Adrenal Cushing syndrome in a patient with corticosteroid-treated asthma and worsening diabetes mellitus

2021 ◽  
Vol 14 (8) ◽  
pp. e241080
Author(s):  
Mari Fukuda ◽  
Keiko Hamada ◽  
Yuki Shimizu ◽  
Tomohiro Tanaka
Keyword(s):  
Diabetes Mellitus ◽  
Adrenal Mass ◽  
Central Obesity ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Diabetic Control ◽  
Current Case ◽  
Endogenous Cortisol ◽  
History Of ◽  
Intravenous Steroids

A 55-year-old woman with poor diabetic control and a long history of corticosteroid-treated asthma was admitted. Hypertension and dyslipidaemia developed 9 and 6 years ago, respectively, and both were poorly controlled. Three years ago, her asthma control improved, and oral/intravenous steroids were switched to inhalers. Around this time, she was diagnosed as diabetes mellitus and heavily treated with insulin and other drugs thereafter. Physical examination showed central obesity, moon face appearance, abdominal striae and purpura. Endocrinological examination revealed suppressed adrenocorticotropic hormone, but unsuppressed endogenous cortisol levels. Right adrenal mass with isotope uptake revealed by CT scan and 131I-adosterol scintigraphy was compatible with cortisol-producing adenoma, leading to the diagnosis of adrenal Cushing syndrome. A history of corticosteroid usage sometimes prevents us from the timely detection of endogenous cortisol excess. Our current case tells us a lesson of the importance of suspecting non-iatrogenic causes of Cushing syndrome even in patients heavily treated with corticosteroids.

scholarly journals PREVALENCE AND RISK FACTORS OF DIABETES MELLITUS IN TUBERCULOSIS PATIENT AT PATRANG DISTRICT INDONESIA

2019 ◽  
Vol 7 (4) ◽  
pp. 79
Author(s):  
Hasri Yulia Sasmita ◽  
Irma Prasetyowati ◽  
Pudjo Wahjudi
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Family History ◽  
Central Obesity ◽  
Smoking Status ◽  
Sampling Technique ◽  
Tuberculosis Patient ◽  
P Value ◽  
Cross Sectional ◽  
History Of

Tuberculosis (TB) is one of cause of death in infectious disease domain. The control of TB is complicated because the inclination of case numbers people with Diabetes Mellitus. Diabetes Mellitus (DM) is an important risk factor for TB development, with prove that more than ten percent of TB patient is DM patient. People with DM have risk three times more likely to suffer from TB than people without DM. The results of TB treatment with comorbid DM will be easier to be failed. Puskesmas Patrang have the highest bacteriologically confirmed BTA TB cases and DM cases in Jember during 2014 until 2016. The aim of this research is to know the DM prevalence in TB patients and to analyze the correlation between DM risk factors in TB patient to TB-DM incidence at Puskesmas Patrang Jember in 2017. The research uses observasional analytic with cross sectional approach. The sampling technique uses simple random sampling with 47 samples. The independent variables include respondent characteristics (age, sex, type of TB, medication category, and family history of DM), central obesity and smoking behavior. While the dependent variable is the DM status. The result shows that the prevelance of DM in TB patients at Puskesmas Patrang Jember regency is 23,4%. Factors associated with TB-DM are age (p-value = 0,012), family history of DM (p-value = 0,003), and smoking status (p-value = 0,035). Factors that do not associated with TB-DM are sex (p-value = 0,731), type of TB (p-value = 0,170), treatment category of TB (p-value = 0,560), central obesity (p-value = 0,435), the number of cigarette (p-value = 1,000) and smoking duration (p-value = 1,000). The most important factor of TB-DM is family history of DM that 10,850 times higher of getting TB-DM than patients without family history of DM.

scholarly journals Biopsychosocial Determinants of Diabetes Mellitus Type 2: Evidence from Surakarta, Central Java

2020 ◽  
Author(s):  
Anggi Putri Aria Gita ◽  
◽  
Isna Qadrijati ◽  
Bhisma Murti ◽  
◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Family History ◽  
Dietary Pattern ◽  
Central Obesity ◽  
Smoking Behavior ◽  
Central Java ◽  
Type 2 Dm ◽  
History Of

