Imaging of the adrenals by endoscopic ultrasound (EUS) is a valuable technique for detection and localization of adrenal lesions, but endosonomorphological tumor distinction remains difficult. In this single-center study, the amount of blood flow in common adrenal lesions, such as adrenal adenomas, adrenal hyperplasia, and pheochromocytomas, was visualized by color-coded duplex EUS (CD-EUS) and was retrospectively analysed. Therefore, we reviewed our EUS database to evaluate and correlate the perfusion patterns of common adrenal lesions with histologically confirmed diagnosis, possible malignancy, and endosonomorphological features such as echogeneity, echostructure, and tumor size. CD-EUS was performed using an endosonoscope Pentax FG 32 UA with a longitudinal 7.5 MHz sector array and Hitachi EUB 525 ultrasound system. In 38 consecutive patients (male=19; female=19; age: mean 53±16 yr SD), perfusion patterns of 46 histologically confirmed adrenal, para- or extra-adrenal lesions of adrenal origin (adenoma: no.=20; nodular hyperplasia: no.=11; pheochromocytoma: no.=15; diameter 26±15 mm, range 6–70 mm) were analyzed and classified semiquantitatively as “not” (no.=24), “slightly” (no.=12), “moderately” (no.=4) or “highly” (no.=6) hypervascularized. Compared to adenomas (p=0.003) and nodular hyperplasia (p=0.047), pheochromocytomas showed a significantly higher grade of perfusion. There was no relationship between perfusion patterns and localization of pheochromocytomas (adrenal: 8; paraadrenal: 3; extra-adrenal: 4). Vascularization was not statistically associated with tumor echogeneity, echostructure, malignancy or tumor size. CD-EUS is an additional tool for adrenal endosonographic tumor distinction and seems to improve the endosonographic detection of pheochromocytomas by visualization of hypervascularization. As an overlap of perfusion patterns exists, CD-EUS findings must be interpreted in the context of clinical, laboratory and chemical results.

OBJECTIVE Hypothalamic-pituitary insufficiency may have diverse causes. The aim of this study was to determine the incidence of hypothalamic-pituitary insufficiency in patients with previous infectious diseases of the central nervous system (CNS) of different etiologies and mild-to-moderate clinical course. DESIGN Patient series. Basal and stimulated (insulin tolerance test) pituitary function testing was performed in 19 patients with previous neuroborreliosis, encephalitis, or meningitis following an interval of between 10 and 56 months (mean 26.1+/-13.1 months) after the acute event. RESULTS Four patients (21%; two males, two females) showed an isolated corticotropic insufficiency (peak cortisol <181.25 microg/l during the insulin tolerance test). Two patients (11%, males) showed borderline gonadotropic insufficiency (basal testosterone between 2.4 and 3.0 microg/l). No patient had somatotropic or thyrotropic insufficiency or evidence for diabetes insipidus; all had prolactin concentrations within the reference range. CONCLUSIONS Hypothalamic-pituitary dysfunction and especially isolated corticotropic insufficiency may develop in a relevant proportion of patients after infectious diseases of the CNS.

OBJECTIVE:Adrenal lesion is one of the features of multiple endocrine neoplasia type 1 (MEN1). This study aimed to assess prevalence, natural course and clinical relevance of small adrenal lesions without clinical symptoms, endocrine activity, or mechanical problems and thus without clear indication for surgical therapy by endoscopic ultrasound (EUS).DESIGN AND METHODS:Forty-nine patients with familial MEN1 were studied. Twenty-seven of these with adrenal lesions were detected by EUS and at least two performed EUS examinations were included into a subgroup where changes in adrenal morphology were studied by measuring changes in the largest diameter of the dominant adrenal tumour.RESULTS:EUS detected adrenal lesions in 36 (73%) patients: 6 (12%) plump adrenals, 17 (35%) nodular hyperplasia, 12 (24%) adenomas and 1 (2%) cyst. Bilateral adrenal lesions were detected in 17 patients and unilateral in 19 patients. A change in the largest tumour diameter was found to be for nodular hyperplasia -0.02+/-1.41% per month (range -2.56 to 4.58%) and for adenomas -0.61+/-1.95% per month (range -6.25 to 1.15%). One patient had an adrenal cyst with significant growth. There was no evidence of carcinoma or metastatic disease during the study.CONCLUSIONS:The prevalence of adrenal lesions in MEN1 is higher than that reported earlier. Except one cystic lesion, no significant change in the tumour size was observed over a mean observation period of more than 2 years. In a typical situation, small adrenal lesions in MEN1 seem to be constant in their morphology.

