Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Antibodies to the acetylcholine receptor (AChR), which are diagnostic of the human autoimmune disease myasthenia gravis, block AChR function and increase the rate of AChR degradation leading to impaired neuromuscular transmission. Steroids are frequently used to alleviate symptoms of muscle fatigue and weakness in patients with myasthenia gravis because of their well-documented immunosuppressive effects. We show here that the steroid dexamethasone significantly increases total surface AChRs on cultured human muscle exposed to myasthenia gravis sera. Our results suggest that the clinical improvement observed in myasthenic patients treated with steroids is due not only to an effect on the immune system but also to a direct effect on muscle. We propose that the identification and development of pharmacologic agents that augment receptors and other proteins that are reduced by human genetic or autoimmune disease will have broad therapeutic applications.
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PMID:Steroids induce acetylcholine receptors on cultured human muscle: implications for myasthenia gravis. 223 23

A case of aspergillotic abscess with granuloma is reported. A 45-year-old man was admitted to our hospital on Apr. 10, 1984 due to the rupture of an aneurysm of the anterior communicating artery. Neck clipping of the aneurysm was proposed on Apr. 12, 1984, but was not performed because of cardiac arrest with unknown etiology during the operation. Neck clipping was performed on Apr. 23, 1984. Antibiotic therapy was prolonged for about three weeks. About 6 months after surgery, he was readmitted on Oct. 12, 1984 with the chief complaint of general fatigue and headache. On readmission, laboratory examinations were normal except for leukocytosis, elevated ESR and positive CRP. Neurological examination revealed left papilledema, disorientation and memory disturbance. On lumbar puncture, the cerebrospinal fluid showed 2 lymphocytes, 71 mg percent protein, 94 mg percent glucose. The skull and chest X-ray findings were normal. The CT scan revealed an irregular low density area in the left frontal lobe with abnormal enhancement. Steroids and antibiotic therapy were initiated. Since mass signs on CT scan increased gradually, partial removal of abscess and granuloma was performed on Nov. 5, 1984. From the necrotic granuloma, Aspergillus was microscopically recognized and Aspergillus fumigatus was cultured on Sabouraud's medium. Immunologically, serum immunoglobulin levels and the subset of lymphocytes were normal. Tuberculin reaction was negative. After the operation, amphotericin-B and 5-fluorocytosine (5-FC) were administered. Nevertheless mass signs on CT scan increased again. The fourth operation was performed on Dec. 6, 1984.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of cerebral aspergilloma following radical operation of a cerebral aneurysm]. 352 Mar 67

23 children with perennial allergic bronchial asthma were treated with ketotifen syrup/capsules. The required therapeutic dose was 0,03 mg/kg body weight twice daily. Improvement was observed in 16 of the 23 patients in part associated with decreased allergic manifestations in the eyes, nose and skin. Steroids could be discontinued in 3 of 7 patients. In 6 children transient tiredness resulted however only in one was a dose reduction necessary.
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PMID:[Protective effect of ketotifen, investigations in allergic children with bronchial asthma (author's transl)]. 719 63

We prospectively withdrew prednisone in 28 adult patients who had stable graft function more than 2 years after orthotopic liver transplantation (OLTx) and had been on 5 mg/d prednisone for at least 6 months. Prednisone was decreased from 5 mg/d to 2.5 mg/d for 1 month then stopped completely. Cyclosporine monotherapy was maintained at a level of approximately 200 ng/mL (TDX). Nineteen patients had prednisone withdrawn without complications. Four (14.2%) had modest elevations in liver function tests (two biopsy proven mild rejections and two were not biopsied). These four were treated with methylprednisolone boluses and then withdrawal of steroids again. Prednisone was restarted in five patients because of generalized fatigue and body aches (n = 4) and colitis (n = 1). Steroids later were successfully withdrawn in two of these patients. After prednisone withdrawal, three of five insulin-dependent diabetic patients were able to discontinue insulin therapy and their glycosylated hemoglobin levels improved. Four of fourteen hypertensive patients were able to discontinue antihypertensive medicines. Mean serum cholesterol decreased from 222.6 +/- 43.3 to 188.3 +/- 33.3 mg/dL (P < .001). The number of patients with serum cholesterol levels > 220 mg/dL decreased from 13 to 4. A control group of 24 patients maintained on 5 mg/d prednisone at least 2 years after liver transplantation also was studied. In this group during the study period, no diabetic became normoglycemic, no patient decreased their antihypertensive medicine, and the mean serum cholesterol levels did not change significantly. We conclude that prednisone withdrawal using cyclosporine monotherapy late after liver transplantation does not lead to graft loss and decreases the prevalence of diabetes, hypertension, and hypercholesterolemia. Symptoms occurring during withdrawal may be minimized by earlier or slower tapering.
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PMID:Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss. 898 86

