General Topics

Diagnosis of Conjunctivitis in Children | Ophthalmology

What is conjunctivitis in children?

Conjunctivitis in children is inflammation of the lining of the eye over the eyeball and inside the eyelids. Infection with bacteria or viruses can cause conjunctivitis. Infection occurs easily, especially if the eye is already irritated. Sometimes children can develop conjunctivitis as part of a cold.

Viral conjunctivitis is very contagious, but bacterial conjunctivitis is not. conjunctivitis in children’s condition is often classified as neonatal conjunctivitis or infantile conjunctivitis. Each group has different causes and treatments.

Types of conjunctivitis in children

  1. Bacterial Conjunctivitis: Bacterial conjunctivitis is another common type of pink eye in which viruses are spread through the air by sneezing and coughing. Bacterial conjunctivitis is a common viral infection of the upper respiratory tract, such as measles, the flu, or the common cold.
  2. Viral Conjunctivitis: Viral conjunctivitis is a common infection in the Western population and is often associated with other infections throughout the body. Due to their correlation with respiratory anatomy, viral upper respiratory infections are a common cause of secondary viral conjunctivitis.
  3. Gonococcal and chlamydial conjunctivitis: It is caused by a bacteria called Neisseria gonorrhea. The newborn passes this type of conjunctivitis through the birth canal of the infected mother. This type of conjunctivitis can be prevented with the use of eye drops at birth in newborns. Newborn eyes are often very red, with thick discharge and swelling of the eyelids. This type usually begins 2 to 4 days after birth. Treatment of gonococcal conjunctivitis usually involves antibiotics through an intravenous (IV) catheter.
  4. Allergic Conjunctivitis: Caused by an allergy, not an infection, not an infection. Antibiotic eye drops may not help, but allergy eye drops can. It usually affects both eyes and the main symptoms in children are watery eyes and itching.
  5. Non-infectious conjunctivitis: Conjunctivitis, which is caused by irritation of the eyes, causes symptoms of conjunctivitis that can occur from a variety of sources, including smoke, diesel exhaust, perfumes, and certain chemicals. Some types of conjunctivitis stem from sensitivity to certain substances ingested, including herbs such as conjunctiva and turmeric.

Causes of conjunctivitis in children

Conjunctivitis in children may be caused by:

  • Bacteria (several different varieties may cause conjunctivitis)
  • Viruses (such as adenovirus or herpes virus)
  • Allergies
  • Exposure to chemicals (rarely, the drops given to newborns for preventing conjunctivitis may have the reverse effect and may irritate the eye)

The causes and treatments of conjunctivitis in children among newborns may differ.

Symptoms of conjunctivitis in children

The following are common symptoms of the condition. However, each child may experience symptoms differently. There may be symptoms:

  • Gritty feeling in one or both eyes
  • Itchy, irritated eyes
  • Clear, thin drainage and increased tearing
  • Sneezing and runny nose
  • Stringy discharge from the eyes
  • Thick, green drainage from the eyes
  • Ear infection
  • A lesion with a crusty appearance
  • Eyes that are matted together in the morning
  • Swelling of the eyelids
  • Pink or red discolouration of the whites of one or both eyes
  • Discomfort when the child looks at a light
  • Burning in the eyes

The symptoms of conjunctivitis in children sometimes resemble other medical problems. Always see your child’s healthcare provider for an examination.

Diagnosis of conjunctivitis in children

Conjunctivitis in children can be diagnosed by its symptoms, and the exact cause can be determined by the paediatrician. Since there are other conditions, such as hay fever, that have similar symptoms, it is important to see a paediatrician as soon as possible.

Common symptoms of infectious conjunctivitis are red, watery, and sticky eyes. However, infectious conjunctivitis is sometimes confused with other types of conjunctivitis, which are treated differently.

Conjunctivitis in children treatment

Treatment depends on your child’s symptoms, age, and general health. It also depends on the cause of the situation, for example:

  • Bacterial infections: It is administered with antibiotic eye drops.
  • Viral infection: Viral conjunctivitis generally does not require treatment. In some cases, antibiotic eye drops can be used to prevent secondary infection.
  • Allergic reaction: Treatment of conjunctivitis caused by allergies generally involves treating the allergies. Your child’s primary care provider may prescribe oral medications or eye drops to help with allergies.
  • Herpes infection: If your child has an eye infection caused by a herpes infection, her paediatrician may refer her to an eye care specialist. You can give your child both oral medications and eye drops.

If the disease is affected by an infection, it is important to know that the disease can spread from one eye to another by touching the affected eye or the fluid that comes out of the eye. The infection can also spread to other people. Fluid from the eye comes out 24 to 48 hours after starting treatment.

To help prevent the spread of infection, you should wash your hands frequently while caring for your baby. Make sure your child does not touch her eyes. Your child should wash her hands often.

Prevention of conjunctivitis in children

Conjunctivitis spreads throughout the nursery or preschool. In some cases, the infection is passed on to the friends of young children, who pass it on to the child.

Common prevention strategies reduce the spread of infections and reduce the risk of recurrent conjunctivitis:

  • Encourage young children to avoid touching or rubbing their eyes.
  • Keep school children away from school with a fever or thick eye discharge.
  • Don’t share eye care products like contact lenses, glasses, or eye makeup. Encourage children not to share these products.
  • Practice washing your hands frequently.
  • Encourage children not to touch their friends’ faces.

Complications of conjunctivitis in children

Pink eye is a depressing condition, especially allergic conjunctivitis, but in most cases, it does not pose a serious health threat.

Complications of conjunctivitis are very rare, but when they do occur they are serious and include:

  • A severe case of allergic conjunctivitis can lead to scarring of the eye
  • In cases of infectious conjunctivitis, the infection can spread to other parts of the body and trigger more serious secondary infections, such as meningitis.

When to contact the doctor

  • Worsening drainage or discharge from the eye
  • Fever in addition to pink eye
  • Blistering or rash on the eyelids
  • Severe light sensation or pain
  • Vision problems
  • Any injury to the eye
  • Symptoms that do not change within a week.

Procedure and Risks of Sleeve Gastrectomy | Endocrinology

What is sleeve gastrectomy?

Sleeve gastrectomy, also entitled vertical sleeve gastrectomy, is a weight-loss surgical procedure. This process is usually done laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. For the duration of sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach the size and shape of a banana.

Limiting the size of your stomach restricts the amount of food you can eat. In addition, the procedure causes hormonal changes that help you lose weight. These same hormonal changes also help alleviate conditions associated with being overweight, such as high blood pressure or heart disease.

It is different from gastric bypass

In a gastric bypass, the surgeon creates a small pouch that bypasses most of the stomach and goes directly into the intestine.

Gastric sleeve surgery is best for persons who have a BMI (body mass index) of at least 40. That means you weigh 100 pounds or more above your ideal weight. Some people are too heavy for gastric bypass surgery, so it can be a good alternative.

People generally lose 60% of their extra weight in a 12 to 18 month period. So if you are 100 pounds overweight, you will lose about 60 pounds, although some lose more and some less. Of course, exercising and eating right adds to weight loss.

Risk factors of sleeve gastrectomy

Infections, bleeding, and, in rare cases, a leak along the staple line is possible. Right after surgery, you may feel nausea, vomiting, or constipated.

Some foods may not suit you right now. You can also develop nutrition problems after surgery, so you must take vitamins and supplements for life. Your doctor will advise you precisely what you need.

  • Excessive bleeding
  • Infection
  • Adverse reactions to anaesthesia
  • Blood clots
  • Breathing or lung problems
  • Escapes from the cut edge of the stomach

Complications of sleeve gastrectomy

Complications associated with sleeve gastrectomy are rare; though, when they do occur, they are more serious than those related to other weight-loss strategies, such as the lap band. If a leak develops, for example, it can take months to resolve the problem. Another downside is that sleeve gastrectomy is a relatively new procedure and there is a dearth of long-term data on the success of weight loss using this procedure over time.

As is the case with any operation, sleeve gastrectomy is associated with a number of risks and, although rare, some of the complications that can occur are described below.

