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Pheochromocytomas and paragangliomas are catecholamine-secreting tumors that originate from chromaffin cells of the adrenal medulla and autonomic neural ganglia, respectively. Patients with pheochromocytomas and paragangliomas typically present with paroxysmal headache, sweating, tachycardia, and hypertension. Although most pheochromocytoma cases are sporadic, many of the cases occur as part of a genetic disorder. Here, we report the case of a 14-year-old male patient who presented with hypertension. Laboratory tests showed elevated levels of serum and urinary catecholamines, metanephrines, and chromogranin. Abdominal ultrasound and computed tomography studies revealed bilateral solid adrenal masses and an isolated splenic mass. Further assessment identified an underlying Von Hippel-Lindau syndrome. The patient was initially treated medically and later surgically. This case highlights the importance of always considering pheochromocytomas and paragangliomas as rare differentials of secondary hypertension, especially in the presence of episodic headaches, sweating, and tachycardia. Furthermore, screening for underlying genetic disorders, such as in our case, should be considered in cases of bilateral tumors, onset at a young age, and presence of extra-adrenal tumors.
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Background With type 2 diabetes (T2D) posing an escalating health challenge to the Kingdom of Bahrain, enhancing public awareness becomes instrumental in mitigating disease outcomes. This study aimed to appraise the level of T2D awareness among the non-medical Bahraini population by evaluating their understanding of the disease, its risk factors, symptoms, complications, monitoring, and prevention methods. Methods We conducted a cross-sectional study from March 2022 to June 2022. The study employed an electronic survey using Google® Forms (Google LLC, Mountain View, California, USA) targeting non-healthcare workers aged 15 and above. The survey consisted of multiple yes-and-no questions designed to evaluate different aspects of respondents' T2D knowledge. Results Out of 835 participants, a total of 613 participants were included. The overall awareness of T2D was found to be average (70.6% CI±6.214, SD ±8.80%). The mean scores of correct answers in the different sections such as general knowledge, risk factors, symptoms, complications, treatment, monitoring, and prevention of T2D were 54.5% CI ±14.8, 75.5% CI±12.5, 77.6% CI±5.3, 61.8% CI±8.5, and 73.4% CI±5.4 respectively. Furthermore, the diabetic population scored an average of 76.7% in awareness in comparison to the non-diabetic population which scored 72.5% in overall awareness. Conclusions These findings underscore the pressing need to enhance T2D awareness among the Bahraini population. Implementing early education programs and strategically utilizing social media platforms may aid in bolstering public understanding of T2D, aiming ultimately to reduce its prevalence and associated economic burden.
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Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum is a rare clinical condition. We present a 75-year-old male with primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum. This patient was initially referred to the clinic for suspected incidental hypercalcemia. Initial imaging showed two suspicious lesions: one adjacent to the thyroid gland and another in the mediastinum. Further investigations identified a sole mediastinal adenoma. The diagnosis was confirmed by normalization of parathyroid hormone levels after its surgical resection. Thoroughly diagnosing such cases can prove challenging and using a single modality such as ultrasonography, computed tomography, or nuclear imaging alone may not yield conclusive findings or can give false positive results. Our case demonstrates that a combination of several imaging modalities can lead to accurate localization of the cause of primary hyperparathyroidism. This will obviate the performance of unnecessary surgical procedures. In addition, the possibility of missing additional sources of ectopic secretions of the parathyroid hormone will be reduced.
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Hyperthyroidism is a common disease. Thyroglossal duct cysts are also a very common type of congenital anomalies. Their co-existence is, however, rare with only a few cases described in the literature of the same. We describe the case of a 44-year-old female who presented initially 16 years ago with hyperthyroid symptoms related to Graves' disease diagnosed serologically and by thyroid scan and ultrasound. Incidentally, she was also noted to have a non-complicated thyroglossal duct cyst. She was initially started on anti-thyroid medications but remained in a hyperthyroid state throughout most of her illness. Radioiodine ablative therapy and surgical resection were delayed due to the patient's dispreference. After a long period of missed follow up, she presented with a thyroid storm and underwent a total thyroidectomy and cyst resection. The key endocrine issues learned from this case include: 1) dealing with non-compliant patients in terms of poorly controlled hyperthyroidism and refusal to follow the recommended treatment, 2) observing the natural disease progression of untreated Graves' disease coexisting with a thyroglossal duct cyst, and 3) describing a rare incidental finding of a thyroglossal duct cyst coexisting with Graves' disease in the absence of ectopic hormone production. A few cases have described hyperthyroidism related to remnants of thyroid tissue in the thyroglossal duct or related to the thyroid gland. To the best of our knowledge, there are no cases reported of Graves' disease coexisting with a non-complicated thyroglossal duct cyst making our case unique and first of its kind.
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Thyrotoxicosis complicated by advance degree atrioventricular block, a rare complication of a common disease. The term apathetic thyrotoxicosis, where palpitations and cardiac involvement are the sole manifestations of disease, is well known. Thyroxin's ability to sensitize the catecholamine receptors causing tachyarrhythmias is well addressed. However, as an aetiology for advanced heart block, thyrotoxicosis is ranked as one of the rarest.
