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Many endocrine diseases can cause fatigue. Tiredness is a frequent symptom of primary and secondary hypothyroidism, hyperthyroidism, excessive glucocorticoid or mineralocorticoid production, primary and secondary adrenal insufficiency, primary and secondary hypogonadism and hyperprolactinemia in the male, acromegaly, diabetes mellitus and diabetes insipidus. A great number of medical diseases other than those mentioned in the articles on cardiological and pneumological fatigue can also cause abnormal tiredness (infectious diseases, hematological, renal, hepatic, gastrointestinal and rheumatological disturbances, vasculitis and malignant tumors). The pathogenesis of tiredness caused by endocrine or medical illnesses, i.e. how the sensation of fatigue is produced, is not clear. The fatigue of the various endocrine or other medical diseases is not disease-specific, i.e. its characteristics do not differentiate it from the fatigue of other illnesses.
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PMID:[Endocrine and other medical causes of abnormal fatigability]. 175 71

This study was undertaken with the aim of improving the understanding of the phenomenon of compliance in adolescents presenting with chronic diseases. In 192 subjects aged 12 to 20 years presenting with diabetes, asthma, cystic fibrosis, systemic lupus erythematosus or juvenile rheumatoid arthritis, appointment keeping, compliance with prescribed medical regimens or general instructions and the filling up of a calendar describing the daily levels of fatigue were studied. Correlations (Pearson) between these various types of measurements were weak: from 0.04 to 0.26. Appointment keeping was about 90%. Overall compliance either with treatments or with general instructions was 50% only (without clearcut changes according to diseases); however only 11% of subjects presented with a good compliance with all the treatment components. Various factors (familial environment, perception of the disease and of the patient-physician relationships) were significantly associated with compliance (p less than 0.005). These results emphasize the necessity of taking care of all aspects of compliance, which is difficult to predict at this age, due to the multiple factors involved.
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PMID:[Compliance in adolescents with chronic disease]. 185 34

Radiographs and clinical records of 61 patients with calcaneal fractures were studied. Twenty-one patients had diabetes mellitus, and 40 were nondiabetic. All diabetic patients were insulin dependent for more than 5 years and had clinically evident peripheral neuropathy. Eighteen of the diabetic patients had no history of significant trauma. Fourteen had calcaneal insufficiency avulsion (CIA) fractures limited to the posterior third of the calcaneus. The fracture pattern in this group occurred in the same plane as a fatigue-type calcaneal fracture. Fragments of the posterior tuberosity were usually displaced 10-30 mm and were frequently rotated. The mean time from diagnosis of diabetes mellitus to CIA fracture was 20 years. Fractures in the nondiabetic group and in the three diabetic patients with a history of trauma did not resemble the CIA pattern. In the nondiabetic group, there were no insufficiency fractures; 39 fractures occurred with significant force (eg, motor vehicle accident or fall from height), and 33 had extension to subtalar or calcaneocuboid joints.
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PMID:Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus. 187 Dec 85

Many current health status instruments either are too long to use in many acquired immune deficiency syndrome (AIDS) clinical trials or omit important concepts. In this study, human immunodeficiency virus (HIV)-relevant items developed for the Medical Outcomes Study (MOS) from subscales for cognitive function, energy/fatigue, health distress, and a single quality of life item were added to a portion of the MOS Short-form General Health Survey. The resulting 30-item questionnaire reliably and distinctly measured ten aspects of health and took less than 5 minutes to complete. To test its validity, this modified measure was used to compare the health of 73 subjects with asymptomatic HIV infection and 44 with early AIDS-related complex (ARC). Compared with ARC subjects, asymptomatic individuals reported superior overall health, less pain, and better physical function, role function, cognitive function, and quality of life (rank-sum, P less than 0.02). Asymptomatic subjects' scores were higher on most subscales than the age-adjusted scores of MOS outpatients with hypertension, diabetes, recent myocardial infarction, or depression; ARC patients scored closest to hypertensive patients. This instrument, containing a subset of the MOS measures of health-related quality of life, may be a useful outcome measure for AIDS clinical trials.
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PMID:A health status questionnaire using 30 items from the Medical Outcomes Study. Preliminary validation in persons with early HIV infection. 187 45