Objectives: The exon 3-deleted/full-length growth hormone receptor (d3/fl GHR; 5p13–12) polymorphism has recently been associated with responsiveness to growth hormone (GH) therapy in idiopathic-short-stature-, small-for-gestational-age-, Turner- and GH-deficient children. The GHRd3-allele was accompanied by an increased responsiveness to GH.

OBJECTIVEEndoscopic ultrasound (EUS) is a highly reliable procedure to localize insulinomas preoperatively. It has been considered to be important in planning surgical strategy, especially considering a minimal invasive approach. However, even under ideal conditions experienced examiners miss about 10-20% of insulinomas by EUS imaging.DESIGN AND METHODSThis retrospective study aimed to identify factors associated with negative EUS imaging. Twenty-nine consecutive patients (24 benign and 5 malignant) with sporadic pancreatic insulinomas confirmed by successful surgery and positive histopathology were included. All EUS examinations were performed by one single experienced examiner over a period of one decade.RESULTSThree of the tumors were not detected by preoperative EUS as they were isoechoic to the surrounding healthy pancreatic tissue; 25 could be detected as hypoechoic lesions, (including all malignant tumors), and one lesion was hyperechoic. Low body mass index (P=0.053) and young age (P=0.037) were associated with negative EUS imaging. All patients with negative imaging were females. The position on the examiner's learning curve, the diameter and location of insulinoma, and endocrine parameters (insulin concentrations and insulin-glucose ratios in the prolonged fasting test) had no influence on the success of EUS imaging.CONCLUSIONSSome insulinomas are missed by preoperative EUS imaging as they are completely isoechoic. A low body mass index, female gender, and young age might be risk factors for negative imaging.

Patients with multiple endocrine neoplasia type 1 (MEN1) represent among cancer patients a particular group of hereditary tumour syndrome with a long duration of disease and multiple follow-ups. MEN1 is characterized by predisposition mainly to tumours of the parathyroid glands and (enteropancreatic) neuroendocrine tumours but also involvement of anterior pituitary, adrenals and other endocrine glands. Only one report regarding quality of life (QoL) in these patients is available so far (Berglund et al., Fam Cancer 2003). Patients and Methods: 23 patients (13 males, 10 females, age range 23–67yrs) with MEN1, followed up by the interdisciplinary team (internists and surgeons) in our university hospital. Patients answered three questionnaires: the Nottingham Health Profile (NHP – a generic healthy survey), the questionnaire for Quality of life – Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA – designed to evaluate adult patients with growth hormone deficiency) and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) Version 3.0– used to asses the health related quality of life in cancer patients (22 patients). The results for the NHP and the EORTC QLQ-C30 were matched to reference data published for theses questionnaires for the German population. Differences ≥ +2 SD (standard deviation) were defined as pathological, ≤+1 as normal and between +1SD and +2 SD as marginal/intermediate. Results: Most pathological scorings in the NHP were for energy lost (26%) and emotional reactions (22%). Only 13% reported pains. 26% of patients showed low QoL as evaluated with the QoL-AGHDA (47% of the studied patients hat pituitary involvement but none of them pituitary hormones deficiencies). Scorings on functional scales of the EORTC QLQ-C30 were comparable and higher for the cognitive and role scales (better QoL), the lowest ratings were achieved for the social, emotional and physical scales. On the symptoms scale more problems were reported with fatigue (41%), less with pain and with nausea/vomiting. The global health/QoL scale reflected only in 14% patients pathological results, but indicated marginal results in 32%. Conclusions: Patients with MEN1 perceives their global/health-related QoL as reduced but still relatively good; items as energy lost/fatigue rises as the most important aspects, probably influencing physical, emotional and social functioning.

