Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy
Acromegaly resulting from the ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. We present a case of acromegaly secondary to proven GHRH-secretion by a bronchial carcinoid tumor in a type 1 diabetic subject and document the clinical course pre- and post-resection of the tumor and...
Gespeichert in:
| Veröffentlicht in: | Pituitary 2012-06, Vol.15 (2), p.260-265 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 265 |
|---|---|
| container_issue | 2 |
| container_start_page | 260 |
| container_title | Pituitary |
| container_volume | 15 |
| creator | Butler, Peter W. Cochran, Craig S. Merino, Maria J. Nguyen, Dao M. Schrump, David S. Gorden, Phillip |
| description | Acromegaly resulting from the ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. We present a case of acromegaly secondary to proven GHRH-secretion by a bronchial carcinoid tumor in a type 1 diabetic subject and document the clinical course pre- and post-resection of the tumor and of subsequent octreotide therapy. A 54-year-old Caucasian man was referred for evaluation of acromegalic symptoms and significantly increased insulin requirements. He had a history of left lung surgery 20 years prior for hemoptysis. Initial laboratory results indicated acromegaly. Fasting serum growth hormone (GH): 26.1 ng/mL (0–5 ng/mL), insulin-like growth factor 1 (IGF-1): 635 ng/mL (87–283 ng/mL), GH at 60 min post-ingestion of 75 grams of oral glucose during a glucose tolerance test: 8.3 ng/mL (normal |
| doi_str_mv | 10.1007/s11102-010-0226-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3470463</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667411021</sourcerecordid><originalsourceid>FETCH-LOGICAL-c503t-7e0ecd9ad738a8a8618a98e29842ce99837622956c78c9010c4ea20c2a23ead73</originalsourceid><addsrcrecordid>eNqNkk1rFTEUhgdRbK3-ADcScOMmmo-ZJONCkNKqUHCj4C7kZs6dSZlJxiTTen-Pf7SZe9tSBUGyyMf7nDc5J6eqXlLylhIi3yVKKWGYUIIJYwLLR9UxbSTHsib8cVlzJTCv6Y-j6llKl6SAhNdPqyNGuGylYsfV7zObw-ws6mO4zgMaQpyCBxxhBJOc7-9OUAIbIbvg0WaHDNrE4O3gzIisidb54DqUlynE98iOzjtbFPg1Q3TgLaBtGMdwvfrtIRSh-O3djO_QGHyPTdkXPdgcIWTXAcoDRDPvnldPtmZM8OJ2Pqm-n599O_2ML75--nL68QLbhvCMJRCwXWs6yZUpQ1BlWgWsVTWz0LaKS8FY2wgrlW1LLWwNhhHLDOOwRp1UHw6-87KZoLPgczSjnqObTNzpYJz-U_Fu0H240ryWpBa8GLy5NYjh5wIp68klC-NoPIQlaUpaXgvJavUfaPnIRjSkKejrv9DLsERfKrGnmBKCr4b0QNkYUoqwvX83JXrtFn3oFl0S12u36DXhVw8Tvo-4a48CsAOQiuR7iA-v_pfrDcgZzsA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1015286638</pqid></control><display><type>article</type><title>Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Butler, Peter W. ; Cochran, Craig S. ; Merino, Maria J. ; Nguyen, Dao M. ; Schrump, David S. ; Gorden, Phillip</creator><creatorcontrib>Butler, Peter W. ; Cochran, Craig S. ; Merino, Maria J. ; Nguyen, Dao M. ; Schrump, David S. ; Gorden, Phillip</creatorcontrib><description>Acromegaly resulting from the ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. We present a case of acromegaly secondary to proven GHRH-secretion by a bronchial carcinoid tumor in a type 1 diabetic subject and document the clinical course pre- and post-resection of the tumor and of subsequent octreotide therapy. A 54-year-old Caucasian man was referred for evaluation of acromegalic symptoms and significantly increased insulin requirements. He had a history of left lung surgery 20 years prior for hemoptysis. Initial laboratory results indicated acromegaly. Fasting serum growth hormone (GH): 26.1 ng/mL (0–5 ng/mL), insulin-like growth factor 1 (IGF-1): 635 ng/mL (87–283 ng/mL), GH at 60 min post-ingestion of 75 grams of oral glucose during a glucose tolerance test: 8.3 ng/mL (normal <1 ng/mL). Pituitary magnetic resonance imaging (MRI) revealed diffuse pituitary enlargement without adenoma. A 4.4 cm left hilar mass was noted on chest computed tomography (CT) scan. Further evaluation for a suspected GHRH-secreting neuroendocrine tumor was pursued. Plasma GHRH level was elevated: 198 pg/mL (<50 pg/mL). Octreoscan showed radiolabelled-octreotide uptake in the left lung mass and pituitary gland. Surgical resection of the lung mass was performed. Immunohistochemical study of the tumor tissue indicated a neuroendocrine tumor secreting GHRH. Postoperatively, serum GHRH, GH and IGF-1 levels fell precipitously. At 10 months, IGF-1 levels were mildly elevated and 7 months of 10 mg long-acting octreotide therapy (Sandostatin
