The SAB recommended that developments in research on medical countermeasures and decontaminants for NAs should be monitored by the OPCW, and used in assistance and protection training courses and workshops organised through its capacity building programmes.Peer reviewe

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Co-Existent Klinefelter\u27s Syndrome, Acquired Cutaneous Hepatic Porphyria and Systemic Lupus Erythematosus

A patient is reported with Klinefelter\u27s syndrome, systemic lupus erythematosus (SLE) and acquired cutaneous hepatic porphyria. Although patients with chromatin positive Klinefelter\u27s syndrome may have elevated auto-antibodies, this patient had definite diagnostic criteria for SLE. Furthermore, evidence of disturbed porphyrin metabolism compatible with acquired cutaneous hepatic porphyria was found. It is speculated that the major disturbance in our patient\u27s porphyrin biosynthesis may be distal to ^-ALA synthetase. Any association between the three diseases is conjectural: however, it is noteworthy that both SLE and porphyria are more common in the female and that our patient had two X chromosomes in addition to a Y chromosome in his karotype

Informed Consent and Cultural Diversity

Introduction : Informed consent allows a mentally competent patient to make his/her decision of undergoinga medical procedure after adequate explanation. Individual practice of informed consent varies not onlyamong physicians but among different countries with different cultures, religious beliefs and practices. Methods : We conducted a study to determine the patient’s desire for information regarding anaesthesia andsurgery; to determine whether variables like age, sex, education, type of surgery and previous anaesthesiaexperiences have any association with the desire for information and to determine whether patients maketheir own decisions or want their family to be involved in the decision making process or give consent ontheir behalf. After written consent, patients visiting the preoperative clinic were asked to fill a questionnairesof 17 pieces of information regarding anaesthesia and surgery. Results : Majority of patients (91%) showed a desire for information. Among different variables only educationwas found to be significantly associated with the desire for information. Educated patients had a higherdesire. A large number of patients wanted to involve family in decision-making and give consent on theirbehalf. This trend was higher in females and less educated patients .Conclusions : We conclude from our study that educated people in society have more desire for informationand autonomy. Our study has also highlighted the influence of culture on the concept of patient autonomyand informed consent

Phenotypic Males with 46, XX Karyotype: Report of Two New Cases

Two sex chromatin positive phenotypic males were found to have 46, XX karyotypes. Both had small testes and elevated gonadotropins with low testosterone levels. Semen analysis could not be obtained but one man claimed to have a daughter. In one patient, mosaicism was suggested by the finding in a single cell of a chromosome morphologically resembling a Y. A second cell line was not found in the other patient. Possible explanations for the development of a male phenotype in the absence of demonstrable Y chromosome include the existence of two cell lines or mosaicism, an autosomal sex determining gene and the translocation of a fragment of the Y chromosome to another chromosome. It is possible that more than a single etiological mechanism accounts for the occurrence of this syndrome