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PubMedDate not supplied

[Development of endocrinology in Serbia].

The beginnings of endocrinology in Serbia date back to the second half of the 19th century. At that time some empiric case reports were published, mostly in Serbian Archives of Medicine and today we know that they belonged to the field of endocrinology. Between two World Wars professional articles and more serious studies in endocrinology were also published, but sporadically and non-systematically. Rapid progress in endocrinology in Serbia occurred after the Second World War, in many segments reaching European and World levels. Enormous contribution to development of clinical endocrinology was made by Prof. Dr. Mioljub Kicić, Prof. Dr. Dusan Durić and Academician Prof. Dr. Borislav Bozović, and to basic, experimental endocrinology by Academician Prof. Dr. Radivoj Milin. Apart from chronological reviews concerning foundation of certain endocrinology clinics and institutes in Belgrade, this paper also deals with foundation of endocrinology institutions in Novi Sad and other university centers in Serbia.

Endocrinology↗
PubMed1997

Variability of endocrinological dysfunction in 55 patients with X-linked adrenoleucodystrophy: clinical, laboratory and genetic findings.

X-linked adrenoleucodystrophy (ALD) has been shown to be one of the most frequent causes of Addison's disease in men. It is characterized by an impaired peroxisomal beta-oxidation of very long chain fatty acids and is associated with mutations of the ALD gene resulting in a defective peroxisomal membrane transport protein. There is a striking variability of endocrinological and neurological symptoms in patients with ALD, with no clearly evident correlation between mutations of the ALD gene and the different neurological phenotypes. No data on endocrinological symptoms and the ALD genotype have been published so far. We report endocrinological, clinical, laboratory and molecular genetic data from 55 patients with ALD from 34 families. Endocrinological symptoms of adrenal insufficiency were observed in 33 patients, 20 of whom showed additional neurological symptoms of cerebral ALD or adrenomyeloneuropathy. Isolated neurological symptoms were seen in 12 patients; in nine patients there were neither endocrinological nor neurological symptoms. Mutations of the ALD gene (n = 28) were detected in 50 patients (including nine sets of brothers) from 32 families. No correlation was found between the ALD gene mutation and endocrinological dysfunction. However, we found that all sets of brothers were concordant for the endocrinological phenotype (cortisol synthesis was reduced in two sets and normal in seven sets), whereas four sets showed a discordant neurological phenotype. As yet unknown hereditary factors other than mutations within the ALD gene may interfere with the endocrinological phenotype more strongly than with the neurological phenotype of ALD.

Addison Disease↗
PubMed1995

Ideal residency curriculum in reproductive endocrinology and infertility.

OBJECTIVE: Knowledge in reproductive endocrinology and infertility is fundamental to the delivery of quality women's health care. In 1991, the American Fertility Society formed a resident education committee to gather data on the current status of reproductive endocrinology and infertility training and develop an ideal curriculum. METHODS: Program directors and reproductive endocrinology and infertility faculty from 288 residencies in obstetrics and gynecology were surveyed about training in reproductive endocrinology and infertility; 257 (89%) of the program directors (survey I) and 203 (82%) of the reproductive endocrinology and infertility faculty (survey II) responded. An ideal curriculum has been developed from consensus discussions, review of survey data, and polling of experienced educators. The curriculum was reviewed and approved by the board of directors of both the Society for Reproductive Endocrinologists and the American Fertility Society. RESULTS: The curriculum is divided into subject matter and therapeutics, which are prioritized into three levels of knowledge: critical core curriculum, less critical material, and material with which residents should have familiarity and general knowledge. In addition, other recommendations and suggestions are made regarding the number of rotations, duration of rotations, and teaching methods. CONCLUSION: The ideal curriculum may serve as a guide to assist program directors in the formulation of the most effective residency training in reproductive endocrinology and infertility. The curriculum can help prioritize what should be taught and where an emphasis can be placed. There is not enough time or resources to teach residents all aspects of reproductive endocrinology and infertility.

Curriculum↗
PubMedDate not supplied

Comparison of diabetes care provided by an endocrinology clinic and a primary-care clinic.

