Acute endocrinology:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2006
|
| Schriftenreihe: | Endocrinology and metabolism clinics of North America
35,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVIII S., S. 663 - 913 Ill., graph. Darst. |
| ISBN: | 141604308X |
Internformat
MARC
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| 245 | 1 | 0 | |a Acute endocrinology |c guest ed.: Greet Van den Berghe |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2006 | |
| 300 | |a XVIII S., S. 663 - 913 |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 490 | 1 | |a Endocrinology and metabolism clinics of North America |v 35,4 | |
| 650 | 7 | |a Acute aandoeningen |2 gtt | |
| 650 | 7 | |a Endocrien systeem |2 gtt | |
| 650 | 4 | |a Endocrinology | |
| 700 | 1 | |a Berghe, Greet Van den |d 1960- |e Sonstige |0 (DE-588)136807836 |4 oth | |
| 830 | 0 | |a Endocrinology and metabolism clinics of North America |v 35,4 |w (DE-604)BV000625447 |9 35,4 | |
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| 999 | |a oai:aleph.bib-bvb.de:BVB01-015463642 | ||
Datensatz im Suchindex
| _version_ | 1804136249707986944 |
|---|---|
| adam_text | CONTENTS
Foreword xiii
Derek LeRoith
Preface xvii
Greet Van den Berghe
Thyrotoxicosis and Thyroid Storm 663
Bindu Nayak and Kenneth Burman
Thyroid storm represents the extreme manifestation of thyrotoxico¬
sis as a true endocrine emergency. Although Graves disease is the
most common underlying disorder in thyroid storm, there is usually
a precipitating event or condition that transforms the patient into
life threatening thyrotoxicosis. Treatment of thyroid storm involves
decreasing new hormone synthesis, inhibiting the release of thy¬
roid hormone, and blocking the peripheral effects of thyroid hor¬
mone. This multidrug, therapeutic approach uses thionamides,
iodine, beta adrenergic receptor antagonists, corticosteroids in cer¬
tain circumstances, and supportive therapy. Certain conditions
may warrant the use of alternative therapy with cholestyramine,
lithium carbonate, or potassium perchlorate. After the critical ill¬
ness of thyroid storm subsides, definitive treatment of the under¬
lying thyrotoxicosis can be planned.
Myxedema Coma 687
Leonard Wartofsky
Myxedema coma is the term given to the most severe presentation of
profound hypothyroidism and is often fatal in spite of therapy.
Decompensation of the hypothyroid patient into a coma may be
precipitated by a number of drugs, systemic illnesses (eg, pneumo¬
nia), and other causes. It typically presents in older women in the
winter months and is associated with signs of hypothyroidism,
hypothermia, hyponatremia, hypercarbia, and hypoxemia. Treat¬
ment must be initiated promptly in an intensive care unit setting.
VOLUME 35 • NUMBER 4 • DECEMBER 2006 vii
Although thyroid hormone therapy is critical to survival, it remains
uncertain whether it should be administered as thyroxine, triio
dothyronine, or both. Adjunctive measures, such as ventilation,
warming, fluids, antibiotics, pressors, and corticosteroids, may be
essential for survival.
Emergencies Caused by Pheochromocytoma, Neuroblastoma,
or Ganglioneuroma 699
Frederieke M. Brouwers, Graeme Eisenhofer,
Jacques W.M. Lenders, and Karel Pacak
Pheochromocytoma may lead to important emergency situations,
ranging from cardiovascular emergencies to acute abdomen and
multiorgan failure. It is vital to think about this disease in any
emergency situation when conventional therapy fails to achieve
control or symptoms occur that do not fit the initial diagnosis.
The importance of keeping this diagnosis in mind is underscored
by the fact that, in 50% of pheochromocytoma patients, the diagno¬
sis is initially overlooked. Two other tumors of the sympathetic
nervous system, neuroblastoma and ganglioneuroma, are less com¬
monly associated with emergency conditions. If they occur, they
are often linked to catecholamine excess, paraneoplastic phenom¬
ena, or local tumor mass effect.
Hyperglycemic Crises in Diabetes Mellitus: Diabetic
Ketoacidosis and Hyperglycemic Hyperosmolar State 725
Abbas E. Kitabchi and Ebenezer A. Nyenwe
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar
state (HHS) potentially are fatal but largely preventable acute met¬
abolic complications of uncontrolled diabetes, the incidence of
which continues to increase. Mortality from DKA has declined
remarkably over the years because of better understanding of its
pathophysiology and treatment. The mortality rate of HHS
remains alarmingly high, however, owing to older age and mode
of presentation of patients and associated comorbid conditions.
