Microalbuminuria is associated with progression to renal disease In Insulindependent diabetes and wtth Increased mortality in noninsulln-dependent diabetes. In contrast, few studies have addressed the effect of mlcroalbumlnurla on cardiovascular risk In nondlabetics. We, therefore, determined the level of microalbuminuria In 316 nondiabetic subjects from the San Antonio Heart Study, a population-based study of diabetes and cardiovascular risk factors. Microalbuminuria (£30 mg/l) was found In 42 of these 316 subjects (13%). Subjects wtth mlcroalbumlnurla had significantly higher blood pressure, trlglyceride concentration, sum of Insulin concentrations during a glucose tolerance test, and prevalence of hypertension and of self-reported myocardlal Infarction than subjects without microalbuminuria. When subjects with hypertension were excluded (n=27), normotensive subjects with mlcroalbumlnurla (n=31) still had significantly higher trlglyceride concentrations and Insulin sum than normotensive subjects without microalbuminuria (n=258), suggesting that an increased atherogenlc risk factor pattern exists even In normotensive subjects with microalbuminuria. Microalbuminuria may be a marker for cardiovascular risk, although It Is not certain whether microalbuminuria causes these metabolic changes or results from some metabolic disturbance such as insulin resistance.
Addison’s disease – the traditional term for primary adrenal insufficiency (PAI) – is defined as the clinical manifestation of chronic glucocorticoid- and/or mineralocorticoid deficiency due to failure of the adrenal cortex which may result in an adrenal crisis with potentially life-threatening consequences. Even though efficient and safe pharmaceutical preparations for the substitution of endogenous gluco- and mineralocorticoids are established in therapy, the mortality in patients with PAI is still increased and the health-related quality of life (HRQoL) is often reduced.PAI is a rare disease but recent data report an increasing prevalence. In addition to the common “classical” causes of PAI like autoimmune, infectious, neoplastic and genetic disorders, other iatrogenic conditions – mostly pharmacological side effects (e. g., adrenal haemorrhage associated with anticoagulants, drugs affecting glucocorticoid synthesis, action or metabolism and some of the novel anti-cancer checkpoint inhibitors) are contributing factors to this phenomenon.Due to the rarity of the disease and often non-specific symptoms at least in the early stages, PAI is frequently not considered resulting in a delayed diagnosis. Successful therapy is mainly based on adequate patient education as a cornerstone in the prevention and management of adrenal crisis. A focus of current research is in the development of pharmacokinetically optimized glucocorticoid preparations as well as regenerative therapies.
Patients with different subtypes of Cushing syndrome show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.
NIDDM patients have a two- to fourfold increased risk of CHD relative to nondiabetic subjects. This excess risk is explained only partially by increased levels of standard risk factors. We compared the plasma concentrations of Lp(a) in NIDDM patients (n = 260) and nondiabetic subjects (n = 336) who participated in a population-based study (San Antonio Heart Study). Lp(a) was measured using a monoclonal anti-Lp(a) antibody. NIDDM patients and nondiabetic subjects had similar Lp(a) concentrations for both men (13.6 +/- 1.5 vs. 16.1 +/- 1.4 mg/dl) and women (12.6 +/- 0.8 vs. 15.9 +/- 1.3 mg/dl) (P = 0.361). Duration of diabetes and level of fasting glycemia were not significantly related to Lp(a) concentrations. Lp(a) levels were significantly higher in patients who had higher total and LDL cholesterol levels. We conclude that in a large population-based study, Lp(a) levels are not increased in NIDDM patients.
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