Adrenal incidentalomas are detected more frequently with high-resolution imaging modalities. It is difficult to distinguish between benign and malignant lesions despite the so-called histologic Weiss criteria, imaging features, and molecular studies. We here present a 52 yr-old man who was found to have an adrenal incidentaloma during an annual check-up at his urologist. An 8 cm large adrenal lesion was detected on ultrasound, computed tomography, and magnetic resonance imaging with imaging features suggestive of malignancy. The lesion was hormonally inactive. A left-sided adrenalectomy was performed and histologic grading revealed a Weiss score of 2, suggesting a benign tumor. However, on further follow-up, the patient developed a local recurrence and pulmonary metastases diagnosed 6 yr after initial presentation. After repeat surgery in the left adrenal bed adrenocortical tumor tissue had a Weiss score of 8, clearly suggesting histologic malignancy. The patient received adjuvant mitotane therapy. Under this therapy, he developed a right-sided adrenal mass (contralateral from the primary tumor) of 2 cm size which disappeared during the following 9 months, whereas the pulmonary metastases remained unchanged, suggesting tumor clones with a variable response to treatment or spontaneous apoptosis. This case suggests that adrenal incidentalomas larger than 6 cm with imaging features such as intratumoral necrosis suggestive of malignancy, should be managed as potential cancers independent of the so-called Weiss criteria. In such patients, close follow-up examinations including high-resolution imaging (preferably 3 monthly) are needed and should be carried out by a physician familiar/specialized in endocrine oncology.
Physical exercise is of paramount therapeutic importance in nonpharmacological interventions of arterial hypertension. The extent and the effects of exercise on blood pressure lowering are analyzed according to the actual literature. Suitable and nonsuitable activities are considered. Dynamic isotonic endurance training is more effective than static isometric exercise. A rather low or moderate extent of endurance training lowers the systolic and diastolic blood pressure by approximately 5-11 mmHg and 3-8 mmHg, respectively. This effect of exercise can be achieved besides the favorable effects on other cardiovascular risk factors. Intensity of exercise should be monitored by the heart rate. The mean intensity should not exceed 70% of the maximal heart rate. An initial ergometry might be suitable for the planning of training recommendations.
Background Symptoms of heart failure (HF) include shortness of breath and limited exercise capacity as a result of fluid retention and circulatory disorders. Life expectancy of HF patients has improved, mainly driven by current treatment modalities. The burden of HF in terms of quality of life (QoL) and emotional well-being is frequently neglected and is less well described than typical HF symptoms. Purpose The aim of this study is to better understand the impact of HF on patients' QoL and emotional well-being from the patients' perspective. Methods Data on disease perception and physical as well as emotional burden was collected using an online survey from Nov to Dec 21 from patients with HF diagnosis (Nfemale=830; Nmale=927). Results Overall, the majority of HF patients considered being capable of fulfilling everyday routines as highly important. In detail, 87% of HF patients rated taking care of themselves, 82% running the household independently, 83% mobility outside the house and 74% social life with highest importance*. Impairments in the same QoL determining aspects from above showed a bimodal distribution of HF patients meaning that they were either highly affected or not affected at all. Male and female HF patients rated QoL aspects in terms of importance and impairment equally, except sexual life importance and sexual impairments, which were ranked higher by men (56% vs. 42%*, 39% vs. 32%§, respectively). Being asked about their biggest concern regarding HF via an open-ended question, death was the most commonly reported term. However, 20% indicated social and emotional worries as their first concern. Indeed, HF patients were frequently emotionally affected and almost every second HF patient stated considerable restrictions of their daily obligations and every third of their social life due to emotional problems. Patient-reported emotions were being worried (53%#), listless/without energy (47%#), fatigue (45%#) and/or afraid (42%#). Interestingly, the fraction of HF patients being unsatisfied with their sexual life was larger when patients indicated feeling emotionally affected (worried, listless, fatigue, afraid). On the other hand, HF patients indicating no negative emotions were more satisfied with their sexual life highlighting the importance of sexual health contributing to QoL. Conclusion(s) The emotional burden experienced by HF patients is as high as their physical impairments culminating in considerable restrictions of their daily routines due to emotional problems. Additionally, emotional well-being is strongly linked with sexual satisfaction. *On a scale from 1 = “not important” to 10 = “very important” rated ≥7. §On a scale from 1 = “not affected” to 10 = “no activity possible” rated ≥7. #On a scale of 1 = “never” to 10 = “very often” rated ≥7. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH
Background Heart failure (HF) and erectile dysfunction (ED) share risk and pathogenetic factors manifesting in a higher prevalence of ED in male HF patients. Despite being a recognized comorbidity, scientific research in this field is limited. Purpose This research aims to better understand the patient journey from a patients' as well as health care professionals' (HCP) perspective in terms of communication, education and ED treatment as recognized concomitant disease in HF patients. Methods Data was collected using two independent online surveys between Nov 21 and Jan 22 from diagnosed male HF patients (N=927) and HCPs including general practitioners (GP), cardiologists and internists (N=78) on quality of life (QoL) with focus on sexual life. As part of the patient survey, male HF patients with ED (N=176) were asked to provide further information about their experiences and ED-related communication with HCPs. Results Male HF patients reported their sexual life as being important (56%*) and their sexual health impacting QoL, with 43% of all men asked (N=927) being unsatisfied with their sexual life. Focusing on HF patients with ED (N=176), half was not aware of the link between HF and ED. Only 33% of male HF patients stated that they were informed about a potential link by their HCP, equally distributed to GPs, cardiologists and urologists. HCPs in turn reported that only 20% of their patients proactively consult them, but the majority of male HF patients with ED (69%) stated that they feel left alone and wish for more personal exchange regarding the topic of ED with a doctor (74%). HCPs reported awareness of strong ED burden in 70% of their male HF patients. In contrast to the patients' perspective, 56% of HCPs report that they do address the topic of ED to their HF patients. Top ranked reason for not addressing the topic of ED from HCP side were the assumption and/or knowledge that patients feel uncomfortable talking about ED. Interestingly, only 7% of male HF patients with ED indeed indicated feeling uncomfortable. Despite their pronounced sexual dissatisfaction only 40% of male HF patients with ED indicated that they talk to a doctor about ED treatment options. In consequence, only 22% of them take prescription drugs. More frequently, HCPs reported that about one third of their patients are non-compliant with HF medication due to ED highlighting the high importance of sexual health for patients' QoL. Conclusions We identified a communication disconnect between HCPs and HF patients regarding ED. As patients' QoL is strongly affected by sexual health, they wish for more personal exchange and information. There is a strong need to proactively address the topic of ED by cardiologists and GPs as the first point of contact for HF patients. New ideas for tools generating a better understanding and more confident conversations about HF and ED are warranted. *On a scale from 1 = “not important” to 10 = “very important” rated ≥7. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH
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