Calcitriol-mediated hypercalcemia secondary to granulomatous disease caused by soft-tissue filler injection: a case report.

Soft-tissue filler (STF) injections have been used worldwide for cosmetic reasons. In most cases, they are not approved by the United States Food and Drug Administration (FDA). Regulatory boards in Latin American countries do not allow the medical use of STF injections; however, these injections are still widely used. A case of calcitriol-mediated hypercalcemia with ectopic calcifications, chronic kidney disease, nephrolithiasis and calcinosis is presented. The reported case highlights the consequences of STF use, including calcitriol-mediated hypercalcemia secondary to granulomatous reactions years after an esthetic procedure.

Stress-induced severe transient hypercortisolism with reversible bilateral adrenal enlargement after cardiogenic shock.

Summary: Acute illness-related stress can result in severe hypercortisolism and bilateral adrenal enlargement in certain patients. We report a case of stress-induced hypercortisolism and bilateral adrenal enlargement in a patient admitted for acute respiratory distress and cardiogenic shock. Bilateral adrenal enlargement and hypercortisolism found during hospitalization for acute illness resolved 3 weeks later following the resolution of acute illness. Acute illness can be a precipitating factor for stress-induced hypercortisolism and bilateral adrenal enlargement. We hypothesize that increased adrenocorticotrophic hormone mediated by corticotrophin-releasing hormone from physical stress resulted in significant adrenal hyperplasia and hypercortisolism. This mechanism is downregulated once acute illness resolves. Learning points: Adrenal enlargement with abnormal adrenal function after stress is uncommon in humans; however, if present, it can have self-resolution after the acute illness is resolved. Stress induces enlargement of the adrenals, and the degree of cortisol elevation could be very massive. This process is acute, and the absence of cushingoid features is expected. Treatment efforts should be focused on treating the underlying condition.

Profile of necessary thyroid tests in a Colombian university hospital / Caracterización del perfil de pruebas tiroideas en un hospital universitario colombiano

Abstract Introduction: There are no clear clinical guidelines for requesting thyroid tests in hospitalized patients. The necessity and profile of requested tests in hospitalized patients at the San Vicente Foundation University Hospital were evaluated. Methods: This retrospective study included patients over 14 years of age who were nonpregnant and hospitalized at the Hospital Universitario de San Vicente Fundación. A total of 351 records were evaluated in the clinical history system, six necessity groups were defined: categories 1 to 4 were considered necessary test requests, and 5 and 6 were considered unnecessary test requests. Demographic and clinical variables were recorded. Quantitative statistical variables were evaluated with the Mann-Whitney U test, and qualitative variables were evaluated with Pearson's chi square and Fisher's tests. Results: Normal values were obtained for 67% of the measured thyroid stimulating hormone (TSH), 80% of the measured thyroxine (T4) and 53% of the measured triiodothyronine (T3). The most frequent abnormality in TSH was an elevation, observed in 24% of tests, the most frequent abnormality for free T4 (T4L) was a decline, observed in 11.5% of tests, and the most frequent abnormality for T3 was an elevation, as observed in 27% of tests. TSH ≤ 0.1 was found in 3.5% and ≥ 20 in 3.9% of tests. Of the 60 patients with elevated TSH, 75% had values between 5 and 9.99 mUI/mL; 11.5% had T4L values ≤ 0.7 ng/dL, and 8.6% had T4L values ≥ 1.48. In total, 95% of T4L measured in the unnecessary category was normal. Conclusions: Requests for necessary thy3roid tests during hospitalization should be improved. An initial approach is proposed only with TSH. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.1057).

Resumen Introducción: se carece de guías clínicas claras para la solicitud de pruebas tiroideas en pacientes hospitalizados. Se evaluó el nivel de pertinencia y tipos de perfil solicitados en pacientes hospitalizados en el Hospital Universitario de San Vicente Fundación. Métodos: estudio retrospectivo en pacientes mayores de 14 años, no gestantes, hospitalizados en el Hospital Universitario de San Vicente Fundación. Se evaluaron 351 registros en el sistema de historia clínica, se definieron seis grupos de pertinencia, las categorías 1 a 4 se consideraron como pertinente, y la 5 y 6 como solicitudes de pruebas no pertinentes. Se registraron variables demográficas y clínicas. Las variables estadísticas cuantitativas fueron evaluadas con la prueba U Mann-Whitney, las variables cualitativas con chi2 Pearson y Estadístico de Fisher. Resultados: se obtuvieron valores normales en 67% de las TSH medidas, en 80% de las T4 y el 53% de las T3. La anormalidad más frecuente de la TSH fue elevación en 24%, para la T4 libre fue su reducción en 11.5% y para la T3 elevación en 27%. Se encontró TSH ≤ 0.1 en 3.5% y ≥ 20 en 3.9%. De los 60 pacientes con TSH elevada el 75% están entre 5 y 9.99 mUI/mL. La T4L ≤ de 0.7 ng/dL fue 11.5% y ≥ 1.48 en 8.6%. El 95% de las T4L medidas en la categoría no pertinente fueron normales. Conclusiones: se debe mejorar la pertinencia de solicitud de pruebas tiroideas en hospitalización. Se propone abordaje inicial solo con TSH. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.1057).