Endocrine
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Case Reports
Cervix neuroendocrine carcinoma presenting with severe hypokalemia and Cushing's syndrome.
Neuroendocrine carcinomas of the cervix are very rare, accounting for only 1-2% of all cervical cancers and <1% of all neuroendocrine tumors. Small-cell carcinoma of the cervix is associated with poor prognosis, even in early stages. Despite their neuroendocrine origin, tumors presenting with syndromes due to secreted neuroendocrine hormones are extremely rare. ⋯ In most reports, Cushing's syndrome associated with these tumors occurred only in association with liver or lung metastasis. Only one single case of primary uterine cervix carcinoma secreting enough ACTH to induce Cushing's syndrome in the absence of metastatic disease has been described in 1994. Here, we describe a case of cervical small-cell carcinoma presenting with an acute onset of severe hypokalemia in Cushing's syndrome without metastatic disease to distant organs.
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For patients with differentiated thyroid carcinoma (DTC), distant metastases are commonly identified in the lungs and bones. However, they are relatively rare in other distant organs, such as the liver, kidneys, or brain. The aim of the current study was to describe the clinical outcomes and evaluate the prognostic factors of patients with no less than three different distant organ system metastases from DTC. ⋯ Patients with no less than three distant organ system metastases from DTC had poor prognosis. RAI avidity and RAIR-DTC were main factors influencing overall survival for patients with distant metastases from DTC in both groups.
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Observational Study
Risk factors for prevalent diabetic retinopathy and proliferative diabetic retinopathy in type 1 diabetes.
Age at diagnosis of type 1 diabetes (DM1) has been implied as an important factor associated with the development of the microvascular complications. Our aim was to identify factors associated with prevalent diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) in DM1 people with early and late-onset. ⋯ Although previous reports suggest that age at DM1 diagnosis may have a role in DR prevalence, the risk factors for DR in early and late-onset DM1 were similar for both groups. Duration of disease and lifelong metabolic control were the major predictors for DR in both groups. Nephropathy was associated with DR in patients with late-onset disease. Neuropathy was associated with PDR occurrence in both groups. BMI was associated with PDR early-onset DM1 group.
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The purpose of this article will be to review the basics of thyroid hormone therapy, including various thyroid hormone formulations, the institution and monitoring of thyroid hormone therapy, adverse effects of overtreatment, the management of patients with persistent symptoms despite normal thyroid function tests, and potential new innovations in thyroid hormone therapy. The conclusions support the necessity to personalize thyroid hormone replacement therapy in hypothyroid patients.
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Subclinical hypothyroidism, defined as increased TSH serum levels and normal serum free T4 concentrations, has been associated with an increased risk of heart disease in adults. But, data in children and adolescents are scanty and treatment of subclinical hypothyroidism is controversial. Growth differentiation factor-15 (GDF-15) is a promising biomarker of cardiac remodeling. This study aimed to evaluate the cardiovascular risk factors in children with subclinical hypothyroidism, measured with tissue Doppler echocardiography (TDE), and conventional echocardiography and GDF-15 level. ⋯ Patients with subclinical hypothyroidism versus healthy individuals had some changes in echocardiographic parameters that indicate involvement of diastolic function of the left ventricle. They were significantly different when compared SH group and the control group. This study demonstrated ventricle diastolic dysfunction in pediatric patients with hypothyroidism. The results of our study suggest that cardiac follow-up may be useful in patients with subclinical hypothyroidism and clinical trials are needed to explore therapeutic effects of T4 and T3 administration in this patients.