- Acute Spontaneous Bilateral Adrenal Hemorrhage Presenting as Hyponatremia. [Case Reports]
- Bilateral adrenal hemorrhage is a very unusual cause of severe adrenal insufficiency and hyponatremia. It can result from trauma, infections, or antiphospholipid antibody syndrome and can be fatal if not diagnosed and treated early. Here, we present a 58-year-old Caucasian man with fatigue, altered sensorium, bradycardia, and hypotension. He denied any abdominal pain, recent trauma, or anti-plate…
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- Akutt binyrebarksvikt hos et barn. [Case Reports]Tidsskr Nor Laegeforen. 2023 Jan 31; 143(2)TN
- CONCLUSIONS: Acute adrenal crisis is a rare primary presentation of adrenal insufficiency, especially in the paediatric population. It is an important differential diagnosis of shock and has high morbidity and mortality.
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- COVID-19-related Adrenal Haemorrhage: Multicentre UK Experience and Systematic Review of the Literature. [Journal Article]Clin Endocrinol (Oxf). 2023 Jan 29 [Online ahead of print]CE
- CONCLUSIONS: Adrenal haemorrhage with consequential adrenal insufficiency can be a complication of COVID-19 infection and vaccination. Adrenal function assessment is mandatory to avoid the potentially fatal consequences of unrecognised adrenal insufficiency. This article is protected by copyright. All rights reserved.
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- The essentials of acute oncology. [Journal Article]Clin Med (Lond). 2023 Jan; 23(1):45-51.CM
- The general medical physician will often encounter patients who develop acute complications of their cancer diagnosis or anti-cancer treatment. Here we provide an overview of emergency solid tumour oncology to guide the initial management of these patients.
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- Immune checkpoint inhibitor-mediated hypophysitis: no place like home. [Journal Article]Clin Med (Lond). 2023 Jan; 23(1):81-84.CM
- Ambulatory emergency care forms a fundamental part of the strategy of trying to ensure safe and sustainable acute care services. Immune checkpoint inhibitor(ICI)-mediated hypophysitis is an important life-threatening complication of therapy. Patients presenting with clinical features and findings consistent with ICI-mediated hypophysitis were considered in the current study. In the absence of sev…
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- Life-Threatening Hypotension in a Brain-Injured, Multi-Trauma Patient With Unilateral Adrenal Gland Damage: How a Single Hydrocortisone Dose Revealed Relative Corticosteroid Insufficiency. [Case Reports]
- We report a case of a multi-trauma, brain-injured young patient with unilateral adrenal gland injury presenting with refractory shock. Acute adrenal insufficiency was revealed after an abrupt hemodynamic response to a corticosteroid; the resistant shock was quickly resolved with IV hydrocortisone. Although available data do not support the use of empiric steroids in trauma patients (with or witho…
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- A PROSPECTIVE ANALYSIS OF THE METYRAPONE SHORT TEST USING TARGETED AND UNTARGETED METABOLOMICS. [Journal Article]Neuroendocrinology. 2023 Jan 16 [Online ahead of print]N
- Introduction The present study aimed to prove the metyrapone short test in a day clinic to be suitable for examining the integrity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with suspected secondary and tertiary adrenal insufficiency and to identify novel effector molecules in acute stress response. Methods 44 patients were prospectively enrolled. Based on stimulated 11-deoxycor…
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- A case of shock after STEMI: Think beyond the cardiogenic one. [Case Reports]
- Acute ST-segment elevation myocardial infarction (STEMI) can typically complicate with the development of cardiogenic shock; nevertheless, other less frequent types of shock may occur, including adrenal crisis (AC). We describe a case of STEMI complicated by AC and, for the first time, AC-induced focal takotsubo syndrome.
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- The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study. [Journal Article]
- CONCLUSIONS: P/C ratio might be a potential prognostic predictor in septic patients with abdominal sources.