  • Bleeding: If postoperative bleeding occurs, which occurs in about 0.5% of cases, a blood transfusion may be necessary.
  • Infection: An infection can occur, in which case antibiotics and sometimes repeat surgery are needed. Coiled infection is more common in people with a higher body mass index.
  • Staple line leaks: This occurs in about 1% of cases and can be life-threatening. A leak may require repeated surgery, and a persistent leak may lead to a fistula or recurrent infection within the abdomen. A leak can result in the patient having to stay in the hospital for weeks or even months after surgery.
  • Inability to tolerate food intake: This is tremendously rare, but since sleeve gastrectomy touches digestive function, some people find that they cannot tolerate adequate food intake. This may mean that they need long-term intravenous nutrients.
  • Organ damage: Accidental injury to organs near the operation site is always a risk in keyhole surgery, and if it occurs, additional surgery may be required to correct any damage to the organs.
  • Deep venous thrombosis: Blood clots in the veins or lungs are also a potential risk.
  • Long-term complications: Any intra-abdominal surgery involving the gastrointestinal tract can be complicated by the formation of scar tissue in the intestine or the formation of a hernia as a result of the sealing of the wound, which could mean that additional surgery is needed.

Sleeve gastrectomy process

Sleeve gastrectomy was initially performed as a modification of another bariatric procedure, the duodenal switch, and later as the first part of a two-stage gastric bypass process in extremely obese patients for whom the risk of gastric bypass surgery is increased. deemed too large. The initial weight loss in these patients was so successful that it began to be investigated as an independent procedure.

Sleeve gastrectomy is the most frequently performed bariatric surgery in the world. In many cases, sleeve gastrectomy is as effective as gastric bypass surgery and includes improvements in glucose homeostasis before substantial weight loss occurs. This independent benefit of weight loss is related to decreased gastric volume, changes in intestinal peptides, and the expression of genes involved in glucose absorption.

Sleeve gastrectomy surgery

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5-6 cm of the pylorus and ending at the fundus near the cardia. The remaining gastric sleeve is calibrated with a spark plug. Most physicians prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate residual size of the stomach after the procedure is approximately 150 ml.


Thyroid Removal Surgery (Thyroidectomy) Overview | Endocrinology

What is thyroidectomy?

A thyroidectomy is a surgical procedure to remove all or part of the thyroid gland and is used to treat diseases of the thyroid gland including:

  • Thyroid cancer
  • Hyperthyroidism (overactive thyroid gland)
  • Large goiters or thyroid nodules causing symptomatic obstruction such as difficulty swallowing or breathing.
  • Multinodular goiter

Thyroidectomy is traditionally a minimally invasive surgery that is performed through a small horizontal incision in the front of the neck. The entire thyroid gland may be removed or just a lobe, part of a lobe, and the isthmus or other structures. Depending on the extent of the operation, patients may need to take levothyroxine, an oral synthetic thyroid hormone.

Thyroidectomy without mutilation

For a select group of patients who are concerned about the possible cosmetic effects of a neck scar, we offer “scarless” thyroidectomy, a technique of removing the thyroid using small oral incisions that removes the scar from the neck. In this procedure, the surgeon accesses the thyroid gland through the patient’s mouth, known as the “transoral” approach. UCSF endocrine surgery is amongst the first programs in the world to pioneer this technique.

A new hybrid procedure using a transoral and submental technique (TOaST) offers patients an additional option, a refinement that combines the transoral approach with a small incision easily hidden just below the chin, offering the following benefits:

  • The decrease in postoperative complications and patient discomfort.
  • The ability to accommodate larger thyroid samples
  • Maintain practically all the cosmetic benefits of traditional surgery without scars.

Types of thyroid surgery

There are several different types of thyroid surgery. The most communal are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

  • Lobectomy: Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this occurs, a doctor will remove only one of the two lobes. The part left behind must retain part or all of its function.
  • Subtotal thyroidectomy: A subtotal thyroidectomy eliminates the thyroid gland but leaves a small amount of thyroid tissue. This preserves some of the thyroid function. Many people who have this type of surgery develop hypothyroidism, a condition that occurs when the thyroid does not produce enough hormones. This is treated with daily hormonal supplements.
  • Total thyroidectomy: A total thyroidectomy removes all of the thyroid and thyroid tissue. This surgery is suitable when nodules, swelling, or irritation affect the entire thyroid gland or when cancer is present.

Risks of thyroidectomy

Thyroidectomy is generally a safe surgical procedure. However, some people have major or minor complications. Possible complications include:

  • Hemorrhage (bleeding) under the neck wound: If this occurs, the wound protrudes and the neck swells, possibly compressing the internal structures of the neck and interfering with breathing. This is an emergency.
  • Thyroid storm: If thyroidectomy is performed to treat a very overactive gland, there may be an increase in thyroid hormones in the blood. This is a very rare complication because medicines are given before surgery to avoid this problem.
  • Recurrent laryngeal nerve injury: Because this nerve innervates the vocal cords, the injury can cause vocal cord paralysis and produce a hoarse voice, either in the short or long term.
  • Injury to a part of the superior laryngeal nerve: If this occurs, the singing patients may not be able to reach high notes and the voice may lose some projection.
  • Infection in the wound
  • Hypoparathyroidism: If the parathyroid glands cannot be protected or are damaged through surgery, the person may not be able to make enough parathyroid hormone. The parathyroid hormone helps keep blood calcium levels within the normal range. Low production of parathyroid hormone causes low levels of calcium in the blood.

Why is it for

Your doctor may indorse a thyroidectomy if you have conditions such as:

  • Thyroid cancer: Cancer is the most common cause of thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid is likely a treatment option.
  • Non-cancerous enlargement of the thyroid (goiter): Removal of all or part of the thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty in breathing or swallowing, or in some belongings if the goiter is causing hyperthyroidism.
  • Overactive thyroid (hyperthyroidism): Hyperthyroidism is a disorder in which the thyroid gland produces too greatly thyroxine hormone. If you have problems with antithyroid medications and do not want radioactive iodine therapy, thyroidectomy may be an option.
  • Suspicious or indeterminate thyroid nodules: Some thyroid nodules cannot be identified as cancerous or non-cancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have a thyroidectomy if the nodules are at increased risk of being cancerous.


Most people with thyroid cancer have no known risk factors, so most cases of this disease cannot be prevented.

Exposure to radiation, especially in childhood, is a known risk factor for thyroid cancer. Because of this, doctors no longer use radiation to treat less serious illnesses. Imaging tests, such as X-rays and CT scans, also expose children to radiation, but in much lower doses, so it is not clear how much they might increase the risk of thyroid cancer (or other cancers). If there is an increased risk, it is probably small, but to be safe, children should not have these tests unless absolutely necessary. When needed, they should be performed using the lowest dose of radiation that still provides a clear image.

Genetic testing can be done to look for gene mutations found in familial medullary thyroid cancer (MTC). Because of this, most familial cases of TCM can be prevented or treated early by removing the thyroid gland. Once the disease is exposed in a family, the rest of the family associates can be tested for the mutated gene.

If you have a family history of TCM, it is important that you see a doctor who is familiar with the latest advances in genetic counselling and genetic testing for this disease. Removing the thyroid gland in children who carry the abnormal gene will likely prevent cancer that could otherwise be fatal.

Thyroidectomy complications

  • Hypocalcemia (3-5%): Most communal cause of airway obstruction after 24 hours
  • Hematoma (1-2%): Most communal cause of airway obstruction within 24 hours
  • Recurrent injury of the laryngeal nerve (0.77%): Usually causes unilateral damage, stridor, hoarseness
  • Wound infection (0.2-0.5%)

Hypocalcemia | Preventive Measures | Endocrinology

What is hypocalcemia?

Hypocalcemia is an electrolyte inequity and is indicated by a low level of calcium in the blood. The normal adult worth for calcium is 4.5-5.5 mEq/L.

Calcium is significant for healthy bones and teeth, as well as for normal muscle and nerve function. Usual blood calcium levels are maintained through the actions of parathyroid hormone (PTH), your kidneys, and intestines. If your blood test fallouts show hypocalcemia, your doctor may check your albumin level as well. If your albumin is low, your calcium level must be corrected for this. A modified calcium level will be higher if the albumin is low.

Signs and symptoms of hypocalcemia

Hypocalcemia is usually asymptomatic

The attendance of hypoparathyroidism may be suggested by the clinical manifestations of the original disorder (e.g., short stature, rounded facies, intellectual disability, calcification of the basal ganglia in type Ia pseudohypoparathyroidism; vitiligo with autoimmune hypoparathyroidism).

The main clinical manifestations of hypocalcemia are due to alterations in the cell membrane potential, which causes neuromuscular irritability.

