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Endocrinological Disorders
"...Another important aspect of the management of patients with endocrine disorders
is, that many require long-term of even life-long hormone substitution treatment. In
order to further the patient's cooperation in maintaining this treatment properly and
consistently, adequate information should be given concerning the effects and side
effects of the medication, and especially the symptoms that may occur if either too
much or too little of it is used..."
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General Considerations
"...There is probably no other area in human pathology where it is as difficult to distinguish
between psychosomatic and somatopsychic mechanisms in the causation of
symptoms as it is in the field of endocrine disorders. This is largely because most
endocrine secretions are regulated from hypothalamic centres which, on the one
hand, are functionally intercalated in the limbic system and thereby subject to either
neuropsychological stimulation or inhibition (like with arousal, apprehension, anxiety,
fear, depression, appetite for food or sexual gratification) and, on the other, are functionally
modified by the specific hormonal effects of their altered secretory activity
through a negative feedback mechanism..."
Diabetes Mellitus
"...Consistent maintenance of blood sugar levels to contribute to the prevention of late
complications in diabetic patients can only be achieved with the active cooperation
of an adequately informed and motivated patient. Consequently, more emphasis
should be placed on patient education. For various reasons, most of which are connected
with the emotional and psychosocial aspects of having diabetes and the consequences
of its treatment on the patient's freedom of choice, only a minority of
patients appears able to adhere to the rules of the treatment, despite having sufficient
knowledge of diabetes. This observation indicates that critical reflections on the
effectiveness of the methods commonly used in the education of these patients are
required..."
Dwarfism: Emotional Deprivation and Growth Retardation
"...A girl of 16 was referred for investigation of possible hypopituitarism as a cause of her dwarfed
stature and delayed menarche. All tests then available for hypopituitarism were normal. However,
the more refined measurement of "pulse" discharges of growth hormone available today might
have shown some abnormality. It was not until the patient returned to be given the results of the
tests that some recognition dawned that there was something odd about the mother's attitude to
her daughter, and vice versa. It was simply that the mother swept into the room with her daughter
trailing behind, just as if she had been a 10-year-old child. At the same time it was immediately
clear that she was intellectually a 16-year-old, despite her juvenile physical appearance. The
thought then flashed through J.W.P.'s mind that this woman might always have treated this girl
like this and that in some way her delayed growth and maturation had been the girl's unconscious
response to try to fulfil her mother's need for her to remain a child. This seemed as possible as
the more usual view that dwarfed children are inevitably treated as if much younger than their
years..."
Idiopathic Hirsutism
"...they had been exposed to a similar parental pattern of behaviour. Mothers
were organising, unloving, ungiving, and hard working and, unusually for their culture, had
administered physical punishment to their daughters. Attempts at attachment to fathers had met
with equivocal responses..."
Hyperprolactinaemia
"...101 patients with hyperprolactinaemia and/or galactorrhoea.
Of these 101 patients, 51 were reared without their fathers and 18 with an
alcoholic and violent one, whereas such situations were uncommon in the population
form which these women were drawn. There was also a significant temporal relationship
of both onset and exacerbations of the condition to external events such as
marriage, birth of a child or actual or threatened loss of a significant person either
by death or separation, including abortions. It was concluded that the adverse childhood
experiences already mentioned appeared to have conditioned these women to
develop hyperprolactinaemia and/or galactorrhoea later in life in response to this type
of event..."
Thyroiditis
"...Mrs. K. G., aged 50, developed Sj–gren's syndrome in 1972, only months after her mother was
killed. In 1979 she presented with thyroiditis shortly after her father's remarriage, which she
saw as an insult to her mother and constituted a further loss.
D: That might have come on really quite soon after your mother's death, I think?
P: It did actually. That is when I got the ulcers in the eyes, and that was after my mother died
actually. Yes.
D: Perhaps a few months afterwards?
P: Yes, and I had to come up to the hospital. She had had an accident. My young sister was
driving the car and when we got there, she had already gone, and I suppose for a little while
you feel a bit bitter. I did towards her. It was silly really, because it wasn't...
D: No, it was understandable.
P: It wasn't her fault, you know.
D: No, but you feel it.
P: I did. I was bitter towards her for a little while.
D: Could you cry at the time?
P: Well, I remember breaking down and I would have cried and cried, and I don't think I have
cried since.
D: You stopped?
P: I don't think I have cried since. I get a choking feeling (points to chest) but never any
tears..."