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1.
Eur J Endocrinol ; 182(4): 439-446, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32061159

RESUMO

Introduction: Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study: To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods: Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results: The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions: Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.


Assuntos
Insulinoma/mortalidade , Tumores Neuroendócrinos/mortalidade , Neoplasias Pancreáticas/mortalidade , Feminino , Humanos , Hipoglicemia/etiologia , Hipoglicemia/mortalidade , Hipoglicemia/patologia , Insulinoma/patologia , Insulinoma/terapia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
3.
Mymensingh Med J ; 29(1): 222-227, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915362

RESUMO

Insulinoma is a rare variety of endocrine neoplasm and is usually benign, solitary, and small in size. The hallmark of this disorder is high endogenous insulin secretion resulting in development of symptoms of hypoglycemia. Insulinomas account for 60% of islet cell tumors (ICT) of the pancreas. Ninety percent (90%) of the insulinomas measure less than 2cm. Early localization of the disease is essential to prevent lethal hypoglycemia. Here we report a case of insulinoma in a 28 year old female who subsequently underwent distal pancreatectomy with splenectomy on February 2017 in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Assuntos
Hipoglicemia , Insulinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Adulto , Bangladesh , Diabetes Mellitus Tipo 2/etiologia , Feminino , Humanos , Hiperinsulinismo/etiologia , Hipoglicemia/etiologia , Insulinoma/patologia , Pancreatectomia , Neoplasias Pancreáticas/patologia , Resultado do Tratamento
4.
Internist (Berl) ; 61(3): 321-325, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31996976

RESUMO

A 32-year-old woman with maple syrup urine disease presented with recurring episodes with hypoglycaemia and cerebral seizures. In most cases a connection to the inborn metabolic disorder is assumed, resulting in symptomatic treatment. Due to these treatments invasive procedures are required. This leads to prescriptions of multiple medications and medical aids. After 2 years of unexplained symptoms a routine examination led to the diagnosis of factitious disorder. The patient received the offer for psychiatric/psychotherapeutic treatment. Further prognosis remains uncertain.


Assuntos
Transtornos Autoinduzidos/diagnóstico , Hipoglicemia/etiologia , Doença da Urina de Xarope de Bordo/complicações , Convulsões/etiologia , Adulto , Transtornos Autoinduzidos/psicologia , Feminino , Humanos , Doença da Urina de Xarope de Bordo/psicologia , Prognóstico
5.
Biochem Med (Zagreb) ; 30(1): 010802, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839727

RESUMO

Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually recovered. What happened: The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous administration of glucose. Main lesson: To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting with tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol use.


Assuntos
Analgésicos Opioides/efeitos adversos , Hipoglicemia/diagnóstico , Tramadol/efeitos adversos , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Peptídeo C/sangue , Glucose/administração & dosagem , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/etiologia , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Tramadol/uso terapêutico
6.
Revista Digital de Postgrado ; 9(1): e202, 2020.
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1095048

RESUMO

La diabetes mellitus (DM) se considera como un conjunto de trastornos metabólicos relacionados con la hiperglucemia, que requiere cambios en estilos de vida, en virtud de que no solo se afecta el estado físico, sino que requiere cambios que pueden influir en el estado emocional y psicosocial. Las personas con diabetes requieren de cuidados continuos orientados al control metabólico centrados en el empoderamiento, autocuidado y en la educación terapéutica para alcanzar metas y resultados orientados a minimizar la aparición de las complicaciones crónicas. Objetivo: analizar la importancia de la educación terapéutica en los pacientes con trastornos afectivos como depresión y ansiedad, asociados a la diabetes. Conclusión: la educación terapéutica como parte integral del tratamiento de la DM ha demostrado mejorar los síntomas asociados a depresión y ansiedad, lo cual podría adquirir un valor importante en el manejo de este grupo de pacientes(AU)


Diabetes mellitus (DM) is considered as a set of metabolic disorders related to hyperglycemia, which requires changes in lifestyle, because not only physical condition is affected, but it also requires changes that can influence emotional state and psychosocial. People with diabetes require continuous care oriented to metabolic control focused on empowerment, self-care and therapeutic education to achieve goals and results aimed at minimizing the occurrence of chronic complications. Objective: to analyze the importance of therapeutic education in patients with affective disorders such as depression and anxiety, associated with diabetes. Conclusion: therapeutic education as an integral part of the treatment of DM has been shown to improve symptoms associated with depression and anxiety, which could acquire an important value in the management of this group of patients(AU)


