Longitudinal analysis of laparoendoscopic single-site adrenalectomy and conventional laparoscopic adrenalectomy regarding patient-reported satisfaction and cosmesis outcomes.

BACKGROUND/OBJECTIVE: To compare longitudinal patient-reported cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) to that of conventional laparoscopic adrenalectomy (CLA). METHODS: A total of 23, 15, and 9 patients underwent transumbilical LESS-A (TU-LESS), subcostal LESS-A (SC-LESS), and CLA, respectively. A questionnaire was administered asking the patient to assess wound pain (0: not painful to 10: very painful), satisfaction (0: not satisfied to 10: very satisfied), and cosmesis (0: very ugly to 10: very beautiful) on the basis of a visual analogue scale. We mailed questionnaires to all patients who received LESS-A and CLA at postoperative 1, 3, 6, 9, and 12 months. RESULTS: No significant differences were observed in the pain scores between TU-LESS, SC-LESS, and CLA at every time point. In the CLA group, the cosmesis and satisfaction scores were significantly lower at postoperative 3 months (p = 0.0033, 0.0130). There were no significant inter-group differences in the cosmesis score between the three groups after postoperative 6 months. However, the satisfaction score of SC-LESS decreased after postoperative 3 months and was significantly lower at postoperative 9 and 12 months (p = 0.0333, 0.0160). The difference between the satisfaction scores of each procedure gradually increased after postoperative 6 months. CONCLUSION: This study is the first comprehensive longitudinal analysis of patient-reported satisfaction and cosmesis outcomes between LESS-A and CLA. The resulting data provide important insights into the improvement in satisfaction in patients who underwent TU-LESS. These findings can facilitate the treatment decision-making process for patients who are considering laparoscopic adrenalectomy.

Sexual symptoms in endocrine diseases: psychosomatic perspectives.

BACKGROUND: Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinemia, but almost all extragonadal endocrinopathies (hyper- and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumors, etc.) may have a greater or lesser effect on sexual function. METHODS: We analyzed scientific literature on the correlations between hormones and sexual behavior, analyzing the most important issue from a practical point of view. The aim of this review article was thus to summarize the sexual symptoms that may be observed with endocrine diseases. RESULTS: Hormones directly or indirectly regulate all human sexual functions (desire, erection/lubrication, ejaculation, orgasm). Some sexual symptoms may occur as a psychosomatic consequence of hormonal impairment. However, in other cases, endocrine failure may be generated by the psychosomatic involvement. CONCLUSIONS: The endocrinologist, as an expert in body chemistry, is ideally positioned to identify and evaluate the full range of medical, physical, and psychiatric problems disrupting sexual function.

Effect of the 2004 mid niigata prefecture earthquake on patients with endocrine disorders.

A major earthquake (Richter scale magnitude 6.8) struck the Chuetsu district of Niigata Prefecture, Japan, a rural area with mountain villages, on October 23, 2004. Strong aftershocks (Grade 5-6 on the Japanese intensity scale, JIS) continued for 2 months. We analyzed the earthquake's impact on 229 patients with various endocrine disorders [6 central diabetes insipidus (CDI), 16 adrenal insufficiency (AI) including 5 panhypopituitarism, 10 ACTH isolated deficiency and 1 Addison's disease, 145 Graves' disease and 62 Hashimoto's disease]. The status of patients with CDI or AI was not adversely affected by the earthquake. Twenty-eight (19%) patients with Graves' disease developed more severe hyperthyroidism; the incidence of developing more severe hyperthyroidism increased with greater degrees of hyperthyroidism. Three (5%) patients with Hashimoto's disease developed increased TSH concentrations. Most patients stayed in their own houses following the first shock. The median PTSD total score for all patients was low. However, the PTSD total score in patients with CDI or Hashimoto's disease was significantly higher than in other patients, while the subscore of mental status in patients with AI was significantly much lower than in other patients. In patients with Hashimoto's disease, patients whose hypothyroidism worsened had higher total and environmental effects score than patients whose hypothyroidism remained stable. Comparing patients whose hyperthyroidism became more severe to those in whom it remained stable, as well as on multiple logistic regression analysis, serum TRAb was found to be a risk factor for developing more severe hyperthyroidism. In conclusion, our findings indicate that Graves' disease patients need to maintain their euthyroid state with a low serum TRAb titer to prevent the development of further thyroid dysfunction after an earthquake, and that all patients should continue to take their medication, since it is likely that their lives will be interrupted by environmental effects owing to earthquake-shock, especially patients with CDI or Hashimoto's disease. Due to the risk of medical facility closure during a disaster, all patients should always have a note or copy of their medical records, including medical history and medications used, to avoid relying on patients remembering their drug names and doses. Furthermore, appropriate information should be provided by all means possible, including the mass media, to affected individuals, particularly those with AI, to decrease the occurrence of adverse consequences.

Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial.

The physiological role of dehydroepiandrosterone (DHEA) is not well understood, but studies suggest positive effects on subjective health and bone metabolism. We have conducted a clinical trial with DHEA replacement in adrenal failure with the primary aim of evaluating effects on subjective health status and sexuality. Thirty-nine women with adrenal failure were randomized to 9 months of treatment with 25 mg DHEA (n = 19) or placebo (n = 20). Treatment effects were assessed by validated questionnaires of subjective health and sexuality. DHEA replacement yielded a wide variation of effects on the subjective health scales, which were not different from the effects of placebo. Almost all patients receiving DHEA obtained normal androgen levels. Eighty-nine percent of the patients receiving DHEA experienced side-effects, in particular increased sweat odor and scalp itching. DHEA replacement did not significantly change the levels of blood lipids, IGF-I, and markers of bone metabolism. In conclusion, we do not find evidence of beneficial effects of DHEA on subjective health status and sexuality in adrenal failure. However, DHEA may be beneficial for subgroups of patients with adrenal failure, but these remain to be identified. Premenopausal androgen levels can be restored with 25 mg DHEA daily in most female patients, but side-effects are frequent.

[Psychiatric disorders in thyroid and adrenal gland diseases]. / Zaburzenia psychiczne w chorobach tarczycy i nadnerczy.

Clinical picture of psychiatric disturbances occurring in dysfunctions of thyroid or adrenal axes is presented.

[Therapeutic action of an antioxidant in chronic emotional-pain stress in the rat]. / Terapevticheskoe deistvie antioksidanta pri khronicheskom émotsional'no-bolevom stresse u krys.

Chronic emotional pain stress in rats causes disturbances of the cardiovascular system function (increase in arterial pressure and in heart rate), typical of neuroses-like state, and changes of the vegetative nervous system reactivity tested with functional load by two-hour hypokinesis. Increase in spleen weight is observed as well as a tendency to adrenals weight increase, a decrease of Na, K-ATPase activity and activation of lipid peroxidation in cortical and hippocampal homogenates. Administration of F-801 antioxidant according to therapeutic scheme after the end of stress action, restores normal function of the cardiovascular system, normal reactivity of the vegetative nervous system, decreases adrenals weight and increases the weight of thymus and also normalizes ATPase activity and the level of lipid peroxidation. A backward correlation dependence of the Na, K-ATPase activity on the level of malondialdehyde in the brain tissue has been established.

Psychiatric symptoms in endocrine diseases. Keys to identifying the underlying disorder.

Several important points should be considered regarding psychiatric symptoms in endocrine disorders. The presence of cognitive deficits in a patient presenting with anxiety, depression, or another apparently "functional" psychiatric complaint should raise the index of suspicion of organic etiology, with endocrine disorders high on the list. Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. When significant disruption of cognitive functioning is evident, residual deficits may develop. Treatment with psychotropic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders.