atherosclerosis/arteriosclerosis

Atherosclerosis/arteriosclerosis

A complex pathological condition in which the body reshapes and also damages the surface of the blood vessels as a direct consequence of various interactive metabolic processes that involve lipids (fats), white blood cells, antibodies, platelets, and other hormones and proteins. The current theory about what causes atherosclerosis is that most atherosclerosis is a product of an inflammation of the endothelium (the lining of blood vessels that comes into direct contact with circulating blood). This inflammatory process is ongoing and may progress and regress, depending upon the local conditions to which the endothelium is exposed. If the damaging process to the vessel continues, the blood vessel may become occluded (blocked).


However, more frequently, plaque accumulates from within the endothelium and finally ruptures into the lumen of the blood vessel, exposing lipids and other proteins directly into the bloodstream. This sets off a massive cascade of events that perpetuates the problem locally. The body harnesses the white blood cells, proteins, hormones, interleukins (hormones made by the white blood cells),
and the platelets, ultimately creating an occlusive blood clot (thrombus).
This clot results in even more blocking of blood flow and also prevents sufficient oxygen from reaching the affected organ. Depending on the severity of the blood flow blockage, atherosclerosis may lead to a heart attack, stroke, or other serious
medical problems. Experts now know that most myocardial infarctions
(heart attacks) occur in blood vessels that are only initially less than 50 percent blocked but, because of less stable caps on the vessel’s lining, are much more likely to rupture. In contrast, vessels that have not yet ruptured but have progressed to 80–99 percent occlusion have thick, fibrous coverings which, although they limit blood flow, are much less likely to rupture and lead to a complete occlusion. In addition, as the condition has typically progressed slowly, the tissue that is endangered has often had sufficient time to develop collateral
blood vessels upon which to rely. These are vessels that have bypassed the diseased area and, thus, help the organ—and the patient—to survive.


Risk Factors

Risk factors for atherosclerosis, include the following:
• High levels of “bad” cholesterol (low-density
lipoproteins)
• Low levels of “good” cholesterol (high-density
lipoproteins)
• Obesity
• DIABETES MELLITUS
• Hypertension
• An age of 65 and older (the risk for atherosclerosis
increases with age)
• Lack of exercise
• Insulin resistance syndrome
• A family history of atherosclerosis

Anovulation

Anovulation

The failure to release an egg in the ovulation process, which then leads to INFERTILITY.
Women with regular menstrual cycles typically have predictable times of ovulation. Those women with AMENORRHEA (failure to menstruate) usually have complete anovulation and, thus, do not ovulate at all. Women with irregular cycles (oligomenorrhea) have an erratic pattern of ovulation. Anovulation has many different etiologies (causes).

POLYCYSTIC OVARY SYNDROME (PCOS) is often a cause of anovulation. Patients with PCOS often have insulin resistance syndrome (IRS). In addition to IRS, LUTEINIZING HORMONE secretions are often abnormal.


The combination leads to hyperandrogenism, the likely underlying cause of the anovulation. Other causes of anovulation are HYPOTHYROIDISM and MENOPAUSE. The physician should screen the patient for thyroid dysfunction before attempting any direct treatment for anovulation.


Said Brinda N. Kalro, M.D., in a 2003 article in Endocrinology and Metabolism Clinics, “With the availability of ovulation-inducing agents, there is a possibility that thyroid disorders may be overlooked in women presenting with menstrual irregularities and anovulation. Pregnancy in women with overt thyroid disease is uncommon, but when it does occur, it can be fraught with complications and have grave consequences. Therefore, evaluation of the thyroid axis in women presenting with thyroid problems is imperative.”


