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THE ENCYCLOPEDIA OF

MEN’S HEALTH

Glenn S. Rothfeld, M.D., M.Ac.,

and Deborah S. Romaine

An Amaranth Book

The Encyclopedia of Men’s Health

Copyright © 2005 by Amaranth

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means,

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Library of Congress Cataloging-in-Publication Data

Rothfeld, Glenn S.

The encyclopedia of men’s health / Glenn Rothfeld and Deborah S. Romaine.

p. ; cm.

“An Amaranth book.”

Includes bibliographical references and index.

ISBN 0-8160-5177-1 (HC : alk. paper)

1. Men—Health and hygiene—Encyclopedias. I. Romaine, Deborah S., 1956. II. Title.

[DNLM: 1. Health—Encyclopedias—English. 2. Men—Encyclopedias—English.

3. Health Promotion—Encyclopedias—English. WA 13 R757e 2005]

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Disclaimer: This book contains the authors’ ideas and facts/knowledge accumulated. It is intended to provide helpful infor￾mation on the subject matter covered herein. It is sold with the understanding that the authors, book producer, and the pub￾lisher are not engaged in rendering professional medical, health, or any other kind of personal professional services via this

book. If the reader wants or needs personal advice or guidance, he or she should seek an in-person consultation with a com￾petent medical professional. Furthermore, the reader should consult his or her medical, health, or other competent profes￾sional before adopting any of the suggestions in the book or drawing inferences from information that is included herein. This

is a supplement, not a replacement, for medical advice from a reader’s personal health care provider. Check with your doctor

before following any suggestions in this book; consult your doctor before using information on any condition that may require

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The authors, book producer, and publisher specifically disclaim any responsibility for any liability, loss, or risk, whether per￾sonal or otherwise, that someone may incur as a consequence, direct or indirect, of the use and application of any contents of

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any adverse effects that result from the use of information in this book rests solely with the reader.

CONTENTS

Introduction v

Entries A–Z 1

Appendixes 347

Selected Bibliography and Further Reading 363

Index 365

Much has changed in the 30 years I have prac￾ticed medicine, though perhaps no change

has been as significant as our collective attitude

toward health. The technological knowledge and

innovations that marked the latter decades of the

20th century have made it possible for us to repair

damaged hearts, cure many forms of cancer, and

even replace diseased organs. Men today can expect

to live a third as long as did their grandfathers. Yet

swirling from the core of these amazing advances is

the growing recognition among many physicians,

including me, that technology alone is not the

answer when it comes to good health. Good health

comes from good health care—not only from the

care physicians can provide, but also from caring for

one’s own health and well-being. Good health is an

integration of technology and lifestyle.

I recognized early in my medical career that for

as much as we benefit from the scope and breadth

of technology in the practice of medicine, there is

much for us to learn from the history of healing.

Medicine, as we practice it in Western cultures, is lit￾tle more than a blip on the time line of humankind.

Healers have worked to improve the human condi￾tion for thousands and thousands of years. The key

lesson that endures is that the human body has a

remarkable capacity to heal and to keep itself

healthy. The methods that are most successful over￾all are those that support this capacity.

As our clinical knowledge of preventive health

care and health maintenance expands, so, too,

does the understanding among men that we can

influence the status of our health. Only with

recent generations has this even been a considera￾tion: until the latter part of the 20th century a

man’s life expectancy extended only to the late 60s

or early 70s. As men are living longer, they want to

live better and are making great strides in improv￾ing their health. Cigarette smoking, for example, is

a leading cause of heart disease and cancer, the two

most significant health conditions American men

face. Nearly 60 percent of American men were

smokers in 1970; today fewer than one in four

men in the United States smoke. Men are improv￾ing their lifestyles in other ways too, through

healthier eating habits and increased physical exer￾cise. In my practice today, I am far more likely to

hear, “Doctor, what can I do to stay healthy?” than

hear, “Doctor, what can you do to fix me?”

My medical education at the State University of

New York at Buffalo School of Medicine and Harvard

University School of Medicine’s Channing Labora￾tory provided me with the best of Western knowl￾edge. For the best of traditional medicine, I studied at

the Traditional Acupuncture Institute in Columbia,

Maryland, and the College of Traditional Chinese

Acupuncture in Leamington Spa, England. Today I

blend these domains in a complementary, holistic

approach to helping people take care of their health.

