The Infertility Workup
Steven R. Bayer, Michael M. Alper, Alan S. Penzias in The Boston IVF Handbook of Infertility, 2017
The initial consultation between the physician and the patient is the crucial first step in understanding the needs of the individual seeking your advice and care. An extensive history and physical examination for both the patient and her partner are necessary. A detailed history and focused review of systems should take between 30–80 minutes with an average of 60 minutes. Findings suggestive of an endocrine disorder should be sought. Screening for thyroid disease, hyperprolactinemia, galactorrhea, and hirsutism should be scrutinized and addressed in all patients. During the initial consultation, the clinician should attempt to define if the patient suffers from pelvic pain, dysmenorrhea, dyspareunia, or vaginismus since they all may have an impact on the likelihood of conception. It is for this reason that even women who desire to achieve pregnancy using donor sperm deserve a detailed evaluation before treatment.
Endocrine and neuroendocrine tumours
Pat Price, Karol Sikora in Treatment of Cancer, 2014
With respect to management, each endocrine disease should be treated on its own merits, but the clinician must remain wary to the possible development of other aspects of disease. Thus, it is reasonable to screen all phaeochromocytoma patients for the presence of an MTC (serum calcitonin levels), and vice versa (plasma and 24-hour urinary catecholamines), whereas patients with pancreatic endocrine tumours require consideration of MEN1. Repeat screening is indicated, as these tumours may present sequentially. Where the gene mutation has been identified, it is now common to offer total thyroidectomy to all affected individuals with MEN2 at, or near, 5 years of age. For MEN3, prophylactic thyroidectomy may be necessary even earlier (within the first 2 years of life). The cloning of the genes for these conditions has considerably altered screening policies and follow-up plans for these families.
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
These are often very reversible causes of fatigue, which can be easy to treat. Â 4 It is therefore important when a patient presents with fatigue to run a simple chemistry panel as part of the work-up. Abnormalities such as hyponatremia, hypokalemia, hypomagnesemia, hypercalcemia, and hyper- or hypoglycemia can be readily diagnosed and corrected with simple measures such as hydration and replacement therapy. A lot of these electrolyte disturbances cause physical/muscle weakness, which can cause significant fatigue. Endocrine disorders are easily missed but can also often be readily reversible or treatable causes of fatigue. Addison disease, for instance, causes significant fatigue, and although this is now uncommon in Western society, hypoadrenalism per se is still fairly common. Many drugs can cause secondary hypoadrenalism, which has identical symptoms to the primary disorder, for example, steroids (when discontinued abruptly). Other common endocrine disorders such as diabetes and hypothyroidism should also be excluded and, if diagnosed, treated promptly with appropriate replacement therapies.
Updated perspectives on how and when lithium should be used in the treatment of mood disorders
Published in Expert Review of Neurotherapeutics, 2023
Janusz K. Rybakowski, Ewa Ferensztajn-Rochowiak
For lithium, acute renal failure and acute myocardial infarction are absolute contraindications. In the case of impairment of kidney function expressed as an increase in creatinine concentration and a decrease in glomerular filtration rate (GFR), the possibility of using lithium should be carefully considered. A relative contraindication may be the presence of arrhythmia, especially Brugada syndrome in the patient or family. This would also be the case for psoriasis because lithium can exacerbate or cause such a condition. Endocrine disorders include thyroid disease, mainly hypothyroidism, as well as Addison’s disease. Myelogenous leukemia may be a contraindication because lithium tends to cause an increase in the number of neutrophils. Lithium should not be introduced during dehydration or low sodium concentration. Caution should be exercised when cerebellar dysfunction is suspected, as cerebellar damage is described as a complication of high doses of lithium. Also, myasthenia may be a relative contraindication, as muscle weakness is often reported after high doses of lithium. Lithium should be introduced with caution in the case of cerebral circulatory disorders, Parkinson’s disease, and uncompensated epilepsy [60].
Cost-effectiveness of baloxavir marboxil compared with laninamivir for the treatment of influenza in patients at high risk for complications in Japan
Published in Current Medical Research and Opinion, 2021
Mariia Dronova, Hidetoshi Ikeoka, Naoya Itsumura, Nobuo Hirotsu, Amir Ansaripour, Samuel Aballéa, Yoshie Onishi, Mark Hill, Ataru Igarashi
The following list of HRC was considered in line with the Centers for Disease Control and Prevention’s definition and phase III clinical trial of baloxavir3,8:Asthma or chronic lung disease.Endocrine disorders.Compromised immune system.Neurological and neurodevelopmental disorders.Heart disease (excluding hypertension).Blood disorders.Metabolic disorders.Morbid obesity.Women within 2 weeks postpartum – for patients aged <65 years only.Residents of long-term care facilities – for patients aged ≥65 years only.
Cytogenetic analysis of patients with primary amenorrhea in Eastern India
Published in Journal of Obstetrics and Gynaecology, 2018
Shaulee Ghosh, Sanchita Roy, Pritha Pal, Atreyee Dutta, Ajanta Halder
Few problems in gynaecology are as challenging and taxing to the gynaecologists as PA, caused by pituitary/hypothalamic disorders (27.8%), gonadal dysfunction (50.4%) and outflow tract abnormalities (21.8%) (Schorge et al. 2008). These abnormalities are due to endocrine disorders, genetic, psychological, environmental or structural anomalies. Several cytogenetic studies reported that frequency of chromosomal abnormalities in PA vary greatly from 15.9% to 63.3% (Joseph and Thomas 1982; Opitz et al. 1983). With the advancement in the field of cytogenetic the identification of chromosomal abnormalities are being revealed more and more. As per our knowledge no such study has been carried out for PA cases of West-Bengal population – the Eastern region of India in recent years. Genetic diagnosis by cytogenetic screening is considered to be crucial in counselling of parents, and special education and management of these cases. In cases such as the present study, where a family has significant emotional and social issues to struggle with the conflict as to whether the child would ever lead a normal life or not, the chromosomal analysis can answer if not all but a significant number of queries from the anxious parents. Thus the present study was carried out to reveal the frequency and type of chromosomal abnormalities and their hormonal correlation in patients with PA.
Related Knowledge Centers
- Diabetes
- Hyperthyroidism
- Secretion
- Thyroid Hormones
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- Type 2 Diabetes
- Endocrine System
- Endocrinology
- Gestational Diabetes
- Thyroid-Stimulating Hormone