1/40. Coexistence of primary endocrine deficiencies: a unique case of male hypergonadism associated with hypoparathyroidism, hypoadrenocorticism, and hypothyroidism.The unique combination of male hypogonadism with hypoparathyroidism, hypoadrenalism, hypothyroidism, diabetes mellitus, and alopecia totalis has been documented in a male patient who has been followed over the past 28 years. In this patient, first seen at the age of six for hypoparathyroidism alone, repeated clinical and laboratory endocrine evaluation detected the sequential development of the additional endocrine deficiencies. The presence of abnormal serum antibodies is consistent with an atuoimmune pathogenesis of this syndrome.- - - - - - - - - - ranking = 1keywords = endocrine (Clic here for more details about this article) |
2/40. adrenal insufficiency masquerading as sepsis in a patient with tetraparesis: a case report.Several endocrine changes have been reported in patients with tetraplegia after spinal cord injury (SCI). These changes should be considered when prescribing medications that influence the endocrine pathways. megestrol acetate has gained acceptance as a way to promote weight gain in cachectic patients without significant adverse effects. We present a case of a 51-year-old man with C5-C6 tetraparesis who was only 67% of his ideal body weight and was placed on megestrol acetate 5 months before admission for a urologic procedure. Postoperatively, the patient had severe hypotension and tachycardia that was interpreted as a septic or cardiac event. Further workup revealed subnormal levels of 8AM cortisol. An adrenocorticotrophic hormone stimulation test demonstrated results consistent with adrenal suppression. hydrocortisone supplementation was started, and 6 months later cortisol levels were within normal limits. cachexia, hypotension, and mild tachycardia are not uncommon in patients with SCI. When severe hypotension and tachycardia are seen in patients with tetraplegia, the diagnosis of adrenal insufficiency should be considered.- - - - - - - - - - ranking = 0.33333333333333keywords = endocrine (Clic here for more details about this article) |
3/40. Thalamic and hypothalamic tumors of childhood: endocrine late effects.Children who have received chemotherapy and radiation therapy for treatment of thalamic/hypothalamic tumors are at risk for late effects, specifically endocrine dysfunction. Evaluation of growth and pubertal development, thyroid function and integrity of the hypothalamic-pituitary-adrenal axis should be undertaken in a prospective manner. Issues of metabolic disturbances such as obesity, altered body composition/bone density as well as ultimate fertility also need to be addressed by ongoing prospective evaluations.- - - - - - - - - - ranking = 0.83333333333333keywords = endocrine (Clic here for more details about this article) |
4/40. adrenal insufficiency in hiv infection: a review and recommendations.adrenal insufficiency is known to be a complication of hiv infection, although estimates of its prevalence and severity vary. adrenal insufficiency is the most serious endocrine complication that occurs in persons with hiv infection. patients with acquired immune deficiency syndrome (AIDS) are considered to be at high risk for primary or secondary adrenal insufficiency. We describe 3 patients with AIDS who had clinical features suggestive of adrenal insufficiency, but their corticotropin (ACTH) stimulation tests were normal. Repeat testing confirmed the diagnosis in one patient, and further testing with the overnight metyrapone test revealed evidence of secondary adrenal insufficiency in the other patients. Persistent clinical improvement was evident on subsequent glucocorticoid therapy. A normal response to the ACTH stimulation test can be dangerously misleading. patients with AIDS and suspected adrenal insufficiency who have normal screening by the ACTH stimulation test should undergo further testing for secondary adrenal disease.- - - - - - - - - - ranking = 0.16666666666667keywords = endocrine (Clic here for more details about this article) |
5/40. hypercalcemia in a patient with tuberculous adrenal insufficiency.OBJECTIVES: To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT: Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION: The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. hyperparathyroidism was ruled out in our patient. adrenal insufficiency should be considered in some patients with hypercalcemia.- - - - - - - - - - ranking = 0.021011413915513keywords = tuberculosis (Clic here for more details about this article) |
6/40. A novel AIRE mutation in an APECED patient with candidiasis, adrenal failure, hepatitis, diabetes mellitus and osteosclerosis.Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disorder, which is characterized by an immune-mediated destruction of endocrine tissues, chronic candidiasis and ectodermal disorders. In contrast to many other autoimmune diseases, APECED is associated with mutations of a single gene, designated autoimmune regulator (AIRE). We describe an APECED patient with severe deformities of the tibia with radiological signs of metaphyseal dysplasia in addition to candidiasis, hepatitis, diabetes mellitus and adrenal failure. In this patient, we identified a novel AIRE mutation in association with the C322fsX372 mutation in exon 8, which is frequently detected in Caucasian patients. The frame shift mutation G263fsX377 in exon 6 results in a protein lacking both PHD zinc-finger domains similar to the R257 X mutation. This novel mutation was not found in 50 German controls.- - - - - - - - - - ranking = 0.16666666666667keywords = endocrine (Clic here for more details about this article) |