Progressive diaphyseal dysplasia (PDD), a rare disorder of bones, in recent years has been accepted as a systemic disease within the spectrum of connective tissue disorders associated with immunological abnormalities. Steroids have been used in the treatment of PDD with variable success. In this report PDD is described in a 5-year-old boy who presented with leg pain, fatigue, headache and anorexia with an onset in infancy. Physical examination revealed a waddling gait, thorax deformity and thickening in the upper extremities. The diagnosis was made by radiologic demonstration of cortical thickening and a narrowed medullary cavity of the long bones of extremities. Bone scintigraphy showed areas of increased osteoblastic activity in the diaphyseal part of the long bones of extremities and the skull. Electron microscopic examination revealed myopathic and vascular changes. Serum immunoglobulin A, G and M levels were elevated and CD4 positive T cell numbers were low. Deflazacort, a steroid with a similar anti-inflammatory effect to prednisolone but with fewer adverse effects, was started in a dose of 1.2 mg/kg/day. Deflazacort treatment resulted in clinical and radiological improvement within 12 months with no side effects. In conclusion, steroids may be recommended as an effective method of treatment in PDD and deflazacort may be a safe alternative steroid.
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PMID:Deflazacort treatment in progressive diaphyseal dysplasia (Camurati-Engelmann disease). 1045 3

Fatigue is often reported after long duration flights. Mild hypobaric hypoxia caused by pressurisation may be involved in this effect through disruption of circadian rhythms, independently of the number of time zones crossed. In this controlled crossover study, we assessed the effects of two levels of hypoxia equivalent to 8000 and 12,000 ft on the circadian rhythm of plasma cortisol, a marker of the circadian time structure. Sixteen healthy young male volunteers (23-39 years) were exposed in a hypobaric chamber for 8 h (08:00-16:00 h) to 8000 ft, followed 4 weeks later to 12,000 ft. Plasma cortisol was assayed during two 24-h cycles (control and hypoxic exposure) every 2h in all subjects. We found a significant change in the pattern of cortisol secretion during both hypoxic exposures, with an initial fall in cortisol followed by a transient rebound, whereas the phase and the 24-h mean level remained unchanged. The change in cortisol pattern followed the alterations in autonomic balance assessed by heart rate variability (HRV) spectral analysis. The normalised high frequencies and the low-to-high frequencies ratio showed a significant shift toward sympathetic dominance with some differences in time course for both altitudes studied. HRV analysis improved the interpretation of cortisol 24-h profiles. Our data, which strongly suggest that prolonged mild hypoxia alters the expression of cortisol circadian rhythm, should be taken into account to interpret secretory rhythm changes after transmeridian flights.
Steroids 2005 Nov
PMID:Hypoxic alterations of cortisol circadian rhythm in man after simulation of a long duration flight. 1601 44

Mild hypobaric hypoxia caused by pressurisation may contribute to alter rhythmicity after long-haul flights, independently of the number of time zones crossed. In this controlled crossover study, we assessed the effects of two levels of hypoxia, equivalent to 8000 ft and 12,000 ft above sea level, on the rhythm of plasma concentrations of three hormones: testosterone, LH, and FSH. A hypoxia-induced decrease in LH and FSH has often been reported during mountaineering while testosterone is considered a marker of fatigue. Sixteen healthy male volunteers, aged 23-39 years, spent 8 h in a hypobaric chamber (08:00-16:30), simulating conditions at 8000 ft. This was followed by an additional 8 h four weeks later, simulating conditions at 12,000 ft. Plasma hormones were assayed every 2 h over two 24-h cycles (control and hypoxic-exposure cycles). We found no significant effects of hypoxia on the circadian profile of the gonadal axis hormones and, therefore, conclude that these hormones do not serve as valuable markers of post-flight alterations of the circadian system in human.
Steroids 2006 Mar
PMID:Simulation of long-haul flights in humans: prolonged mild hypoxia does not alter the circadian time structure of plasma testosterone and gonadotrophins. 1641 89

Sjogren's syndrome is an autoimmune exocrinopathy that predominantly affects salivary and lachrymal glands, leading to dry eyes and mouth. The most common clinical problems faced by the rheumatologist are those of dry eyes and mouth, parotid swelling, fatigue and extraglandular manifestations. The first stage in management is to make an accurate diagnosis based on the American/European consensus criteria. The most frequent differential diagnoses are dry eyes and mouth symptoms, a variant of chronic fatigue syndrome and fibromyalgia, and sialosis, which causes a non-inflammatory enlargement of the parotid glands. The mainstay of treatment for the sicca symptoms is local therapy, and that for the milder systemic symptoms is hydroxychloroquine. Steroids and immunosuppressive drugs are reserved for more severe extraglandular disease. In spite of intensive research in other systemic treatments including biologic therapies, there is limited evidence to support their use in routine clinical practice.
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PMID:Management of patients presenting with Sjogren's syndrome. 1697 38

Fatigue is a common debilitating complication of primary biliary cirrhosis (PBC), the pathophysiologic mechanism of which is poorly understood. Recently, the neuroactive steroid dehydroepinadrosterone sulfate (DHEAS) was reported to be implicated in Chronic Fatigue Syndrome in the absence of liver disease. The present study was undertaken to analyse fatigue scores and their relationship with disease severity and circulating levels of DHEAS as well as its precursors DHEA and pregnenolone in PBC patients with (n=15) or without fatigue (n=10) compared to control subjects (n=11). Fatigue was assessed using the fatigue impact scale (FIS) including cognitive, physical and psychosocial subclasses. Steroids were measured by radioimmunoassay or gas chromatography/mass spectrometry. Plasma concentrations of DHEAS were significantly reduced in PBC patients with fatigue as compared to controls, while those of its precursors DHEA and pregnenolone remained within the control range. Plasma levels of DHEAS in PBC patients were significantly correlated with fatigue severity as reflected by total FIS scores including total (rp=-0.42; p=0.018), as well as the cognitive (rp=-0.37; p=0.03), physical (rp=-0.48; p=0.006) and psychosocial (rp=-0.35; p=0.04) subclasses of fatigue scores. No correlation of fatigue scores was observed with indices of liver function. These findings suggest that reduced levels of the neurosteroid DHEAS may contribute to fatigue in patients with PBC; substitutive therapy using DHEAS or its precursor DHEA could be beneficial in the management of fatigue in patients with low levels of DHEAS.
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PMID:Reduced plasma dehydroepiandrosterone sulfate levels are significantly correlated with fatigue severity in patients with primary biliary cirrhosis. 1766 54

Wegener's Granulomatosis (WG) is a rare, Multisystem disease of the medium and small sized arteries and veins. It most commonly involves the upper respiratory tract, lungs, and kidneys and often presents as chronic fatigue, upper respiratory infection, sinusitis, and otitis media. Symptoms can include fever, weight loss and fatigue, though these are not usually the primary presenting complaints. development of the disease is highly skewed across ethnicities, with up to 98% of cases being reported in caucasians. We present the case of a 56-year-old African-American male who presented primarily with complaints of uncontrollable fever of unknown origin (FUO) for past two weeks with accompanying sore throat, nasal congestion, night sweats, malaise, and unexplained weight loss of 10 pounds over the past month. Treatment with antibiotics for one week prior to admission showed no relief of symptoms. Chest x-ray showed focal course markings in the right upper lobe. Urinalysis revealed microscopic hematuria and leukocyturia. Chest and abdominal CT scans revealed a right lower lobe pulmonary nodule and heterogeneous areas of enhancement in the spleen. Head CT revealed right mastoid opification. Labs revealed proteinase-3 antibody titer > 100, which is characteristic of WG. Steroids and cyclophosphamide were started with relief of presenting symptoms. Renal biopsy showed pauci-immune P-ANCA associated crescentic and focally necrotizing glomerulonephritis and vascilitis. This case is unique in that the patient presented with primary complaint of FUO. WG should be considered as a rule-out in cases of uncontrollable FUO, even if none of the classic triad of symptoms is present. Though rare, WG should be considered in cases involving non-Caucasian patients.
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PMID:Wegener's granulomatosis presenting as fever of unknown origin in an African-American male. 1860 51


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