Over 90 percent of neuroendocrine tumors, including nonfunctioning pancreatic tumors are expressing somatostatin receptors.

MEN1 is characterised by predisposition mainly to tumors of the parathyroid glands and enteropancreatic neuroendocrine tumors (NET). Pituitary involvement was underestimated.

Endoscopic ultrasound (EUS) enables detection and localization of pancreatic neuroendocrine tumours. Even small tumours down to a diameter of 1-2 mm can be visualized. Since such small tumours usually cannot be detected by computed tomography (ct), magnetic resonance imaging (mri) and somatostatin receptor scintigraphy (srs), and experience with EUS imaging is limited, there is no clear evidence for clinical management in multiple endocrine neoplasia type 1 (MEN1). Knowledge about the natural course of growth and metastatic distribution is mandatory to come to appropriate clinical decisions and guidelines. This prospective study was aimed to assess the natural course of small (<15 mm) neuroendocrine pancreatic tumours without clinical symptoms due to endocrine activity or mechanical problems and without clear indication for surgical therapy in MEN1 by EUS. A total of 82 asymptomatic tumours<15 mm (5.9+/-3.2 mm diameter at baseline) in 20 patients with MEN1-disease (8 female/12 male, 43+/-13 years) were studied over a period of 20+/-12 months (33.8 patient years, 106.7 tumour years) by EUS. Change in largest diameter of each tumour and annual tumour incidence rate in the patients' cohort were calculated. Increase of largest tumour diameter was found to be 1.3+/-3.2% per month, annual tumour incidence rate 0.62 new tumours per patient year. In one patient, rapid progressive pancreatic manifestation of MEN1 was observed. There was no evidence in ct and/or srs and/or mri for metastatic disease in all patients. Only 4/84 (4.8%) pancreatic tumours could be visualized by computed tomography, 5/79 (6.3%) by somatostatin receptor imaging and 4/39 (10.3%) by magnetic resonance imaging. Small asymptomatic neuroendocrine pancreatic tumours in MEN1 usually seem to grow slowly. Annual tumour incidence rate is low. However, faster growing tumours and patients with rapidly progressive disease can be observed. Risk for obvious metastatic disease from asymptomatic neuroendocrine pancreatic tumours<15 mm in MEN1 seems to be low.

Nebenniere Die Adenohypophyse korrespondiert mit der Nebennierenrinde durch die Sekretion von ACTH; periphere Antwort ist die Sekretion von Kortisol. Bei vielen malignen Erkrankungen bzw. der Durchführung von Chemotherapien ist die hochdosierte Gabe von Dexamethason oder anderen Glukokortikoiden Standard. Die dadurch ausgelöste Osteoporose ist geläufig, ebenso die potente, in aller Regel aber vorübergehende Suppression von Hypophyse und Hypothalamus [32]. Eine weitere Komplikation ist die aseptische Knochennekrose.

