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Neuropharmacology 2021 Jun 4:108632. Epub 2021 Jun 4.

Departamento de Farmacología y Terapéutica, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Ramón y Cajal de Investigación Biosanitaria (IRYCIS), Madrid, Spain. Electronic address:

Cardiovascular side effects of varenicline and a case report of a hypertensive crisis in a varenicline-prescribed patient with pheochromocytoma have been reported. The goal of the present study was to determine whether such side effects might derive, in part, from increased exocytosis of secretory vesicles and subsequent catecholamine release triggered by varenicline in human chromaffin cells of the adrenal gland. In this study, we performed electrophysiological plasma membrane capacitance and carbon fiber amperometry experiments to evaluate the effect of varenicline on exocytosis and catecholamine release, respectively, at concentrations reached during varenicline therapy (100 nM). Read More

Crit Care Nurse 2021 Jun;41(3):25-32

Josh Eckroth is a bedside and charge nurse in the mixed ICU, Asante Rogue Regional Medical Center.

Introduction: Known as the "great mimic," pheochromocytoma is rare and difficult to diagnose. When a pheochromocytoma begins to cause end-organ damage, it becomes pheochromocytoma multisystem crisis, an even more rare and deadly diagnosis.

Clinical Findings: N. Read More

BMJ Case Rep 2021 May 27;14(5). Epub 2021 May 27.

Department of Oncology, Oslo University Hospital, Oslo, Norway.

Treatment with immune checkpoint inhibitors (ICI) has drastically improved the prognosis for melanoma patients, but immune-mediated adverse events can occur in any organ, including the pituitary. In ICI-induced hypophysitis, lymphocytic infiltration and hypersensitivity reactions cause headache and pituitary deficiency. Most cases with ICI-induced hypophysitis develop central adrenal insufficiency. Read More

Glob Pediatr Health 2021 12;8:2333794X211015484. Epub 2021 May 12.

Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Secondary hypertension in children, to the rare extent, can be caused by endocrine factors such as pheochromocytoma, an adrenal tumor that secretes catecholamine. Only a few cases have been reported in the past 3 decades. To the best of our knowledge, this is the first case report of pediatric pheochromocytoma from Indonesia. Read More

Med Sci (Paris) 2021 May 18;37(5):500-506. Epub 2021 May 18.

Service d'endocrinologie, diabétologie, gynécologie pédiatriques, Hôpital universitaire Necker-Enfants malades, AP-HP-Centre, 149 rue de Sèvres, 75015 Paris, France. - Centre régional de dépistage néonatal - Île-de-France, AP-HP, 149 rue de Sèvres, 75015 Paris, France. - Université de Paris, Paris, France.

Congenital Adrenal Hyperplasia (CAH) is a genetic disorder, mostly (95%) due to CYP21A2 mutations. Its incidence in France is 1/15,000 to 1/16,000 births. The screening of newborns in France is effective since 1996, by using a 17-hydroxyprogesterone dosage on a dried blood spot. Read More

Cureus 2021 Apr 11;13(4):e14420. Epub 2021 Apr 11.

Cardiology, Maimonides Medical Center, New York, USA.

We report a case of a 36-year-old male who presented to the emergency department with complaints of weakness. On presentation the patient was hypotensive, hyperkalemic, and hyponatremic. The patient experienced a sudden cardiac arrest in the computed tomography (CT) scanner moments after arrival. Read More

Clin Endocrinol (Oxf) 2021 May 15. Epub 2021 May 15.

Department of Endocrinology, South Shore University Hospital, Bay Shore, New York, USA.

Objective: The aim of this study was to describe rates and characteristics of non-elective 30-day readmission among patients hospitalized for adrenal insufficiency and to assess predictors of readmission.

Design: We analysed the 2018 National Readmission Database. Adrenal insufficiency hospitalizations were identified using the International Classification of Diseases, Tenth Revisions, Clinical Modification diagnosis codes for principal diagnostic codes of primary adrenal insufficiency, Addisonian crisis, drug-induced adrenocortical insufficiency, and other and unspecified adrenocortical insufficiency. Read More

J Med Case Rep 2021 May 8;15(1):229. Epub 2021 May 8.

Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.

Background: Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis.

Case Presentation: We describe the case of a 45-year-old Ethiopian woman who presented with generalized fatigue for 18 years which progressed to anorexia, nausea, vomiting, diarrhea, and abdominal pain of 6 years' duration, for which she was treated symptomatically throughout these years. Read More

Am J Case Rep 2021 May 5;22:e930908. Epub 2021 May 5.

Internal Medicine, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.

BACKGROUND Sheehan syndrome (pituitary necrosis after postpartum hemorrhage) can present in various ways, depending on the hormones that are deficient. There may be a long delay to diagnosis of over a decade because symptoms are often vague and pituitary dysfunction progresses gradually. We describe a case of a patient with acute presentation of Sheehan syndrome 7 years after the obstetric event and with no clear precipitating event. Read More

Tidsskr Nor Laegeforen 2021 05 27;141(7). Epub 2021 Apr 27.

