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1.
Artigo em Inglês | MEDLINE | ID: mdl-33542545

RESUMO

The current Coronavirus disease outbreak requires that physicians work in collaboration with other physicians especially in intensive care and emergency units. To fight against this new disease, whose pathogenesis, effects, and results have not been clearly demonstrated, especially in patients with the pre-existing chronic disease, requires special expertise and perspectives. Due to the need for dynamic glucocorticoid treatment at different stages of the disease in patients with adrenal insufficiency, the existence of reports indicating that "coronavirus disease 2019" also affects the adrenal reserve, and the use of glucocorticoids also in advanced stages in patients with Coronavirus disease require this issue to be emphasized with precision. Herein, treatment of the pre-existing adrenal insufficiency in patients with actual Coronavirus disease and the effects of the this critical disease on the adrenal gland have been reviewed.


Assuntos
Insuficiência Adrenal/tratamento farmacológico , Glucocorticoides/uso terapêutico , Hidrocortisona/uso terapêutico , Glândulas Suprarrenais/metabolismo , Insuficiência Adrenal/complicações , Insuficiência Adrenal/metabolismo , Gerenciamento Clínico , Progressão da Doença , Terapia de Reposição Hormonal/métodos , Hospitalização , Humanos , Inflamação , Estresse Fisiológico
2.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495195

RESUMO

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Insuficiência Adrenal/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Testes de Função do Córtex Suprarrenal , Insuficiência Adrenal/induzido quimicamente , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Idoso , Asma/tratamento farmacológico , Proteína C-Reativa/metabolismo , Diagnóstico Diferencial , Ecocardiografia , Eczema/tratamento farmacológico , Eletrocardiografia , Glucocorticoides/efeitos adversos , Terapia de Reposição Hormonal , Humanos , Hidrocortisona/uso terapêutico , Hiperpotassemia/etiologia , Hiponatremia/etiologia , Masculino , Pneumonia/complicações , Pneumonia/diagnóstico , Cardiomiopatia de Takotsubo/complicações
4.
Clinics (Sao Paulo) ; 75: e2022, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555949

RESUMO

The coronavirus disease 2019 (COVID-19) is an emerging pandemic challenge. Acute respiratory distress syndrome (ARDS) in COVID-19 is characterized by a severe cytokine storm. Patients undergoing glucocorticoid (GC) replacement therapy for adrenal insufficiency (AI) represent a highly vulnerable group that could develop severe complications due to the SARS-CoV-2 infection. In this review, we highlight the strategies to avoid an adrenal crisis in patients with AI and COVID-19. Adrenal crisis is a medical emergency and an important cause of death. Once patients with AI present symptoms of COVID-19, the dose of GC replacement therapy should be immediately doubled. In the presence of any emergency warning signs or inability to administer oral GC doses, we recommend that patients should immediately seek Emergency services to evaluate COVID-19 symptoms and receive 100 mg hydrocortisone by intravenous injection, followed by 50 mg hydrocortisone intravenously every 6 h or 200 mg/day by continuous intravenous infusion.


Assuntos
Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Glucocorticoides/administração & dosagem , Hidrocortisona/administração & dosagem , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Humanos , Injeções Intravenosas , Fatores de Risco , Índice de Gravidade de Doença
5.
Eur J Clin Invest ; 50(7): e13262, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32383239

RESUMO

The Covid-19 pandemic confronted us with unknown clinical pictures, also in diabetology and endocrinology. Sharing clinical experiences is therefore of enormous importance. Actually, information about the care given in the Covid-19 ward (in contrast to that provided in the Emergency Room/ICU) is still sparse. The last weeks we built experience and gathered knowledge while giving hospital care to patients who had a pre-existent endocrine disease (and diabetes; most patients suffered from a type two diabetes). In our contribution we presented our insights obtained from this intensive period obtained in the Covid-19 ward.


