1/9. 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 = gland (Clic here for more details about this article) |
2/9. Troglitazone and liver function abnormalities: lessons from a prescription event monitoring study and spontaneous reporting.OBJECTIVES: To investigate whether there were any cases of liver function abnormalities possibly associated with troglitazone use in general practice in England. DESIGN: A prescription-event monitoring (PEM) study was undertaken between October 1997 and December 1997. SETTING: Data from prescriptions were obtained electronically for the troglitazone cohort in the immediate postmarketing period. STUDY PARTICIPANTS: Event data were obtained for a total of 1344 patients. RESULTS: Troglitazone was effective in 394 (75%) of the 529 patients for whom an opinion was given. The most frequent reasons for stopping treatment related to drug tolerability were malaise/lassitude (16 reports), abnormal liver function tests (II reports) and nausea/vomiting (9 reports). The major cause of stopping troglitazone was because the drug was withdrawn from the market (1101 reports). 30 patients with liver dysfunction were identified from the cohort. In 9 of these patients there were alternative explanations for the liver dysfunction and hence these patients were not followed up further. 21 patients were followed up, for whom 19 questionnaires were returned. In 5 patients their liver dysfunction was assessed as possibly related to troglitazone, in 6 patients the liver dysfunction was unlikely to be attributed to troglitazone, while in 7 patients it was difficult to assess the causality because of limited information and confounding factors. The remaining patient was not included as this individual did not fit the inclusion criteria of the study. CONCLUSION: Although the cohort is small (the drug was available for only 3 months in the UK), 5 patients with abnormal liver function, considered possibly related to troglitazone were detected in this PEM study. It is possible for PEM to contribute to the elucidation of safety signals in the UK.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
3/9. 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 = 1keywords = gland (Clic here for more details about this article) |
4/9. Schmidt's syndrome in a Saudi family.We present 3 patients from a Saudi family who are presented with polyglandular autoimmune syndrome type 2. They have Addison's disease with either autoimmune thyroid disease or insulin dependent diabetic mellitus. Although this syndrome is rare, the incidence among saudi arabia or the Arab population is not known.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/9. Panhypopituitarism in a patient with breast cancer.BACKGROUND: Malaise and fatigue are common symptoms of advanced malignant disease. Nevertheless, a specific cause--requiring specified treatment--for this symptom should be ruled out. We report on a patient with a complex endocrine dysfunction that developed due to a tiny metastasis of a breast carcinoma in the pituitary stalk. CASE REPORT: A 46- year-old woman presented with general ill feeling 3 years after operation for a breast carcinoma. She was diagnosed to have hepatic and peritoneal metastases and malignant pleural effusion. For the application of chemotherapy, an i.v.-port system in the right brachiocephalic vein was inserted. In the postoperative period, an emergency situation developed due to demasked cortisol deficiency and hypernatremia. Careful laboratory investigations revealed hypofunction of the anterior lobe of the pituitary gland and diabetes insipidus centralis. By MRI imaging of the parasellar region, a 4 x 5 mm metastatic lesion in the pituitary stalk was found--notable only in knowledge of the clinical diagnosis. The patient's condition and quality of life improved markedly with hormone replacement therapy. CONCLUSION: Metastatic cancer may present as endocrine disease, either by release of hormone-like substances or by tumorous destruction of endocrine structures. Metastases of solid tumors to the pituitary gland are often asymptomatic or present with diabetes insipidus. The presentation with a hypofunction of the anterior and posterior lobe of the pituitary gland is a rare event. It is recommended to consider endocrine dysfunction as potential cause of 'malaise' in a cancer patient.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
6/9. Exacerbations of Graves' disease after unilateral adrenalectomy for Cushing's syndrome.Cushing's syndrome is characterized by endogenously increased production of glucocorticoids. The activity of immune system is regulated mainly by two systems in the body. glucocorticoids and NF-kappaB counteract the effects of each other on the immune system. It has been reported that immune response is exaggerated after the amelioration of Cushing's syndrome. We report a rare case of exacerbation of Graves' disease after unilateral adrenalectomy for Cusing's syndrome. A 50-yr-obese woman with hypertension, dyslipidemia, impaired glucose tolerance and insulin resistance wasadmitted to outpatients clinic of endocrinology. The results of evaluation of glucocorticoids metabolism and adrenal magnetic resonance imaging revealed the Cusing's syndrome. We also assessed thyroid function tests because of the diagnosis of goiter and thyroid hormone replacement in her medical history, and the presence of exophthalmia and tachycardia in examination. Althoug TSH level was detected at the lower border of normal range, free T4 and free T3 were in normal range and autoantibody of thyroidal peroxidase and thyroglobulin was higer than normal reference range. An operation was performed and a mass was removed from her left adrenal gland. The pathologic examination confirmed adrenal adenoma. She was re-admitted to the outpatient clinic 9 months after with complaints of palpitation, malaise and weight loss. Tests carried out to determine the thyroid function revealed Graves' disease. We prescribed propylthiouracil and beta-blocker treatment.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/9. leptospirosis in new england.Although rarely reported in humans in new england, leptospirosis is enzootic in western and central massachusetts. Recently there were three cases of leptospira interrogans, serotype var pomona, in Easthampton, Mass. Our study and others indicate a potential for waterborne epidemics in humans.- - - - - - - - - - ranking = 5keywords = gland (Clic here for more details about this article) |
8/9. Conn syndrome in a child, caused by adrenal adenoma.hyperaldosteronism owing to aldosterone-producing adenoma (Conn syndrome) is a rare but potentially curable form of pediatric hypertension. The authors report on a 5-year-old girl who had symptoms of polyuria, polydipsia, and fatigue, and for whom the diagnosis of hyperaldosteronemia was suggested by a low serum potassium level and persistent hypertension. The diagnosis was confirmed by increased levels of plasma aldosterone and decreased levels of plasma renin. The tumor was localized with ultrasonography and computed tomography, which showed a 2-cm mass in the left adrenal gland. The left adrenal gland was excised, and pathological assessment showed an adenoma. Only 14 other pediatric cases (< 16 years of age) have been reported in the English-language literature.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
9/9. A case of primary hyperparathyroidism that had been treated under a diagnosis of depression for 10 years.A 66 year old man who had been treated under a diagnosis of depression for 10 years was referred to the Kyoto Prefectural University of medicine, Kyoto because of general fatigue and appetite loss. The patient was diagnosed as having primary hyperparathyroidism (PHPT) based on the increased parathyroid hormone (PTH) and serum calcium levels. Computed tomography revealed solitary adenoma of parathyroid gland. The resection of this solitary adenoma improved the PTH and serum calcium concentrations to normal ranges, which resulted in an improvement in his depressive state. This case suggests that ionic calcium levels contribute to the mental symptoms associated with PHPT. As PHPT is curable, the possibility of PHPT should be taken into account when patients have depressive symptoms.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |