Overview of Adrenalectomy | Endocrinology

What is Adrenalectomy?

There is one adrenal gland above each of your kidneys. The adrenal glands produce different hormones that help regulate metabolism, the immune system, blood pressure, blood sugar, and other basic functions.

Most adrenal gland tumors are noncancerous (benign). You may need surgery to remove the adrenal gland if the lump is producing excess hormones or is large (more than 2 inches or 4 to 5 centimetres). You may also need surgery if the lump is precancerous (malignant) or suspected to be precancerous. This surgery is called adrenalectomy.  You might also need adrenalectomy to remove cancer that has spread (metastasized) from additional location, such as the kidney or lung.

If both adrenal glands are removed, you will need to take supplemental hormone medications. If only one gland is detached, the other will take over full function without the need for ongoing medications.

Types of adrenalectomy

Surgeons may perform adrenalectomy through minimally invasive (laparoscopic) surgery, traditional open surgery, or the use of cryoablation. The procedure they commend depends on the extent and type of tumor or the condition affecting your adrenal gland.

Minimally invasive surgery:  Endocrine surgeons are often capable to use minimally invasive (laparoscopic) surgery for tumors of the adrenal gland because the gland is relatively small. Laparoscopic surgery has many benefits, including smaller scarring, less pain and a shorter recovery period than traditional open surgery.

An alternative approach to laparoscopic surgery is endoscopic posterior adrenalectomy (PRA), in which surgeons make small incisions in your back. Surgeons sometimes use the robotic da Vinci surgical system to perform laparoscopic adrenalectomy.

  • Open surgery: Doctors usually reserve open surgery for large or cancerous (malignant) tumors. They perform open surgery using incisions and traditional tools.
  • Cryoablation: Additionally, doctors may use cryoablation to treat adrenal gland tumors. This procedure uses a CT scan to guide the insertion of a probe that freezes and destroys adrenal tumors. Interventional radiologists may use cryoablation as a treatment option for small tumors that have spread to the adrenal gland (metastasis), especially when surgery involves high risk.

How is adrenalectomy done?

The surgeon will work in one of two ways:

  • Open adrenalectomy: The surgeon may use open surgery if the lump is large or it may be cancerous. The surgeon makes a large open incision (cut) in the abdomen to remove the gland (s).
  • Laparoscopic adrenalectomy: Most commonly, the surgeon makes a few small incisions and performs a minimally invasive procedure. This method uses a laparoscope, which is a thin tube equipped with a tiny video camera so that the surgeon can see what is inside the body. Robotic surgery uses the same incisions but uses wrist tools instead of solid ones. Whether the procedure is laparoscopic or robotic, the procedure can be performed either by placing incisions on the back (posterior approach) or on the side (lateral approach).

Both procedures are equally successful, with the posterior approach providing the advantages of not entering the abdomen. The back method is also preferred in patients with a previous history of upper abdominal incisions and two-sided tumors. Due to the small working area with the posterior approach, only tumors smaller than 6 cm are approached through the back.

Does adrenalectomy remove one gland or both?

The surgeon may remove the tumor, only one gland, or both. The surgery that removes one gland is a unilateral removal of the adrenal gland. Two-sided adrenalectomy removes both glands. People with excess cortisol (Cushing’s syndrome may take a hydrocortisone supplement for about a year after surgery until the remaining gland begins producing enough hormone on its own. For other patients, testing is done after surgery to determine if the patient needs to be on a steroid substitute).

After the adrenalectomy procedure

The hospital stay after surgery is usually 4 to 5 days. The patient can return to his normal activities as soon as he feels ready. Patients are advised to avoid strenuous exercise for 6-8 weeks after surgery.

Benefits of adrenalectomy

The advantages of adrenalectomy treatment are:

  • Smaller scars
  • Less risk of hernia
  • Pain relief after the operation
  • Shortest hospital stay and recovery time

Risks of adrenalectomy

The risks associated with adrenalectomy are:

  • Hormonal imbalance is a potential risk, leading to complex health problems such as slow healing, blood pressure disorders or metabolic disorders.

Other potential risks include

  • Bleeding
  • Bowel disorders
  • Blood clots in the lungs
  • Infections
  • Pain
  • Scarring, or damage to the pancreas.


  • Damage to neighbouring organs
  • Hernia

Causes and Treatments of Watery Eyes | Ophthalmology

What are watery eyes?

Watery eyes, epiphora, or tearing, in which tears flow profusely down the face, often without a clear explanation. There is insufficient tear film drainage from the eye or eyes. Instead of tears flowing through the nasolacrimal system, they overflow onto the face. The surface in front of the eye needs tears to stay healthy and maintain a clear vision, but most tears are difficult to see. It is difficult or dangerous to drive.

Tears are usually released through the tear ducts and then evaporate. When you produce too many tears, they overwhelm your tear ducts and cause your eyes to fill with tears. Most of the time, watery eyes resolve without treatment, but this condition can sometimes turn into a chronic problem. See your doctor if you have chronic eyes, especially if you have other symptoms.

Epiphora can develop at any age, but it is more common in those younger than 12 months or older than 60 years. It affects one or both eyes. Watery eyes are usually treated effectively.

When should you call a doctor?

The cause of your dry eyes will determine the best treatment. You should see a doctor or ophthalmologist if you have excessive or chronic tearing and any of the following symptoms:

  • Loss of vision or visual disturbances.
  • Wounded or scratched eye
  • Chemicals in your eye
  • Discharge or bleeding from your eye
  • A foreign object is caught in your eye on the inside of your eyelid
  • Red, irritated, swollen, or sore eyes.
  • Unexplained injuries around your eye
  • Tenderness around the nose or sinuses.
  • Eye problems along with severe headaches.
  • Watery eyes that don’t get better on their own

Symptoms of watery eyes

Symptoms include watery eyes and excessive tearing.

  • Decreased vision
  • Pain or swelling around the eyes
  • A feeling that there is something in the eye
  • Persistent redness of the eye.
  • Eye pain,
  • Eye inflammation or infection.
  • Runny nose,
  • Visual disability,
  • Allergies,
  • Sneeze,
  • Swelling of the eye and
  • The eye is red.

Causes of watery eyes

  • It is common for extra temporary tears to occur when you experience strong emotions, laughter, coughing, vomiting, or yawning.
  • Dry eye syndrome is the most common cause of watery eyes. Very dry eyes can give you extra tears. As your eyes receive proper lubrication, you will constantly produce abundant tears, which will continue the cycle.
  • If you don’t have the proper balance of water, salt, and oil in your tears, your eyes will become very dry. The resulting irritation can cause an overproduction of tears that burst through the tear ducts.

Other common causes include:

  • Weather conditions such as dusty, windy, cold and sunny weather
  • Load in the eye
  • Environmental factors such as bright light and smoke.
  • Common cold, sinus problems, and allergies.
  • Inflammation of the eyelid (blepharitis)
  • The eyelid is outward (ectopic) or inward (entropal)
  • Ingrown hair (trichiasis)
  • Pink eyes (conjunctivitis) or other infections
  • Blocked tear ducts
  • Foreign objects, chemicals, or gases and liquids that can cause eye irritation
  • Injuries such as cuts or scrapes to the eye
  • Some prescription drugs
  • Cancer treatments including chemotherapy and radiation.

Usually, watery eyes are temporary and resolve on their own when the cause resolves or your eyes heal. However, in some cases, the situation can continue.

Diagnosis of watery eyes

If a doctor cannot determine the cause of the water in the eyes, they can refer the patient to an ophthalmologist. The diagnosis of epiphora is very simple. The doctor will try to find out if it is caused by an ulcer, infection, entropion (inward eyelid), or ectopic (externally rotating eyelid).

In some cases, the patient may be referred to an ophthalmologist or ophthalmologist who will examine the eyes, possibly under anaesthesia. A tube can be inserted to find out if they are blocked in the narrow drainage channels inside the eye.