ABSTRACT Background: Stress has been shown to have major effects on metabolic activity. Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia that results from an alteration of the secretion or action of insulin. This study aimed to investigate biopsychosocial determinants of diabetes mellitus type 2 Subjects and Method: A case control study was conducted in Surakarta, Centra Java, Indonesia, from November 2019 to January 2020. A sample of 200 patients with type 2 DM was selected by fixed disease sampling. The dependent variable was type 2 DM. The independent variables were family history of DM, dietary pattern, physical activity, body mass index (BMI), central obesity, stress, hypertension, and smoking. The data were collected by medical record and questionnaire. The data were analyzed by a multiple logistic regression run on Stata 13. Results: The risk of type 2 DM increased with family history of tipe 2 DM (OR= 12.88; 95% CI= 5.18 to 32.04; p<0.001), poor dietary pattern (OR= 2.92; 95% CI= 1.16 to 7.36; p= 0.023), and low physical activity (OR= 3.15; 95% CI= 1.22 to 8.18; p= 0.018), central obesity (OR= 4.55; 95% CI= 1.55 to 13.41; p= 0.006), stress (OR= 3.07; 95% CI= 1.21 to 7.79; p= 0.018), history of hypertension (OR= 3.83; 95% CI= 1.49 to 9.79; p= 0.005), and smoking behavior (OR= 3.86; 95% CI= 1.29 to 11.57; p= 0.016). The risk of type 2 DM decreased with normal BMI (OR= 0.37; 95% CI= 0.13 to 1.01; p= 0.053). Conclusion: The risk of type 2 DM increases with family history of tipe 2 DM, poor dietary pattern, and low physical activity, central obesity, stress, history of hypertension, and smoking behavior. The risk of type 2 DM decreases with normal BMI. Keywords: Determinan biopsikososial, DM tipe 2. Correspondence: Anggi Putri Aria Gita. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: +628975406464. DOI: https://doi.org/10.26911/the7thicph.01.46

scholarly journals A case of diabetic myonecrosis: A rare complication of a common disease

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882346
Author(s):  
Rami Alkhoury
Keyword(s):  
Diabetes Mellitus ◽  
Rare Complication ◽  
Diabetic Control ◽  
Serum Glucose ◽  
Sudden Onset ◽  
Common Disease ◽  
Diabetic Patients ◽  
History Of ◽  
Uncommon Condition

Diabetes mellitus is a growing concern in today’s population and a common cause of significant morbidity and mortality in those affected. Diabetic myonecrosis is an uncommon condition that can be seen in uncontrolled, long-standing diabetic patients who complain of localized, sudden-onset muscle pain. We present a 57-year-old woman with type 2 diabetes mellitus who presented to the emergency department with left-sided pelvic pain for the past 2 months. The pain had progressively gotten worse with a significant reduction in the range of motion of her left hip. Magnetic resonance imaging imaging revealed focal enhancement, edema, and enlargement of the left iliacus muscle. Assessment of serum glucose and hemoglobin A1c revealed a history of poor diabetic control, eventually giving rise to a diagnosis of diabetic myonecrosis. She was discharged with a new diabetic regimen, pain control, and outpatient physical therapy.

scholarly journals A Case of Canine Polyglandular Deficiency Syndrome with Diabetes Mellitus and Hypoadrenocorticism

2021 ◽  
Vol 8 (3) ◽  
pp. 43
Author(s):  
Sho Furukawa ◽  
Natsuko Meguri ◽  
Kazue Koura ◽  
Hiroyuki Koura ◽  
Akira Matsuda
Keyword(s):  
Diabetes Mellitus ◽  
Oral Administration ◽  
Ketone Body ◽  
Adrenocorticotropic Hormone ◽  
Low Dose ◽  
Blood Chemistry ◽  
Deficiency Syndrome ◽  
Appetite Loss ◽  
History Of ◽  
Treatment Of Diabetes

