1/15. pheochromocytoma and sub-clinical Cushing's syndrome during pregnancy: diagnosis, medical pre-treatment and cure by laparoscopic unilateral adrenalectomy.The coexistence of pheochromocytoma and primary adrenal Cushing's syndrome of the same adrenal gland has rarely been reported. We describe here the case of a female patient presenting with mild Cushing's stigmata, hypertension and diabetes mellitus in whom we diagnosed a pheochromocytoma of the left adrenal gland with coexisting non-ACTH-dependent cortisol hypersecretion. While hormonal work-up was still in progress, the patient became pregnant and wanted to carry her pregnancy to full-term. A laparoscopic adrenalectomy in the 17th week of gestation was decided upon and the patient accordingly prepared for surgery by pre-treatment with phenoxybenzamine. Successful surgery--the first ever reported laparoscopic resection of a pheochromocytoma in pregnancy--without perioperative complications was performed under general anesthesia, with the patient receiving peri- and post-operative hydrocortisone substitution. Pathohistological examination revealed a pheochromocytoma with positive immunostaining for interleukin-6 (IL-6) and negative immunostaining for ACTH, vasoactive intestinal polypeptide (VIP) and cytochrome P450, and with no signs of malignancy. A paracrine stimulation of the ipsilateral adrenal cortex by IL-6 produced by the pheochromocytoma, leading to cortical hyperplasia and subclinical Cushing's syndrome, is suggested by the positive immunostaining for IL-6 and the MRI findings. Post-operatively, secondary adrenal insufficiency ensued, necessitating continuing hydrocortisone replacement over 12 months. hypertension resolved after surgery, and diabetes after the uncomplicated vaginal delivery at term.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/15. Type 2 diabetes in obese white children.We report four white adolescents aged 13 to 15 years (three females, one male) from the south and west region of england who presented with type 2 diabetes mellitus associated with significant obesity (body mass index more than 3SDS) in the past two years. Although these are the first reported obese, white cases from the UK to present with diabetes, we believe this clinical scenario will become more prevalent given the epidemic of childhood obesity in this country.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
3/15. Unilateral adrenalectomy improves insulin resistance and diabetes mellitus in a patient with ACTH-independent macronodular adrenal hyperplasia.ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is considered to be a standard therapy for AIMAH, although lifetime replacement of glucocorticoids is necessary after the procedure. This paper describes a subject with AIMAH who underwent unilateral adrenalectomy of the predominantly enlarged gland and subsequently displayed an improvement in insulin resistance and diabetes mellitus, the cardinal symptoms before the operation, concomitant with alleviation of abnormal cortisol secretion. The patient was a 61-year-old man with a body mass index of 25.6 kg/m2. He was diagnosed as having diabetes mellitus, hypertension, and hyperlipidemia at 50 years of age. Eight years after diagnosis, bilateral enlargement of the adrenal glands was revealed by chance upon computed tomography of the abdomen. Typical manifestations of Cushing's syndrome were not demonstrated. Basal levels of serum and urinary cortisol had not increased, although the serum cortisol level displayed no circadian rhythm and no response to the administration of dexamethasone. Despite sulfonylurea treatment, the patient's HbA1C level was as high as 7.6% (normal range 4.3-5.8%). fasting insulin concentration was increased to 42.6 microU/ml, and the homeostasis model insulin resistance index (HOMA-R) was calculated to be 15.5 (with a normal range of less than 2.5), indicating severe insulin resistance. Unilateral adrenalectomy of the predominantly enlarged gland revealed that the resected gland consisted of multiple nodules of various sizes. Based on endocrinological, radiological, and pathological findings, a diagnosis of AIMAH was made. Ten months after the unilateral adrenalectomy, cortisol circadian rhythms were restored, and serum cortisol concentration was suppressed in response to the administration of low doses of dexamethasone, suggesting an improvement in the cortisol secretory pattern. Levels of HbA1C, fasting insulin, and HOMA-R decreased to 5.7%, 12.7 microU/ml, and 2.2, respectively. An improvement in hyperlipidemia was also observed. insulin resistance and glucose intolerance are recognized as features of mild hypercortisolism. In the present case, unilateral adrenalectomy was effective in ameliorating insulin resistance and improving glycemic control. Unilateral adrenalectomy might be an alternative therapy for improvement of glucose and lipid metabolism in subjects with AIMAH.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