Successful diagnosis and treatment of the underlying disease may resolve a woman’s anovulation. If the cause cannot be determined, sometimes ovulation can be stimulated with fertility drugs. These drugs should be administered and monitored by a physician who is experienced in treating women with infertility.

adrenal cortical cancer

Adrenal cortical cancer

A malignant tumor of the cortex of the adrenal gland, also known as an adrenocortical carcinoma or adrenal cancer. Only about one or two people in a million develop this very rare form of cancer. When it occurs, it is usually found among adults who are in their 40s or 50s, although adrenal cortical cancer also can be seen in children under the age of five years. It more commonly occurs in females. Sometimes adrenal cortical cancer is found among patients diagnosed
with MULTIPLE ENDOCRINE NEOPLASIA, type 1 (MEN 1). A tumor found in the adrenal medulla or in an area other than the adrenal cortex is known as a
PHEOCHROMOCYTOMA. Some tumors actively secrete hormones, while
others do not. Different studies have shown variable percentages of patients with actively secreting tumors. Patients with actively secreting hormones are discovered upon a physical evaluation of the patient, who typically presents with signs and symptoms of CUSHING’S SYNDROME or virilization (male symptoms in females). This includes hair where it is not typically seen in females, such as on
the chest, face, and so forth.

In the case of patients who have a nonsecreting tumor, the tumor is usually identified because of symptoms caused by its large size. In other cases, the tumor is found serendipitously when the patient has had an imaging study for an unrelated issue. An inactive tumor is more commonly seen in older patients. This type often progresses at a faster rate than those that are hormonally active.
An adrenocortical tumor is usually curable only when it is identified in an early stage, when the tumor is still confined to the adrenal gland. At this point, that particular adrenal gland can be surgically removed. Patients can then live a normal life, with the other adrenal gland taking over full duty to make the appropriate levels of hormones needed by the body. However, discovering this tumor at an early stage is not common. In fact, an early tumor, if discovered, is usually found accidentally.

By the time adrenal cortical cancer is usually identified, it has often metastasized (spread to other organs), typically to the lung, liver, lymph nodes, and bones.

endocrine glands

Endocrine glands

Ductless glands in the endocrine system that secrete hormones needed for normal functioning as well as for the sustaining of life. These glands work via hormones that are typically secreted into the bloodstream and travel to other organs to have their effects. If the hormones act upon nearby cells, even upon other cells within
the same gland, they display the paracrine effect.


The endocrine glands are the following: the adrenal glands, hypothalamus, ovaries, pancreas, parathyroid glands, pineal gland, pituitary gland, testes, thyroid gland, and the thymus. As researchers learn more and more about the human body, all organs in the body can clearly act as endocrine glands, which is to say, they secrete hormones.

For instance, the gastrointestinal tract is now known to synthesize and secrete over 40 hormones, many of whose function and operation are still unknown. The heart makes a hormone called atrial natriuretic factor or peptide that is involved
in the body’s salt and water balance.

Osteoporosis and Seniors

Osteoporosis and Seniors

Middle-aged and younger people may develop OSTEOPOROSIS. However, it is the most dangerous when present among elderly individuals because of the increased risk for bone fractures. In addition, the rate of hospitalization for vertebral fractures caused by osteoporosis increases dramatically with age. For example, among people between the ages of 65–74 in the United States, 6.7 people per 1,000 are hospitalized because of an osteoporotic vertebral fracture. This rate nearly quadruple for people age 75–84, to a rate of 26 people per 1,000. The rate of hospitalization for vertebral fractures rises still higher for people ages 85 and older, with a rate of 39 people per 1,000.



Many people believe that only older women are at risk for osteoporosis. However, older men are at risk as well. In some studies, such as the Rotterdam Study, bone loss in men ages 70–75 was actually worse than the bone loss found among same-aged women.

Some experts believe that bone loss is linked to declining levels of growth hormone among elderly individuals, but studies to date have not borne out this hypothesis. Further studies are needed to determine if administering growth hormone could improve bone density levels in older individuals.

However, studies on providing another substance, vitamin D, to elderly individuals who were deficient in vitamin D have demonstrated that bone density can improve with this supplementation. In one study, femoral bone density increased 2–7 percent over 18 months in elderly women given vitamin D, while it declined 4–6 percent in the group that received the placebo.

Osteoporosis is considered primary osteoporosis if no illness or cause can be found for it. It is usually reated with medications such as alendronate (Fosamax) to build up the bones. Other drugs that are prescribed for osteoporosis are risedronate (Actonel), raloxifene (Evista), and calcitonin (Miacalcin).

