The Journal of clinical endocrinology and metabolism
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J. Clin. Endocrinol. Metab. · Jan 2006
Clinical TrialAdvancing human circadian rhythms with afternoon melatonin and morning intermittent bright light.
Both light and melatonin can be used to phase shift the human circadian clock, but the phase-advancing effect of the combination has not been extensively investigated. ⋯ Afternoon melatonin, morning intermittent bright light, and a gradually advancing sleep schedule advanced circadian rhythms almost 1 h/d and thus produced very little circadian misalignment. This treatment could be used in any situation in which people need to phase advance their circadian clock, such as before eastward jet travel or for delayed sleep phase syndrome.
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J. Clin. Endocrinol. Metab. · Jan 2006
Comparative Study Clinical TrialSeptic shock and sepsis: a comparison of total and free plasma cortisol levels.
Severe systemic infection leads to hypercortisolism. Reduced cortisol binding proteins may accentuate the free cortisol elevations seen in systemic infection. Recently, low total cortisol increments after tetracosactrin have been associated with increased mortality and hemodynamic responsiveness to exogenous hydrocortisone in septic shock (SS), a phenomenon termed by some investigators as relative adrenal insufficiency (RAI). ⋯ Free cortisol is likely to be a better guide to cortisolemia in systemic infection because it corresponds more closely to illness severity. The attenuated cortisol increment after tetracosactrin in RAI is not due to low cortisol-binding proteins. Free cortisol levels can be determined reliably using total cortisol and CBG levels.
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J. Clin. Endocrinol. Metab. · Jan 2006
Multicenter StudyPartial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly.
Surgery is a cornerstone in the treatment of acromegaly, but its efficacy in large, invasive tumors is scant. ⋯ Surgical tumor removal (>75%) enhances the response to SSAs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.