bowang0911/MedQuAD huggingface dataset:
No single treatment is effective for all patients. Treatment should be individualized, and often combined, depending on patient characteristics such as age and tumor size.
                
If the tumor has not yet invaded surrounding nonpituitary tissues, removal of the pituitary adenoma by an experienced neurosurgeon is usually the first choice. Even if a cure is not possible, surgery may be performed if the patient has symptoms of neurological problems such as loss of peripheral vision or cranial nerve problems. After surgery, hormone levels are measured to determine whether a cure has been achieved. This determination can take up to 8 weeks because IGF-I lasts a long time in the body's circulation. If cured, a patient must be monitored for a long time for increasing GH levels.
                
If surgery does not normalize hormone levels or a relapse occurs, an endocrinologist should recommend additional drug therapy. With each medication, long-term therapy is necessary because their withdrawal can lead to rising GH levels and tumor re-expansion.
                
Radiation therapy is generally reserved for patients whose tumors are not completely removed by surgery, who are not good candidates for surgery because of other health problems, or who do not respond adequately to surgery and medication.
- Acromegaly is a hormonal disorder that results from too much growth hormone (GH) in the body.  - In most people with acromegaly, a benign tumor of the pituitary gland produces excess GH.  - Common features of acromegaly include abnormal growth of the hands and feet; bone growth in the face that leads to a protruding lower jaw and brow and an enlarged nasal bone; joint aches; thick, coarse, oily skin; and enlarged lips, nose, and tongue.  - Acromegaly can cause sleep apnea, fatigue and weakness, headaches, impaired vision, menstrual abnormalities in women, and erectile dysfunction in men.  - Acromegaly is diagnosed through a blood test. Magnetic resonance imaging (MRI) of the pituitary is then used to locate and detect the size of the tumor causing GH overproduction.  - The first line of treatment is usually surgical removal of the tumor. Medication or radiation may be used instead of or in addition to surgery.
Cirrhosis* is scarring of the liver. Scar tissue forms because of injury or long-term disease. Scar tissue replaces healthy liver tissue and blocks the normal flow of blood through the liver.
                
A healthy liver
                
- makes proteins  - helps fight infections  - cleans the blood  - helps digest food  - stores a form of sugar that your body uses for energy
                
A liver with too much scar tissue cannot work properly. You cannot live without a liver that works. But early treatment can control symptoms and keep cirrhosis from getting worse.
                

                
*See the Pronunciation Guide for tips on how to say the words in bold type.
Causes of cirrhosis include
                
- heavy alcohol use  - some drugs, medicines, and harmful chemicals  - infections  - chronic hepatitis B, C, or Dviral infections that attack the liver  - autoimmune hepatitis, which causes the bodys immune system to destroy liver cells  - nonalcoholic fatty liver disease, which is often caused by obesity  - diseases that damage or destroy bile ductstubes that carry bile from the liver
                
Some inherited diseasesdiseases that are passed from parent to childcan cause cirrhosis:
                
- hemochromatosis, a disease that causes iron to collect in the liver  - Wilson disease, a condition that causes copper to build up in the liver  - porphyria, a disorder that affects the skin, bone marrow, and liver
You may have no symptoms in the early stages of cirrhosis. As cirrhosis gets worse you may
                
- feel tired or weak  - lose your appetite  - feel sick to your stomach  - lose weight  - notice red, spider-shaped blood vessels under your skin
                
Cirrhosis can lead to other serious problems:
                
- You may bruise or bleed easily, or have nosebleeds.  - Bloating or swelling may occur as fluid builds up in your legs or abdomenthe area between your chest and hips. Fluid buildup in your legs is called edema; buildup in your abdomen is called ascites.  - Medicines, including those you can buy over the counter such as vitamins and herbal supplements, may have a stronger effect on you. Your liver does not break medicines down as quickly as a healthy liver would.   - Waste materials from food may build up in your blood or brain and cause confusion or difficulty thinking.   - Blood pressure may increase in the vein entering your liver, a condition called portal hypertension.   - Enlarged veins, called varices, may develop in your esophagus and stomach. Varices can bleed suddenly, causing you to throw up blood or pass blood in a bowel movement.   - Your kidneys may not work properly or may fail.   - Your skin and the whites of your eyes may turn yellow, a condition called jaundice.   - You may develop severe itching.   - You may develop gallstones.
                
