Cleveland Clinic journal of medicine
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Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. Previously considered rare, it is now recognized as a common cause of acute coronary syndrome, particularly in young women. Despite growing awareness of this disease, there is a paucity of data on acute and long-term therapy. This review summarizes the existing literature on treatment of SCAD and describes a comprehensive management strategy.
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In a perimenopausal or postmenopausal woman, an elevation in human chorionic gonadotropin (hCG) can raise the concern of malignancy or even pregnancy, but it can also be a benign physiologic finding due to production in the pituitary gland in this patient population. Diagnosing the underlying cause of hCG elevation can be challenging, especially if a pituitary source is not considered. Pituitary hCG production remains largely underrecognized and can lead to unnecessary testing, harmful therapy such as chemotherapy, or delay in receiving appropriate care for other unrelated diseases. It is therefore important to establish guidelines to aid medical evaluation.
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Dual-energy x-ray absorptiometry (DXA) can detect bone mineral density loss before it can be identified on usual skeletal radiography, making it possible to diagnose osteoporosis in postmenopausal women and older men before clinical fractures arise. However, when DXA is used outside these populations or if the clinical picture does not match the reported T-scores, mistakes can arise in interpreting results and determining the need for pharmaceutical therapy.
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Cancer chemotherapy and radiotherapy can be toxic to the ovaries, but women can improve their chances of preserving their fertility. Three options are available: gonadotropin-releasing hormone (GnRH) analogues, oocyte cryopreservation, and ovarian tissue cryopreservation. A fourth option, ovarian transposition, is valid for patients undergoing pelvic radiation but is not useful in patients undergoing chemotherapy.