Such an integration is, I believe, the future of health

care and the path to better health for all of us. This

book, The Encyclopedia of Men’s Health, reflects this phi￾losophy. I want you, the reader, to know all that is

available to help you (or the man in your life) stay

healthy as well as to take care of your ills and injuries.

—Glenn S. Rothfeld, M.D., M.Ac.,

Medical Director, WholeHealth New England, Inc.

INTRODUCTION

v

ENTRIES A–Z

A

A-B-C-D skin examination See SKIN CANCER.

abdominal adiposity A body fat distribution pat￾tern in which excess fat collects around the waist.

Although men tend to joke about their “spare tire,”

abdominal adiposity reflects potentially serious

health issues. Abdominal adiposity often signals the

pressure of INSULIN RESISTANCE, correlating to an

increased risk for various diseases such as HYPERTEN￾SION (high blood pressure), CORONARY ARTERY DISEASE

(CAD), INSULIN RESISTANCE, and type 2 DIABETES. This

fat distribution pattern can show up in younger men

who are overweight or obese, although it has a ten￾dency to affect more men as they enter middle age

and beyond. Men with abdominal adiposity usually

have BODY MASS INDEXES (BMIs) over 28, the clinical

marker for overweight, although they may not look

overweight.

One reason abdominal adiposity becomes a

health factor is that excess body fat does not just

form a layer under the skin that extends the waist￾line but also accumulates around the organs in the

abdomen and chest. This puts pressure on these

organs, interfering with their abilities to function

properly. The heart must work harder, and ulti￾mately less efficiently, to get adequate blood supply

out to the rest of the body. The GASTROINTESTINAL

SYSTEM feels the pinch as well, with problems such

as GASTROESOPHAGEAL REFLUX DISORDER (GERD),

HIATAL HERNIA, and GALLBLADDER DISEASE becoming

more common.

Although lifestyle (eating and exercise habits) is

the key factor in body fat accumulation and weight

gain, recent studies suggest that gene mutations

might establish this particular pattern of body fat

distribution, along with other disturbances that

affect the body’s mechanisms for regulating blood

pressure and lipid metabolism. The combined

effect allows blood pressure and blood lipid levels

to rise, causing a multifold leap in risk for heart dis￾ease. The gene mutations appear to permit alter￾ations in the structure of the cells that line the

interior walls of the arteries, reducing their resist￾ance to arterial plaque accumulations.

Men with a waist circumference of 40 inches or

greater (measured around the waist above the hip

bones and below the navel) have the greatest risk

for serious health problems as a consequence of

excess body fat. Health experts now consider

abdominal adiposity a more significant predictor

for heart disease than any other single factor

except cigarette smoking. Lifestyle changes that

incorporate nutritional eating habits and regular

exercise to lose excess body weight and body fat

help to improve a man’s cardiovascular and overall

health. However, predisposition toward a body fat

accumulation pattern of abdominal adiposity

remains a warning. The more body fat a man

prone to abdominal adiposity acquires, the higher

his risk for health problems, even more so than a

man with the same amount of body fat who has a

generalized body fat distribution pattern. Doctors

are likely to implement treatment strategies such

as lipid-lowering medications and antihypertensive

medications earlier and more aggressively in men

with abdominal adiposity.

See also BODY SHAPE AND HEART DISEASE; LIFESTYLE

AND HEALTH; NUTRITION AND DIET; OBESITY; WEIGHT

MANAGEMENT.

accidental injury An unintended event that

results in bodily damage. Accidental injury is the

leading cause of death for men under age 25 and a

significant cause of disability and death for men of

1

all ages. In all age groups except men between the

ages of 18 and 24, falls account for the greatest

number of injuries. Men between the ages of 25

and 44 have the highest accidental injury rate and

nearly twice the motor vehicle accident rate of any

other age group.

Most accidental injuries are preventable. Health

care professionals encourage men of all ages to fol￾low common safety practices such as:

• Wearing seatbelts whenever driving or riding in

motor vehicles

• Wearing helmets when riding motorcycles or

bicycles

• Following appropriate handling precautions

when using firearms

• Avoiding altercations that could result in physi￾cal violence

acetaminophen An over-the-counter ANALGESIC

MEDICATION taken to relieve mild to moderate pain

and fever. Acetaminophen became familiar to the

American public under the brand name Tylenol,

although today there are dozens of different brands

and generic products available. Acetaminophen

also appears in numerous combination products

such as those for allergies, sinus headache, and

colds and flu. It also comes in regular and

extended-release formulas. Tylenol has been avail￾able since 1955.

