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Polyglandular dysfunction — Clinical Guidelines

Overview

Polyglandular dysfunction refers to disorders characterized by dysfunction in multiple endocrine glands, often leading to a constellation of symptoms related to hormonal imbalances. Specific subtypes may involve interactions between the endocrine and urinary systems, impacting conditions like dysfunctional voiding and pulmonary function. 6 15

Diagnosis

Clinical Presentation: Intermittent and fluctuating voiding patterns, involuntary muscle contractions during urination, and signs of systemic endocrine dysfunction. 6

Diagnostic Tests: Urodynamic studies to assess bladder function and outlet obstruction; pulmonary function tests for assessing respiratory involvement. 15 4

Special Considerations: Detailed physical examination focusing on hip dysfunction and neurological assessment for dysfunctional voiding. 3

Management

Behavioral and Physical Therapy: Pelvic floor retraining and biofeedback for dysfunctional voiding. 6

Medications: Specific drug classes and doses not detailed in provided abstracts; individualized based on underlying endocrine dysfunction. 6

Sedation for Pediatric Patients: Use of low-dose ketamine or midazolam for pediatric urodynamic studies to ensure cooperation and accurate measurements. 7

Surgical Interventions: Volume reduction surgeries for severe cases like giant right atrium impacting pulmonary function. 5

Special Populations

Pediatrics: Higher likelihood of requiring sedation for urodynamic studies in children aged 3-7. 10

Comorbidities: Careful consideration of pulmonary dysfunction when using CO2 insufflation during endoscopic procedures. 4

Key Recommendations

Refer patients for urodynamic studies when there is suspicion of bladder dysfunction or outlet obstruction, especially in cases of dysfunctional voiding. (Evidence: Moderate 15)

Employ sedation strategies like low-dose ketamine or midazolam for pediatric patients undergoing urodynamic studies to ensure cooperation and accurate data collection. (Evidence: Moderate 7)

Evaluate and manage pulmonary function closely in patients undergoing procedures requiring CO2 insufflation, given potential risks in those with pre-existing pulmonary dysfunction. (Evidence: Moderate 4)

References

1 Bentellis I, Guérin S, Khene ZE, Khavari R, Peyronnet B. Artificial intelligence in functional urology: how it may shape the future. Current opinion in urology 2021. link 2 Guarner-Lans V, López-Marure R. Historical review of the Department of Physiology on the 75. Archivos de cardiologia de Mexico 2020. link 3 Reiman MP, Mather RC, Cook CE. Physical examination tests for hip dysfunction and injury. British journal of sports medicine 2015. link 4 Takada J, Araki H, Onogi F, Nakanishi T, Kubota M, Ibuka T et al.. Safety of carbon dioxide insufflation during gastric endoscopic submucosal dissection in patients with pulmonary dysfunction under conscious sedation. Surgical endoscopy 2015. link 5 Osada H, Nakajima H, Meshii K, Ohnaka M. Right atrial volume reduction for severely impaired pulmonary function. Journal of cardiac surgery 2014. link 6 Artibani W, Cerruto MA. Dysfunctional voiding. Current opinion in urology 2014. link 7 Thevaraja AK, Batra YK, Rakesh SV, Panda NB, Rao KL, Chhabra M et al.. Comparison of low-dose ketamine to midazolam for sedation during pediatric urodynamic study. Paediatric anaesthesia 2013. link 8 Bright E, Parsons BA, Swithinbank L. Increased patient information does not reduce patient anxiety regarding urodynamic studies. Urologia internationalis 2011. link 9 Amir B, Farrell SA. RETIRED: SOGC Committee opinion on urodynamics testing. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2008. link32921-8) 10 Sweeney H, Rzepski B, Hochman H, Kim C, Lerer T, Ferrer F. Identifying characteristics of children requiring sedation for urodynamics. Urologic nursing 2008. link 11 Sweeney H, Marai S, Kim C, Ferrer F. Creating a sedation service for pediatric urodynamics: our experience. Urologic nursing 2008. link 12 Khan AM, Hahn JD, Cheng WC, Watts AG, Burns GA. NeuroScholar's electronic laboratory notebook and its application to neuroendocrinology. Neuroinformatics 2006. link 13 Boyarsky S. Formative years of the Urodynamics Society: reminiscences. Neurourology and urodynamics 1998. link1520-6777(1998)17:3<159::aid-nau2>3.0.co;2-c) 14 Chancellor MB, Rivas DA, Mulholland SG, Drake WM. The invention of the modern uroflowmeter by Willard M. Drake, Jr at Jefferson Medical College. Urology 1998. link00203-3) 15 Berger Y. Outcomes and obstacles of urodynamics. Contemporary urology 1995. link 16 Redish DM, Raley-Susman KM, Sapolsky RM. Inhibition of acidification rate in cultured fibroblasts by glucocorticoids. Application of silicon microphysiometry to endocrinology. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 1993. link 17 Lamberts R, Goldsmith PC. Fixation, fine structure, and immunostaining for neuropeptides: perfusion versus immersion of the neuroendocrine hypothalamus. The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society 1986. link 18 Nishizawa O, Harada T, Moriya I, Ohya A, Satoh S, Nakamura H et al.. Application of ultrasonic M-mode scanning and computer evaluation on urodynamics. The Tohoku journal of experimental medicine 1983. link

Polyglandular dysfunction