OBJECTIVE: To compare the quality of ambulatory diabetes care provided by physicians in an endocrinology clinic with that in a primary-care clinic. METHODS: We conducted a retrospective study of the medical records of patients with diabetes treated for 2 to 4 years in an endocrinology clinic and a primary-care clinic at an academic medical center. Adherence to American Diabetes Association (ADA) clinical practice recommendations and hemoglobin A(1c) (HbA(1c)) levels were assessed in randomly chosen patients-a total of 68 patients from the primary-care clinic and 105 patients from the endocrinology clinic, with total patient-years of follow-up of 241 and 370, respectively. RESULTS: In six of seven areas assessed, the endocrinology clinic was significantly more compliant with ADA recommendations than was the primary-care clinic: queries about hypoglycemia (88% versus 20%); frequency of glycated hemoglobin determinations (3.3 versus 2.1 per patient/yr); yearly lipid panel (44% versus 25%); and yearly ophthalmologic (90% versus 50%), neurologic (56% versus 37%), and foot (88% versus 59%) examinations (all P<0.001). The rate of yearly proteinuria evaluations was similar in the two clinics (66% versus 65%). On assessment of all patients, the mean HbA(1c) level was significantly lower in the endocrinology clinic (8.29%) than in the primary-care clinic (8.73%) (P = 0.01). CONCLUSION: Adherence to ADA clinical practice recommendations was significantly better in the endocrinology clinic than in the primary-care clinic. This finding and the significantly lower levels of HbA(1c) in patients in the endocrinology clinic setting would be expected to translate into improved long-term patient outcome.

Adult↗
PubMed1999

[Thyroid hormone determination at the Public Assistance Hospital of Paris: ordering, costs and opinions of physicians qualified in endocrinology].

OBJECTIVES: To determine the distribution of orders for hormonal tests assessing thyroid function in a hospital setting. To collect the opinion of physicians specialized in endocrinology concerning free triodothyronine (FT3) assessment. METHODS: Using a cross-sectional survey numbers of free thyroxine (FT4), total T4 (TT4), FT3, total T3 (TT3), and TSH tests were collected from the heads of laboratory assessing thyroid function in June 95 at the Assistance Publique-Hôpitaux de Paris (AP-HP). Cost for these tests was estimated. The physicians of the AP-HP specialized in endocrinology were asked through a questionnaire for circumstances justifying FT3 test ordering. RESULTS: Twenty-eight laboratories (93%) responded: 28455 measurements (TSH: 43%, FT4: 33%, TT4: 2%, FT3: 20%, TT3: 2%) were performed and were valued at 3.4 million French Francs. Proportions of T4 (36%) and T3 (20%) tests were lower in hospitals with an inpatient department of endocrinology than in hospitals with an outpatient clinic with specialists in endocrinology (T4: 36%; T3: 27%) or with no endocrinology unit (T4: 33%, T3: 27%); proportion of TSH tests was higher in hospitals with an inpatient endocrinology unit (respectively 44%, 40%, 32%). Forty-two endocrinologists (76%) from 21 departments answered. Follow-up of treatment with amiodarone and euthyroid sick syndrome were considered the only conditions justifying FT3 test ordering. CONCLUSION: Though the opinion of physicians specialized in endocrinology was not uniform regarding recommendations for TT3 or FT3 tests as a first-line measurement, the cost of these tests has been estimated at 650 thousand Francs for a month at the AP-HP.

Costs and Cost Analysis↗
PubMed2001

Integration of neuroscience and endocrinology in hybrid PBL curriculum.

At the University of Missouri-Columbia, the medical school employs a problem-based learning curriculum that began in 1993. Since the curriculum was changed, student performance on step 1 of the United States Medical Licensing Examination has significantly increased from slightly below the national average to almost one-half a standard deviation above the national mean. In the first and second years, classes for students are organized in classes or blocks that are 8 wk long, followed by 1 wk for evaluation. Initially, basic science endocrinology was taught in the fourth block of the first year with immunology and molecular biology. Student and faculty evaluations of the curriculum indicated that endocrinology did not integrate well with the rest of the material taught in that block. To address these issues, basic science endocrinology was moved into another block with neurosciences. We integrate endocrinology with neurosciences by using the hypothalamus and its role in neuroendocrinology as a springboard for endocrinology. This is accomplished by using clinical cases with clear neuroscience and endocrinology aspects such as Cushing's disease and multiple endocrine neoplastic syndrome type 1.