Acetaminophen works to relieve fever through

its actions on the hypothalamus, the structure

deep within the brain that regulates body temper￾ature. Acetaminophen activates body mechanisms

that cause sweating and peripheral blood vessel

dilation, helping to cool the body by circulating

more blood near the surface of the skin. The cool￾ing effect of evaporation (sweating) further lowers

skin temperature. As a pain reliever, acetamino￾phen acts to interrupt the release of prost￾aglandins. Prostaglandins are chemicals that convey

pain signals.

Acetaminophen has few side effects when taken

as directed, and doctors generally recommend it for

pain and fever relief when there is no need for an

anti-inflammatory effect (acetaminophen does not

relieve inflammation). However, the liver is very

sensitive to acetaminophen. When taken in excess

or in combination with alcohol, or in other cir￾cumstances that impair liver function, such as

chronic alcohol or substance abuse, acetamino￾phen can accumulate to toxic levels capable of

causing serious, permanent liver damage. This can

result from a single excess or from a mild excess

over time (such as with extended use).

See also ASPIRIN; NONSTEROIDAL ANTI-INFLAMMATORY

DRUG.

ACL See ANTERIOR CRUCIATE LIGAMENT.

acne A skin condition in which the sebaceous

glands become inflamed and infected, resulting in

characteristic whiteheads (milia) and blackheads

(comedones). Acne most commonly affects the

face, back, and chest in men. Although the hor￾monal changes of puberty trigger acne, acne can

affect a man at any age. Adolescent acne generally

begins around age 12 or 13 and lasts through the

late teens or early 20s. The surge of ANDROGENS

(male hormones) that signals the onset of adoles￾cence initiates many changes in the body; among

them is a change in the way hair follicles produce

2 acetaminophen

HOSPITAL EMERGENCY DEPARTMENT VISITS FOR ACCIDENTAL INJURIES, 1999–2000

Cause of Accidental Injury Men 18–24 Men 25–44 Men 45–64 Men 65 and older

motor vehicle accident 469,000 848,000 316,000 114,000

falls 307,000 850,000 582,000 579,000

cut/pierced 394,000 764,000 294,000 102,000

struck by person or object 405,000 781,000 232,000 112,000

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical

Care Survey (2002)

sebum. At adolescence, sebum becomes sticky and

abundant, easily plugging the sebaceous gland and

the hair follicle. This traps bacteria, causing a local￾ized infection that erupts in an often painful bump,

commonly called a pimple.

Skin care and cleanliness are important to help

clear excess sebum from the pores. Daily shaving

with a sharp, fresh blade to keep the face clean￾shaven reduces the opportunity for skin oils and

moisture to accumulate. Numerous skin cleansing

products are available without a doctor’s prescrip￾tion. Products containing salicylic acid, sulfur, TEA

TREE OIL, witch hazel, and aloe often are effective in

controlling mild to moderate acne. Products con￾taining benzoyl peroxide have a stronger astrin￾gent (drying) effect for moderate acne. It is

important to follow label directions for all prod￾ucts, as overusing them is of little value and can

cause skin irritation, redness, flaking, and peeling.

Conventional soaps tend to leave residue, which

itself can plug pores and exacerbate, rather than

relieve, acne.

Prescription medications to treat moderate

acne include antibiotics such as tetracycline,

which can be taken long term, and topical creams

containing retinol, a form of vitamin A. A derma￾tologist should evaluate and treat acne that forms

pustules and cysts that leave scars and pitting.

There are numerous prescription medications

available that can treat severe acne. A single 20-

week course of treatment with oral Accutane

(isotretinoin) permanently ends acne for most

men who take it. Accutane alters the biochem￾istry of the skin in ways that changes sebum pro￾duction; these changes generally are permanent.

However, Accutane has potentially serious side

effects, including severe DEPRESSION and suicidal

tendencies, PSYCHOSIS, PANCREATITIS (inflammation

of the PANCREAS), permanent liver damage and

liver failure, and increased blood pressure within

the brain (a condition called pseudotumor cere￾bri). Accutane also causes birth defects when

taken by women who are pregnant. There are

strict prescribing guidelines for Accutane: doctors

can prescribe it only for severe (nodular) acne

that causes scarring and pitting when other treat￾ments have failed.

