The Endocrinologist (ENDOCRINOLOGIST )

Publisher: Lippincott, Williams & Wilkins


This journal exists to promote the transfer of new discoveries in endocrinology, diabetes, and metabolism into clinical practice. To review and set clinical standards in endocrinology and metabolism. To upgrade the practice of medicine by publishing information relevant to the practitioner in the form of invited mini-reviews, historical vignettes, book reviews, and current literature reviews all chosen for their relevance to the day-to-day practice of endocrinology.

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    Endocrinologist, The website
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    The Endocrinologist
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Lippincott, Williams & Wilkins

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    • Publisher last reviewed on 10/04/2014
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Publications in this journal

  • The Endocrinologist 09/2014; Atumn 2014(113):9.
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    ABSTRACT: Katmus: specific application to support assited music transcription
    The Endocrinologist 01/2011; 214:135.
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    ABSTRACT: A 73-year-old woman with an 11-year history of type 2 diabetes mellitus and hypertension was admitted to hospital because of acute confusion. Laboratory analysis showed severe hyponatremia with a serum sodium concentration of 109 mEq/L. No edema was found in her extremities. Neurologic examination revealed no abnormalities. She had been taking pioglitazone for 4 months. Sodium level was normal before the start of pioglitazone. Her blood pressure was 150/90 mm Hg. Serum and urine osmolalities were 245 and 613 mOsm/kg, respectively. Thyroid function tests, plasma corticotropin, and serum cortisol concentrations were normal. Clinical history and laboratory findings suggested that the cause of the severe hyponatremia was the syndrome of inappropriate antidiuretic hormone secretion caused by pioglitazone therapy. After withdrawal of pioglitazone, she was treated with infusion of hypertonic saline (3% sodium chloride, 300 mL/24 h) for 3 days. The patient's sodium concentration increased gradually and the clinical situation improved rapidly. Her serum sodium returned to nearly normal ranges within 1 week and she was discharged.
    The Endocrinologist 10/2010; 20(6):277-278.
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    ABSTRACT: In the light of the contemporary definition of Turner syndrome (TS), not all cases of 45,X/46,XX mosaicism should be considered as this syndrome. This report describes 2 mothers with 45,X/46,XX karyotype and their offspring. In one family, a mother and 2 daughters had 45,X/46,XX mosaicism. In the second one, a mother with a mosaic karyotype delivered 2 children, 1 healthy and 1 with Xp deletion, 46,Xdel(X)(p11.2). In both families, the daughters were initially diagnosed as TS, whereas mosaicism in their mothers was confirmed during further analysis. All 3 daughters with chromosomal aberrations had somatic and/or visceral TS stigmata, menstrual cycle disturbances and 2 of them were short in stature. However, the clinical presentation differs substantially between the mothers and their offspring as well as between siblings of the same mother. We also observed that a similar karyotype may result in a dissimilar phenotype, even in 1 family. This report shows that determining the diagnosis of TS might be a complicated task, especially in patients with low 45,X/46,XX mosaicism. It also indicates that there is a need for genetic counseling for mothers of daughters with TS.
    The Endocrinologist 10/2010; 20(6):283-285.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    The Endocrinologist 10/2010; 20(6):259.
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    ABSTRACT: Objective: To evaluate the contribution of ultrasonography and frozen-section analysis (FS) in the prediction of malignancy in thyroid nodules with suspicious papillary thyroid carcinoma (PTC) cytology. Methods and Results: The sample consisted of 89 patients with thyroid nodules diagnosed as suspicious for PTC by fine-needle aspiration cytology. Histology revealed malignancy in 69 of 89 patients (77.5%). Malignancy was observed in 55 of 58 nodules (94.8%) with suspicious ultrasonographic findings versus 14 of 31 (45.1%) without suspicious characteristics (P < 0.05). In 69 patients, FS revealed malignancy. Of them, 66 (95.6%) were found to be true carcinoma. In 17 of 20 patients (85%) with FS showing no malignancy, the nodule was confirmed to be benign. Conclusion: Total thyroidectomy is indicated when a thyroid nodule with suspicious PTC cytology exhibits suspicious ultrasonographic characteristics or when FS reveals malignancy. Otherwise, lobectomy should be the initial procedure in cases of nonsuspicious ultrasonographic findings and absence of malignancy upon FS.