Der Typ 2 Diabetes mellitus gehört zu den häufigsten chronischen Krankheiten und führt nicht selten zu schwerwiegenden Folgeerkrankungen, deren Behandlung gesellschaftlich einen großen Aufwand erfordert. Inwieweit Physiotherapeuten und Sporttherapeuten im Rahmen der medizinischen Trainingstherapie einen Beitrag zur Reduzierung von Risikofaktoren für Folgeerkrankungen bei Typ 2 Diabetikern leisten können, war Fragestellung dieser Arbeit. Anhand aktueller Literatur wurde die Wirkung von Training auf das Körpergewicht bzw. die Körperzusammensetzung (Fettgewebe, fettfreie Masse Muskelgewebe), die Insulinresistenz sowie Parameter des Glukosestoffwechsels (Glykämie, Insulinämie, HbA1c), die Blutfettwerte (Triglyzeride, Gesamtcholesterin, HDL-, LDL-Cholesterin) und auf den Blutdruck bestimmt. Die Literatursuche in der computerbasierten Datenbank MEDLINE für den Zeitraum von 1984 bis einschließlich August 2004 nach Studien, die den Effekt von regelmäßigem Training bei Typ 2 Diabetikern gegenüber einer nichttrainierenden Kontrollgruppe untersuchten bzw. die den Effekt unterschiedlicher Trainingsformen oder Intensitäten verglichen, ergab zur Auswertung 17 Publikationen zu 15 randomisierten kontrollierten Studien. Regelmäßiges Training mit übergewichtigen Typ 2 Diabetikern führt zu einer Abnahme des Körperfettanteils, vor allem der abdominalen Fettdepots, und einer Zunahme der fettfreien Masse und der Muskulatur. Eine Gewichtsreduktion erfolgt nicht zwingend bzw. langsam. Insulinsensitivität und Glukosetoleranz werden verbessert und die durchschnittlichen Tagesblutzuckerspiegel abgesenkt, während ein Einfluss auf den Nüchternblutzucker und erhöhte Insulinspiegel nicht nachgewiesen werden konnte. Nach längeren Trainingsperioden sinkt zudem das HbA1c. Dagegen lassen sich die Blutfettwerte durch Ausdauertraining nicht regelhaft und durch Krafttraining überhaupt nicht positiv beeinflussen. Die Ruheblutdruckwerte bleiben sowohl bei Ausdauer- als auch bei Krafttraining gleich oder sinken ab. Somit können Physiotherapeuten bzw. Sporttherapeuten im Rahmen der medizinischen Trainingstherapie Einfluss auf Faktoren nehmen, die zur Entstehung mikro- oder makroangiopathischer Veränderungen führen und zur Senkung der Komplikationsrate bei Typ 2 Diabetikern beitragen.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Analysis and interpretation of insulin-like growth factor 1 in serum (IGF-1) is a principal diagnostic and follow-up tool in growth hormone-related disorders and is becoming of interest for many other disorders. Only for the automated chemiluminescence immunoassay Nichols Advantage have age- and sex-specific reference values based on a large population and valid for different laboratories been established. The aim of the present study was to compare two different assays (the automated chemiluminescence immunoassay and the enzyme-linked immunosorbent assay DSL-10-2800) in order to prove applicability of recently published reference values. The study included 95 serum samples from 88 patients, adults as well as children, with different or no endocrine disorders, and acromegalic as well as growth hormone-deficient patients. IGF-1 measurements were performed with both methods. The results have shown a very high correlation between the IGF-1 values obtained with the two assays (r=0.971, p<0.0001). In conclusion, the reference values established for the chemiluminescence assay are applicable also for the enzyme-linked immunosorbent assay.

Endoscopic ultrasonography is recently known as a valuable procedure in detection and localization of adrenal lesions. Nevertheless, tumor classification by endosonomorphological criteria is still difficult.

Objective: After primary hyperaldosteronism (PA) is hormonally documented, the most important step is to differentiate between a disease that can be surgically cured (aldosterone-producing adenoma – APA) and other entities of PA, especially bilateral adrenal hyperplasia (BAH). Classical imaging of adrenal glands (computed tomography, magnetic resonance, adrenal scintigraphy) may miss small unilateral or bilateral lesions or give ambiguous results, though it is necessary to make the distinction by adrenal venous sampling (AVS). We evaluated retrospectively the value of endosonography in detecting adrenal tumors or adrenal hyperplasia.