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    1 OF 28

    Thyrotoxic and pheochromocytoma multisystem crisis: a case report.
    J Med Case Rep 2017 Jun 23;11(1):173. Epub 2017 Jun 23.
    Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
    Background: Thyrotoxic crisis and pheochromocytoma multisystem crisis are rare, life-threatening, emergency endocrine diseases with various clinical manifestations. Here we report a case of a patient who simultaneously developed thyrotoxic crisis and pheochromocytoma multisystem crisis and required intensive cardiovascular management.

    Case Presentation: A 60-year-old Asian man experienced nausea and vomiting, and subsequently developed dyspnea and cold sweats while farming. Read More

    Adrenal insufficiency - recognition and management.
    Clin Med (Lond) 2017 Jun;17(3):258-262
    Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
    Adrenal insufficiency is characterised by inadequate -glucocorticoid production owing to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation. In primary adrenal insufficiency, lack of mineralocorticoids is also a feature. Patients can present with an insidious onset of symptoms, or acutely in adrenal crisis, which requires prompt recognition and treatment. Read More

    Endocrine Emergencies With Neurologic Manifestations.
    Continuum (Minneap Minn) 2017 Jun;23(3, Neurology of Systemic Disease):778-801
    Purpose Of Review: This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities.

    Recent Findings: To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. Read More

    Thyrotoxicosis leading to adrenal crises reveals primary bilateral adrenal lymphoma.
    Endocrinol Diabetes Metab Case Rep 2017 16;2017. Epub 2017 May 16.
    Anatomopathology Department, Hospital de Egas Moniz C.H.L.O.-E.P.E, LisbonPortugal.
    Primary adrenal lymphoma is a rare malignancy. It frequently presents bilaterally and with symptoms of adrenal insufficiency. Amiodarone may induce secondary organ dysfunction, and thyrotoxicosis develops in 15% of cases. Read More

    A case report of pedigree of a homozygous mutation of the steroidogenic acute regulatory protein causing lipoid congenital adrenal hyperplasia.
    Medicine (Baltimore) 2017 May;96(21):e6994
    aDepartment of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China bThe Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China.
    Rationale: Lipoid congenital adrenal hyperplasia (LCAH) is extremely rare, but is the most fatal form of congenital adrenal hyperplasia resulting from mutations in the steroidogenic acute regulatory protein (STAR) gene. LCAH arises from severe defects in the conversion of cholesterol to pregnenolone, the precursor of all steroids.

    Patient Concerns: A case was reported that an 11-month-old Chinese girl who presented with a sex development disorder and hyponatremia. Read More

    Three-Quarters Adrenalectomy for Infantile-Onset Cushing Syndrome due to Bilateral Adrenal Hyperplasia in McCune-Albright Syndrome.
    Horm Res Paediatr 2017 May 19. Epub 2017 May 19.
    Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
    Background: Bilateral adrenalectomy is performed in cases with infantile-onset Cushing syndrome due to bilateral adrenal hyperplasia in McCune-Albright syndrome (MAS) because severe Cushing syndrome with heart failure and liver dysfunction can have a lethal outcome. This procedure can completely ameliorate hypercortisolism, although lifetime steroid replacement therapy and steps to prevent adrenal crisis are necessary. Recently, the efficacy of unilateral adrenalectomy has been reported in adult cases of bilateral macronodular adrenal hyperplasia, but there is no consensus regarding the appropriate surgical treatment for bilateral adrenal hyperplasia in MAS. Read More

    Quality of compounded hydrocortisone capsules used in the treatment of children.
    Eur J Endocrinol 2017 May 16. Epub 2017 May 16.
    O Blankenstein, Institute for experimental paediatric endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany
    Objectives: Due to the lack of paediatric licensed formulations, children are often treated with individualized pharmacy-compounded adult medication. An international web-based survey about the types of medication in children with adrenal insufficiency (AI) revealed that the majority of paediatric physicians are using pharmacy-compounded medication to treat children with AI. Observations of loss of therapy control in children with congenital adrenal hyperplasia with compounded hydrocortisone capsules and regained control after prescribing a new hydrocortisone batch led to this "real world" evaluation of pharmacy-compounded paediatric hydrocortisone capsules. Read More

    Patients treated with immunosuppressive steroids are less aware of sick day rules Than those on endocrine replacement therapy and may be at greater risk of adrenal crisis.
    Ir J Med Sci 2017 May 4. Epub 2017 May 4.
    Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Beaumont Road, Dublin 9, Co. Dublin, Ireland.
    Background: Patients taking corticosteroids for immune suppression are vulnerable to adrenal crisis during acute illness or if steroids are stopped abruptly. Although patients treated for adrenal failure in endocrine units are routinely provided with sick day guidelines, we wished to ascertain whether patients on immunosuppressive steroids are appropriately advised.