DKA and HHS also are economically burdensome; therefore, any
resources invested in their prevention would be rewarding.
Hypoglycemia 753
Jean Marc Guettier and Phillip Gorden
Under physiologic conditions, glucose plays a critical role in pro¬
viding energy to the central nervous system. A precipitous drop
in the availability of this substrate results in dramatic symptoms
that signal a medical emergency and warrant immediate therapy
aimed at restoring plasma glucose to normal levels. A systemic ap¬
proach to the differential diagnosis is useful in identifying the
cause of hypoglycemia. Once established, a specific and/or defini¬
tive intervention that addresses that underlying problem can be
viii CONTENTS
implemented. In most cases, this systemic approach to diagnosis
and therapy is rewarded with a good outcome for the patient.
Acute Adrenal Insufficiency 767
Roger Bouillon
Adrenal insufficiency is a rare disorder, usually with gradually
evolving clinical symptoms and signs. Occasionally, an acute adre¬
nal insufficiency crisis can become a life threatening condition
because of acute interruption of a normal or hyperfunctioning
adrenal or pituitary gland or sudden interruption of adrenal replace¬
ment therapy. Acute stress situations can aggravate the symp¬
tomatology. A simple strategy of diagnostic screening and early
intervention with sodium chloride—containing fluids and hydrocor
tisone should be widely implemented for cases with suspicion of an
acute Addison disease crisis. In contrast, the chronic replacement
dosage for patients with adrenal insufficiency should be as low as
possible with clear instructions for dosage adjustments in case of
stress or acute emergencies.
The Dynamic Neuroendocrine Response to Critical Illness 777
Lies Langouche and Greet Van den Berghe
The severity of striking alterations in the hypothalamic anterior
pituitary peripheral hormone axes, which are the hallmark of
severity of critical illness, is associated with a high risk for morbid¬
ity and mortality. Most attempts to correct the hormone balance are
ineffective or harmful because of lack of pathophysiologic under¬
standing. Extensive research has provided more insight in the
biphasic neuroendocrine response to critical illness: the acute phase
is characterized by an actively secreting pituitary but low periph¬
eral effector hormone levels. In contrast, in prolonged critical
illness, uniform suppression of the neuroendocrine axes, predomi¬
nantly of hypothalamic origin, contributes to low serum levels of
the respective target organ hormones.
Changes Within the Growth Hormone/Insulin like Growth
Factor I/IGF Binding Protein Axis During Critical Illness 793
Dieter Mesotten and Greet Van den Berghe
Interest in the somatotropic axis, with its complex network of inter¬
actions, during critical illness arose only a few decades ago. The
distinguishing neuroendocrine features of prolonged critical illness
were not differentiated from those during the acute phase until the
early 1990s. This incomplete understanding of the somatotropic
axis contributed to some disastrous results, such as the multicenter
growth hormone trial. The goal of stimulating the somatotropic
axis without a proper preceding neuroendocrine diagnosis should
be held obsolete. Moreover, the fascinating link between regulators
of carbohydrate metabolism, such as insulin and insulin like
CONTENTS i*
growth factor I, and the somatotropic axis may lead to future ther¬
apeutic possibilities.
Changes Within the Thyroid Axis During the Course
of Critical Illness 807
Liese Mebis, Yves Debaveye, Theo J. Visser,
and Greet Van den Berghe
This article reviews the mechanisms behind the observed changes
in plasma thyroid hormone levels in the acute phase and the pro¬
longed phase of critical illness. It focuses on the neuroendocrinol
ogy of the low triiodothyronine syndrome and on thyroid
hormone metabolism by deiodination and transport.
The Hypothalamic Pituitary Adrenal Axis in Critical Illness 823
Philipp Schuetz and Beat Miiller
The hypothalamic pituitary adrenal response to stress is a dynamic
process. The homeostatic corrections that have emerged in the
course of human evolution to cope with the catastrophic events
during critical illness involve a complex multisystem endeavor.
Although the repertoire of endocrine changes has been probed in
some detail, discerning the vulnerabilities and failures of this
system is far more challenging. One of the most controversially
debated topics in the current literature is the characterization and
optimal treatment of allegedly inadequate adaptations of the hy¬
pothalamic pituitary adrenal axis during critical illness. This out¬
line attempts to touch briefly some of the debated issues, stir the
discussion, and thereby contribute to resolving the dispute.
Catecholamines and Vasopressin During Critical Illness 839
Gabriele Bassi, Peter Radermacher, and Enrico Calzia
This article summarizes the effects of catecholamines and vasopres¬
sin on the cardiovascular system, focusing on their metabolic and
immunologic properties. Particular attention is dedicated to the
septic shock condition.
Diabetes of Injury: Novel Insights 859
Use Vanhorebeek and Greet Van den Berghe
Critically ill patients usually develop hyperglycemia, a condition
referred to as diabetes of injury. More and more evidence argues
against the concept that this is an adaptive beneficial response. In¬
deed, the development of hyperglycemia seems to be detrimental
for the outcome of critically ill patients, because maintenance of
normoglycemia with intensive insulin therapy prevents morbidity
and reduces mortality of critically ill patients to a large extent. The
mechanisms underlying these clinical benefits are being studied
further.
X CONTENTS
Disorders of Body Water Homeostasis in Critical Illness 873
Suzanne Myers Adler and Joseph G. Verbalis
Disorders of sodium and water homeostasis are among the most
commonly encountered disturbances in the critical care setting, be¬
cause many disease states cause defects in the complex mecha¬
nisms that control the intake and output of water and solute.
Because body water is the primary determinant of extracellular
fluid osmolality, disorders of body water balance can be catego¬
rized into hypoosmolar and hyperosmolar disorders depending
on the presence of an excess or a deficiency of body water relative
to body solute. Because the main constituent of plasma osmolality
is sodium, hypoosmolar and hyperosmolar disease states are gen¬
erally characterized by hyponatremia and hypernatremia, respec¬
tively. After a brief review of normal water metabolism, this
article focuses on the diagnosis and treatment of hyponatremia
and hypernatremia in the critical care setting.
Index 895
CONTENTS xi
|
| adam_txt |
CONTENTS
Foreword xiii
Derek LeRoith
Preface xvii
Greet Van den Berghe
Thyrotoxicosis and Thyroid Storm 663
Bindu Nayak and Kenneth Burman
Thyroid storm represents the extreme manifestation of thyrotoxico¬
sis as a true endocrine emergency. Although Graves' disease is the
most common underlying disorder in thyroid storm, there is usually
a precipitating event or condition that transforms the patient into
life threatening thyrotoxicosis. Treatment of thyroid storm involves
decreasing new hormone synthesis, inhibiting the release of thy¬
roid hormone, and blocking the peripheral effects of thyroid hor¬
mone. This multidrug, therapeutic approach uses thionamides,
iodine, beta adrenergic receptor antagonists, corticosteroids in cer¬
tain circumstances, and supportive therapy. Certain conditions
may warrant the use of alternative therapy with cholestyramine,
lithium carbonate, or potassium perchlorate. After the critical ill¬
ness of thyroid storm subsides, definitive treatment of the under¬
lying thyrotoxicosis can be planned.
Myxedema Coma 687
Leonard Wartofsky
Myxedema coma is the term given to the most severe presentation of
profound hypothyroidism and is often fatal in spite of therapy.
Decompensation of the hypothyroid patient into a coma may be
precipitated by a number of drugs, systemic illnesses (eg, pneumo¬
nia), and other causes. It typically presents in older women in the
winter months and is associated with signs of hypothyroidism,
hypothermia, hyponatremia, hypercarbia, and hypoxemia. Treat¬
ment must be initiated promptly in an intensive care unit setting.
VOLUME 35 • NUMBER 4 • DECEMBER 2006 vii
Although thyroid hormone therapy is critical to survival, it remains
uncertain whether it should be administered as thyroxine, triio
dothyronine, or both. Adjunctive measures, such as ventilation,
warming, fluids, antibiotics, pressors, and corticosteroids, may be
essential for survival.
Emergencies Caused by Pheochromocytoma, Neuroblastoma,
or Ganglioneuroma 699
Frederieke M. Brouwers, Graeme Eisenhofer,
Jacques W.M. Lenders, and Karel Pacak
Pheochromocytoma may lead to important emergency situations,
ranging from cardiovascular emergencies to acute abdomen and
multiorgan failure. It is vital to think about this disease in any
emergency situation when conventional therapy fails to achieve
control or symptoms occur that do not fit the initial diagnosis.
