RESUMO
Intussusception is an infrequent cause of mechanical bowel obstruction in adults and surgical resection is warranted in most cases. Small bowel is a common site of recurrence from cutaneous melanoma but early diagnosis is still a challenge. Acute peritonitis, haemorrhage and obstruction are known clinical presentations. Wide surgical excision with free margins and accompanied mesentery is the treatment of choice and may improve the prognosis. We present a case of small bowel obstruction due to three intussusceptions by metastatic malignant melanoma submitted to surgery.
Assuntos
Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/patologia , Adulto , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Murinos/uso terapêutico , Azatioprina/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Evolução Fatal , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Masculino , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , RituximabRESUMO
Virilising ovarian tumours are a rare cause of hyperandrogenism in women, accounting for less than 5% of all ovarian neoplasms. It occurs most often in - and postmenopausal women. We report a case of a 64 year-old woman with signs of virilisation that had started 3 years before. Blood hormone analysis revealed increased levels of testosterone, and 17-hydroxyprogesterone. The tetracosactin test revealed 21-hydroxylase deficiency. Radiological imaging demonstrated a nodule in her left ovary. The patient was submitted to bilateral laparoscopic oophorectomy, and histopathological examination revealed a luteoma of the left ovary. Postoperative serum testosterone level and 17-hydroxyprogesterone returned to normal levels in one month. Virilism regressed within six months. Our patient also showed an elevation in 17-OHP serum levels. Normalization of 17-OHP after oophorectomy suggests a case of intratumoral 21-hydroxylase deficiency. To our knowledge, this is the first description of ovarian intratumoral 21-hydroxylase deficiency in a postmenopausal woman. Arq Bras Endocrinol Metab. 2012;56(9):672-6.
Tumores ovarianos virilizantes são uma causa rara de hiperandrogenismo em mulheres, contabilizando menos de 5% de todos as neoplasias ovarianas. Esses tumores ocorrem mais comumente em mulheres em peri ou pós-menopausa. Relatamos aqui o caso de uma mulher de 64 anos de idade com sintomas de virilização que começaram 3 anos antes. O perfil hormonal revelou níveis aumentados de testosterona e de 17-hidroxiprogesterona (17-OHP). O teste de tetracosactin demonstrou deficiência de 21-hidroxilase. Exames radiológicos mostraram um nódulo no ovário esquerdo. A paciente foi submetida à ooforectomia laparoscópica bilateral e o exame histopatológico revelou um luteoma no ovário esquerdo. A concentração sérica de testosterona e de 17-hidroxiprogesterona após a cirurgia retornou aos níveis normais em um mês. A virilização regrediu em 6 meses. Nossa paciente também revelou uma elevação dos níveis séricos de 17-OHP. A normalização da 17-OHP após a ooforectomia sugere um caso de deficiência de 21-hidroxilase intratumoral. Esta é a primeira descrição de deficiência de 21-hidroxilase intratumoral em uma mulher na pós-menopausa. Arq Bras Endocrinol Metab. 2012;56(9):672-6.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Hiperplasia Suprarrenal Congênita/patologia , Hirsutismo/etiologia , Luteoma/complicações , Neoplasias Ovarianas/complicações , Cosintropina , Hirsutismo/patologia , Luteoma/patologia , Neoplasias Ovarianas/patologia , Pós-Menopausa , Testosterona/sangueRESUMO
We report a 9-month-old male patient with autoimmune enteropathy treated with intravenous methylprednisolone who developed firm, red, subcutaneous nodules 20 days after abrupt steroid interruption. The diagnosis of poststeroid panniculitis (PSP) was made based on clinical and histological grounds. PSP is an unusual complication of systemic corticosteroid therapy, which might occur following rapid steroid tapering or withdrawal. Physicians should be aware of this rare condition and distinguish it from other causes of erythematous subcutaneous nodules and plaques in children.
Assuntos
Glucocorticoides/efeitos adversos , Metilprednisolona/efeitos adversos , Paniculite/induzido quimicamente , Diarreia/tratamento farmacológico , Humanos , Lactente , Masculino , Poliendocrinopatias Autoimunes/tratamento farmacológicoRESUMO
Virilising ovarian tumours are a rare cause of hyperandrogenism in women, accounting for less than 5% of all ovarian neoplasms. It occurs most often in - and postmenopausal women. We report a case of a 64 year-old woman with signs of virilisation that had started 3 years before. Blood hormone analysis revealed increased levels of testosterone, and 17-hydroxyprogesterone. The tetracosactin test revealed 21-hydroxylase deficiency. Radiological imaging demonstrated a nodule in her left ovary. The patient was submitted to bilateral laparoscopic oophorectomy, and histopathological examination revealed a luteoma of the left ovary. Postoperative serum testosterone level and 17-hydroxyprogesterone returned to normal levels in one month. Virilism regressed within six months. Our patient also showed an elevation in 17-OHP serum levels. Normalization of 17-OHP after oophorectomy suggests a case of intratumoral 21-hydroxylase deficiency. To our knowledge, this is the first description of ovarian intratumoral 21-hydroxylase deficiency in a postmenopausal woman.
