Biomedical subjects

W F Young

Publications and source records attributed to W F Young.

134 records · Page 8Linked to original sources

PubMedDate not supplied

Pituitary adenoma in Carney complex: an immunohistochemical, ultrastructural, and immunoelectron microscopic study.

First described in 1985, Carney complex is a rare, heritable disorder featuring abnormal skin pigmentation, cardiac and cutaneous myxoma, melanotic schwannoma of psammomatous type, and endocrine abnormalities, including pituitary adenomas. Patients with the latter present with elevated growth hormone (GH) levels and acromegaly or gigantism. Prolactin (PRL) elevation may also be seen. The authors have investigated 2 resected pituitary adenomas from patients with Carney complex. One, a 19-year-old female acromegalic with elevated GH, IgF-1, and PRL levels, had a mammosomatotroph adenoma immunoreactive for GH and PRL. Ultrastructurally, GH and PRL were present in the same secretory granules. The second patient, a 27-year-old acromegalic, had a sparsely granulated GH cell adenoma that by immuno-electron microscopy revealed GH immunoreactivity only. The lack of morphologic similarity between the 2 adenomas indicatesthat pituitary tumors in patients with Carney complex may not exhibit the same phenotype.

Abnormalities, Multiple↗

PubMedDate not supplied

Preventive care in diabetes mellitus. Current practice in urban health-care system.

Early identification and treatment of complications of diabetes mellitus may reduce the severity of the complications. As part of a program to reduce these complications in the Denver Department of Health and Hospitals patient population, our study determined how frequently preventive care, e.g., fundoscopic examinations, referral to an ophthalmologist, foot examinations, and assessment of cardiovascular risk factors, was provided to diabetic patients. With the use of billing records to identify a large sample of diabetic patients, a chart review of 544 patients was conducted. During the study year, the mean +/- SE number of visits to primary-care clinics was 5.7 +/- 0.22, with 86.4% having at least one visit. Most diabetic patients were seen by primary-care physicians; only 9% received care in a specialized diabetes clinic. Despite frequent primary-care visits, most diabetic patients in this county health-care system did not have documentation of care to detect complications of diabetes mellitus, and referral services for detection and treatment of these complications were infrequently used. Moreover, among patients seen on greater than or equal to 10 occasions in a primary-care setting, preventive care was not provided to 30% of the patients. Preventive care does not appear to be a regular part of a primary-care visit for most of the diabetic patients in this study.

Colorado↗

PubMedDate not supplied

Medical care patterns at the onset of insulin-dependent diabetes mellitus: association with severity and subsequent complications.

The hospitalization of a child at the onset of insulin-dependent diabetes mellitus (IDDM) has become routine in many parts of the world, although controversy exists about its necessity. We examined the patterns of medical care use and the prognosis for acute complications after diagnosis for children with newly diagnosed IDDM in Colorado from 1978 to 1982. We reasoned that if children cared for entirely in outpatient settings at diagnosis had no more frequent acute complications after diagnosis than hospitalized children, we would be encouraged to further explore other potential benefits of outpatient care at onset. Twelve percent of 305 children studied statewide received only outpatient care during the first 2 wk after diagnosis, and, prognostically, their subsequent hospitalization and ketoacidosis rates were 2-3.7 times lower than those of children who received any inpatient care. No differences were noted for severe insulin reaction rates. Children classified as "severe" at onset, or with parents of lower education and income, or aged 10-14 yr at onset, regardless of care setting, had 2-4 times higher subsequent acute complication rates after onset than children without these characteristics. These findings, together with data on nights hospitalized and average length of stay in hospital at onset, suggest that a 42% reduction in total nights hospitalized could occur if children with "mild" or "normal" severity at onset were treated largely in the outpatient setting.

Acidosis↗

PubMedDate not supplied

Acth-independent Cushing's syndrome: bilateral cortisol-producing adrenal adenomas.

ACTH-independent Cushing's syndrome (CS) usually results from a solitary adrenocortical adenoma. We recently encountered a patient with ACTH-independent CS associated with bilateral adrenal enlargement. The evaluation led us to consider some rare but interesting entities. The patient was a 69 year-old woman who had a 10-15 year history of controlled hypertension, back pain associated with osteoporosis, easy bruising, and truncal obesity. Her medications included conjugated estrogens. Physical examination revealed classical features of CS. She had a raised blue lesion on her buccal mucosa. Plasma cortisol concentrations were elevated at 36 (a.m.) and 38 (p.m.) microg/dL. Urinary free cortisol was normal at baseline (65 microg/24 hours) but failed to suppress adequately in response to the low-dose dexamethasone suppression test (75 microg/24 hours). The plasma ACTH concentration was undetectable. Plasma cortisol concentrations failed to suppress (37 microg/dL) with an 8 mg overnight dexamethasone test. A CT scan of the abdomen revealed bilateral adrenal masses. The possibilities of food-induced CS and primary pigmented nodular adrenal disease were excluded by a lack of marked stimulation in cortisol secretion to a mixed-meal and dermatologic confirmation of the buccal mucosa lesion as an angioma and not a blue nevus. Adrenal venous sampling showed cortisol secretion from both adrenals. The patient underwent bilateral adrenalectomy with pathology confirming bilateral adenomas. This case illustrates an unusual application of selective venous sampling in the CS evaluation and raises questions about the pathogenesis of cortisol-secreting adrenocortical adenomas.

Journal Article↗

PubMedDate not supplied

Transient hypopituitarism.