Assuntos
Humanos , Diabetes Mellitus/patologia , Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Diabulimia/patologia , Hipoglicemia/etiologia , Ansiedade , Terapêutica , Sintomas Afetivos , Depressão
7.
BMC Surg ; 19(1): 197, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852474

RESUMO

BACKGROUND: Ectopic insulinoma is a rare entity that is difficult to diagnose before surgery. This article reports two cases of ectopic insulinoma. CASE PRESENTATION: Two patients manifested recurrent hypoglycemia with a typical Whipple triad. In terms of the qualitative diagnosis, the oral glucose tolerance test (OGTT) suggested a diagnosis of hyperinsulinemic hypoglycemia. However, preoperative imaging did not show a significant mass in the pancreas. In one patient, preoperative abdominal enhanced volume perfusion computed tomography (CT), somatostatin receptor imaging and 99mTc-HYNIC-TOC SPECT/CT revealed a mass with a rich blood supply anterior to the duodenum. In the other patient, preoperative enhanced CT, magnetic resonance imaging (MRI) and 68Ga-Exendin-4 PET/CT showed a mass above the spleen. After surgical removal of the tumor, both patients received a confirmed diagnosis of neuroendocrine tumors by postoperative pathology. The symptoms of hypoglycemia were relieved after surgery, and the blood glucose level was significantly increased. CONCLUSION: Ectopic insulinoma is difficult to locate before surgery. 68Ga-Exendin-4 PET/CT has a high diagnostic value. Surgical removal of the lesion is main treatment.


Assuntos
Insulinoma/diagnóstico , Insulinoma/cirurgia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Feminino , Humanos , Hipoglicemia/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
9.
Pan Afr Med J ; 34: 32, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762900

RESUMO

Pancreatic insulinoma is a rare, often benign, neuroendocrine tumor which may give rise to life-threatening consequences due to hypoglycemia-related accidents. Adrenal deficiency can also cause hypoglycemia. We report the case of a 68-year old patient hospitalized for recurrent hypoglycaemia. Tests were performed that showed endogenous hyperinsulinism, adrenocorticotropin deficiency and hypergonadotropic hypogonadism. The patient received hydrocortisone without improvement. Five years later topography showed insulinoma. This study highlights the clinical, biological, radiological and therapeutic features of insulinoma as well as laboratory test results and shows that insulinoma can cause adrenocorticotropic deficiency and peripheral hypogonadism.


Assuntos
Insuficiência Adrenal/etiologia , Hipogonadismo/etiologia , Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Idoso , Humanos , Hidrocortisona/administração & dosagem , Hiperinsulinismo/etiologia , Hipoglicemia/etiologia , Insulinoma/complicações , Masculino , Neoplasias Pancreáticas/complicações
10.
Pan Afr Med J ; 33: 322, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692874

RESUMO

Introduction: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes. Recent years have seen a marked increase in prevalence of diabetic ketoacidosis, but mortality is low. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with severe or moderate DKA admitted to the Emergency Department. Methods: He conducted a prospective, descriptive study including patients with moderate or severe DKA. Standardized care protocol. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study involved 185 patients with moderate or severe DKA. The average age of patients was 38+/-18 years, with a sex ratio of 0.94. Known diabetes was reported in 159 patients (85%) of whom 116 had type 1 diabetes. The most common factors of decompensation were treatment discontinuation in 42% and infection in 32%. Average blood glucose was 32.7+/-12 mmol/L, pH =7.14+/-0.13, HCO3- =7.2+/-3.56 mmol/L. The mean duration of intravenous insulin was 17.3 +/- 16 hours. Hypoglycaemia was reported in 26 patients (14%), hypokalemia in 80 (43%) patients and hyperchloraemic mineral acidosis in 43 patients (23%). Intrahospital mortality was 2.1%. Conclusion: Diabetic ketoacidosis occurs in young subjects treated with insulin therapy. Treatment is based on intravenous insulin associated with correction of fluid deficit. Complications mainly include hypokalemia and hypoglycemia and mortality is low.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/epidemiologia , Insulina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/tratamento farmacológico , Serviço Hospitalar de Emergência , Feminino , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Hipoglicemiantes/administração & dosagem , Hipopotassemia/epidemiologia , Hipopotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
11.
Ann Saudi Med ; 39(5): 359-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580708

