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New Diagnostic Criteria of Adrenal Subclinical Cushing’s Syndrome

New diagnostic criteria and the treatment policy for adrenal subclinical Cushing’s syndrome (SCS) are proposed
on behalf of the Japan Endocrine Society. The current diagnostic criteria for SCS have elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by an overnight 1-mg dexamethasone suppression test
(DST); (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries.

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Red Flags in Headache

Patients presenting with headaches need to be screened for primary vs secondary etiologies.  “Red flags” associated with secondary headaches are crucial to identify. Physical examination should be completed with careful assessment of clues obtained during the history. It should include blood pressure measurements, assessment of mental status, and cranial nerve (CN) examination including but not limited to fundoscopic examination, gait, and facial strength.

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Rosemont Criteria for Chronic Pancreatitis

Chronic pancreatitis is an irreversible disease of exocrine pancreas characterized by progressive destruction of pancreatic parenchyma and remodeling processes leading to the replacement of the exocrine parenchyma by extensive fibrosis. These changes result in malabsorption, diabetes mellitus and severe and chronic abdominal pain.
Moreover, it is possible the development of several complications which will determine the clinical course developing in some cases pancreatic pseudocyst (25-30%), bile duct strictures (40-50%), even pancreatic cancer (1-3%). The mainstay is detecting early pancreatic changes and treating its related complications. Continue reading “Rosemont Criteria for Chronic Pancreatitis”

Diagnostic Criteria for Idiopathic Multicentric Castleman Disease (iMCD)

Human herpesvirus-8 (HHV-8)–negative, idiopathic multicentric Castleman disease (iMCD) is a rare and life-threatening disorder involving systemic inflammatory symptoms, polyclonal lymphoproliferation, cytopenias, and multiple organ system dysfunction caused by a cytokine storm often including interleukin-6. Accurate diagnosis is challenging, because no standard diagnostic criteria or diagnostic biomarkers currently exist, and there is significant overlap with malignant, autoimmune, and infectious disorders. Continue reading “Diagnostic Criteria for Idiopathic Multicentric Castleman Disease (iMCD)”

Diagnostic Criteria of Acute Adrenal Insufficiency

The Endocrine Society guidelines on the diagnosis and treatment of Acute Adrenal Insufficiency (AAI) defines an adrenal crisis as a medical emergency with hypotension, abdominal symptoms and laboratory abnormalities requiring emergency treatment.

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Diagnostic Criteria for Peripartum Cardiomyopathy

Typically, peripartum cardiomyopathy occurs in the first 4 months postpartum; fewer than 10% of cases occur prepartum. Common symptoms include dyspnea, cough, orthopnea, hemoptysis, and paroxysmal nocturnal dyspnea. Most affected patients have New York Heart Association (NYHA) class III or IV function. Additional symptoms include nonspecific fatigue, malaise, palpitations, chest and abdominal discomfort, and postural hypotension. Diagnosis requires a high degree of suspicion, because symptoms of peripartum cardiomyopathy can be confused with physiologic changes associated with advanced pregnancy. Continue reading “Diagnostic Criteria for Peripartum Cardiomyopathy”

Diagnostic Criteria for Cannabis Use Disorder

Cannabis use induces a variety of acute psychological and physiological effects that vary in intensity and duration according to the dose, the route of administration, and the degree of tolerance in the user. Acute psychological effects include euphoria (“high”), relaxation, and sedation (usually desired by persons who use cannabis recreationally), increased appetite (“munchies”) and impaired short-term memory, concentration, and psychomotor coordination. Some people experience increased anxiety, panic attacks, or paranoia, especially at higher doses. Psychotic symptoms, such as perceptual alterations, hallucinations, and delusions, are less common. Acute physical effects include impaired motor coordination, slurred speech, dry mouth, conjunctival injection (“red eye”), tachycardia, orthostatic hypotension, and horizontal nystagmus. Smoked cannabis induces cough, wheezing, and dyspnea; increases sputum production; and exacerbates asthma. Continue reading “Diagnostic Criteria for Cannabis Use Disorder”

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