Spontaneous recovery of pituitary function in patients with hypopituitarism is rare. We report the case of a 30-year-old man in whom hypopituitarism and sudden onset of bilateral hearing loss developed after a viral infection. No evidence of a mass lesion was detected on computed tomography or magnetic resonance imaging of the pituitary gland. The patient received a 3-week course of treatment with a high dose of glucocorticoids; in a period of 6 weeks, he felt clinically well, and biochemical tests showed spontaneous return of normal anterior pituitary function. We speculate that an immune response triggered by the viral infection initiated an inflammatory process that involved the hypothalamus or pituitary gland and caused the hypopituitarism. The treatment with high-dose glucocorticoids could have prompted the resolution of the hypothalamic-pituitary inflammatory process and facilitated spontaneous recovery of pituitary function. This case shows that hypopituitarism may be transient an outcome that should be considered in patients with idiopathic hypopituitarism.

Journal Article↗

PubMedDate not supplied

The ovine corticotropin-releasing hormone stimulation test in the differential diagnosis of adrenocorticotropic hormone-dependent cushing's syndrome.

OBJECTIVE: To determine the efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in distinguishing between adrenocorticotropic hormone (ACTH)-dependent types of Cushing's syndrome. METHODS: The cortisol and ACTH responses to intravenously administered oCRH were determined in 64 patients with pituitary-dependent Cushing's syndrome and 13 patients with ectopic ACTH production. RESULTS: Of the 64 patients with pituitary-dependent Cushing's syndrome, 57 (89%) had a positive ACTH response to administration of oCRH (an increase of 50% or more above baseline), and 56 (88%) had a positive cortisol response (an increase of 20% or more above baseline). One patient with an ectopic ACTH-secreting tumor had a false-positive cortisol response to administration of oCRH. Two patients with ectopic ACTH-secreting tumors had false-positive responses to both ACTH and cortisol after oCRH was administered. Because both these patients did not have hypercortisolemia at the time of testing, they were excluded from the statistical analysis. When analyzed on the basis of ACTH response alone, oCRH testing yielded a diagnostic sensitivity and specificity for the diagnosis of pituitary-dependent hypercortisolism of 89% and 100%, respectively. The positive predictive value was 100%, and the negative predictive value was 61%. CONCLUSION: oCRH testing distinguished between the ectopic ACTH syndrome and pituitary-dependent hyper-cortisolism in most cases. Therefore, this test is a useful procedure in the diagnostic evaluation of ACTH-dependent forms of Cushing's syndrome.

Journal Article↗

PubMedDate not supplied

Primary aldosteronism: A common and curable form of hypertension.

Since its initial description in 1955, primary aldosteronism was thought to be a rare cause of hypertension. However, with improved screening methodologies, it appears that primary aldosteronism is the most common form of secondary hypertension. Diagnosis of this disorder results in either the cure of hypertension or targeted pharmacotherapy. In addition, recent evidence suggests that aldosterone excess may have specific cardiotoxicity that is reversible with treatment. Patients with hypertension and hypokalemia and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism. A random and ambulatory ratio of plasma aldosterone concentration (ng/dl) to plasma renin activity (ng/ml per hour) >20 and a plasma aldosterone concentration >15 ng/dl is a positive screen for primary aldosteronism. A plasma aldosterone concentration/plasma renin activity ratio >20 alone is not diagnostic of primary aldosteronism; primary aldosteronism must be confirmed by demonstrating inappropriate aldosterone secretion with either the intravenous saline suppression test or measurement of 24-hour urinary aldosterone while on a high-sodium diet. The 2 major subtypes of primary aldosteronism are unilateral aldosterone-producing adenoma and bilateral idiopathic hyperplasia. Patients with aldosterone-producing adenoma are usually treated with unilateral adrenalectomy, and patients with idiopathic hyperplasia are treated medically. The subtype evaluation may require one or more tests, the first of which is imaging the adrenals with computed tomography (CT). When CT reveals a solitary unilateral macroadenoma (>1 centimeter) and normal contralateral adrenal morphology in a patient with primary aldosteronism, unilateral laparoscopic adrenalectomy is a reasonable therapeutic option. However, in many cases, CT imaging may reveal normal-appearing adrenals or ambiguous findings. Adrenal venous sampling helps solve these clinical dilemmas.

Adult↗

PubMedDate not supplied

Rathke cleft cyst: CT, MR, and pathology of 23 cases.

OBJECTIVE: We report the radiologic findings in 23 cases of Rathke cleft cyst (RCC) and correlate them with the histopathology. MATERIALS AND METHODS: We reviewed the radiology and pathology of 23 cases of surgically treated RCC operated upon at our institution or referred in consultation. RESULTS: There appears to be a correlation between the MR and CT appearance of the cyst, the gross appearance of the cyst contents, and the histopathologic characteristics of the cyst lining. Some of the lesions demonstrated peripheral enhancement, which in two cases was clearly due to a peripherally displaced rim of pituitary tissue. CONCLUSION: The appearance of RCC with CT and MRI is variable, and radiologic diagnosis can be difficult. Imaging features such as a sellar epicenter, smooth contour, absence of calcification, absence of internal enhancement, and homogeneous attenuation or signal intensity within the lesion suggest the diagnosis of RCC. Rim enhancement does not correlate with the presence of squamous metaplasia, hemosiderin, or cholesterol within the cyst wall and is not consistently seen in cases with changes of mild, chronic inflammation. In some cases, rim enhancement is due to a peripherally displaced rim of pituitary tissue.

Adolescent↗