Fluid can be inserted into the tear duct to determine if it is leaking through the patient’s nose. If it is clogged, a colour can be injected to find the exact location of the obstacle; This is done using an X-ray image of the area. The colour shows up on the X-ray.

Treatment of watery eyes

Treatment depends on the cause and severity of the problem. In mild cases, doctors may simply recommend waiting carefully or doing nothing and monitoring the patient’s progress.

The various causes of watery eyes include specific treatment options:

  • Irritation: If the watery eyes are caused by infectious conjunctivitis, the doctor may want to wait a week or more to see if the problem clears up without antibiotics.
  • Trichomoniasis: A doctor removes inward-growing hair or foreign objects in the eye.
  • Ectropion: The eyelid protrudes; the patient may need surgery to tighten the ligament that holds the outer eyelid in place.
  • Blocked tear ducts: Surgery can create a new canal from the tear impingement to the inside of the nose. This makes it possible to avoid the blocked part of the tear duct. This surgical procedure is called a dacryocystorhinostomy (DCR).

If the drainage channels inside the eye or the canaliculi are narrow but not completely blocked, the doctor may use a tube to widen them. It may be necessary to operate when the drains are completely blocked.

Lacrimation of the eyes in children.

  • In newborns, this condition usually resolves within a few weeks.
  • Sometimes a sticky fluid can form around the baby’s eye or eyes. You can use a cotton ball soaked in clean water to clean your eyes.
  • Clean water needs to be boiled, but the cotton is cooled before dipping.
  • Tears can sometimes be removed by gently massaging the tear ducts. Apply light pressure with your index finger and thumb to the outside of your nose.

Home remedies for watery eyes

In some cases, watery eyes can be treated without consulting a doctor.

Here are some suggestions:

  • Take a break from reading, watching TV, or using the computer
  • Lubricate your eyes with eye drops, available to buy over the counter (OTC) or online.
  • Place a warm, damp cloth over the eyes and massage the lids.

Adipose Tissue Dysfunction – an Overview | Endocrinology

What is adipose tissue dysfunction?

Adipose tissue dysfunction not only possesses an important role in the storage of excess nutrients but also acts as a critical immune and endocrine organ. Researchers and clinicians now consider adipose tissue dysfunction to be an active endocrine organ that secretes a variety of humoral factors called “adipokines” that produce significant systemic metabolic effects from food intake to glucose tolerance.

In addition to the production of specific adipokines, Adipose tissue dysfunction also secretes pro-inflammatory cytokines, which contribute to low-grade systemic inflammation, which has become a hallmark of various chronic pathologies associated with metabolic syndromes, such as metastasis and cachexia due to Cancer. These systemic effects are mediated by communication networks derived from a wide variety of resident fat cells, including adipose cells, endothelial cells, neural cells, stem cells, and other precursors, and recent studies have shown that the population of a wide variety of immune cells plays a key role in the development of adipose tissue and abnormalities.

In this chapter, we describe the various molecular ways in which excessive fat lipid storage is associated with chronic inflammation and review current knowledge on the triggers of esophagus and coccyx-related inflammation in adipose tissue. Finally, we describe how interference between adipose tissue inflammation and non-resident adipocyte cells in tissues is involved in this metabolic alteration.

Disturbed adipose tissue (AT) dysfunction function in PCOS

Adipose tissue dysfunction is regarded as an endocrine organ that plays a major role in the regulation of glucose and lipid metabolism and storage, with an impact on energy expenditure, inflammation and immunity, cardiovascular function, and reproduction, among other functions. Adipocytes are the major, but not the sole constituent of adipose tissue, which also contains fibroblasts, macrophages, stromal cells, monocytes (MNCs), and preadipocytes, and is a rich source of stem cells. Adipogenesis develops as a two-step process: undifferentiated mesenchymal cells convert into preadipocytes, which then differentiate to lipid-filled adipocytes.

The location and distribution of adipose tissue are function related. In general, subcutaneous (SC) adipose tissue has been associated with temperature regulation and with specific female and male fat distribution patterns. In turn, visceral or omental (OM) adipose tissue is responsible for maintaining organs in the normal position, occupying the spaces between them. Greater SC and mainly ON mass and adipocyte size have been linked to hepatic and peripheral insulin resistance as well as metabolic comorbidities such as dyslipidemia, decreased glucose tolerance, diabetes, and hypertension.

In addition, under metabolic stress, adipose tissue dysfunction expansion is altered, causing hypertrophy rather than hyperplasia. Adipose hypertrophy is associated with a lower number of adipocytes than adipose hyperplasia. In fact, the pathophysiological mechanism of fat expansion in hyperplasia is less deleterious, being the adipocytes still functional. In turn, hypertrophic adipocytes are more susceptible to inflammation, apoptosis, fibrosis, and release of free fatty acids.

Moreover, OM adipose tissue in women with PCOS may present specific functional derangements, related to increased catecholamine-induced lipolysis and possibly linked to altered stoichiometric properties of the adipose protein kinase hormone-sensitive lipase.

PCOS is closely linked to functional derangements in adipose tissue dysfunction, although the mechanisms underlying this association are not well established. As described for metabolic stress, adipocytes seem to be prone to hypertrophy when exposed to androgen excess, as experienced by PCOS women, and both adipose tissue hypertrophy and hyperandrogenism are related to insulin resistance. Moreover, evidence suggests that reduced catecholamine-induced lipolysis in SC adipocytes may also be associated with adipocyte hypertrophy in PCOS.

Oxygen tension of adipose tissue (AT) dysfunction in human balance

Since adipose tissue dysfunction has been identified as an important process in the pathophysiology of esophageal disorders, the number of studies aimed at identifying the trigger for adipose tissue dysfunction has increased significantly. The prevailing notion is that insufficient oxygen in adipose tissue is commonly called “adipose tissue hypoxia,” which refers to adipose tissue dysfunction in obesity.

It has been proposed that adipose tissue angiogenesis is inadequate to maintain normoxia in adipose tissue during the progressive development of obsolescence. In other words, reduced oxygen delivery to tissue is proposed to induce adipose tissue dysfunction. It is true that angiogenic genes (eg, VEGF) and lower capillary density were found in abdominal subcutaneous adipose tissue compared to lean individuals. The net result of the structural and functional properties of the adipose tissue vasculature determines tissue blood flow.

A consistent observation made by our lab and others is that fasting and postprandial ATBF decreases in lean insulin-resistant or insulin-sensitive versus insulin-sensitive subjects, indicating that the oxygen supply to adipose tissue is actually weaker. We recently demonstrated for the first time that both ATBF drug (local administration of vasoactive agents) and ATBF physiological manipulation (oral glucose drink) induce similar changes in adipose tissue oxygen partial pressure (AT PO2) in humans. ), Which indicates that the supply of oxygen to adipose tissue actually affects AT PO2.

The second argument proposed to develop the concept of hypoxia of adipose tissue in ob arrhythmia is that the diameter of hypertrophic adipocytes in arrhythmia exceeds the normal diffusion distance of oxygen in the tissues (100-200 m). However, in human adipose tissue, there appears to be only a very small proportion of fat cells with a diameter> 100 µm. Therefore, the importance of reducing oxygen diffusion from capillaries to hypertrophic fat cells in obese humans can be questioned.

Conclusion and future directions

Adipose tissue dysfunction is a key factor in the pathophysiology of chronic cardiovascular and metabolic diseases. Recent studies have suggested that changes in AT PO2 can cause adipose tissue dysfunction in obese patients, although many questions remain. More research is needed on the functional effects of AT PO2, as well as modified AT PO2, in well-characterized observational and clinical intervention studies in humans.

