Showing papers by "Silvio E. Inzucchi published in 1996"

Growth hormone and the maintenance of adult bone mineral density.

Abstract: Growth hormone serves many important functions in man. It influences carbohydrate, lipid and protein metabolism, regulates the secretion and action of a variety of other hormones, and interacts with the immune system. Its most studied role, however, as its name implies, is the orchestration of longitudinal growth, which occurs predominantly at the epiphyseal plate. Here, GH acts both directly and indirectly, through the systemic and local production of IGF-I (Isaksson et al., 1987). A separate role for the GH/IGF-I axis in the maintenance of normal bone mineral density (BMD) after epiphyseal closure is also apparent and is an area of active clinical investigation. In this review, we examine the effects of GH on mature bone, summarize the findings of studies on the skeletal effects of GH in adults, and consider the potential use of GH as an anabolic agent in the treatment of osteoporosis.

CLINICAL CASE SEMINAR: A 73-Year-Old Man with Hyperglycemia, Skin Rashes, Anemia and Weight Loss*

Abstract: A 73-yr-old white male with recently diagnosed diabetes mellitus presented to the emergency room with fever and lower extremity rash of l-week duration. One month previously, he consulted his primary physician because of several weeks of polyuria, polydipsia, blurred vision, and 12-lb weight loss. His plasma glucose level was 24.7 mmol/L (normal range, 3.9-5.8; 445 mg/dL), and electrolytes were normal. A diagnosis of diabetes mellitus was made, and the patient was started on glyburide (10 mg/day). After 10 days, while he felt improved, blood glucose values were still in excess of 11.1 mmol/L (200 mg/dL), and he was switched to insulin (20 U NPH in the morning). One week later, he returned to his primary physician with pain, redness, and swelling of both lower legs. Oral antibiotics were prescribed for presumed cellulitis. Despite therapy, the rash persisted, and he developed fever and chills and was referred for admission. There was no antecedent history of skin wound, leg trauma, or prolonged immobilization. The past medical history was notable for idiopathic neutropenia, diagnosed 22 yr earlier. A bone marrow aspirate at that time demonstrated a hypocellular marrow, but no evidence of an infiltrative or myeloproliferative process. Baseline leukocyte counts had been stable between 3.2 X 10” and 4.8 X lO’/L, with absolute neutrophil counts of approximately lOOO/pL. The past history also included benign monoclonal gammopathy, osteoarthritis, uric acid nephrolithiasis, transurethral resection of the prostate, and bilateral inguinal herniorrhaphies. Several weeks before admission, he developed an erythematous exfoliating scrotal skin eruption. Scrapings of the rash by a dermatologist revealed budding yeast and pseudohyphae, indicative of a candidal infection. Scattered eczematous lesions over the lower extremities were also noted. Ketoconazole cream and triamcinolone ointment were prescribed, with subsequent improvement. On admission, the patient was using these topical agents and the aforementioned insulin, but no other