Cushing’s syndrome as a cause of secondary obesity and metabolic syndrome: a case report

We describe the case of a woman affected by morbid obesity associated to type 2 diabetes mellitus (T2DM), hyperlipidaemia and hypertension, configuring a picture of metabolic syndrome (MS). Hormonal investigations revealed that her MS was secondary to the presence of a cortisol-producing left adrenal adenoma. After monolateral adrenalectomy, the MS subsided. Excessive and sustained hypercortisolism gives rise to the entire spectrum of MS. As some clinical manifestations of MS and Cushing’s syndrome (CS) overlap, it is important to consider CS as a possible cause of secondary MS, in order to avoid a delay in diagnosis and proper treatment, which exposes the patient to an increased risk of morbidity and mortality.     

Obesity: a main factor of metabolic syndrome?

The metabolic syndrome (MS) is a common metabolic disorder that has been recently related to the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) will be applicable worldwide. The pathophysiology has been largely attributed, in the past years, to insulin-resistance, even if several epidemiological and pathophysiological data are attractive to indicate visceral obesity as a main factor in the occurrence of the MS, promoting new definitions and re-evaluation of the pathogenesis of this syndrome. In this review, we have analyzed the role of visceral obesity in the new definition of the MS such as the pathophysiological role of the abnormal fat distribution in the occurrence of this syndrome. In view of this, relationships between visceral obesity, free fatty acids, dyslipidaemia and insulin-resistance have been reported. In addition, the effects of some adipocytokines and other proinflammatory factors produced by fat accumulation on the appearance of the MS have been also emphasized. Finally, according to recommendations of several international societies, the role of the life-style change and of the weight loss in the prevention and treatment both of obesity and of other associated risk factors has been analyzed.     

Metabolic syndrome and psychopathology: a possible relationship?

The intent of the authors was to evaluate the possible presence of psychopathological aspects in people with metabolic syndrome. Through a research protocol that involved a thorough physical examination, a psychological clinical interview and the administration of psychodiagnostic tests, the authors highlighted the significative incidence of depressive disorders and/or anxiety in people with metabolic syndrome. This area of investigation in a clinical setting is configured as a territory still unexplored; the authors point out, therefore, the need for further study and for the development of intervention protocols providing the synergistic presence of different specialists with specific skills.     

Is the primary antiphospholipid syndrome a forerunner of SLE?

INTRODUCTION: Antiphospholipid syndrome is a multi-organ autoimmune disorder, characterized by arterial and venous thrombotic events, and a well-defined group of recurrent foetal wasteage due to pathologic antibodies against phospholipids and protein co-factors. Antiphospholipid antibodies can be formed in primary antiphospholipid syndrome, but also in other conditions, most often in systemic lupus erythematosus. This may modify the outcome of lupus increasing the risk for thrombotic complications. Less is known about the outcome in primary antiphospholipid syndrome, whether it may precede the development of systemic lupus. AIMS: Authors hereby describe the case of four patients with primary antiphospholipid syndrome in whom the disease progressed to systemic lupus erythematosus. RESULTS: Lupus followed the primary antiphospholipid syndrome within around a three-year period. It was indicated by the appearance of different antinuclear autoantibodies and clinical complications, such as polyarthritis, nephritis and hematologic disturbances. All of the patients presented cerebrovascular accident as the thrombotic manifestation. All but one, were around forty years old, and had a milder form of lupus. Symptoms of the antiphospholipid syndrome determined the outcome. On the other hand, a typical lupus developed in the youngest patient. CONCLUSIONS: According to present cases antiphospholipid syndrome may be considered as the initiative phase of SLE, but APS being a separate entity also may associate to lupus. Present observations indicate the importance of follow-up the patients with APS by immunologic respect. Future prospective, multi-centre studies with larger number of cases are needed to provide further evidence on the fact that patients with APS may acquire other autoimmune disorder.     

The sick building syndrome: a chicken and egg situation?