Assuntos
Infecções por Coronavirus/terapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Pneumonia Viral/terapia , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Bélgica , Betacoronavirus , Glicemia/metabolismo , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Complicações do Diabetes , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Gerenciamento Clínico , Hemoglobina A Glicada/metabolismo , Unidades Hospitalares , Hospitalização , Humanos , Hiperglicemia/etiologia , Hiperglicemia/metabolismo , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo
10.
BMJ Case Rep ; 13(3)2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32169991

RESUMO

The differential diagnosis of shock following percutaneous coronary intervention (PCI) is vast. Access site complications and bleeding can cause hypovolemic shock. Peri-procedural myocardial infarction, abrupt closure, stent thrombosis, coronary dissection and coronary perforation have a stormy presentation. Vasovagal shock is manifested by bradycardia and hypotension and quickly responds to atropine. Anaphylactic shock secondary to contrast administration can be stormy but usually responds to steroids or adrenaline. Septicemia due to unsterile techniques can cause a less dramatic shock. Acute adrenal insufficiency causing shock following PCI has not been described to the best of our knowledge. We report the case of a 54-year-old woman who underwent successful multivessel PCI. She had refractory unexplained shock following the PCI with no much response from inotropic or intra-aortic balloon pump. After ruling out all possible causes of shock and clinical suspicion of adrenal insufficiency, she was treated with steroids resulting in dramatic improvement in her hemodynamics.


Assuntos
Insuficiência Adrenal/complicações , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/etiologia , Doença Aguda , Insuficiência Adrenal/tratamento farmacológico , Cardiologistas , Doença da Artéria Coronariana/complicações , Diagnóstico Diferencial , Feminino , Humanos , Infusões Intravenosas , Perda de Seguimento , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
11.
Clin Chim Acta ; 505: 78-91, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32035851

RESUMO

Adrenal insufficiency (AI) is a serious condition, which can arise from pathology affecting the adrenal gland itself (primary adrenal insufficiency, PAI), hypothalamic or pituitary pathology (secondary adrenal insufficiency, SAI), or as a result of suppression of the hypothalamic-pituitaryadrenal (HPA) axis by exogenous glucocorticoid therapy (tertiary adrenal insufficiency, TAI). AI is associated with an increase in morbidity and mortality and a reduction in quality of life. In addition, the most common cause of PAI, autoimmune adrenalitis, may be associated with a variety of other autoimmune disorders. Untreated AI can present with chronic fatigue, weight loss and vulnerability to infection. The inability to cope with acute illness or infection can precipitate life-threatening adrenal crisis. It is therefore a critical diagnosis to make in a timely fashion, in order to institute appropriate management, aimed at reversing chronic ill health, preventing acute crises, and restoring quality of life. In this review, we will describe the normal physiology of the HPA axis and explain how knowledge of the physiology of this axis helps us understand the clinical presentation of AI, and forms the basis for the biochemical investigations which lead to the diagnosis of AI.


Assuntos
Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/fisiopatologia , Insuficiência Adrenal/complicações , Insuficiência Adrenal/terapia , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia
12.
J Neuropathol Exp Neurol ; 79(4): 458-462, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106287

RESUMO

MIRAGE syndrome is a multisystem disorder characterized by myelodysplasia, infections, restriction of growth, adrenal hypoplasia, genital phenotypes, and enteropathy. Mutations in the sterile alpha motif domain containing 9 (SAMD9) gene which encodes a protein involved in growth factor signal transduction are thought to cause MIRAGE syndrome. SAMD9 mutations lead to an antiproliferative effect resulting in a multisystem growth restriction disorder. Though rare, a few patients with SAMD9 mutations were reported to have hydrocephalus and/or cerebellar hypoplasia on imaging. The neuropathologic features of MIRAGE syndrome have not been previously described. Here, we describe the postmortem neuropathologic examinations of 2 patients with a clinical diagnosis of MIRAGE syndrome and confirmed SAMD9 mutations. Common features included microcephaly, hydrocephalus, white matter abnormalities, and perivascular calcifications. One of the 2 cases showed marked cerebellar hypoplasia with loss of Purkinje and granule neurons as well as multifocal polymicrogyria and severe white matter volume loss; similar findings were not observed in the second patient. These cases demonstrate the variation in neuropathologic findings in patients with MIRAGE syndrome. Interestingly, the findings are similar to those reported in ataxia-pancytopenia syndrome caused by mutations in SAMD9L, a paralogue of SAMD9.


