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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the role of insulin receptors in the pathogenesis of insulin resistance observed in glucocorticoid excess, we measured 125I-insulin binding to circulating erythrocytes in 7 patients with Cushing's syndrome and 7 patients with adrenal insufficiency. Insulin receptor binding was higher in Cushing's syndrome and was lower in adrenal insufficiency, compared to normal subjects. Insulin binding decreased after transsphenoidal surgery in 2 patients with Cushing's syndrome. In addition, glucocorticoid treatment in 6 patients with adrenal insufficiency resulted in the increase of insulin binding. The biological significance of this phenomenon must await further investigation, but it does suggest that insulin resistance in glucocorticoid excess should be interpreted as an alteration of cellular mechanisms of insulin at a step distal to the insulin receptor. Increased insulin binding to the receptor is probably modulated by postreceptor events.
Diabetes Res Clin Pract 1985 Dec
PMID:The effect of glucocorticoid on 125I-insulin binding to human erythrocytes. Possible postreceptor modulation of receptor binding. 391 63

The clinical response of 57 adult patients with Cushing's syndrome due to bilateral adrenocortical hyperplasia or adrenocortical adenoma is documented following resolution of hypercortisolaemia by various forms of treatment. Despite satisfactory biochemical remission of the disease the clinical result was far less satisfactory when assessed by persistence of obesity (55%), menstrual irregularity (41%), hypertension (29%) and insulin-dependent diabetes (22%). Myopathy, hirsuitism and psychological abnormalities persisted to a lesser extent. The mortality rate of the series over a 30 year follow-up period was 4 times that of a general population matched for sex, age and year of entry into the series. Cardiovascular disease was the cause of death in 85%. Irreparable cardiovascular disease is produced early in the course of hypercortisolaemia, emphasizing the vital importance of the earliest possible recognition and treatment of this disease.
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PMID:The clinical response to treatment in adult Cushing's syndrome following remission of hypercortisolaemia. 398 55

A 57-year-old male, who had been suffered from hypertension and diabetes mellitus for 10 years, was admitted to the hospital because of thirst, lassitude and muscle wasting. On admission, his urinary excretion of 17-OHCS and plasma cortisol levels were elevated without diurnal variations. Plasma ACTH levels were found to be very low with repeated determinations. Dexamethasone suppression test, 2 mg 4 times a day orally for 2 days, showed no changes in plasma cortisol levels and only a mild reduction in urinary 17-OHCS excretion. Estimation of urinary catecholamines showed an increase only in norepinephrine. Abdominal computerized tomography and radionuclide scanning of adrenal glands with 131I-adosterol demonstrated a well-defined adrenal mass in the left side without apparent changes in the right side. 131I-metaiodobenzylguanidine scintigraphy was negative. At surgery, his left adrenal medulla was found to be hypertrophic in addition to the cortical tumor. The left adrenal gland was also removed. After surgery, excretion of urinary catecholamines fell to nearly the normal range and he was discharged without insulin and antihypertensive drugs. Microscopically, the cortical tumor is an adenoma consisting of lipid laden cells and eosinophilic compact cells. Medullary cells were distinctly hyperplastic in appearance and many of the cells were extensively vacuolated, suggesting an active functional status. The present report describes a patient with Cushing's syndrome who showed increased urinary catecholamine excretion due to the possible coexistence of adrenal medullary hyperplasia. As far as we know, this is the first case of Cushing's syndrome with this abnormality.
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PMID:A case of Cushing's syndrome associated with possible adrenomedullary hyperplasia. 404 90

The etiology of several specific types of hypertension are described in order of increasing difficulty of diagnosis: glycyrrhizine poisoning, oral contraceptives, coarctation of the aorta, pheochromocytoma, Conn syndrone, Cushing syndrome, parenchymal nephropathy, unilateral renal atrophy, and renovascular hypertension. Glycerryyzine and oral contraceptive etiologies can be diagnosed by questioning the patient and improved by eliminating their intake. Coarctation of the aorta is easily identified by clinical signs, but surgical repair is probably mor e risky than drug treatment. A pheochromocytoma is signaled clinically and by catecholamine excretion. Conn syndrome has characteristic clinical signs, particularly hypokalemia during intake of diuretics. Cushing syndrome is recognized by corticosteroid excretion as well as peculiear obesity, acne, erythrosis, and diabetes. Bilateral nephropathy is common (25% of hypertensions) and rather difficult to dia gnose and treat. Unilateral renal atrophy can be demonstated by renal arteriography and cystography, but predicting the outcome of nephrectomy is problematic. Renovascular hypertension due to occlusion of the renal artery requires the most sophisticated tests and care for an effective treatment. A table and an outline of diagnostic tests to differentiate these disorders are included.
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PMID:[Etiologic survey of arterial hypertension. Its justifications and practical modalities]. 549 42