Objectives: To examine the temporal relationship and specificity between self-reports on the indoor environment at work and symptoms that are traditionally connected with the sick building syndrome (SBS). Methods: This questionnaire study used a prospective full panel design as regards self-reports on exposure and outcome. At the baseline, the sample comprised 2,164 adults selected randomly from the general population. Of these 1,402, who were still working and living in the same place, completed a second questionnaire a year later. Health measures were symptoms that are traditionally connected with the SBS, as well as some “dummy” symptoms that hardly can be causally related to the indoor environment. The associations between self-reports on the indoor environment and these symptom groups were assessed both in cross-sectional and longitudinal analyses, the latter examining the normal direction that exposure leads to symptoms as well as the reverse order: that symptoms lead to perceived exposure. Results: In cross-sectional analyses, the indoor environment factors were associated equally with SBS symptoms and with “dummy” symptoms. In longitudinal analyses, only few of the indoor environment factors predicted the development of any of the symptom groups. However, both the SBS symptoms and the “dummy” symptoms were risk factors for beginning to report exposures in the indoor environment. Conclusions: Symptoms predict future reports on exposures in the indoor environment indicating that it is difficult to determine what existed first: the outcome or the exposure. In addition, the perceived indoor environment is associated not only with the traditional SBS symptoms, but also with symptoms that cannot be physiologically linked to the indoor environment. These results suggest that there is a risk of reporting bias when assessing non-specific symptoms. Thus, many of the associations found in previous cross-sectional studies on SBS symptoms and indoor environment factors may possibly be explained by reporting bias.     

Does a diagnosis of metabolic syndrome have value in clinical practice?

"The metabolic syndrome" is the name for a clustering of risk factors for cardiovascular disease and type 2 diabetes that are of metabolic origin. These risk factors consist of atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose, a prothrombotic state, and a proinflammatory state. There are 2 major, interacting causes of the metabolic syndrome-obesity and endogenous metabolic susceptibility. The latter typically is manifested by insulin resistance. The metabolic syndrome is accompanied by a 2-fold increase in the risk of cardiovascular disease and a 5-fold increase in the risk of type 2 diabetes. A clinical diagnosis of the metabolic syndrome is useful because it affects therapeutic strategy in patients at higher risk. However, there are 2 views about the best therapeutic strategy for patients with the metabolic syndrome. One view holds that each of the metabolic risk factors should be singled out and treated separately. The other view holds that greater emphasis should be given to implementing therapies that will reduce all of the risk factors simultaneously. The latter approach emphasizes lifestyle therapies (weight reduction and increased exercise), which target all of the risk factors. This approach is also the foundation of other therapies for targeting multiple risk factors together by striking at the underlying causes, as in the development of drugs to promote weight reduction and to reduce insulin resistance. Treating the underlying causes does not rule out the management of individual risk factors, but it will add strength to the control of multiple risk factors.     

Early onset adiposity: a pathway to polycystic ovary syndrome in adolescents?

Polycystic Ovary Syndrome is a heterogenous syndrome of unknown causation commonly associated with obesity. The particular timing of the onset of obesity may be important, since the earlier the onset of obesity the greater the severity of the metabolic and hormonal aberrations. Early postnatal life and peripubertal periods may be critical windows for the development of the "adiposity insult". The interaction of adiposity with genetic traits as well as with prenatal environmental factors may further aggravate the metabolic and endocrine abnormalities, which become more pronounced in adolescence.     

Is alcohol consumption a cofactor in the development of acquired immunodeficiency syndrome?

Excessive alcohol (EtOH) consumption and acquired immunodeficiency syndrome (AIDS) are two major public health problems in the United States. Overwhelming evidence is showing that heavy EtOH ingestion broadly suppresses the various arms of immune response, seriously impairing the body's normal host defense to invading microbes and tumorigenesis. The onset of clinical symptoms of AIDS (low CD4⁺ T cells count, opportunistic infections, and tumors) is quite variable among HIV' individuals with a mean incubation time 3–10 years following serocon version. Because of the deleterious effects of chronic EtOH consumption on Cyokine release, immune response, host defense, nutritional status, and oxidative stress, it has been believed to be a possible cofactor that could enhance the host's susceptibility to infections, and subsequently increase the rate of AIDS development. The purpose of this review is to present evidence indicating clinical disorders during EtOH ingestion in murine AIDS. These EtOH-induced abnormalities may promote a more rapid development of AIDS in HIV-infected individuals.     