This report describes the first clinical case, to our knowledge, of a dog with polyglandular deficiency syndrome with diabetes mellitus and hypoadrenocorticism. A six-year-old female Cavalier King Charles Spaniel presented with a history of lethargy and appetite loss. The dog was diagnosed with diabetic ketoacidosis based on hyperglycemia and renal glucose and ketone body loss. The dog’s condition improved on intensive treatment of diabetes mellitus; daily subcutaneous insulin detemir injection maintained an appropriate blood glucose level over half a year. However, the dog’s body weight gradually decreased from day 207, and on day 501, it presented with a decreased appetite; the precise cause could not be determined. Based on mild hyponatremia and hyperkalemia, hypoadrenocorticism was suggested; the diagnosis was made using an adrenocorticotropic hormone stimulation test. Daily fludrocortisone with low-dose prednisolone oral administration resulted in poor recovery of the blood chemistry abnormalities; however, monthly desoxycorticosterone pivalate (DOCP) subcutaneous injection with daily low-dose prednisolone oral administration helped in the significant recovery of the abnormalities. Therefore, clinicians should consider the possibility of coexistence of hypoadrenocorticism in dogs with diabetes mellitus presenting with undifferentiated weight loss. Additionally, DOCP (not fludrocortisone) may be useful in treating dogs with diabetes mellitus complicated with hypoadrenocorticism.

scholarly journals Severe Cushing Syndrome Due to Ectopic ACTH Secretion by Pheochromocytoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A156-A156
Author(s):  
Rafael Buck Giorgi ◽  
Rayssa Fabiana Chamma ◽  
Rayssa F Chamma ◽  
Ituo Filho ◽  
Giane Cristina Garcia ◽  
...  
Keyword(s):  
Ct Scan ◽  
Adrenal Mass ◽  
Cushing Syndrome ◽  
Urinary Free Cortisol ◽  
Secondary Hypertension ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
Free Cortisol ◽  
Ectopic Acth Production ◽  
History Of

Abstract Introduction: Ectopic ACTH production is a very unusual cause of Cushing Syndrome (CS). When it occurs, lung cancer is the main cause. Very rarely, this ectopic source of ACTH can arise from a Pheochromocytoma (Pheo). A recent literature review identified less than 100 cases described. We present a case of 28 years old woman who was referred for adrenalectomy for CS with notorious adrenal mass. However, during the investigation, ectopic ACTH due a Pheo was identified. Case Report: A 28-year-old woman required emergency care for ecchymosis and asymptomatic hypertension (BP: 230x130mmHg). Hyperpigmentation of the skin was evident on physical examination. Severe hypokalemia (K: 2.5mEq/liter) was detected. She denied taking any medication and was unaware of any previous illness. She always had normal BP measurements as well as laboratory tests. No family history of adrenal disease or secondary hypertension causes. During hospitalization, the hypothesis of CS was made and confirmed after: cortisol after 1mg dexamethasone: 44.5mcg/dl (&lt;1.8mcg/dl) and 24h urinary free cortisol: 6228 mcg/dl (28-213mcg/dl). Concomitantly, a CT scan of the abdomen exhibited a left adrenal mass (3.1x2.8x3.5cm) of uncertain etiology and ACTH: 352pg/ml (&lt;46pg/ml). Additionally, the patient presented hyperglycemia during hospitalization. After confirmation of the ACTH dependent CS, pituitary MRI was performed with normal results and a chest CT scan ruled out lung masses. As there was still no etiological confirmation and due to clinical deterioration, it was decided to start Ketoconazole 200mg/day, rising until 600mg and spironolactone with doses up to 250mg/day with a significant improvement in hypokalemia, decreased cortisol levels and optimal BP control. Due to the extremely high levels of ACTH and indeterminate adrenal mass, the hypothesis of ACTH ectopic due Pheo was postulated. Patient underwent abdomen MRI with left adrenal mass with hypersignal at T2 and urinary metanephrines levels: 6132mcg/24h (&lt;289mcg/24h), urinary normetanephrines: 1808mcg/24h (&lt;732mcg/24h). Once the diagnosis was elucidated, she received preoperative preparation with alpha blocker (Doxazosin) and underwent adrenalectomy without complications. After discharge, she received prednisone 10mg/day. The patient presented normalization of BP levels, as well as glycemic control with a slight improvement in skin hyperpigmentation. The pathology department confirmed Pheo and an ACTH expression was observed in immunohistochemistry. A genetic panel for Pheo is running with no results so far. Conclusion: Despite an extremely rare cause of CS, the ectopic production of ACTH by a Pheo has extremely high mortality rates, especially when not diagnosed or managed correctly. The clinicians must always remain alert and suspect this syndrome when the patient has a confirmed ACTH dependent CS associated with adrenal masses.

