RESUMO
BACKGROUND: Antithyroid drug-induced agranulocytosis (AIA) (neutrophils <500/µL) is a rare but serious complication in the treatment of hyperthyroidism. METHODOLOGY: Adult patients with AIA who were followed up at 12 hospitals in Spain were retrospectively studied. A total of 29 patients were studied. The etiology of hyperthyroidism was distributed as follows: Graves' disease (n = 21), amiodarone-induced thyrotoxicosis (n = 7), and hyperfunctioning multinodular goiter (n = 1). Twenty-one patients were treated with methimazole, as well as six patients with carbimazole and two patients with propylthiouracil. RESULTS: The median (IQR) time to development of agranulocytosis was 6.0 (4.0-11.5) weeks. The most common presenting sign was fever accompanied by odynophagia. All of the patients required admission, reverse isolation, and broad-spectrum antibiotics; moreover, G-CSF was administered to 26 patients (89.7%). Twenty-one patients received definitive treatment, thirteen patients received surgery, nine patients received radioiodine, and one of the patients required both treatments. Spontaneous normalization of thyroid hormone values occurred in six patients (four patients with amiodarone-induced thyrotoxicosis and two patients with Graves' disease), and two patients died of septic shock secondary to AIA. CONCLUSIONS: AIA is a potentially lethal complication that usually appears around 6 weeks after the initiation of antithyroid therapy. Multiple drugs are required to control hyperthyroidism before definitive treatment; additionally, in a significant percentage of patients (mainly in those treated with amiodarone), hyperthyroidism resolved spontaneously.
RESUMO
OBJECTIVE: To analyze the clinical features, diagnostic procedures, treatment, and clinical outcome of insulinomas diagnosed and treated in the period 1983-2014 in four Spanish hospitals. METHODS: All patients with either biochemical and morphological criteria of insulinoma and/or histological demonstration of insulin-secreting tumor were included. RESULTS: Twenty-nine patients [23 women (79.3%); mean age 48.7±17.4 years (range, 16-74)] were recruited. Twenty-six patients (89.7%) had sporadic tumors, and the rest (3 women, 10.3%) developed in the context of multiple endocrine neoplasia type 1. There were 3 (10.3%) multiple insulinomas, one associated with multiple endocrine neoplasia type 1, and two (6.9%) malignant insulinomas, both sporadic. Most patients (n=18, 62.1%) had fasting hypoglycemia, about a third (31%) both postprandial and fasting hypoglycemia, and 6.9% postprandial hypoglycemia only. Time to glucose nadir (37.3±6.5mg/dL) in the fasting test was 9.0±4.4h, with maximal insulin levels of 25.0±20.3µU/mL. Abdominal CT detected insulinoma in 75% of patients. Twenty-seven (93.1%) patients underwent surgery [enucleation, 18 (66.7%) and subtotal pancreatectomy, 9 (33.3%); tumor size, 1,7±0,7cm]. Surgery achieved cure in the majority (n=24, 88.9%) of patients. CONCLUSION: In our setting, insulinoma is usually a benign, small, and solitary tumor, mainly affecting women aged 45-50 years, and usually localized with abdominal CT. The most commonly used surgical technique is enucleation, which achieves a high cure rate.