Neurological manifestations

Muscle cramps that affect the back and legs are common. Sinister hypocalcemia can cause mild diffuse encephalopathy and should be suspected in patients with mysterious dementia, depression, or psychosis.

Papilledema occurs occasionally

Severe hypocalcemia with serum calcium <7 mg/dl (<1.75 mmol / l) can cause hyperreflexia, tetany, laryngospasm, or generalized seizures. Tetany is usually the result of severe hypocalcemia but may be due to a reduction in the ionized fraction of serum calcium without marked hypocalcemia, as occurs in severe alkalosis. Tetany is characterized by the following:

  • Sensory symptoms consisting of paresthesias of the lips, tongue, fingers, and feet.
  • Carpopedal spasm, which can be prolonged and painful.
  • Generalized muscle pain
  • Spasm of facial muscles

Tetany can be manifest with spontaneous or latent symptoms and require provocation tests for its appearance. Latent tetany generally occurs with less severely decreased serum calcium concentrations: 7 to 8 mg / dL (1.75 to 2.20 mmol / L). Chvostek and Trousseau signs are easily obtained at the bedside to identify latent tetany. Chvostek’s sign is an involuntary contraction of the facial muscles caused by a light tapping of the facial nerve just before the outer auditory meatus. It is present in ≤ 10% of healthy people and most people with acute hypocalcemia but is often absent in chronic hypocalcemia.

Trousseau’s sign is the precipitation of carpal spasm by the reduced blood supply to the hand with a tourniquet or blood pressure cuff inflated to 20 mm Hg above systolic blood pressure applied to the forearm for 3 minutes. Trousseau’s sign also occurs in alkalosis, hypomagnesemia, hypokalemia, and hyperkalemia, and approximately 6% of people without identifiable electrolyte disturbances.

Other manifestations

Many other abnormalities can occur in patients with chronic hypocalcemia, such as dry and flaky skin, brittle nails, and coarse hair. Candida infections occasionally occur in hypocalcemia, but occur more frequently in patients with idiopathic hypoparathyroidism. Cataracts occasionally occur with long-lasting hypocalcemia and are not reversible by correction of serum calcium.

Hypocalcemia causes

Hypocalcemia most often occurs when too much calcium is lost in the urine or when not enough calcium is transferred from the bones to the blood. Causes of hypocalcemia include the following:

  • A low level of parathyroid hormone (hypoparathyroidism), such as can occur when the parathyroid glands are damaged during thyroid gland surgery.
  • Lack of response to a normal level of parathyroid hormone (pseudohypoparathyroidism)
  • Absence of parathyroid glands at birth (for example, in DiGeorge syndrome)
  • A low level of magnesium (hypomagnesemia), which reduces the activity of the parathyroid hormone.
  • Vitamin D deficiency (due to inadequate intake or inadequate exposure to sunlight)
  • Kidney dysfunction, which results in increased excretion of calcium in the urine and makes the kidneys less able to activate vitamin D
  • Inadequate calcium intake
  • Disorders that decrease calcium absorption
  • Pancreatitis

Certain medications, including rifampicin (an antibiotic), anticonvulsants (such as phenytoin and phenobarbital), bisphosphonates (such as alendronate, ibandronate, risedronate, and zoledronic acid), calcitonin, chloroquine, corticosteroids, and plicamycin.

Diagnosis of hypocalcemia

The first step in diagnosis is a blood test to determine your calcium levels. Your doctor may also use mental and physical exams to look for signs of hypocalcemia. A physical exam may include a study of your:

  • Hair
  • Skin
  • Muscles

A mental exam may include tests to:

  • Dementia
  • Hallucinations
  • Confusion
  • Irritability
  • Convulsions

Your doctor may also test for the signs of Chvostek and Trousseau, both of which are related to hypocalcemia. Chvostek’s sign is a spasm response when a set of facial nerves is touched. Trousseau’s sign is a spasm in the hands or feet that comes from ischemia or a restriction in the blood supply to the tissues. Contractions or spasms are considered positive responses to these tests and suggest neuromuscular excitability due to hypocalcemia.

Treatment of hypocalcemia

  • Calcium supplements
  • Sometimes vitamin D

Calcium supplements, taken by mouth, are often all that is needed to treat hypocalcemia. If a cause is identified, treating the disorder causing hypocalcemia or changing medications can restore the calcium level. Once symptoms appear, calcium is usually given intravenously. Taking vitamin D supplements helps increase calcium absorption from the digestive tract. Sometimes people with hypoparathyroidism are given a synthetic form of parathyroid hormone.

Risk factors for hypocalcemia

Some risk factors can increase your potential for developing hypoglycemia.

Certain populations

Children with type 1 diabetes, the elderly, and people who are unfamiliar with hypoglycemia are at increased risk of developing hypoglycemia. Lack of awareness of hypoglycemia can occur if you experience low blood sugar frequently, which can make your body insensitive to symptoms. The inability to feel symptoms such as sweating, shaking, increased heart rate, anxiety, or hunger is dangerous because it can lead to loss of consciousness or even death.

Complications of hypocalcemia

Untreated hypoglycemia can lead to:

  • Seizure
  • Loss of consciousness
  • Death
  • Hypoglycemia can also contribute to the following:
  • Dizziness and weakness
  • Falls
  • Injuries
  • Motor vehicle accidents
  • Increased risk of dementia in older adults
  • Ignorance of hypoglycemia

Over time, repeated episodes of hypoglycemia can make hypoglycemia unaware. The body and brain no longer produce signs and symptoms that warn of low blood sugar, such as tremors or irregular heartbeats. When this happens, the risk of severe and life-threatening hypoglycemia increases.

If you have diabetes, recurring episodes of hypoglycemia, and lack of knowledge of hypoglycemia, your doctor may modify your treatment, raise your blood sugar goals, and recommend blood glucose awareness training.

Untreated diabetes

If you have diabetes, hypoglycemic episodes are uncomfortable and can be scary. Fear of hypoglycemia can cause you to take less insulin to make sure your blood sugar doesn’t drop too low. This can lead to uncontrolled diabetes. Talk to your doctor about your fear and do not change the dose of your diabetes medicine without your doctor’s permission.

Hypocalcemia prevention

  • If you have diabetes
  • Continuous glucose monitor

Follow the diabetes management plan that you and your doctor have developed. If you are taking new medications, changing your eating or medication schedules, or adding new exercises, talk with your doctor about how these changes could affect your diabetes control and your risk for hypoglycemia.

A continuous glucose monitor (CGM) is an option for some people, particularly those unfamiliar with hypoglycemia. A CGM has a tiny wire that is inserted under the skin that can send blood glucose readings to a receiver.

If your blood sugar levels are getting too low, some CGM models will alert you with an alarm. Some insulin pumps are now integrated with CGM and can stop insulin delivery when blood sugar levels are dropping too fast to help prevent hypoglycemia.

Make sure you always carry a fast-acting carbohydrate, such as glucose tablets or juice, so you can treat the drop in blood sugar before it drops dangerously low.

If you don’t have diabetes

For periodic episodes of hypoglycemia, eating frequent small meals throughout the day is a stopgap amount to help prevent blood sugar levels from dropping too low. However, this approach is not recommended as a long-term strategy. Work with your doctor to identify and treat the cause of hypoglycemia.


Diagnosis of Primary Ovarian Insufficiency (POI) | Endocrinology

What is primary ovarian insufficiency?

Primary ovarian insufficiency usually occurs when the ovaries stop working before age 40. When this happens, the ovaries do not produce the normal amount of the hormone estrogen or release eggs regularly. This condition often leads to infertility.

Primary ovarian insufficiency is sometimes confused with premature menopause, but these conditions are not the same. Women with primary ovarian failure can have irregular or intermittent periods of years and can become pregnant. But women with premature menopause do not have periods and become pregnant.

Restoring estrogen levels in women with primary ovarian failure can help prevent some of the complications that can result from low estrogen levels, such as osteoporosis. The term health care provider POI is used when the female ovaries stop working before age 40.

Most women experience fertility naturally in their 40s. This age indicates the onset of irregular periods that indicate the onset of menopause. For women with primary ovarian insufficiency (POI), irregular periods and decreased fertility occur before age 40, sometimes even in adolescence.

