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

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

A 56-year-old woman with many unusual manifestations of von Hippel-Lindau syndrome is described. In addition to retinal hemangioblastomas, pheochromocytoma, renal cell carcinoma, and multiple organ cysts, she had a cerebellar astrocytoma, pancreatic exocrine insufficiency, diabetes mellitus, thyrotoxicosis, and a metastatic calcitonin-secreting islet cell carcinoma. This case report documents the first example of a metastatic islet cell tumor in a patient with von Hippel-Lindau disease. The possible relationship between this disorder, the other neurocutaneous syndromes, and the multiple endocrine neoplasia syndromes is discussed.
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PMID:Metastatic islet cell tumor in von Hippel-Lindau disease. 633 Nov 59

An equally lowered insulin specific binding in the fatty cell plasmic membranes was found in patients with glucocorticoid, somatotropin and catecholamine hyperproduction during diabetes mellitus and/or its absence. This fall is due exclusively to a reduced amount of binding sites in patients with hypercorticism and acromegaly, accompanied or not by diabetes, and in persons with diabetes-aggravated pheochromocytoma. The above decrease is caused by a lowered binding site number and augmented negative cooperativity in patients suffering from pheochromocytoma without diabetes. The results obtained allow a conclusion that inhibited expression of insulin receptors in the presence of counter-insulin hormone hyperproduction promotes diabetes arising.
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PMID:[Fatty tissue insulin receptors in patients with an elevated level of contrainsulin hormones with and without concomitant diabetes mellitus]. 638 48

Persons with either borderline or established hypertension should always be instructed in a series of general measures. These include a reduction of overweight, dietary salt restriction, no smoking, whenever possible discontinuation of oral contraceptives, appropriate physical exercise, and treatment, primarily by diet, of a coexisting hyperlipidemia. Such non-pharmacologic measures may often improve the potential risk constellation and in some persons with borderline or mild hypertension even normalize the blood pressure. Pharmacotherapy is recommended only in selected cases with persistent borderline blood pressure elevation but, on a partly empirical basis, appears usually to be indicated for established hypertension of greater than or equal to 160/95 mm Hg. The coexistence of diabetes mellitus or renal functional impairment and advancing age of a patient deserve special consideration in the choice and/or dosage of antihypertensive drugs. Failure to achieve satisfactory blood pressure control through general measures and appropriately dosed triple drug therapy (including a diuretic, a betablocker or other sympatholytic or calcium antagonist, and (di)hydralazine, prazosin or endralazine) calls for thorough reevaluation of the situation. Causes which may simulate or induce resistant hypertension include technical problems with measurement, oral contraceptives, insufficient patient cooperation, sodium fluid volume retention, insufficient pharmacotherapy, drug interactions, "office hypertension" with satisfactory blood pressure in the patient's daily environment, and potentially operable causes such as renal artery stenosis or pheochromocytoma. If none of these factors is present, persistent uncontrolled hypertension can very often be treated satisfactorily with newer potent drugs such as the convertase inhibitor captopril as first choice agent in women, or the direct vasodilator minoxidil as the preferred agent in men. Together with the necessary steps to improve patient compliance, including increased blood pressure measurements by the patient himself, practitioners can now rely upon effective therapeutic tools. The present social and economic burden resulting for the individual and the public from neglected therapeutic opportunities, from excess morbidity and early death due to inadequately treated hypertension, can and must be reduced in the interests of the community at large.
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PMID:[Long-term treatment of hypertension in 1983]. 641 60

The effects of glucagon on the adrenergic system have been studied in experimental and clinical conditions. 1. in vitro studies: In the first experiment a continuous flow incubation system was developed in which the secretory response to these drugs was characterized by a serial fluorimetric assay of catecholamines in the effluent medium. Pig adrenal medulla or human pheochromocytoma were studied. There was an initial massive release of catecholamines which declined to basal levels (0.02 micrograms/mg) after 1.5 hours. When 10(-4) glucagon was infused for 10 minutes following 2 hours of preincubation, both adrenaline and nonadrenaline outputs rose abruptly to concentrations of 0.08 micrograms/mg and 0.07 micrograms/mg respectively. In the second experiment the effect of these drugs on the in vitro release of catecholamines from the isolated in vitro chromaffin granules of the pig adrenal medulla were studied. The results were the same as in the previous experiment. 2. clinical studies: The effects of glucagon were studied on the blood pressure and urinary catecholamine levels of healthy control subjects, of patients suffering from essential hypertension, thyroid disease, diabetes mellitus and acromegaly. Glucagon induced a slight but constant increase in blood pressure. By contrast no significant urinary catecholaline elevation was evoked. There was no difference in the effect of intravenous glucagon between normal subjects and patients suffering from the above-mentioned disorders.
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PMID:[A reevaluation of the glucagon provocative test for pheochromocytoma--on the in vitro release of catecholamine from the adrenal medulla or pheochromocytoma tissue, and on the effect of intravenous glucagon on urinary catecholamine excretion and blood pressure (author's transl)]. 740 74

