Endocrinology and metabolism clinics of North America
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Diabetic neuropathy (DN) is the most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. The clinical assessment of diabetic peripheral neuropathy and its treatment options are multifactorial. Patients with DN should be screened for autonomic neuropathy, as there is a high degree of coexistence of the two complications. A review of the clinical assessment and treatment algorithms for diabetic neuropathy, painful neuropathy, and autonomic dysfunction is provided.
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Endocrinol. Metab. Clin. North Am. · Sep 2013
ReviewSleep disorders and the development of insulin resistance and obesity.
Normal sleep is characterized both by reduced glucose turnover by the brain and other metabolically active tissues, and by changes in glucose tolerance. Sleep duration has decreased over the last several decades; data suggest a link between short sleep duration and type 2 diabetes. ⋯ Obesity is a major risk factor for OSA, but whether OSA leads to obesity is unclear. The quality and quantity of sleep may profoundly affect obesity and glucose tolerance, and should be routinely assessed by clinicians.
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Endocrinol. Metab. Clin. North Am. · Jun 2013
ReviewDiagnosis and treatment of osteoporosis in older adults.
Osteoporosis in the elderly is a serious problem that is increasing as the population ages. Diagnosis is established by measurement of bone mineral density or by the presence of a fragility fracture, especially a spine or hip fracture. Bone-active agents should be prescribed for older patients with osteoporosis to decrease fracture risk. Nonskeletal risk factors for fracture and psychosocial impairment must be identified and managed, and therapy must be individualized.
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Adequate iodine intake is required for the synthesis of thyroid hormones that are important for normal fetal and infant neurodevelopment. In this review, we discuss iodine physiology during pregnancy and lactation, methods to assess iodine sufficiency, the importance of adequate iodine nutrition, studies of iodine supplementation during pregnancy and lactation, the consequences of hypothyroidism during pregnancy, the current status of iodine nutrition in the United States, the global efforts toward achieving universal iodine sufficiency, and substances that may interfere with iodine use.
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The pituitary gland undergoes much anatomic and physiologic variation during pregnancy. Pituitary disease may have a significant impact on a patient prior to conception as well as throughout her pregnancy. It is imperative to provide care to patients affected by pituitary disease with a multidisciplinary approach involving endocrinologists, obstetricians and, when appropriate, neurosurgical care, as this group of disorders can represent a substantial level of morbidity and mortality for both mother and fetus.