Endocrinology

A 62-year-old man presents with painful cramps in his left lower leg that began about 6 months earlier and have recently become more frequent. The cramps occur with vigorous walking and cease when he stops for several minutes.

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

Determining the cause of generalized weakness can be a daunting task, since the differential diagnosis is vast. An overall approach to the patient who complains of generalized weakness is presented in our article

The differential diagnosis of generalized weakness is enormous; it includes disorders at all levels of the neur-axis. A variety of electrophysiological, pathological, radiographic, and other laboratory studies may be indicated depending on the specific diagnostic possibilities; costs can be controlled if such investigations are selected judiciously.

Identifying the cause of a persistent, asymptomatic aminotransferase elevation can be challenging. The possible diagnoses are many and varied. To narrow the differential, begin with a detailed history.

Treatment of hypertension can minimize both microvascular and macrovascular complications of diabetes and helps prevent nephropathy and cardiovascular events.

Sometimes, despite compliance with prescribed thyroid medication, a patient's thyroid-stimulating hormone (TSH) level remains high.

For 2 weeks, a 43-year-old white female had worsening nausea and multiple episodes of vomiting. Her symptoms began with increased malaise and decreased appetite. The emesis was unrelated to meals and was sometimes accompanied by mild abdominal distention. She had occasional fevers but denied any recent contact with ill persons. She also reported a 12-lb weight loss, decreased energy level, and an increased tan complexion over the past several months.

A 66-year-old woman was hospitalized because of severe anemia secondary to myelodysplastic syndrome. She had had associated fatigue and throbbing pain in both legs for several days.

Worsening painful ulcers on both legs prompted a 62-year-old woman to seek medical attention. She had a history of rheumatoid arthritis (RA), demonstrated by the markedly deformed interphalangeal joints in her thumbs (A), and scleroderma-polymyositis overlap syndrome.

A 74-year-old woman presented with a refractory pruritic eruption. Four months earlier, she had sought evaluation of a thickened, slightly crusted 6 3 8-cm patch on her right ankle of 2 months' duration. Contact dermatitis with secondary impetigo from scratching was suspected, and a topical corticosteroid and an oral antibiotic were prescribed.

Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: 8 different classes of non-insulin drugs and 8 different types of insulin are now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagonlike peptide analogs, and dipeptidyl peptidase IV inhibitors.

BOURNEMOUTH, England-A campaign to urge kids to stop drinking sugared carbonated beverages-an effort to have them lose weight or prevent obesity-didn’t seem to have much value in the long run, reported investigators here.

WACOL, Australia-Schizophrenia leads to an age-related mortality rate that is about 2.5 times that of the general population, and the difference appears to be increasing, researchers here reported.

Here: a look at the many possible causes of poorly controlled blood glucose levels, and steps to overcome them.

ROCHESTER, NY-Breast cancer patients with a history of traumatic or stressful life events have a significantly increased risk of recurrent disease, investigators here have found.

DENVER-A higher intake of omega-3 fatty acids found in fish was linked to a lower risk of pancreatic islet autoimmunity in children at genetic risk for type 1 diabetes, according to a preliminary study.

SAN FRANCISCO-Oncologists may be able to predict which breast cancer patients need and will respond to systemic therapies with a single genomic profiling assay, researchers said.

SAN FRANCISCO-Biology, rather than access, income, or education, is the major driver of the well-known racial differences in breast cancer outcome, researchers reported here.

ABSTRACT: Low-density lipoproteins are the most common atherogenic particles in diabetic dyslipidemia; therefore statins, which dramatically reduce low-density lipoprotein (LDL) cholesterol, are first-line therapy for patients with diabetes. These agents produce equivalent relative risk reductions in those with and without diabetes but confer greater absolute risk reduction because of the increased incidence of ischemic cardiovascular events in those with diabetes. The LDL cholesterol goal for patients with diabetes who do not have coronary heart disease is below 100 mg/dL. For secondary prevention, the goal is below 70 mg/dL. High-dose statin therapy may be required to achieve these goals. Fibric acids are a reasonable initial option for patients with triglyceride levels above 200 mg/dL and high-density lipoprotein (HDL) cholesterol levels below 40 mg/dL; in such patients they reduce risk as effectively as statins. Intermediate-release niacin raises HDL cholesterol levels; the effect is enhanced when niacin is combined with a statin.

For 2 weeks, a 67-year-old obese woman has had episodes of diffuse, nonradiating abdominal pain that last for several hours and are slightly relieved by famotidine/antacid. She rates the pain as 7 on a scale of 1 to 10.

ROCKVILLE, Md. -- The FDA has approved lanreotide acetate (Somatuline) for the treatment of the rare endocrine disorder acromegaly.

MELBOURNE, Australia -- Adolescent boys deprived of a high glycemic index junk-food diet had better clearing of acne vulgaris in 12 weeks than a medicine chest full of pimple medications can provide.

NEW YORK -- Bone-generating osteoblasts secrete a protein that appears to regulate insulin function and glucose metabolism, revealing an endocrine role for the skeleton, researchers here said.

For several days, a 50-year-old man has had copious green stools, vomiting, and fever. His symptoms began shortly after he was discharged from a regional burn center, where he was treated for full-thickness burns that covered 60% of his body surface.

ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

A large right adrenal mass was noted incidentally on an MRI scan of the lumbar spine, which had been performed for other reasons in a 55-year-old non-obese woman. The bright heterogeneous mass (T2-weighted image) measured 6.2 3 6.2 3 4.1 cm and sat like the head of a serpent on the superior pole of the right kidney. Its margins were smooth, but signal intensity was increased on T2 weighting because of high water content. The left adrenal gland was normal.

At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.

CHICAGO -- A child who has a body mass index in the range of the 85th to 95th percentile for age and sex should be considered overweight, not "at risk of overweight".

SAN DIEGO -- Men older than 50 with androgen deficiency are at a greater risk for all-cause mortality than their peers with age-appropriate testosterone, reported investigators here.