1/8. Adrenocortical insufficiency.Primary adrenocortical insufficiency is a rare disease which may present with protean clinical symptoms and signs. At one end of the spectrum is the patient with a long clinical history with marked pigmentation and documented episodes of crises which may follow relatively minor viral illnesses. The other extreme is illustrated by patients with a rapid deterioration in health culminating in unexpected or unexplained death. In the latter instances, the forensic pathologist may well be involved, and the case will present a significant challenge to diagnosis. We report 5 cases of primary and secondary adrenocortical insufficiency seen at the Victorian Institute of forensic medicine in 1 year. One adult man presented as a case of sudden unexplained death. In 2 cases, the diagnosis of adrenocortical insufficiency was raised following postmortem examination and confirmed by the treating physician following further consultation. In the remaining 2 cases, the diagnosis was known prior to postmortem examination and the diagnosis confirmed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. 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 = 1keywords = physician (Clic here for more details about this article) |
3/8. 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 = 1keywords = physician (Clic here for more details about this article) |
4/8. Cushing's syndrome caused by topical steroid therapy for psoriasis.A 72-year-old woman developed manifestations of Cushing's syndrome after long-term topical steroid therapy for psoriasis. Shortly after tapering the dose of topical steroids she developed signs of adrenal insufficiency (provoked by a urinary tract infection) requiring intravenous administration of a stress dose of hydrocortisone. There have only been a few reports of systemic side effects of topically applied corticosteroids in adults. Considering their serious consequences physicians should be alert to signs of Cushing's syndrome in patients on long-term topical steroid therapy. Furthermore, clobetasol propionate ointment doses exceeding 50 g a week should not be prescribed and use of occlusive dressings should be avoided.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Mood disorder and secondary adrenal insufficiency after pituitary tumor operation and radiotherapy.Psychological manifestations can be noted in patients with pituitary hypofunction or injuries after surgery and radiotherapy. We report on a 38-year-old female with acute adrenal insufficiency who presented with an affective disorder. The patient was brought to our emergency department because of general weakness and fever. Low plasma glucose concentration and low blood pressure were noted at arrival. She expressed mood change and persecutive thoughts. The brain MRI demonstrated no obvious brain damage except empty sella. The cortisol level was undetectable. Intravenous hydrocortisone was administered after the diagnosis of acute adrenal insufficiency. The patient improved physically after treatment, but social withdrawal and inappropriate affect persisted. We present the case and review the relevant literature to impress on physicians that the cognitive disorders in hypopituitarism can result from not only hormone insufficiency, but also the influences of pituitary tumor surgery and radiotherapy on neuropsychological functions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Recognition and management of adrenal emergencies.Although clinical conditions associated with dysfunction of the ad-renal gland are often subtle, even insidious, in their presentation,and diagnosis and treatment usually are confined to outpatient clinics and offices, there are several situations that warrant the attention of emergency physicians. Recognition of the spectrum of presentations of pheochromocytoma, adrenal insufficiency, and pituitary apoplexy, and the sequelae of corticosteroid therapy and withdrawal, are critically important areas to emergency medicine.Prompt diagnosis with appropriate treatment and referral will reduce morbidity and mortality in many patients each year. A related topic pertinent to emergency physicians is the management of incidental adrenal masses that are discovered on abdominal radio-logic imaging.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/8. fatigue: the role of adrenal insufficiency.The case described confirms the status of chronic fatigue among the most common--and most frustrating--of all the symptoms physicians are called on to evaluate. New theories regarding the causes of the complaint implicate not only neuroendocrine interactions but the immune system and its cytokines as well.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. "Masked" 21-hydroxylase deficiency of the adrenal presenting with gynecomastia and bilateral testicular masses.An infertile 27 year old man with precocious puberty is described. He presented in adulthood with unilateral and then bilateral gynecomastia, and subsequently testicular tumors developed. An early diagnosis of congenital adrenal hyperplasia would have avoided unnecessary surgery. Initial detailed metabolic evaluation led to the erroneous diagnosis of 11-hydroxylase deficiency because of the presence of an unusual steroid (21-desoxycortisol) in serum which was falsely reported as an increased 11-desoxycortisol (compound S). The observed low urinary pregnanetriol measurements would have supported this diagnosis. Subsequent specific measurements of 21-desoxycortisol established its presence in the serum and its major metabolite, tetrahydro-21-desoxycortisol, in the urine. The unique features in this case of 21-hydroxylase deficiency alert the physician to its unusual clinical presentation and the pitfalls that may be encountered when evaluating adrenal steroidogenesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |