美国内分泌学会的临床指南:库欣综合征的诊断

凡例 专家组用统一的短语和符号来表示建议的力度和证据的确凿程度,即用数字1表示强烈推荐,用数字2表示一般推荐;用●○○○、●●○○、●●●○和●●●●,分别表看示极低、低、中等和高度可靠的证据.     

高甘油三酯血症的评估和治疗美国内分泌学会临床指南

1 诊断和定义 1.1 重度(11.2 ～ 22.4 mmol/L)和极重度高甘油三酯血症(≥22.4 mmol/L)可增加胰腺炎的发生风险,而轻度(1.7 ～ 2.3 mmol/L)或中度高甘油三酯血症(2.3 ～ 11.2 mmol/L)可能是心血管疾病的危险因子.因此,推荐成人至少每5年筛查1次高甘油三酯血症. 1.2 推荐根据空腹甘油三酯水平,而不是非空腹甘油三酯水平来确诊高甘油三酯血症. 1.3不推荐高甘油三酯血症患者常规检查脂蛋白颗粒异质性.检查载脂蛋白B或脂蛋白(a)具有一定的临床参考价值,而其他载脂蛋白水平的临床参考价值不大.     

高催乳素血症的诊治——介绍美国内分泌学会临床应用指南

美国内分泌学会的临床指南小组遵循国际GRADE组织(Grading of Recommendations,Assessment,Development,and Evaluation goup)的分级推荐标准,结合近期相关领域的研究成果,编写了该指南(以符号(+)○○○、(+)(+)○ ○、(+)(+)(+)○和(+)(+)(+)(+)分别表示从低到高的证据质量).指南建议的内容又分为“推荐”和“建议”,分别用“1”和“2”表示,根据推荐施行,通常对患者利多于弊,而如按建议执行时则需要更多考虑患者的个体化情况.     

减肥手术后患者的内分泌和营养管理:美国内分泌学会临床实践指南

循证建议的制定方法 利用所得到的最佳研究证据进行推荐,以一致的语言和图表描述推荐的强度和证据的质量.为了标明推荐的强度,强烈推荐使用"推荐"和数字1,弱的推荐使用"建议"和数字2.     

儿童肥胖的预防和治疗:美国内分泌学会根据专家共识制定的临床指南

与1963～1970年的调查相比,1999～2000年的肥胖患病率在6～11岁儿童中增加了4倍,在12～19岁青少年中增加了3倍.于1976～1980年间,婴幼儿(0～23个月)的肥胖患病率从7.2%增至11.6%,2～5岁儿童从5%增至13.9%.儿童肥胖的总患病率为17.1%.同期,6岁以上儿童中的超重发生率增加了 2.5倍,达37.2%.     

2013年美国心脏病学会和美国心脏协会成人降胆固醇治疗指南介绍

<正>美国心脏病学会(ACC)与美国心脏协会(AHA)联合颁布了2013版成人降胆固醇治疗降低动脉粥样硬化性心血管疾病(ASCVD)风险指南[1]。该指南以现有研究证据为依据,强调他汀类药物在降低ASCVD风险方面的获益,对ASCVD的一级、二级预防及风险评估、他汀类药物的管理、药物不良反应的处理等方面提出了具体建议。这一指南虽然针对西方人群所制定,但对我国人群的血脂异常管理与ASCVD的防治具有很好的参考价值。现将其要点介绍如下。     

美国成人肾动脉狭窄诊断和介入治疗指南解读

肾动脉狭窄的诊断是临床上经常遇到的问题,其介入治疗涉及到心脏内科、血管外科、放射科和肾脏内科等多科医师,因此肾动脉狭窄的诊断和介入治疗需要规范化。为了提高肾动脉狭窄诊断和治疗的质量,美国介入放射学学会(So cietyofInterventionalRadiology)于2 0 0 2年11月组织制订了《成人肾动脉狭窄诊断和治疗中血管造影术、血管成形术和支架置入术质量提高指南》。该指南分为方法学、定义、适应证、成功率、肾血管性高血压、心脏紊乱综合征(cardiacdistur bancesyndrome)和并发症七个部分,重点是患者筛选、完成手术操作和患者监测。虽然该…     

成人脑死亡诊断循证指南更新版美国神经病学学会质量标准委员会的报告

目的 就1995年美国神经病学学会制定的成人脑死亡诊断指南的以下问题进行更新:有符合脑死亡临床标准而又神经功能恢复的患者吗?确保神经功能永久丧失的观察时间需要多长才足够?在脑死亡患者中是否有时候会观察到错误提示脑功能存在的复杂运动?判定呼吸暂停的相对安全的方法 是什么?是否有准确识别脑死亡患者的新的辅助检查手段?方法 ...     

解读美国心脏病学院及美国心脏学会关于成人慢性心力衰竭评估和治疗指南

美国心脏病学院及美国心脏学会(ACC/AHA)于1995年首次发表了“心力衰竭的评估和治疗指南”。此后,由于对此常见综合征的药理学和非药理学治疗都有许多进展,有必要予以更新,又于2001年发表了“成人慢性心力衰竭的评估和治疗ACC/AHA指南”(以下简称本指南)。他们认为,寻找最佳的治疗方法仍在不断进行中,将来会有更合适的指南。     

睡眠呼吸暂停的诊治首次纳入美国临床内分泌医师学会糖尿病综合治疗方案指南

美国临床内分泌医师学会(ACCE)于2011年公布了最新糖尿病综合治疗方案指南(以下简称指南),建议临床医生在诊治糖尿病患者时不应只局限在血糖控制方面,而应该对患者进行多系统、多器官的全面评估.指南为临床医生提供了目前最新的工作规划,旨在使临床医生能够对糖尿病及其并发症的预防及诊断、治疗制订出综合治疗方案,从而改善糖尿病患者的预后,提高其生活质量.指南首次提出了应该重视糖尿病患者睡眠呼吸暂停的诊断及治疗,表明内分泌科医生已经开始重视睡眠呼吸暂停的诊治.     

Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline

OBJECTIVE: The objective is to provide guidelines for the evaluation and treatment of adults with GH deficiency (GHD). PARTICIPANTS: The chair of the Task Force was selected by the Clinical Guidelines Subcommittee of The Endocrine Society (TES). The chair selected five other endocrinologists and a medical writer, who were approved by the Council. One closed meeting of the group was held. There was no corporate funding, and members of the group received no remuneration. EVIDENCE: Only fully published, peer-reviewed literature was reviewed. The Grades of Evidence used are outlined in the Appendix. CONSENSUS PROCESS: Consensus was achieved through one group meeting and e-mailing of drafts that were written by the group with grammatical/style help from the medical writer. Drafts were reviewed successively by the Clinical Guidelines Subcommittee, the Clinical Affairs Committee, and TES Council, and a version was placed on the TES web site for comments. At each level, the writing group incorporated needed changes. CONCLUSIONS: GHD can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. GH therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.     

The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline

OBJECTIVE: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. PARTICIPANTS: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. CONSENSUS PROCESS: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. CONCLUSIONS: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.     

Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. Conclusions: Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.