- Adrenal Insufficiency in a Patient with Acute Myocardial Infarction Plus Shock. [Case Reports]
- KCKorean Circ J 2018; 48(12):1163-1164
- Subclinical hypothyroidism or central hypothyroidism-The danger of thyroid function misinterpretation. [Journal Article]
- CCClin Case Rep 2018; 6(10):1953-1957
- Correct interpretation of thyroid function tests is critical to providing appropriate care to patients with suspected thyroid disease. It is particularly important to distinguish central hypothyroidi...
Correct interpretation of thyroid function tests is critical to providing appropriate care to patients with suspected thyroid disease. It is particularly important to distinguish central hypothyroidism from other types due to the potential of concurrent secondary adrenal insufficiency and thus the need for immediate steroid replacement prior to commencing thyroxine.
- Comprehensive Management Considerations of Select Noncardiac Organ Systems in the Cardiac Intensive Care Unit. [Review]
- WJWorld J Pediatr Congenit Heart Surg 2018; 9(6):685-695
- As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems ma...
As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems may affect clinical outcomes in the cardiac intensive care unit and must be recognized and managed. The Pediatric Cardiac Intensive Care Society sought to provide an expert review of some of the most common challenges of the respiratory, gastrointestinal, hematological, renal, and endocrine systems in pediatric cardiac patients. This review provides a brief overview of literature available and common practices.
- Delayed hypopituitarism following Russell's viper envenomation: a case series and literature review. [Review]
- PPituitary 2018 Oct 13
- CONCLUSIONS: DHP is an important complication of RVE, and a delay in its diagnosis is associated with significant morbidity. Patients with RVE should be followed up for a long term to identify DHP.
- Acute Kidney Injury after Pembrolizumab-Induced Adrenalitis and Adrenal Insufficiency. [Journal Article]
- CRCase Rep Nephrol Dial 2018 May-Aug; 8(2):171-177
- Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death protein 1 (PD-1) antigen and induces an immune response against tumor tissues. It has been successful in inducin...
Pembrolizumab is an immune checkpoint inhibitor that targets the programmed cell death protein 1 (PD-1) antigen and induces an immune response against tumor tissues. It has been successful in inducing remission in patients with severe metastatic disease, often refractory to other chemotherapeutic agents. The risk of injury of other organ systems has been noted with reported cases of glomerular disease and endocrine disease. In addition, hypophysitis as well as dermatological and gastroenterological side effects have been reported. Renal injury with immune checkpoint inhibitors like nivolumab and pembrolizumab is usually mediated via interstitial nephritis, though glomerular disease presentations like anti-neutrophil cytoplasmic antibody-associated vasculitis, immune complex disease, and thrombotic microangiopathy have also been reported. We report a 70-year-old Caucasian male who underwent treatment with pembrolizumab for adenocarcinoma of the lung. He developed acute adrenal insufficiency and concomitant severe hypotension upon presentation. He did not require renal replacement therapy, rather his severe acute kidney injury resolved with hydration, normalization of blood pressures with vasopressors, and treatment with high-dose corticosteroids. His urinary indices (fractional excretion of urea, FEUrea) and clinical course were highly suspicious for acute tubular necrosis that resolved quickly after treating his underlying adrenalitis. The urinary sediment, proteinuria, and clinical course were not typical for the usually expected renal lesion of interstitial nephritis in patients treated with immune checkpoint inhibitors.
- Acute adrenal insufficiency due to adrenal hemorrhage complicating colorectal surgery: Report of two cases and correlation with the antiphospholipid antibody syndrome. [Journal Article]
- IJInt J Surg Case Rep 2018; 51:90-94
- CONCLUSIONS: Antiphospholipid syndrome is an acquired thrombophilia caused by circulating antibodies against a heterologous group of phospholipids. Recent literature has identified a causative relation between APS and primary adrenal insufficiency (AI), identifying it as its most common endocrine manifestation. Surgeries along with inflammation or hormones have been identified as precipitating factors. Spontaneous haemorrhagic infarction of the adrenal glands has been observed in patients with APS in the postoperative period during anticoagulant treatment. Signs and symptoms are non-specific and are easily confused with those of the underlying condition.Early recognition and prompt treatment of adrenal insufficiency due to APS in surgical patient is of vital importance. Patients correctly diagnosed and treated that survive the critical phase have a better prognosis regarding restoration of adrenal function.