    Aim: This study sets out to compare patient awareness of steroid sick day rules in endocrine and non-endocrine patients. Read More

    De novo disruption of promoter and exon 1 of STAR gene reveals essential role for gonadal development.
    Endocrinol Diabetes Metab Case Rep 2017 13;2017. Epub 2017 Mar 13.
    Laboratory of Biochemistry, Mercer University School of Medicine, Savannah, GeorgiaUSA.
    Summary: Cholesterol transport into the mitochondria is required for synthesis of the first steroid, pregnenolone. Cholesterol is transported by the steroidogenic acute regulatory protein (STAR), which acts at the outer mitochondrial membrane prior to its import. Mutations in the STAR protein result in lipoid congenital adrenal hyperplasia (CAH). Read More

    Autoimmune polyendocrine syndrome type 1 in an Indian cohort: a longitudinal study.
    Endocr Connect 2017 Apr 26. Epub 2017 Apr 26.
    E Bhatia, Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
    Objective: Autoimmune polyendocrine syndrome type 1 (APS 1) is a rare autosomal recessive disorder characterized by progressive organ-specific autoimmunity. There is scant information on APS1 in ethnic groups other than European Caucasians. We studied clinical aspects and autoimmune regulator (AIRE) gene mutations in a cohort of Indian APS1 patients. Read More

    Management of Childhood Congenital Adrenal Hyperplasia-An Integrative Review of the Literature.
    J Pediatr Health Care 2017 Apr 13. Epub 2017 Apr 13.
    Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires parents to administer steroids up to three times daily, supplementing maintenance doses with oral or injectable doses during times of illness. The purpose of this integrative review was to explore the management, care, and associated health issues for children with CAH and the family response to the condition. Four literature indexes were searched, with 39 articles included. Read More

    Paraganglioma of the bladder in a kidney transplant recipient: A case report.
    Mol Clin Oncol 2017 Apr 6;6(4):553-555. Epub 2017 Mar 6.
    Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
    Renal transplantation has been associated with a significantly increased risk of developing cancer, including bladder neoplasia, with urothelial carcinoma being the most frequent type of bladder cancer. Bladder paraganglioma, also referred to as extra-adrenal pheochromocytoma, is a rare but severe condition that may cause a severe hypertensive crisis during handling and mobilization of the tumor. We herein present the case of a 67-year-old kidney transplant recipient with a bladder polyp consistent with paraganglioma of the bladder. Read More

    Clinical characteristics of Taiwanese children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency detected by neonatal screening.
    J Formos Med Assoc 2017 Apr 6. Epub 2017 Apr 6.
    Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address:
    Background/purpose: Neonatal screening for congenital adrenal hyperplasia (CAH) has been conducted in Taiwan since 2000. This study aimed to determine the clinical characteristics of Taiwanese children with CAH due to 21-hydroxylase deficiency (21-OHD) detected by neonatal screening.

    Methods: From 2000 to 2015, 26 neonates (14 boys and 12 girls) with classic 21-OHD detected by neonatal screening and confirmed at National Taiwan University Hospital were enrolled. Read More

    Primary pigmented nodular adrenocortical disease: literature review and case report of a 6-year-old boy.
    J Pediatr Endocrinol Metab 2017 May;30(5):603-609
    University of Novi Sad, Faculty of Medicine, Novi Sad.
    Cushing's syndrome is rare in childhood and is usually caused by a pituitary adenoma. Primary hyperfunction of adrenal glands is less frequent, particularly primary pigmented nodular adrenocortical disease (PPNAD). It occurs usually in children and adolescents, with female preponderance, while Cushing's disease has increased frequency in prepubertal males. Read More

    A Complex Interplay: Cognitive Behavioural Therapy for Severe Health Anxiety in Addison's Disease to Reduce Emergency Department Admissions.
    Behav Cogn Psychother 2017 Jul 9;45(4):419-426. Epub 2017 Apr 9.
    Department of Psychology,University of Bath,Bath,UK.
    Background: Addison's disease (AD) is a rare chronic illness caused by adrenocortical insufficiency. Due to the pivotal role of the regulating hormone cortisol in AD, there is a common symptom overlap between the presentation of anxiety and adrenal crisis. Previous literature has identified the prevalence of anxiety in endocrinological disorders, however there is a paucity of research examining the complex interplay between AD and anxiety. Read More

