Health

What are the leading causes of nephrolithiasis? The most common causes of nephrolithiasis are the various types of polygenic idiopathic hypercalciuria (IH): absorptive hypercalciuria (AH) types AH-I to AH-III (renal phosphate leak) and renal hypercalciuria (RH). Other causes are primary hyperparathyroidism, hyperoxaluria, hyperuricosuria, hyperphosphaturia, hypocitraturia, hypomagnesuria, infection stones, gouty diathesis, renal tubular acidosis, cystinuria, calcifying …

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Who is at risk for the development of kidney stones? Kidney stones affect 12% of the world’s population. The average prevalence of kidney stones in the United States has increased and is approximately 11% in men and 7% in women, with an overall prevalence of 9%. The lifetime risk for kidney stones is 19% in …

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Is life expectancy altered by hypopituitarism? All-cause mortality and vascular death are increased in patients with hypopituitarism compared with age- and gender-matched controls. A recent meta-analysis concluded that the standardized mortality ratio associated with hypopituitarism in men is 2.06 (95% confidence interval [CI], 1.94–2.20] and in women is 2.80 (95% CI, 2.59–3.02). Pituitary irradiation seems …

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Are there any interactions between replacement hormones? Because GH therapy can decrease circulating free T 4 levels in adults with GH deficiency, free T 4 should be measured 6 weeks after initiation of GH replacement and after each dose escalation to rule out a mild case of central hypothyroidism. This also applies to those patients with central hypothyroidism already …

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Do antiepileptic medications interact with hormone replacement therapy? Some antiepileptic drugs (AEDs), including phenytoin, carbamazepine, oxcarbamazepine, and topiramate, enhance hepatic cytochrome P450 (CYP450) isoenzyme activity, increasing the catabolism of certain hormonal preparations and resulting in lower serum concentrations of these hormones. For example, patients with central adrenal insufficiency taking dexamethasone or prednisone, who are also …

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How is hypopituitarism in pregnancy managed Because fertility is usually impaired in women with pituitary insufficiency, they rarely have spontaneous pregnancies. ACTH deficiency: Hydrocortisone, which does not cross the placenta, should be the drug of choice. Higher doses may be required (20%–40% more), particularly during the third trimester. Dexamethasone, which is not inactivated in the placenta, …

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What are the risks of hormonal overreplacement in hypopituitarism? Excessive glucocorticoid doses in patients with central adrenal insufficiency can cause weight gain, metabolic syndrome, increased overall and cardiovascular mortality, bone loss, and, especially in men, increased vertebral fracture risk despite the restoration of gonadal status. Low-dose hydrocortisone replacement may actually increase bone formation and promote …

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