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- Acute paracoccidioidomycosis worsened by immunosuppressive therapy due to a misdiagnosis of Crohn's disease. [Case Reports]
- Paracoccidioidomycosis (PCM) is a systemic mycosis endemic in Latin America, mostly in Brazil. The involvement of the gastrointestinal tract is uncommon and usually associated with the acute form. Recently, a cluster of acute PCM cases has been described in Rio de Janeiro, Brazil. We report a 42-year-old male, resident of Rio de Janeiro, presenting chronic diarrhea and abdominal pain in the past …
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- Etiology, clinical characteristics and mortality among Indian patients with Addison's disease. [Journal Article]Endocr Connect. 2023 Jan 01 [Online ahead of print]EC
- The etiology, presentation and mortality of patients with primary adrenal insufficiency (PAI) in developing countries may differ from economically developed nations. However, information in this regard is scanty. The aim of this study was to determine the etiology and compare the clinical characteristics and mortality in infectious and autoimmune causes of PAI in Indian patients. All eligible (n=…
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- Post-COVID-19 syndrome increased the requirement for corticosteroids in a dialysis patient with preexisting adrenal insufficiency. [Journal Article]
- A 77-year-old male patient on maintenance hemodialysis therapy who underwent unilateral adrenonephrectomy 9 years ago was transferred to our hospital after 4 months of acute treatment for skull base osteomyelitis. He presented with unexplained hypotension during dialysis sessions. Further evaluation led to a diagnosis of primary adrenal insufficiency, followed by the start of oral hydrocortisone.…
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- Newly diagnosed autoimmune Addison's disease in a patient with COVID-19 with autoimmune disseminated encephalomyelitis. [Case Reports]
- A man in his 20s with a history of acute disseminated encephalomyelitis (ADEM) was brought into the emergency department (ED) after his family found him at home collapsed on the floor unresponsive with a blood glucose of 28 mg/dL at the field. In the ED, the patient was tachycardic, tachypnoeic and hypotensive, requiring pressors and intubation at 9 hours and 12 hours after arrival, respectively.…
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- Electrolyte abnormalities and stress dosing predict illness-related hospitalizations among infants and toddlers with congenital adrenal hyperplasia. [Journal Article]Clin Endocrinol (Oxf). 2023 Jan 02 [Online ahead of print]CE
- CONCLUSIONS: Infants and toddlers with classical CAH are at high risk for acute illness and hospitalizations and often do not receive adequate stress dosing before the ED.
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- The Role of Apoptosis and Autophagy in the Hypothalamic-Pituitary-Adrenal (HPA) Axis after Traumatic Brain Injury (TBI). [Journal Article]
- Traumatic brain injury (TBI) is a major health problem affecting millions of people worldwide and leading to death or permanent damage. TBI affects the hypothalamic-pituitary-adrenal (HPA) axis either by primary injury to the hypothalamic-hypophyseal region or by secondary vascular damage, brain, and/or pituitary edema, vasospasm, and inflammation. Neuroendocrine dysfunctions after TBI have been …
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- Clinical characteristics of adrenal insufficiency induced by pembrolizumab in non-small-cell lung cancer. [Journal Article]Thorac Cancer. 2022 Dec 15 [Online ahead of print]TC
- CONCLUSIONS: The incidence of AI among patients treated with pembrolizumab is more frequent than previously reported. In addition, secondary AI, especially isolated ACTH deficiency, is a major form of AI induced by pembrolizumab.
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- Seizure from water intoxication following bowel preparation: a case report. [Case Reports]
- CONCLUSIONS: In addition to the use of certain well-documented medications and the presence of comorbidities that can lead to hyponatremia, clinicians should also be aware of the use of desmopressin as an important risk factor. Thorough history taking can guide individualized bowel preparation regimens to minimize the risk of undesired complications.
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- Autoimmune polyendocrine syndrome II presenting paradoxically as Takotsubo cardiomyopathy: a case report and reappraisal of pathophysiology. [Journal Article]
- CONCLUSIONS: Intricate relationship and interplay exist between the steroid hormones and catecholamines in the pathogenesis of TCM. Steroid hormones not only potentiate the actions of catecholamines, but they also regulate and channelize catecholaminergic actions preventing their deleterious effects on the cardiac tissue. Hence, both steroid deficiency and exogenous steroid replacement may precipitate TCM. Evidence from more such cases and larger perspective studies in future will further improve our understanding of this complex disease process and its myriad associations.
