- A 40-year-old patient presented with low-grade fever, coughing up blood, and weight loss. Tests showed signs of tuberculosis (TB) and the patient was started on anti-TB drugs. However, the patient died suddenly after 3 days of treatment.
- Addison's disease is a condition caused by insufficient production of hormones by the adrenal glands. It was first described by Dr. Thomas Addison in the 19th century. Common causes include autoimmune disease and TB infection of the adrenal glands.
- Without treatment, Addison's disease can cause low blood pressure, low blood sugar, high potassium levels, and even death. Treatment involves replacing glucocorticoid and
The prevalence of well-documented, permanent adrenal insufficiency is 5 in 10,000 in the general population. Hypothalamic-pituitary origin of disease is most frequent, with a prevalence of 3 in 10,000, whereas primary adrenal insufficiency has a prevalence of 2 in 10,000. Approximately one-half of the latter cases are acquired, mostly caused by autoimmune destruction of the adrenal glands; the other one-half are genetic, most commonly caused by distinct enzymatic blocks in adrenal steroidogenesis affecting glucocorticoid synthesis (i.e. congenital adrenal hyperplasia.)
Adrenal insufficiency arising from suppression of the HPA axis as a consequence of exogenous glucocorticoid treatment is much more common, occurring in 0.5–2% of the population in developed countries.
The prevalence of well-documented, permanent adrenal insufficiency is 5 in 10,000 in the general population. Hypothalamic-pituitary origin of disease is most frequent, with a prevalence of 3 in 10,000, whereas primary adrenal insufficiency has a prevalence of 2 in 10,000. Approximately one-half of the latter cases are acquired, mostly caused by autoimmune destruction of the adrenal glands; the other one-half are genetic, most commonly caused by distinct enzymatic blocks in adrenal steroidogenesis affecting glucocorticoid synthesis (i.e. congenital adrenal hyperplasia.)
Adrenal insufficiency arising from suppression of the HPA axis as a consequence of exogenous glucocorticoid treatment is much more common, occurring in 0.5–2% of the population in developed countries.
Addison Disease
By Dr Usama Ragab Youssif
The term ‘adrenal insufficiency’ (AI) refers to failure of the adrenal cortex to secrete enough glucocorticoids, mineralocorticoids, or both. AI can be divided into two general categories:
lack of adequate hormone secretion by the adrenals (primary AI)
inadequate ACTH or CRH secretion (secondary AI).
Infertility is defined as the inability of a couple to conceive after at least one year of regular unprotected intercourse.
Male infertility refers to a male's inability to cause pregnancy in a fertile female.
IDD situation in our country has improved
A good number of thyroid disorder patients are either undiagnosed and or untreated
Thyroid disorder in pregnancy- Rate high
As a sound thyroid functioning status is crucial for growth, development in children; reproduction, psychological and general wellbeing in adults, we must be proactive in screening, diagnosing and treating our patients.
Over the past several years it has been proved that maternal thyroid disorder influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. It is associated with fetal loss, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring.1 In pregnancy, overt hypothyroidism is seen in 0.2% cases2 and sub clinical hypothyroidism in 2.3% cases3. Fetal loss, fetal growth restriction, pre-eclampsia and preterm delivery are the usual complications of overt hyperthyroidism (low TSH and high T3, T4) seen in 2 of 1000 pregnancies whereas mild or sub clinical hyperthyroidism (suppressed TSH alone) is seen in
1.7% of pregnancies and not associated with adverse outcomes4. Autoimmune positive euthyroid pregnancy shows doubling of incidence of miscarriage and preterm delivery. Worldwide more than 20 million people develop neurological sequel due to intra uterine, iodine deprivation5. Other problems of thyroid disorders in pregnancy are post partum thyroiditis, thyroid nodules and cancer, hyper emesis gravidarum etc. Debates and disputes persist regarding several protocol and management plan in this specific spectrum of diseases.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Case study:
• A patient of 40 years came to doctor with
the complaints of low grade fever for 3
months, haemoptysis and wt. loss. In
investigation- ESR 110 mm hr, x-ray
reveals-TB focus. Anti-TB drug started
but patient died suddenly after 3 days.
The doctor became confused whether
the patient died due to TB or anti-TB
drugs or some other causes.
???
3. • Addison's disease is a clinical condition
resulting from adrenocortical
insufficiency due to primary acquired
disease of adrenal gland. An English
physician, Thomas Addison, first
described this disease almost 150 years
ago.
4. These pictures are from Thomas
Addison's book in which he first
described Addison's Disease.
5.
6. Incidence:
• Addison's disease is a rare endocrine or
hormonal disorder that affects about 1 in
100,000 people. It occurs in all age groups and
afflicts men and women equally.
7. Causes of Addison’s Disease:
Common causes:
• Autoimmune mechanism- 80% cases (more in female)
• Tuberculosis (of adrenal gland)-10%
• Secondary deposit in adrenals
• HIV infection
• Bilateral adrenalectomy
Other causes:
• Amyloidosis
• Sarcoidosis
• Haemochromatosis
• Bilateral adrenal haemorrhage- following meningococcal septicaemia
(Waterhouse- Friedrichson syndrome), trauma
• Lymphoma
8. Clinical features:
• Due to glucocorticoid insufficiency-
Weight loss
Malaise
Weakness
Anorexia
Nausea
Vomiting
Gastrointestinal-diarrhoea or constipation
Postural hypotension
Shock
Hypoglycaemia
Hyponatraemia (dilutional)
Hypercalcaemia
9. Clinical features(contd.)
• Due to mineralocorticoid insufficiency-
Hypotension
Shock
Hyponatraemia (depletional)
Hyperkalaemia
10. Clinical features(contd.)
• Due to ACTH excess-
Pigmentation:
Sun-exposed areas
Pressure areas, e.g. elbows, knees
Palmar creases
Knuckles
Mucous membranes
Conjunctivae
Recent scars
11. Clinical features(contd.)
• Due to adrenal androgen insufficiency:
Decreased body hair and loss of
libido, especially in female
12. Diagnostic criteria of Addison’s
Disease:
Triad of-
• Weakness or emaciation (100% cases)
• Pigmentation (90% cases)
• Hypotension
13. Investigation
• Random plasma cortisol level-
Usually low but may be within normal range.Refute the diagnosis if the
value is >460nmol/L
• Short ACTH stimulation test/Tetracosactide or short
synacthen test-250microgram ACTH by i.m at any time of day -0 and
30min for plasma cortisol-in addison’s disease plasma
cortisol<460nmol/L
• Long ACTH stimulation test-1mg depot ACTH i.m daily for 3 days-
plasma cortisol <700nmol/L at 8hrs after last injection
14. Investigation(contd):
• CBC-
For pernicious anaemia
• Blood glucose-
Low or lower limit, specially during
Addisonian crisis.
• Electrolytes-
a)Hyponatraemia.
b)Hyperkalaemia.
Only hyponatraemia is more important.
15. Investigation(contd):
• Tests to find out causes-
a)Chest X-ray (tuberculosis).
b)Plain X-ray of abdomen (to see adrenal calcification in
tuberculosis).
c)Adrenal auto-antibody.
d)Ultrasonography or CT scan of adrenals.
e)HIV test.
• Other tests-
Plasma calcium-high
Plasma renin activity-high
Plasma aldosterone-low
16. Treatment:
Replacement of hormones-
• Glucocorticoid (hydrocortisone-15 mg on waking and 5 mg at 6p.m)
• Mineralocorticoid (fludrocortisone 0.05 to 0.1mg daily)
Supportive treatment and treatment of cause:
e.g. if TB- antitubercular therapy
General advice to the patient-
• Good nutrition, regular meal, high carbohydrate and sufficient salt
• When oral therapy is not possible, injection hydrocortisone should
be taken
18. ADVICE TO PATIENTS ON
GLUCOCORTICOID REPLACEMENT:
Intercurrent stress
• e.g. Fever, cold, trauma-double dose of hydrocortisone.
During surgery
Minor operation-hydrocortisone 100 mg i.m. with pre-medication .
Major operation-hydrocortisone 100 mg 6-hourly for 24 hours, then 50 mg i.m. 6-
hourly until ready to take tablets .
Vomiting
Must have parenteral hydrocortisone if unable to take by mouth.
Bracelet and steroid card
patient should always carry this. Should have information regarding the diagnosis,
dose of steroid and doctor.
21. Principle of glucocorticoid therapy
• Do not administer glucocorticoids unless
absolutely indicated or more conservative
measures have failed
• Keep dosage and duration of administration to
the minimum required for adequate
treatment
22. Checklist prior to glucocorticoid
treatment:
• Screen for tuberculosis with a PPD or CXR
• Evidence of IGT,H/O gestational diabetes,Strong family
H/O type II diabetes mellitus in first degree relative
Screen for DM by blood sugar measurement.
• Evidence of HTN,Cardiovascular disease or
hyperlipidaemia
• Evidence of pre-existing or high risk for
osteoporosis(Bone density assessment)
• Screen for glaucoma and cataracts before treatment
• H/O PUD, gastritis or oesophagitis
• H/O psychological disorders
23. Advise to the pt.
• Diet:
-monitor calorie intake to prevent weight gain
-diabetic diet if glucose intolerant
-restrict sodium intake to prevent oedema and
minimize HTN
-provide supplementary potassium if
necessary
• Administer glucocorticoids with meal to prevent
ulcer. Consider omeprazole 20-40 mg/day
24. Advise to the pt.(contd.)
• Minimize loss of bone mineral density
-Consider administering gonadal hormone
replacement therapy in post menopausal woman: 0.625-
1.25 mg conjugated estrogens given cyclically with
progesterone, unless the uterus is absent(Testosterone
replacement in hypogonadal men)
-Adequate calcium intake ~1200 mg/day elemental
calcium
-Administer a minimum of 800-1000 IU/day
supplemental vit D
-Consider administering biphosphonate
prophylactically, e.g. Alendronate 10 mg daily or 70 mg
weekly
25. Advise to the pt.(contd.)
• Prepare the pt. and family for possible adverse effect on
mood, memory and cognitive function
• Inform the pt. about side effects like wt. gain, osteoporosis
• Avoid prolonged bed rest that will accelerate muscle
weakness and bone mineral loss. Ambulate early after
fractures
• Avoid elective surgery, if possible. Vit A 20,000 U daily for 1
wk. may improve wound healing
• Avoid activities that could cause falls or other trauma
• Avoid smoking and alcohol
• Dose to be increased during stress according to advice of
doctor
26. Follow up:
History:
• About mood, memory and cognitive function
• Visual disturbance(cataract)
• Menstrual disturbance
• Wasting and weakness of proximal thigh
muscles
• About urine test result at home wkly for
glucose
27. Follow up(contd.)
Examination:
• Blood pressure
• Body wt
• Edema
• Cataract and glaucoma 3 months after Rx then
yearly
• Height(severe to document degree of axial
spine demineralization with compression)
30. Definition:
It is a medical emergency due to acute
adrenocortical insufficiency
31. Causes:
• Sudden withdrawal of steroid(commonest cause, if pt.
on steroid for long time)
• Following stress e.g.intercurrent disease,trauma,
surgery, severe infection or prolonged fasting in a pt
with latent insufficiency
• Following sudden destruction of pituitary
gland(pituitary necrosis)or when thyroid hormone or
drugs which increase steroid metabolism(e.g.
phenytoin)given to a pt with hypoadrenalism
• Following bilateral adrenalectomy
• Following injury to both adrenals due to
trauma,adrenal vein thrombosis,adrenal haemorrhage
due to meningococcaemia or anticoagulant therapy
33. Treatment:
• I/V hydrocortisone 100 mg 6 hrly until GI
symptoms abate then oral therapy
• I/V fluid normal saline and 10% dextrose for
hypoglycaemia
• Precipitating factors should be find out and
treated
39. The patient may have subclinical
hypoadrenalism. After giving anti-TB
drugs due to Rifampicin induced
increased hepatic metabolism of
adrenocortical hormone, the patient
developed acute adrenocortical
insufficiency and died.