[Decalcification of bone due to corticosteroids].
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Adrenal Cortex Hormones↗
Biomedical subjects
W F Lems
Publications and source records attributed to W F Lems.
Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa.
A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.
Administration, Oral↗
Aggravation of hypoglycemia in insulinoma patients by the long-acting somatostatin analogue octreotide (Sandostatin).
Recently somatostatin analogues were successfully used to control insulin-induced hypoglycemia in patients with insulinoma. We observed a transient decrease in glucose levels and symptomatic hypoglycemia after administration of the long-acting somatostatin-analogue octreotide (Sandostatin) in two insulinoma patients. We studied the acute effects of octreotide (administered before breakfast) on blood glucose and gluco-regulatory hormones in these patients. In one patient, we studied the effects of glucagon replacement and changing the time of breakfast (relative to octreotide administration) on octreotide-associated changes in blood glucose and glucoregulatory hormones. Compared with control levels, octreotide therapy reduced insulin levels. During hypoglycemia glucagon and growth hormone levels were suppressed, but cortisol levels appropriately increased. The increase in catecholamine levels was normal in one patient, but markedly attenuated in the other. A transient decrease in serum glucose after octreotide was absent after glucagon replacement, but present when breakfast was taken before administration of octreotide. We conclude that in patients with insulinoma, octreotide therapy may be associated with clinically important hypoglycemia, during which counterregulatory hormone secretion may be attenuated.
Adenoma, Islet Cell↗
Malignant insulinoma: is combined treatment with verapamil and the long-acting somatostatin analogue octreotide (SMS 201-995) more effective than single therapy with either drug?
The efficacy of treatment with either verapamil (V), the long-acting somatostatin analogue octreotide (OCT) alone, and the combined treatment (V + OCT) were studied in a patient with a symptomatic metastasized malignant insulinoma. Treatment with V alone resulted in a slight increase in blood glucose levels. Treatment with OCT alone resulted in a clear increase in blood glucose levels. Treatment with V + OCT was slightly more effective than single therapy with either drug but could not prevent hypoglycaemic episodes completely. It is also shown that the effect of treatment with V and OCT alone on glucoregulatory hormones is completely different. While treatment with V did not inhibit insulin secretion, treatment with OCT clearly did. Treatment with OCT might also modify counterregulatory hormone secretion during hypoglycaemia.
Adenoma, Islet Cell↗
Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids.
OBJECTIVES: To examine the relationship between roentgenological deformities of the vertebral column and clinical manifestations of vertebral fractures in patients with RA, treated with glucocorticosteroids (Cs). METHODS: In all outpatients of Utrecht University Hospital with RA, who were currently using Cs (n = 52), roentgenograms of the thoracic and lumbar vertebral column were taken. Roentgenological deformities were scored à vue using the Kleerekoper score, and quantitatively using the Heidelberg and Utrecht scoring methods. Clinical manifestation of a vertebral fracture was defined as a vertebral deformity leading to prescription of therapy: bedrest and/or analgesics. Clinical manifestations of fractures were also recorded in a control group of 55 RA patients not on Cs, matched for age and gender. RESULTS: The prevalence of vertebral deformities in the Cs-treated RA patients, assessed with the Kleerekoper score, was 58% (30 of 52 patients). In 7 of the Cs-treated patients clinical manifestations of a vertebral fracture were present, versus 1 in the control group (p = 0.03). No significant correlation between the 3 deformity scores and the cumulative dose of Cs was found. No (inverse) correlation between serum osteocalcin and the daily dosage of prednisone was found. CONCLUSION: Corticosteroids in active RA are associated with fractures, even when low doses are used: the prevalence of vertebral deformities (58%) in the Cs-treated RA patients was much higher than the frequency in postmenopausal women of the same age reported in the literature, and the reported incidence of clinically manifestations of vertebral fractures was higher in the Cs-treated RA patients than in the control group of RA-patients not treated with Cs.
Aged↗