Previously, primary ovarian insufficiency (POI) was called “premature menopause” or “premature ovarian failure,” but those terms did not accurately describe what happens in a woman with primary ovarian insufficiency (POI). A woman who has gone through menopause will not have another normal period and will not be able to conceive. If a woman with primary ovarian insufficiency (POI) does not become regular, she may still be pregnant.

Symptoms of primary ovarian insufficiency

You may not know that your ovaries are working normally. Some women with premature ovarian failure still have periods and may become pregnant. But many people with this condition have trouble getting pregnant. This usually prompts you to visit a doctor.

Common symptoms of premature ovarian failure are rare or missing periods. Periods that start as they expect, then stop and start again. Other symptoms can resemble menopause and can include:

  • Hot flushes; Hot vapours
  • Night sweats
  • Anxiety, depression, or mood swings
  • Concentration or memory problems.
  • Your sex drive is not what it used to be
  • Trouble sleeping
  • Vaginal dryness, which makes sex uncomfortable.

Primary ovarian insufficiency causes

Inside the ovaries are small sacs called follicles. The eggs are captured as they grow. Girls are generally born with 2 million “seeds” that develop into these follicles, which go through menopause.

If you have a primary ovarian defect, your follicles may swell (as your doctor calls this degeneration) or not function properly (also known as dysfunction). Doctors do not know why this happens.

This condition is more likely to occur if you have a mother or sister. Other things that make it more:

  • Autoimmune disorders
  • Chemotherapy and radiotherapy.
  • Genetic and chromosomal disorders, including Fragile X syndrome and Turner syndrome
  • Viral infections

Primary ovarian insufficiency risk factors

Factors that can increase your risk of developing primary ovarian failure:

  • Years: The risk increases between the ages of 35 and 40. Although rare before age 30, primary ovarian failure is also possible in young women and adolescents.
  • Family history: Having a family history of primary ovarian failure increases the risk of developing this disorder.
  • Ovarian surgery: Surgeries that involve the ovaries increase the risk of primary ovarian failure.

Complications of primary ovarian insufficiency

Complications of primary ovarian failure:

  • Sterility: The inability to get pregnant is a problem of primary ovarian failure. In rare cases, pregnancy is possible until the eggs hatch.
  • Osteoporosis: A hormone called estrogen helps maintain strong bones. Women with low estrogen levels are at higher risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
  • Depression or anxiety: The risk of infertility and other problems caused by low estrogen levels can make some women feel depressed or anxious.

Heart disease Early loss of estrogen increases your risk.

How is primary ovarian insufficiency diagnosed?

Primary ovarian insufficiency (POI) key codes:

  • Missing or irregular 4-month periods, usually after spending some time regularly
  • High levels of follicle-stimulating hormone (FSH)
  • Low estrogen levels 4,6,13
  • If a woman is under 40 and starts having irregular periods or stops for 4 months or more, her healthcare provider can take these steps to diagnose the problem:
  • Take a pregnancy test: This test ruled out an unexpected pregnancy as the cause of missed periods
  • Do a physical exam: During the physical exam, the doctor will see signs of other disorders. In some cases, the presence of these other disorders overrides the POI. Or, if there are other disorders associated with POI, such as Addison’s disease, the healthcare provider may know that there is POI.
  • Collect blood: The healthcare provider collects your blood and sends it to a lab where the technician performs several tests:
  • Follicle-stimulating hormone (FSH) test: FSH refers to the ovaries for estrogen production, sometimes called the “female hormone” because women need high levels for fertility and general health. When the ovaries are not working properly, the level of FSH in the blood rises, as in POI. The doctor can perform two FSH tests at least once a month. If the FSH level in both tests is as high as in women who have gone through menopause, then the probability of having a POI.
  • Luteinizing hormone test: LH refers to the mature follicle that releases an egg. Women with POI have higher LH levels, further evidence that follicles are not working normally
  • Estrogen test: In women with POI, estrogen levels are generally lower because the ovaries do not function properly in the role of estrogen producers.1,6
  • Karyotype test: This test looks for abnormalities in your 46 chromosomes. Karyotype tests reveal genetic changes in the structure of chromosomes associated with POI and other health problems.
  • Do a pelvic ultrasound: In this test, the doctor uses a sound wave machine (ultrasound) to create and view images within the female pelvic area. Ultrasound shows whether the ovaries are dilated or have multiple follicles 4,11

The healthcare provider also asks questions about a gynaecological history. He or she may ask:

  • A blood relative with POI or its symptoms
  • A blood relative with Fragile X syndrome or undiagnosed intellectual or developmental disability
  • Ovarian surgery
  • Radiation or chemotherapy treatment
  • Pelvic inflammatory disease or other sexually transmitted infections.
  • An endocrine disorder such as diabetes 4

If they don’t perform tests to rule out POI, some healthcare providers may find missing periods stressful. However, this approach is problematic because it delays diagnosis; Further evaluation is required.

Treatments of primary ovarian insufficiency

Treatment for primary ovarian failure usually focuses on problems caused by estrogen deficiency. Your doctor may recommend:

Estrogen therapy

Estrogen therapy can help prevent osteoporosis, as well as eliminate hot flashes and other symptoms of estrogen deficiency. Your doctor will usually prescribe estrogen with a hormone called progesterone, especially if your uterus is still there. Adding progesterone protects the lining of the uterus (endometrium) from premature changes caused by estrogen alone.

The combination of hormones will rejuvenate your period, but will not restore ovarian function. Depending on your health and preferences, you can take hormone therapy until age 50 or 51, the average age of natural menopause.

In older women, chronic estrogen plus progestin therapy increases the risk of cardiovascular (cardiovascular) disease and breast cancer. In young women with primary ovarian failure, the benefits of hormone therapy outweigh the potential risks.

Calcium and vitamin D supplements

Both of these nutrients are important in preventing osteoporosis, and you may or may not be exposed to sunlight in your diet. Your doctor may prescribe a bone density test before starting supplements to get a baseline measurement.

For women ages 19 to 50, experts generally recommend 1,000 milligrams (mg) of calcium per day through diet or supplements, increasing to 1,200 mg per day for women 51 and older. The exact daily dose of vitamin D is not yet clear. A good starting point for adults is 600 to 800 international units (IU) per day, per diet or medication. If your blood D levels are low, your doctor may prescribe higher doses.

Solve infertility

Treatment to restore fertility has not been proven. Some women and their partners continue to conceive through in vitro fertilization using donor eggs. In this process, the eggs are collected from the donor and fertilized in the laboratory with your partner’s sperm. The fertilized egg (embryo) is placed in your uterus.


Types and Treatments of Keratitis | Ophthalmology

What is keratitis?

Keratitis is a painful inflammation of the eye. It can be caused by infection or injury. There are many types of keratitis, and each type requires different treatment. If you have red eyes or other symptoms of keratitis, make an appointment with your doctor. With immediate care, mild to moderate cases of keratitis can usually be treated effectively without losing vision. If left untreated, or if the infection is severe, this can lead to serious complications that can permanently damage your vision.

The eye is very sensitive and there are many ways to protect it from damage. The eyelid covers the eye and protects against tears and fluid infection. The cornea is the outer layer of the eye and provides a barrier against dust, germs, and disease. Keratitis is a common condition. People who wear contact lenses experience keratitis more often than people who do not wear contact lenses. In both cases, you can take steps to prevent this situation. If you develop keratitis, see your doctor immediately.

Types of keratitis

There are two main types of keratitis, depending on the cause. Keratitis can be classified as infectious or contagious.

Infectious keratitis

Infectious keratitis is caused by one of the following:

  • Bacteria: Pseudomonas aeruginosa and Staphylococcus aureus are the two most common bacteria that cause this disease. It is more likely to develop in people who do not use contacts correctly.
  • Fungi: Fungal keratitis is caused by Aspergillus, Candida, or Fusarium. Like bacterial keratitis, fungal keratitis primarily affects contact lens wearers. However, it is possible to expose these fungi outside.
  • Parasites: Acanthumoba is the most common contact lens wearer in the United States. The parasite lives outside and can be contracted by swimming in a lake, walking through the woods, or getting infected water on your contact lenses. This type of infection is called acanthoma keratitis.
  • Viruses: Viral keratitis is mainly caused by the herpes simplex virus, which grows from conjunctivitis to this disease.

