1/81. adrenal insufficiency caused by primary aggressive non-Hodgkin's lymphoma of bilateral adrenal glands: report of a case and literature review.A 64-year-old woman was hospitalized because of poor general condition, gastrointestinal upset, unexplained fever, electrolyte imbalances, and an incidental finding of bilateral huge adrenal masses on computerized tomography (CT) of the abdomen. Non-Hodgkin's lymphoma (NHL) of B-cell origin was proven by ultrasound-guided aspiration biopsy of the left adrenal gland. Meanwhile, primary adrenal insufficiency was confirmed by her low serum cortisol level, high ACTH level, and inadequate adrenal response to the rapid ACTH stimulation test. The diagnosis of primary adrenal NHL was supported by detailed physical examinations, bone marrow examination, and such imaging studies as CT scan and sonography. She received three courses of chemotherapy with cyclophosphamide, vincristine, and prednisolone and there was an initial transient response, but she died of sepsis and progression of NHL three and a half months later.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/81. A case of primary bilateral adrenal lymphoma with partial adrenal insufficiency.Unilateral or bilateral non-Hodgkin's lymphomas arising primarily in the adrenal glands are extremely rare. These lymphomas are usually present with large, bilateral adrenal masses with or without lymphadenopathy, and may be accompanied by adrenal insufficiency in some cases. A review of the literature indicates that patients with primary lymphoma of the adrenal glands usually do not have disease elsewhere, and if present, it is frequently extranodal. We report here an unusual case of primary bilateral adrenal lymphoma with partial adrenal insufficiency.- - - - - - - - - - ranking = 0.4keywords = gland (Clic here for more details about this article) |
3/81. adrenal insufficiency: an uncommon cause of fatigue.BACKGROUND: adrenal insufficiency is a rare condition that can cause common and nonspecific symptoms. One such symptom, reported by all patients with adrenal insufficiency, is fatigue. On the other hand, up to 20% of patients seeking care from primary care physicians will have fatigue as a complaint. Only a small percentage of patients are found to have underlying medical disease. methods: A medline literature search was performed from 1966 to the present using the key words "fatigue," "adrenal insufficiency," and "polyglandular autoimmune endocrinopathy." Major endocrinology textbooks were also referenced. In addition, references were obtained from bibliographies of available articles. RESULTS AND CONCLUSIONS: This article describes a patient with adrenal insufficiency and fatigue as the primary complaint. A brief discussion of fatigue and clues to organic causes follows, along with a more detailed discussion of adrenal insufficiency. Important medical history or signs and symptoms of organic disease suggest the need for screening tests and more detailed evaluation to uncover the uncommon medical causes of fatigue.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
4/81. adrenal insufficiency due to metastatic hepatocellular carcinoma.A 73-year-old man with general malaise and nausea following a common cold diagnosed by a local physician was found to have multiple hepatocellular carcinomas with enlarged bilateral adrenal glands, combined with adrenal insufficiency. hydrocortisone replacement improved the symptoms and laboratory findings. autopsy findings revealed that each adrenal gland was completely replaced by the tumor measuring 11 cm in diameter, and no adrenal tissue was recognized. Histologically, the adrenal tumors, as well as the liver tumors, were moderately differentiated Edmondson type II hepatocellular carcinomas. This is a second report of adrenal insufficiency due to hepatocellular carcinoma as a primary site of metastatic adrenal tumor.- - - - - - - - - - ranking = 0.4keywords = gland (Clic here for more details about this article) |
5/81. Bilateral adrenal non-Hodgkin's lymphoma with adrenal insufficiency.A 74 year old women presented with lethargy and weight loss and was found to have profound adrenal insufficiency and bilateral adrenal mass lesions. Histological examination revealed non-Hodgkin's lymphoma. There was no evidence of lymphoma outside the adrenal glands. Isolated bilateral adrenal masses may rarely be due to primary adrenal non-Hodgkin's lymphoma, which is often associated with adrenal insufficiency.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
6/81. Reversible adrenocorticol insufficiency in fulminant meningococcemia.A 13-year-old girl who had been well previously was admitted with fulminant meningococcemic purpura. Her plasma cortisol level was only 3 micrograms/dL and failed to rise after cosyntropin administration. maintenance doses of corticosteroid were administered. As her infection cleared her adrenal glands were restimulated and shown to have near normal response. Replacement doses of corticosteroids should be given to patients with fulminant meningococcemia until adrenal cortical insufficiency can be excluded because of the high incidence of adrenal failure in these patients and the possibility that excessive adrenal stimulation might contribute to adrenal abnormality.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