Important factors to consider in future studies are the severity, duration, and pattern of exposure to PO2, as different experimental conditions may indicate different study results. In addition, it is of particular interest to examine the differences in fat stores in AT PO2 (eg, lower body versus upper body) and to discover whether metabolic and inflammatory responses to chronic physiological levels of O2 are related to fat deposits and specific cell types. [For example, adipocyte (anterior), vascular stromal cells, macrophages] and/or donor characteristics.

Furthermore, it is important to understand whether AT PO2 is more strongly related to metabolic syndrome (eg, insulin resistance) in obesity than to increased adipose tissue mass. Finally, human intervention studies are needed to determine if AT can modify PO2 (eg, weight loss, oxygen therapy) and subsequently cause changes in metabolism and inflammatory phenotype. These studies should be comprehensive in nature combined with measurements in tissue biopsies and cell culture experiments, in vivo evaluation of adipose tissue, and whole-body physiology.

Studies in this exciting field of research may lead to new opportunities for therapeutic intervention in obese people with adipose tissue dysfunction, thereby improving cardiometabolic health.


Macular Pucker | A Guide to Causes and Treatments | Ophthalmology

What is a macular pucker?

The eye is often compared to a camera. The front of the eye has a lens that focuses images on the back of the eye. This area, called the retina, is covered by specialized nerve cells that respond to light. These nerve cells are located very close to the centre of the retina, where the eye focuses on the images we see. This small part of the retina is called the macula.

The macula is usually flat on the inner posterior surface of the eye. Sometimes cells can shrink inside the eye and pull on the macula. Occasionally, an injury or medical condition creates fibres of scar tissue within the eye. These are called the epithelial membrane and can pull on the macula and cause a distortion of vision. When this pulls on the macula wrinkles, it is called macular pucker. In some eyes, it has less effect on vision, but in others, it can cause significantly distorted vision.

Macular pucker (also known as epithelial membrane) is an eye condition that affects the central retina or the macula. As the name suggests, it is caused by distortion or “compression” of the macula. This condition is sometimes called “cellophane maculopathy” because it is caused by a thin, transparent layer of cellophane-like scar tissue on neurons in the macula.

Although macular frown is a different disease than age-related macular degeneration, both diseases have similar characteristics such as wavy or distorted vision in the middle of the visual field. Macular pucker usually causes only a slight distortion of vision in one eye; However, less often it affects both eyes and significantly loses central vision.

Scar tissue grows through an injury to the eye. The most common type of “injury” is the separation of the jelly (vitreous) in the middle of the eye from the retina, which occurs in most people during the aging process. The vitreous is made up of water and a network of tiny fibres. When these fibres separate from the retina, they pull on the retina and cause enough damage to stimulate the growth of scar tissue. Alternatively, the growth of scar tissue can be induced by inflammation, trauma, and possibly, in rare cases, cataract surgery to the eye.

What causes macular pucker?

Much of the inside of the eye is covered with a gel-like vitreous substance that helps the eye maintain a rounded shape. As we age, the vitreous slowly contracts and moves away from the surface of the retina. This is called a vitreous detachment. It is normal and causes no symptoms. Some people may have a small increase in floaters that are less “cobwebs” or spectra that appear to float in the field of view, but this is generally not harmful.

But sometimes the vitreous retina is damaged when it is pulled. (It doesn’t look like a macular hole.) When this happens, the retina begins the healing process of the damaged area and forms scar tissue, called “epithelial membrane.” This scar tissue sticks firmly to the surface of the retina. When it shrinks, it can cause wrinkles or wrinkles on the retina. It generally does not harm the central vision. However, if scar tissue forms on the part of the retina that supports the macula, acute central vision becomes blurry and distorted.

Most macular pus is related to aging, but it can also be caused by other eye conditions. These include isolated retina, uveitis, and diabetic retinopathy. A macular pucker can occur due to injury from eye surgery or an eye injury.

What are the symptoms of macular pucker?

The main feature of the macular pucker is a changed in vision. Vision changes and damage range from none to severe. But severe vision loss is rare.

People with macular frown may notice that their vision is blurry or slightly distorted and straight lines with rings appear. They may find it difficult to see fine details and read the fine print. They may also have a grey area or blind spot in the centre of vision.

Is macular pus equal to age-related macular degeneration?

No! Macular wrinkling and age-related macular degeneration are two different conditions, but the symptoms are the same. Both conditions are called “macular” because they have a “macular” area on the retina. Talk to your eye doctor if you think you have any of these conditions.

Will macular pucker get worse?

For most people with macular degeneration, vision worsens over time, but it doesn’t happen quickly. Macular pucker usually affects one eye first, but then affects the other eye.

Is a macular pucker similar to a macular hole?

A macular pucker and a macular hole are different conditions, but both can occur due to the vitreous pulling away from the retina. When pulling only causes minor damage, the retinal scar tissue heals on its own. This is the macular pucker. If severe damage occurs when pulling, the retina in the macular region will tear and a hole will be created. This is the macular hole. Macular pucker does not turn into a macular hole.

Both conditions cause blurred and distorted vision, but the macular cavity causes more permanent vision loss than macular pucker. If you think you have any of these conditions, talk to your eye doctor.

Diagnosis and monitoring of the Macular pucker

An ophthalmologist who examines the retina after a student dilates the drops can diagnose macular degeneration. By measuring visual acuity, your progress over time can be tracked by looking at a graph called an Amsler grid or by checking for distorted vision through special photographs. These include colour photographs of the retina and important cross-sectional photographs of the retina taken using a procedure called optical coherence tomography (OCT). OCT shows the extent of retinal scar formation and retinal distortion due to traction of scar tissue.

Treatment: Non-surgical intervention macular pucker

Since most patients have only mild symptoms, they can best benefit from new glasses, reading lamps, and perhaps magnifying glasses. For patients with more severe symptoms, medical or surgical treatment may be appropriate. A subset of patients with macular pus caused by a vitreous pull on the macula (in vitro macular traction) may benefit from a single injection into the eye of an active drug called jetrea. This drug is an enzyme that digests small fibres in the vitreous, releasing traction.

Treatment: macular pucker surgery to remove scar tissue

For patients who do not benefit from jetrea, surgery can help. Surgery is performed on the patient under local anaesthesia and the vitreous is removed (vitrectomy) and the cellophane-like scar tissue is usually rubbed off. Helps relieve retinal traction, reduces vision distortion, and improves visual acuity.

Related disorders

The related disease is the macular hole, which is caused by traction on the retina and requires vitrectomy surgery to relieve the traction and close the hole. Another disease called retinal detachment occurs, usually, the retina separates from the back of the eye, usually caused by a tear in the peripheral retina that causes a vitreous pull on the retina during retinal detachment. Symptoms of a retinal tear/detachment in one eye:

  • Bright light curves in peripheral vision;
  • New floating black dots insight; OR
  • A curtain that blocks peripheral vision, which can be expanded to block the central vision.

Since retinal detachment is an emergency, patients with symptoms of retinal detachment should call their ophthalmologist immediately for vision protection treatment if an eye detachment or detachment is diagnosed.

What are the benefits and risks of surgery?

In most cases, surgery for macular pucker can improve vision but does not bring it back to normal. Most people are able to regain about half of the vision they lost from a macular pucker. Some people have much more vision restored, some less. In most cases, surgery can help with vision distortion. Vision recovery can continue for as long as three months after surgery.

The most common complication of a vitrectomy is an increase in how quickly cataracts develop. You might need surgery for cataracts within a year or two after the vitrectomy. Less common complications include retinal detachment either during or after surgery, and infection after surgery. Also, the macular pucker can grow back, but this is rare. Talk to your eye doctor about whether surgery is a good option for you.


Possible Causes & Treatments of Red Spot on the Eye | Ophthalmology

What is a red spot on the eye?