RESUMO

Hypoglycemia is a clinically significant disorder with a wide variety of underlying causes. We report an unusual case of hypoglycemic episodes caused by an iatrogenic infection in a 17-year-old white female who presented to our emergency department complaining of 2-3 episodes of syncope per week in the previous year, which started after an appendectomy in 2016. She was hypoglycemic and a vague painless abdominal mass was found upon palpation. An abdominal CT revealed a large, well-defined heterogeneous lesion. The excised mass was surrounded by pieces of gauze that had remained in her abdomen since the appendectomy. An asymptomatic infection was the cause of her hypoglycemic episodes. After antibiotic therapy, the abdominal symptoms resolved within the first week and at follow up at 6 months after surgery, her glucose level was back to normal. This is the first reported case of iatrogenic occult infection with episodic hypoglycemia as a cardinal feature. This case illustrates that infection should remain in the differential diagnosis although cardinal signs are absent. SIMILAR CASES PUBLISHED: 0.


Assuntos
Corpos Estranhos/complicações , Hipoglicemia/etiologia , /diagnóstico , Adolescente , Apendicectomia/efeitos adversos , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hipoglicemia/diagnóstico , Doença Iatrogênica , /etiologia
12.
Turk J Pediatr ; 61(1): 134-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559736

RESUMO

Sag E, Kamasak T, Kaya G, Çakir M. A rare clinical association: Barth syndrome and cystic fibrosis. Turk J Pediatr 2019; 61: 134-138. Barth syndrome (BS) is a rare X-linked recessive metabolic disorder characterized by cardiomyopathy, hypotonia, neutropenia, growth retardation and 3-methylglutaconic aciduria type II. Cystic fibrosis is a common autosomal recessive genetic disorder in Caucasians. Herein, we reported a rare clinical association in an infant diagnosed based on clinical and genetic analysis. A six-month old boy admitted with chronic steatorrhea. The diagnosis of cystic fibrosis was made after clinical and laboratory examinations. Fifteen days later, the patient was presented with restlessness and moaning. He had hypoglycemia and lactic acidosis. The patient died three hours after the admission. Pedigree analysis revealed similar sudden infant deaths in close relatives. Postmortem genetic analysis revealed the diagnosis of Barth syndrome. This is the first case of the association of Barth syndrome with cystic fibrosis. Our case reinforces the importance of pedigree analysis and postmortem examinations.


Assuntos
Síndrome de Barth/diagnóstico , Síndrome de Barth/genética , Fibrose Cística/diagnóstico , Mutação , Fatores de Transcrição/genética , Acidose Láctica/etiologia , Evolução Fatal , Humanos , Hipoglicemia/etiologia , Lactente , Masculino , Linhagem , Esteatorreia/etiologia
13.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527214

RESUMO

A 61-year-old man, without noteworthy medical history, presented with complaints of progressive fatigue and flushes. Diagnostic imaging revealed a large tumour in the stomach with liver metastases, and histopathological examination showed a well-differentiated gastric neuroendocrine tumour (NET). After chemotherapy, everolimus was administered, and upon progression, PD-1 inhibitor PDR001 was started. Two weeks after the first gift, he was admitted with loss of consciousness and a blood glucose level of 1.6 mmol/L. Plasma insulin was below 0.5 mU/L, C-peptide level was 250 pmol/L, insulin-like growth factor (IGF)-II was 804 ng/mL, and pro-IGF-IIE level was 80 µg/L. Based on the clinical findings, the patient was diagnosed with non-islet cell tumour hypoglycaemia (NICTH) with an overproduction of pro-IGF-IIE and eventually IGF-II due to progressive metastatic well-differentiated gastric NET. NICTH is a very rare condition. It has been reported in several tumour types but has never been described as a consequence of NET.


