Alstrom syndrome medical therapy: Difference between revisions
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===Obesity=== | ===Obesity=== | ||
Regular exercise and a healthy low calorie diet are recommended for weight control. | Regular [[exercise]] and a healthy low calorie diet are recommended for weight control. | ||
===Cardiomyopathy=== | ===Cardiomyopathy=== | ||
Angiotensinogen-converting enzyme (ACE) inhibitors, diuretics, digoxin, and possibly beta- | [[Angiotensinogen-converting enzyme (ACE) inhibitors]], [[diuretics]], [[digoxin]], and possibly [[beta-blocker]]s should be used in the treatment of [[cardiac failure]]. | ||
===Insulin Resistance/Type 2 Diabetes=== | ===Insulin Resistance/Type 2 Diabetes=== | ||
Should be treated as in the general population unless heart failure and/or liver dysfunction are present. The diabetes mellitus is characterized by insulin resistance, but some individuals respond to a low-sugar, low-fat diet; exercise; and metformin. | Should be treated as in the general population unless [[heart failure]] and/or liver dysfunction are present. The [[diabetes mellitus]] is characterized by insulin resistance, but some individuals respond to a low-sugar, low-fat diet; exercise; and [[metformin]]. [[Glitazone]]s are added to further reduce [[insulin]] resistance but must be avoided in the presence of active or treated heart failure. These treatments should be discontinued when the [[serum creatinine]] concentration exceeds 200 µmol/L or if [[cardiomyopathy]] is evident. [[Incretin]] analogues given subcutaneously, as in nonsyndromic [[type 2 diabetes]], are successful in two thirds of cases. | ||
===Hypertriglyceridemia=== | ===Hypertriglyceridemia=== | ||
Nicotinic acid derivatives can be helpful in long-term reduction of severe hypertriglyceridemia (>20 mmol/l) especially if pancreatitis has occurred and diabetes is absent or well controlled. | [[Nicotinic acid]] derivatives can be helpful in long-term reduction of severe [[hypertriglyceridemia]] (>20 mmol/l) especially if [[pancreatitis]] has occurred and diabetes is absent or well controlled. [[Statin]]s are unlikely to be effective but can be considered for long-term prevention of [[atherosclerosis]] in adults with low [[HDL]], high [[LDL]], and diabetes. Pancreatitis should be treated as in the general population. | ||
===Endocrine Disorders=== | ===Endocrine Disorders=== | ||
* Gonadotropin and pituitary hormones should be assessed to determine if hormonal adjustments are necessary when the child approaches puberty. | * Gonadotropin and pituitary hormones should be assessed to determine if hormonal adjustments are necessary when the child approaches puberty. | ||
* Testosterone is used to treat male hypogonadism to preserve sexuality, muscle strength, and bone health. | * [[Testosterone]] is used to treat male [[hypogonadism]] to preserve sexuality, muscle strength, and bone health. | ||
* Hypothyroidism is treated by thyroxine therapy. | * [[Hypothyroidism]] is treated by thyroxine therapy. | ||
===Renal Failure=== | ===Renal Failure=== | ||
If proteinuria is detected, use of enzyme ACE inhibitors may be considered. | If [[proteinuria]] is detected, use of enzyme [[ACE inhibitors]] may be considered. | ||
===Hepatic Dysfunction=== | ===Hepatic Dysfunction=== | ||
Portal hypertension can be treated using beta-blockade and sclerotherapy of the esophageal veins. Banding should be done in order to prevent upper-GI hemorrhage from varices. | [[Portal hypertension]] can be treated using beta-blockade and [[sclerotherapy]] of the esophageal veins. [[Banding]] should be done in order to prevent upper-GI hemorrhage from [[varices]]. | ||
===Pulmonary Disease=== | ===Pulmonary Disease=== | ||
General activity, including breathing exercises, can reduce chronic hypoxia and improve | General activity, including breathing exercises, can reduce chronic [[hypoxia]] and improve well being. Coaching by an exercise expert may be necessary in order to achieve adequate [[spirometry]] results to determine the presence of obstructive airways disease. | ||
==References== | ==References== | ||
Revision as of 15:15, 25 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Medical Therapy
Rod-Cone Dystrophy
Use of red-orange tinted prescription lenses may reduce symptoms early in the disease phase when photodysphoria is significant. Instruction in the use of Braille, mobility training, adaptive living skills, and computing skills (including voice recognition and transcription software), and the use of large print reading materials while vision is still present are crucial.
Obesity
Regular exercise and a healthy low calorie diet are recommended for weight control.
Cardiomyopathy
Angiotensinogen-converting enzyme (ACE) inhibitors, diuretics, digoxin, and possibly beta-blockers should be used in the treatment of cardiac failure.
Insulin Resistance/Type 2 Diabetes
Should be treated as in the general population unless heart failure and/or liver dysfunction are present. The diabetes mellitus is characterized by insulin resistance, but some individuals respond to a low-sugar, low-fat diet; exercise; and metformin. Glitazones are added to further reduce insulin resistance but must be avoided in the presence of active or treated heart failure. These treatments should be discontinued when the serum creatinine concentration exceeds 200 µmol/L or if cardiomyopathy is evident. Incretin analogues given subcutaneously, as in nonsyndromic type 2 diabetes, are successful in two thirds of cases.
Hypertriglyceridemia
Nicotinic acid derivatives can be helpful in long-term reduction of severe hypertriglyceridemia (>20 mmol/l) especially if pancreatitis has occurred and diabetes is absent or well controlled. Statins are unlikely to be effective but can be considered for long-term prevention of atherosclerosis in adults with low HDL, high LDL, and diabetes. Pancreatitis should be treated as in the general population.
Endocrine Disorders
- Gonadotropin and pituitary hormones should be assessed to determine if hormonal adjustments are necessary when the child approaches puberty.
- Testosterone is used to treat male hypogonadism to preserve sexuality, muscle strength, and bone health.
- Hypothyroidism is treated by thyroxine therapy.
Renal Failure
If proteinuria is detected, use of enzyme ACE inhibitors may be considered.
Hepatic Dysfunction
Portal hypertension can be treated using beta-blockade and sclerotherapy of the esophageal veins. Banding should be done in order to prevent upper-GI hemorrhage from varices.
Pulmonary Disease
General activity, including breathing exercises, can reduce chronic hypoxia and improve well being. Coaching by an exercise expert may be necessary in order to achieve adequate spirometry results to determine the presence of obstructive airways disease.