A red spot on the eye can be alarming, but it is probably not as serious as it sounds. One or more tiny blood vessels in the eye may have broken and are leaking. This is called a subconjunctival hemorrhage. It can happen after something as simple as an unexpected cough or sneezing attack.

Despite appearances, you probably won’t feel anything. It is usually harmless and goes away without treatment. Read on to learn about approximately the causes of red eye spots, plus signs that it could be somewhat more serious.

Causes of red spot on the eye

Bloodshot eyes appear red because the vessels on the surface of the white portion of the eye (sclera) become inflamed. The vessels can swell due to:

  • Eye dryness
  • Too much sun exposure
  • Dust or other particles in the eye
  • Allergies
  • Infection
  • Injury

Eye infections or irritation can cause redness, as healthy as possible itching, discharge, pain, or vision problems. These may be due to:

  • Blepharitis: Swelling along the edge of the eyelid.
  • Conjunctivitis: Swelling or infection of the transparent tissue that lines the eyelids and covers the surface of the eye (the conjunctiva). This is often known as “conjunctivitis.”
  • Corneal ulcers: Sores on the cornea that are most often caused by a serious bacterial or viral infection.
  • Uveitis: Inflammation of the uvea, counting the iris, ciliary body, and choroid. The cause is most often unknown. It can be related to an autoimmune disorder, infection, or exposure to toxins. The type of uveitis that causes the worst red eyes is called iritis, in which only the iris becomes inflamed.

Other possible causes of red eyes include:

  • Colds or allergies
  • Acute glaucoma: A sudden increase in pressure in the eye that is extremely painful and causes serious visual problems. This is a medical emergency. The most common form of glaucoma is long-term (chronic) and gradual.
  • Scratches on the cornea: Injuries caused by sand, dust or excessive use of contact lenses.

Sometimes a cheerful red spot called a subconjunctival hemorrhage, will appear on the white of the eye. This usually occurs after straining or coughing, which causes a blood vessel on the surface of the eye to rupture. Most of the time, there is no pain and your vision is normal. It is almost never a serious problem. Because blood leaks into the conjunctiva, which is clear, the blood cannot be cleaned or rinsed. Like a bruise, the red spot will disappear in a week or two.

Home care

  • Try to rest your eyes if the redness is due to fatigue or eye strain. No other treatment is needed.
  • If you have eye pain or a vision problem, call your ophthalmologist right away.

Treatment of red spot on the eye

Subconjunctival hemorrhages do not usually require treatment. The healing time can vary from a few days to a few weeks, contingent on the size of the stain. Persons can use false tears to relieve irritation or dryness. Artificial tears are available at drugstores, pharmacies, and online.

A doctor may recommend antibiotic eye drops if the red spot is the result of a bacterial infection. People should not be alarmed if the red spot on the eye changes colour from red to yellow or orange. This is a sign that the bleeding is healing. Like a bruise, it can slowly fade over time.

Treatments for diabetic retinopathy or red spot on the eye include:

  • Injectable medications to reduce swelling
  • Laser eye surgery to close leaky blood vessels
  • Vitrectomy or surgery that involves the removal of vitreous gel and blood from the back of the eye

Diagnosis of red spot on the eye

Your physician can diagnose a subconjunctival hemorrhage just by looking at it. If you have symptoms that suggest something else, you will probably need a comprehensive eye exam.

Your doctor should evaluate any underlying problems, such as diabetes or high blood pressure. If it looks like you have hyphema, your doctor may want to monitor the pressure in your eye or do a CT scan to see if there is any less visible damage.


Signs and Symptoms of Hormonal Imbalance | Endocrinology

Here are 10 signs of hormonal imbalance to watch out for and what you can do about it:

Here are signs of hormonal imbalance:

  1. Mood swings: The female sex hormone estrogen has an effect on neurotransmitters in the brain, including serotonin (a mood-enhancing chemical). Fluctuations in estrogen can cause premenstrual syndrome (PMS) or depressed mood during perimenopause (the phase before periods stop completely) and menopause.

What to do: If feeling depressed or anxious significantly interferes with your daily life, then diet and lifestyle changes, such as exercising, drinking less alcohol, and quitting smoking, herbal remedies (such as St. Juan) and hormones Replacement therapy (HRT), if you are perimenopausal or menopausal, can improve your mood. Keeping a symptom diary will also help you and your doctor identify whether hormonal changes may be to blame.

  1. Heavy or painful periods: If accompanied by other symptoms such as abdominal pain, frequent urination, low back pain, constipation, and painful intercourse, you may have fibroids. Fibroids are non-cancerous growths that develop in or around the uterus. The exact cause is unknown, although they are believed to be stimulated by estrogen while having a family history can also increase your risk.

What to do: If you are experiencing symptoms, consult a qualified healthcare professional who can prescribe medication to shrink fibroids. In severe cases or if the medication does not solve the problem, surgery may be considered to remove them.

  1. Low libido: Low libido is particularly common in women going through perimenopause or menopause due to decreased levels of estrogen and testosterone (although known as the male hormone, women also have testosterone). Other symptoms of menopause such as night sweats, fatigue, low mood, and anxiety can also have an impact on your sex life.

What to do: If you are going through menopause, you may want to consult a women’s health expert about trying testosterone as part of your HRT. This can improve your libido and improve your mood and energy levels. It is administered in very low doses as a gel applied to the skin.

  1. Insomnia and poor quality sleep: During perimenopause and menopause, the ovaries gradually produce less estrogen and progesterone, which promotes sleep. Dropping estrogen levels can also contribute to night sweats that disrupt sleep and contribute to fatigue and lack of energy.

What to do: The first step is to get an accurate diagnosis. If you are going through perimenopause or menopause, talk to your doctor about the benefits of HRT, which will restore your estrogen and progestin levels. You can also do practical things to improve your sleep like wearing cotton pajamas, sleeping between cotton sheets, keeping your bedroom cool and as dark as possible, exercising, and cutting down on alcohol and caffeine.

  1. Unexplained weight gain: A number of hormone-related conditions can cause weight gain, including an underactive thyroid (when the thyroid gland does not produce enough thyroid hormones that regulate metabolism), polycystic ovary syndrome (PCOS) (a hormone-related problem that causes small cysts on the ovaries) and menopause (which leads to hormonal changes that can cause weight gain around the abdomen).

What to do: If you are experiencing unexplained weight gain, with no changes in diet or exercise levels, you may want to consult a women’s health expert to check for conditions such as thyroid problems or ovarian cysts. If you are going through menopause, you may want to discuss the benefits of HRT with your doctor. Some women believe that HRT causes weight gain, but there is no evidence to support it.

  1. Skin problems: Chronic acne in adults can be a sign of low estrogen and progesterone levels and high levels of androgen hormones and can also indicate polycystic ovarian syndrome. Similarly, hormonal imbalances during pregnancy or menopause can lead to itchy skin, while dry skin is a symptom of menopause or thyroid problems.

What to do: If you think a persistent skin problem is caused by hormonal balance, you can consult a women’s health expert to diagnose and treat the underlying problem.

  1. Fertility problems: Hormonal imbalance is one of the main causes of female infertility and with changing hormone levels, a woman’s fertility naturally declines after the age of 35. High levels of follicle-stimulating hormone (FSH) can reduce a woman’s chances of contracting. If you are pregnant with low levels of luteinizing hormone (LH), which stimulates the ovaries to release an egg and start producing progesterone, you can also cause fertility problems. Early menopause and other hormone-related conditions, such as polycystic ovary syndrome, will affect her fertility.

What to do: Your GP may arrange a blood test to check FSH and LH levels and if you have been trying to conceive for a year, or less time if you are over 35, then you may consider consulting an expert on women’s health to diagnose any underlying causes of your difficulty conceiving.

  1. Headaches: Many women suffer from headaches due to hormonal changes during the menstrual cycle, pregnancy, or menopause.

