RESUMO
Paraneoplastic syndromes, induced by an immunological cross-reaction or hormone/peptide secretion, are an atypical presentation of tumors. Some tumors, such as small cell lung cancer and bronchial carcinoid, can be adrenocorticotropic hormone (ACTH) secreting tumors. Less commonly, parotid acinic cell carcinoma can be ACTH-secreting tumor leading to Cushing's syndrome. Few literature cases have described ACTH related paraneoplastic syndrome of parotid adenocarcinoma. Because of the rarity of the condition, little is known about the management and prognosis of this phenomenon. In this report, we highlighted the case of a 59-year-old male with a past medical history of parotid adenocarcinoma treated with surgery, chemotherapy, and radiation therapy presented with clinical and biochemical signs of hyperaldosteronism. Abdominal ultra-sound, computed tomography, and magnetic resonance imaging showed hepatic mass. Liver biopsy with immunohistochemistry confirmed the presence of parotid adenocarcinoma secreting ACTH. He is on paclitaxel and carboplatin medication with good clinical response.
Assuntos
Síndrome de ACTH Ectópico , Carcinoma de Células Acinares , Síndrome de Cushing , Síndromes Paraneoplásicas , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/etiologia , Hormônio Adrenocorticotrópico , Carcinoma de Células Acinares/complicações , Carcinoma de Células Acinares/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/etiologiaRESUMO
Diabetic ketoacidosis is a feared complication in patients with diabetes mellitus and poses high risk of mortality and morbidity unless treated in timely manner. Infection is one of the most common precipitating factors for the development of diabetic ketoacidosis. Bacteremia with Group A and Group B beta hemolytic streptococcal strains are well known, however nonenterococcal Group D strains such as the Streptococcus bovis/Streptococcus equinus complex (SBSEC) still remains an understudied entity. Here we present a case of a 35-year-old Type I diabetic female presenting with severe diabetic ketoacidosis with overlapping features of hyperosmolar hyperglycemia, precipitated by Streptococcus alactolyticus bacteremia, successfully treated with four-week course of parenteral ceftriaxone. This case report emphasizes the potential importance of SBSEC as an emerging pathologic strain and culprit for triggering diabetic ketoacidosis which requires prompt diagnosis and targeted therapy.
RESUMO
BACKGROUND: Functional glomus jugulare tumors (GJTs) are commonly managed with resection. Although primary radiation therapy of functional GJT can provide durable control of tumor growth, little is known of its ability to ablate functional capacity. METHODS AND RESULTS: We describe a case of a 47-year-old man with a symptomatic norepinephrine-hypersecreting GJT treated with definitive single-fraction gamma knife radiosurgery and pharmacologic catecholamine blockade. At a 32-month follow-up, he has experienced significant symptomatic improvement, excellent control of local tumor growth, minimal treatment-related morbidity, and near normalization of catecholamine levels. CONCLUSION: Radiosurgery was safe and effective in significantly reducing the functional capacity of a paraganglioma. Care must be taken to avoid inducing a hypertensive crisis during and following treatment, and longer follow-up will help determine whether and when pharmacologic blockade can be discontinued.
Assuntos
Tumor do Glomo Jugular/cirurgia , Norepinefrina/metabolismo , Radiocirurgia , Tumor do Glomo Jugular/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/efeitos adversosRESUMO
OBJECTIVE: We evaluated the role of a single measurement of HbA(1c) in a diabetes case finding in hospitalized patients with random hyperglycemia at admission. RESEARCH DESIGN AND METHODS: From 20 March to 31 July 2000, 508 patients admitted through the emergency department of one hospital were tested for random hyperglycemia (plasma glucose [PG] >125 mg/dl). Consenting patients with hyperglycemia (without preexisting diabetes or on corticosteroids) underwent testing for HbA(1c) levels, two fasting PG levels, and an outpatient oral glucose tolerance test (OGTT) if necessary. RESULTS: Of the patients, 50 (9.8%) met the inclusion criteria. Of these, 70% (n = 35) completed the study, and 60% (n = 21) were diagnosed with diabetes. Patients with diabetes had higher HbA(1c) levels than subjects without diabetes (6.8 +/- 0.4 vs. 5.3 +/- 0.1%, P = 0.002). An HbA(1c) level >6.0% was 100% specific (14/14) and 57% sensitive (12/21) for the diagnosis of diabetes. When a lower cutoff value of HbA(1c) at 5.2% was used, specificity was 50% (10/21) and sensitivity was 100% (7/14). CONCLUSIONS: In acutely ill patients with random hyperglycemia at hospital admission, an HbA(1c) >6.0% reliably diagnoses diabetes, and an HbA(1c) level <5.2% reliably excludes it (paralleling the operating characteristics of the standard fasting glucose measurements); however, the rapidity of the HbA(1c) level can be useful for diabetes case finding and treatment initiation early in the hospital course.