See also ACTINIC KERATOSIS; ROSACEA.

acquired immunodeficiency syndrome See

HIV/AIDS.

acromegaly Overproduction of growth hormone

by the PITUITARY GLAND, causing characteristically

enlarged hands, feet, and facial features. It most

often develops in middle age as a result of pituitary

ADENOMA, a benign (noncancerous) tumor, but

also can result from adenomas in other locations.

Adenomas usually grow slowly, so symptoms

develop gradually, typically over years. A man

might notice that his hair becomes coarse and his

voice deepens, his clothing and shoes become too

small, and he sweats excessively with offensive

body odor—all common symptoms.

Diagnosis and treatment are important, as

endocrine dysfunction becomes more pervasive

and causes a cascade of health problems such as

OSTEOARTHRITIS, cardiomegaly (enlarged heart),

HYPERTENSION (high blood pressure), ERECTILE DYS￾FUNCTION, intestinal POLYPS, and DIABETES. Because

early symptoms are vague and acromegaly is rela￾tively uncommon, it sometimes takes time to reach

the correct diagnosis. Laboratory tests that meas￾ure the amount of growth hormone in the blood￾stream and imaging procedures such as a COMPUTED

TOMOGRAPHY (CT) SCAN or MAGNETIC RESONANCE

IMAGING (MRI) can make the diagnosis. Treatment

might include surgery or radiation, depending on

the tumor’s location, or injections of drugs

(bromocriptine, also used to treat PARKINSON’S DIS￾EASE, or octreocide, a hormone that suppresses

growth hormone production) to suppress growth

hormone production. Many of the symptoms go

away with treatment, although physical changes

such as enlarged feet and hands remain. Diseases

such as diabetes and hypertension often also per￾sist, requiring treatment.

Actors Richard Kiel, who played the character

Jaws in the James Bond 007 movies; Carel Struy￾cken, who played the character Lurch in The Addams

Family movies; and Andre the Giant, who started his

career as a professional wrestler and later starred in

a number of movies, including The Princess Bride in

which he played Fezzik, all had acromegaly. About

five in a million people in the United States are

diagnosed with acromegaly each year.

See also ENDOCRINE SYSTEM.

acromegaly 3

ACTH See ADRENOCORTICOTROPIC HORMONE.

actinic keratosis A skin condition in which over￾exposure to the sun causes patches of rough, thick￾ened skin that are at high risk for becoming

cancerous. The patches typically start out as small

areas where the skin appears flaky or scaly. The

area gradually (over years) enlarges and becomes

more rough. Actinic keratosis lesions, as doctors

call them, are most common on the face, neck, and

ears—the places that receive the highest concen￾trations of ultraviolet exposure. However, they can

appear anywhere on the body. Dermatologists

(doctors who specialize in treating skin conditions)

recommend that men who spend a lot of time in

the sun, and men who are over age 50, receive

annual dermatology examinations to look for

actinic keratosis and other skin problems with the

potential to turn malignant.

Treatment generally consists of removing the

lesions by applying liquid nitrogen to freeze them

off, if practical, and by excising them if not. The

dermatologist can do this in his or her office. With

liquid nitrogen treatment, the dermatologist

freezes the area with a focused spray, causing the

cells to die (often scraping a few cells for laboratory

examination). Over the following 10–14 days, the

area darkens and then sloughs off. With excision,

the dermatologist numbs the area with a local

anesthetic and cuts out the lesion, pulling the

edges together with sutures if necessary. The

wound takes seven to 10 days to heal. All excised

lesions undergo pathological examination to deter￾mine whether they are precancerous or cancerous;

if they are, the dermatologist might recommend

further treatment. With both methods, discomfort

is minor, healing is quick, and typically there is no

scarring.

Removing actinic keratosis lesions is the surest

way to prevent certain forms of skin cancer. Wear￾ing sunscreen and protective clothing (including a

hat that shades the ears and face) to reduce sun

exposure helps to prevent actinic keratosis from

developing. Dermatologists usually can diagnose

actinic keratosis on visual examination because of

its characteristic appearance, and laboratory analy￾sis can provide definitive diagnosis.