Background: Pheochromocytoma is referred to as 'the great mimic' with a broad spectrum of presenting symptoms. In the following case, the diagnosis had an unusual presentation as a medical emergency - pheochromocytoma crisis.

Case Presentation: A previously healthy woman in her fifties was admitted due to abdominal pain and dyspnoea. Read More

Endocrinol Metab (Seoul) 2021 Apr 27;36(2):312-321. Epub 2021 Apr 27.

Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Immune-related adverse events (irAEs) affecting the endocrine glands are among the most frequent irAEs induced by immune checkpoint inhibitors (ICIs) and include hypopituitarism, primary adrenal insufficiency, thyrotoxicosis, hypothyroidism, hypoparathyroidism, and type 1 diabetes mellitus. Since the incidence and clinical features of endocrine irAEs vary according to the ICI used, it is important to understand the characteristics of these irAEs and to manage each one appropriately. Since some endocrine irAEs, including adrenal crisis and diabetic ketoacidosis, are potentially life-threatening, predicting the risk of endocrine irAEs before their onset is critical. Read More

Endocrinol Diabetes Metab 2021 04 2;4(2):e00205. Epub 2020 Dec 2.

Endocrine and Metabolic Unit Royal Adelaide Hospital and University of Adelaide Adelaide SA Australia.

Objective: To determine whether adrenal crisis (AC) identification may be affected by the definition of hypotension.

Context: Delays in AC diagnosis can result in adverse outcomes. AC-related cardiovascular compromise may vary according to baseline blood pressure and may be associated with delayed AC detection in some patients. Read More

Surg Endosc 2021 Apr 12. Epub 2021 Apr 12.

Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.

Background: Laparoscopic adrenalectomy (LA) is the gold standard treatment for unilateral primary aldosteronism. However, satisfactory results have also been published with radiofrequency ablation (RFA). The aim of this study was to compare LA and RFA for the treatment of primary aldosteronism. Read More

Cureus 2021 Mar 3;13(3):e13683. Epub 2021 Mar 3.

Emergency Medicine, San Antonio Military Medical Center, San Antonio, USA.

Pheochromocytoma is a rare, often undiagnosed adrenal tumor that typically presents in early adulthood and is characterized by intermittent surges of catecholamines. While this "Great Mimic" may present with a variety of vague complaints such as headache, abdominal pain, or palpitations, it may also appear as a severely hypertensive patient with multi-organ failure and cardiopulmonary collapse known as pheochromocytoma crisis. Management of hypertensive emergency in these patients is unique, and the associated metabolic derangements, coagulopathy, thromboembolic events, and risk of adrenal capsule rupture add significant complexity, morbidity, and mortality to these cases. Read More

Am J Forensic Med Pathol 2021 Apr 7. Epub 2021 Apr 7.

From the Department of Pathology, State University of New York, Syracuse, NY.

Abstract: Adrenal crisis is a life-threatening manifestation of acute adrenal insufficiency. One of the most important underlying causes is Addison disease (primary adrenal insufficiency).A 42-year-old White woman with a medical history of Addison disease on chronic steroid therapy was admitted to the emergency department due to sustained episodes of cardiopulmonary arrest. Read More

J Clin Res Pediatr Endocrinol 2021 Apr 8. Epub 2021 Apr 8.

Pediatric Endocrinologist at Pediatric endocrine department,. Obesity, Endocrine, and Metabolism Center, , King Fahad Medical City, Riyadh, Saudi Arabia.

Pseudohypoaldosteronism type 1 (PHA1) is an autosomal-recessive disorder characterized by defective regulation of body sodium levels. The abnormality results from mutations in the gene-encoding subunits of the epithelial sodium channel (ENaC). Patients with PHA1 present in infancy as being in adrenal crisis. Read More

Front Psychol 2021 18;12:621853. Epub 2021 Mar 18.

Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. Read More

Case Rep Cardiol 2021 18;2021:8848893. Epub 2021 Mar 18.

Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.

Cardiogenic shock during a pheochromocytoma crisis is a life-threatening disorder. This case report illustrates a 49-year-old male with profound cardiogenic shock, extreme hemodynamic instability (systolic blood pressure ranging from 45 up to 290 mmHg in a cyclic pattern), and progressive multiple organ failure in the presence of a unilateral adrenal mass. Emergency adrenalectomy led to rapid hemodynamic stabilization. Read More

J Investig Med High Impact Case Rep 2021 Jan-Dec;9:2324709621999956

University of Alabama at Birmingham, AL, USA.