In the early stages, cirrhosis causes your liver to swell. Then, as more scar tissue replaces healthy tissue, your liver shrinks.
                
A small number of people with cirrhosis also get liver cancer.
Once you have cirrhosis, nothing can make all the scar tissue go away. But treating the cause will keep cirrhosis from getting worse. For example, if cirrhosis is from heavy alcohol use, the treatment is to completely stop drinking alcohol. If cirrhosis is caused by hepatitis C, then the hepatitis C virus is treated with medicine.
                

                
Your doctor will suggest treatment based on the cause of your cirrhosis and your symptoms. Being diagnosed early and carefully following a treatment plan can help many people with cirrhosis. In the late stages of cirrhosis, certain treatments may not be effective. In that case, your doctor will work with you to prevent or manage the problems that cirrhosis can cause.
                

                
What if the cirrhosis treatment doesnt work?   If too much scar tissue forms, your liver could fail. Then you will need a liver transplant. A liver transplant can return you to good health. For information about liver transplantation, see the booklet What I need to know about Liver Transplantation from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
To prevent cirrhosis,
                
- see your doctor for treatment of your liver disease. Many of the causes of cirrhosis are treatable. Early treatment may prevent cirrhosis.   - try to keep your weight in the normal range. Being overweight can make several liver diseases worse.   - do not drink any alcohol. Alcohol can harm liver cells. Drinking large amounts of alcohol over many years is one of the major causes of cirrhosis.   - do not use illegal drugs, which can increase your chances of getting hepatitis B or hepatitis C.   - see your doctor if you have hepatitis. Treatments for hepatitis B, C, and D are available. If you are on treatment, carefully follow your treatment directions.   - if you have autoimmune hepatitis, take your medicines and have regular checkups as recommended by your doctor or a liver specialist.
- Cirrhosis is scarring of the liver. Scar tissue replaces healthy liver tissue.  - Some common causes of cirrhosis include heavy alcohol use, hepatitis infections, and nonalcoholic fatty liver disease.  - In the early stages of cirrhosis, you may have no symptoms. As the disease gets worse, cirrhosis can cause serious problems.  - Once you have cirrhosis, nothing can make all the scar tissue go away. But treatment can prevent cirrhosis from getting worse.  - If too much scar tissue forms and your liver fails, you will need a liver transplant.  - You can take steps to prevent cirrhosis or keep it from getting worse.
NDM is a monogenic form of diabetes that occurs in the first 6 months of life. It is a rare condition occurring in only one in 100,000 to 500,000 live births. Infants with NDM do not produce enough insulin, leading to an increase in blood glucose. NDM can be mistaken for the much more common type 1 diabetes, but type 1 diabetes usually occurs later than the first 6 months of life. In about half of those with NDM, the condition is lifelong and is called permanent neonatal diabetes mellitus (PNDM). In the rest of those with NDM, the condition is transient and disappears during infancy but can reappear later in life; this type of NDM is called transient neonatal diabetes mellitus (TNDM). Specific genes that can cause NDM have been identified. More information about each type of NDM is provided in the appendix.
                