Guillain-Barré syndrome

Guillain-Barré syndrome is the most common paralytic illness affecting children and adolescents in countries with established immunization programs. The term is currently used to encompass a group of disorders in which an autoimmune response occurs days or weeks after an antecedent infection or event (e.g., immunization) and results in an acute polyradiculoneuropathy with flaccid weakness, areflexia, and increased cerebrospinal fluid protein. This chapter reviews the epidemiology, clinical presentation, diagnostic criteria, pathogenesis, treatment, and outcome of this condition.     

Factor analysis of self-reported symptoms: does it identify a Gulf War syndrome?

Active duty US Naval mobile construction battalion personnel (Seabees) were surveyed in 1994 for the presence of a variety of symptoms. Questions were drawn from the Hopkins Symptom Checklist and from a collection of symptoms either defining clinical depression or commonly reported by Persian Gulf War veterans. Of those surveyed, 524 were Gulf War veterans and 935 were nondeployed Gulf War-era veterans. Factor analysis applied to Gulf War veterans yielded five factors, three deriving from the Hopkins Symptom Checklist, one suggesting clinical depression, and one containing symptoms commonly reported by Gulf War veterans. Factor analysis applied to nondeployed veterans yielded five similar factors. Three of the factors yielded statistically significantly greater standardized factor scores for Gulf War veterans than for nondeployed veterans. Four of the factors resembled factors resulting from a previous analysis on a sample of similar Gulf War veterans. Gulf War veterans and nondeployed era veterans reported similar clusters of symptoms and illnesses. However, Gulf War veterans reported these same clusters with greater frequencies than did nondeployed veterans. The authors conclude that, in contrast to a previous report, factor analysis did not identify a unique Gulf War syndrome.     

Dysmobility syndrome: is exercise a key component in its prevention and treatment?

Aim

Dysmobility syndrome (DS) represents a cluster of six factors (some of them major public health problems) with a shared pathogenesis used to identify older adults at risk of a wide range of adverse health outcomes. This commentary discusses the role of exercise, a type of physical activity, in the prevention and treatment of this condition.

Subjects and methods

To accomplish the purpose of this commentary, we contextualize DS providing its definition, risk factors and recommended cutoff points for each factor. We further provide the current prevalence of DS and its impact on the health of older adults. This commentary also provides information on the benefits of exercise on  each of the recommended factors in isolation. We end the commentary with a brief research agenda that we believe will help establish exercise as a treatment approach for DS.

Results

The prevalence of DS is of great concern, and this condition has been found to be associated with a large array of adverse health outcomes including falls, a major public health problem. Based on the identified factors comprising DS, the current literature provides substantial evidence of the benefits of exercise to prevent this condition. However, to the best of our knowledge, no studies have been carried out to examine the effects of exercise on DS.

Conclusion

While the value of DS over and above other more established measures such as frailty may be questionable, the DS criteria at least provide a great opportunity for early identification of important deficits that can compromise independency and quality of life later in life.

     

Is there a conflicted surrogate syndrome affecting quality of care in nursing homes?

Is there a point at which family complaints about care cease to be constructive and become excessive and counterproductive? Do excessive complaint behaviors represent a "conflicted surrogate syndrome" that is indicative of psychopathology in the family member or family system? Can this psychopathology result in avoidance behavior by the nursing staff sufficient to result in poor care? While many family/resident complaints are valid and should be viewed as constructive there are occasions when excessive complaints by the family of a nursing facility resident are a result of psychiatric illness or psychological problems in the family member(s) or are evidence of an abnormality in the family system. This series of brief case reports is offered to create discussion of what might be termed a "conflicted surrogate syndrome" that may result in avoidance behavior by staff and consequent poor care.