Two patients presenting with diabetes mellitus and hypokalaemia resulting from markedly increased ACTH and cortisol secretion are described. Neither patient showed any evidence of a tumour and both responded dramatically to treatment with metyrapone in that all abnormal clinical features disappeared, ACTH concentrations returned to normal and both patients showed prolonged remission after metyrapone treatment was stopped. One patient relapsed after a severe viral illness and the administration of dexamethasone and cortisone. It is suggested that these cases may represent an unusual form of Cushing's syndrome in which ACTH secretion is stimulated by increasing concentrations of cortisol. When these are reduced by metyrapone administration ACTH secretion falls in parallel and prolonged remission of disease may result.
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PMID:Prolonged remission in florid Cushing's syndrome following metyrapone treatment. 627 22

Patients with increased circulating levels of adrenocorticosteroids or with diabetes mellitus are described as having a predilection for skin tags. These cutaneous outgrowths are usually filiform papules in the axillae and on the neck or eyelids. I saw the unusual development of broad-based lipofibromas on the legs of a diabetic woman with Cushing's syndrome. These tumors were multiple, soft, sessile, and hyperpigmented.
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PMID:Eruptive lipofibromata. 685 5

The isoenzymes of canine alkaline phosphatase have been separated by isoelectric focusing on agarose gels. Alkaline phosphatase from normal tissue extracts gave heterogeneous focusing patterns with the following isoelectric points: liver pH 4.3, bone pH 4.0 to 4.9, kidney pH 4.4 to 4.7 and intestine pH 3.6 to 4.6. Plasma alkaline phosphatase isoenzymes were examined in 123 dogs with activities at least twice the normal maximum. The isoenzymes from these plasma samples had multiple bands at pH 4.3 to 4.6 but in 67 per cent of all cases, the predominant isoenzyme, named isoenzyme A, was a single band of isoelectric point pH 3.5. Isoenzyme A occurred in all dogs with diabetes mellitus or Cushing's syndrome and in 93 per cent of animals receiving steroid therapy. Increased activities of the pH 4.3 to 4.6 isoenzymes were more likely to occur in cases of hepatic degeneration.
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PMID:Isoenzymes of canine plasma alkaline phosphatase: an investigation using isoelectric focusing and related to diagnosis. 687 82

Once thought to be solely a disease of insulin deficiency, diabetes mellitus now is recognized as a disorder with multiple pathogenetic mechanisms. Newer terminology identifies those uncommon patients with true insulin deficiency as having insulin-dependent diabetes (IDDM), while the majority of patients with diabetes have some residual insulin secretion but may have a disorder of insulin receptor number or affinity. These patients have non-insulin dependent diabetes (NIDDM). Other patients may have gestational diabetes, impaired glucose tolerance, a potential for glucose intolerance, or a previous history of diabetes. A few patients will have diabetes secondary to a known cause, such as pancreatitis or Cushing's syndrome. Understanding this nosological approach to diabetes should enhance the clinician's decisions regarding therapy.
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PMID:Classification and pathogenesis of the diabetes syndrome: a historical perspective. 705 Feb 15

Age-related somatic variability studied by 15 anthropometric parameters was assessed in 278 subjects (138 boys and 140 girls) aged between 5 and 20 years. Of these, 30% had simple obesity, 10.0% obesity associated with hypothyroidism, 10.0% obesity with diabetes, 25% obesity with adrenocortical reaction, 23.5% functional adiposo-genital syndrome and 1.5% Cushing's syndrome. The peculiarities related to the somatic development as a whole, the degree of bone development, and adiposity are interpreted in the main clinical forms of obesity, on the basis of the morphogram.
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PMID:Somatotyping in the obese children and adolescents. 743 66

Cushing's syndrome, an unusual group of disorders characterized by hypercortisolism, must be considered in the differential diagnosis of such common clinical problems as hirsutism, menstrual irregularity, hypertension, diabetes mellitus, and obesity. Its distinct forms--pituitary-dependent Cushing's syndrome (Cushing's disease), adrenal tumor and ectopic ACTH syndrome--must be identified correctly so that specific therapy can be administered. In the majority of cases, use of a relatively simple diagnostic sequence will provide accurate and rapid diagnosis. However, in our experience with more than 60 patients, diagnostic difficulties may arise from a variety of conditions (e.g., drug interference, alcohol ingestion, and depression). In addition, unusual circumstances, such as unexpected responses to dexamethasone, may complicate the diagnosis. Our approach to these problems is illustrated through a report of seven cases, and we emphasize that the proper management of Cushing's syndrome mandates a thorough marshalling of all the available data.
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PMID:Cushing's syndrome: problems in diagnosis. 745 63


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