See also ACNE; ROSACEA; SEBORRHEIC KERATOSIS;

SKIN CANCER.

acupuncture The centuries-old therapy founda￾tion of TRADITIONAL CHINESE MEDICINE (TCM) in

which practitioners insert fine needles into certain

points on the body. From the perspective of East￾ern medicine and TCM, acupuncture influences

the flow of energy (called chi or qi) within the

body. Each of the several thousand acupuncture

points accesses a network of energy channels

called meridians, which are representational rather

than physical structures that roughly follow to the

body’s blood vessels and nerves. Inserting needles

along these meridians releases energy blockages,

restoring the flow and balance of energy and

relieving symptoms. There are acupuncture point

combinations for a broad spectrum of physical and

emotional ailments.

The Western perspective views acupuncture as a

method that stimulates cells to release chemicals

that improve their ability to communicate with

one another (neurotransmitters and HORMONES) or

that naturally relieve pain (endorphins and

enkephalins). Western acupuncturists often com￾bine acupuncture with augmentations such as

electrical or ultrasound stimulation of the

acupuncture needles, which intensifies the effects.

Acupuncture has become popular for pain relief

and to facilitate healing in sports injuries, chronic

health problems, chronic DEPRESSION, ADULT ATTEN￾TION DEFICIT DISORDER (ADD), nausea or vomiting,

substance abuse, and health situations that fail to

respond to conventional approaches.

In 1997 the National Institutes of Health issued

its “Consensus Statement on Acupuncture.” This

statement identified conditions for which clinical

research studies have established acupuncture’s

therapeutic effects. Among them are:

• addiction

• asthma

• carpal tunnel syndrome

• dental pain

• headache

• low back pain

4 ACTH

• nausea following chemotherapy and surgery

• osteoarthritis

• stroke rehabilitation

• tennis elbow

Although acupuncture has been practiced

around the world for 3,000 years or longer, it did

not come to the attention of the Western world

until 1971, when American journalist James

Reston, in China on assignment for The New York

Times, experienced acupuncture anesthesia and

pain relief when he had emergency surgery to

remove his appendix. Today there are an estimated

15,000 licensed acupuncturists practicing in the

United States; about 25 percent of them are also

medical doctors. However, training and experience

requirements vary widely among states, so it is

important to ask about the acupuncturist’s qualifi￾cations.

Ancient acupuncture needles were made of var￾ious substances, from bone to gold. Modern

acupuncture needles are made of surgical steel and

are very fine and flexible; four of them could fit

inside a typical hypodermic needle. They are ster￾ile and disposable, intended for single use to pre￾vent contamination and the spread of infectious

diseases. There is no pain associated with inserting

them, although some people experience a slight

pressure or tingling sensation. Acupuncturists call

this sensation deqi. For many people, relief is

immediate and lasts several days to several weeks

or even months.

See also INTEGRATIVE MEDICINE; HERBAL REMEDIES.

Adam’s apple A protrusion of the thyroid carti￾lage, which forms the front of the larynx (voice

box), that becomes prominent enough during ado￾lescence to form a bulge in a man’s throat. The

Adam’s apple has no known function or purpose.

See also SEXUAL CHARACTERISTICS, SECONDARY.

Addison’s disease An autoimmune disorder

affecting the adrenal cortex in which there is a

deficiency of two hormones the adrenal cortex

produces, cortisol and aldosterone. Cortisol regu￾lates many essential body functions, including con￾version of stored glycogen into glucose (sugar the

body can use for its energy needs), the body’s

inflammatory response, and nutrient metabolism,

particularly in response to events that physically

stress the body, such as infection or injury. Aldos￾terone regulates the body’s electrolyte (salt) and

water balance, which controls BLOOD PRESSURE and

blood volume. Addison’s disease also is called

hypoadrenocorticism or adrenal insufficiency.

Most cases of Addison’s disease develop when

the body’s immune system produces antibodies

that attack adrenal cortex cells, erroneously per￾ceiving them as foreign to the body. This is similar

to the autoimmune process that results in type 1

DIABETES and hypothyroidism, other more com￾mon autoimmune disorders of the ENDOCRINE SYS￾TEM; having one such disorder increases the

likelihood of having another. Tumors, particularly

adrenal ADENOMAS, can also cause Addison’s dis￾ease. A similar condition, secondary adrenal insuf￾ficiency, can develop when the pituitary gland fails

to produce enough ADRENOCORTICOTROPIC HOR￾MONE (ACTH), the hormone that stimulates the

adrenal cortex to produce cortisol. In secondary

adrenal insufficiency, however, aldosterone pro￾duction remains normal.