    The Endocrinologist 10/2010; 20(6):301-303.
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    ABSTRACT: This report describes a case of Cushing syndrome due to ectopic adrenocorticotropic hormone (ACTH) secretion, complicated with disseminated nocardiosis. A 52-year-old postmenopausal woman presented with acute onset of hirsutism and easy bruisability associated with fatigue and generalized weakness, predominantly involving the proximal musculature of the extremities. Laboratory evaluation revealed high cortisol and ACTH levels, with negative pituitary magnetic resonance imaging (MRI). A 2-day high-dose dexamethasone suppression test (8 mg/d) was indicative of ectopic ACTH secretion. During the course of the disease, the patient developed disseminated nocardiosis that involved the left lung, skin, and central nervous system and was treated accordingly. Despite ketokonazole treatment, cortisol levels remained high and a bilateral adrenalectomy was planned but not performed because the patient died approximately 2 months after initial admission.
    The Endocrinologist 10/2010; 20(6):286-287.
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    ABSTRACT: Slipped capital femoral epiphysis typically occurs during periods of high-bone growth and growth plate weakening especially in puberty. It is rare after 16 to 18 years of age. If it does occur, causes of bone age delay should be evaluated. Clinical suspicion is very important in patients with pain in the hip, thigh, or knee. Delayed diagnosis is associated with more complications. We present a 19-year-old man with panhypopituitarism secondary to a craniopharyngioma, who developed pain in the left hip and knee that proved to be a slipped femoral capital epiphysis. We discuss the factors involved in the late appearance of this problem.
    The Endocrinologist 10/2010; 20(6):262-263.
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    ABSTRACT: Computed tomography (CT) is a less commonly ordered test in the diagnosis and management of hyperthyroidism. The attenuation of the thyroid on CT varies among different thyroid disorders and may provide insight into a patient's disease. We discuss the case of a woman with acquired immune deficiency syndrome who presented with fever, neck pain, and severe hyperthyroidism. On CT, her thyroid was diffusely enlarged with very low attenuation in the range typically seen with cysts. She was treated with beta blockers, antithyroid medication, and high-dose glucocorticoids, which resulted in improved, but still elevated, levels of thyroid hormones after several weeks. Shortly before her death from multiorgan failure, a fine needle aspiration of the thyroid was performed. Pathology revealed cells infected with cytomegalovirus, which was confirmed by immunohistochemistry. The exact cause of the thyroiditis is unknown, but we propose that the attenuation of the thyroid on CT, as well as the structural imaging findings on CT, provide useful clues in the diagnosis of hyperthyroidism in patients with acquired immune deficiency syndrome and other immunocompromised states.
    The Endocrinologist 10/2010; 20(6):264-266.
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    ABSTRACT: Although the effects of hypothyroidism or hyperthyroidism on weight have clearly been demonstrated, data regarding the effects of relatively minor defects in thyroid function are limited. In the present study, the relationship between body mass index (BMI) and alterations in thyroid function within the normal range was investigated in obese patients. Three hundred fifty-seven euthyroid, obese patients (309 female and 48 male; mean age, 42 years) were included in the study. The patients were divided into 2 groups based on a BMI threshold value of 40 kg/m2. Thyroid function, BMI, and the epidemiologic characteristics of the patients were retrospectively evaluated. No statistically significant difference was detected between the groups with respect to gender, place of birth, place of residence, smoking habits, and family history. Severely obese patients with a BMI ≥40 kg/m2 were older and had a lower serum-free thyroxine level (fT4) than obese patients with a BMI <40 kg/m2 (P < 0.01). In patients with normal thyroid function, a negative correlation between fT4 and BMI existed. No statistically significant association was detected between BMI and epidemiologic characteristics in euthyroid, obese patients.
    The Endocrinologist 10/2010; 20(6):304-307.
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    ABSTRACT: Highly active antiretroviral therapy is effective at reducing morbidity and mortality in human immunodeficiency virus (HIV)-infected patients presenting with symptoms of disease progression. A complex metabolic syndrome has been described in patients treated with highly active antiretroviral therapy. This includes atrophy and redistribution of subcutaneous adipose tissue representing a kind of acquired lipodystrophy (LDHIV, lipodystrophy in HIV-infected patients). LDHIV can be associated with metabolic abnormalities such as dyslipidemia, hyperglycemia, and insulin resistance. Several HIV protease inhibitors can inhibit preadipocyte differentiation or can promote apoptosis of adipocytes. We describe the case of a patient with typical LDHIV and its associated metabolic alterations.
    The Endocrinologist 10/2010; 20(6):293-295.
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    ABSTRACT: Fenofibrate, a fibric acid derivative, is frequently used to treat diabetic dyslipidemia and hypertriglyceridemia alone or in combination with statins. Rhabdomyolysis is a syndrome that results from striated muscle necrosis and release of its contents into the systemic circulation and extracellular fluid. Fenofibrate-induced rhabdomyolysis is a rare clinical condition if there is not a predisposing factor such as diabetes mellitus, hypothyroidism, and renal insufficiency. In this study, we present a case of a patient who developed rhabdomyolysis after micronized fenofibrate use without known predisposing factor.
    The Endocrinologist 10/2010; 20(6):288-289.
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    ABSTRACT: We report a case of a 46-year-old woman suffering from 5 years of premenopausal osteoporosis due to systemic mastocytosis (SM). The only clinical symptom was severe back pain and restricted spinal movements resulting from the existing vertebral compression fractures. There were no skin lesions. Because of the severity of the case, nonresponse to the administered treatment, and the premenopausal initiation of her osteoporosis, a further investigation for an underlying cause was accomplished. Laboratory evaluations excluded metabolic or endocrinologic abnormalities. Serum tryptase was slightly elevated while urinary excretion of histamine was highly increased. A diagnostic bone marrow biopsy specimen was done and the patient fulfilled the diagnostic criteria for SM. SM should be included in the differential diagnosis in cases of unusually presented osteoporosis due to its significant morbidity and the existing treatment options.
    The Endocrinologist 10/2010; 20(6):260-261.
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    ABSTRACT: An adrenal incidentaloma is an adrenal mass, generally 1 cm or more in diameter that is discovered serendipitously during a radiologic examination performed for indication other than evaluation for adrenal disease. With the increasing use of ultrasonography, computerized tomography, and magnetic resonance tomography, an adrenal mass may be identified more frequently. Most adrenal incidentalomas are nonfunctioning adenomas. Metastatic cancer should be considered in patients with known malignancy and having an adrenal mass with suspicious imaging characteristics. Although adrenal metastases are frequently bilateral and greater than 3 cm in size, they may be unilateral and small. A fine-needle biopsy of an adrenal mass may be indicated for diagnosis in such cases. Adrenal carcinoma presenting as an incidental adrenal mass is exceedingly rare. Metastatic tumors in people with no known malignancy is considerably more common. The following report illustrates 1 such case in a 57-year-old man with no prior malignancy, presenting with hemoptysis due to a cavitary lesion in his right lung. A large, right adrenal mass with suspicious imaging characteristics was incidentally noted. Fine-needle biopsy of the adrenal mass proved to squamous cell carcinoma, most likely of the lung. This is a rare case of lung carcinoma (hitherto unknown) presenting with an adrenal mass, where final diagnosis was made by adrenal biopsy.
    The Endocrinologist 10/2010; 20(6):279-282.
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    ABSTRACT: A 36-year-old man was admitted because of muscle weakness. He had a history of hypertension since the age of 20 years. He worked in a hot and humid environment, and his symptoms first appeared at work. He was diagnosed with hypokalemic myopathy. He exhibited a right-hand grasping power of 0 kg and walking difficulties. Further examination revealed a right adrenal gland adenoma and led to a diagnosis of primary aldosteronism (PA). Because PA can now be screened by measuring aldosterone and renin in plasma, PA with extreme myopathy, like the present case is very rare. The causes of the myopathy were considered to be excessive sodium intake and dehydration.
    The Endocrinologist 10/2010; 20(6):298-300.
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    The Endocrinologist 10/2010; 20(6):296-297.
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    ABSTRACT: Managing toxic multinodular goiter in elderly patients can be challenging as age, presence of chronic disease, polypharmacy, and poor medication compliance can limit the use of surgery and long-term antithyroid drugs. Treatment with 131I may not produce the best outcome in states of low radioiodine uptake. Recombinant human thyroid-stimulating hormone (rh-TSH, Thyrogen) used as pretreatment for radioiodine therapy, however, can be useful in this clinical scenario. We report a patient successfully treated (a 94-year-old man on polypharmacy for multiple medical conditions) with radioiodine after pretreatment with rh-TSH. The radioiodine uptake increased with rh-TSH administration and allowed successful treatment with 15.4 mCu of 131I. Recovery from hyperthyroidism was associated with a 71% reduction in the size of thyroid gland by sonography.
    The Endocrinologist 08/2010; 20(5):208-210.
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    ABSTRACT: We describe clinicopathologic features, laboratory data, and imaging and therapeutic management of a rare case of Hashimoto thyroiditis arising in struma ovarii. The patient was a 38-year-old woman with clinical symptoms of hyperthyroidism. Laboratory data showed elevated levels of total and free thyroxine, low thyrotropin level, and positive specific antithyroid antibodies without ultrasound evidence of morphologic abnormalities of the thyroid gland. Pelvic ultrasonography and magnetic resonance imaging of the abdomen showed bilateral solid ovarian masses containing cystic and fat areas diagnostic of teratoma. The performance of a 131I whole-body scan demonstrated a focus of intense uptake in the pelvis with minimal residual thyroid gland. The patient had a bilateral oophorectomy, and histologic examination revealed thyroid tissue in both masses with all the features of Hashimoto thyroiditis in the right ovary. Symptoms of hyperthyroidism diminished after the surgery, and the thyroid hormone levels and antithyroid antibodies were in the normal range in 1 month. The present case further confirms the rare occurrence of Hashimoto thyroiditis in struma ovarii. This diagnosis should be suggested in the differential diagnosis of patients with symptoms of thyroid disease and a normal thyroid gland.
    The Endocrinologist 08/2010; 20(5):220-221.
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    ABSTRACT: We evaluated familial aggregation of metabolic syndrome components in obese children. A total of 198 obese children and their parents were enrolled in a prospective cohort study and were evaluated for the intrafamilial relationships of metabolic syndrome components. Metabolic syndrome was diagnosed in 25 (26%) of 96 obese boys, in 27 (26.4%) of 102 obese girls, in 53 (34.8%) of 152 mothers, and in 37 (33.6%) of 110 fathers. Compared with obese boys, obese girls showed higher correlations with their mothers for waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol and with their fathers for total cholesterol. Compared with obese girls, obese boys showed higher correlations with their fathers for waist circumference, body mass index, high-density lipoprotein cholesterol, triglyceride, fasting plasma glucose, and diastolic blood pressure and with their mothers for total cholesterol, low-density lipoprotein, and triglyceride. There was a significant resemblance of metabolic syndrome and its components among families. Gender-related correlations should be considered for future interventions.
    The Endocrinologist 08/2010; 20(5):240-242.