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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Overnight metabolic studies in 39 poorly controlled insulin-treated diabetic patients aged 9 to 66 years showed hypoglycaemia (blood-glucose less than 2 mmol/1) in 22 patients; it lasted 3 h or more in 17. Hypoglycaemic symptoms were very mild or absent, but 19 patients had other features of overtreatment with insulin. These included lethargy, depression, night sweats, morning headaches, fits (3 patients), glycogen-laden hepatomegaly (3), and acquired tolerance to high doses of insulin (mean 1 u/kg/24 h). The best clinical clue to recurrent nocturnal hypoglycaemia was the intermittent occurrence of symptoms, however "mild" and infrequent these appeared to be. Reduction of insulin by a mean of 25% in these patients (without change of species) did not result in loss of overall control; 1 patient with recurrent ketoacidosis was stablished on 40% of his initial dose. It is difficult, sometimes impossible, to achieve good overnight control with conventional once or twice daily insulin therapy. Since patients readily become tolerant of low blood-glucose levels, reliance on urine tests and symptoms of hypoglycaemia as a guide to dosage easily produces a spiral of overtreatment.
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PMID:Unrecognised nocturnal hypoglycaemia in insulin-treated diabetics. 8 75

A boy aged 9 years and 8 months was evaluated for headache and an enlarged sella. His neurological status and visual fields were normal. After injection of radiographic contrast agent, computerized axial tomography showed evidence of an intrasellar tumor. The most striking endocrine abnormalities were growth hormone insufficiency after arginine infusion and after insulin-induced hypoglycemia, and excessively elevated prolactin levels ranging between 1220 ng/ml and 1560 ng/ml. A slightly granulated, acidophilic pituitary adenoma was selectively removed by the trans-sphenoidal approach. The function of the anterior pituitary improved post-operatively. Growth hormone secretion after insulin-induced hypoglycemia returned to normal, and the basal serum prolactin levels decreased, but are still three times higher than normal.
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PMID:Prolactin-producing pituitary adenoma in a 9 year old boy. 21 87

Antepartum pituitary infarction occurs only in insulin-dependent diabetic patients. It is manifested by severe headache, followed by decreasing insulin requirements. Delivery is frequently premature, with high fetal wastage and increased maternal mortality. During the puerperium, the first manifestation of pituitary deficiency, other than a lower insulin requirement than would be expected, is failure to lactate. Subsequent evaluation of pituitary function reveals variable deficiencies with loss of growth hormone and gonadotropins being most frequent. This case is the eighth report of this entity, and it represents the first patient to survive a pituitary infarction prior to the third trimester of pregnancy. Recognition of this syndrome is critical in order to ensure that the mother's health and the viability of the offspring be preserved.
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PMID:Antepartum pituitary infarction. 42 20

This investigation was undertaken to define the "adequate" sodium concentration in the dialytic fluid allowing to maintain a stable plasma effective osmolality during dialysis. Isonatric dialysate is shown to miss this aim by inducing a predictable postdialytic hypernatremia. To avoid this effect a new approach was made. 17 clinically stabilized patients, previously dialyzed over a period of at least 2 years with a dialysate sodium concentration of 133 mEq/l, underwent dialysis with the "adequate" sodium concentration in the dialysate for over 3 years. During dialysis cramps, headache, hypotension, hypertensive crises and postdialytic weakness were reduced in frequency and nearly disappeared. No deterioration in blood pressure control occurred and improvement in some general parameters (hematocrit, glucose and insulin metabolism, well-being) was reported after prolonged treatment.
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PMID:Hemodialysis with "adequate" sodium concentration in dialysate. 46 5

10 patients entered a controlled 4-week study to evaluate the effect of a glucose-enriched dialysate (400 mg/100 ml) on hemodialysis tolerance. Headache during and after dialysis and post-dialysis fatigue decreased in a statistically significant manner. The average glycemia was only moderately increased with an adequate insulin response. Blood cholesterol and triglycerides did not vary signifcantly during this short study period.
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PMID:Glucose-enriched dialysate and tolerance to maintenance hemodialysis. 51 25

Four episodes of acute left hemiparesis occurred in three pediatric-age, insulin-dependent diabetic patients. Each had a concomitant respiratory tract infection and headache, but no obvious signs of systemic hypoglycemia. No cerebral abnormalities were demonstrated by angiography or computerized tomography. The clinical course was benign, with slow but complete resolution of neurologic abnormalities within 8 to 24 hours of onset, and no further neurologic complaints in a 7- to 16-month follow-up.
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PMID:Acute hemiparesis in juvenile insulin-dependent diabetes mellitus (JIDDM). 57 16