4/15. hemorrhage into a thyroid nodule as a cause of thyrotoxicosis.OBJECTIVE: To describe a case of thyrotoxicosis after nontraumatic hemorrhage into the thyroid gland during anticoagulant therapy. methods: We report the details of the initial presentation, subsequent course, and outcome in a patient with a nontraumatic thyroid hematoma and thyrotoxicosis. RESULTS: In a 63-year-old woman, an acute painful neck mass developed during follow-up while she was receiving low-molecular-weight heparin therapy for deep vein thrombosis. Ultrasound study and magnetic resonance imaging revealed a massive intrathyroidal hematoma. This finding was followed by an increase in serum free thyroxine and free triiodothyronine levels and a decrease in the level of serum thyroid-stimulating hormone (thyrotropin). Anticoagulant therapy was discontinued. The clinical course of the thyrotoxicosis was self-limited, and no antithyroid therapy was necessary. The serum thyroid hormone levels decreased into normal ranges as the hematoma underwent subtotal shrinkage. CONCLUSION: endocrine glands are highly vascularized tissues, but nontraumatic hematomas into these organs are extremely rare conditions. Nevertheless, physicians should be aware of the potential occurrence of such a situation, as emphasized in the current case report.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/15. Current surgery/drug combination treatment of diabetic gangrene of the foot.Twenty-eight patients, 20 females and eight males (age 45-85 years) were treated for diabetic gangrene of the foot using a combination of surgery and intraarterial administration of prostaglandin F and cefotaxime. In 64% of the patients treated it was possible for the leg in question to be saved. We therefore consider intraarterial administration of cefotaxime in conjunction with prostaglandin E, and with simultaneous local surgery of the focal infection, to be a promising concept. Further studies, however, are necessary in order to establish whether the initial success can be consistently reproduced.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
6/15. Computed tomography in malignant external otitis.Malignant external otitis is a severe infection of the external auditory meatus occurring predominantly in diabetics and usually caused by pseudomonas aeruginosa. The infection may spread along several routes: directly by bony erosion into the adjacent mastoid bone, anteriorly into the parotid gland and temporomandibular joint and inferiorly into the soft tissues of the infratemporal fossa. We present four cases of malignant external otitis that illustrate the typical patterns of spread of this disease and the role that radiology, and in particular computed tomography, plays in its diagnosis and management.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
7/15. Isolated adrenocorticotropin deficiency associated with polyglandular failure.A female patient presented with isolated ACTH deficiency and diabetes mellitus. During the course of a year's replacement with hydrocortisone, goiter developed, which, on biopsy, was diagnosed as typical Hashimoto's thyroiditis. Four years later, she experienced tetany, and the diagnosis of idiopathic hypoparathyroidism was made. Immunological studies revealed the presence of antithyroid antibodies in the serum and cell-mediated immunity to the thyroid and parathyroid. These data strongly suggest that the autoimmune process is involved in the genesis of some, though not all, forms of isolated ACTH deficiency.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
8/15. Sertoli--Leydig cell tumor with endometroid differentiation. Case report and discussion of histogenesis.A case of sertoli-leydig cell tumor with endometrioid differentiations is reported. The tumor was associated with hirsutism and androgenic excess which normalized following surgical removal. On light-microscopic study, the tumor resembled a well-differentiated endometrioid tumor with luteinized stroma. With further study, the interstitial stromal cell were recognized as leydig cells, containing scattered Reinke crystals. Tubules and solid cords reminiscent of sex cord elements were also recognized. The dilated glandular elements showed scant apical and luminal positivity with the PAS stain following diastase digestion. Electron-microscopic examination confirmed a dual population of cells, featuring sertoli-leydig cell tumor and endometrioid cells. We postulate that this tumor may represent yet another example of multidirectional differentiation.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
9/15. diabetes mellitus and hypopituitarism.A 38-year-old diabetic woman developed hyponatraemia and fatal non-ketotic coma after elective cholecystectomy. At the autopsy, it was revealed that the immediate cause of death was cerebral oedema with secondary pontine haemorrhage. The cerebral oedema was associated with severe hyponatraemia and atrophy of the endocrine organs, including the adrenal glands. Biochemical analysis of serum taken immediately before death indicated that the primary defect was pituitary insufficiency, a recognised but rare complication of diabetes.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
10/15. Silent myocardial rupture in a patient with diabetes and Addison's disease.We present a case of left ventricular rupture and formation of a pseudoaneurysm after silent myocardial infarction in a patient with Schmidt syndrome (polyglandular deficiency syndrome including Addison's disease, lymphocytic thyroiditis and diabetes mellitus). This case illustrates the possibility of myocardial rupture without hemodynamic collapse and a possible role of chronic steroid substitution.- - - - - - - - - - ranking = 0.5keywords = gland (Clic here for more details about this article) |
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