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- Pituitary apoplexy and COVID-19 vaccination: a case report and literature review. [Case Reports]
- A 50-year-old man was admitted to our hospital for vomit, nausea, diplopia, and headache resistant to analgesic drugs. Symptoms started the day after his third COVID-19 mRNA vaccine (Moderna) whereas SARS-CoV-2 nasal swab was negative. Pituitary MRI showed recent bleeding in macroadenoma, consistent with pituitary apoplexy. Adverse Drug Reaction was reported to AIFA (Italian Medicines Agency).A s…
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- Case report: Hypoadrenocorticism crisis complicated by non-cardiogenic pulmonary edema in a dog. [Case Reports]
- A 6-year-old castrated male Labradoodle was referred in uncompensated hypovolemic shock, with a 72-h history of lethargy, vomiting and diarrhea that had acutely worsened with subsequent development of profuse hemorrhagic diarrhea in the last 24 h after a visit to the groomer. In most respects this case was classic for a patient with a primary hypoadrenocortical crisis. After initial attempts to a…
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- Clinical characteristics of a male child with non-classic lipoid congenital adrenal hyperplasia and literature review. [Case Reports]
- CONCLUSIONS: The clinical phenotypes of non-classic LCAH are highly variable. Routine physical examination, laboratory measurement, genetic testing, and, importantly, enzymatic activity assay may facilitate the early diagnosis of non-classic LCAH. The age of primary adrenal insufficiency (PAI) onset may not be a diagnostic basis for non-classic LCAH, and enzymatic activity assay determination may be more effective.
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- Approach to the Patient with Adrenal Hemorrhage. [Journal Article]J Clin Endocrinol Metab. 2022 Nov 21 [Online ahead of print]JC
- Adrenal hemorrhage is an uncommon underrecognized condition that can be encountered in several clinical contexts. Diagnosing adrenal hemorrhage is challenging due to the non-specific clinical features. Therefore, it remains a diagnosis that is made serendipitously on imaging of acutely unwell patients rather than with prospective clinical suspicion. Adrenal hemorrhage can follow abdominal trauma …
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- Severe COVID-19 with persistent respiratory failure-A retrospective cohort study in a tertiary centre in Malaysia. [Journal Article]
- CONCLUSIONS: Almost half of the patients with severe COVID-19 had PRF, with a predominant radiological OP pattern. More than two-thirds of the PRF patients required prolonged oral corticosteroid treatment. Familiarising clinicians with the disease course, radiological patterns, and potential outcomes of this group of patients may better equip them to manage their patients.
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- StatPearls: Adrenal Hemorrhage [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Adrenal hemorrhage is an uncommon disorder characterized by bleeding into the suprarenal glands. The hematoma may be unilateral or bilateral, and the clinical presentation can range from nonspecific abdominal pain to catastrophic cardiovascular collapse. The etiologies for this unusual disorder are diverse. Potential causes include blunt abdominal trauma, septicemia, coagulopathies, anti-coagulan…
- Side-chain cleavage enzyme deficiency: Systematic review and case series. [Journal Article]Clin Endocrinol (Oxf). 2022 Nov 10 [Online ahead of print]CE
- CONCLUSIONS: SCCD-TMG is associated with four specific genotypes and distinct gonadal characteristics from SCCD-AG with overlapping features of PAI.
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- Endotext: Adrenal Insufficiency [BOOK]Endotext. MDText.com, Inc.: South Dartmouth (MA)BOOK
- Adrenal insufficiency is a serious pathologic condition characterized by decreased production or action of glucocorticoids and/or mineralocorticoids and adrenal androgens. This life-threatening disorder may be classified as primary, secondary or tertiary, resulting from diseases affecting the adrenal cortex, the anterior pituitary gland or the hypothalamus, respectively. The clinical manifestatio…
- StatPearls: Adrenal Insufficiency (Nursing) [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Adrenal insufficiency ranges from mild nonspecific symptoms to life-threatening shock condition. Adrenal insufficiency is a diagnosis that will not be made unless the clinician maintains a level of suspicion. The decreasing or suppressed adrenal function may be masked until stress or illness triggers an adrenal crisis.[1][2][3] An important distinction in these patients is the presence of mineral…
- StatPearls: Adrenal Insufficiency [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- The adrenal gland is made up of two parts, the cortex and the medulla. The adrenal cortex produces hormones necessary for normal body functioning; deficiency of these hormones results in adrenal insufficiency. The cortex is responsible for producing glucocorticoids, mineralocorticoids, and androgens. Destruction or dysfunction of the adrenal cortex mainly causes glucocorticoid and mineralocortico…
- Recurrence of Hypophysitis After Immune Checkpoint Inhibitor Rechallenge. [Case Reports]
- Immune checkpoint inhibitor (ICI)-induced hypophysitis is an immune-mediated pituitary inflammation that tends to cause long-term pituitary deficiency. Management of ICI-induced hypophysitis includes corticosteroids for acute inflammation and long-term hormone replacement due to irreversible pituitary cell damage. We report a case of recurrent hypophysitis following ICI rechallenge for metastatic…
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