- [Diagnosis and Management of Adrenal Insufficiency]. [Review]
- DMDtsch Med Wochenschr 2018; 143(17):1242-1249
- Adrenal insufficiency is a potentially life-threatening endocrine disorder. Therefor it is very important to detect the symptoms in sufficient time and treat effectively to avoyed acute renal insuffi...
Adrenal insufficiency is a potentially life-threatening endocrine disorder. Therefor it is very important to detect the symptoms in sufficient time and treat effectively to avoyed acute renal insufficiency. This article provides an insight into diagnostically procedures and therapeutically specific aspects of this rare endocrine disease.
- A case of subacute combined degeneration of the spinal cord due to folic acid and copper deficiency. [Journal Article]
- BDBrain Dev 2018 Aug 10
- Subacute combined degeneration of the spinal cord (SACD) is a rare neurologic disorder manifesting progressive symptoms of paresthesia and spastic paralysis. Herein we present an autopsy case of SACD...
Subacute combined degeneration of the spinal cord (SACD) is a rare neurologic disorder manifesting progressive symptoms of paresthesia and spastic paralysis. Herein we present an autopsy case of SACD caused by folic acid and copper deficiency. A 16-year-old male presented with gradually worsening unsteady gait, and bladder and rectal dysfunction. He had a medical history of T-cell acute lymphoblastic leukemia (T-ALL), diagnosed 1.5 years previously. The patient had undergone chemotherapy, including methotrexate, as well as allogeneic bone mallow transplantation. Laboratory tests revealed normal vitamin B12 and methylmalonic acid concentration, but reduced serum copper, ceruloplasmin and folic acid concentrations. Magnetic resonance imaging revealed symmetrical T2 signal hyperintensities in the posterior and lateral spinal cord. The patient was treated with oral copper, oral folate, and intravenous vitamin B12. A month after this treatment, the patient's symptoms were unchanged, and 2 months later he died of acute adrenal insufficiency. The pathological findings of the spinal cord were compatible with SACD. Because SACD is usually reversible with early treatment, it should be suspected in high-risk patients undergoing chemotherapy or those who are malnourished with characteristic symptoms of SACD, even in young patients.
- Hyponatremia in kidney transplant patients: its pathophysiologic mechanisms. [Journal Article]
- CKClin Kidney J 2018; 11(4):581-585
- Kidney transplant patients (KTPs), and particularly those with advanced chronic kidney rejection, may be affected by opportunistic infections, metabolic alterations and vascular and oncologic disease...
Kidney transplant patients (KTPs), and particularly those with advanced chronic kidney rejection, may be affected by opportunistic infections, metabolic alterations and vascular and oncologic diseases that promote clinical conditions that require a variety of treatments, the combinations of which may predispose them to hyponatremia. Salt and water imbalance can induce abnormalities in volemia and/or serum sodium depending on the nature of this alteration (increase or decrease), its absolute magnitude (mild or severe) and its relative magnitude (body sodium:water ratio). Hyponatremia appears when the body sodium:water ratio is reduced due to an increase in body water or a reduction in body sodium. Additionally, hyponatremia is classified as normotonic, hypertonic and hypotonic and while hypotonic hyponatremia is classified in hyponatremia with normal, high or low extracellular fluid. The main causes of hyponatremia in KTPs are hypotonic hyponatremia secondary to water and salt contraction with oral hydration (gastroenteritis, sepsis), free water retention (severe renal failure, syndrome of inappropriate antidiuretic hormone release, hypothyroidism), chronic hypokalemia (rapamycin, malnutrition), sodium loss (tubular dysfunction secondary to nephrocalcinosis, acute tubular necrosis, tubulitis/rejection, interstitial nephritis, adrenal insufficiency, aldosterone resistance, pancreatic drainage, kidney-pancreas transplant) and hyponatremia induced by medication (opioids, cyclophosphamide, psychoactive, potent diuretics and calcineurinic inhibitors). In conclusion, KTPs are predisposed to develop hyponatremia since they are exposed to immunologic, infectious, pharmacologic and oncologic disorders, the combinations of which alter their salt and water homeostatic capacity.
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- Variations in the management of acute illness in children with congenital adrenal hyperplasia: An audit of three paediatric hospitals. [Journal Article]
- CEClin Endocrinol (Oxf) 2018; 89(5):577-585
- CONCLUSIONS: Prehospital and in-hospital management of children with CAH can vary between health services. Children under 12 months have lower levels of stress dosing prior to hospital than other age groups. Experience with acute episodes improves self-management of CAH in the context of acute illness in educated patient populations.