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

In 1953, Poulsen described the remarkable case of a woman with type I diabetes mellitus who experienced resolution of her retinopathy following postpartum pituitary necrosis. Since that time, many investigators have pursued the hypothesis that anterior pituitary hormones, particularly growth hormone, play a role in the pathogenesis of the microvascular complications of diabetes mellitus. While most observers have demonstrated the importance of growth hormone in the initiation and progression of diabetic retinopathy, the role of growth hormone in the development of diabetic nephropathy has been more difficult to document. In this case report, we describe a woman with long-standing type I diabetes mellitus complicated by retinopathy and nephropathy whose complications stabilized as she developed growth hormone deficiency.
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PMID:Hypopituitarism stabilizes the renal and retinal complications of diabetes mellitus. 148 75

To determine the role of growth hormone in overnight insulin requirements and lipolysis, five patients with chronic growth hormone deficiency and Type 1 (insulin-dependent) diabetes mellitus and six control patients with diabetes were each studied on two separate nights. Insulin was infused at a variable rate throughout one night to maintain euglycaemia and fixed at 04.00 hours on another. During the variable infusion, euglycaemia was maintained in control patients by a 36% increase in insulin infusion rate between 03.00 and 08.00 hours while a 46% decrease in the rate was required in growth hormone deficient patients (p less than 0.02). Despite this difference, mean free insulin values were equivalent. This finding is suggestive of increased insulin clearance in growth hormone sufficient patients. Glucose levels rose in control and fell in growth hormone deficient patients when insulin infusion rates were fixed at 04.00 hours. Glycerol production and non-esterified fatty acid concentrations were significantly lower in the growth hormone deficient diabetic patients, p less than 0.001, and when normalized with a heparin infusion, had no effect on insulin requirements. We conclude that: (1) growth hormone contributes to the development of the "dawn phenomenon," possibly by increasing insulin clearance (2) growth hormone helps sustain nocturnal lipolysis in Type 1 diabetes and (3) non-esterified fatty acids are not involved in the dawn phenomenon.
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PMID:Absence of the dawn phenomenon and abnormal lipolysis in type 1 (insulin-dependent) diabetic patients with chronic growth hormone deficiency. 151 66

The thyroid gland and pancreas were ultrasonographically examined in order to determine their normal sizes in children. In 418 healthy children the thickness and width of the right and left lobes of the thyroid gland were measured at the transverse section of the neck. In 145 healthy children the long axis and short axis diameters of the profile of the head and body of the pancreas were measured by the sagittal scanning at the epigastrium. The mean +/- standard deviations as a function of height was determined as the normal size in children. In 23 patients with congenital hypothyroidism and hyperthyropinanemia ultrasonographic findings of the thyroid gland were classified into 4 groups: large thyroid gland image, normal thyroid gland image, small thyroid gland image, and no image of the thyroid gland. The patients in the no image of the thyroid gland group revealed extremely high serum thyrotropin level at the initial diagnosis, and they needed a total replacement dose of l-T4. Thyroid scintigraphy was carried out in 7 of the 23 patients. The ultrasonographic findings coincided with the scintigrams in all 7 patients. We concluded that no image of the thyroid gland by ultrasonography was in accord with thyroid aplasia or ectopic thyroid gland, and large thyroid gland image by ultrasonography was goitorous congenital hypothyroidism. In 18 patients with insulin-dependent diabetes mellitus (IDDM) the size of the pancreas was smaller than in the healthy controls. However there was no correlation between the size of the pancreas and clinical parameters, such as duration of IDDM, mean HbA1 and the insulin dose. In 31 patients with growth hormone deficiency undergoing growth hormone therapy, pancreas size was not different from the healthy controls. Thus it was suggested that in IDDM patients the size of the pancreas was small at the time of onset, and that the growth hormone had morphologically no influence on the pancreas in patients with growth hormone deficiency.
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PMID:[Ultrasonography of the thyroid gland and the pancreas in healthy children and in patients with endocrinological disease]. 200 37

Hypoglycemia due to endocrine disorders commonly manifests itself during the newborn period or in early infancy. Hyperinsulinism accounts for more than 50% of all cases of persistent hypoglycemia occurring during the first year of life. The underlying cause of hyperinsulinism is probably a functional dysregulation of the B cells of the pancreas. These patients suffer from severe, sometimes life-threatening hypoglycemia during their first hours and days of life. Hypoglycemia cannot be prevented by a high carbohydrate supply exceeding the endogenous glucose production rate of the liver. The diagnosis of hyperinsulinism is established by an increased insulin concentration (above 10-12 mU/l) during hypoglycemia (blood glucose less than 40 mg/dl). Macrosomia of these newborns without a history of maternal diabetes supports the diagnosis. Most of the patients require a 90%-95% pancreatectomy in order to prevent severe brain damage, as medical and dietary treatment are ineffective. Hypoglycemia due to panhypopituitarism, growth hormone deficiency and inherited glucocorticoid deficiency also develops during early infancy, but can be discriminated from hyperinsulinism by one important criterion: hypoglycemia can be avoided by continuous glucose infusion dosed at the endogenous glucose production rate. If additional symptoms are lacking the diagnosis has to be established by the plasma concentrations of the different hormones and provocation tests.
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PMID:[Endocrine-induced forms of hypoglycemia]. 285 99

The manifestations of congenital rubella syndrome (CRS) can be grouped according to time of onset into newborn, extended, and delayed CRS. The delayed manifestations are not present in early life and include the following: endocrinopathies: diabetes, thyroid disease, and growth hormone deficiency; deafness; ocular damage: glaucoma, keratic precipitates, keratoconus, corneal hydrops, and absorption of the cataractous lens; vascular effects: fibromuscular proliferation of the intima, sclerosis of arteries, systemic hypertension secondary to renal disease, and subretinal neovascularization; and progressive rubella panencephalitis. Several mechanisms of pathogenesis of the damage have to be considered for the delayed manifestations, including growth of the virus in tissues, resulting in a reduced growth rate and shortened life-span of the cells; autoimmune responses, initially stimulated by the infection; genetic susceptibility; vascular damage by the viral infection with further stenosis or occlusion of the vessels later; reactive hypervascularization; and chronic persistence of the virus in the tissue with subsequent extension of the infection to other areas.
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PMID:Delayed manifestations of congenital rubella. 400 24

MELAS syndrome is a form of mitochondrial myopathy with manifestations of seizure, stroke-like syndrome, lactic acidosis, ragged red muscle fibres and mitochondrial encephalopathy. The syndrome has been reported in association with a variety of endocrine and metabolic disorders including diabetes mellitus (DM), hypothalamo-pituitary hypofunction, hypothalamic growth hormone deficiency and delayed puberty. Mitochondrial DNA (mtDNA) point mutation may be the major pathological defect. However, association of MELAS syndrome with hyperthyroidism has not previously been reported. A case is reported from Taiwan of a 32-year-old woman suffering from MELAS syndrome with associated DM and hyperthyroidism. When the latter was diagnosed in April 1988, the patient underwent subtotal thyroidectomy. There was no family history of thyroid disease. Because of repeated seizures, she had computed tomography (CT) and magnetic resonance imaging (MRI) of the brain which showed focal, low-density lesions over the cerebral hemispheres. Both serum and cerebral spinal fluid lactic acid levels were elevated. Mild elevations of serum T4 and T3 and a high titre of TSH receptor antibody were still present. Hyperglycaemia was noted during hospitalization and DM confirmed by oral glucose tolerance test. Muscle biopsy showed ragged red fibres. DNA analysis showed an A-to-G transition at the 3243rd nucleotide position of the tRNA(Leu(UUR)) gene of the mtDNA from the patient. Quantitative polymerase chain reaction (PCR) and restriction analysis revealed that about 60% of the blood mtDNA was of mutant type. The patient received antithyroid drugs for hyperthyroidism, diet control for DM and anti-epileptic drugs for seizure.
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PMID:MELAS syndrome associated with diabetes mellitus and hyperthyroidism: a case report from Taiwan. 755 21