What to do: Keeping a symptom diary will help you and your doctor identify the triggers for your headaches. Eating small, frequent snacks and maintaining a regular sleep pattern can help. If you have regular attacks, your doctor may prescribe migraine medications or taking the birth control pill or HRT may help.

  1. Weak bones: decreased levels of estrogen during perimenopause and menopause can cause bone loss.

What to do: Women often don’t realize they have brittle bones until they have a fracture, so it is important to adopt lifestyle changes to improve bone health as they reach middle age and beyond. Exercising with weights, such as running, playing tennis, or dancing, a healthy diet that includes sources of calcium and vitamin D, and taking HRT to treat menopausal symptoms may be beneficial.

  1. Vaginal dryness: Vaginal dryness is most often caused by a drop in estrogen levels, especially during perimenopause and menopause. Taking the birth control pill or antidepressants can also change hormone levels and cause the problem.

Symptoms of hormonal imbalance

Generalized symptoms include fatigue, irritability, mood swings, fluctuating blood sugar levels, trouble concentrating, insomnia, and weight gain.


These are the most common forms of hormonal imbalance resulting in:

  • Abnormal weight gains Increased facial hair: This also increases hair on the man’s dependent areas such as the upper lips, chin, and chest.
  • Irregular Periods: Sometimes these also result in a 60-90 day cycle with very low flow.
  • Anovulation that leads to infertility: There is impaired ovulation because a woman may have difficulty conceiving.
  • Acne: Increased androgen levels in women with PCO leads to acne and abnormal weight gain.
  • Fatigue is a common symptom that can occur due to a hormonal imbalance. If progesterone levels are low, they can cause poor sleep and, if they are too high, they can increase fatigue.
  • Thyroid imbalance: Hypothyroidism in which TSH is high and T3 and T4 are low can cause fatigue, weight gain, back pain, hair loss, a hoarse voice, constipation, poor concentration, and increased drowsiness. weight loss of appetite, heartburn, eye flushing and lack of heat.

Estrogen imbalance:

The decrease in estrogen levels during the monthly cycle causes mood swings. Women can seek comfort foods that are high in fat, calories, sugar, and salt to help them feel better. Unfortunately, all this food is counterproductive and makes the woman feel even worse. Sodium increases fluid retention and bloating, sugar increases fat and calories, causing her to put on weight again. Headache can also be precipitated by decreased estrogen levels. Vaginal dryness that occurs in the perimenopausal age group also occurs due to a low level of estropeis.

Low testosterone:

Testosterone through typically male hormones also plays a vital role in women. Low levels of testosterone can cause a decrease in libido and sexual desire.

Changes in the breasts:

High levels of estrogen can cause heavy, lumpy breasts and increased cysts.

Unstable sugar:

Insulin and glucagon imbalance can lead to abnormal blood sugar like diabetes.


This is the most common byproduct of hormonal imbalance, especially PCOD.

Aging of the skin and loss of bone mass:

The decrease in estrogen levels leads to perimenopause, which leads to aging of the skin, makes the skin thinner, drier, and less elastic.

Mental health problem:

Estrogen has a positive impact on the brain by regulating neurotransmitters, cognition, and the ability to cope with stress. The decrease in estrogen leads to the risk of psychosis.

Osteoporosis or thin bones:

Loss of estrogen leads to thin and weak bones, increasing the risk of fracture in the perimenopausal age group.

Cancer of the breast, ovary, and uterus:

The dominance of estrogens can lead to cancers of the ovaries, breast, and uterus.

It is very important to regulate hormone levels. Therefore, hormone replacement therapy for the desired hormonal imbalance can really help. Apart from that, leading a healthy lifestyle also helps to overcome the effects of hormonal imbalance.

Causes of a hormonal imbalance

There are many possible causes of hormonal imbalance. The causes differ depending on the hormones or glands affected. Common causes of hormonal imbalance include:

  • Diabetes
  • Hypothyroidism or underactive thyroid
  • Hyperthyroidism or overactive thyroid
  • Hypogonadism
  • Cushing’s syndrome
  • Thyroiditis
  • Over-functioning thyroid nodules
  • Hormone therapy
  • Tumors (benign or cancerous)
  • Congenital adrenal hyperplasia
  • Eating disorders
  • Medicines
  • Stress
  • Suprarrenal insufficiency
  • Pituitary tumor
  • Injury or trauma
  • Cancer treatments

Unique causes of women

Many causes of hormonal imbalance in women are connected to reproductive hormones. Common causes include:

  • Menopause
  • The pregnancy
  • Breastfeeding
  • SOP
  • Premature menopause
  • Hormonal medications such as birth control pills
  • Primary ovarian failure

Treatment for hormonal imbalance

Treatment for hormonal imbalances can vary depending on the cause. Each person may require different types of treatment for hormonal imbalances.

Treatment options for women with hormonal imbalances include:

  • Hormonal or contraceptive control: For those who are not trying to get pregnant, medications that contain forms of estrogen and progesterone can help regulate unequal menstrual cycles and symptoms. People can take birth control medications in the form of a pill, ring, patch, shot, or an intrauterine device (IUD).
  • Vaginal estrogen: People experiencing vaginal dryness related to changes in estrogen levels can apply creams that contain estrogen directly to vaginal tissues to decrease symptoms. They can also use estrogen tablets and rings to decrease vaginal dryness.
  • Hormone replacement drugs: Medications are obtainable to temporarily reduce severe symptoms related to menopause, such as hot flashes or night sweats.
  • Eflornithine (Vaniqa): This prescription cream can slow the excessive growth of facial hair in women.
  • Anti-androgen drugs: Medications that block androgen, the predominantly male hormone, can help limit severe acne and excessive hair growth or loss.
  • Clomiphene (Clomid) and letrozole (Femara): These medications help stimulate ovulation in people with PCOS who are trying to get pregnant. People with PCOS and infertility can also receive gonadotropin injections to help increase the chances of pregnancy.
  • Assisted reproductive technology: In vitro fertilization (IVF) can be used to help people with complications of PCOS become pregnant.

Treatment options for anyone with hormonal imbalances include:

  • Metformin: A medicine for type 2 diabetes, metformin can help control or lower blood sugar levels.
  • Levothyroxine: Medications that contain levothyroxine, such as Synthroid and Levothroid, can help improve the symptoms of hypothyroidism.

Treatment options for men with hormonal imbalances include:

  • Testosterone drugs: Gels and patches that contain testosterone can help reduce symptoms of hypogonadism and other conditions that cause low testosterone, such as delayed or atrophied puberty.

Diagnosis of hormonal imbalance

There is no single test obtainable for doctors to diagnose a hormonal imbalance. Start by making an appointment with your doctor for a physical exam. Be prepared to describe your symptoms and the timeline along which they occurred. Bring a list of all the medications, vitamins, and supplements you are currently taking.

Your doctor may ask you questions like:

  • How often do you have symptoms?
  • Is there anything that helps relieve your symptoms?
  • Have you recently lost or gained weight?
  • Are you more stressed than usual?
  • When was your last period?
  • Are you planning to get pregnant?
  • Do you have trouble accomplishment or keeping an erection?
  • Do you have vaginal waterlessness or pain during sex?

Liable on your symptoms, your doctor may suggest one or more diagnostic tests. You can also ask your doctor to do these tests.

  • Blood test: Your doctor will send a sample of your blood to a laboratory for testing. Most hormones can be detected in the blood. A doctor can use a blood test to checkered your thyroid, estrogen, testosterone, and cortisol levels.
  • Pelvic exam: If you are a woman, your doctor may perform a Pap test to feel for unusual lumps, cysts, or tumors. If you are male, your doctor may check your scrotum for lumps or abnormalities.
  • Ultrasound: An ultrasound machine uses sound surfs to look inside your body. Doctors may use an ultrasound to take pictures of the uterus, ovaries, testicles, thyroid, or pituitary gland.