Non-infectious keratitis


  • Like eye injuries, scratches
  • Your contact lenses will wear out too long
  • Wearing extended clothing contacts
  • Wear your contact lenses while swimming
  • Living in a hot climate increases the risk of plant substances damaging the cornea
  • Weakened immune system
  • Exposure to strong sunlight, also known as photokeratitis

Keratitis symptoms

  • Red eyes
  • Pain and irritation in the affected eye.
  • Vision changes, such as blurred vision or inability to see
  • Sensitivity to light
  • Inability to open the eye
  • Eye discharge
  • Excessive tearing

Without treatment, the symptoms of this disease can progress and get worse. Depending on the type, when symptoms appear. For example, symptoms of bacterial keratitis appear immediately.

Causes of keratitis

  • Injury: Most of the time, it comes from damaging the cornea. You may have pierced your eye or scratched your eye with your finger. This can happen even if you wear your contact lenses for a long time or wear lenses that don’t fit well. The wound can cause inflammation, but it can also allow bacteria or fungi to cause an infection.
  • Viral infection: It is usually caused by herpes simplex, chickenpox virus, or a cold. If you are sick, be careful not to touch your eyes and keep your hands clean.
  • Bacterial infections: This is less common, but can be a problem for people who wear contact lenses. Bacteria can grow on your contact lenses or your contact case if you don’t clean and store them properly. Extended wear lenses can lead to you sleeping for days or weeks at a time. Infection can also come from contaminated eye drops or contact solutions. Or it can happen after eye surgery.
  • Parasite: Acanthumoba is a microbe that lives everywhere: in the air, soil, and bodies of water. It is also found in tap water. It is harmless most of the time. But it can also cause an eye infection, especially if you wear contact lenses. It is very rare, but also very difficult to treat.
  • Yeast: It is also very rare for you to get a yeast infection in your eye. It usually comes from scratches on the eyes or contacts contaminated by a branch. Eye surgery can also cause this.
  • Other causes: Vitamin A deficiency, some diseases that are a problem for your immune system, and diseases that cause very dry eyes can lead to this.

Risk factors for keratitis

  • Put glasses on the surface of the eye. Wearing contact lenses, especially sleeping glasses, increases the risk of infectious and non-infectious keratitis. The risk is wearing contact lenses for longer than recommended, improper disinfection, or swimming.
  • It is more common in people who wear long-wear contact lenses or who wear contact lenses continuously than in those who wear contact lenses for daily wear and take them out at night.
  • Decreased immunity If your immune system is compromised by illness or medication, you are at risk of developing this disease.
  • Corticosteroids Using corticosteroid drops to treat an eye disorder may increase the risk of infectious keratitis.
  • Eye wound. If one of your corneas has been damaged by an injury in the past, you are more likely to develop this disease.

Diagnosis of keratitis

The diagnosis generally includes the following:

  • Vision test: Although it may be uncomfortable to open your eyes for a test, it is important to have your eyes examined by your doctor. The test involves how well you can see (visual acuity).
  • Penelope test: Your doctor may examine your eye with penicillin to check your student’s reaction, size, and other factors. Your doctor may apply the stain to the surface of your eye to help determine the extent and symptoms of corneal ulcers and surface manipulations.
  • Slit-lamp test: Your doctor will examine your eyes with a special device called a slit lamp. Provides a bright light source and magnification to determine the role and extent of this disease, as well as its effect on other structures in the eye.
  • Laboratory analysis: Your doctor may take a sample of the tear or some cells from your cornea for lab tests to help determine the cause of this disease and develop a treatment plan for your condition.

Keratitis treatment

If a person has this disease and wears contact lenses, they should be removed as soon as they develop any symptoms of infection or irritation. Contact lenses should not be reused until the condition clears. If a person has mild bacterial keratitis, the doctor may recommend that they use antibacterial eye drops.

In more serious cases, the person may need antibiotics. Steroid eye drops reduce inflammation if it is particularly severe. People can apply eye drops at home and should use them regularly. As the condition improves, people may use medications less often.

People with fungal keratitis may need to use antifungal medications for a few months. If this does not resolve the condition, surgery may be necessary in severe cases. Eye drops or antiviral medications are used to treat viral keratitis. Since there is no cure for the herpes simplex virus that causes viral keratitis, this condition can recur.

Parasitic keratitis is a very difficult type to treat and requires emergency medical treatment and surgery. During treatment, anyone should consult an ophthalmologist:

  • The condition does not improve with the use of eye drops.
  • Your vision becomes blurry
  • The eye becomes more painful or red
  • The size of the white spot on the cornea increases.


  • Chronic corneal inflammation and scars.
  • Chronic or recurrent viral infection of your cornea
  • Open sores on the cornea (corneal ulcer)
  • Temporary or permanent reduction in your vision.
  • Blindness

 Prevention of keratitis

If you wear contact lenses, proper wear, cleaning, and disinfection can help prevent this disease. Follow these tips:

  • Choose contact lenses for daily use and remove them before bed.
  • Wash, rinse, and dry your hands well before handling your contact lenses.
  • Follow the recommendations of your eye care professionals for caring for your lenses.
  • Use only clean products made specifically for contact lens care, and use lens care products made for the lenses you wear.
  • Gently rub the lenses during cleaning to increase the cleaning performance of the contact lens solutions. Avoid rough handling that can make your lenses scratch.
  • Replace your contact lenses as recommended.
  • Change your contact lens case every three to six months.
  • Ignore the solution in the contact lens case every time you disinfect your lenses. Do not “fill in” an existing old solution.
  • Do not wear contact lenses when you go swimming.
  • Prevent the spread of the virus.

Some forms of viral keratitis are not eliminated. But the following steps can control the incidence of viral keratitis:

  • If you have a cold sore or herpes blister, avoid touching your eyes, eyelids, and the skin around your eyes, unless you wash your hands well.
  • Use only eye drops prescribed by an ophthalmologist.
  • Washing your hands frequently can spread the virus.

Causes and Diagnosis of Fabry disease | Endocrinology

What is Fabry disease?

Fabry disease is hereditary. You can have various symptoms, such as pain in the hands and feet and a certain type of rash. When you have Fabry disease, a certain type of fat builds up in the cells of your body. It narrows the blood vessels, which can damage the skin, kidneys, heart, brain, and nervous system.

Your doctor will call Fabry disease a “storage disorder.” It usually begins in childhood and is more common in men than in women. There are treatments for how you feel on a daily basis. Getting the support of your family and friends is also very important.

Who gets Fabry disease?

People with Fabry disease inherit a mutated gene on the X chromosome from their parents. Males inherit an X chromosome from their mothers. Females have two X chromosomes, one from each parent. Parents can pass the faulty gene that causes Fabry disease to their children in a number of ways:

  • Parents pass their X chromosomes to all their daughters with defective gene.
  • All of these daughters have a genetic mutation that causes Fabry disease.
  • Children are not at risk because men inherit the Y chromosome (not the X chromosome) from their parents.
  • Mothers are 50% more likely to pass the affected X chromosome to their daughters or sons.
  • Some family members may have a genetic mutation, while others do not.

What are the types of Fabry disease?

Fabry disease types reflect a person’s age when symptoms first appear. Types:

  • Classic type: Symptoms of classic Fabry disease appear in childhood or adolescence. A distinctive symptom, a painful burning sensation in the hands and feet, can be noticed by the age of two. Symptoms gradually get worse over time.
  • Late-onset / typical type: People with late-onset Fabry disease have no symptoms until age 30 or older. The first sign of a problem may be kidney failure or heart disease.

How common is Fabry disease?

One in 40,000 men has classic Fabry disease. Late or typical Fabry disease is more common. It affects one in 1,500 to 4,000 men. Experts are not sure how many women have Fabry disease. Some women have no or mild to moderate symptoms, so this condition is usually not diagnosed in women.

Symptoms of Fabry disease

You may notice:

  • Exercise, fever, heat, or pain and burning in your arms and legs when you are tired
  • Small dark red spots usually appear between the belly button and the knees
  • Cloudy vision
  • Hearing loss
  • Ringing in the ears
  • Sweating less than usual
  • Stomach pain, bowel movements immediately after eating

Fabry disease can cause more serious problems, especially in men. These include:

  • Chance of having a heart attack or stroke
  • Severe kidney problems, including kidney failure
  • Hypertension
  • Heart failure
  • Dilated heart
  • Osteoporosis

What Causes Fabry Disease; Is genetic?