Symptoms of NDM include thirst, frequent urination, and dehydration. NDM can be diagnosed by finding elevated levels of glucose in blood or urine. In severe cases, the deficiency of insulin may cause the body to produce an excess of acid, resulting in a potentially life-threatening condition called ketoacidosis. Most fetuses with NDM do not grow well in the womb and newborns are much smaller than those of the same gestational age, a condition called intrauterine growth restriction. After birth, some infants fail to gain weight and grow as rapidly as other infants of the same age and sex. Appropriate therapy improves and may normalize growth and development.
MODY is a monogenic form of diabetes that usually first occurs during adolescence or early adulthood. However, MODY sometimes remains undiagnosed until later in life. A number of different gene mutations have been shown to cause MODY, all of which limit the ability of the pancreas to produce insulin. This process leads to the high blood glucose levels characteristic of diabetes and, in time, may damage body tissues, particularly the eyes, kidneys, nerves, and blood vessels. MODY accounts for about 1 to 5 percent of all cases of diabetes in the United States. Family members of people with MODY are at greatly increased risk for the condition.
                
People with MODY may have only mild or no symptoms of diabetes and their hyperglycemia may only be discovered during routine blood tests. MODY may be confused with type 1 or type 2 diabetes. People with MODY are generally not overweight and do not have other risk factors for type 2 diabetes, such as high blood pressure or abnormal blood fat levels. While both type 2 diabetes and MODY can run in families, people with MODY typically have a family history of diabetes in multiple successive generations, meaning that MODY is present in a grandparent, a parent, and a child. Unlike people with type 1 diabetes who always require insulin, people with MODY can often be treated with oral diabetes medications. Treatment varies depending on the genetic mutation that has caused the MODY. More information about each type of MODY is provided in the appendix.
Testing for monogenic diabetes involves providing a blood sample from which DNA is isolated. The DNA is analyzed for changes in the genes that cause monogenic diabetes. Abnormal results can determine the gene responsible for diabetes in a particular individual or show whether someone is likely to develop a monogenic form of diabetes in the future. Genetic testing can also be helpful in selecting the most appropriate treatment for individuals with monogenic diabetes. Prenatal testing can diagnose these conditions in unborn children.
                
Most forms of monogenic diabetes are caused by dominant mutations, meaning that the condition can be passed on to children when only one parent is affected. In contrast, if the mutation is a recessive mutation, a disease gene must be inherited from both parents for diabetes to occur. For recessive forms of monogenic diabetes, testing can indicate whether parents or siblings without disease are carriers for recessive genetic conditions that could be inherited by their children.
                
If you suspect that you or a member of your family may have a monogenic form of diabetes, you should seek help from health care professionals-physicians and genetic counselors-who have specialized knowledge and experience in this area. They can determine whether genetic testing is appropriate, select the genetic tests that should be performed, and provide information about the basic principles of genetics, genetic testing options, and confidentiality issues. They also can review the test results with the patient or parent after testing, make recommendations about how to proceed, and discuss testing options for other family members.
Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomenthe area between the chest and hipsbelow the liver.
                
Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.
The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenumthe fi rst part of the small intestine.
                
The liver produces bilea fl uid that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. Bile mostly consists of cholesterol, bile salts, and bilirubin. Bilirubin, a reddish-yellow substance, forms when hemoglobin from red blood cells breaks down. Most bilirubin is excreted through bile.
                

                

                
The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct, and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.
Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.
                
The two types of gallstones are cholesterol and pigment stones:
                
- Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.1  - Pigment stones, dark in color, are made of bilirubin.
Certain people have a higher risk of developing gallstones than others:2
                
- Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.   - People over age 40 are more likely to develop gallstones than younger people.   - People with a family history of gallstones have a higher risk.   - American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United Statesalmost 65 percent of women and 30 percent of men have gallstones.   - Mexican Americans are at higher risk of developing gallstones.
                
Other factors that affect a persons risk of gallstones include2
                
- Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation.   - Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgerysurgery that limits the amount of food a person can eat or digestlead to rapid weight loss and increased risk of gallstones.   - Diet. Research suggests diets high in calories and refi ned carbohydrates and low in fi ber increase the risk of gallstones. Refi ned carbohydrates are grains processed to remove bran and germ, which contain nutrients and  fiber. Examples of refi ned carbohydrates include white bread and white rice.   - Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohns disease, are associated with gallstones.   - Metabolic syndrome, diabetes, and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.
                
