Spotlight on Acromegaly and gigantism

Acromegaly is a disease characterized by the gradual enlargement of the peaked (acral) parts of the body, including the nose, lips, tongue, lower jaw, hands, and feet and by hyperplastic alterations in the entire osseous system. Gigantism occurs before epiphyseal closure. AIP mutations (AIPmut) often predispose to familial isolated pituitary adenomas with clinical features that may negatively impact treatment efficacy.

In this article, Dr. Ryan Jacobson of Rush University discusses the clinical picture of acromegaly, which is influenced by many factors, including the levels of growth hormone and insulin-like growth factor, age, tumor size, and delay in diagnosis. Surgical excision of the adenoma by transnasal transsphenoidal approach or by endoscopic endonasal transsphenoidal surgery is recommended. In the case of radiotherapy, stereotactic radiosurgery with the use of the gamma knife is choice. Pegvisomant is a medical therapy that blocks growth hormone action at peripheral receptors, normalizes insulin-like growth factor-1 levels, reduces signs and symptoms, and corrects metabolic defects.

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Twitter Digest for April 3, 2019

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Spotlight on Inadequate sleep hygiene

Inadequate sleep hygiene entails the behaviors, practices, rituals, and habits that result in sleep onset or maintenance difficulties and unrefreshing sleep. It is prevalent across all age groups from young children to the elderly. In our present society, we embrace a culture of taking liberties with our sleep in order to improve academic performance and productivity or to fulfill social or official obligations. This leads to behaviors and habits that then make it difficult to fall asleep or stay asleep through the night. This can result in chronic sleep complaints as well as daytime fatigue and sleepiness. In addition, poor sleep hygiene has been shown to worsen other comorbid psychiatric and neurologic disorders. Electronic device use before or during bedtime, especially in young adults, is becoming more common and has been associated with higher risk of poor sleep. Recognition, counseling, and therapeutic strategies can result in increased sleep quantity, improved sleep quality, and improved daytime functioning.

In this article, Dr. Souzana Obretenova and Dr. Raman Malhotra of Washington University School of Medicine discuss the presentation, impact, and treatment of inadequate sleep hygiene.

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Twitter Digest for March 29, 2019

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Spotlight on Personalized neurology

Personalized neurology is the application of principles of personalized medicine, ie, the prescription of specific therapeutics best suited for an individual taking into consideration both genetic and environmental factors that influence response to therapy. The aim is to improve the efficacy and reduce the adverse effects of various therapies. Several biotechnologies are being integrated to develop personalized medicine. Besides omics, eg, neurogenomics and neuroproteomics, nongenomic technologies such as cell therapy and nanobiotechnology are also used. Biomarkers and integration of diagnostics with therapeutics are important for the selection and monitoring of treatments.

Dr. K K Jain is a Consultant in Neurology in Basel, Switzerland, and in this article, he provides examples of personalized approaches in the management of particular neurologic disorders.

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Twitter Digest for March 27, 2019

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