Additional exams

Sometimes more advanced tests are required. These may include:

  • biopsy
  • magnetic resonance
  • X-rays
  • thyroid scan
  • sperm count

Complications of hormonal imbalance

Hormonal imbalances are associated with many long-term or chronic health conditions. Without proper treatment, you could be at risk for several serious medical conditions, including:

  • Diabetes
  • Hypertension
  • High cholesterol
  • Heart disease
  • Neuropathy
  • Obesity
  • Sleep apnea
  • Kidney damage
  • Depression and anxiety
  • Endometrial cancer
  • Osteoporosis or bone loss
  • Loss of muscle mass
  • Breast cancer
  • Infertility
  • Urinary incontinence
  • Sexual dysfunction
  • Goiter

Risk factors for hormonal imbalance

Risk factors for endocrine disorders include:

  • Elevated cholesterol levels.
  • Family history of endocrine disorder.
  • Inactivity.
  • Personal history of autoimmune illnesses, such as diabetes.
  • Poor diet.
  • Pregnancy (in cases like hyperthyroidism)
  • Recent surgery, trauma, infection, or serious injury.

Supplements and natural remedies

There are many nutritional supplements on the market that claim to treat menopause and hormonal imbalance. However, few of them are supported by scientific evidence.

Many of these supplements contain hormones of plant origin. They are sometimes called “bioidentical” hormones because chemically they resemble the body’s natural hormones. However, there is no evidence to suggest that they work better than regular hormone therapy.

Some people find that yoga helps treat the symptoms of hormonal imbalance. Yoga is great for your strength, flexibility, and balance. It can also help you lose weight, which can help regulate your hormones.

You can also make the following lifestyle changes:

  • Lose weight: A 10 per cent reduction in women’s body weight can help make their periods more regular and increase their chances of getting pregnant. Losing weight in men can help improve erectile function.
  • Eat well: A stable diet is an important part of overall health.
  • Reduces vaginal discomfort: Use lubricants or moisturizers without parabens, glycerin and petroleum.
  • Avoid hot flashes: Try to identify the things that commonly trigger your hot flashes, such as hot temperatures, spicy foods, or hot drinks.
  • Remove unwanted hair: If you have excess facial or body hair, you can use a depilatory cream, laser hair removal, or electrolysis.

Hormones affected by exercise

  • Dopamine: Studies have shown that exercise increases dopamine levels in the brain, reducing stress and even depression. This biochemical causes the famous “high” because it enhances those “feel good” transmitters. Increased dopamine also helps eliminate that “jittery” feeling that stress creates, Petty adds.
  • Serotonin: Millions of Americans suffer from insomnia and sleep apnea and seek help to sleep. Instead, Petty recommends a healthy dose of exercise. Physical action releases serotonin, which promotes a good night’s rest. Increased serotonin levels can also have a positive impact on mood, social behaviour, appetite, digestion, memory, and sexual function.
  • Testosterone: A man’s muscle mass, strength, sex drive, and sperm count are directly related to his testosterone levels. As man ages, testosterone naturally decreases. However, Petty says that getting regular physical activity can help boost testosterone, which can slow the natural effects of aging.
  • Estrogen: The symptoms of menopause are due in part to an imbalance and decrease in estrogen. One way to combat this is to exercise. Increasing your heart rate for at least half an hour every day helps increase estrogen levels, which can help ease symptoms of menopause.

Exercises that help increase hormone levels

Petty recommends a combination of strength training and cardiovascular exercise to maximize health benefits and increase hormone levels. High-intensity exercises like squats, lunges, pull-ups, sit-ups, and push-ups are ideal, with minimal rest time in between. The more penetrating a workout, the more hormones are released. Consistency is also key to retaining a steady stream of healthy hormones throughout the body.

“Exercise is a journey. Results don’t happen overnight. The key is to stay focused on consistency. It’s not about how hard you work, it’s about sticking with it and making it a lifestyle instead of a binge, “says Petty.

Here are some foods to avoid

  • Vegetables
  • Red meat
  • Stevia
  • Soy products
  • Dairy products

Types and Causes of Lagophthalmos | Ophthalmology

What is lagophthalmos?

Lagophthalmos mentions the inability to fully close the eyelids. The space between the upper and lower lids exposes the ocular surface, causing dryness problems that can be aggravated and threaten the integrity of the eye and the quality of vision.

Symptoms of lagophthalmos

The main symptom of lagophthalmos is not being able to close your eyes. If you have nocturnal lagophthalmos, you may not even know it. The expression for these additional symptoms in one or both eyes if you reason you have lagophthalmos:

  • Increased tears
  • Foreign body sensation, which is the sensation of something rubbing against the eye
  • Pain or irritation, especially in the morning.

Types lagophthalmos

Nocturnal lagophthalmos is the incapability to close the eyelids during sleep. It can reduce the quality of sleep because symptoms related to the exposure or, if severe, cause damage to the cornea (exposure keratopathy). The degree of lagophthalmos can be minor (dark lagophthalmos) or quite obvious.

It is often caused by an abnormality of the eyelid that prevents complete closure. Treatment may include surgery to correct poor eyelid position. Point plugs can be used to increase the amount of lubrication on the surface of the eyeball by blocking some of the tear drainage ducts. Eye drops can also be used to provide additional lubrication or to stimulate the eyes to increase tear production.

The condition is not widely understood; in one case, a passenger was removed from a US Airways flight because of it.

Causes of lagophthalmos

Lagophthalmos is caused by the following three main causes:

  • Orbicularis muscle function failure of the eyelids. This is the most common cause. It may be paralytic, due to the fact that the facial intracranial nerve affects the orbicularis oculi muscle, or spastic, as seen in thyrotoxicosis.
  • The excessive bulge of the globe in the orbit. Lagophthalmos can accompany proptosis or buphthalmos (enlarged cornea due to elevated intraocular pressure in young children), even though the eyelids are normal, not covering the eye with proptosis.
  • The inadequate vertical dimension of the upper or lower eyelid. It can be structural when the retraction or shortening of the eyelids is due to scarring or atrophy after injury (eg burns) or illness. Babies with a collodion membrane may have temporary lagophthalmos due to the restrictive effect of the membrane on the eyelids.
  • During sleep, some degree of physiological lagophthalmos can normally occur. Functional lagophthalmos in an unconscious patient can be very troublesome.

Treatments of lagophthalmos

In treating lagophthalmos, the main goal is to prevent exposure to keratitis (inflammation of the cornea), as well as to try to restore eyelid function.

The first treatment plan is usually to keep the eyes hydrated. Blinking usually prevents dryness by dispersion the tear film and meibomian gland secretion over the surface of the conjunctiva and cornea. As patients with lagophthalmos cannot blink normally, an ophthalmic ointment or lubricating eye drops are usually applied both day and night. In extreme cases, taping the lid closed and using a humid chamber to prevent the surface of the eyeball from drying out could remedy extreme dryness. If the condition is acute, botulinum toxin injections into the levator eyelid may allow for better occlusion of the eye.

Permanent treatments will often target the paralyzed facial nerve. For example, facial nerve repair or facial nerve crossover graft can restore the function of the eyelid muscles and also help restore facial symmetry. These procedures are generally not used in older patients.

If conventional surgical procedures do not improve the condition, a second option is a procedure known as tarsorrhaphy. This includes sewing the lids together partially, to narrow the lid opening. Other similar techniques, such as eyelid loading, involve placing a small weight on the upper eyelid, thus increasing the downward pull on it, so that this will gradually cause the eye to close when forced to close. The weight is light enough to experience a gravitational pull and is often made of gold.

In summary, It is most often caused by facial nerve palsy and often has a good recovery rate if treated right away. Understanding the cause is essential in determining which treatment strategy will offer the best success rate. Treatment of the underlying condition should improve facial nerve function and cosmetic appearance, although unfortunately, there are some conditions where this can be difficult.