  • Fabry disease is a genetic disorder. A genetic disorder is caused by a mutation or change in a part of a person’s DNA.
  • In Fabry disease, the defective gene is on the X chromosome, one of the two sex chromosomes.
  • Sex chromosomes determine a person’s sex at birth. We all inherit one sex chromosome from each parent. While mothers travel only on the X chromosome, fathers can travel on the X or Y chromosome.
  • The chromosome sent by the father determines the sex of the offspring: females have two X chromosomes (XX) and males have one X chromosome and one Y chromosome (XY).
  • Fabry disease mainly affects men who receive an X chromosome with an abnormal gene.
  • Women with Fabry disease also receive an X chromosome with a defective gene; Since women have two X chromosomes, a common X chromosome provides some protection against developing the disorder.
  • Fabry disease is caused by a genetic mutation that results in a deficiency of an enzyme called alpha-galactosidase A (A-gal A). A genetic defect causes the body not to get enough of this enzyme, leading to the accumulation of fat called globotriaosylceramide (GB3 or GL-3) in the body.
  • Fabry disease is the result of what is known as X-linked inheritance, that is, a disease caused by a defect in the X chromosome. Genetic mutations linked to the X chromosome occur mainly in men and rarely in women.
  • If a mother carries a defective gene for Fabry disease, both men and women have a 50% chance of inheriting it from their mother. If the father is a carrier of the Fabry gene, the female offspring will inherit the defective gene, because the father will pass the X chromosome to them, but the male children with the Y chromosome will not.
  • Women who inherit a defective X chromosome are called carriers and can pass the genetic mutation on to their male offspring.

How is Fabry disease diagnosed?

Your healthcare provider may order tests to diagnose Fabry disease, including:

  • Enzyme test: This test measures alpha-GAL enzymes in the blood. Measurements of 1% or less indicate disease. This test is very reliable for men and should not be used for women.
  • Gene: Since women with this disease have normal levels of alpha-GAL enzymes, providers use genetic testing (DNA sequencing) to detect GLA mutations.
  • Neonatal Screenings: Some states screen newborns for Fabry disease and other lysosomal storage disorders. Enzyme testing is included as part of routine neonatal testing.

Treatment of Fabry disease

There are two treatments. The most common is enzyme replacement therapy (ERT), which replaces a missing or malfunctioning enzyme. This allows your body to break down fatty acids. Helps reduce pain and other symptoms caused by Fabry disease. Visit a patient centre every few weeks to inject the enzyme into a vein.

The new choice is oral drug Migalastat (Galafold). This is in contrast to ERT, which acts to stabilize inactive enzymes. It also helps reduce the effects of the disease on your organs.

Your doctor may also recommend:

  • Pain relievers (prescription or non-prescription)
  • Medicines for stomach problems.
  • Blood thinners or other medicines for irregular heartbeats or other heart problems
  • Blood pressure medicine, which also helps protect your kidneys.
  • You may need dialysis or a kidney transplant if it causes severe kidney damage.

You can also expect to have regular tests to see how you are doing. These may include:

  • Blood, urine and thyroid tests.
  • EKG (electrocardiogram): A nurse or other medical professional will place soft, sticky patches on various parts of your body. These patches measure your heart’s electrical signals and tell you how fast your heart is beating and if there is a healthy rhythm.
  • Echocardiogram: This is an ultrasound of your heart. It shows that all parts of your heart are healthy and that you are pumping well.
  • Brain MRI: An MRI, or MRI, takes pictures of your body’s organs and structures.
  • CT of her head: A CT scan, or CT scan, is a powerful X-ray that generates detailed images of the inside of your body.
  • Hearing and eye exams
  • Pulmonary function test to see how much air you breathe in and out, and how much oxygen your blood is getting

Take care of yourself

Be good to yourself. Do the things you enjoy, spend time in good company, and save energy for the things that are really important to you. Part of this may be saying “no” and letting people know what helps you.

Your family and friends may not know much about Fabry disease. Help them understand what is happening to you. Sometimes when people have serious health problems, they become depressed or anxious because the problem is too high. Your doctor should check how you feel, but you should mention it and ask for a referral to a counsellor. Talking to someone can help.

What are the complications of Fabry disease?

Years of the build-up of the fatty substance can damage blood vessels and lead to life-threatening problems, such as:

  • Heart problems, including arrhythmia, heart attacks, an enlarged heart and heart failure.
  • Kidney failure.
  • Nerve damage (peripheral neuropathy).
  • Strokes, including transient ischemic attacks (TIA or ministrokes).

Symptoms & Complications of Sheehan’s Syndrome | Endocrinology

What is Sheehan’s syndrome?

Sheehan’s syndrome is a condition that occurs when the pituitary gland is damaged during childbirth. It is caused by excessive blood loss (hemorrhage) or extremely low blood pressure during or after childbirth. Lack of blood deprives the pituitary of the oxygen it needs to function properly.

The pituitary gland is at the improper of the brain. It produces hormones that monitor the function of the other glands in your body. That is why it is identified as “the master gland”. This gland is more vulnerable to injury during labor because it increases in size during pregnancy.

When the pituitary doesn’t work as well as it should, the glands it controls, including the thyroid and adrenal glands, can’t release enough hormones. Sheehan’s syndrome affects the production of these pituitary hormones:

  • Thyroid-stimulating hormone (TSH) directs the thyroid gland to produce its hormones, which regulate its metabolism.
  • Luteinizing hormone (LH) helps regulate your menstrual cycle and egg production, along with FSH.
  • Follicle Stimulating Hormone (FSH) helps regulate your menstrual cycle and egg production, along with LH.
  • Growth hormone (GH) controls the growth of organs and tissues.
  • Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to release cortisol and other stress hormones.
  • Prolactin stimulates milk production.

Sheehan’s syndrome is also called postpartum hypopituitarism.

Symptoms of Sheehan’s syndrome

The pituitary gland produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid, and the adrenal glands. The lack of these hormones can cause a variety of symptoms. While some women may experience early symptoms, such as difficulty breastfeeding or the inability to breastfeed (breast milk never “comes in”), in most cases the signs and symptoms of Sheehan’s syndrome advance slowly, sometimes over a period of months or even years.

For many, symptoms become apparent when the body is stressed by infection or surgery sometime after delivery. This type of stressor can lead to an adrenal crisis. Symptoms that may develop include:

  • Fatigue
  • Pain in the joints
  • Hypoglycemia
  • dizziness
  • Amenorrhea (lack of menstrual bleeding)
  • Oligomenorrhea (infrequent menstrual periods)
  • Hot flushes
  • Decreased libido
  • Loss of pubic and armpit hair
  • Low blood pressure (hypotension)
  • Slow mental functioning
  • Weight gain
  • Difficulty staying warm
  • Arrhythmia
  • Contraction of the breasts

Causes of Sheehan’s syndrome

Sheehan’s syndrome is caused by severe blood loss or tremendously low blood pressure through or after delivery. These factors can be particularly harmful to the pituitary gland, which enlarges during pregnancy and destroys hormone-producing tissue so that the gland cannot function normally.

Pituitary hormones regulate the rest of your endocrine system, signalling other glands to increase or decrease the production of the hormones that control metabolism, fertility, blood pressure, breast milk production, and many other vital processes. Lack of any of these hormones can cause difficulties throughout the body.

The hormones from the front of your pituitary gland include:

  • Growth hormone (GH): This hormone pedals bone and tissue growth and maintains the proper stability of muscle and fat tissue.
  • Thyroid-stimulating hormone (TSH): This hormone stimulates the thyroid gland to produce key hormones that regulate your metabolism. The shortage of TSH results in an underactive thyroid gland (hypothyroidism).
  • Luteinizing hormone (LH): In women, LH regulates estrogen.
  • Follicle Stimulating Hormone (FSH): Working with LH, FSH helps to stimulate egg development and ovulation in women.
  • Adrenocorticotropic hormone (ACTH): This hormone stimulates the adrenal glands to produce cortisol and other hormones. Cortisol assistances your body deal with stress and influences many bodily functions, including blood pressure, heart function, and immune system.

A low level of adrenal hormones caused by damage to the pituitary gland is called a secondary adrenal deficiency.

  • Prolactin: This hormone adjusts the development of female breasts, as well as the production of breast milk.

Risk factors

The main risk factor for the development of Sheehan’s syndrome in pregnancy. The pathophysiological variations of the pituitary gland during pregnancy leave the gland weak to ischemia in the event of bleeding. Similar blood loss in non-pregnant women does not cause hypopituitarism, lending credence to this claim. Postpartum hemorrhage can be tough to predict due to the unpredictable nature of the delivery procedure.