The importance of keeping this diagnosis in mind is underscored
by the fact that, in 50% of pheochromocytoma patients, the diagno¬
sis is initially overlooked. Two other tumors of the sympathetic
nervous system, neuroblastoma and ganglioneuroma, are less com¬
monly associated with emergency conditions. If they occur, they
are often linked to catecholamine excess, paraneoplastic phenom¬
ena, or local tumor mass effect.
Hyperglycemic Crises in Diabetes Mellitus: Diabetic
Ketoacidosis and Hyperglycemic Hyperosmolar State 725
Abbas E. Kitabchi and Ebenezer A. Nyenwe
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar
state (HHS) potentially are fatal but largely preventable acute met¬
abolic complications of uncontrolled diabetes, the incidence of
which continues to increase. Mortality from DKA has declined
remarkably over the years because of better understanding of its
pathophysiology and treatment. The mortality rate of HHS
remains alarmingly high, however, owing to older age and mode
of presentation of patients and associated comorbid conditions.
DKA and HHS also are economically burdensome; therefore, any
resources invested in their prevention would be rewarding.
Hypoglycemia 753
Jean Marc Guettier and Phillip Gorden
Under physiologic conditions, glucose plays a critical role in pro¬
viding energy to the central nervous system. A precipitous drop
in the availability of this substrate results in dramatic symptoms
that signal a medical emergency and warrant immediate therapy
aimed at restoring plasma glucose to normal levels. A systemic ap¬
proach to the differential diagnosis is useful in identifying the
cause of hypoglycemia. Once established, a specific and/or defini¬
tive intervention that addresses that underlying problem can be
viii CONTENTS
implemented. In most cases, this systemic approach to diagnosis
and therapy is rewarded with a good outcome for the patient.
Acute Adrenal Insufficiency 767
Roger Bouillon
Adrenal insufficiency is a rare disorder, usually with gradually
evolving clinical symptoms and signs. Occasionally, an acute adre¬
nal insufficiency crisis can become a life threatening condition
because of acute interruption of a normal or hyperfunctioning
adrenal or pituitary gland or sudden interruption of adrenal replace¬
ment therapy. Acute stress situations can aggravate the symp¬
tomatology. A simple strategy of diagnostic screening and early
intervention with sodium chloride—containing fluids and hydrocor
tisone should be widely implemented for cases with suspicion of an
acute Addison disease crisis. In contrast, the chronic replacement
dosage for patients with adrenal insufficiency should be as low as
possible with clear instructions for dosage adjustments in case of
stress or acute emergencies.
The Dynamic Neuroendocrine Response to Critical Illness 777
Lies Langouche and Greet Van den Berghe
The severity of striking alterations in the hypothalamic anterior
pituitary peripheral hormone axes, which are the hallmark of
severity of critical illness, is associated with a high risk for morbid¬
ity and mortality. Most attempts to correct the hormone balance are
ineffective or harmful because of lack of pathophysiologic under¬
standing. Extensive research has provided more insight in the
biphasic neuroendocrine response to critical illness: the acute phase
is characterized by an actively secreting pituitary but low periph¬
eral effector hormone levels. In contrast, in prolonged critical
illness, uniform suppression of the neuroendocrine axes, predomi¬
nantly of hypothalamic origin, contributes to low serum levels of
the respective target organ hormones.
Changes Within the Growth Hormone/Insulin like Growth
Factor I/IGF Binding Protein Axis During Critical Illness 793
Dieter Mesotten and Greet Van den Berghe
Interest in the somatotropic axis, with its complex network of inter¬
actions, during critical illness arose only a few decades ago. The
distinguishing neuroendocrine features of prolonged critical illness
were not differentiated from those during the acute phase until the
early 1990s. This incomplete understanding of the somatotropic
axis contributed to some disastrous results, such as the multicenter
growth hormone trial. The goal of stimulating the somatotropic
axis without a proper preceding neuroendocrine diagnosis should
be held obsolete. Moreover, the fascinating link between regulators
of carbohydrate metabolism, such as insulin and insulin like
CONTENTS i*
growth factor I, and the somatotropic axis may lead to future ther¬
apeutic possibilities.
