Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
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Practice Guideline Guideline
American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update.
In these clinical practice guidelines, specific recommendations are made for determining the most effective methods of diagnosing and treating hypogonadism in adult male patients. The target populations for these guidelines include the following: (1) men with primary testicular failure requiring testosterone replacement (hypergonadotropic hypogonadism); (2) male patients with gonadotropin deficiency or dysfunction who may have received testosterone replacement therapy or treatment for infertility (hypogonadotropic hypogonadism); and (3) aging men with symptoms relating to testosterone deficiency who could benefit from testosterone replacement therapy. Initial hormonal evaluation generally consists of a testosterone determination, in conjunction with a free testosterone or sex hormone-binding globulin level, inpatients with clear symptoms and signs but normal-range total testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin levels. ⋯ Therapeutic options generally consist of testosterone replacement by injections, patches, or topically applied gel in hypergonadotropic patients and in hypogonadotropic patients not interested in fertility. In hypogonadotropic patients interested in fertility, gonadal stimulation option scan be considered, including human chorionic gonadotropin stimulation therapy with or without human menopausal gonadotropin (or follicle-stimulating hormone) or gonadotropin-releasing hormone pump therapy. These therapies may be combined with assisted reproductive technologies such as in vitro fertilization with intracytoplasmic sperm injection, which may allow pregnancy to occur with very low numbers of sperm.
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Review
Diabetic myonecrosis in a previously healthy woman and review of a 25-year Mayo Clinic experience.
To describe a case of diabetic myonecrosis, an unusual complication of diabetes mellitus, and to provide an overview of an institutional experience with this condition. ⋯ The current case is the first report of myonecrosis as the initial manifestation of diabetes. This case also demonstrates that myonecrosis, although typically involving the thigh, can extend abruptly to the calf. Diabetic myonecrosis should be included in the differential diagnosis of an acutely painful lower extremity mass in patients with diabetes.
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To report an unusual case of thyrotoxicosis caused by "silent thyroiditis" in a lithium-treated patient and to summarize all prior case reports of lithium-associated thyroiditis and compare them with our current case. ⋯ Thyrotoxicosis caused by silent thyroiditis may be associated with lithium therapy and is likely to be underreported. The pathogenic mechanism for such cases of thyroiditis is still unclear.
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To describe an association between Graves' disease and myasthenia gravis and discuss the clinical features and laboratory tests that may help distinguish these two diseases. ⋯ The overlapping clinical features may cause diagnostic confusion when myasthenia gravis and Graves' disease coexist, and numerous tests may be needed to distinguish these two conditions, which have differing treatments and prognoses.