We have recorded clues to the clinical recognition of chronic insulin overdosage in 101 pediatric patients with diabetes mellitus, identified predisposing circumstances, and reconsidered the traditional strategy of slow reduction in insulin dose. Overtreatment occurred in 70%, overall, and in 90% of those referred for instability; mean overdose was 38% of the readjusted dose. The most common findings were frank hypoglycemic episodes, polyuria/nocturia/enuresis despite increasing insulin dosage, excessive appetite, hepatomegaly, weight gain, headaches, exercise intolerance, marked variation in glucosuria, mood swings, and frequence bouts of rapidly developing ketoacidosis. Overtreatment usually developed because of attempts to achieve metabolic control using glucosuria as principal criterion. One fourth of those observed became overtreated during periods of emotional turmoil when need for increased insulin to counter stress-induced hyperglycemia and ketosis led to chronic increase in dosage. Persistent glucosuria/ketonuria and exacerbation of hypoglycemic symptoms were more frequent with slow than with rapid reduction in insulin dosage.
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PMID:Chronic overtreatment with insulin in children and adolescents. 88 3

The blood levels of free tryptophan, glucose and insulin were determined in different groups of patients suffering from headache, initially and after a glucose tolerance and a tolbutamide tolerance test. The control group consisted of subjects without neurological or psychiatric disturbance. A sharp drop of blood tryptophan levels was observed in migraine patients during the tolbutamide tolerance. Migraine attacks may be induced in certain subjects by a disturbance of 5-hydroxytryptamine turnover.
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PMID:Insulin secretion in migraine: influence on the blood levels of tryptophan. 97 99

It is not common to have experienced the nasopharyngeal extension of pituitary adenomas. Recently we have experienced such a case. A man, aged 18, height 168 cm, weight 66 kg, who admitted to the hospital with the complaints of headache, left nasal obstruction, loss of visual acuity and defect of his temporal fields. On examination of both fundi there was primary optic atrophy. At this time large tumor could be seen in the nasopharyngeal cavity. Plain X-ray showed that the pituitary fossa was definitely enlarged and that there was considerable destruction of the sella and the clivus. Definite soft tissue mass could be visualised clearly by tomography. Via transoral and transsphenoidal approach, total removal of the nasopharyngeal tumor and intracapsulary subtotal resection of the tumor were performed. Microscopical examination established the diagnosis of chromophobe adenoma. On postoperative examination of hypothalamopituitary function he had no responces to insulin hypoglycemia and arginine infusion in growth hormone. 60Co irradiation, totally 6,000 rad, was given. Two years postoperatively he showed fairly good deal of improvement of his visual field defect. There was no serious complaints other than visual impairment on the left eye.
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PMID:[Nasopharyngeal extension of a large chromophobe adenoma of the pituitary (author's transl)]. 98 20

The safety and tolerability of carvedilol, a new antihypertensive agent with the combined pharmacological activities of beta-blockade and vasodilation, and of nifedipine were investigated in patients with essential hypertension and non-insulin-dependent (type II) diabetes mellitus. Twenty patients were openly randomized to receive 25 mg carvedilol once daily (five men and five women; mean age, 63 years) or 10 mg nifedipine t.i.d. (three men and seven women; mean age, 64 years) for a period of 4 weeks. Baseline mean sitting blood pressures were 168/98 and 169/95 mm Hg in the carvedilol and nifedipine groups, respectively. Baseline mean areas under the curve (AUC) of the intravenous glucose tolerance test (IVGTT) for the carvedilol and nifedipine groups were 6,136 +/- 1,195 and 6,287 +/- 1,228 mg/dl/min, respectively. Demographic and efficacy variables were not statistically different between treatment groups. After 4 weeks of therapy, mean sitting blood pressure was significantly (p less than 0.02) reduced to 144/91 mm Hg in the carvedilol group and to 149/87 mm Hg in the nifedipine group. Week 4 IVGTT AUC values of 5,735 +/- 1,464 mg/dl/min in the carvedilol group and 5,988 +/- 993 mg/dl/min in the nifedipine group, representing mean reductions of 6.14% and 3.17%, respectively, were not statistically different from baseline. Both treatments were well tolerated. No patient experienced adverse events in the carvedilol treatment group, whereas two patients in the nifedipine group reported episodes of headache (one patient) and palpitations (one patient); each episode was mild in severity and considered to be related to study medication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of the effects of carvedilol and nifedipine in patients with essential hypertension and non-insulin-dependent diabetes mellitus. 137 56


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