A practical approach and algorithm for intensifying beyond basal insulin in type 2 diabetes.

Despite the availability of long-term data demonstrating the benefits of timely and aggressive intensification of antihyperglycaemic regimens among individuals with type 2 diabetes, intensification beyond basal insulin continues to be suboptimal and a global challenge. This review summarizes the evidence surrounding the various options of advancing glucose-lowering management beyond basal insulin and provides a practical algorithm to assist in optimizing patient care and enhancing glycaemic target achievements.

Management of Rathke's cleft cysts.

BACKGROUND: Incidental diagnosis of Rathke's cleft cysts (RCCs) has increased due to the improvements in imaging techniques; however, symptomatic cases are rare and accurate preoperative diagnosis can be difficult. METHODS: Files and magnetic resonance imaging (MRI) of 10 surgically treated patients with RCC and 8 conservatively managed cases with a suspected diagnosis were reviewed retrospectively. Clinical, radiological, and histological features as well as intraoperative findings were scrutinized. RESULTS: In the surgical group, headache was present in 4 patients, hormonal abnormality in 4, visual deficits in 3, and otolaryngological symptoms in 2. Two of the nonsurgical cases had hyperprolactinemia, and the remaining were asymptomatic. The cyst had suprasellar extension (SSE) in 9 patients and was entirely suprasellar in 1 in the surgical group. It was purely intrasellar in 6 nonsurgical cases and had SSE in 2. The cyst content showed hyperintense MRI signal in the majority of T1 and T2 images in both groups. Transsphenoidal surgery was performed in 8 and transcranial surgery in 2 patients. Squamous metaplasia and inflammation was present in 3 cases each. Initial hormonal deficiencies did not improve postoperatively and new deficits were observed in 2 cases. There was no recurrence with an average follow-up of 32 months. CONCLUSIONS: Rathke's cleft cysts is a rare pathology with a wide spectrum of clinical and radiological features. Reactive inflammation of the normal pituitary gland may have a role in the pathogenesis of hormonal deficiency, in addition to compression. Preoperative recognition of the anteriorly displaced normal residual gland may be important in avoiding postoperative hormonal deficiency after transsphenoidal approach.

A practical guide to diagnosis, management and treatment of testosterone deficiency for Canadian physicians.

The percentage of men receiving appropriate management for testosterone deficiency syndrome (TDS) is small in comparison to prevalence estimates. This is despite linkages to cardiovascular disease, osteoporosis, diabetes, sexual function, sarcopenia, emotional well-being and the metabolic syndrome. Furthermore, the availability of guidelines has not significantly enhanced the care of TDS patients. A multidisciplinary group of medical experts sought to improve the management of testosterone-deficient patients by Canadian physicians. This report describes their conclusions and defines an algorithm for appropriate TDS management.