Ketone bodies are produced in the liver, mainly from the oxidation of fatty acids, and are exported to peripheral tissues for use as an energy source. They are particularly important for the brain, which has no other substantial non-glucose-derived energy source. The 2 main ketone bodies are 3-hydroxybutyrate (3HB) and acetoacetate (AcAc). Biochemically, abnormalities of ketone body metabolism can present in 3 fashions: ketosis, hypoketotic hypoglycemia, and abnormalities of the 3HB/AcAc ratio. Normally, the presence of ketosis implies 2 things: that lipid energy metabolism has been activated and that the entire pathway of lipid degradation is intact. In rare patients, ketosis reflects an inability to utilize ketone bodies. Ketosis is normal during fasting, after prolonged exercise, and when a high-fat diet is consumed. During the neonatal period, infancy and pregnancy, times at which lipid energy metabolism is particularly active, ketosis develops readily. Pathologic causes of ketosis include diabetes, ketotic hypoglycemia of childhood, corticosteroid or growth hormone deficiency, intoxication with alcohol or salicylates, and several inborn errors of metabolism. The absence of ketosis in a patient with hypoglycemia is abnormal and suggests the diagnosis of either hyperinsulinism or an inborn error of fat energy metabolism. An abnormal elevation of the 3HB/AcAc ratio usually implies a non-oxidized state of the hepatocyte mitochondrial matrix resulting from hypoxia-ischemia or other causes. We summarize the differential diagnosis of abnormalities of ketone body metabolism, as well as pertinent recent advances in research.
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PMID:Medical aspects of ketone body metabolism. 755 86

We report a classical case of Prader-Willi syndrome (PWS) in an adult with typical interstitial deletion of chromosome 15, and emphasize the study of hormonal change. This 21-year-old female had PWS face characteristics, small hands and feet, marked obesity, mental retardation, growth retardation, absence of puberty and amenorrhea. She also had the characteristic history of infantile hypotonia, poor feeding, failure to thrive and then improved appetite, followed by obesity from the age of four years. She had compulsive hyperphagia, to the extent of stealing and lying to take food. Chromosome study with high resolution banding technique revealed a small interstitial deletion at band q12 of chromosome 15, which is characteristically found in a majority of patients with PWS. Hormonal study revealed hypogonadism and growth hormone deficiency of supposed hypothalamic origin. She also had non-insulin-dependent diabetes mellitus with decreased pancreatic insulin reserve.
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PMID:Hormonal change in an adult with Prader-Willi syndrome: report of a case. 791 75

A non-invasive pulse-wave-velocity Doppler ultrasound technique for the assessment of aortic compliance is described. A computational approach for correcting for the effect of non-chronic changes in blood pressure is considered and applied to compliance measurements performed on an age-select cohort of 70 normotensive, normal healthy volunteers. In order to permit the wider availability of the pulse-wave-velocity Doppler ultrasound technique, the authors have developed a MkII system based on a standard 80486/33 MHz IBM compatible WINDOWS based personal computer; real-time spectral analysis being achieved using a relatively inexpensive but fast analogue to digital signal processing card. An overview of the new apparatus is provided and verification work to compare the repeatability of the MkI and MkII systems is described. Medical disorders such as atherosclerosis, diabetes mellitus, familial hypercholesterolaemia, growth hormone deficiency, and Ehlers-Danlos and Marfan's syndromes have all been shown to affect arterial wall compliance. We suggest that the in vivo clinical measurement of blood pressure corrected aortic distensibility using the MkII system may be a useful, reproducible, non-invasive tool for assessing such patients' susceptibility to atheromatous arterial disease as well as for monitoring their response to therapeutic interventions. Measurements in the aorta may be especially pertinent since the natural history of fatty streaks there tends to parallel that in the coronary vasculature thereby potentially affording a convenient surrogate estimate of coronary heart disease.
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PMID:Aortic compliance measured by non-invasive Doppler ultrasound: application of a personal computer based MkII system and its repeatability. 806 7

The concept of body composition covers the division of the body into a number of compartments. The most important are the fat mass (FM), the fat-free mass (FFM), the total body protein and the total body bone mineral content. Numerous methods for the measurement of body composition are available. The three classical methods for the measurement of FM and FFM, namely underwater weighing, measurement of total body potassium and measurement of total body water by isotope dilution, are often regarded as reference methods. However, newer methods such as computed tomography, neutron activation analysis and dual energy X-ray absorptiometry are increasingly used because of their reliability and ability for independent measurement of two or more components. Bioelectrical impedance analysis has become popular because of its clinical applicability. Three- or four-compartment models involving combination of two, three or more separate methods are more accurate than single methods, but are usually confined to research purposes because of the laborious measurement procedures. Computed tomography and dual energy X-ray absorptiometry have the unique possibility of regional measurements of body composition. Fat distribution and relative overweight may be estimated by simple anthropometric measures such as skinfold thicknesses. There are many applications for body composition measurements in research and clinical practice. These include treatment of obesity, growth hormone deficiency, diabetes mellitus and climacteric changes, as well as clinical nutrition and estimation of the hydration of dialysis patients and of critically ill intensive or surgical patients.
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PMID:[Non-invasive measurement of body composition]. 806 96


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