- 著者
- Tetsuo Nishikawa Masao Omura Fumitoshi Satoh Hirotaka Shibata Katsutoshi Takahashi Naohisa Tamura Akiyo Tanabe
- 出版者
- The Japan Endocrine Society
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.58, no.9, pp.711-721, 2011 (Released:2011-09-30)
- 参考文献数
- 21
- 被引用文献数
- 386 413
The Japan Endocrine Society (JES) attempted to develop guidelines for the diagnosis and treatment of primary aldosteronism (PA). The Task Force Committee (TFC) was composed of a chair, selected by the JES, and additional experts. Systematic reviews of available evidence for Japanese patients were used to recommend the key treatment and prevention. We have evaluated the methods of screening, confirmatory tests and imaging, plus adrenal vein sampling (AVS). Consensus was guided by systematic review of evidence and discussion during each annual meeting of the JES, plus its related meetings, and by e-mail communication. The drafts prepared by TFC were reviewed successively by the members of Research on Intractable Diseases provided by the Japanese Ministry of Health, Labour and Welfare, and in comments from the JES’s councilors. At each stage of review, TFC received written comments and incorporated suggested changes. In conclusion, all patients with hypertension should be screened for PA, because of the high prevalence of cardiovascular disease and the current low case-detection rate in Japan. Case detection can be performed in hypertensive patients and those with hypokalemia by determining the aldosterone/renin ratio, and the diagnosis of PA can be confirmed by two of three confirmatory tests. The presence of a unilateral aldosterone-producing adenoma should be established/excluded by AVS by an experienced radiologist, optimally followed by laparoscopic adrenalectomy. In contrast, patients with bilateral adrenal hyperplasia, or those unsuitable for surgery, are optimally treated medically with mineralocorticoid receptor antagonists.
- 著者
- TETSUO NISHIKAWA TAKASHI IIZUKA MASAO OMURA NOBUHIKO KURAMOTO TAKASHI MIKI HIROKO ITO SHYOZO CHIBA
- 出版者
- The Japan Endocrine Society
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.43, no.6, pp.671-677, 1996 (Released:2006-11-25)
- 参考文献数
- 19
- 被引用文献数
- 5 4
The present investigations were performed in order to clarify the effects of mazindol on body weight and insulin sensitivity in patients with morbid obesity who had already been treated with a verylow- calorie diet containing 480kcal food (VLCD) with various amino acids. We attempted to study whether a further decrease in body weight would be achieved by the administration of mazindol, because it is difficult to obtain sufficient and continuous reduction of body weight after VLCD therapy. Thirteen female severely obese subjects were 51.0±13.9 years old (25-73 years old), with a mean height of 154.7±5.6cm (146.0-160.5cm), mean weight of 84.5±9.4kg (69-98kg) and a mean body mass index (BMI) of 35.3±3.6kg/m2 (29.2-41.0kg/m2). Their mean body weight decreased to 76.7±2.2kg (net decrease: 6.3±0.9kg) after VLCD therapy for 2-4 weeks. Then they were treated by the administration of mazindol with diet restriction (1000-1200kal/day). Mazindol administration resulted in a further weight reduction of 2.9±0.5kg after 4 weeks, 4.9±0.5kg after 8 weeks and 6.9±0.9kg after 12 weeks. Their blood pressure was not changed after mazindol treatment. The responses of blood glucose and insulin levels in a 75g oral glucose tolerance test (OGTT) were not significantly different before and after mazindol administration. The blood glucose area calculated from the data obtained during OGTT for 120min did not significantly differ before and after mazindol administration, while the insulin area significantly decreased after mazindol treatment (from 98.0±12.1 before administration to 70.1±7.8). The mean M value reflecting insulin sensitivity in the whole body determined by euglycemic glucose clamping was increased significantly after mazindol treatment (from 4.92±0.30mg/kg/min to 6.36± 0.43mg/kg/min). The results demonstrated that mazindol administration with diet restriction further reduced body weight in the morbidly obese subjects after treatment with VLCD, with an increase in the M value and a decrease in insulin release. The results suggest that mazindol is useful for reducing body weight as well as improving insulin sensitivity.