Deutsche medizinische Wochenschrift
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Adrenal masses are common incidental findings on imaging procedures. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but in up to 20 % they require therapeutic intervention. The aim of this article is to provide essential guidance for clinicians regarding clinical management of patients with adrenal incidentalomas based on the respective current clinical guidelines. The following main questions are addressed: How to distinguish a nonfunctioning incidentaloma from a functioning one and how to assess risk of malignancy? How to define and manage low-level autonomous cortisol secretion, formerly called "subclinical" Cushing's syndrome? Which patients have to be treated surgically and which approach should be used? What follow-up is indicated if the adrenal incidentaloma is not surgically removed?
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Dtsch. Med. Wochenschr. · Jan 2022
[General practitioners, attitudes, procedures and challenges towards supporting family caregivers - results of a survey of primary care physicians].
General practitioners are considered to be well suited when it comes to addressing the information and care needs of family caregivers. The aim of the present study is to examine how general practitioners assess their possibilities to support caregivers, what priorities they set and to what extent they experience challenges. ⋯ GPs can play a central role in supporting family caregivers. A crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for.
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Dtsch. Med. Wochenschr. · Jan 2022
Case Reports[Pancytopenia and B-symptoms - an unexpected souvenir?]
The 79-year-old patient was admitted with recurring fever, weight loss, night sweat, a decrease in physical capacity and hematomas of the extremities. ⋯ Pancytopenia and corresponding symptoms are suspect for visceral Leishmaniasis also in patients supposed to be immunocompetent with travel history of endemic regions.
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Primary aldosteronism represents the most frequent cause of endocrine hypertension. It is associated with a higher morbidity and mortality compared to essential hypertension. Early identification of the affected patients is crucial, as the adequate therapy leads to an excellent long-term prognosis, especially after unilateral adrenalectomy. ⋯ Adrenal vein sampling still represents the gold standard in subtype differentiation of primary aldosteronism. Steroid profiling could possibly make dispensable adrenal vein sampling in patients with bilateral hyperplasia. Different studies investigate the potential of functional imaging for differential diagnosis of primary aldosteronism.