Assuntos
Hipoglicemia/etiologia , Neoplasias Intestinais/patologia , Neoplasias Hepáticas/secundário , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia , Antineoplásicos/uso terapêutico , Glicemia/análise , Quimioterapia Combinada , Nutrição Enteral , Evolução Fatal , Humanos , Hipoglicemia/dietoterapia , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico
14.
Zhonghua Shao Shang Za Zhi ; 35(8): 617-618, 2019 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-31474045

RESUMO

A 44 years old male patient suffered from flame burn of 20% total body surface area was admitted to our hospital on February 14th, 2018. On admission, his abdominal CT was not obviously abnormal. Eleven hours after burn, the patient had left upper abdominal pain, accompanied by reduction of urine output. Then he suffered from sudden hypotension and hypoglycemia. Acute pancreatitis was diagnosed by abdominal CT reexamination. Low glucose level was ameliorated slowly through positive rescue, and pancreatitis crisis progressed rapidly. The family members gave up rescue care, and patient discharged. The case indicates that physicians should pay attention to glucose levels of severe burn patients, and be cautious of appearance of postburn pancreatitis.


Assuntos
Queimaduras/complicações , Hipoglicemia/etiologia , Pancreatite/complicações , Doença Aguda , Adulto , Humanos , Masculino , Pancreatite/diagnóstico
15.
West J Emerg Med ; 20(5): 833-837, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31539342

RESUMO

INTRODUCTION: Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes. METHODS: We included adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009-2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis. The data analysis was descriptive. RESULTS: We reviewed the charts of 591 patients meeting inclusion criteria. Of these 591 patients, 99 (17%; 95% confidence interval, 14-20%) were classified as iatrogenic. Of these 99 patients, 61 (61%) cases of hypoglycemia were caused by insulin administration and 38 (38%) were caused by unrecognized malnutrition. Of the 61 patients with iatrogenic hypoglycemia after ED insulin administration, 45 and 15 patients received insulin for hyperkalemia and uncomplicated hyperglycemia, respectively. One patient received insulin for diabetic ketoacidosis. CONCLUSION: In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipoglicemia/epidemiologia , Doença Iatrogênica , Adulto , Glicemia/metabolismo , Feminino , Humanos , Hipoglicemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Nutrients ; 11(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398808

RESUMO

AIM: We studied the effect of the addition of an oral nutrition supplement (ONS) on the rate of hypoglyemia among hospitalized type 2 diabetes mellitus (DM) patients. METHODS: In this retrospective analysis, all DM patients with hypoalbuminemia (albumin < 3.5 g/dL) admitted to internal medicine "E" at Wolfson Medical Center between 1 June 2016 and 30 April 2017 were included. One bottle of ONS (Glucerna, 330 KCAL, 28 g carbohydrates, 17 g protein, 17 g fat) was added to the morning meal. The consumption of the ONS was verified during the morning rounds. All glucose measurements were recorded automatically in the patients' electronic medical records. A logistic regression model was used to evaluate the effect of the nutrition support on the occurrence of hypoglycemia. RESULTS: 218 patients (mean age 77.4 ± 12.0 years, 63.3% female, mean albumin 3.13 ± 0.32 g/dL), of whom 27.9% had documented hypoglycemia during hospitalization were included. The patients consumed 69.5% ± 37.1 of the ONS provided, and ONS was started 4.3 ± 5.3 days from admission. A logistic regression model indicated that age (Odds ratio [OR] 1.048, 95% CI 1.014-1.083, p = 0.005), insulin treatment (OR 3.059, 95% CI 1.497-6.251, p = 0.002), and the day of ONS started from admission (OR 1.094, 95% CI 1.021-1.173, p = 0.011) were associated with an increased risk of hypoglycemia. Complete consumption of the ONS was associated with a reduced risk of hypoglycemia: OR 0.364, 95% CI 0.149-0.890, p = 0.027. Age, other DM medications and serum albumin did not affect the risk. CONCLUSION: The intake of a complete serving of ONS may be associated with a reduction of the risk of hypoglycemia among diabetes in-patients with hypoalbuminemia.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Carboidratos da Dieta/administração & dosagem , Gorduras Insaturadas na Dieta/administração & dosagem , Suplementos Nutricionais , Hipoalbuminemia/etiologia , Hipoglicemia/terapia , Idoso , Glicemia/análise , Feminino , Hospitalização , Humanos , Hipoglicemia/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
18.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466960

RESUMO

Cancer immunotherapy has been used in several malignancies with clinical benefit. Despite the clinical success, immune-related adverse events are frequent and endocrinopathies can be particularly severe. We report a 55-year-old male patient with stage IV pulmonary carcinoma treated with nivolumab who presented with thyroid dysfunction after the sixth administration of the drug. One year after thyroid dysfunction, the patient complained of severe fatigue, asthenia and weight loss. Laboratory testing showed low morning cortisol with undetected adrenocorticotropic hormone; other pituitary hormones were normal and MRI showed homogeneous enhancement of the pituitary gland and no space-occupying lesions. The diagnosis of nivolumab-induced hypophysitis was made and replacement treatment with hydrocortisone was started with clinical improvement. This case demonstrates that patients under immunotherapy are at risk for a large spectrum of endocrine dysfunctions that may worsen their prognosis. Close monitoring of these patients is warranted.