Assuntos
Insuficiência Adrenal/complicações , Encéfalo/patologia , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/patologia , Pneumopatias/complicações , Síndromes Mielodisplásicas/complicações , Insuficiência Adrenal/genética , Doenças do Sistema Nervoso Central/genética , Feminino , Humanos , Lactente , Peptídeos e Proteínas de Sinalização Intracelular/genética , Síndromes Mielodisplásicas/genética , Neuropatologia , Nascimento Prematuro
13.
Ann Pharmacother ; 54(8): 742-749, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31928081

RESUMO

Background: Cortisol thresholds defining adrenal insufficiency (AI) in some cirrhosis-specific studies differ from those recommended by the SCCM/ESICM (Society of Critical Care Medicine/European Society of Intensive Care Medicine) guidelines, which may influence treatment decisions. Objective: To determine if stress-dose hydrocortisone (HC) improves outcomes in vasopressor-dependent patients meeting cirrhosis-specific criteria for AI. Methods: In this retrospective study, AI was defined using criteria from 2 studies in critically ill cirrhosis patients showing mortality reduction with HC (random cortisol <20 µg/dL, or if a standard-dose cosyntropin test was performed, baseline cortisol <15 µg/dL or delta cortisol <9 µg/dL if baseline = 15-34 µg/dL). Use of HC was at the discretion of the intensivist. The primary endpoint was days of vasopressor therapy. Secondary endpoints included hospital mortality and newly acquired infections. Sixty-four patients were evaluated; 40 patients received HC and 24 did not. Results: Mean random cortisol was significantly lower in the HC group (9.8 ± 3.2 vs 12.0 ± 3.7 µg/dL, P = 0.04). Delta cortisol also tended to be lower in the HC group (8.2 ± 4.4 vs 11.3 ± 6.4 µg/dL, P = 0.25). Patients in the HC group exhibited significantly fewer median days of vasopressor therapy (4.0 [2.0-7.0] vs 7.0 [4.2-10.8], P = 0.006), lower mortality (22.5% vs 50%, P = 0.02), and a similar incidence of newly acquired infections. Conclusion and Relevance: The use of HC in patients meeting cirrhosis-specific criteria for AI resulted in significantly shorter duration of vasopressor therapy, lower mortality, and no increased risk of infection. Use of traditional AI definitions may exclude patients with cirrhosis that could benefit from HC therapy.


Assuntos
Insuficiência Adrenal/tratamento farmacológico , Hidrocortisona/sangue , Cirrose Hepática/tratamento farmacológico , Norepinefrina/uso terapêutico , Vasoconstritores/uso terapêutico , Insuficiência Adrenal/sangue , Insuficiência Adrenal/complicações , Insuficiência Adrenal/mortalidade , Adulto , Cuidados Críticos , Estado Terminal , Feminino , Humanos , Hidrocortisona/administração & dosagem , Incidência , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Estudos Retrospectivos , Fatores de Tempo , Vasoconstritores/administração & dosagem
15.
J Vet Med Sci ; 82(1): 31-34, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31748437

RESUMO

A 3-year-old male Rottweiler presented with the chief complaint of recurrent vomiting, diarrhea, hypothermia, and lethargy. Hypovolemic shock was noted with abnormal electrolytes (Na/K ratio, 27.9) and anemia (hematocrit, 17.3%). Since the hematocrit was 49.2% four days earlier when the primary veterinarian examined the dog, acute anemia was diagnosed. Melena was observed on the next day. The general condition and hydration improved with treatment, and an adrenocorticotropic hormone stimulation test identified hypoadrenocorticism. However, the hematocrit decreased further to 9%, necessitating blood transfusion. The cause of severe acute anemia was thought to be gastrointestinal hemorrhage. It should be noted that hypoadrenocorticism can lead to potentially fatal anemia with gastrointestinal tract bleeding, and blood transfusion may be required.