    [A clinical analysis of 123 cases of primary empty sella].
    Zhonghua Nei Ke Za Zhi 2017 Apr;56(4):268-272
    Department of Endocrinology and Metabolism, General Hospital of Tianjin Medical University, Tianjin 300052, China.
    Objective: This study was conducted to analyze the clinical characteristics and pituitary function of patients with primary empty sella (PES). Methods: The clinical data from 123 hospitalized adult patients with PES from January 2010 to May 2016 were retrospectively studied. Results: (1) The average age of the 123 (male 43, female 80) PES patients was (59. Read More

    Symptomatic adrenal suppression among children in Canada.
    Arch Dis Child 2017 Apr 9;102(4):338-339. Epub 2016 Nov 9.
    Department of Pediatrics (Endocrinology), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
    Background: Adrenal suppression (AS) is an under-recognised side effect of glucocorticoid (GC) use. AS may go undetected until a physiological stress precipitates an adrenal crisis. The incidence of AS has not been established. Read More

    Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital.
    Endocrinol Metab (Seoul) 2017 Mar 19;32(1):83-89. Epub 2017 Jan 19.
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
    Background: Adrenal insufficiency (AI) is a life-threatening disorder caused by the deficiency of adrenal steroid hormones. This retrospective cross-sectional study investigated the characteristics of patients with AI in Korea.

    Methods: All consecutive patients with suspected AI who received care at a tertiary referral center in Korea in 2014 and underwent adrenocorticotropic hormone stimulation or insulin-tolerance testing were identified through a review of medical charts. Read More

    [Improvement in Hyperglysemia Following Unilateral Adrenalectomy for ACTH-Independent Macronodular Adrenal Hyperplasia (AIMAH) : A Case Report].
    Hinyokika Kiyo 2017 Jan;63(1):7-10
    The Department of Radiology, Kansai Medecal University.
    Adrenal corticotropin (ACTH) -independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is the treatment of choice, but lifetime steroid replacement is essential. Here we report a case of AIMAH whose hyperglycemia was improved following unilateral adrenalectomy. Read More

    Nivolumab induced myxedema crisis.
    J Immunother Cancer 2017 21;5:13. Epub 2017 Feb 21.
    Department of Hematology/Oncology, St. John Hospital and Medical Center, 19229 Mack Ave Suite 23 Grosse Pointe Woods, Detroit, 48236 Michigan USA.
    Background: Nivolumab is an anti-programmed cell death (anti-PD-1) monoclonal antibody that is approved by Food and Drug Administration for treatment of metastatic non-small cell lung cancer, metastatic melanoma, relapsed Hodgkin lymphoma and advanced renal cell cancer. We report a rare case of myxedema crisis induced by nivolumab in a patient with metastatic squamous cell carcinoma of lung.

    Case Presentation: Fifty three-year old woman with metastatic squamous cell carcinoma currently on treatment with nivolumab presented with diffuse facial and tongue swelling, slurred speech, depressed mentation, fatigue and weakness. Read More

    Septo-optic dysplasia/de Morsier's syndrome.
    Saudi J Anaesth 2017 Jan-Mar;11(1):106-107
    Department of Anesthesia, São João Hospital Centre, Porto, Portugal; Department of Anesthesia, Medical Faculty, Oporto University, Porto, Portugal.
    Septo-optic dysplasia (SOD)/de Morsier's syndrome is characterized by optic nerve hypoplasia, pituitary endocrine dysfunction, and midline brain abnormalities. Hypopituitarism, hypothyroidism, hypogonadism, and adrenal insufficiency can lead to severe hypoglycemia, adrenal crisis, seizures, and sudden death. Anesthetic management of SOD was associated with high perioperative mortality. Read More

    From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia.
    Case Rep Anesthesiol 2017 18;2017:5495808. Epub 2017 Jan 18.
    Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
    Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. Read More

    Two Moroccan Sisters Presenting with a Severe Salt-Wasting Form of Congenital Adrenal Hyperplasia but Normal Female Genitalia.
    Sex Dev 2017 11;11(2):82-85. Epub 2017 Feb 11.
    Neonatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
    We report the case of 2 sisters (46,XX) born from consanguineous Moroccan parents. Both sisters had normal female genitalia, but within 2 weeks after birth, they presented with a severe salt-wasting crisis. Hormonal investigations suggested the diagnosis of congenital adrenal hyperplasia, which was confirmed by subsequent molecular analysis to be caused by 3β-hydroxysteroid dehydrogenase type 2 deficiency. Read More

