Endocrinology and Metabolism Clinics of North America, Dec 1, 2011
Pregnancy dramatically affects the function of the adrenal glands and is associated with altered ... more Pregnancy dramatically affects the function of the adrenal glands and is associated with altered levels of adrenal hormones. Endocrine adaptation to pregnancy involves changes in the activities of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axes. As a result, pregnancy may influence the course of pre-existing adrenal diseases or lead to their unmasking. Although disorders of the adrenal glands are rare during pregnancy, they may pose a serious health problem. The fact that some symptoms of adrenal disorders may be erroneously interpreted as symptoms of normal pregnancy together with overlapping their biochemical features make diagnosis of adrenal disorders in pregnancy difficult. Antenatal diagnosis and correct treatment of these disorders is necessary to prevent maternal and fetal morbidity and mortality. The aim of this paper is provide a scientific understanding of the normal function of adrenal glands in pregnancy and to discuss the pathophysiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy. We provide the reader with some practical recommendations concerning the approach to pregnant women with adrenal disturbances.
ABSTRACT Cushing’s syndrome (CS) is rare during pregnancy because it is associated with infertili... more ABSTRACT Cushing’s syndrome (CS) is rare during pregnancy because it is associated with infertility in approximately 71% of female patients who have the disease. The diagnosis of CS is challenging in the nonpregnant state and even more so during pregnancy for several reasons. First, pregnant women without CS develop some features of Cushing’s, such as hypertension, hyperglycemia, and striae. Second, the various yet normal functional alterations involving the hypothalamic-pituitary axis during pregnancy make it difficult to use the standard testing normal ranges that are used to diagnose Cushing’s in nonpregnant states (e.g., low-dose dexamethasone suppression testing and assessment of 24-h urinary free cortisol and salivary cortisol). However, because hypercortisolism is associated with unfavorable maternal and fetal outcomes, it is important to have a high index of suspicion of the disease to prevent delay in diagnosis. In this chapter, we explore the different causes of CS during pregnancy, as well as the normal changes affecting the hypothalamic-pituitary-adrenal (HPA) axis and how to incorporate that information into the interpretation of biochemical testing data. We propose a general approach to treatment with both medical and surgical options, while keeping in mind the paramount importance of individualizing therapy. Key WordsCushing’s syndrome-Pregnancy-Cortisol-ACTH-Hypothalamic-pituitary-adrenal axis
OBJECTIVES Because of the mandatory sanitary measures established during the Covid-19 Pandemic, w... more OBJECTIVES Because of the mandatory sanitary measures established during the Covid-19 Pandemic, we have proposed to describe the new clinical, educative, and research practices of an international sample of doctors. METHODS We have used an online electronic survey of a convenient sample of doctors from 40 countries using a multiple-choice online questionnaire, including three domains. 424 out of 456 respondents provided adequate responses. RESULTS Most respondents were from medical (51.5%) and surgical (11.8%) specialties. Over half of the respondents practiced in academic centers and one fifth in the private sector. Coronavirus pandemic induced frequent changes in practice, such as seeing fewer patients in clinics than usual (34.9%) and utilization of telemedicine (31.3%). A significant disruption in medical education activities and residents' training was observed, resulting in the cancellation of many activities such as grand rounds, departmental and multidisciplinary meetin...
Background: Research is an essential component in the advancement of medicine. Evidence indicates... more Background: Research is an essential component in the advancement of medicine. Evidence indicates that developing regions have low research productivity and contribution to the international literature. It is unclear if physicians' attitudes and perceptions of research could be contributory. Objectives: This study examined the attitudes to research, perceived barriers to research, and experiences of prior participation in research projects among physicians from the Middle East and Africa. Subjects and Methods: A cross-sectional electronic survey was developed based on the published literature to address these questions and was E-mailed to a large sample of practising clinicians and academics. Results: A total of 283 responses received, 61.1% were men with a mean age of 48 years. Responses originated from 23 countries. The majority were from the Middle East (79.2%), whereas 29.9% were from African countries. Over half of physicians (51.1%) held high-level speciality qualification...
Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide ... more Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide with high prevalence of both the risk factors in the United Arab Emirates. In recent years, obesity has been associated with vitamin D deficiency, but very few studies have been published about the correlation between them in the UAE population. Subjects and Methods: This is a cross-sectional study designed to find a correlation between vitamin D deficiency and obesity along with other metabolic factors. Data were collected from electronic medical records of 300 subjects ranging from 15 to 85 years of age of various ethnic origins residing in Dubai. Results: The study showed a high prevalence of obesity (44.9%) and vitamin D deficiency (40.1) in our study population. There is no evidence of a relation between vitamin D level and the obesity; 40.1% of the subjects were vitamin D deficient, out of which 46.7% were obese. However, a statistically significant relationship was found between c...