Assuntos
Insuficiência Adrenal/veterinária , Anemia/veterinária , Doenças do Cão/diagnóstico , Hemorragia Gastrointestinal/veterinária , Insuficiência Adrenal/complicações , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/tratamento farmacológico , Hormônio Adrenocorticotrópico/farmacologia , Anemia/etiologia , Animais , Transfusão de Sangue/veterinária , Doenças do Cão/etiologia , Cães , Masculino , Melena/veterinária , Potássio/sangue , Sódio/sangue
16.
Ann Dermatol Venereol ; 147(1): 36-40, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31653452

RESUMO

INTRODUCTION: Netherton syndrome (NS) is a rare disease caused by SPINK5 mutations associated with ichthyosis (erythroderma and desquamation), alopecia and atopic manifestations. There are no effective treatments. Topical corticosteroids may be used for a limited period in the event of eczema. Herein we report on a patient with fatal complications related to misuse of topical corticosteroids. PATIENTS AND METHODS: A 38-year-old woman with NS had been using betamethasone for about ten years for severe pruritus. Consumption was estimated at 7.2kg per year. On examination, she had osteoporosis, Cushing's syndrome, corticotropic insufficiency and inframammary, axillary, and intergluteal superinfected intertrigo. During hospitalization for necrotic leg wounds on severe skin atrophy, she sustained a fracture on falling down. The course was marked by the onset of septic shock of unknown etiology, complicated by acute adrenal insufficiency leading to fatal multi-organ failure. DISCUSSION: Many iatrogenic cases related to topical corticosteroids in children have been reported in the literature, including one case of fatal outcome (CMV infection) in an infant. Such iatrogenic cases are rarer in adults and we observed no fatal cases. In NS, the adverse effects of topical corticosteroids are amplified due to the major defect in the skin barrier which enhances the systemic passage of these drugs. In the absence of any effective therapeutic alternative, weaning patients off topical corticosteroids is usually difficult. CONCLUSION: This case illustrates the severity of iatrogenic effects secondary to misuse of topical corticosteroids in NS as well as the need to find effective new treatments for this syndrome.


Assuntos
Betametasona/efeitos adversos , Glucocorticoides/efeitos adversos , Síndrome de Netherton/tratamento farmacológico , Insuficiência Adrenal/complicações , Adulto , Betametasona/administração & dosagem , Síndrome de Cushing/induzido quimicamente , Evolução Fatal , Feminino , Fíbula/lesões , Fraturas Ósseas/diagnóstico por imagem , Glucocorticoides/administração & dosagem , Humanos , Intertrigo/induzido quimicamente , Intertrigo/patologia , Insuficiência de Múltiplos Órgãos/etiologia , Síndrome de Netherton/patologia , Osteoporose/induzido quimicamente , Choque Séptico/complicações
17.
BMJ Case Rep ; 12(12)2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31831513

RESUMO

An 18-year-old woman with a history of hollow visceral myopathy presented with a small-bowel obstruction. High-dose opioid analgesia was required subsequently during hospital admission. She suffered two episodes of documented fasting hypoglycaemia, despite adjustment of parenteral carbohydrate administration. Investigations for non-insulin-mediated hypoglycaemia revealed a low morning cortisol of 109 nmol/L and an inappropriately low Adrenocorticotropic hormone (ACTH) level of 2.2 pmol/L. A diagnosis of secondary adrenal insufficiency was confirmed on repeat cortisol and ACTH testing. The 250 µg short Synacthen test cortisol response was normal, suggestive of acute rather than chronic ACTH deficiency. This pattern was consistent after further opioid exposure. Adrenal recovery occurred shortly after opioid cessation. Opioid-induced hypoadrenalism is likely an under-recognised clinical entity with potentially serious adverse patient outcomes. There are reported cases involving commonly prescribed opioids including fentanyl and tramadol. However, we believe this is the first reported clinical case of acute transient opioid-induced secondary hypoadrenalism associated with fasting hypoglycaemia.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Hipoglicemia/etiologia , Tramadol/efeitos adversos , Adolescente , Insuficiência Adrenal/complicações , Analgésicos Opioides/farmacologia , Feminino , Fentanila/farmacologia , Humanos , Tramadol/farmacologia
18.
Am J Case Rep ; 20: 1857-1863, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31827062

