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Adrenal crisis

Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey
BACKGROUND: Adrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS. METHODS: In this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month...
2016: Allergy, Asthma, and Clinical Immunology
Yasmin Hakim, Anna Forbes, Momina Khan, Benjamin C Whitelaw
Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed...
2016: Acute Medicine
Xiaojing Wang, Fan Ping, Cuijuan Qi, Xinhua Xiao
BACKGROUND: Autoimmune polyglandular syndrome type 2 (APS-2), also known as Schmidt's syndrome, is an uncommon disorder characterized by the coexistence of Addison's disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Addison's disease as the obligatory component is potentially life-threatening. Unfortunately, the delayed diagnosis of Addison's disease is common owing to its rarity and the nonspecific clinical manifestation. METHODS: Here we reported a case of 38-year-old female patient who presented with 2 years' history of Hashimoto's thyroiditis and received levothyroxine replacement...
October 2016: Medicine (Baltimore)
Chuan Shi, Fen Wang, Anli Tong, Xiao-Qian Zhang, Hong-Mei Song, Zheng-Yin Liu, Wei Lyu, Yue-Hua Liu, Wei-Bo Xia
BACKGROUND: Common variable immunodeficiency (CVID) with central adrenal insufficiency is a recently defined clinical syndrome caused by mutations in the nuclear factor kappa-B subunit 2 (NFKB2) gene. We present the first case of NFKB2 mutation in Asian population. METHODS AND RESULTS: An 18-year-old Chinese female with adrenocorticotropic hormone (ACTH) deficiency was admitted due to adrenal crisis and pneumonia. She had a history of recurrent respiratory infections since childhood and ectodermal abnormalities were noted during physical examination...
October 2016: Medicine (Baltimore)
Thomas Cuny, Marc Klein
No abstract text is available yet for this article.
October 10, 2016: Lancet Diabetes & Endocrinology
Jana Vrbíková
Congenital adrenal hyperplasia is a life-long disease requiring an integrated therapy. It may negatively influence the quality of life. In childhood, the main problems of the care of these patients involve sex determination and ensuring optimum growth and puberty. The therapeutic goals for adults are the prevention of Addisonian crisis and ensuring the best possible quality of life, including fertility.Key words: androgens - cardiovascular risk - congenital adrenal hyperplasia - bone density - testicular rest tumors...
2016: Vnitr̆ní Lékar̆ství
Nobumasa Ohara, Yasuyuki Uemura, Naomi Mezaki, Keita Kimura, Masanori Kaneko, Hirohiko Kuwano, Katsuya Ebe, Toshio Fujita, Takeshi Komeyama, Hiroyuki Usuda, Yuto Yamazaki, Takashi Maekawa, Hironobu Sasano, Kenzo Kaneko, Kyuzi Kamoi
BACKGROUND: Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. Hypertension secondary to pheochromocytoma is often paroxysmal, and patients occasionally present with sudden attacks of alternating hypertension and hypotension. Spontaneous, extensive necrosis within the tumor that is associated with catecholamine crisis is an infrequent complication of adrenal pheochromocytoma, but its pathogenesis remains unclear. CASE PRESENTATION: A 69-year-old Japanese man developed acute-onset episodic headaches, palpitations, and chest pains...
October 12, 2016: Journal of Medical Case Reports
Alexandra Ahmet, Vincent Brienza, Audrey Tran, Julie Lemieux, Mary Aglipay, Nick Barrowman, Ciaran Duffy, Johannes Roth, Roman Jurencak
OBJECTIVE: Adrenal suppression (AS), a glucocorticoid (GC) side effect with potentially significant morbidity, is poorly understood. The purpose of our study was to determine frequency, duration and predictors of AS following a gradual taper of GC in children with rheumatologic conditions. METHODS: Prospective observational cohort study was conducted. All patients ≤16 years ready to discontinue GC after >4weeks of therapy were included. Morning cortisol was tested 4 weeks after GC taper to physiologic doses and then repeatedly until normalization...
October 9, 2016: Arthritis Care & Research
Brande Brown, Levon Agdere, Cornelia Muntean, Karen David
BACKGROUND Allgrove syndrome, or triple "A" syndrome (3A syndrome), is a rare autosomal recessive syndrome with variable phenotype, and an estimated prevalence of 1 per 1,000,000 individuals. Patients usually display the triad of achalasia, alacrima, and adrenocorticotropin (ACTH) insensitive adrenal insufficiency, though the presentation is inconsistent. CASE REPORT Here, the authors report a case of Allgrove syndrome in a pediatric patient with delayed diagnosis in order to raise awareness of this potentially fatal disease as a differential diagnosis of alacrima...
October 4, 2016: American Journal of Case Reports
Giuseppe Damiano Sanna, Giuseppe Talanas, Giuseppina Fiore, Antonella Canu, Pierfranco Terrosu
Pheochromocytoma is a rare neuroendocrine tumor with a highly variable clinical presentation. The serious and potentially lethal cardiovascular complications of these tumors are related to the effects of secreted catecholamines. We describe a case of a 50-year-old woman urgently admitted to our hospital because of symptoms and clinical and instrumental findings consistent with an acute coronary syndrome complicated by acute heart failure. Urgent coronary angiography showed normal coronary arteries. During her hospital stay, the recurrence of episodes characterized by a sudden increase in blood pressure, cold sweating, and nausea allowed us to hypothesize a pheochromocytoma...
