Asunto(s)
Oftalmopatías/inducido químicamente , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Enfermedad Arterial Periférica/inducido químicamente , Pirimidinas/efectos adversos , Xantomatosis/inducido químicamente , Oftalmopatías/diagnóstico por imagen , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Pirimidinas/administración & dosificación , Radiografía , Xantomatosis/diagnóstico por imagenRESUMEN
Thymus hyperplasia and Graves' disease association is not well known and is probably not incidental. We report the case of a young woman affected with Graves' disease in which a retrosternal mass was disclosed during a neck ultrasonographic-examination and confirmed by chest CT-examination. Follow-up ultrasound survey showed a decrease in the thymic mass size. Because of various antithyroid drugs allergy, a surgical procedure was performed, during which both her thyroid and thymic mass were removed. The histopathologic examination of this mass confirmed the hyperplasic nature of the thymic bulging. Ninety-one cases of thymus hyperplasia and Graves' disease association have been reported in literature, of which 20 were histologically confirmed. Among these cases 35 showed a thymic mass regression under medical treatment alone. Accordingly, surgical procedures are most frequently unnecessary in such associations because of the thymic mass decrease incurred by antithyroid drug treatment.
Asunto(s)
Enfermedad de Graves/complicaciones , Hiperplasia del Timo/complicaciones , Adulto , Antitiroideos/uso terapéutico , Femenino , Enfermedad de Graves/cirugía , Humanos , Hiperplasia del Timo/diagnóstico , Hiperplasia del Timo/cirugíaRESUMEN
Ritonavir and atazanavir (ATZ) are protease inhibitors (PI) that inhibit the P450 3A4 cytochrome. They are used together to boost ATZ levels and reduce pill burden in human immunodeficiency virus infection, but association with medications metabolized by this cytochrome can cause serious adverse effects. Several cases of Cushing's syndrome have been reported when patients received inhaled therapy with fluticasone for asthma, sometimes complicated by secondary adrenal failure after stopping fluticasone. We report a case of Cushing's syndrome associated with onset of diabetes mellitus in a patient treated with boosted PI (ATZ and ritonavir) for HIV 2 (CD4360/ml). Asthma was treated with inhaled fluticasone 1500mug/day for several months that was stopped at admission. A few days later, typical secondary adrenal failure developed and was confirmed by dosage of cortisol and ACTH, both low. Hydrocortisone replacement treatment resulted in rapid improvement of symptoms. Diabetes was initially treated with insulin then sulfonyluraes, but repeated hypoglycemias lead to diet alone. Physicians should be aware of the potential danger of the association of "boosted" IP and some kind of inhaled corticotherapy.
Asunto(s)
Androstadienos/efectos adversos , Síndrome de Cushing/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Ritonavir/efectos adversos , Administración por Inhalación , Hormona Adrenocorticotrópica/sangre , Glucemia/metabolismo , Broncodilatadores/efectos adversos , Creatinina/metabolismo , Síndrome de Cushing/tratamiento farmacológico , Complicaciones de la Diabetes/tratamiento farmacológico , Dieta para Diabéticos , Fluticasona , Hemoglobina Glucada/metabolismo , Inhibidores de la Proteasa del VIH/efectos adversos , VIH-2 , Humanos , Hidrocortisona/sangre , Hidrocortisona/uso terapéutico , Masculino , Persona de Mediana Edad , Tiroxina/sangreRESUMEN
A 54-year-old woman was referred to hospital because of poor metabolic control. Clinical examination revealed marked acanthosis nigricans, and a striking lack of adipose tissue on the limbs, and excess fat deposits on the neck and face. She had been treated for diabetes since 2001 with high doses of insulin along with metformin. Clinical tests showed hypertriglyceridaemia with low high density lipoprotein (HDL) cholesterol, and cholestasis with mild cytolysis. Dunnigan syndrome (familial partial lipodystrophy type 2) was suspected and confirmed by molecular genetics. Pioglitazone was added to her treatment, and follow-up showed improvement of metabolic control 7 months after introducing pioglitazone, and improvement of insulin sensitivity 2 years later. Diabetes related to mutations of the lamin A/C gene is difficult to treat because of severe insulin resistance. Nevertheless, therapy with pioglitazone resulted in marked and sustained improvements in metabolic control and insulin sensitivity.