Der Internist
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The use of thyroid-stimulating hormone (TSH) testing in routine laboratory screening and testing of TSH before administration of contrast medium, resulted in an increased number of incidentally detected elevated TSH levels. In the case of slightly increased values in asymptomatic patients, repeated measurement of TSH is recommended for confirmation. ⋯ In subclinical hypothyroidism it remains unclear at which TSH levels the initiation of substitution therapy makes sense. In the case of simultaneously elevated peripheral thyroid hormones rare diseases, such as secondary hyperthyroidism and thyroid hormone resistance should be considered.
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Autoimmune pancreatitis (AIP) was first classified as a defined disease entity in 1995. It accounts for approximately 2 % of cases of chronic pancreatitis (western world prevalence 36-41/100,000 inhabitants) and AIP is diagnosed in 2.4 % of pancreas resection specimens. ⋯ Although AIP is increasingly being identified, the differentiation from pancreatic adenocarcinoma still remains difficult and in cases of a suspicion of neoplasia, resection should be favored. It can successfully be treated conservatively with steroids and rituximab.
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A positive signal when testing urine for proteinuria is a frequent finding, either in the context of a routine medical check-up or when searching for a specific renal disorder. This brief overview aims to provide assistance in the classification of proteinuria and to provide guidance to the next diagnostic and therapeutic steps. The normal urine protein loss of a healthy adult is less then 150 mg/day. ⋯ Principally, proteinuria is 1) a symptom of renal diseases, 2) a progression factor for renal diseases and 3) a risk factor for cardiovascular diseases and total mortality. In this article proteinuria is defined, the correlation to various renal diseases is described and the relevance for progression of renal diseases and total mortality is shown. Finally, diagnostic procedures are described and a perspective on therapeutic measures is provided.
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Recent years have seen dramatic changes in the biological understanding and treatment of solid tumors. Based on the tumor biology, targeting agents have been developed which directly affect the underlying genetic or immunological changes found in specific tumor entities. Significant increases in survival have delivered the functional proof of the concept of targeted and immunological tumor therapy. ⋯ Such agents include hormone therapy with enzalutamide and abiraterone, radiotherapy with cabazitaxel and xofigo (radium 223), metastatic breast cancer (eribulin and everolimus), renal cell carcinoma (sunitinib, sorafenib, axitinib, everolimus and temsirolimus), non-small cell lung cancer (crizotinib and afatinib), colorectal cancer and gastrointestinal stromal tumor (regorafenib) and melanoma (ipilimumab and vemurafenib). The treatment of rarer tumors, such as pancreatic and hepatocellular cancer and soft tissue sarcoma has entered the stage of targeted therapy with the approval of nanoparticle albumin-bound (nab)-paclitaxel, sorafenib, and eribulin/pazopanib. Current clinical trials are focusing on the best time point and sequence of therapy and also improvement in the management of these promising agents.
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A relative or absolute increase of lymphocytes in peripheral blood is a frequent incidental finding. The differential diagnosis of such a finding includes a broad spectrum ranging from normal variations to neoplastic diseases. ⋯ Further diagnostics aim to reliably differentiate between reactive and neoplastic conditions. If a lymphoma or leukemia is suspected this should lead to a rapid hemato-oncological investigation.