Slipped capital femoral epiphysis (SCFE) commonly occurs in overweight or obese adolescents, but can also be associated with endocrine disorders including hypothyroidism, pituitary tumors, and growth hormone deficiency. In this article, we present a case of panhypopituitarism that initially presented with SCFE. A 16-year-old male presented with right SCFE. Read More

J Pediatr Adolesc Gynecol 2021 Mar 26. Epub 2021 Mar 26.

Department of Thoracic Surgery, Capital Institute of Pediatrics, Beijing, China.

Background: Adrenocortical carcinoma is a rare, isolated malignancy.

Case: A 13-year-old girl presented with secondary amenorrhea, hirsutism, and hypertension. Her clinical manifestations were interpreted as polycystic ovary syndrome and hyperinsulinemia. Read More

Rev Endocr Metab Disord 2021 Jun 26;22(2):179-204. Epub 2021 Mar 26.

Department of Endocrinology, Yeditepe University, Medical School, Istanbul, Turkey.

The hypothalamo-pituitary-adrenal (HPA) axis is one of the main components of the stress system. Maintenance of normal physiological events, which include stress responses to internal or external stimuli in the body, depends on appropriate HPA axis function. In the case of severe cortisol deficiency, especially when there is a triggering factor, the patient may develop a life-threatening adrenal crisis which may result in death unless early diagnosis and adequate treatment are carried out. Read More

BMJ Case Rep 2021 Mar 24;14(3). Epub 2021 Mar 24.

Department of Endocrinology, University of Wales College of Medicine, Cardiff, UK.

A 53-year-old man presented with 6 months history of weight loss associated with nausea, fatigue, dizziness and headache. On arrival he was in adrenal crisis. Biochemistry revealed anterior hypopituitarism with low cortisol, thyroxine, testosterone and a slightly raised prolactin. Read More

Palliat Med 2021 05 24;35(5):972-976. Epub 2021 Mar 24.

Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.

Background: Immunotherapy is increasingly used in the management of early and advanced malignancy. There is limited data regarding the associations between immunotherapy, malignancy, pain and haemophagocytic lymphohistiocytosis.

Case: A 40-year-old woman was diagnosed with advanced melanoma, with metastases to her brain, liver, lung, adrenal glands and bone. Read More

Intern Med 2021 Mar 15. Epub 2021 Mar 15.

Department of Endocrinology and Diabetes, Yamanashi Prefectural Central Hospital, Japan.

A 46-year-old woman with exacerbating hemoptysis and dyspnea was diagnosed with diffuse alveolar hemorrhage (DAH). High doses of glucocorticoids were initiated, but afterward, paroxysmal hypertension (210/140 mmHg) with headache and abdominal pain appeared. A 50-mm left adrenal tumor with an intense uptake by iodine-123 metaiodobenzylguanidine scintigraphy and catecholamine hypersecretion revealed complication with pheochromocytoma. Read More

Mol Diagn Ther 2021 May 12;25(3):327-337. Epub 2021 Mar 12.

Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.

Background And Objective: Congenital adrenal hyperplasia involves a series of autosomal recessive disorders where adrenal steroidogenesis is affected. We present a detailed molecular investigation of 13 newborns affected from the severe form of congenital adrenal hyperplasia related to 21-hydroxylase deficiency.

Methods: All patients were diagnosed with classical congenital adrenal hyperplasia in the neonatal period due to adrenal crisis and/or ambiguous genitalia presentation. Read More

Curr Neurol Neurosci Rep 2021 03 11;21(5):21. Epub 2021 Mar 11.

Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.

Purpose Of Review: Endocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the systemic effect of hormones across many organs and systems including the nervous system. This is a narrative review of the recent evidence of the diagnosis and treatment approach of these medical and neurological emergencies. Read More

Nat Rev Dis Primers 2021 03 11;7(1):19. Epub 2021 Mar 11.

Endocrinology in Charlottenburg, Berlin, Germany.

Adrenal insufficiency (AI) is a condition characterized by an absolute or relative deficiency of adrenal cortisol production. Primary AI (PAI) is rare and is caused by direct adrenal failure. Secondary AI (SAI) is more frequent and is caused by diseases affecting the pituitary, whereas in tertiary AI (TAI), the hypothalamus is affected. Read More

Int J Mycobacteriol 2021 Jan-Mar;10(1):1-7

Department of Medicine, University College Hospital, Ibadan, Nigeria.

Introduction: Tuberculosis (TB) is a disease of public health importance globally. The incidence of pulmonary TB is rising in sub-Saharan Africa. Bilateral adrenal destruction and the use of medications such as rifampicin are possible mechanisms by which TB cause adrenal insufficiency. Read More

Endocrine 2021 May 11;72(2):539-545. Epub 2021 Mar 11.

School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, NSW, Australia.

Purpose: Patients with adrenal insufficiency (AI) are at risk of life-threatening illness. Medical jewellery is recommended for emergencies, but its uptake is unknown. This study assessed the use of medical jewellery among Australian AI patients aged 25 years and under. Read More