Changes Within the Thyroid Axis During the Course
of Critical Illness 807
Liese Mebis, Yves Debaveye, Theo J. Visser,
and Greet Van den Berghe
This article reviews the mechanisms behind the observed changes
in plasma thyroid hormone levels in the acute phase and the pro¬
longed phase of critical illness. It focuses on the neuroendocrinol
ogy of the low triiodothyronine syndrome and on thyroid
hormone metabolism by deiodination and transport.
The Hypothalamic Pituitary Adrenal Axis in Critical Illness 823
Philipp Schuetz and Beat Miiller
The hypothalamic pituitary adrenal response to stress is a dynamic
process. The homeostatic corrections that have emerged in the
course of human evolution to cope with the catastrophic events
during critical illness involve a complex multisystem endeavor.
Although the repertoire of endocrine changes has been probed in
some detail, discerning the vulnerabilities and failures of this
system is far more challenging. One of the most controversially
debated topics in the current literature is the characterization and
optimal treatment of allegedly inadequate adaptations of the hy¬
pothalamic pituitary adrenal axis during critical illness. This out¬
line attempts to touch briefly some of the debated issues, stir the
discussion, and thereby contribute to resolving the dispute.
Catecholamines and Vasopressin During Critical Illness 839
Gabriele Bassi, Peter Radermacher, and Enrico Calzia
This article summarizes the effects of catecholamines and vasopres¬
sin on the cardiovascular system, focusing on their metabolic and
immunologic properties. Particular attention is dedicated to the
septic shock condition.
Diabetes of Injury: Novel Insights 859
Use Vanhorebeek and Greet Van den Berghe
Critically ill patients usually develop hyperglycemia, a condition
referred to as "diabetes of injury." More and more evidence argues
against the concept that this is an adaptive beneficial response. In¬
deed, the development of hyperglycemia seems to be detrimental
for the outcome of critically ill patients, because maintenance of
normoglycemia with intensive insulin therapy prevents morbidity
and reduces mortality of critically ill patients to a large extent. The
mechanisms underlying these clinical benefits are being studied
further.
X CONTENTS
Disorders of Body Water Homeostasis in Critical Illness 873
Suzanne Myers Adler and Joseph G. Verbalis
Disorders of sodium and water homeostasis are among the most
commonly encountered disturbances in the critical care setting, be¬
cause many disease states cause defects in the complex mecha¬
nisms that control the intake and output of water and solute.
Because body water is the primary determinant of extracellular
fluid osmolality, disorders of body water balance can be catego¬
rized into hypoosmolar and hyperosmolar disorders depending
on the presence of an excess or a deficiency of body water relative
to body solute. Because the main constituent of plasma osmolality
is sodium, hypoosmolar and hyperosmolar disease states are gen¬
erally characterized by hyponatremia and hypernatremia, respec¬
tively. After a brief review of normal water metabolism, this
article focuses on the diagnosis and treatment of hyponatremia
and hypernatremia in the critical care setting.
Index 895
CONTENTS xi |
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| spelling | Acute endocrinology guest ed.: Greet Van den Berghe Philadelphia [u.a.] Saunders 2006 XVIII S., S. 663 - 913 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Endocrinology and metabolism clinics of North America 35,4 Acute aandoeningen gtt Endocrien systeem gtt Endocrinology Berghe, Greet Van den 1960- Sonstige (DE-588)136807836 oth Endocrinology and metabolism clinics of North America 35,4 (DE-604)BV000625447 35,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=015463642&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Acute endocrinology Endocrinology and metabolism clinics of North America Acute aandoeningen gtt Endocrien systeem gtt Endocrinology |
| title | Acute endocrinology |
| title_auth | Acute endocrinology |
| title_exact_search | Acute endocrinology |
| title_exact_search_txtP | Acute endocrinology |
| title_full | Acute endocrinology guest ed.: Greet Van den Berghe |
| title_fullStr | Acute endocrinology guest ed.: Greet Van den Berghe |
| title_full_unstemmed | Acute endocrinology guest ed.: Greet Van den Berghe |
| title_short | Acute endocrinology |
| title_sort | acute endocrinology |
| topic | Acute aandoeningen gtt Endocrien systeem gtt Endocrinology |
| topic_facet | Acute aandoeningen Endocrien systeem Endocrinology |
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