7/81. syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and adrenal insufficiency induced by rathke's cleft cyst: a case report.We report a case of a seventy-year-old woman with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and adrenal insufficiency induced by Rathke's cleft cyst. She experienced nausea, vomiting, diarrhea, and headache and disturbance of consciousness induced by hyponatremia at a serum sodium level of 100 mEq/l. In spite of severe hyponatremia, urinary sodium excretion was not suppressed and serum osmolality (270 mOsm/kg) was lower than urine osmolality (304 mOsm/kg), and arginine vasopressin (AVP) remained within normal range. SIADH was diagnosed because she was free from other diseases known to cause hyponatremia such as dehydration, cardiac dysfunction, liver dysfunction, renal dysfunction, hypothyroidism, and adrenal insufficiency. Cranial computed tomographic (CT) scan and cranial magnetic resonance (MR) imaging showed a cystic lesion of approximately 2 cm in diameter in the pituitary gland. These images suggested that the cystic lesion was a Rathke's cleft cyst, which was the cause of SIADH. water restriction therapy normalized her serum sodium concentration and improved her symptoms. After one year, she suffered from general fatigue, appetite loss, fever, and body weight loss (5 kg/2 months). She had neither hypotension nor hypoglycemia, but her serum sodium level was low and serum cortisol, ACTH, and urine free cortisol were very low. Therefore, secondary adrenal insufficiency was suspected and diagnosed by stimulation tests. After start of hydrocortisone replacement therapy (10 mg/day), her symptoms disappeared. In conclusion, Rathke's cleft cyst should be kept in mind as a potential cause in a patient with SIADH, hypopituitarism, and/or adrenal insufficiency.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
8/81. A case of isolated ACTH deficiency who developed autoimmune-mediated hypothyroidism and impaired water diuresis during glucocorticoid replacement therapy.A case of isolated ACTH deficiency who developed autoimmune-mediated hypothyroidism and still showed impaired water diuresis during glucocorticoid replacement therapy is reported. A 45-year-old woman was initially admitted for nausea, vomiting, and general malaise. Her serum sodium and plasma osmolality, ACTH and cortisol values were low, but her urine osmolality was high. Other pituitary hormone levels, thyroid hormone levels, and a computed tomogram of the pituitary gland were normal. The patient was treated with hydrocortisone and followed in the outpatient clinic; however, she was lost to follow up 18 months after admission. Three years later she presented with hypoglycemia and hyponatremia. Her serum or plasma ACTH, FT3, FT4, cortisol levels were low and her serum TSH level was high. Pituitary stimulation tests revealed a blunted response of ACTH to CRH and an exaggerated response of TSH to TRH. plasma ADH was inappropriately high, and a water-loading test revealed impaired water diuresis and poor suppression of ADH. Although ADH was suppressed, impaired water diuresis was observed in the water loading test after hydrocortisone supplementation. thyroxine supplementation completely normalized the water diuresis. Her outpatient clinic medical records revealed a gradual increase in TSH levels during follow up, indicating that she had developed hypothyroidism during glucocorticoid replacement therapy. The hyponatremia on the first admission was due to glucocorticoid deficiency, whereas the hyponatremia on the second admission was due to combined deficiencies of glucocorticoid and thyroid hormones.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
9/81. fatigue and hyponatremia in a 75-year-old woman: unusual presentation of hypophysitis.A 75-year-old woman presented with general fatigue progressing to somnolence. Laboratory tests showed marked hyponatremia. TSH in the normal range, but low levels of free T3 and free T4. Evaluation of pituitary hormones and magnetic resonance imaging of the pituitary unmasked findings characteristic for hypophysitis with secondary adrenal insufficiency and secondary hypothyroidism. Hormonal substitution with hydrocortisone and levothyroxine resulted in rapid improvement of all symptoms and signs. Without additional treatment shrinkage of the pituitary gland could be documented. Our report extends the known clinical and pathological spectrum of hypophysitis and illustrates the need to include this uncommon entity in the differential diagnosis of hyponatremia even in elderly patients.- - - - - - - - - - ranking = 0.2keywords = gland (Clic here for more details about this article) |
10/81. growth hormone deficiency in autoimmune polyglandular disease type 1.This is a case report of 2 patients who were diagnosed to have autoimmune polyglandular disease type 1. Both developed mucocutaneous candidiasis, hypoparathyroidism, vitiligo, and adrenocortical insufficiency. Both were noticed to have subnormal linear growth velocity and delayed bone age. Both showed subnormal stimulated serum growth hormone values indicating growth hormone deficiency. The first case showed favorable response to growth hormone therapy.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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