Assuntos
Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/etiologia , Doenças Genéticas Inatas/etiologia , Hipoglicemia/etiologia , Hipotireoidismo/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/efeitos adversos , Hormônio Adrenocorticotrópico/sangue , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/diagnóstico , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/diagnóstico , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipofisite/induzido quimicamente , Hipofisite/diagnóstico por imagem , Hipofisite/tratamento farmacológico , Hipotireoidismo/complicações , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Resultado do Tratamento
19.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451477

RESUMO

Thyroid storm (accelerated hyperthyroidism) is an uncommon life-threatening emergency. The diagnosis is difficult and at times delayed owing to atypical presentation. Early diagnosis is the key to its successful management. We came across a patient who had presentations of acute abdomen but later diagnosed in thyroid storm. Multiorgan involvement leads all resuscitative measures futile and prevented us to salvage the patient.


Assuntos
Dor Abdominal , Hipoglicemia , Enteropatias/diagnóstico , Icterícia , Insuficiência de Múltiplos Órgãos , Crise Tireóidea , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Deterioração Clínica , Tratamento Conservador/métodos , Cuidados Críticos/métodos , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Icterícia/diagnóstico , Icterícia/etiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Crise Tireóidea/sangue , Crise Tireóidea/complicações , Crise Tireóidea/diagnóstico , Crise Tireóidea/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/etiologia
20.
Am J Case Rep ; 20: 1085-1088, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31337745

RESUMO

BACKGROUND The urea cycle converts amino acids to urea and is excreted by the kidneys. Ornithine carbamoyltransferase (OTC) deficiency is a rare X-linked urea cycle disorder which results in hyperammonemia. Diagnosis is made based on a clinical presentation of poor feeding, hypotonia, biochemical profile, and genetic testing. Another genetic cause for hyperammonemia is hyperammonia hyperinsulinemia (HAHI) syndrome. A mutation coding for glutamate dehydrogenase (GDH) results in increased alpha-keto glutarate and ATP, triggering the secretion of pancreatic insulin. However, unlike OTC deficiency, these patients are asymptomatic but do have symptoms of hypoglycemia. The purpose of this article is to present the case of a 66-year-old woman with an unusual late-onset of OTC deficiency compounded with an underlying HAHI syndrome with co-disease management. CASE REPORT A 66-year-old female with a history significant for transient ischemic attack (TIA) and urea cycle disorder was admitted for new adverse symptoms. Further evaluation revealed hyperammonemia and hypoglycemia. Despite standard previous treatment for her underlying urea cycle disorder, high ammonia levels and hypoglycemia persisted. The contradicting values with continued hypoglycemia regardless of dextrose treatment was suspicious for underlying HAHI. Further genetic testing during her admission revealed a deletion in GLUD-1 gene concurrent with diagnosis of HAHI. After co-diagnosis was established, effective management required medications for both disorders in concordance with dietary restriction. CONCLUSIONS This is an extremely rare case of OTC deficiency, with a vague presentation in an elderly female. Exploring compounding genetic disorders in the presence of one that is already established and early recognition are crucial for prompt diagnosis and management.


Assuntos
Hiperamonemia/terapia , Hiperinsulinismo/terapia , Hipoglicemia/terapia , Doença da Deficiência de Ornitina Carbomoiltransferase/terapia , Idoso , Dieta com Restrição de Proteínas , Feminino , Glucose/administração & dosagem , Glutamato Desidrogenase/genética , Humanos , Hiperamonemia/diagnóstico , Hiperamonemia/genética , Hiperinsulinismo/diagnóstico , Hiperinsulinismo/genética , Hipoglicemia/etiologia , Infusões Intravenosas , Mutação , Doença da Deficiência de Ornitina Carbomoiltransferase/complicações , Edulcorantes/administração & dosagem
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