RESUMO
BACKGROUND: Double pituitary adenomas are a rare occurrence. Synchronous clinical manifestation is extremely rare. CASE DESCRIPTION: We report a case of a 51-year-old female with symptoms of both hypercortisolism and acromegaly during the past 2 years. Endocrine evaluation confirmed active acromegaly and revealed adrenocorticotropin hormone-dependent hypercortisolemia. Preoperative magnetic resonance imaging of the pituitary demonstrated separated double microadenomas with different intensity. Immunohistochemical analysis of each separate adenoma confirmed an exact diagnosis. The diagnosis of acromegaly and adrenocorticotropin hormone-dependent Cushing's disease was confirmed. CONCLUSIONS: This is the third reported case in the literature of synchronous clinical manifestation of acromegaly and Cushing's disease. Extensive surgical exploration of the sella must be performed to avoid surgical failures from residual tumor. Immunohistochemical analysis is required to confirm an exact diagnosis for each of the double pituitary adenomas.
Assuntos
Adenoma Hipofisário Secretor de ACT/diagnóstico por imagem , Adenoma Hipofisário Secretor de ACT/cirurgia , Acromegalia/diagnóstico por imagem , Acromegalia/etiologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Hipersecreção Hipofisária de ACTH/diagnóstico por imagem , Hipersecreção Hipofisária de ACTH/etiologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Corticotrofos/metabolismo , Feminino , Humanos , Hidrocortisona/metabolismo , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Somatotrofos/metabolismo , Resultado do TratamentoRESUMO
Hypercalcemia in hypoparathyroidism has rarely been described. A 55 year-old male patient with primary hypoparathyroidism, left eye melanoma, and Noonan's syndrome, was referred to the endocrinology clinics due to hypoparathyroidism. Laboratories showed serum calcium of 7.8 mg/d, and phosphate 4.8 mg/dl, while using calcium carbonate 1200 mg and vitamin D3 600 IU daily. Calcitriol 0.25 mcg daily was started and calcium carbonate discontinued. Abdominopelvic CT scan and thoracolumbar MRI, showed metastasis to liver, pancreas, and osteolytic lesions in spine, humerus, and ribs. Liver biopsy confirmed metastatic melanoma. Eight weeks later, serum calcium increased to 12 mg/dl. PTH, vitamin D 1,25-OH and PTHrP levels were within the lower range of normal compatible with hypercalcemia of malignancy, secondary to osteolytic disease. Zoledronic acid was added to treat hypercalcemia and bone pain. Our case demonstrates a successful treatment and monitoring of hypocalcemia after administration of bisphosphonate in a patient with hypoparathyroidism.
Assuntos
Hipercalcemia/etiologia , Hipoparatireoidismo/fisiopatologia , Melanoma/complicações , Ácido Zoledrônico/administração & dosagem , Conservadores da Densidade Óssea/administração & dosagem , Calcitriol/administração & dosagem , Difosfonatos/administração & dosagem , Neoplasias Oculares/patologia , Humanos , Hipercalcemia/tratamento farmacológico , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Pessoa de Meia-Idade , Síndrome de Noonan/fisiopatologiaRESUMO
This is the case of a 38 year-old female patient with an intrauterine pregnancy, in which a previous incidentally identified adrenal mass proved to be a pheochromocytoma during the antenatal period. The patient was started on α-and ß-adrenergic blockade to maintain hemodynamic stability, and surgical removal of the lesion was performed during the second trimester without major complications. In view of the rarity of this disorder in pregnancy, it is imperative to have a high index of suspicion for a prompt and dedicated management, since this tumor, if unrecognized, is associated with high fetal and maternal mortality.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Feocromocitoma/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Feminino , Humanos , Feocromocitoma/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/cirurgia , Segundo Trimestre da GravidezRESUMO
Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years. Although it typically presents as a thyroid nodule, it can spread to distant sites via hematogenous dissemination. Bone metastasis is diagnosed clinically in 2%-13% of patients with differentiated thyroid cancer; nevertheless spinal cord compression complicating thyroid carcinoma is rare and only few cases has been reported in the literature. This case illustrates a strange case of a minimally invasive follicular carcinoma that showed an aggressive behavior, and thus the importance of considering metastatic thyroid carcinoma in the differential diagnosis of chronic back pain progressing to spinal cord compression carrying a severe morbidity.
Assuntos
Adenocarcinoma Folicular/diagnóstico , Dor nas Costas/etiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/patologia , Dor Crônica/etiologia , Diagnóstico Diferencial , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias da Glândula Tireoide/patologiaRESUMO
Follicular thyroid carcinoma is the second most common type of thyroid cancer, and its incidence has increased dramatically in recent years. Although it typically presents as a thyroid nodule, it can spread to distant sites via hematogenous dissemination. Spinal cord compression complicating thyroid carcinoma is rare with only few cases reported in the literature. This case illustrates a minimally invasive follicular carcinoma that showed such an aggressive behavior, and thus the importance of considering metastatic thyroid carcinoma in the differential diagnosis of chronic back pain, which may possibly progress to spinal cord compression carrying severe morbidity.
Assuntos
Adenocarcinoma Folicular/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adenocarcinoma Folicular/complicações , Dor nas Costas/etiologia , Dor Crônica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/complicaçõesRESUMO
OBJECTIVE: To describe the state of glycemic control in noncritically ill diabetic patients admitted to the Puerto Rico University Hospital and adherence to current standard of care guidelines for the treatment of diabetes. METHODS: This was a retrospective study of patients admitted to a general medicine ward with diabetes mellitus as a secondary diagnosis. Clinical data for the first 5 days and the last 24 hours of hospitalization were analyzed. RESULTS: A total of 147 noncritically ill diabetic patients were evaluated. The rates of hyperglycemia (blood glucose ≥180 mg/dL) and hypoglycemia (blood glucose <70 mg/dL) were 56.7 and 2.8%, respectively. Nearly 60% of patients were hyperglycemic during the first 24 hours of hospitalization (mean random blood glucose, 226.5 mg/dL), and 54.2% were hyperglycemic during the last 24 hours of hospitalization (mean random blood glucose, 196.51 mg/dL). The mean random last glucose value before discharge was 189.6 mg/dL. Most patients were treated with subcutaneous insulin, with basal insulin alone (60%) used as the most common regimen. The proportion of patients classified as uncontrolled receiving basal-bolus therapy increased from 54.3% on day 1 to 60% on day 5, with 40% continuing to receive only basal insulin. Most of the uncontrolled patients had their insulin dose increased (70.1%); however, a substantial proportion had no change (23.7%) or even a decrease (6.2%) in their insulin dose. CONCLUSION: The management of hospitalized diabetic patients is suboptimal, probably due to clinical inertia, manifested by absence of appropriate modification of insulin regimen and intensification of dose in uncontrolled diabetic patients. A comprehensive educational diabetes management program, along with standardized insulin orders, should be implemented to improve the care of these patients.