Diagnosis of lagophthalmos

The diagnosis of lagophthalmos is mainly clinical.

  • A slit-lamp examination by an ophthalmologist may show interpalpebral punctate epithelial keratopathy, which is a diagnosis of this disease or incomplete blinking. The distribution of punctate epithelial keratopathy depends on the position of the cornea during sleep in patients with nocturnal lagophthalmos.
  • The external examination for complete eyelid closure should be performed with the patient gently closing the eyes.
  • Acute dysfunction of the seventh intracranial nerve, due to Bell’s palsy, trauma, or iatrogenic injury, can cause this disease. In cases of understated weakness of the orbicularis oculi muscle, manual distraction of the eyelids throughout forced closure can expose a weakness that can cause nocturnal lagophthalmos or incomplete blinking.
  • It is important to check corneal sensitivity to rule out any component of fifth intracranial nerve dysfunction.
  • The vertical dimension of the upper and lower eyelid skin should be evaluated in patients with alleged lagophthalmos. In the lower lids, vertical thinning is usually apparent and manifests as a “sclera show” and eyelid retraction. However, in the upper eyelids, the lid margin often rests at a normal height, and only with the downward distraction of the eyelid does vertical shortening of the skin become apparent.
  • In all patients suspected of this disease, the function of the superior levator palpebral muscle should be measured (during the eyelid excursion from top to bottom). Patients with inadequate mobility of the upper eyelid retractors may have this disease notwithstanding a normal amount of vertical skin.
  • The symblepharon between the bulbar and palpebral conjunctiva in the superior cul-de-sac can also limit the downward excursion of the upper eyelid, thus causing this disease.
  • The balloon bulge increases the amount of eyelid excursion required to completely cover the cornea during eye closure. It associated with proptosis can cause exposure to keratopathy.
  • Nocturnal lagophthalmos causes a foreign body sensation and watery eyes upon waking.
  • Comatose patients usually present with this disease due to the inadequate tone of the seventh central intracranial nerve.

Complications of lagophthalmos

  • Untreated lagophthalmos leaves your eyes vulnerable to scratches and other injuries because they are not protected by your eyelids.
  • Continuous eye exposure can also lead to exposure keratopathy, which has the same symptoms as lagophthalmos. Exposure keratopathy can eventually cause the cornea, the clear front part of the eye, to swell or become thin. It can also lead to a corneal ulcer.
  • Surgery to treat this disease can also have complications. Tarsorrhaphy can leave permanent scars, while gold-weight implants can begin to move away from their original location. Be sure to follow your doctor’s post-surgery instructions to avoid additional problems.

How can it be prevented?

In general, It cannot be prevented, unless it is the result of retraction of the eyelid after blepharoplasty surgery through the skin or other surgical scars. In principle, it is important to detect it, to establish if it represents any risk to vision or the eye and to take the necessary measures for its treatment.

Is lagophthalmos common?

Nocturnal lagophthalmos (partial opening of the eyes during sleep) is an anatomical irregular in the usual human population; in fact, it occurs in 23% of the population.

Can lagophthalmos be cured?

Work with your physician to figure out the underlying cause. Contingent on the cause, you can treat this disease with also surgery or products to help keep your eyes moisturized and protected.


Bartter Syndrome | Causes and Treatment Options | Endocrinology

What is bartter syndrome?

Bartter syndrome is an over-all term for a group of rare genetic disorders in which there are specific flaws in kidney function. These defects damage the kidney’s ability to reabsorb salt and cause imbalances in the various electrolytes and fluid attentions in the body. The electrolytes affected are primarily mineral salts such as potassium, calcium, magnesium, sodium, and chloride.

The symptoms and severity of Bartter syndrome vary from one individual to another and can range from mild to severe. The age of onset of overt symptoms can variety from before birth to adulthood. Bartter syndrome is caused by alterations (changes) in one of several different genes. Treatment is aimed at correcting the electrolyte imbalances through the use of supplements and certain medications such as nonsteroidal anti-inflammatories (NSAIDs) and diuretics.

Causes of bartter syndrome

Bartter syndrome can be caused by mutations in any of several genes; the genetic cause in each case corresponds to the type of Bartter syndrome that each affected individual has. Type I is due to mutations in the SLC12A1 gene. Type II is caused by mutations in the KCNJ1 genetic factor. Type III results from mutations in the CLCNKB genetic factor.

Type IV can be caused by mutations in the BSND gene or by a combination of mutations in the CLCNKA and CLCNKB genes. The last variant, type V, has associated mutations in the CASR gene. In some people with Bartter syndrome, the genetic cause of the disorder is unknown; There may be other genes that cause the condition that has not yet been identified.

All of these genes are essential for normal kidney function – they are involved in the kidneys’ ability to reabsorb salt. Abnormal variations in these genes affect these abilities, allowing the loss of excess salt through the urine and also affecting the reabsorption of other things, such as potassium and calcium. The resulting imbalance of these in the body leads to the signs and symptoms of Bartter syndrome.

Symptoms of bartter syndrome

This disease usually occurs in childhood. Symptoms include:

  • Constipation
  • The rate of weight gain is much lower than that of other children of similar age and sex (stunting)
  • Need to urinate more repeatedly than usual (urinary frequency)
  • Low blood pressure
  • Kidney stones
  • Muscle cramps and weakness

Diagnosis of bartter syndrome

  • Electrolyte levels in serum and urine
  • Exclusion of similar disorders

Bartter syndrome and Gitelman syndrome should be supposed in children with characteristic symptoms or related laboratory abnormalities, such as metabolic alkalosis and hypokalemia. Measurement of urinary electrolytes shows elevated levels of sodium, potassium, and chloride that are inappropriate for the euvolemic or hypovolemic state of the patient. Diagnosis is made by excluding other disorders:

  • Primary and secondary aldosteronism can often be distinguished by the presence of hypertension and normal or low plasma renin levels (see Differential Diagnosis of Aldosteronism).
  • Surreptitious vomiting or laxative exploitation can often be distinguished by low levels of urinary chloride (usually <20 mmol / L).
  • Surreptitious diuretic abuse can often be distinguished by low urinary chloride levels and a urine diuretic test.

A 24-hour measurement of urine calcium or urine calcium/creatinine ratio can help distinguish the two syndromes; levels are typically normal too high in Bartter syndrome and low in Gitelman syndrome.


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Definitive diagnosis, including identification of disease subtypes, is made using genetic tests, which are now increasingly available.

Treatment of bartter syndrome

It is treated by eating foods rich in potassium or taking potassium supplements.

Many people also need salt and magnesium supplements. Medications that block the kidney’s ability to remove potassium may be needed. High doses of non-steroidal anti-inflammatory drugs (NSAIDs) can also be used.

Alternative names

  • Potassium wasting
  • Salt-wasting nephropathy


The risk factors for this disease remain unknown because the disease has its origin in genetic mutations of unknown causes.


There are no known prevention methodologies for this disease because the disease results from mutations of the genes.


Idiopathic intracranial hypertension (IIH) – an Overview | Ophthalmology

What is idiopathic intracranial hypertension?

Idiopathic intracranial hypertension (IIH) is a disorder associated with high pressure in the brain. It reasons the signs and symptoms of a brain tumor. It is also occasionally called pseudotumor cerebri or benign intracranial hypertension.

The unsolidified that environs the spinal cord and brain is called cerebrospinal fluid, or CSF. If too much fluid is produced or not enough is reabsorbed, CSF can build up. This can cause symptoms like those of a brain tumor.

IIH is classified into these categories:

  • Symptoms occur suddenly, often due to a head injury or stroke.
  • Symptoms develop over time: They may be due to an underlying health problem.
  • Idiopathic: The cause is unknown.