RESUMO

BACKGROUND Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder characterized by central adrenal insufficiency (AI) but normal secretion of pituitary hormones other than adrenocorticotropic hormone. IAD usually presents with unspecific symptoms of AI, such as anorexia and fatigue, but some patients present with a variety of atypical manifestations. Rhabdomyolysis is a potentially life-threatening clinical syndrome caused by skeletal muscle injury with the release of muscle cell contents into the circulation. A wide variety of disorders can cause rhabdomyolysis. Herein, we report an unusual case of IAD presenting with hyponatremia and rhabdomyolysis. CASE REPORT A 67-year-old Japanese woman with a 2-month history of anorexia and fatigue was diagnosed with severe hyponatremia (serum sodium, 118 mEq/L) and rhabdomyolysis (serum creatine phosphokinase, 6968 IU/L), after 2 days of vomiting and muscle weakness. Physical and laboratory findings did not show dehydration or peripheral edema. Her rhabdomyolysis resolved with normalization of serum sodium levels during administration of sodium chloride. However, her anorexia and fatigue remained unresolved. After reducing the amount of sodium chloride administered, the patient still had hyponatremia. Detailed endocrinological examinations indicated IAD; her hyponatremia was associated with inappropriately high plasma arginine vasopressin levels. The patient received corticosteroid replacement therapy, which resolved her anorexia, fatigue, excessive arginine vasopressin, and hyponatremia. CONCLUSIONS This case highlights the importance of considering the possibility of central AI in patients with hyponatremia and excessive arginine vasopressin levels. In addition, rhabdomyolysis associated with hyponatremia can be an important manifestation of IAD.


Assuntos
Insuficiência Adrenal/complicações , Hiponatremia/etiologia , Rabdomiólise/etiologia , Insuficiência Adrenal/tratamento farmacológico , Idoso , Anorexia , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Fadiga , Feminino , Humanos , Hidrocortisona/uso terapêutico , Hiponatremia/tratamento farmacológico , Rabdomiólise/tratamento farmacológico , Cloreto de Sódio/uso terapêutico
19.
Pediatr Neonatol ; 60(6): 603-610, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31564521

RESUMO

Late-onset glucocorticoid-responsive circulatory collapse (LGCC) in infants is characterized by sudden onset of hypotension and/or oliguria, which is resistant to volume expanders and inotropes but responds rapidly to intravenous glucocorticoids. LGCC occurs after the first week of life mainly in relatively stable very low birth weight (VLBW) infants. In Japan, the incidence of LGCC is reported to be 8%. Relative adrenal insufficiency (AI) is considered the most likely cause of LGCC, but its detailed pathophysiology remains unclear. Intrinsic and extrinsic factors may affect the pathophysiological mechanism. LGCC should be recognized as one of the high-risk complications in VLBW infants and managed promptly and properly, because if it is not, it may cause life-long neurological problems. To diagnose relative AI, an accurate evaluation of adrenal function is necessary; however, the interpretation of basal serum cortisol levels is difficult in preterm infants after 7 days of life. To recognize LGCC, it is recommended that blood pressure and urine volume be carefully monitored, even outside of the transitional period. If no underlying causes are documented or volume expansion and inotropic support fail, intravenous hydrocortisone should be initiated, and an additional dose of hydrocortisone is required when the response is inadequate. There are few reports to verify or characterize LGCC and this phenomenon has not been recognized worldwide to date. This review summarizes the current knowledge about LGCC in premature infants and evaluates the most significant new findings regarding its pathophysiology, treatment, and prognosis.


Assuntos
Glucocorticoides/uso terapêutico , Hidrocortisona/uso terapêutico , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/tratamento farmacológico , Choque/diagnóstico , Choque/tratamento farmacológico , Insuficiência Adrenal/complicações , Idade de Início , Humanos , Hipotensão/etiologia , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Japão , Monitorização Fisiológica , Oligúria/etiologia , Prognóstico
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