    [Recommendations for the diagnosis and treatment of classic forms of 21-hydroxylase-deficient congenital adrenal hyperplasia].
    An Pediatr (Barc) 2017 Feb 1. Epub 2017 Feb 1.
    Hospital Clínico Universitario Virgen Arrixaca, Murcia, España.
    Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by mutations in the CYP21A2 gene. Cortisol and aldosterone synthesis are impaired in the classic forms (adrenal insufficiency and salt-wasting crisis). Females affected are virilised at birth, and are at risk for genital ambiguity. Read More

    Clinical features and practice patterns of treatment for adrenal crisis: a nationwide cross-sectional study in Japan.
    Eur J Endocrinol 2017 Mar;176(3):329-337
    Department of General MedicineNational Defense Medical College, Tokorozawa, Saitama, Japan.
    Context: Adrenal crisis is an endocrine emergency that requires prompt diagnosis and treatment. However, the clinical features and practice patterns of treatment for adrenal crisis are not completely understood.

    Objective: To investigate patient characteristics, comorbidities and treatments of adrenal crisis. Read More

    Consensus guideline for the diagnosis and treatment of aromatic l-amino acid decarboxylase (AADC) deficiency.
    Orphanet J Rare Dis 2017 Jan 18;12(1):12. Epub 2017 Jan 18.
    Department of Child Neurology and Metabolic Disorders, University Children's Hospital, Heidelberg, Germany.
    Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare, autosomal recessive neurometabolic disorder that leads to a severe combined deficiency of serotonin, dopamine, norepinephrine and epinephrine. Onset is early in life, and key clinical symptoms are hypotonia, movement disorders (oculogyric crisis, dystonia, and hypokinesia), developmental delay, and autonomic symptoms.In this consensus guideline, representatives of the International Working Group on Neurotransmitter Related Disorders (iNTD) and patient representatives evaluated all available evidence for diagnosis and treatment of AADCD and made recommendations using SIGN and GRADE methodology. Read More

    Acute management of autoimmune toxicity in cancer patients on immunotherapy: Common toxicities and the approach for the emergency physician.
    Emerg Med Australas 2017 Apr 16;29(2):245-251. Epub 2017 Jan 16.
    Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
    When a patient receiving anti-cancer treatment presents acutely unwell, an understanding of associated side effects of their therapy is critical. This review will discuss the approach to patients receiving anti-cancer treatment with immunotherapy presenting with autoimmune toxicities in the emergency setting. These toxicities are commonly referred to as immune-related adverse events (irAE). Read More

    Pheochromocytoma Multisystem Crisis Behaving Like Interstitial Pneumonia: An Autopsy Case.
    Intern Med 2017 15;56(2):149-152. Epub 2017 Jan 15.
    Department of Cardiology, Fuchu Hospital, Japan.
    Pheochromocytoma multisystem crisis is a rare and life-threatening disease that is associated with numerous symptoms and which is also difficult to diagnose. We herein report an autopsy case of a 61-year-old man who died due to pheochromocytoma multisystem crisis. The patient complained of vomiting and breathlessness. Read More

    Cystic Pheochromocytoma Presenting as Adrenal Cyst.
    J Clin Diagn Res 2016 Nov 1;10(11):OD09-OD10. Epub 2016 Nov 1.
    Senior Medical Specialist, GB Pant Hospital , Port Blair, Andaman and Nicobar Islands, India .
    Pheochromocytomas are usually solid tumours. But it can present as cystic lesions in the adrenal gland. Cystic lesions in adrenal gland with hypertension needs attention to rule out pheochromocytoma. Read More

    Effect of Exercise on Ovulation: A Systematic Review.
    Sports Med 2016 Dec 29. Epub 2016 Dec 29.
    Laboratory of Protein Biochemistry, Federal University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
    Background: Infertility has been described as a devastating life crisis for couples, and has a particularly severe effect on women, in terms of anxiety and depression. Anovulation accounts for around 30% of female infertility, and while lifestyle factors such as physical activity are known to be important, the relationship between exercise and ovulation is multi-factorial and complex, and to date there are no clear recommendations concerning exercise regimes.

    Objectives: The objective of this review was to systematically assess the effect of physical activity on ovulation and to discuss the possible mechanisms by which exercise acts to modulate ovulation in reproductive-age women. Read More

    Sheehan syndrome.
    Nat Rev Dis Primers 2016 12 22;2:16092. Epub 2016 Dec 22.
    Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey.
    Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Read More

    Adrenal crises: perspectives and research directions.
    Endocrine 2017 Feb 19;55(2):336-345. Epub 2016 Dec 19.
    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
    Adrenal crises are life-threatening complications of adrenal insufficiency. These events have an estimated incidence of between 5 and 10  adrenal crises/100 patient years and are responsible for some of the increased morbidity and excess mortality experienced by patients with adrenal insufficiency. Treatment involves urgent administration of IV/IM hydrocortisone and IV fluids. Read More

    Anesthetic Management of Clinically Silent Familial Pheochromocytoma with MEN 2A: A Report of Four Cases.
    Indian J Surg 2016 Oct 15;78(5):414-417. Epub 2016 Aug 15.
    Department of Anesthesia, V.M.M.C. and Safdarjung Hospital, A7/14 Mianwali Nagar Paschim Vihar, New Delhi, 110087 India.
    Familial pheochromocytomas are commonly associated with multiple endocrine neoplasia type 2 (MEN 2) syndrome. Majority of the patients present with normal clinical and biochemical parameters in the preoperative period, the incidence of hypertension being only 50 %. Even though patients may be clinically asymptomatic, surveillance and proper preoperative evaluation is important, as surgery for associated tumors may precipitate a hypertensive crisis and result in severe complications. Read More

    Conduct protocol in emergency: Acute adrenal insufficiency.
    Rev Assoc Med Bras (1992) 2016 Nov;62(8):728-734
    Degree in Endocrinology and Metabology from Sociedade Brasileira de Endocrinologia e Metabologia (SBEM). Assistant Physician at the Internal Medicine Service of Hospital de Base. Researcher at Centro Integrado de Pesquisa (CIP), Hospital de Base, São José do Rio Preto. Endocrinology Coordinator of the Specialties Outpatient Clinic (AME), São José do Rio Preto, SP, Brazil.
    Introduction:: Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably.

    Objective:: To alert all health professionals about the diagnosis and correct treatment of this complication.

    Method:: We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic. Read More

    Hypertensive Crisis From the Aquamantys Bipolar Sealing System.
    A A Case Rep 2016 Dec;7(12):270-271
    From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
    Hypertension is a common occurrence during general anesthesia. Apart from pathological causes of hypertension, it is rarely extreme enough to be classified as a hypertensive crisis (systolic blood pressure >180 mm Hg or diastolic blood pressure >120 mm Hg). There is literature concerning the unintentional electrocauterization of the adrenal gland leading to hypertensive crisis, but to date, no reports have been made of adrenal stimulation from the use of an Aquamantys for hemostasis. Read More

    [Adrenal Insufficiency].
    Dtsch Med Wochenschr 2016 Nov 30;141(24):1740-1742. Epub 2016 Nov 30.
    Even under established replacement therapy, chronic adrenal insufficiency is associated with an impairment in daily life activities and a higher number of sick-days. In patients with individually adjusted glucocorticoid doses (avoiding over-replacement) the frequency of glucocorticoid side effects is low. Besides the standard treatment with conventional hydrocortisone, new formulas aiming at more adjusted physiological circadian cortisol profiles or improved individual dosing have been evaluated in recent clinical trials. Read More

    Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge.
    BMJ Case Rep 2016 Nov 29;2016. Epub 2016 Nov 29.
    Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK.
    A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. Read More

    Hypertensive Crisis During Norepinephrine Syringe Exchange: A Case Report.
    A A Case Rep 2017 Apr;8(7):178-181
    From the *Department of Medical Technology and Clinical Physics; †Department of Anaesthesiology, Intensive Care and Emergency Medicine; ‡Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands; and §Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands.
    A 67-year critically ill patient suffered from a hypertensive crisis (200 mm Hg) because of a norepinephrine overdose. The overdose occurred when the clinician exchanged an almost-empty syringe and the syringe pump repeatedly reported an error. We hypothesized that an object between the plunger and the syringe driver may have caused the exertion of too much force on the syringe. Read More

