A Case Report of Sheehan Syndrome: A Rare Cause of Hypopituitarism.

Sheehan syndrome is a rare cause of hypopituitarism characterized by pituitary gland necrosis after postpartum hemorrhage. It is a pertinent cause of maternal morbidity and mortality in developing countries with deficient obstetrical care but is frequently overlooked in developed countries where its occurrence is uncommon. We present the case of a 66-year-old female diagnosed with Sheehan syndrome more than 30 years after her last delivery complicated by postpartum hemorrhage. Although the patient presented several symptoms and signs of pituitary hormonal deficiencies, a diagnosis had never been established before. The complete laboratory analysis revealed a deficiency in the pituitary axis, and the cranial imaging showed an empty sella turcica. Hormonal replacement therapy resolved several impairments in terms of general energy, physical capacity, temperature regulation, skin characteristics, and sexual function. It also improved her cardiovascular and osteoporosis risk, and, most importantly, prevented a potential life-threatening adrenal crisis. This report highlights the subtle manifestations of Sheehan syndrome to help clinicians establish a prompt diagnosis. Even in developed countries such as Portugal, this condition should be regarded as a potential cause of hypopituitarism.

Premolares con tres conductos radiculares / Premolars with three root canals / Pré-molares com três canais radiculares

RESUMEN El sistema de conductos radiculares es complejo. En él podemos encontrar piezas dentales como los premolares, cuya anatomía interna es variable. Así pues, en las piezas premolares superiores predominan tres conductos, mientras que en las piezas premolares inferiores se observa un menor porcentaje de incidencia. Hoy en día, el uso de las tomografías computarizadas es indispensable ya que estas nos brindan imágenes tridimensionales que nos ayudan a generar un correcto diagnóstico, garantizar un adecuado procedimiento y lograr el mejor pronóstico favorable para una endodoncia. El propósito del presente artículo de revisión es compendiar información en una búsqueda manual de artículos diferentes de investigación científica de PubMed y Google Académico, donde se describirán las variaciones anatómicas, el diagnóstico y el tratamiento de los dientes premolares con tres conductos.

ABSTRACT The root canal system is complex. In it we can find dental pieces such as premolars, whose internal anatomy is variable. Thus, in the upper premolars three canals predominate, while in the lower premolars there is a lower percentage of incidence. Nowadays, the use of CT scans is indispensable since they provide us with three-dimensional images that help us to generate a correct diagnosis, guarantee an adequate procedure and achieve the best favorable prognosis for endodontics. The purpose of this review article is to summarize information in a manual search of different scientific research articles from PubMed and Google Scholar, where the anatomical variations, diagnosis, and treatment of premolar teeth with three canals will be described.

RESUMO O sistema de canais radiculares é complexo. Inclui dentes como os pré-molares, cuja anatomia interna é variável. Assim, nos pré-molares superiores predominam os três canais, enquanto nos inferiores observa-se uma menor percentagem de incidência. Hoje em dia, a utilização da tomografia computadorizada é indispensável, uma vez que nos fornece imagens tridimensionais que nos ajudam a gerar um diagnóstico correto, a garantir um procedimento adequado e a obter o melhor prognóstico favorável em endodontia. O objetivo deste artigo de revisão é compilar informação proveniente de uma pesquisa manual de diferentes artigos de investigação científica da PubMed e do Google Scholar, descrevendo as variações anatómicas, o diagnóstico e o tratamento de dentes pré-molares com três canais.

Addison's Disease: A Diagnosis Easy to Overlook.

Addison's disease is a rare and potentially life-threatening clinical condition that often presents with an insidious onset of nonspecific symptoms and signs, frequently resulting in a significant delay in diagnosis. Clinical presentation usually includes fatigue and electrolyte imbalance disorders such as hyponatremia. However, specific diagnostic features, such as hyperpigmentation, should raise clinical suspicion. This case report describes a 43-year-old Caucasian male who presented with general malaise, fatigue, anorexia, and weight loss (7 Kg in four weeks). On physical examination, he was found to have severe hyperpigmentation of the skin and mucosal surfaces as well as hypotension. Laboratory tests revealed hypoosmolar hyponatremia and serum potassium levels in the upper limit of normal. Findings of high serum adrenocorticotropic hormone (ACTH) and renin, as well as low cortisol and aldosterone levels, helped establish a diagnosis of Addison's disease. After the initiation of treatment, the patient experienced full recovery of symptoms, normalization of hyponatremia, and improvement of hyperpigmentation. Patients with Addison's disease have the potential to resume normal daily activities with a highly functional status. However, this condition requires lifelong follow-up and surveillance.