RESUMO
INTRODUCTION: Methadone is a synthetic opioid which is being used with increased frequency in the palliative care setting for management of complex pain. There have been cases published reporting the development of oedema with methadone maintenance therapy but no cases on the association with methadone and peripheral oedema in the palliative care setting. As yet, the underlying mechanisms are unclear. CASE PRESENTATION: This case report describes a gentleman with ependymoma and difficult-to-control lower back pain and scrotal pain. This pain had failed to respond to other strong opioids. He was prescribed methadone and then subsequently developed bilateral peripheral oedema. CASE MANAGEMENT: Peripheral oedema resolved following cessation of methadone. CONCLUSIONS: This highlights an important potential adverse effect of methadone in a society of increased methadone prescription for pain control. The published literature to date is reviewed and possible underlying mechanisms explored.
Assuntos
Alfentanil/uso terapêutico , Analgésicos Opioides/administração & dosagem , Dor nas Costas/tratamento farmacológico , Edema/induzido quimicamente , Ependimoma/tratamento farmacológico , Metadona/administração & dosagem , Neoplasias da Coluna Vertebral/tratamento farmacológico , Adulto , Analgésicos Opioides/efeitos adversos , Esquema de Medicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Ependimoma/complicações , Humanos , Infusão Espinal , Masculino , Metadona/efeitos adversos , Cuidados Paliativos , Escroto , Neoplasias da Coluna Vertebral/complicações , Resultado do TratamentoRESUMO
Adrenal incidentalomas (AIs) are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in several investigations that are usually conducted in the endocrinology clinic. In 2011, we audited the prevalence and management of AIs identified on computed tomography (CT) imaging of abdomen over 1 calendar month. Consequently, a decision pathway for adrenal lesions was introduced in the radiology department of the Royal Free London Hospital. One year later, we re-audited the local practice. In total, 690 CT scans were reviewed in 2011 compared with 1,264 in 2012. In 2011, 17 (2.46%) patients with AIs were identified, and 26 (2.01%) in 2012. Of those, 1.01% in 2011 and 0.95% in 2012 had newly identified AIs. Only a few patients had been tested to exclude a functional lesion and there was inconsistent terminology in reporting adrenal lesions. Therefore, we support comprehensive reporting of AIs and a selective testing strategy.