It is known that women who have experienced a previous postpartum hemorrhage are three times more likely to have a postpartum hemorrhage in their subsequent pregnancies. A situation analysis concluded that those diagnosed with Sheehan’s syndrome have a significantly higher disseminated intravascular coagulation (DIC) score than their non-disease counterparts. The DIC score, which is based on the patient’s disease history, clinical symptomatology, and coagulation laboratories, may be an important determinant of the potential for disease development.

Women with Sheehan’s syndrome report more pregnancy complications than their counterparts who do not have it. The linked complications of stillbirth, miscarriage, abruption, placental retention, uterine rupture, hysterectomy, and multiple pregnancies are related to the potential for bleeding and are more frequently reported and known to cause potentially life-threatening bleeding risks.


Complications of Sheehan’s syndrome include:

  • Adrenal crisis, a life-threatening condition in which the adrenal glands do not make enough cortisol, the stress hormone
  • Low blood pressure
  • Unexpected weight loss
  • Irregular periods

Diagnosis of Sheehan’s syndrome

Diagnosing Sheehan’s syndrome can be difficult. Many symptoms overlap with those of other conditions. To diagnose Sheehan’s disease, your doctor will likely:

  • Collect a complete medical history: It is important to mention any complications you had during labour, no matter how long ago you gave birth. Also, be sure to tell your doctor if you didn’t produce breast milk or were unable to start your period after delivery, two key signs of Sheehan’s syndrome.
  • Take blood tests: Blood tests will check your levels of pituitary hormones.
  • Request a pituitary hormone stimulation test: You may need a pituitary hormone stimulation test, which involves injecting hormones and doing repeated blood tests to see how your pituitary responds. This test is usually done after consulting a doctor who specializes in hormonal disorders (endocrinologist).
  • Request imaging tests: You may also need imaging tests, such as an MRI or CT scan, to check the size of the pituitary gland and look for other possible reasons for your symptoms, such as a pituitary tumor.

Treatment of Sheehan’s syndrome

Treatment for Sheehan’s syndrome is a lifelong hormone replacement therapy for the hormones you are missing. Your specialist may mention one or more of the following medications:

  • Corticosteroids: Hydrocortisone (Cortef) or prednisone (Rayos) replaces adrenal hormones that are not produced due to a deficiency of adrenocorticotropic hormone (ACTH).

You will need to adjust your medication if you become seriously ill or experience significant physical stress. During these times, your body would normally make extra cortisol, a stress hormone. The same type of dose adjustment may be necessary when you have the flu, diarrhoea or vomiting, or are undergoing surgery or dental procedures.

Dose changes may also be necessary during pregnancy or with obvious weight gain or loss. Taking the right amount can help avoid the side effects associated with high doses of corticosteroids.

  • Levothyroxine (Levoxyl, Synthroid, others): This medicine increases deficient thyroid hormone levels caused by poor or deficient production of thyroid-stimulating hormone (TSH).

If you change brands, tell your doctor to make sure you keep getting the correct dose. Also, do not skip doses or stop taking the medicine because you feel better. If you do, the signs and symptoms will gradually return.

  • Estrogen: This includes estrogen-only if you have had your uterus removed (hysterectomy) or a combination of estrogen and progesterone if you still have a uterus.

Estrogen use has been linked to an increased risk of blood clots and strokes in women who still produce their own estrogen. The risk should be lower in women who are replacing the missing estrogen.

Preparations containing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), also called gonadotropins, may make future pregnancies possible. These can be given by injection to stimulate ovulation.

After age 50, around the time of natural menopause, talk with your doctor about the risks and benefits of continuing to take estrogen or estrogen and progesterone.

  • Growth hormone: The growth hormone can improve the relationship between muscles and body fat, maintain bone mass, and lower cholesterol levels. The growth hormone is expensive and side effects can include stiff joints and fluid retention.

Types and Causes of Paget’s Disease | Endocrinology

What is Paget’s disease?

Paget’s disease of bone is a chronic illness of the skeleton. In healthy bones, a process called reshaping removes old pieces of bone and replaces them with fresh, new bone. It causes this process to become unbalanced, resulting in abnormally shaped, weak, and brittle new bone. It most often affects older people and occurs in about 2 to 3 percent of the population over 55 years of age.

Many patients with Paget’s disease have no symptoms and are not aware that they have the disease until X-rays are taken for some other reason. When there is bone pain and other symptoms, they may be related to the disease itself or to complications that arise from the disease, such as arthritis, bone deformity, and fractures.

In most cases, the treatment of Paget’s disease involves taking medications to help slow or stop the progress of the disease. For patients who have difficulties, surgery may be desirable to realign deformed bones or to help fractures heal.


Paget’s disease causes no symptoms in most people with the condition and is often seen incidentally when X-ray tests are obtained for other reasons. However, It can cause pain, deformity, fracture, and arthritis in the bones. The bone pain of Paget’s disease is localized to the affected area of the bone.

The bones most commonly affected by Paget’s disease include the spine, thigh bone (femur), pelvis, skull, clavicle (clavicle), and upper arm bone (humerus). Fractures can occur because the affected bone is not as strong as normal bone. Arthritis occurs due to deformity of the affected bone adjacent to the joint and bowing of the affected long bones. The resulting type of arthritis is osteoarthritis.

The symptoms of Paget’s disease rest on the bones affected and the severity of the disease. Enlarged bones can pinch adjacent nerves, causing tingling and numbness. Arching of the legs may occur. Hip or knee involvement can cause arthritis, lameness, as well as pain and stiffness in the hip or knee.

Headache, vision, and hearing loss can occur when the bones of the skull are affected. With widespread Paget’s disease, it is possible to develop congestive heart failure due to an increased workload on the heart. Sometimes the skin over the affected bone is warmer than usual. This is due to the increased blood supply to the pagetic bone.


  • Monostotic type: When a single site of the bone is affected by Paget’s disease, it is known as the monostotic type.
  • Polyostotic type: When Paget’s disease affects multiple sites in the bone, it is called the polyostotic type.


Researchers have yet to definitively establish the cause of Paget’s disease. It appears to be hereditary. Rendering to the American College of Rheumatology, an additional than one family member has the disorder in 30 percent of cases.

Another suggestion is that the disorder is possibly due to an infection with the measles virus during childhood. Recent studies affirm that measles could alter the mechanism of bone formation and cause Paget’s disease.

Evidence suggests that the number of people with Paget’s disease has been declining over the past 25 years. Some scientists have linked the increase in vaccination in many countries and the resulting decrease in the number of people with measles to decreasing rates of Paget’s disease.

Risk factors

Years: People over the age of 40 are more likely to develop Paget’s disease of bone.

Sex: Men are affected more often than women.

National origin: Paget’s disease of bone is most common in England, Scotland, central Europe, and Greece, as well as in countries colonized by European immigrants. It is rare in Scandinavia and Asia.

Family history: If you have a close relative who has Paget’s disease of bone, they are more likely to develop the condition.


During the physical exam, your doctor will examine the areas of your body that are causing you pain. You can also order X-rays and blood tests that can help confirm the diagnosis of Paget’s disease of bone.

Imaging tests

The bone changes common to Paget’s disease of bone can be revealed by:

  • X-rays: The first sign of Paget’s disease of the bone is repeatedly abnormalities found on x-rays done for other reasons. X-ray images of your bones can show areas of bone resorption, bone enlargement, and deformities that are individual of Paget’s disease of bone, such as prostration of the long bones.
  • Bone scan: In a bone scan, a radioactive substance is injected into your body. This material travels to the points in the bones most affected by Paget’s disease of bone, which is why it lights up in the scanned images.

Lab tests

People who have Paget’s disease of bone generally have elevated levels of alkaline phosphatase in their blood, which can be revealed by a blood test.


If you don’t have symptoms, you may not need treatment. However, if the disease is active, designated by an elevated alkaline phosphatase level, and is affecting high-risk sites in your body, such as your skull or spine, your doctor may recommend treatment to prevent complications, even if you have no symptoms.