Osteoporosis is considered to be secondary if other factors have caused this medical problem. Many older people have secondary osteoporosis that
was originally caused by hypogonadism, THYROTOXICOSIS, and HYPERPARATHYROIDISM. Some medications, such as GLUCOCORTICOIDS and anticonvulsants, can also cause secondary osteoporosis. Some lifestyle
choices, such as alcohol abuse and smoking, can induce secondary osteoporosis as well. With secondary osteoporosis, a variety of treatment
recommendations can be made based on the underlying cause of the osteoporosis. For example, people who smoke should immediately stop smoking.


Endocrine diseases and disorders such as hypogonadism, thyrotoxicosis, and hyperparathyroidism can and should be treated. If medications are inducing secondary osteoporosis, physicians may change the drug or lower the dose. For example, if glucocorticoid drugs have caused secondary osteoporosis, physicians may decide to prescribe thiazide diuretics to correct this problem.

Never be depressed for you now know why

Depression

Clinically abnormal condition of low mood state with the inability to enjoy life and function at optimal levels. Depression may be caused by events in a person’s life, or it may be triggered by an endocrine disorder or other illness. In some cases, depression is misdiagnosed when the underlying problem is actually an endocrine disease, such as HYPOTHYROIDISM or CUSHING’S SYNDROME, and the patient is not truly clinically depressed. It is also true that patients may have an endocrine disorder as well as depression.

Most physicians consider depression highly treatable, and many patients respond very well to antidepressant medications. Most of the modern selective serotonin reuptake inhibitors (SSRIs) have response rates in the 80 percent range. Many different types of antidepressants are available.

Consequently, even if the first medication does not work, another medication may be efficacious.

Patients may also need to receive short-term therapy, such as cognitive-behavioral therapy (CBT), in which the therapist teaches the patient how to identify and challenge irrational beliefs that are self-defeating and destructive.

Mother's first contribution to the intellectual child

Breast-feeding

Providing nutrition to newborns, older infants, and sometimes toddlers through milk produced by a woman’s breasts. Breast-feeding is also known as lactation. Breast-feeding is strongly encouraged as a positive and nutritious way to feed a baby.


Some studies have indicated that women with HYPOCALCEMIA (below-normal levels of calcium in their blood) may actually show improvement in this condition during pregnancy and lactation, largely because of the production of PROLACTIN, a hormone linked to pregnancy, childbirth, and breast-feeding. Some women who were hypocalcemic may even become temporarily hypercalcemic while breast-feeding, as may some women with previously normal calcium blood levels.

A very small number of women, however, such as women with DIABETES MELLITUS who have proliferative retinopathy (an eye disease that may cause blindness), should consider refraining from breastbreast-their babies. The act of breast-feeding can worsen their retinopathy. Physicians have also discouraged breast-feeding among women being treated
for hyperthyroidism, although this view is moderating. A recent report in the Journal of Clinical Endocrinology & Metabolism, which studied 51 infants who were nursed by mothers taking methimazole (Tapazole), an antithyroid drug, revealed that the babies had normal THYROID-STIMULATING HORMONE (TSH) levels as well as other normal thyroid levels.

The children’s intellectual development, at 48 and 74 months, was normal as well.

Be aware of bone related diseases

Bone diseases

Illnesses that cause an underproduction of bone mass, such as osteoporosis, an overproduction of bone, such as PAGET’S DISEASE and ACROMEGALY, or abnormal bone, seen to varying extents in OSTEOPOROSIS, fibrous dysplasia, and Paget’s disease. Disorders of bone may be induced by nonendocrine causes, such as cancer, infection, vitamin deficiency, disorders of cartilage production, and genetic defects.



Bone density can be measured using a variety of techniques, most commonly with the dual-energy X-ray absorptiometry scan (DEXA SCAN). Bone biopsies are helpful in some cases. Blood and urine tests can help to determine the activities of the major cells within the bone, namely, the osteoclasts, which help to break down the bone, and the osteoblasts, which help to create the new bone.