1/69. Case study: missed diagnosis and mistreatment of unrecognized comorbid graves disease.Comorbid medical conditions are known to complicate the course and treatment of psychiatric disorders. This case study provides the first published report of graves disease exacerbating the symptoms of Tourette's disorder and attention-deficit hyperactivity disorder (ADHD). The lack of diagnosis of the graves disease compromised the efficacy of the treatment of Tourette's disorder and ADHD. This case study supports the need to the consider increased risk of a second immunoendocrinological disorder in the presence of diabetes mellitus type I, one of the several disorders that comprise the syndrome of polyglandular autoimmune endocrinopathy type II.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/69. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in a patient with Down's syndrome.The prevalence of thyroid disease is increased in Down's syndrome. Compared with adults, thyroid dysfunction in children with Down's syndrome is less frequently reported. Insulin dependent diabetes mellitus is also uncommon in Down's syndrome children. Coexistent insulin dependent diabetes mellitus and hyperthyroidism in Down's syndrome was only reported once previously in literature. We report an 8-year-old girl with Down's syndrome that had polyuria, polydipsia, abdominal pain and urinary incontinence one and half a month prior to admission. physical examination revealed typical face of Mongolism and tachycardia. Thyroid glands were not palpable. Laboratory data revealed diabetic ketoacidosis with plasma glucose: 860 mg/dl. She had thyroid hyperfunction with TSH: < 0.1 microU/ml, T3: 219.7 ng/dl, T4: 15 micrograms/dl. Thyroid autoimmune antibodies were also increased. There was markedly increased radiotracer uptake in the bilateral thyroid glands in Tc-99 thyroid scan. We suggest that Down's syndrome children with insulin dependent diabetes mellitus should be evaluated carefully for thyroid function and autoimmune disease.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
3/69. Ketoacidosis accompanied by epileptic seizures in a patient with diabetes mellitus and mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS).We herein report a rare case of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) and diabetes mellitus with ketoacidosis. An 18-year-old female patient was diagnosed to have diabetes mellitus and insulin therapy was thereafter initiated. At 26 years of age, she was hospitalized for diabetic ketoacidosis, soon followed by a loss of consciousness, left-sided dysmetria, and ataxic speech. MELAS was diagnosed because of the presence of ragged red fibers in a muscle biopsy. At 33 years of age, she was admitted to our hospital because of ketoacidosis and partial status epilepticus. A blood gas examination revealed as follows; arterial pH, 6.88; bicarbonate, 2.1 mmol/l; base excess - 29.8 mmol/l. The serum level of glucose had also increased to 30 mmol/l. The serum levels of lactate and B-hydroxybutyrate were elevated to 11.4 mmol/l and 1,990 micromol/l, respectively. Ketoacidosis improved by fluid replacement and continuous intravenous insulin infusion. A brain MRI demonstrated hyperintensity areas on FLAIR images in the bilateral temporal lobes and the cerebellum. A proton MRS demonstrated the abnormal lactate accumulation in the bilateral temporal and occipital lobes. Since epileptic seizures are rare in patients with diabetic ketoacidosis, such seizures may indicate the existence of melas syndrome.- - - - - - - - - - ranking = 0.26952833905288keywords = lobe (Clic here for more details about this article) |
4/69. Coexistence of common variable immunodeficiency and autoimmune polyglandular syndrome type 2.A six year-old boy with common variable immunodeficiency developed insulin dependent diabetes mellitus, autoimmune thyroiditis, and total alopecia leading to the diagnosis of autoimmune polyglandular syndrome type 2. Previously unreported co-occurence of these two entities may be explained by strong autoimmunity and HLA association of both conditions.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
5/69. Polyserositis as a rare component of polyglandular autoimmune syndrome type II.Polyglandular autoimmune (PGA) syndromes (types I and II) may affect various endocrine and non-endocrine organs in the body. In the commoner PGA type II, primary adrenal insufficiency, autoimmune thyroid disease and type I diabetes mellitus are the most frequent manifestations. serositis with pericardial or pleural involvement is not a well known component of the disease. Here, we report a 21-year-old man who first presented with a pleuropericardial effusion and Graves' disease, and who then developed type I diabetes mellitus.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
