Presse Med
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Addison's disease is a rare autoimmune disorder. In the developed world, autoimmune adrenalitis is the commonest cause of primary adrenal insufficiency, where the majority of patients have circulating antibodies against the key steroidogenic enzyme 21-hydroxylase. A complex interplay of genetic, immunological and environmental factors culminates in symptomatic adrenocortical insufficiency, with symptoms typically developing over months to years. ⋯ This article provides an overview of our current understanding of the natural history and underlying genetic and immunological basis of this condition. Future research may reveal novel therapeutic strategies for patient management. Until then, optimisation of pharmacological intervention and continued emphasis on education and empowerment of patients should underpin the management of individuals with autoimmune Addison's disease.
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In France, daily tobacco consumption increased among adults between 18 and 75 years between 2005 and 2010, particularly women. At 17 age-old, it raised 10% between 2008 and 2011 (32.7% in boys and 30.2% in girls). The number of cigarettes smoked per day decreased between 2005 and 2010 in France, from 15.4 to 13.9 cigarettes smoked per day. ⋯ Smoking cessation methods include: minimal counseling provided by general practitioners (when given during a medical visit for another motive than smoking cessation, one out of 50 smokers stops); minimal counseling given by any health professional; and the smoking cessation services framework. Evidence-based medications associated with a non-pharmacologic support and with a regular follow-up significantly increase smoking cessation rates. Risk reduction by decreasing progressively tobacco consumption with the help of medications is only suggested nowadays.
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We have to trust the patient. Pain is undertreated. Inadequate treatment has adverse consequences. ⋯ They are responsive to opioid analgesia. They need baseline opioids ("opioid debt"), mostly a well-stabilized OST. They require higher doses, more frequent dosing and longer opioid administration.
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Autonomic nervous system (ANS) modulates the function of all body organs through both parasympathetic and sympathetic fibers. Orthostatic hypotension is frequently observed in the course of central nervous system diseases including cortical (stroke, epilepsy, dementias), neurodegenerative (Parkinson's disease, multisystem atrophies) and spinal cord diseases. In some cases, the mechanism of orthostatic hypotension associated with central nervous system diseases involves a dysfunction of peripheral ANS fibers.
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Hypotension is defined by a low blood pressure either permanently or only in upright posture (orthostatic hypotension). In contrast to hypertension, there is no threshold defining hypotension. The occurrence of symptoms for systolic and diastolic measurements respectively below 90 and 60 mm Hg establishes the diagnosis. ⋯ Hypotension is a rare manifestation of pheochromocytomas, especially during surgical removal when the patient has not been prepared with calcium inhibitors. Every flush with hypotension should suggest a carcinoid crisis, which is very sensitive to subcutaneous somatostatin analog. An accurate etiological diagnosis should allow treat efficiently endocrine hypotension without inducing hypertension in supine posture.