Medications for osteoporosis (bisphosphonates) are the most common treatment for Paget’s disease of bone. Some bisphosphonates are taken by mouth, while others are injected. Oral bisphosphonates are generally well-tolerated but can irritate the gastrointestinal tract. Examples include:

  • Alendronate (Fosamax)
  • Ibandronate (Boniva)
  • Pamidronate (Aredia)
  • Risedronate (Actonel)
  • Zoledronic acid (Zometa, Reclast)

In rare cases, bisphosphonate therapy has been related to severe muscle, joint, or bone pain, which may not resolve when the drug is stopped. Bisphosphonates can also increase the risk of a rare condition in which a section of the jaw dies and deteriorates (osteonecrosis of the jaw), usually associated with active dental disease or oral surgery.

If you cannot tolerate bisphosphonates, your doctor may prescribe calcitonin (Miacalcin), a natural hormone involved in the regulation of calcium and bone metabolism. Calcitonin is a medicine that you give yourself by injection or nasal spray. Side effects can include nausea, facial flushing, and irritation at the injection site.


In rare cases, surgery may be required to:

  • Helps heal fractures
  • Replace joints damaged by severe arthritis
  • Realign deformed bones
  • Reduce pressure on nerves

Paget’s disease of bone frequently causes the body to make too many blood vessels in pretentious bones, increasing the risk of serious blood loss during an operation.

If you are arranged for surgery involving bones affected by Paget’s disease, your physician may prescribe medications to reduce the activity of the disease, which can help reduce blood loss during surgery.


Bone expansion: The bone affected by Paget’s disease expands and can become deformed. Long bones can curve, so, for example, one leg may end up shorter than the other.

Fractures: The bone affected by Paget’s disease is weaker than usual, so it is more likely to break than healthy bone. It can also take longer than normal for a bone to heal after a fracture.

Nerve compression: When bones expand, they can sometimes squeeze nearby nerves. This is more likely to occur in the spine, which can lead to weakness and tingling in the legs.

Deafness: If the bones in the head are affected by Paget’s disease, it can lead to hearing loss, for example, if the bones around the ear become thicker.

Osteoarthritis: Abnormal bone growth can put extra pressure on the joints and damage the cartilage that covers the ends of the bones. This can lead to osteoarthritis in the joint. Symptoms of osteoarthritis include pain (especially when the joint is moved), stiffness, and sometimes swelling.

Tumors: Very rarely, a cancerous tumor can develop in a bone affected by Paget’s disease. This is estimated to happen in less than 1 in 500 cases. The first signs of this are increased pain and swelling around the tumor.


To reduce the risk of complications associated with Paget’s disease of bone, try these tips:

  • Avoid falls, Paget’s disease of bone puts you at high risk for bone fractures
  • Protect your home from falls
  • Eat well
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Hyphema | Treatment Options | Ophthalmology

What is hyphema?

Hyphema is the pooling or collection of blood within the anterior chamber of the eye (the space between the cornea and the iris). Blood covers most or all of the iris and pupil, partially or completely obstructing vision. Hyphema is usually painful. If left untreated, it can cause permanent vision problems. Hyphema is usually caused by an injury to the eye and is accompanied by increased intraocular pressure (pressure inside the eye). However, it can occur without warning in children with sickle cell anemia or other medical conditions such as hemophilia.

The lesions can cause bleeding in front of the eye (or anterior chamber), between the cornea and the iris. This bleeding is called hyphema. This part of your eye contains a clear liquid called aqueous humor. The folds behind the eye (or posterior chamber) called the ciliary process produce this fluid. Enter the previous room for your student. Hyphema requires immediate medical attention. Wearing eye protection while playing sports is the best way to prevent hypothermia. Also, never take eye injuries lightly. If it does not bleed, see your eye doctor.

What are other symptoms of hyphema?

In addition to the blood in the eye, the following symptoms usually are associated with hyphema:

  • Visible blood in the front of the eye
  • Sensitivity to light
  • Pain
  • Blurry, clouded, or blocked vision
  • Blood might not be visible if the hyphema is small
  • Blurry or distorted vision
  • Eye pain
  • Light sensitivity (photophobia)
  • Headache

Eye pain, sensitivity to light and headache are especially likely to occur if a hyphema is causing increased intraocular pressure (IOP).

Causes and risk factors of hyphema

70% of hyphemas occur in children, especially men 10-20 years of age. They are usually caused by blunt force injuries from such activities:

  • Sports
  • Industrial accidents
  • Waterfall
  • Fights
  • Shoot BB and Airsoft guns

Less common causes:

  • Eye surgery
  • Abnormal blood vessels in your iris
  • Herpes virus eye infection
  • Blood clotting problems
  • Eye cancer

Some things that affect your blood You may have hyperemia,

  • Leukemia
  • Hemophilia
  • Sickle-cell anaemia
  • Von Willebrand disease
  • Blood-thinning drugs (anticoagulants)

Diagnosis of hyphema

Your doctor will ask if you have ever had an eye injury and what happened before the hyphema. For example, it is important for them to know if you have been hit in the eye with a baseball or if you have run into a tree branch.

The doctor will do an eye exam. These include:

  • Visual acuity test to see how well you can see. They also control the pressure inside your eye (called intraocular pressure).
  • Look into your eye with a special microscope called a slit lamp. Hyphema looks like a clot or a layer of blood in front of the eye. If the anterior chamber is filled with blood, it is called a total, black, or eight-ball hyphema. Your doctor can also see if you have a microhyphema that looks like a fog of red blood cells.
  • CT scan to view the eye sockets and other parts of the face if the injury is severe
  • Screening for sickle cell anemia or thalassemia in people of African descent

Questions to ask your doctor

  • How great is hypothermia?
  • Are there signs of permanent damage?
  • Are there signs of permanent vision loss?
  • How can I prevent this injury from happening again?
  • Should I stop taking blood thinners?
  • When can I go back to my normal activities?

Treatment of hyphema

If your hyphema is mild, it will heal on its own in a week. You can treat any pain you experience with over-the-counter pain relievers that do not contain aspirin. Aspirin should be avoided because it binds to the blood and can increase bleeding. Your doctor will decide how to treat your hyphema based on a variety of factors:

  • Your age, general health, and medical history
  • The extent of the injury
  • Your patience for drug specifics
  • Opinion or personal preference

Once your doctor has collected this information, you will be able to choose from the following treatments:

  • Eye drops (steroid drops to limit inflammation and/or drops to help with pain)
  • Patch on the affected eye
  • Bed rest
  • Limited eye movement (i.e. not reading)
  • The head must be at least 40 degrees high during sleep (helps the body absorb blood)
  • Check eye pressure daily

Medical treatment

Between 15% and 20% of people with hyphema will bleed more in 3 to 5 days. Your body normally absorbs blood, but your doctor will definitely want it to happen. If the pressure in the eye increases or bleeds more, you may need to stay in the hospital.

It is important to follow your treatment plan. It usually includes:

  • Limit eye movement: Relax on the sofa with the head of the bed elevated as high as possible.
  • Use eye drops as directed: Your doctor will prescribe atropine to disperse (expand) your pupil and corticosteroids to prevent scarring.
  • Protect your eyes: Cover them with arm or to prevent further injury. You will need to wear a patch over the arm or to keep light away from your eye.
  • Take care of your medications: Do not take aspirin medications. It causes more bleeding. Also avoid nonsteroidal anti-inflammatory drugs like naproxen, ibuprofen, and many arthritis-like drugs. You can use a mild pain reliever like acetaminophen, but don’t take too much. You need to know if you have pain in your eyes. It may be related to increased stress. If the pain is severe, see a doctor immediately.
  • Manage your stress: Your doctor may want to measure the pressure inside your eye every day for several days.

You can also get medicine to prevent vomiting that increases the pressure inside your eye.

Red blood cells blocking the mesh inside your eye can sometimes increase stress. If your eye pressure rises, your doctor may prescribe a medicine called a beta-blocker. Children and the elderly may not be able to follow a home treatment plan. They and those with problems must stay in the hospital. Depending on your case and your other medical conditions, you may need surgery.

Possible complications of a hyphema

When a hyphema is present, there are certain complications that a person can experience. These may include:

  • Glaucoma: This condition is characterized by pressure in the eye increasing. If glaucoma is not treated, it can lead to blindness.
  • Eye structure damage: This condition can sometimes lead to corneal blood staining. In some cases, this can result in permanently cloudy vision.
  • Recurrent bleeding: It is possible for a hyphema to bleed again. This is more common with more severe cases.
  • Vision loss: It is important that a hyphema is viewed as an emergency and treated immediately. Without immediate treatment, vision loss is possible.