®
LAR
®
) was trialed. At 20 months, off octreotide, serum IGF-1 levels had normalized, acromegalic features were receding, and the patient’s daily insulin requirements had decreased by 57%.</description><identifier>ISSN: 1386-341X</identifier><identifier>EISSN: 1573-7403</identifier><identifier>DOI: 10.1007/s11102-010-0226-7</identifier><identifier>PMID: 20379782</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Acromegaly ; Adenoma ; Antineoplastic Agents, Hormonal - therapeutic use ; Bronchial Neoplasms - drug therapy ; Bronchial Neoplasms - metabolism ; Carcinoid Tumor - drug therapy ; Carcinoid Tumor - metabolism ; Chest ; Computed tomography ; Diabetes mellitus ; Endocrinology ; Fasting ; Glucose tolerance ; Growth hormone ; Growth hormone-releasing hormone ; Growth Hormone-Releasing Hormone - metabolism ; Hemoptysis ; Human Physiology ; Humans ; Insulin ; Insulin-like growth factor I ; Insulin-like growth factors ; Lung ; Magnetic resonance imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neuroendocrine tumors ; octreotide ; Octreotide - therapeutic use ; Pituitary ; Surgery</subject><ispartof>Pituitary, 2012-06, Vol.15 (2), p.260-265</ispartof><rights>US Government 2010</rights><rights>Springer Science+Business Media, LLC 2012</rights><rights>US Government 2010 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-7e0ecd9ad738a8a8618a98e29842ce99837622956c78c9010c4ea20c2a23ead73</citedby><cites>FETCH-LOGICAL-c503t-7e0ecd9ad738a8a8618a98e29842ce99837622956c78c9010c4ea20c2a23ead73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11102-010-0226-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11102-010-0226-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20379782$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butler, Peter W.</creatorcontrib><creatorcontrib>Cochran, Craig S.</creatorcontrib><creatorcontrib>Merino, Maria J.</creatorcontrib><creatorcontrib>Nguyen, Dao M.</creatorcontrib><creatorcontrib>Schrump, David S.</creatorcontrib><creatorcontrib>Gorden, Phillip</creatorcontrib><title>Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy</title><title>Pituitary</title><addtitle>Pituitary</addtitle><addtitle>Pituitary</addtitle><description>Acromegaly resulting from the ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. We present a case of acromegaly secondary to proven GHRH-secretion by a bronchial carcinoid tumor in a type 1 diabetic subject and document the clinical course pre- and post-resection of the tumor and of subsequent octreotide therapy. A 54-year-old Caucasian man was referred for evaluation of acromegalic symptoms and significantly increased insulin requirements. He had a history of left lung surgery 20 years prior for hemoptysis. Initial laboratory results indicated acromegaly. Fasting serum growth hormone (GH): 26.1 ng/mL (0–5 ng/mL), insulin-like growth factor 1 (IGF-1): 635 ng/mL (87–283 ng/mL), GH at 60 min post-ingestion of 75 grams of oral glucose during a glucose tolerance test: 8.3 ng/mL (normal <1 ng/mL). Pituitary magnetic resonance imaging (MRI) revealed diffuse pituitary enlargement without adenoma. A 4.4 cm left hilar mass was noted on chest computed tomography (CT) scan. Further evaluation for a suspected GHRH-secreting neuroendocrine tumor was pursued. Plasma GHRH level was elevated: 198 pg/mL (<50 pg/mL). Octreoscan showed radiolabelled-octreotide uptake in the left lung mass and pituitary gland. Surgical resection of the lung mass was performed. Immunohistochemical study of the tumor tissue indicated a neuroendocrine tumor secreting GHRH. Postoperatively, serum GHRH, GH and IGF-1 levels fell precipitously. At 10 months, IGF-1 levels were mildly elevated and 7 months of 10 mg long-acting octreotide therapy (Sandostatin