Addison’s disease develops slowly, unfolding

over months and often years. Symptoms include

fatigue, weakness, chronic nausea, weight loss,

HYPOTENSION (low blood pressure), salt cravings,

irritability, and darkened skin (hyperpigmentation)

that looks like a deep tan. For about half of those

who have it, diagnosis follows an Addisonian crisis

brought on by stress to the body, such as a signifi￾cant injury, infection, or surgery. An Addisonian

crisis is a life-threatening medical emergency that

requires immediate treatment to replace the defi￾cient hormones.

Diagnosis comes with response to an ACTH

challenge, in which ACTH is given by injection to

stimulate cortisol production. When Addison’s dis￾ease is present, the body’s cortisol level remains

unchanged because the adrenal cortex cannot

increase its cortisol production. Treatment is oral

hormone supplementation, taken daily, to help the

body maintain adequate cortisol and aldosterone

levels—hydrocortisone to replace cortisol, and flu￾drocortisone to replace aldosterone. This therapy

can cause characteristic swelling most noticeable in

Addison’s disease 5

the face and neck. Because the body cannot

respond to physiological crisis, people with Addi￾son’s disease must pay close attention to minor ill￾nesses and injuries to avoid dehydration, and

adjust their medication dosages as necessary. Addi￾son’s disease requires close medical monitoring,

including blood tests to measure blood electrolyte

levels.

English physician Thomas Addison first

described the condition that now bears his name in

1855, when he observed the symptoms and con￾nected them to tuberculosis affecting the adrenal

glands.

adrenocorticotropic hormone (ACTH) A HOR￾MONE the pituitary gland secretes that stimulates

the adrenal cortex to produce its hormones: corti￾sol, aldosterone, and ANDROGENS. These hormones

have many essential functions. Cortisol regulates

the body’s response to physiological stress, includ￾ing the conversion of glycogen to glucose in the

liver, interactions with insulin in glucose regula￾tion, and inflammatory reaction (injury and ill￾ness). Aldosterone regulates the body’s electrolyte

(salt) and water balance to control blood pressure

and blood volume. Adrenal androgens contribute

to the transformations of puberty and in the adult

man play a role in bone density and strength. Cir￾culating levels of ACTH in the bloodstream trigger

the hypothalamus, a structure deep within the

brain, which in turn signals the pituitary gland to

release ACTH. The lower the circulating ACTH

level (which can be measured by blood tests), the

stronger the hypothalamic response.

Doctors sometimes administer injections of

ACTH to treat RHEUMATOID ARTHRITIS, ULCERATIVE

COLITIS, and other AUTOIMMUNE DISORDERS that acti￾vate the body’s inflammatory response. In health,

the inflammatory response causes swelling to

protect parts of the body that are injured. In

autoimmune disorders, this response overreacts

and itself causes damage and pain. Suppressing

cortisol release helps to subdue the inflammatory

response.

See also ENDOCRINE SYSTEM.

adenoma A noncancerous tumor that arises

from the epithelium, or surface layer of cells, of

glandular tissue. Adenomas can affect the func￾tions of the glands where they are growing and can

cause diseases such as CUSHING’S SYNDROME (adre￾nal adenoma) and ACROMEGALY (pituitary ade￾noma). Many adenomas do not cause symptoms

and go without detection until an examination

(such as a computed tomography [CT] scan) for

other purposes reveals them. Treatment depends

on the tumor’s location and the effect it is having,

and might include surgery, radiation, or a combi￾nation. Adenomas tend to recur (grow back)

unless treatment (surgery or radiation) completely

eradicates them. It is important to determine

whether the tumor is malignant. An adenoma has

distinctive characteristics that help to make this

determination, although BIOPSY with pathology

examination provides the diagnosis.

See also CANCER; ENDOCRINE SYSTEM.

adult attention deficit disorder (ADD) A chronic

behavioral disorder of inattention and impulsive￾ness. These symptoms make focus, concentration,

and control difficult. Researchers do not know pre￾cisely what causes adult ADD; it likely is a combi￾nation of factors centered on complex biochemical

interactions in the brain that affect the brain’s

functions.

6 adrenocorticotropic hormone

NIMH-DEFINED ADD SYMPTOMS

Inattention Impulsiveness

• becomes easily distracted by irrelevant activity • blurts inappropriate comments

• forgets and loses things • answers before questions are finished

• does not follow instructions • steps in front of others when waiting in line

• makes careless mistakes • disregards rules and procedures

• leaves tasks incomplete • outbursts of anger disproportionate to the situation