Search

Background: Treatment of hemodynamic instability in patients with PPGL in the intra-and postoperative periods is challenging. Persistent postoperative hypotension is a common and serious complication, reportedly occurring in 30-60% of PPGL patients. This phenomenon reflects 1) high doses of pre-operative antihypertensive drugs; 2) low intravascular volume secondary to chronic catecholamine-induced vasoconstriction with pressure natriuresis; 3) the sudden drop in circulating catecholamines after surgery. It has been shown that tumor size and preoperative levels of catecholamines are directly related to the need for treatment with vasopressor agents in the early period after tumor removal. The aim of this study was to evaluate the efficacy and safety of the current perioperative treatment protocol for PPGL used in our Institute. Methods: We retrospectively reviewed the rate of hemodynamic instability and postoperative hypotension in relation to catecholamine levels, and the efficiency of preoperative pharmacological preparation in consecutive patients with PPGL treated between 2000-2019. Results: There were 39 patients (F/M 19/20; mean age 50.4 ±16.5 years) 33 of which had adrenal lesions and 6 had extra-adrenal tumors. Mean tumor size was 3.9 ±2.2 cm. Median metanephrine and normetanephrine levels were 5 and 10 fold the upper limit of the normal range respectively. All patients were treated with α-blockade (phenoxybenzamine-17, mean dose 60±38 mg/day; doxazosin-22; mean dose 9.6±6.1mg/day) along with β- blockade, and high sodium diet and IV saline 24 hours before the operation. The length of the preoperative preparation period was 3.4±2 weeks. Within the first 24-48 hours from surgery, no episodes of hypotension (

Background: Diabetic subjects with life-long massive obesity that have reached old age, often develop heart failure, severe hypertension and renal failure. Fluid retention necessitates increasing doses of diuretics, with further decline in renal function. Rationale: In older obese subjects who failed numerous standard dietary attempts and have developed complications which preclude bariatric surgery, prolonged periods of long and repetitive intermittent fasting may lead to a) regular fasting diuresis, such that will lessen the need for diuretics; b) fat loss. Both may ameliorate intractable comorbidities. Goal: To examine whether or not complete intermittent fasting can positively impact fluid overload, functional status and life quality in old obese diabetic subjects with heart and renal failure. Methods: Two 77y/o outpatient men were instructed to avoid any caloric intake, but consume calorie-free fluids ad libitum for 36 hours (last evening meal on the pre-fasting day; first next meal◊ breakfast on the post- fasting day), twice a week (total fasting hours 72/168 weekly hours) over 17 [patient A; A] and 13 months [patient B; B]. Insulin, GLP-1 analogs and oral drugs were individually adjusted for each fasting interval. Results: Extent of Experience: We accrued experience of 30 patient months. Effects: within this time frame, the following effects were observed: 1) Weight (and BMI) declined from 92 to 77kg (37.8->31.6kg/m2) and 108 to 84.6kg (40◊31kg/m2) in A, and B, respectively. 2) Heart failure (diastolic dysfunction with preserved systolic function) and functional capacity: we recorded: I. Improvement from NYHA class IV and III to II in B, A); II. Cessation of pulmonary edema events ( vs. 2 events/ patient in the preceding year); III: decrease >50% in the doses of furosemide; d/c of IV furosemide; IV: disappearance of peripheral edema; 3) Improvement in renal function in B (eGFR 15.7-->36.7cc/min) and stabilization in A (35cc/ml); 4) Improvement in anemia: hemoglobin rose by 2Gr% in B and 0.8gr% in A; 5) HgA1C was unchanged in A (7.8, 7.7%) in A and declined in B (6.7% ->5% in B). 5) Hypertension was not affected. Safety: hypoglycemia was not detected with regular, multiple point home glucose monitoring on the fasting days. Hyperkalemia was present a priori in both patients, required continuous f/u and treatment, but no other electrolyte and mineral abnormalities were seen. Compliance: Several events of partial/complete skipping of fasting resulted in fluid accumulation and leg edema, following which self-reported compliance has been nearly complete. At the present time, these subjects refuse to get off the protocol. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Background: With the growing prevalence of obesity, there is also a rise in the incidence of metabolic syndrome (MS). It is characterizes by hyperinsulinemia, increased fasting glucose, hypertriglyceridemia, low HDL, increased waist circumference and hypertension.Insulin-degrading enzyme (IDE) is the major enzyme responsible for insulin degradation among other proteins linked to glucose metabolism such as glucagon. Using genome wide associated studies, IDE was identified as a diabetes susceptibility gene. Furthermore, inhibition of IDE was suggested as therapeutic target for type 2 diabetes. Objectives: Study the difference in IDE levels between healthy and MetS subjects. Characterize metabolic parameters which correlate with IDE.Explore IDE levels in a mouse model of obesity/ insulin resistance. Methods: We developed highly specific anti IDE antibodies with the ability to detect human IDE levels using ELISA. IDE levels were measured in 45 MS subjects and 30 controls. Results: As expected, MS subjects had higher BMI, glucose, triglycerides and insulin levels, with lower HDL levels. IDE levels were higher in MS subjects (average 692 +/-464 vs 420 +/- 232 pg/microliter; p

Because only the free fraction of serum cortisol can readily access glucocorticoid receptors, we investigated whether or not a gender-related difference in serum free cortisol (FC) exists in the basal and adrenocorticotropic hormone (ACTH)-stimulated state.Serum total cortisol (TC) and FC were measured in 323 subjects (175 men; 148 women). Additionally, the low-dose 1-μg ACTH test was performed in 56 subjects (30 women, 26 men). Subjects were healthy volunteers, recruited in a preventive medicine screening program and an outpatient clinic.Overall, basal serum TC and FC level were ~18 and ~33%, respectively, higher in men than in women (TC, 14.5 ± 0.33 μg/dL vs. 12.3 ± 0.33 μg/dL; P.0001; FC, 0.68 ± 0.02 μg/dL vs. 0.51 ± 0.02 μg/dL; P.0001). The higher FC in men relative to women was apparent across a wide age range (17 to 86 years) and persisted after adjustment for age and body mass index. The FC fraction (%FC, out of TC) was concordantly higher in men (5.4 ± 0.09% vs. 4.8 ± 0.3%; P = .046). FC was not related to the estimated menopausal status (women age below and above 47, 50, or 53 years). ACTH-stimulated FC levels were significantly higher in men compared to women, as reflected by the area under the response curve (49.4 ± 3.4 μg × min vs. 39.6 ± 2.2 μg × min; P = .0014).Gender is an unrecognized determinant of serum FC in humans. The possibility of lifelong exposure to the higher bioactive fraction of cortisol under basal conditions or daily stress involving ACTH stimulation should be further investigated in the context of gender-related phenotypic features such as "android" (visceral) fat deposition and longevity.ACTH = adrenocorticotropic hormone BMI = body mass index CBG = cortisol-binding globulin FC = free cortisol HPA = hypothalamic-pituitary-adrenal TC = total cortisol.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) has recommended a downward shift in target blood pressure to

The authors assessed the practicality and results of forced titrating of blood pressure to