More information about these conditions is provided in the NIDDK health topic, Insulin Resistance and Prediabetes.
                
- cirrhosisa condition in which the liver slowly deteriorates and malfunctions due to chronic, or long lasting, injury   - infections in the bile ducts   - severe hemolytic anemiasconditions in which red blood cells are continuously broken down, such as sickle cell anemia
Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
                
If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.1 Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
                
Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include infl ammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver.
                
A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitisin flammation of the pancreas.
                
Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.
People who think they have had a gallbladder attack should notify their health care provider. Although these attacks usually resolve as gallstones move, complications can develop if the bile ducts remain blocked.
                
People with any of the following symptoms during or after a gallbladder attack should see a health care provider immediately:
                
- abdominal pain lasting more than 5 hours   - nausea and vomiting   - fevereven a low-grade feveror chills  - yellowish color of the skin or whites of the eyes, called jaundice   - tea-colored urine and light-colored stools
                
These symptoms may be signs of serious infection or infl ammation of the gallbladder, liver, or pancreas.
Factors related to eating, diet, and nutrition that increase the risk of gallstones include
                
- obesity   - rapid weight loss   - diets high in calories and refi ned carbohydrates and low in fi ber
                
People can decrease their risk of gallstones by maintaining a healthy weight through proper diet and nutrition.
                
Ursodiol can help prevent gallstones in people who rapidly lose weight through low-calorie diets or bariatric surgery. People should talk with their health care provider or dietitian about what diet is right for them.
- Gallstones are hard particles that develop in the gallbladder.  - Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur.   - Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans have a higher risk of developing gallstones.   - Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones.  - If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack.  - Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.  - Gallstone symptoms may be similar to those of other conditions.   - If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment.   - The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.   - The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile  flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
Microscopic colitis is an inflammation of the colon that a health care provider can see only with a microscope. Inflammation is the bodys normal response to injury, irritation, or infection of tissues. Microscopic colitis is a type of inflammatory bowel diseasethe general name for diseases that cause irritation and inflammation in the intestines.
                
The two types of microscopic colitis are collagenous colitis and lymphocytic colitis. Health care providers often use the term microscopic colitis to describe both types because their symptoms and treatments are the same. Some scientists believe that collagenous colitis and lymphocytic colitis may be different phases of the same condition rather than separate conditions.
                
In both types of microscopic colitis, an increase in the number of lymphocytes, a type of white blood cell, can be seen in the epitheliumthe layer of cells that lines the colon. An increase in the number of white blood cells is a sign of inflammation. The two types of colitis affect the colon tissue in slightly different ways:
                
- Lymphocytic colitis. The number of lymphocytes is higher, and the tissues and lining of the colon are of normal thickness.  - Collagenous colitis. The layer of collagen, a threadlike protein, underneath the epithelium builds up and becomes thicker than normal.
                
When looking through a microscope, the health care provider may find variations in lymphocyte numbers and collagen thickness in different parts of the colon. These variations may indicate an overlap of the two types of microscopic colitis.
The colon is part of the gastrointestinal (GI) tract, a series of hollow organs joined in a long, twisting tube from the mouth to the anusa 1-inch-long opening through which stool leaves the body. Organs that make up the GI tract are the
                
- mouth  - esophagus  - stomach  - small intestine  - large intestine  - anus
                
The first part of the GI tract, called the upper GI tract, includes the mouth, esophagus, stomach, and small intestine. The last part of the GI tract, called the lower GI tract, consists of the large intestine and anus. The intestines are sometimes called the bowel.
                
The large intestine is about 5 feet long in adults and includes the colon and rectum. The large intestine changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is 6 to 8 inches long in adults and is between the last part of the coloncalled the sigmoid colonand the anus. During a bowel movement, stool moves from the rectum to the anus and out of the body.