Curriculum↗
PubMed1999

What can predict postoperative "endocrinological cure" in Cushing's disease?

OBJECTIVE: The goal of surgical treatment for Cushing's disease is "endocrinological cure." The purpose of this study was to determine predictors for postoperative endocrinological cure in Cushing's disease. METHODS: Postoperative endocrinological studies were evaluated in 18 patients with Cushing's disease who underwent transsphenoidal surgery for selective adenomectomy. Serum adrenocorticotropic hormone (ACTH) levels were measured by radioimmunoassay during the first week after surgery. One week after surgery, a test using corticotropin-releasing hormone (CRH) was performed on each patient to check the reserve function of normal ACTH-secreting cells. RESULTS: In eight patients, postoperative ACTH levels were below the measurable level for 1 week, and ACTH showed no response to the CRH test. In these patients, serum ACTH and cortisol levels were kept in the normal range with a normal diurnal variation during long-term follow-up. These patients can be defined as endocrinologically cured. In seven patients, the ACTH level returned to within normal range on the day after surgery, but ACTH was provoked by the CRH test. Five of these seven patients showed subsequent re-elevation of ACTH above the normal range. ACTH levels were never normalized in the remaining three patients, and medical treatments were unavoidable. CONCLUSION: The most reliable indicators for predicting endocrinological cure in Cushing's disease are no response of ACTH to the CRH test in the early postoperative stage and an unmeasurably low ACTH level in the week after surgery. Obtaining a normal range of ACTH level postoperatively is insufficient to define endocrinological cure.

Adenoma↗
PubMed2004

A short history of pediatric endocrinology in North America.

Pediatric endocrinology evolved as a subspecialty from the era of biochemical and metabolic clinical investigation led by John Howland, Edwards Park, and James Gamble at Johns Hopkins; Allan Butler at Boston University and Harvard University; Daniel Darrow at Yale University; and Irving McQuarrie at the University of Rochester and the University of Minnesota during the early 20th century. The father of the new subspecialty was Lawson Wilkins, a private pediatric practitioner in Baltimore, Maryland, who was invited by Dr. Edwards Park to establish an endocrine clinic at the Harriet Lane Home at Johns Hopkins in 1935. Dr. Wilkins managed his practice and the clinic until 1946, when, at the age of 52, he accepted a full-time position at the University. Dr. Nathan Talbot was invited to develop a pediatric endocrine clinic at Massachusetts General Hospital by Allan Butler in 1942. These units and their associated subspecialty training programs during the 1950s and 1960s provided the large majority of the second-generation pediatric endocrinologists who went on to establish endocrine subspecialty programs in university medical centers in North America as well as Europe and South America. Diabetes as a clinical pediatric discipline evolved in parallel from the early clinics of Elliott Joslin and Priscilla White in Boston, M.C. Hardin and Robert Jackson at the University of Iowa, George Guest at the University of Cincinnati Children's Hospital, and Alex Hartman at the St. Louis Children's Hospital. The Lawson Wilkins Pediatric Endocrine Society was founded in 1971, and the Council on Diabetes and Youth was established within the American Diabetes Association in 1980. Medical and economic factors led to increasing integration of pediatric diabetes and general endocrine care and training, and diabetes care now is a major activity within the subspecialty of pediatric endocrinology. The growth of pediatric endocrinology in North America has paralleled the growth of academic medicine during the past half-century. In 2002, there were 72 training programs in North America: 65 in the United States and seven in Canada. The endocrinology sub-board of the American Board of Pediatrics was established in 1978 to certify training and competence in endocrinology, including diabetes. By 2002, the board had certified 927 pediatric endocrinologists. Pediatric endocrine subspecialists during the past half-century have contributed major advances in our understanding of the ontogeny of endocrine systems and the diagnosis and treatment of fetal-perinatal endocrine disorders; newborn screening for endocrine and metabolic disorders; the physiology and therapies for disorders of sexual differentiation and pubertal maturation; the development of anthropometric standards for childhood growth and development; the characterization and physiology of hormone systems, including receptors and hormone actions; the molecular genetics of a number of congenital endocrine disorders and heritable endocrine diseases; development of pediatric endocrine diagnostics and reference standards; the pathophysiology and management of autoimmune endocrine disease; and development of a growing armamentarium of therapeutic agents for treatment of endocrine and metabolic diseases.