®
LAR
®
) was trialed. At 20 months, off octreotide, serum IGF-1 levels had normalized, acromegalic features were receding, and the patient’s daily insulin requirements had decreased by 57%.</description><subject>Acromegaly</subject><subject>Adenoma</subject><subject>Antineoplastic Agents, Hormonal - therapeutic use</subject><subject>Bronchial Neoplasms - drug therapy</subject><subject>Bronchial Neoplasms - metabolism</subject><subject>Carcinoid Tumor - drug therapy</subject><subject>Carcinoid Tumor - metabolism</subject><subject>Chest</subject><subject>Computed tomography</subject><subject>Diabetes mellitus</subject><subject>Endocrinology</subject><subject>Fasting</subject><subject>Glucose tolerance</subject><subject>Growth hormone</subject><subject>Growth hormone-releasing hormone</subject><subject>Growth Hormone-Releasing Hormone - metabolism</subject><subject>Hemoptysis</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Insulin</subject><subject>Insulin-like growth factor I</subject><subject>Insulin-like growth factors</subject><subject>Lung</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neuroendocrine tumors</subject><subject>octreotide</subject><subject>Octreotide - therapeutic use</subject><subject>Pituitary</subject><subject>Surgery</subject><issn>1386-341X</issn><issn>1573-7403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkk1rFTEUhgdRbK3-ADcScOMmmo-ZJONCkNKqUHCj4C7kZs6dSZlJxiTTen-Pf7SZe9tSBUGyyMf7nDc5J6eqXlLylhIi3yVKKWGYUIIJYwLLR9UxbSTHsib8cVlzJTCv6Y-j6llKl6SAhNdPqyNGuGylYsfV7zObw-ws6mO4zgMaQpyCBxxhBJOc7-9OUAIbIbvg0WaHDNrE4O3gzIisidb54DqUlynE98iOzjtbFPg1Q3TgLaBtGMdwvfrtIRSh-O3djO_QGHyPTdkXPdgcIWTXAcoDRDPvnldPtmZM8OJ2Pqm-n599O_2ML75--nL68QLbhvCMJRCwXWs6yZUpQ1BlWgWsVTWz0LaKS8FY2wgrlW1LLWwNhhHLDOOwRp1UHw6-87KZoLPgczSjnqObTNzpYJz-U_Fu0H240ryWpBa8GLy5NYjh5wIp68klC-NoPIQlaUpaXgvJavUfaPnIRjSkKejrv9DLsERfKrGnmBKCr4b0QNkYUoqwvX83JXrtFn3oFl0S12u36DXhVw8Tvo-4a48CsAOQiuR7iA-v_pfrDcgZzsA</recordid><startdate>20120601</startdate><enddate>20120601</enddate><creator>Butler, Peter W.</creator><creator>Cochran, Craig S.</creator><creator>Merino, Maria J.</creator><creator>Nguyen, Dao M.</creator><creator>Schrump, David S.</creator><creator>Gorden, Phillip</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120601</creationdate><title>Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy</title><author>Butler, Peter W. ; Cochran, Craig S. ; Merino, Maria J. ; Nguyen, Dao M. ; Schrump, David S. ; Gorden, Phillip</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-7e0ecd9ad738a8a8618a98e29842ce99837622956c78c9010c4ea20c2a23ead73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acromegaly</topic><topic>Adenoma</topic><topic>Antineoplastic Agents, Hormonal - therapeutic use</topic><topic>Bronchial Neoplasms - drug therapy</topic><topic>Bronchial Neoplasms - metabolism</topic><topic>Carcinoid Tumor - drug therapy</topic><topic>Carcinoid Tumor - metabolism</topic><topic>Chest</topic><topic>Computed tomography</topic><topic>Diabetes mellitus</topic><topic>Endocrinology</topic><topic>Fasting</topic><topic>Glucose tolerance</topic><topic>Growth hormone</topic><topic>Growth hormone-releasing hormone</topic><topic>Growth Hormone-Releasing Hormone - metabolism</topic><topic>Hemoptysis</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Insulin</topic><topic>Insulin-like growth factor I</topic><topic>Insulin-like growth factors</topic><topic>Lung</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neuroendocrine tumors</topic><topic>octreotide</topic><topic>Octreotide - therapeutic use</topic><topic>Pituitary</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Butler, Peter W.</creatorcontrib><creatorcontrib>Cochran, Craig S.</creatorcontrib><creatorcontrib>Merino, Maria J.</creatorcontrib><creatorcontrib>Nguyen, Dao M.</creatorcontrib><creatorcontrib>Schrump, David S.</creatorcontrib><creatorcontrib>Gorden, Phillip</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pituitary</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Butler, Peter W.