What are the symptoms of idiopathic intracranial hypertension?

Symptoms can include:

  • Headaches
  • Tinnitus (ringing in the ears)
  • Temporary blindness
  • Double vision
  • Blind spots
  • Neck and shoulder pain
  • Loss of peripheral (side) vision

If you notice any changes in your vision or other symptoms, talk to your eye doctor.

Causes of idiopathic intracranial hypertension

In the idiopathic or primary type (IIH), obesity is careful a factor in young women. However, only a small fraction of obese people develop IIH, so other unknown causes have yet to be determined.

The many potential causes of subordinate intracranial hypertension have been noted above. Note that in secondary IH, different IIH, obesity, sex, age, and race are NOT risked factors, but may be present.

The mechanism by which IH is produced is not known, but several possibilities have been suggested. Most research supports the theory that there is resistance or obstruction to the outflow of CSF through normal pathways in the brain, leading to a relative overproduction of CSF.

Diagnosis of idiopathic intracranial hypertension

  • MRI with magnetic resonance venography
  • Lumbar puncture

If clinical findings suggest idiopathic intracranial hypertension, clinicians should check visual fields and optic fundus, even in patients without visual symptoms.

The diagnosis of idiopathic intracranial hypertension is clinically suspected and established by brain imaging (preferably MRI with magnetic resonance venography) that has normal consequences (except for tapering of the transverse venous sinus), followed, if not contraindicated, by lumbar puncture with cerebrospinal fluid (CSF).) tests that indicate high opening pressure and normal CSF composition.

The use of certain medications and certain disorders can produce a clinical picture resembling idiopathic intracranial hypertension and should be excluded (see Conditions Associated with Papilledema and Similar to Idiopathic Intracranial Hypertension).

Treatment of Idiopathic intracranial hypertension (IIH)

For most people, IIH symptoms improve with treatment. Treatments include:

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Weightloss. For people who are overweight or obese and have IIH, weight loss is often the first treatment. Losing about 5 to 10 per cent of your body weight can help decrease your symptoms; for example, if you weigh 200 pounds, that means losing about 10 to 20 pounds. Talk to your doctor about safe and sustainable ways to lose weight.

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Medicine. Your physician may endorse a medicine called acetazolamide (Diamox) in addition to weight loss. This medicine helps your body make less CSF.

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Surgery. If other treatments don’t work, your physician might suggest surgery to help relieve the pressure. In bypass surgery, doctors make a small hole and add a tinny tube, called a bypass, to help the extra fluid drain around your brain into the rest of your body. There is also an eye surgery in which doctors make a small hole in the covering that surrounds the optic nerve.


Overview of Metabolic Alkalosis | Endocrinology

What is metabolic alkalosis?

Metabolic alkalosis is a metabolic illness in which the pH of the tissue rises outside the normal range (7.35 to 7.45). This is the rank of decreased hydrogen ion concentration, leading to increased bicarbonate or then, a direct result of increased bicarbonate concentrations.

Causes of metabolic alkalosis

Several different underlying conditions can cause metabolic alkalosis. These include:

Loss of stomach acids: This is the most shared cause of metabolic alkalosis. It is usually produced by vomiting or suctioning through a nasal feeding tube.

  • Gastric juices are high in hydrochloric acid, a strong acid. Its damage causes an increase in the alkalinity of the blood.
  • Vomiting can be the result of various stomach disorders. By discovering and treating the cause of vomiting, your doctor will cure metabolic alkalosis.

Excess antacids: The use of antacids will not normally lead to metabolic alkalosis. But if you have weak or worsening kidneys and use a no absorbable antacid, it can cause alkalosis. No absorbable antacids contain aluminium hydroxide or magnesium hydroxide.

  • Diuretics Some diuretics (water pills) commonly prescribed for high blood pressure can increase uric acid secretion. Increased acid secretion in your urine can make your blood more alkaline.
  • If alkalosis occurs when you are taking medications such as thiazides or loop diuretics, your doctor may ask you to stop.

Potassium deficiency (hypokalemia): A potassium deficiency can cause hydrogen ions normally present in the fluid around cells to move inside cells. The absence of acidic hydrogen ions makes fluids and blood more alkaline.

  • Reduced volume of blood in the arteries (EABV): This can come from both a weakened heart and cirrhosis of the liver. Reduced blood flow affects your body’s ability to remove alkaline bicarbonate ions.

Heart, kidney or liver failure: Metabolic alkalosis can be caused by the failure of a major organ, such as your heart, kidney, or liver. This leads to potassium depletion.

  • A normal saline solution (sodium chloride) can make things worse by making your body retain fluids without eliminating the excess bicarbonate ions that are causing the alkalosis.

Genetic causes: In rare cases, a congenital genetic factor can be the cause of metabolic alkalosis. Five congenital diseases that can cause metabolic alkalosis are:

  • Bartter syndrome
  • Gitelman syndrome
  • Liddle syndrome
  • glucocorticoid remediable aldosteronism
  • apparent excess of mineralocorticoids

Signs and symptoms of metabolic alkalosis

Symptoms and signs of mild alkalemia are often related to the underlying disorder. More plain alkalemia rises the protein compulsory of ionized calcium (Ca ++), foremost to hypocalcemia and subsequent headache, lethargy, and neuromuscular excitability, occasionally with delirium, tetany, and seizures. Alkalemia also lowers the threshold for anginal symptoms and arrhythmias. Concomitant hypokalemia can cause weakness.

Treatment of metabolic alkalosis

To treat alkalosis, your provider must first find the underlying cause. For alkalosis caused by hyperventilation, breathing into a paper bag allows you to retain more carbon dioxide in your body, which improves alkalosis. If your oxygen level is low, you may be receiving oxygen.

Medications may be needed to correct the loss of chemicals (such as chloride and potassium). Your provider will monitor your vital signs (temperature, pulse, breathing rate, and blood pressure).

Diagnosis of metabolic alkalosis

To begin with the diagnosis, your doctor will take your medical history and perform a physical exam.

If they suspect alkalosis, they will do blood and urine tests. They will look at the levels of oxygen and carbon dioxide in your arteries and measure the acidity and alkalinity of your blood.

Understand pH levels

The acidity or alkalinity of a liquid is unhurried on a scale called pH. In metabolic alkalosis, the pH of the blood is high.

The most unbiased substance, water, has a pH of 7. When the pH of a runny falls below 7, it becomes acidic. When it rises above 7, it is alkaline.

Your blood normally has a pH of 7.35 to 7.45, or slightly alkaline. When the pH rises significantly above this level, you have metabolic alkalosis.

Urine analysis

Your doctor can also test the concentrations of chloride and potassium ions in your urine.

When the chloride level is low, it indicates that it may respond to treatment with a saline solution. A low potassium concentration may indicate a potassium deficiency or overuse of laxatives.

Prevention of metabolic alkalosis

Reduce your risk of developing alkalosis by maintaining good health, eating a healthy diet, and staying hydrated. Choosing foods high in nutrients and potassium can help fight electrolyte deficiencies. The nutrients and potassium are mainly found in fruits and vegetables, as well as some other foods, such as:

  • Carrots
  • Bananas
  • Milk
  • Beans
  • Spinach
  • Saved

Steps you can take to prevent dehydration include:

  • Drink 8 to 10 glasses of aquatic a day
  • Drink water before, during and after exercise
  • Using electrolyte replacement drinks for high-intensity exercise
  • Avoiding sodas or juices, which are high in sugar and can make dehydration worse
  • Limiting caffeine, which is created in soda, tea, and coffee
  • It is important to remember that you are already dehydrated if you are thirsty.

Dehydration can also happen quickly if you lose a lot of electrolytes. This can happen when you are vomiting from the flu. If you can’t keep potassium-rich foods in your stomach, be sure to drink enough fluids, such as water, sports drinks, and broth-based soups.