Animals↗
PubMedDate not supplied

Applications of genomic medicine in endocrinology and post-genomic endocrine research.

In the mid 1980's, two advances revolutionized Medicine in a way that is comparable only to some of the most important events in the approximately 3,000 years of its history. The first was the introduction of the concept of "positional cloning", i.e. the idea that one can identify genes for human disease though knowing nothing or very little about their function. The second was the discovery of the method of polymerase chain reaction (PCR) which made DNA easier to work with for all biomedical researchers and clinicians. Fresh in the history of Endocrinology were the great discoveries of neuroendocrinology, and even more contemporary and potent, the influence of the then emerging field of molecular endocrinology. Cancer medicine and traditional human genetics were the fields that benefited most from the first applications of the new genomic concepts and technologies. Almost two decades later, and after the first successful applications of positional cloning in Endocrine Genetics with the identification of RET, menin, PTEN and PRKAR1A in the various forms of multiple endocrine tumor syndromes, and a number of other genes in developmental diseases affecting the pituitary, thyroid, parathyroid, pancreas, adrenal and gonadal glands, endocrinology has made a comeback to the forefront of "genomically"- influenced as well as post-genomic Medicine. This report, using the example of endocrine tumor genetics, presents the process and some of the accomplishments of positional cloning and discusses the influence of endocrinology on contemporary translational research. The author suggests that some of the most traditional endocrine concepts, established in the previous two centuries, could help us understand the complex pathways recently unraveled in cancer genetics and, consequently, other fields. It is suggested that "Endocrine" genes that control cellular signaling act as "conductor" since they regulate differentiation, growth and proliferation. Their complex function and resultant "transcriptomes" are now being investigated by post-genomic Medicine. In cancer research, endocrine genes defy classic definitions of tumor suppressors and oncogenes and regulate gatekeepers, caretakers, and landscapers. In the post-genomic, translational Medicine, Endocrinology once again could help us to understand cellular regulation and pathophysiology and to design new treatments.

Chromosome Mapping↗
PubMedDate not supplied

Evaluation of a "formal" endocrinology curbside consultation service: advice by means of internet, fax, and telephone.

OBJECTIVE: To describe the development, implementation, and assessment of an Internet- and fax-based endocrinology curbside consultation service. METHODS: An Internet- and fax-based endocrinology consultation service was designed by developing a simple Web site so that requesting physicians could complete a form about the patient. Community and academic-based primary-care physicians were invited to use the service. One month after each consultation, a follow-up questionnaire about the effectiveness and use of the Internet and fax consultation service was sent to each physician who had requested the consultation. RESULTS: During the 5-month period in which the service was offered, 67 physicians requested a total of 85 "formal" endocrinology curbside consultations. Of these 85 requests, 46 were by e-mail, 31 by fax, and 8 by telephone. Follow-up questionnaires were returned by 61 of the 67 physicians who used the service. One hundred percent of the physicians found the service to be useful, and about 33% noted formal consultation had been avoided. In approximately 55% of the consultations, physicians indicated that the response caused them to alter the treatment of their patient. Consultation questions encompassed the full spectrum of endocrinology. The issues were approximately equally distributed among test interpretation, medication, and management. CONCLUSION: We successfully designed and implemented an Internet- and fax-based endocrinology curbside consultation service. This form of consultation was used by physicians and brought about change in the management of their patients.

Attitude of Health Personnel↗