</au><au>Cochran, Craig S.</au><au>Merino, Maria J.</au><au>Nguyen, Dao M.</au><au>Schrump, David S.</au><au>Gorden, Phillip</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy</atitle><jtitle>Pituitary</jtitle><stitle>Pituitary</stitle><addtitle>Pituitary</addtitle><date>2012-06-01</date><risdate>2012</risdate><volume>15</volume><issue>2</issue><spage>260</spage><epage>265</epage><pages>260-265</pages><issn>1386-341X</issn><eissn>1573-7403</eissn><abstract>Acromegaly resulting from the ectopic secretion of growth hormone-releasing hormone (GHRH) is rare. We present a case of acromegaly secondary to proven GHRH-secretion by a bronchial carcinoid tumor in a type 1 diabetic subject and document the clinical course pre- and post-resection of the tumor and of subsequent octreotide therapy. A 54-year-old Caucasian man was referred for evaluation of acromegalic symptoms and significantly increased insulin requirements. He had a history of left lung surgery 20 years prior for hemoptysis. Initial laboratory results indicated acromegaly. Fasting serum growth hormone (GH): 26.1 ng/mL (0–5 ng/mL), insulin-like growth factor 1 (IGF-1): 635 ng/mL (87–283 ng/mL), GH at 60 min post-ingestion of 75 grams of oral glucose during a glucose tolerance test: 8.3 ng/mL (normal <1 ng/mL). Pituitary magnetic resonance imaging (MRI) revealed diffuse pituitary enlargement without adenoma. A 4.4 cm left hilar mass was noted on chest computed tomography (CT) scan. Further evaluation for a suspected GHRH-secreting neuroendocrine tumor was pursued. Plasma GHRH level was elevated: 198 pg/mL (<50 pg/mL). Octreoscan showed radiolabelled-octreotide uptake in the left lung mass and pituitary gland. Surgical resection of the lung mass was performed. Immunohistochemical study of the tumor tissue indicated a neuroendocrine tumor secreting GHRH. Postoperatively, serum GHRH, GH and IGF-1 levels fell precipitously. At 10 months, IGF-1 levels were mildly elevated and 7 months of 10 mg long-acting octreotide therapy (Sandostatin
®
LAR
®
) was trialed. At 20 months, off octreotide, serum IGF-1 levels had normalized, acromegalic features were receding, and the patient’s daily insulin requirements had decreased by 57%.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>20379782</pmid><doi>10.1007/s11102-010-0226-7</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1386-341X |
| ispartof | Pituitary, 2012-06, Vol.15 (2), p.260-265 |
| issn | 1386-341X 1573-7403 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3470463 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Acromegaly Adenoma Antineoplastic Agents, Hormonal - therapeutic use Bronchial Neoplasms - drug therapy Bronchial Neoplasms - metabolism Carcinoid Tumor - drug therapy Carcinoid Tumor - metabolism Chest Computed tomography Diabetes mellitus Endocrinology Fasting Glucose tolerance Growth hormone Growth hormone-releasing hormone Growth Hormone-Releasing Hormone - metabolism Hemoptysis Human Physiology Humans Insulin Insulin-like growth factor I Insulin-like growth factors Lung Magnetic resonance imaging Male Medicine Medicine & Public Health Middle Aged Neuroendocrine tumors octreotide Octreotide - therapeutic use Pituitary Surgery |
| title | Ectopic growth hormone-releasing hormone secretion by a bronchial carcinoid tumor: clinical experience following tumor resection and long-acting octreotide therapy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T23%3A04%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ectopic%20growth%20hormone-releasing%20hormone%20secretion%20by%20a%20bronchial%20carcinoid%20tumor:%20clinical%20experience%20following%20tumor%20resection%20and%20long-acting%20octreotide%20therapy&rft.jtitle=Pituitary&rft.au=Butler,%20Peter%20W.&rft.date=2012-06-01&rft.volume=15&rft.issue=2&rft.spage=260&rft.epage=265&rft.pages=260-265&rft.issn=1386-341X&rft.eissn=1573-7403&rft_id=info:doi/10.1007/s11102-010-0226-7&rft_dat=%3Cproquest_pubme%3E2667411021%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1015286638&rft_id=info:pmid/20379782&rfr_iscdi=true |