Diabetes mellitus in Cushing' syndrome: a systematic review

2017 ◽  
Author(s):  
Thiza Londero ◽  
Ana Marina Moreira ◽  
Cristiane Leitao ◽  
Ticiana Rodrigues ◽  
Mauro Czepielewski
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Cushing Syndrome

High HBA1C Level Is Associated With Low Heamoglobin Level

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Mafooza Rashid ◽  
B. K. Gupta, Vinay Bharat ◽  
Abhishek Gupta ◽  
Zubair Rashid
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Good Control ◽  
Diabetic Control ◽  
Medical College ◽  
High Hba1c ◽  
Normal Controls

Background: The aim of the study was to compare the hemoglobin levels among normal controls (patients) and patients of TypeII diabetes with HbA1c levels below 7 % & above 7 %.and secondly to identify the undetected cases of anemia in TypeII diabetes. Materials & Methods - 50 patients of type 2 diabetes mellitus with their glycosylated hemoglobin levels less than 7 %, 50 patients of type 2 diabetes mellitus with their glycosylated hemoglobin levels more than 7 % attending the Medicine outpatient department of Subharti Medical College and Hospital will be the subjects for the study.50 age and sex matched controls will be selected randomly from Subharti Medical College and Hospital. Informed written consent will be taken from all the subjects. The study will be conducted from January 2016 to January. Result - We studied 50 cases with HbA1C>7(poor control),50 cases with HbA1C 5.6 to7 (good control) and 50 controls with HbA1C ≤5.6, we observed in cases with HbA1C>7 (poorly control) ,the mean HbA1C is 9.9±2 and mean Hb is 9.8±1.3 as compared to cases with HbA1C 5.6 to 7(good control) where mean HbA1C is 6±0.4 and Hb is 13±0.5,this clearly indicates that in cases HbA1C is more Hb levels are low and when HbA1C is less Hb levels are higher. Conclusion - In the present study we found negative correlation between HbA1c & Hb levels. As the value of HbA1c increases, as in cases of HbA1c >7(poor diabetic control), we found low Hb levels as compared to the cases with HbA1c <7(5.6-7) (good control).

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

Eksplorasi Kesadaran Diri, Persepsi Dan Sikap Pada Individu Yang Memiliki Riwayat Keluarga Diabetes Melitus Tipe 2

2019 ◽  
Vol 1 (1) ◽  
pp. 52-62
Author(s):  
Mulia Mayangsari
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Family History ◽  
Diabetes Type 2 ◽  
Diabetes Type ◽  
Self Awareness ◽  
Perceptions And Attitudes ◽  
History Of ◽  
Diabetes Melitus

 Individuals who have a family history oftype 2 diabetes mellitus (DM) have a highrisk for type 2 diabetes. Type 2 diabetescan be prevented by improving modifiablerisk factors, supported by self-awareness,perceptions and attitudes of individualswho have a high family history of DM. Thisstudy used a qualitative phenomenologicaldesign. A Purposive Sampling techiniquewas applied to determine individuals whohad parents with type 2 diabetes. Nineindividuals participated in this study. AQualitative content analysis with Collaiziapproach used as a data analysis method.The main themes depicted individuals selfawareness,perceptions, & attitudes were:denials that diabetes caused by heredityfactors; misperception about diabetes;“traditional modalities” as a preventionmeasurement toward type 2 diabetes; andDM is perceived as a “threatening disease”.Further study is needed to examine indepth the themes that have been identifiedon the number of participants are morenumerous and varied.

Glucose Levels and Outcome After Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Incidence Rate ◽  
Glucose Level ◽  
Intraventricular Hemorrhage ◽  
Laboratory Data ◽  
History Of ◽  
Poor Outcomes ◽  
The Impact

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

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