Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Indoles/uso terapéutico , Yoduro Peroxidasa/antagonistas & inhibidores , Neoplasias Renales/tratamiento farmacológico , Pirroles/uso terapéutico , Carcinoma de Células Renales/sangre , Humanos , Hipotiroidismo/sangre , Yoduro Peroxidasa/metabolismo , Neoplasias Renales/sangre , Percloratos/química , Sunitinib , Pruebas de Función de la Tiroides , Tirotropina/sangreRESUMEN
Osteoporosis related fractures contribute to morbidity and mortality in U.S. patients, placing a heavy financial burden on society. Randomized clinical trials involving over 30,000 subjects have established bisphosphonates' efficacy in reducing the incidence of fragility fractures. However, as bisphosphonates are retained for years in the skeleton, reports of adverse events from prolonged use are surfacing in the literature, namely, esophageal cancer, atrial fibrillation, osteonecrosis of the jaw, and atypical fracture development. The concept of a drug holiday has been proposed to potentially reduce incidence of these adverse events. This review will highlight the benefits and risks of bisphosphonate therapy and discuss the extension data available from the bisphosphonate trials. As randomized clinical trial evidence is not yet available on who may qualify for drug holiday, this review will provide suggestions for clinicians on identification of possible candidates and monitoring during a bisphosphonate drug holiday.
Asunto(s)
Difosfonatos/efectos adversos , Difosfonatos/uso terapéutico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Selección de Paciente , Fibrilación Atrial/inducido químicamente , Fibrilación Atrial/epidemiología , Osteonecrosis de los Maxilares Asociada a Difosfonatos/epidemiología , Neoplasias Esofágicas/inducido químicamente , Neoplasias Esofágicas/epidemiología , Humanos , Incidencia , Osteoporosis/complicaciones , Fracturas Osteoporóticas/epidemiología , Medición de RiesgoRESUMEN
Pancreatic neuroendocrine tumors (PNETs), a group of endocrine tumors arising in the pancreas, are among the most common neuroendocrine tumors. The genetic causes of familial and sporadic PNETs are somewhat understood, but their molecular pathogenesis remains unknown. Most PNETs are indolent but have malignant potential. The biological behavior of an individual PNET is unpredictable; higher tumor grade, lymph node and liver metastasis, and larger tumor size generally indicate a less favorable prognosis. Endocrine testing, imaging, and histological evidence are necessary to accurately diagnose PNETs. A 4-pronged aggressive treatment approach consisting of surgery, locoregional therapy, systemic therapy, and complication control has become popular in academic centers around the world. The optimal application of the multiple systemic therapeutic modalities is under development; efficacy, safety, availability, and cost should be considered when treating a specific patient. The clinical presentation, diagnosis, and treatment of specific types of PNETs and familial PNET syndromes, including the novel Mahvash disease, are summarized.