7/40. Acute adrenal crisis together with unilateral adrenal mass caused by isolated tuberculosis of adrenal gland.OBJECTIVE: To describe a patient admitted with acute adrenocortical failure and a right adrenal mass without evidence of tuberculosis, who was ultimately diagnosed with isolated adrenal tuberculosis after postoperative histopathologic evaluation. methods: A case report is presented, with clinical, laboratory, and imaging findings. We also discuss potential factors that may complicate the diagnosis of tuberculosis. RESULTS: A 61-year-old man was admitted with symptoms and signs of acute adrenal crisis. The patient had an erythrocyte sedimentation rate of 30 mm in 1 hour, a negative tuberculin skin test, a 6-cm right adrenal mass, and left adrenal nodularity in conjunction with normal findings on a computed tomographic scan of the chest. He recovered dramatically after intravenous corticosteroid treatment. Investigation, including acid-fast staining and cultures for tuberculosis of all available specimens, gastroduodenoscopy and rectosigmoidoscopy, intestinal x-ray imaging, and autoantibody studies, did not disclose the diagnosis. Subsequently, bilateral adrenalectomy revealed isolated tuberculosis of the adrenal glands on histopathologic evaluation. Quadruple antituberculous therapy was initiated, and continued follow-up of the patient is scheduled. CONCLUSION: Our case indicates that acute or chronic adrenocortical failure can occur as a result of tuberculosis of the adrenal gland, despite the absence of clinical and laboratory evidence of tuberculosis.- - - - - - - - - - ranking = 0.11556277653532keywords = tuberculosis (Clic here for more details about this article) |
8/40. Allgrove syndrome--a syndrome of primary adrenocortical insufficiency with achalasia of the cardia and deficient tear production.Primary adrenal insufficiency is an uncommon disease which has worldwide distribution. The commonest cause in underdeveloped countries is tuberculosis followed by autoimmune destruction of the adrenal gland. We report a case of a 15 years boy who had congenital adrenal insufficiency associated with achalasia of the cardia and deficient tear secretion.- - - - - - - - - - ranking = 0.010505706957757keywords = tuberculosis (Clic here for more details about this article) |
9/40. brain tumor presenting as anorexia nervosa in a 19-year-old man.Slow-growing brain tumors can produce disturbances of food intake and endocrine dysfunction. We report a case of slow-growing midline brain tumor in a patient with clinical presentation of anorexia nervosa (AN). A 19-year-old man was referred from a general practitioner to a psychiatric clinic due to illness behavior and psychopathological characteristics of AN. His body weight had decreased from 52 kg to 40 kg within 6 months. Laboratory tests showed hypernatremia (160 mmol/L), adrenal insufficiency (adrenocorticotrophic hormone, 11.4 pg/mL; 8 am cortisol, 1.4 microg/dL; 4 pm cortisol, 11.4 microg/dL) and hypogonadotropic hypogonadism (testosterone < 0.5 ng/mL, follicle-stimulating hormone < 0.1 mIU/mL, luteinizing hormone < 0.7 mIU/mL). brain magnetic resonance imaging showed an extensive mass lesion at suprasellar, hypothalamic region, third ventricle, pineal region, lateral ventricle, and corpus callosum. Owing to central herniation during physical assessment, he died of unknown intracranial pathology. This case suggests that an intracranial tumor near the hypothalamus should be included in the differential diagnosis of AN. Any male adolescent with the clinical impression of AN should receive periodic re-evaluation, including neurological, endocrinological and, if necessary, neuroimaging study.- - - - - - - - - - ranking = 0.16666666666667keywords = endocrine (Clic here for more details about this article) |
10/40. Addisonian crisis and tuberculous epididymo-orchitis.OBJECTIVE: To describe a case of acute primary adrenal insufficiency in which tuberculosis was subsequently detected as the etiologic factor when the patient presented with tuberculous epididymo-orchitis. methods: A case of acute primary adrenal insufficiency associated with bilaterally enlarged adrenal glands is reported, along with the subsequent finding of a scrotal mass diagnosed as tuberculous epididymo-orchitis. diagnosis, adrenal function, and results of imaging studies after institution of antituberculous treatment are discussed. RESULTS: A 41-year-old Egyptian man, who had immigrated to the united states 5 years previously, had acute psychosis and addisonian crisis. A substantially increased early morning level of plasma adrenocorticotropic hormone and a low level of serum cortisol confirmed the diagnosis of primary adrenal insufficiency. Both adrenal glands were enlarged but without calcification on computed tomography. A previous bacille Calmette-Guerin vaccination complicated the interpretation of a positive tuberculin skin test result. Both lungs were clear on chest radiography and computed tomography. Seven months later, the patient had a left scrotal mass and underwent radical orchiectomy. Examination of the pathology specimen showed caseous granulomatous inflammation and necrosis, and acid-fast bacilli were identified. culture was positive for mycobacterium tuberculosis. CONCLUSION: In a patient from a country where tuberculosis is endemic, tuberculosis should be considered in the differential diagnosis when primary adrenal insufficiency is detected, especially in association with enlarged or calcified adrenal glands. Extra-adrenal tuberculous involvement should be actively sought because it may provide indirect microbiologic or histologic clues. Other than the lungs, special attention should be paid to the genitourinary system.- - - - - - - - - - ranking = 0.042022827831027keywords = tuberculosis (Clic here for more details about this article) |
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