October 2016: Journal of the Saudi Heart Association
Alaa Al Nofal, Irina Bancos, Khalid Benkhadra, Naykky Maruquel Singh Ospina, Asma Javed, Ekta Kapoor, Kalpana Muthusamy, Juan P Brito, Adina F Turcu, Zhen Wang, Larry Prokop, Dana Z Erickson, Aida N Lteif, Neena Natt, Mohammad Hassan Murad
INTRODUCTION: Various glucocorticoid regimens have been used in the treatment of patients with adrenal insufficiency, yet the differences between such regimens on health outcomes are unclear. OBJECTIVE: We performed a systematic review and meta-analysis to compare the effect of various glucocorticoid regimens on quality of life, bone density, incidence of adrenal crisis and death. In pediatric studies, we searched for final adult height. METHODS: We searched 6 databases through July 2016...
September 15, 2016: Endocrine Practice
R F Wang, X F Gu, J Ye, L S Han, W J Qiu, H W Zhang, Y G Yu, Z W Gong
OBJECTIVE: To analyze the phenotype-genotype correlation of 21-hydroxylase deficiency (21-OHD) patients found by neonatal screening, and to investigate the characteristics of gene frequency of these patients. METHOD: Clinical and biochemical data of 66 21-OHD patients diagnosed by neonatal screening in department of pediatric endocrinology and genetics and neonatal screening center of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2009 to 2014 were retrospectively analyzed...
September 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Andrew J Hale, Mary LaSalvia, James E Kirby, Allison Kimball, Rachel Baden
Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock...
2016: IDCases
Mridul Dhar, Nimisha Verma, Ram Badan Singh, Vishal Krishna Pai
INTRODUCTION: Allgrove syndrome (AS) is a rare autosomal recessive disorder characterized by achalasia cardia, alacrimia, and adrenocorticotropic hormone-resistant adrenal insufficiency which is sometimes associated with autonomic dysfunction. It has also been referred to as the triple A syndrome in view of the cardinal symptoms described above. First described by Allgrove et al in 1978, the disorder usually presents mostly during the first decade of life. These patients have the threat of adrenal crisis, shock, and hypoglycemia and are usually on steroid supplementation...
September 2016: Journal of Clinical Anesthesia
Toshihiko Yanase
No abstract text is available yet for this article.
April 10, 2016: Nihon Naika Gakkai Zasshi. the Journal of the Japanese Society of Internal Medicine
Tsan Lee, Chirag Kapadia
Acute adrenal insufficiency crisis usually occurs after a prolonged period of nonspecific complaints due to a loss of both glucocorticoids and mineralocorticoids; by the time overt symptoms occur, 90% of the adrenal gland may be destroyed. Patients (such as ours) may present with symptoms such as abdominal pain, weakness, vomiting, fever, and decreased responsiveness.
June 2016: Journal of Family Practice
Min Yang, Hui Ding, Min Cai, Yan-An He, Yu Cai, Yong Zeng, Bo-Le Tian
Pheochromocytoma is primarily derived from the adrenal medulla. The majority of extra-adrenal pheochromocytoma cases occur in the superior para-aortic region and para-adrenal area. However, pheochromocytoma originating from the pancreas is rare. The present study reports the cases of three patients who had no history of hypertension but were post-operatively diagnosed with pheochromocytoma located in the pancreas. Of the three patients, two were admitted to hospital due to abdominal pain, and imaging examinations revealed a soft-tissue lesion in the head of pancreas...
August 2016: Oncology Letters
Amr El Kouny, Mohammed Al Harbi, Rashid Muhammad Arif, Nazar Ilyas, El Abbasy Omar Hamed, Maqsood Memon, Ali Nawaz, Vassilios Dimitriou
A 52 yearold female presented with a thoracic paravertebral tumour causing spinal nerve root compression and lower limbs neurologic symptoms. The patient was scheduled to undergo thoracic decompression laminectomy and instrumentation. Markedly severe hemodynamic fluctuations happened during the manipulation of the tumor and continued after the tumor was removed. After multimodal antihypertensive therapy the vital signs were adequately managed and the surgery was successfully performed without complications...
February 2016: Middle East Journal of Anesthesiology
Mary B Abraham, Vinutha B Shetty, Fiona McKenzie, Jacqueline Curran
BACKGROUND: The etiology of primary adrenal insufficiency has implications for further management of the condition. CASE CHARACTERISTICS: A 5-year-old boy presented in adrenal crisis with glucocorticoid and mineralocorticoid deficiency. OBSERVATION: Investigations confirmed primary adrenal insufficiency and ruled out the common etiologies. Genetic testing identified a novel NR0B1/DAX gene mutation. MESSAGE: A genetic diagnosis in children with primary adrenal insufficiency is useful to provide genetic counselling...
June 8, 2016: Indian Pediatrics
Toshihiko Yanase, Toshihiro Tajima, Takuyuki Katabami, Yasumasa Iwasaki, Yusuke Tanahashi, Akira Sugawara, Tomonobu Hasegawa, Tomoatsu Mune, Yutaka Oki, Yuichi Nakagawa, Nobuhiro Miyamura, Chikara Shimizu, Michio Otsuki, Masatoshi Nomura, Yuko Akehi, Makito Tanabe, Soji Kasayama
This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 μg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test...
June 24, 2016: Endocrine Journal
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