6/69. A hard thyroid mass due to plasma cell granuloma.plasma cell granuloma involving the thyroid is very rare. A 29-year-old man with type 1 diabetes mellitus presented with a one-week history of fever, sore throat, neck tenderness and dysphagia. Antibiotics were given but over the next two weeks a hard 8 cm mass in the left lobe of the thyroid developed. Fine needle aspiration was not diagnostic and surgical exploration revealed an inflammatory process arising from the left lobe of the thyroid involving the left sternothyroid muscle and parapharyngeal spaces. histology of multiple biopsies showed plasma cell granuloma. Immunoperoxidase staining demonstrated the presence of IgG, IgM and IgA with predominance of IgG. The residual mass resolved and was impalpable after four weeks. plasma cell granuloma should be suspected when there is a rapidly developing hard thyroid mass. Open biopsy/removal and histological confirmation are mandatory and residual disease may resolve within weeks.- - - - - - - - - - ranking = 0.26952833905288keywords = lobe (Clic here for more details about this article) |
7/69. Schmidt's syndrome in a Saudi family.We present 3 patients from a Saudi family who are presented with polyglandular autoimmune syndrome type 2. They have Addison's disease with either autoimmune thyroid disease or insulin dependent diabetic mellitus. Although this syndrome is rare, the incidence among saudi arabia or the Arab population is not known.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/69. Presacral myelolipoma in a patient with colon carcinoma.myelolipoma is an uncommon benign tumor, composed of an admixture of adipose tissue and hematopoietic cells, usually discovered within the adrenal glands. Extra-adrenal myelolipomas are rare and approximately half of the reported cases were presacral. We report a case of an asymptomatic presacral myelolipoma measuring 9x8x7 cm, incidentally found in a 71-year-old woman with a stenosing colon cancer. ultrasonography, computed tomography and magnetic resonance imaging of the presacral mass evidenced a well circumscribed tumor with heterogeneous features due to a nonuniform composition. Surgical excision of the mass was performed.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
9/69. Familial insulin-resistant diabetes, multiple somatic anomalies, and pineal hyperplasia.West, R. J., Lloyd, J. K., and Turner, W. M. L. (1975). archives of Disease in Childhood, 50, 703. Familial insulin-resistant diabetes, multiple somatic anomalies, and pineal hyperplasia. A syndrome comprising unusual facies, dry skin, acanthosis nigricans, thickened nails, hirsutism, dental precocity and dysplasia, abdominal protuberance, and phallic enlargement is described in 2 sibs. Both have developed diabetic ketoacidosis with insulin resistance. The elder child, a girl, had recurrent septic episodes and died at the age of 7-8 years. At necropsy the pineal gland was hyperplastic, weighing 900 mg. Investigation of the younger sib over a 4-year period has shown decreasing glucose tolerance, and he was frankly diabetic with ketoacidosis by the age of 6-8 years. serum insulin concentrations have always been grossly raised. Though the mechanism for insulin resistance has not been definitely established, a functional abnormality of the hypothalamus or pituitary is postulated to explain the many endocrine features of the syndrome.- - - - - - - - - - ranking = 133.62608398479keywords = pituitary, gland (Clic here for more details about this article) |
10/69. diagnosis of acromegaly in a patient with type 1 diabetes mellitus.OBJECTIVE: To describe a case of acromegaly in a young patient with poorly controlled diabetes mellitus and suggest guidelines to distinguish acromegaly and high growth hormone (GH) levels previously reported in poorly controlled type 1 diabetes. methods: We present a detailed case report, including clinical findings and serial laboratory results in a patient with type 1 diabetes and a GH-secreting pituitary tumor. RESULTS: A 28-year-old woman with type 1 diabetes underwent assessment for secondary amenorrhea and worsening glycemic control. A low estradiol level and an inappropriately low level of follicle-stimulating hormone prompted magnetic resonance imaging of the head, which demonstrated a pituitary adenoma. Subsequent endocrine investigation revealed a high insulin-like growth factor i (IGF-I) level (849 mg/L; normal range, 122 to 400). The concentration of insulin-like growth factor-binding protein-3 (IGFBP-3) was also elevated (5.5 mg/L; normal range, 2.0 to 4.2). GH levels measured during episodes of spontaneous hyperglycemia (>180 mg/dL) were in the range of 3 to 5 ng/mL and failed to suppress to below 2 ng/mL after a bromocriptine suppression test. The patient underwent transsphenoidal resection of a pituitary tumor, which stained positively for GH by immunohistochemistry. Postoperatively, glycemic control improved, with decreased fluctuations of hypoglycemia and hyperglycemia, despite a decrease in insulin requirements. CONCLUSION: This report highlights the difficulty in interpreting GH and IGF-I levels in patients with type 1 diabetes. In addition, a detailed review of the literature suggests that IGFBP-3 measurements may be helpful in confirming the diagnosis of concurrent acromegaly and distinguishing it from high GH levels attributable to poor control of diabetes.- - - - - - - - - - ranking = 397.87825195438keywords = pituitary (Clic here for more details about this article) |
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