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mary adrenal insuf ciency manifest signs and symptoms associated with a de ciency or absence of all adrenal cortical hormones including cortisol, DHEA, and aldosterone [283,284] Women with panhypopituitarism have severe androgen de ciency due to a lack of both ovarian and adrenal androgen production [248] Pituitary insuf ciency can lead to a de cit of DHEA as the zona reticularis of the adrenal gland produces DHEA in response to stimulation by pituitary ACTH, similar to the stimulation of DHEA in the Leydig cell by LH [286] Low DHEA levels have also been described in a variety of non-endocrine medical conditions The age-related decline in circulating DHEA levels may correlate with many age-related phenomena such as diabetes and states of insulin resistance, hypertension, atherosclerosis, coronary artery disease, decreased bone mineral density, cancer, and dementia [287 291] Low levels of DHEA have also been described in correlation with various conditions unrelated to aging, including obesity, depression, and other mood disorders, eating disorders, autoimmune disorders, immune de ciency states, and chronic stress states [287 289,292,293] In the Massachusetts Male Aging Study (MMAS) DHEA-S was the only hormone which showed a strong (negative) correlation with the prevalence of ED among 17 investigated hormones, including T and estradiol [294] Various drugs can contribute to decreased circulating levels of DHEA Exogenous corticosteroids can decrease adrenal DHEA synthesis via negative feedback to the hypothalamus and pituitary gland, decreasing corticotropin-releasing hormone (CRH) and ACTH secretion, respectively Both adrenolytic drugs, such as mitotane, and inhibitors of corticosteroid synthesis, such as ketoconazole, can reduce adrenal production of DHEA along with cortisol [295,296] More recently, a DHEA de ciency state has been reported in young, healthy, regularly menstruating premenopausal women presenting with decreased libido [297] The regular menstrual periods support normal cyclical ovarian function and ovarian testosterone production However, since adrenal DHEA contributes to almost half of a premenopausal woman s circulating androgens, such a de ciency.

Rearward, domestic perspective; subsidies for old industries; trade-stunting policies; fossil fuel orientation; hostile to foreigners; highly leveraged, consumption-focus; little value on environment; little interest in low GDP countries; focus on domestic GDP at any cost

18 DHEA replacement in women with adrenal insuf ciency has been shown to have numerous bene cial effects including improved overall well-being, improved mood, and improved sexual functioning in the majority of the studies [284,286,298,301] Con icting reports have arisen concerning some of the metabolic effects of DHEA replacement in hypoadrenal patients DHEA replacement has been shown by some investigators to improve insulin sensitivity and lipid pro les [298,302] However, other studies did not con rm these effects [284,286,298,303] DHEA replacement also has been shown to have little to no effect on body composition, body mass index, or exercise capacity in patients with adrenal insuf ciency [303]

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can manifest with symptoms of sexual dysfunction The clinical manifestations of such a DHEA de ciency become more evident when ovarian function is diminished (use of hormonal contraceptives or ovarian failure), as DHEA is also produced by the ovaries

The threat model in a MANET environment is also different from the threat model in traditional static enterprise networks In this section we discuss the type of threats that we consider in this chapter and discuss potential attacks that are possible in such an environment Later in this chapter we discuss speci c schemes for detecting some of these attacks In this chapter, we focus on both outsider and insider threats against MANET The threats from outsiders can result from users that have penetrated the preventive security layers protecting the MANET Such users are not authorized to be a part of the

Forward, external perspective; subsidies for future viable industries; tradeenhancing policies; diversi ed energy approach; encouraging foreign participation; less leveraged, investment-focus; greater value on environment; greater interest in low GDP countries; focus on well-being beyond traditional yardsticks Less reliance on imported oil; diversi ed approach to electricity; more public incentives for renewables, with focus on solar Nonproliferation; wider NATO membership; exible, rapid response strategies; smaller underwriter of global defense; defense geared toward higher probability scenarios; peace through cooperation; reduced physical US armed presence overseas; greater UN peacekeeping efforts; reducing US oil access commitments; limited arms sales (Continued )

Measuring DHEA blood levels is generally not recommended because of variable secretion during the day and its short terminal half-life of approximately 45 hours [298] DHEA also manifests a circadian rhythm and varies throughout the menstrual cycle The measurement of DHEA-S is preferred over that of DHEA because of more stable levels in the blood due to DHEA-S s longer half-life of approximately 24 hours The measurement of DHEA-S can be performed at any time during the day as there is no diurnal variation, or any time during the menstrual cycle, as there is no midcycle rise as is seen with androstenedione or testosterone Two different reliable and reproducible assays for DHEA-S have been performed for many years

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