    Adrenal crisis secondary to bilateral adrenal haemorrhage after hemicolectomy.
    Endocrinol Diabetes Metab Case Rep 2016 25;2016. Epub 2016 Oct 25.
    Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia; The University of Sydney, Sydney, Australia.
    Adrenal haemorrhage is a rare cause of adrenal crisis, which requires rapid diagnosis, prompt initiation of parenteral hydrocortisone and haemodynamic monitoring to avoid hypotensive crises. We herein describe a case of bilateral adrenal haemorrhage after hemicolectomy in a 93-year-old female with high-grade colonic adenocarcinoma. This patient's post-operative recovery was complicated by an acute hypotensive episode, hypoglycaemia and syncope, and subsequent computed tomography (CT) scan of the abdomen revealed bilateral adrenal haemorrhage. Read More

    Novel SCC mutation in a patient of Mexican descent with sex reversal, salt-losing crisis and adrenal failure.
    Endocrinol Diabetes Metab Case Rep 2016 4;2016. Epub 2016 Oct 4.
    Laboratory of Biochemistry, Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia, USA; Anderson Cancer Institute, Memorial University Medical Center, Savannah, Georgia, USA.
    Congenital adrenal hyperplasia (CAH) is caused by mutations in cytochrome P450 side chain cleavage enzyme (CYP11A1 and old name, SCC). Errors in cholesterol side chain cleavage by the mitochondrial resident CYP11A1 results in an inadequate amount of pregnenolone production. This study was performed to evaluate the cause of salt-losing crisis and possible adrenal failure in a pediatric patient whose mother had a history of two previous stillbirths and loss of another baby within a week of birth. Read More

    Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study.
    Korean J Radiol 2016 Nov-Dec;17(6):864-873. Epub 2016 Oct 31.
    Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China.
    Objective: To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer.

    Materials And Methods: From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Read More

    A successfully treated case of cardiac arrest after Caesarean section complicated by pheochromocytoma crisis and amniotic fluid embolism.
    J Anesth 2017 Feb 10;31(1):140-143. Epub 2016 Nov 10.
    Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan.
    Both pheochromocytoma and amniotic fluid embolism (AFE) are important causes of maternal mortality. We present a case of a 29-year-old woman who developed cardiac arrest after Caesarean section, complicated by both pheochromocytoma crisis and AFE. After resuscitation, the patient developed multiple organ dysfunction, rhabdomyolysis and disseminated intravascular coagulation (DIC). Read More

    Pheochromocytoma Multisystem Crisis Triggered by Glucocorticoid Administration and Aggravated by Citrate Dialysis.
    A A Case Rep 2017 Feb;8(3):58-60
    From the Departments of *Anaesthesiology and †Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore.
    Pheochromocytoma multisystem crisis is the most severe presentation of pheochromocytoma. We report on a 68-year-old survivor of pheochromocytoma multisystem crisis, whose clinical course was triggered inadvertently by a short innocuous course of oral dexamethasone to suppress inflammation and swelling after a left orbital floor fracture repair. He presented first with severe epigastric pain and headache, and subsequently experienced insults to neurological, cardiac, respiratory, hepatobiliary, renal, and immune system in his prolonged intensive care unit stay. Read More

    MANAGEMENT OF ENDOCRINE DISEASE: Regenerative therapies in autoimmune Addison's disease.
    Eur J Endocrinol 2017 Mar 3;176(3):R123-R135. Epub 2016 Nov 3.
    Institute of Genetic MedicineInternational Centre for Life, Centre Parkway, Newcastle upon Tyne, UK.
    The treatment for autoimmune Addison's disease (AAD) has remained virtually unchanged in the last 60 years. Most patients have symptoms that are relatively well controlled with exogenous steroid replacement, but there may be persistent symptoms, recurrent adrenal crisis and poor quality of life, despite good compliance with optimal current treatments. Treatment with conventional exogenous steroid therapy is also associated with premature mortality, increased cardiovascular risk and complications related to excessive steroid replacement. Read More

    Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider?
    Rheumatol Int 2017 Apr 1;37(4):657-662. Epub 2016 Nov 1.
    Division of Rheumatology, Department of Internal Medicine, School of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey.
    Steroid treatment is commonly recommended for autoimmune disorders in rheumatology practice. While adrenal crisis may occur upon existence of an inducing factor in patients with known or unknown adrenal insufficiency as well as in those with a suppressed hypothalamic-pituitary-adrenal (HPA) axis due to chronic steroid use, addisonian crisis rarely develops in patients on supraphysiological doses of steroid and, when emerged, it might be very difficult to recognize. Here, we present a patient who developed adrenal crisis while receiving high-dose methylprednisolone treatment due to retroperitoneal fibrosis and we also discuss possible mechanisms with a brief literature review. Read More

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