Promoting cost-saving generics.
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Cost Control↗
Biomedical subjects
T B Kaye
Publications and source records attributed to T B Kaye.
Hyperprolactinemia. Causes, consequences, and treatment options.
Hyperprolactinemia is one of the most common pituitary abnormalities. The cause can usually be determined by review of the patient's history, physical examination, selected laboratory tests and, when indicated, magnetic resonance imaging scans of the sella. Pituitary tumors and medications are the most common causes of hyperprolactinemia. Appropriate treatment is determined by the cause and by the patient's tolerance of the clinical consequences.
Humans↗
Hypercalcemia. How to pinpoint the cause and customize treatment.
Hypercalcemia is a commonly diagnosed metabolic disorder that is most often caused by primary hyperparathyroidism or malignant disease. Parathyroid hormone assays are useful and reliable in differential diagnosis. Treatment depends on the degree of hypercalcemia, symptoms, and the underlying cause. Pharmacologic therapy, especially with bisphosphonates, may effectively lower serum calcium levels, but the underlying cause of the hypercalcemia must be treated to definitively restored normocalcemia.
Humans↗
Increased serum ferritin levels in patients with diabetes mellitus.
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Diabetes Mellitus↗
Thyroid function tests. Application of newer methods.
Thyroid function tests are often used to diagnose thyroid disease. Free thyroxine estimates and second- and third-generation assays for serum thyrotropin have simplified and enhanced the accuracy of thyroid function testing. All thyroid function tests have limitations and cannot be used in isolation of the clinical setting. Used appropriately, however, thyroid function tests are an invaluable aid in determining a patient's thyroid status.
Humans↗
Effect of glycemic control on the overnight dexamethasone suppression test in patients with diabetes mellitus.
Because many of the clinical features associated with Cushing's syndrome are frequently found in patients with diabetes mellitus, diabetic patients are often evaluated for Cushing's syndrome. The initial test for Cushing's syndrome is the 1 mg overnight dexamethasone suppression test (DST), but its value as a screening test in diabetic subjects, especially those with poor glycemic control, has been questioned. To address this issue, an overnight DST was administered to 100 subjects with diabetes. Only 7 patients failed to suppress their plasma cortisol to less than 140 nmol/L (5.0 micrograms/dL), achieving a specificity of 93%. There was no relation between acute glycemic control (as measured by the mean of 4 serum glucose values obtained before receiving dexamethasone) or chronic glycemic control (as measured by glycohemoglobin) and false positive responses to the 1 mg overnight DST. The mean of the measures of acute glycemic control of the 7 subjects who had false positive results, 14.4 +/- 2.8 mmol/L, was not significantly different than that of the 93 subjects with normal responses, 13.2 +/- 3.3 mmol/L. Similarly, the mean glycohemoglobin of the subjects with false positive results, 12.8 +/- 2.4%, was not significantly different than that of the subjects with normal responses, 12.9 +/- 2.5%. There was no correlation between plasma cortisol after dexamethasone and glycohemoglobin (r = 0.05), and only a weak correlation with the mean serum glucose (r = 0.21). We conclude that the 1 mg overnight DST is a valid screening test for Cushing's syndrome in patients with diabetes, regardless of glycemic control.
Adult↗
The Cushing syndrome: an update on diagnostic tests.
STUDY OBJECTIVE: Review and evaluation of diagnostic tests for the Cushing syndrome based on reports published since 1978. DATA IDENTIFICATION: Studies published in the English literature from 1978 through 1989 were identified using Index Medicus and cross searching of bibliographies. STUDY SELECTION AND DATA EXTRACTION: Studies of five or more patients for general analysis and smaller studies and case reports when pertinent. To develop criteria for the corticotropin-release hormone (CRH) stimulation test, only studies reporting individual patient data were analyzed. RESULTS: No new test is clearly better than existing tests in establishing a definitive diagnosis. Among tests to determine cause, the CRH stimulation test, by newly developed criteria, has a 91% sensitivity (95% CI, 85% to 95%) and a 95% specificity (CI, 82% to 99%), and the overnight high-dose dexamethasone suppression test has an 89% sensitivity (CI, 80% to 94%) and a 100% specificity (CI, 84% to 100%) for the pituitary Cushing syndrome. Magnetic resonance imaging has greater sensitivity for detecting adrenocorticotropin (ACTH)-producing pituitary adenomas than computed tomography. Inferior petrosal sinus sampling can correctly identify a pituitary cause in 88% (CI, 79% to 94%) of cases. CONCLUSIONS: Diagnosis is still best established by using 24-hour urine free cortisol measurements or low-dose dexamethasone suppression testing. The CRH stimulation test is an outpatient alternative to determine cause, and the over-night high-dose dexamethasone test may become the test of choice along with plasma ACTH measurements by radioimmunoassay in the initial evaluation of cause. Magnetic resonance imaging should be used to evaluate the pituitary Cushing syndrome, and inferior petrosal sinus sampling is most useful in problematic cases with uncertain cause.
Adenoma↗
Non-insulin-dependent diabetes mellitus and elevated serum ferritin level.
An elevated serum ferritin concentration recently has been shown to be associated with coronary artery disease and its risk factors, including blood glucose concentration. The purpose of this study is to establish the prevalence of elevated levels of serum ferritin in patients with non-insulin-dependent diabetes mellitus (NIDDM) without hemochromatosis and to determine whether or not deferoxamine is of therapeutic value in treating such patients. The level of serum ferritin was measured in consecutive eligible patients with NIDDM seen at routine outpatient visits. Five patients with an elevated serum ferritin were treated with deferoxamine, 1 g intramuscularly, twice a week for 12 weeks. The level of serum ferritin was measured every 4 weeks, and the level of glycosylated hemoglobin was measured at baseline, at the end of the treatment, and 12 weeks after treatment was completed. The level of serum ferritin was elevated in 34 of 102 (33%) patients with NIDDM. The level of serum ferritin remained elevated in 30 of 32 (94%) of these patients on repeat testing. In three of the five patients treated with deferoxamine, the level of serum ferritin was normalized, but no patient had an appreciable change in dosage of medication for diabetes or glycemic control. Non-insulin-dependent diabetes is a condition frequently associated with elevated levels of serum ferritin. Treatment with deferoxamine intramuscularly was not effective in improving control of glucose in our patient group.
Aged↗