Endocrinology and Metabolism Clinics of North America, Dec 1, 2011
Pregnancy dramatically affects the function of the adrenal glands and is associated with altered ... more Pregnancy dramatically affects the function of the adrenal glands and is associated with altered levels of adrenal hormones. Endocrine adaptation to pregnancy involves changes in the activities of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axes. As a result, pregnancy may influence the course of pre-existing adrenal diseases or lead to their unmasking. Although disorders of the adrenal glands are rare during pregnancy, they may pose a serious health problem. The fact that some symptoms of adrenal disorders may be erroneously interpreted as symptoms of normal pregnancy together with overlapping their biochemical features make diagnosis of adrenal disorders in pregnancy difficult. Antenatal diagnosis and correct treatment of these disorders is necessary to prevent maternal and fetal morbidity and mortality. The aim of this paper is provide a scientific understanding of the normal function of adrenal glands in pregnancy and to discuss the pathophysiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy. We provide the reader with some practical recommendations concerning the approach to pregnant women with adrenal disturbances.
ABSTRACT Cushing’s syndrome (CS) is rare during pregnancy because it is associated with infertili... more ABSTRACT Cushing’s syndrome (CS) is rare during pregnancy because it is associated with infertility in approximately 71% of female patients who have the disease. The diagnosis of CS is challenging in the nonpregnant state and even more so during pregnancy for several reasons. First, pregnant women without CS develop some features of Cushing’s, such as hypertension, hyperglycemia, and striae. Second, the various yet normal functional alterations involving the hypothalamic-pituitary axis during pregnancy make it difficult to use the standard testing normal ranges that are used to diagnose Cushing’s in nonpregnant states (e.g., low-dose dexamethasone suppression testing and assessment of 24-h urinary free cortisol and salivary cortisol). However, because hypercortisolism is associated with unfavorable maternal and fetal outcomes, it is important to have a high index of suspicion of the disease to prevent delay in diagnosis. In this chapter, we explore the different causes of CS during pregnancy, as well as the normal changes affecting the hypothalamic-pituitary-adrenal (HPA) axis and how to incorporate that information into the interpretation of biochemical testing data. We propose a general approach to treatment with both medical and surgical options, while keeping in mind the paramount importance of individualizing therapy. Key WordsCushing’s syndrome-Pregnancy-Cortisol-ACTH-Hypothalamic-pituitary-adrenal axis
OBJECTIVES Because of the mandatory sanitary measures established during the Covid-19 Pandemic, w... more OBJECTIVES Because of the mandatory sanitary measures established during the Covid-19 Pandemic, we have proposed to describe the new clinical, educative, and research practices of an international sample of doctors. METHODS We have used an online electronic survey of a convenient sample of doctors from 40 countries using a multiple-choice online questionnaire, including three domains. 424 out of 456 respondents provided adequate responses. RESULTS Most respondents were from medical (51.5%) and surgical (11.8%) specialties. Over half of the respondents practiced in academic centers and one fifth in the private sector. Coronavirus pandemic induced frequent changes in practice, such as seeing fewer patients in clinics than usual (34.9%) and utilization of telemedicine (31.3%). A significant disruption in medical education activities and residents' training was observed, resulting in the cancellation of many activities such as grand rounds, departmental and multidisciplinary meetin...
Background: Research is an essential component in the advancement of medicine. Evidence indicates... more Background: Research is an essential component in the advancement of medicine. Evidence indicates that developing regions have low research productivity and contribution to the international literature. It is unclear if physicians' attitudes and perceptions of research could be contributory. Objectives: This study examined the attitudes to research, perceived barriers to research, and experiences of prior participation in research projects among physicians from the Middle East and Africa. Subjects and Methods: A cross-sectional electronic survey was developed based on the published literature to address these questions and was E-mailed to a large sample of practising clinicians and academics. Results: A total of 283 responses received, 61.1% were men with a mean age of 48 years. Responses originated from 23 countries. The majority were from the Middle East (79.2%), whereas 29.9% were from African countries. Over half of physicians (51.1%) held high-level speciality qualification...
Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide ... more Introduction: Vitamin D deficiency and obesity have been classified as pandemic issues worldwide with high prevalence of both the risk factors in the United Arab Emirates. In recent years, obesity has been associated with vitamin D deficiency, but very few studies have been published about the correlation between them in the UAE population. Subjects and Methods: This is a cross-sectional study designed to find a correlation between vitamin D deficiency and obesity along with other metabolic factors. Data were collected from electronic medical records of 300 subjects ranging from 15 to 85 years of age of various ethnic origins residing in Dubai. Results: The study showed a high prevalence of obesity (44.9%) and vitamin D deficiency (40.1) in our study population. There is no evidence of a relation between vitamin D level and the obesity; 40.1% of the subjects were vitamin D deficient, out of which 46.7% were obese. However, a statistically significant relationship was found between c...
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