Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
J Clin Endocrinol Metab ; 105(11)2020 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-32915987

RESUMEN

BACKGROUND: Recurrent hypoglycemia blunts counter-regulatory responses to subsequent hypoglycemic episodes, a syndrome known as hypoglycemia-associated autonomic failure (HAAF). Since adrenergic receptor blockade has been reported to prevent HAAF, we investigated whether the hypoglycemia-associated rise in plasma epinephrine contributes to pathophysiology and reported interindividual differences in susceptibility to HAAF. METHODS: To assess the role of hypoglycemia-associated epinephrine responses in the susceptibility to HAAF, 24 adult nondiabetic subjects underwent two 2-hour hyperinsulinemic hypoglycemic clamp studies (nadir 54 mg/dL; 0-2 hours and 4-6 hours) on Day 1, followed by a third identical clamp on Day 2. We challenged an additional 7 subjects with two 2-hour infusions of epinephrine (0.03 µg/kg/min; 0-2 hours and 4-6 hours) vs saline on Day 1 followed by a 200-minute stepped hypoglycemic clamp (90, 80, 70, and 60 mg/dL) on Day 2. RESULTS: Thirteen out of 24 subjects developed HAAF, defined by ≥20% reduction in average epinephrine levels during the final 30 minutes of the third compared with the first hypoglycemic episode (P < 0.001). Average epinephrine levels during the final 30 minutes of the first hypoglycemic episode were 2.3 times higher in subjects who developed HAAF compared with those who did not (P = 0.006).Compared to saline, epinephrine infusion on Day 1 reduced the epinephrine responses by 27% at the 70 and 60 mg/dL glucose steps combined (P = 0.04), with a parallel reduction in hypoglycemic symptoms (P = 0.03) on Day 2. CONCLUSIONS: Increases in plasma epinephrine reproduce key features of HAAF in nondiabetic subjects. Marked interindividual variability in epinephrine responses to hypoglycemia may explain an individual's susceptibility to developing HAAF.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/etiología , Epinefrina/sangre , Hipoglucemia/complicaciones , Adulto , Sistema Nervioso Autónomo/fisiopatología , Enfermedades del Sistema Nervioso Autónomo/sangre , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Glucemia , Femenino , Técnica de Clampeo de la Glucosa , Humanos , Hipoglucemia/sangre , Hipoglucemia/fisiopatología , Insulina/sangre , Masculino , Persona de Mediana Edad
2.
Diabetes ; 66(11): 2764-2773, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28860128

RESUMEN

Although intensive glycemic control improves outcomes in type 1 diabetes mellitus (T1DM), iatrogenic hypoglycemia limits its attainment. Recurrent and/or antecedent hypoglycemia causes blunting of protective counterregulatory responses, known as hypoglycemia-associated autonomic failure (HAAF). To determine whether and how opioid receptor activation induces HAAF in humans, 12 healthy subjects without diabetes (7 men, age 32.3 ± 2.2 years, BMI 25.1 ± 1.0 kg/m2) participated in two study protocols in random order over two consecutive days. On day 1, subjects received two 120-min infusions of either saline or morphine (0.1 µg/kg/min), separated by a 120-min break (all euglycemic). On day 2, subjects underwent stepped hypoglycemic clamps (nadir 60 mg/dL) with evaluation of counterregulatory hormonal responses, endogenous glucose production (EGP, using 6,6-D2-glucose), and hypoglycemic symptoms. Morphine induced an ∼30% reduction in plasma epinephrine response together with reduced EGP and hypoglycemia-associated symptoms on day 2. Therefore, we report the first studies in humans demonstrating that pharmacologic opioid receptor activation induces some of the clinical and biochemical features of HAAF, thus elucidating the individual roles of various receptors involved in HAAF's development and suggesting novel pharmacologic approaches for safer intensive glycemic control in T1DM.


Asunto(s)
Glucosa/administración & dosificación , Hipoglucemia/metabolismo , Insulina/administración & dosificación , Receptores Opioides/metabolismo , Adulto , Glucemia/efectos de los fármacos , Péptido C/sangre , Estudios Cruzados , Epinefrina/sangre , Femenino , Glucosa/metabolismo , Técnica de Clampeo de la Glucosa , Humanos , Hidrocortisona/sangre , Insulina/sangre , Masculino , Morfina/farmacología , Norepinefrina/sangre
3.
Future Cardiol ; 13(3): 247-257, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28570141

RESUMEN

Acute coronary syndrome (ACS) coinciding with active malignancy presents a unique clinical challenge given intersecting pathophysiology and treatment-related effects. There is little established clinical guidance on management strategies, rendering most treatment approaches anecdotal. We present a case highlighting the complexity of managing a patient being treated for malignancy who concurrently suffers from ACS. We then review the literature on co-management of ACS and malignancy, including reports of specific cancer therapies associated with ACS, unique features of clinical presentation and optimal use of dual antiplatelet therapy to minimize risks of bleeding and thrombosis. We also describe gaps in current literature, challenges in systematically studying the clinical intersection of these disease processes and propose alternative methodologies for further research.


Asunto(s)
Antineoplásicos/efectos adversos , Trombosis Coronaria/terapia , Isquemia Miocárdica/terapia , Stents , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Síndrome Coronario Agudo , Antineoplásicos/uso terapéutico , Trombosis Coronaria/etiología , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Isquemia Miocárdica/inducido químicamente , Neoplasias de la Vejiga Urinaria/etiología
4.
Endocr Pract ; 21(4): 368-82, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25297659

RESUMEN

OBJECTIVE: Pheochromocytomas are complex tumors that require a comprehensive and systematic management plan orchestrated by a multidisciplinary team. METHODS: To achieve these ends, The Mount Sinai Adrenal Center hosted an interdisciplinary retreat where experts in adrenal disorders assembled with the aim of developing a clinical pathway for the management of pheochromocytomas. RESULTS: The result was a consensus for the diagnosis, perioperative management, and postoperative management of pheochromocytomas, with specific recommendations from our team of adrenal experts, as well as a review of the current literature. CONCLUSION: Our clinical pathway can be applied by other institutions directly or may serve as a guide for institution-specific management.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/terapia , Vías Clínicas , Feocromocitoma/terapia , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Humanos , Feocromocitoma/diagnóstico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...