Hypothalamic tissue levels of nine regulatory peptides (bombesin, calcitonin gene-related peptide [CGRP], galanin, neuromedin B, neuropeptide Y [NPY], neurotensin, somatostatin, substance P, and vasoactive intestinal peptide [VIP]) were compared in Aston obese diabetic (ob/ob) and lean (+/?) mice aged 4, 16, and 28 weeks. Neurotensin concentrations were significantly lower in ob/ob mice than in lean mice, with a 20% reduction (P = .03) in the whole hypothalamus at 4 weeks of age, a 24% reduction (P = .009) in the lateral hypothalamus at 16 weeks, and a 50% reduction (P = .0007) in the central hypothalamus at 28 weeks of age. Apart from a 42% increase in vasoactive intestinal peptide concentrations in the central hypothalamus of ob/ob mice at 28 weeks (P = .02), levels of the other eight peptides examined did not differ significantly between obese and lean groups. Neurotensin is known to cause anorexia and increased energy expenditure when injected into the central hypothalamus. Reduced hypothalamic neurotensin concentrations may reflect reduced neurotensinergic activity, which might contribute to hyperphagia and decreased energy expenditure, two major defects that contribute to obesity and diabetes in the ob/ob syndrome.
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PMID:Reduced hypothalamic neurotensin concentrations in the genetically obese diabetic (ob/ob) mouse: possible relationship to obesity. 194 36

Effects of essential fatty acids on nerve conduction, hypoxic resistance, skeletal muscle contractile properties, and capillary density were examined in streptozocin-induced diabetic rats. Nondiabetic and diabetic controls and three diabetic groups treated with 10% supplements of corn oil, evening primrose oil (Efamol), or a mixture of 80% evening primrose oil and 20% fish oil (Efamol Marine) for 2 mo were used. Efamol and Efamol Marine increased plasma gamma-linolenic acid levels, but arachidonic acid was elevated only with Efamol. Diabetes resulted in 15-29% reductions in sciatic motor and sensory saphenous nerve conduction velocity. Efamol prevented conduction deficits more effectively than Efamol Marine, and corn oil had no effect. In vitro measurement of sciatic nerve hypoxic resistance revealed a 49% increase in the time taken for action potential amplitude to decline by 50% with diabetes. Corn oil had no significant effect. With Efamol, hypoxic resistance was within the nondiabetic range. Efamol Marine produced intermediate results. Functional improvements may relate to enhanced vasa nervorum perfusion, because endoneurial capillary density increased by 22% with Efamol, angiogenesis perhaps resulting from eicosanoid production from arachidonic acid. Soleus muscle contractions were prolonged by diabetes. This was partially corrected by treatment, Efamol being most effective. Extensor digitorum longus muscle had reduced tetanic tension with diabetes, and this was prevented by all treatments. Soleus showed a modest increase in capillarization with Efamol, which may have contributed to reduced susceptibility to fatigue. The data suggest involvement of abnormal fatty acid metabolism in the etiology of diabetic neuropathy and myopathy.
Diabetes 1991 May
PMID:Essential fatty acid diet supplementation. Effects on peripheral nerve and skeletal muscle function and capillarization in streptozocin-induced diabetic rats. 202 1

Ketanserin is a 5-HT2 receptor antagonist without partial agonist properties which also possesses weak alpha 1-adrenoceptor antagonistic activity, which may explain its antihypertensive mechanism of action in patients with essential hypertension. It also inhibits the effects of serotonin on platelets in cardiovascular disease, inhibits vasoconstriction caused by the amine, and when administered intravenously improves some haemorheological indices in patients with ischaemic diseases. The antihypertensive effect of oral ketanserin 40 mg twice daily is comparable with that of total daily doses of metoprolol 200 mg, propranolol 160 mg, captopril 100 mg, enalapril 20 mg, hydrochlorothiazide 50 mg, or alpha-methyldopa 1000 mg and is achieved without adverse effect on plasma lipoproteins or carbohydrate metabolism in patients with concomitant diabetes mellitus. Evidence from prospective studies suggests a greater antihypertensive efficacy in the elderly than in younger patients. In patients with intermittent claudication, results have been inconsistent in small studies, while a large study showed no improvement in pain-free walking distance but fewer amputations compared to placebo. In Raynaud's phenomenon symptomatic improvement relative to placebo was achieved in larger trials. Its role in preventing atherosclerotic complications requires further investigation. Ketanserin is reasonably well tolerated, the frequency of adverse effects being comparable with that of other antihypertensive drugs in controlled trials. Dizziness, tiredness, oedema, dry mouth and weight gain are the most commonly reported effects. Ketanserin prolongs QT interval in a dose-related manner, and when given in certain predisposing circumstances ventricular arrhythmias and syncope may occur. Administered intravenously, ketanserin 10mg followed by an infusion of 2 to 4 mg/h controls moderate to severe pre- and postoperative hypertension in most patients, acting as a balanced vasodilator, lowering cardiac pre- and afterload. Although the arrhythmogenic potential of ketanserin in patients receiving potassium-depleting diuretics requires suitable precautions, it appears that its antihypertensive activity is suited to the elderly provided plasma potassium concentrations are normal at the start of treatment and are maintained within the normal range.
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PMID:Ketanserin. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in hypertension and peripheral vascular disease. 207 1

Clinical manifestations and autopsy findings on 23 patients who died of acute sepsis of Escherichia coli origin lead the authors to the conclusion on polymorphic clinical run of the disease. It varies with premorbid background (food intoxication, acute respiratory disease in decompensated diabetes mellitus, chronic somatic disorders) and risk factors (inadequate antibacterial therapy, nervous strain, fatigue). Inadequate antibacterial therapy promoting dysbacteriosis aggravated preexisting pathomorphological shifts in the intestine likely after toxic infection, diabetes-specific foci, contributed to the onset of intestinal sepsis.
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PMID:[Acute intestinal infection caused by Escherichia coli]. 208 42

The diabetic hypersomolar state is defined by a serum glucose greater than 600 mg/dl and a serum osmolarity greater than 320 m Osm/L. Ketoacidosis or lactic acidosis may co-exist with DHS in the same patient. The incidence of this acute complication of diabetes is high enough (17.5 cases per 100,000 person-years) for primary care physicians to encounter a case every year or two. Predisposing factors include older age, female sex, nursing home residence, and infection. A substantial proportion of cases occur in patients with no prior history of diabetes. Common presenting signs include fatigue or weakness, polydipsia, polyuria, nausea, and alteration of consciousness. The mainstay of therapy is intravenous fluid replacement with close monitoring of glucose and electrolytes in a hospital setting. Current mortality figures are high, at 10% to 20%, and the chance of survival is adversely affected by older age, higher osmolarity, and the presence of an associated severe illness. Prevention includes screening for diabetes, educating diabetic patients and their care givers about the symptoms of hyperglycemia, prompt treatment of any infection in a diabetic person, avoidance of drugs that increase carbohydrate intolerance in diabetic people, and encouraging compliance with treatment of diabetes.
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PMID:The diabetic hyperosmolar state. 222 47

The reported effects of diabetes on quality of life have been assessed in two groups of attenders at out-patient clinics: 1. One hundred and twenty-one non-insulin-dependent diabetic patients randomly allocated to diet, tablet or ultralente insulin therapy; 2. Fifty-seven patients with insulin-dependent diabetes consecutively attending an out-patient clinic. The overall picture for those with non-insulin-dependent diabetes was of relatively little disruption to most areas of life, but 27% reported considerable loss of enjoyment and reduction in social life. High fasting plasma glucose was significantly associated with fatigue and leisure difficulties. The type of therapy, tablet, diet or insulin, made little difference to psychological, social or attitude variables. Those with insulin dependent diabetes showed similar psychological morbidity, but described a rather different pattern of social consequences with more effects on work and less on leisure.
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PMID:Quality of life in non-insulin-dependent diabetes and a comparison with insulin-dependent diabetes. 231 7


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