Pheochromocytoma accounts for about 0.1 per cent of patients with diastolic hyperstension. It mimics many diseases varying from anxiety psychoneurosis to intracranial tumors. Cardinal symptoms include sevre headache (72 to 92 per cent), sweating (60 tp 70 per cent), palpitations (51 to 73 per cent), and hypertension (> 90 per cent) of which 50 per cent is sustained, 50 per cent paroxysmal. Many drugs (phenothiazines, Saralasin, antiemetics, steroids, etc.) have been reported as precipitating factors. Patients who should be screened for pheochromocytoma include: (1) all symptomatic patients with sustained or paroxysmal hyperstension; (2) asymptomatic hypertension; (3) all patients with MEA 2a,b (hyperparathyroidism, medullary carcinoma of the thyroid, neurocutaneous lesions) and their first degree relatives, even if the latter are asymptomatic and normotensive; (4) hypertension plus diabetes mellitis or hypermetabolism; (5) hypertensive episode during induction of anesthesia or radiologic procedure; and (6) hypertensive response during histamine administration, i.e., gastric analysis. Urinary metanephrine is the single best screening test. Plasma catecholamine determination is particularly helpful when collected before and immediately after an attack. Provacative agents (histamine, glucagon, tyramine) are needed rarely. Preoperative localization of the tumor can be done with nephrotomography IVP, computerized axial tomography, ultrasound, 131-I-19-iodocholesterol scan, arteriography, venography.
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PMID:Pheochromocytoma: clinical manifestations and diagnostic tests. 745 90

Studies of ocular immunity showed that incubation of peritoneal exudate cells with antigen in the presence of aqueous humor containing TGF-beta, conferred upon them the ability to systemically inhibit antigen-specific cellular immunity when injected into naive recipients. Since cell mediated immunity has been implicated in the destruction of the islets of Langerhans in diabetes, it was theorized that injection of naive diabetes prone BB/W or rats with peritoneal exudate cells pre-cultured in the presence of islet antigen and TGF-beta might similarly inhibit their anti-islet immune reactions and prevent their development of diabetes. 34.2% (13 of 38) of experimental recipient diabetes prone rats developed diabetes while 78.4% (29 of 37; p < 0.0005 compared to experimentals), 72.2% (13 of 18; p < 0.03 compared to experimentals), 68.8% (11 of 16; p < 0.09 compared to experimentals), and 77.7% (7 of 9; p < 0.08 compared to experimentals) of controls receiving peritoneal exudate cells pre-cultured alone, with TGF-beta, with TGF-beta and pheochromocytoma (PC12) cells, or with islets + TGF-beta + anti-TGF-beta antibody, respectively, became diabetic. Experimental treatment did not markedly alter recipient spleen cell subsets, and spleen cells from protected rats did not confer disease protection when transferred into naive recipients. These data demonstrate that the above approach is efficacious and represents a unique strategy for preventing the development of autoimmune type I diabetes in an animal model.
Diabetes Res 1994
PMID:Prevention of diabetes in BB/Wor rats by injection of peritoneal exudate cells cultured in the presence of transforming growth factor beta (TGF-beta) and islet cells. 764 92

Pheochromocytoma, although rare, is associated with a high degree of morbidity and mortality if not recognized. A high degree of suspicion in patients with new-onset hypertension; hypertension with sudden worsening or development of diabetes mellitus; or a family history of MEN, neuroectodermal tumors, or simple pheochromocytoma should prompt biochemical confirmation with either 24-hour urine catecholamines (norepinephrine and epinephrine) or total MET (NMET plus MET). Following confirmation of the diagnosis, radiologic studies with CT and (if needed) MIBG are employed to localize the tumor. Surgical removal is the only definitive therapy. Medical management with alpha-blocking agents, to control symptoms and prevent a hypertensive crisis, is generally advocated for 2 weeks preoperatively and intraoperatively. Occasionally, beta-blockers, employed only after adequate alpha-blockade, are necessary to control tachycardia and tachyarrhythmias. High-dose MIBG and combination chemotherapy have been used adjunctively to treat malignant pheochromocytoma, although neither modality provides lasting satisfactory results. Normal urine assays performed 2 weeks postoperatively ensure the complete removal of all tumor. Additionally, lifelong follow-up (yearly initially) is necessary to detect any signs of benign recurrence or malignancy because these have been reported to occur as long as 41 years after the initial surgical resection. Biochemical evidence of excess catecholamine production usually precedes the clinical manifestations of catecholamine excess when these tumors recur.
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PMID:Pheochromocytoma. Update on diagnosis, localization, and management. 780 88

The frequency of glucose intolerance including diabetes and IGT in endocrine diseases was compared between Japan and foreign countries. It was revealed that the frequency of diabetes in endocrine diseases is generally higher in Japan than in foreign countries. In addition, plasma insulin response to glucose was exaggerated in Cushing's syndrome with glucose intolerance, but was impaired in acromegaly and pheochromocytoma with glucose intolerance.
Diabetes Res Clin Pract 1994 Oct
PMID:Endocrine disorders and diabetes in Japan. 785 94

Among surgical patients renal diseases association with diabetes mellitus was found in 117, with thyroid affection in 82 patients. Twenty-six patients were treated for primary hyperparathyroidism, 46 were operated on for adrenal tumors: pheochromocytoma (23 cases), Conn's syndrome (3 cases). Hyperglycemic coma in patients with acute purulent renal diseases was primarily due to overlooked diabetes mellitus. Thyrotoxic crises emerged after urgent ureterolithotomy in a female patient suffering from toxic goiter, hypothyroid coma occurred in a male subject with undetected hypothyroidism following pyelolithotomy. Clinical variability of the symptoms, no attempts oriented on their detection led to diagnosis of pheochromocytoma, Conn's syndrome, primary hyperparathyroidism in emergency situations or at autopsy. Timely diagnosis and pathogenetic therapy of endocrine crises produced favourable outcomes.
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PMID:[Endocrine crises in patients with kidney diseases]. 794 Nov 21


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