scholarly journals Chronic Heroin Dependence Leading to Adrenal Insufficiency

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Gautam Das
Keyword(s):  
Pain Relief ◽  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Negative Impact ◽  
Endocrine System ◽  
Multiple Organ ◽  
Drug Addicts ◽  
Secondary Adrenal Insufficiency ◽  
Long Period ◽  
Organ Systems

Opioids have been the mainstay for pain relief and palliation over a long period of time. They are commonly abused by drug addicts and such dependence usually imparts severe physiologic effects on multiple organ systems. The negative impact of opioids on the endocrine system is poorly understood and often underestimated. We describe a patient who developed severe suppression of the hypothalamic-pituitary adrenal (HPA) axis leading to secondary adrenal insufficiency due to long standing abuse of opioids.

scholarly journals Endocrine Flawed In COVID-19 Era

2021 ◽  
pp. 49-64
Author(s):  
Farhana Akter ◽  
Rahnuma Ahmad ◽  
Mainul Haque
Keyword(s):  
Adrenal Insufficiency ◽  
Negative Impact ◽  
Medical Science ◽  
Endocrine System ◽  
Clinical Expertise ◽  
Angiotensin Converting Enzyme 2 ◽  
Global Pandemic ◽  
History Of ◽  
Hypothalamic Pituitary Axis ◽  
Adequate Management

The clinical practice and social relationships have been changed since the emergence of COVID-19. It is declared a global pandemic affecting millions of people across the world. SARS-CoV-2 virus while infecting human has been noted to affect several vital organs and biological systems. This can occur directly through virus-induced damage or indirectly due to the host response after virus entry, which produce a negative impact on body systems. Human endocrine system similar fatal effect. Thereafter, the knowledge and clinical expertise about the management of the endocrine pathological consequences of COVID-19 is essential in the current pandemic situation. The need of such clinical proficiency is increasing more demanding as SARS-CoV-2 pandemic is growing towards more devastating phase. The coronavirus enters the human body by using the angiotensin converting enzyme 2 (ACE-2). Other than the pneumocytes, ACE-2 is expressed by several endocrine glands like the pancreas, pituitary gland, adrenal glands, thyroid, ovary, and testes. Diabetes has a significant impact on covid 19. Diabetes Mellitus is one of the comorbidities most frequently linked to severity and mortality resulting from COVID-19 infection. Thus, careful management that includes modification of treatment may be needed to protect from the most dangerous outcomes of the virus infection or hospitalization with COVID-19, not only for patients with a known history of diabetes but also those suffering SARS-CoV-2 induced new-onset diabetes. Those suffering from obesity are more susceptible to SARS-CoV-2 as well as to adverse effects. In order to limit the susceptibility and severity of SARS-CoV-2 infection, there needs to be adequate management of nutrition of obese and undernourished patients. Hypothalamic-pituitary axis suppression, adrenal insufficiency, thyroid dysfunction, hypocalcemia, vitamin D lack, and vertebral fractures have also been reported as frequent findings in COVID-19 infected individuals who needed to be hospitalized and often associated with fatal clinical outcomes. Prompt glucocorticoid adjustment is also required in patients with COVID-19 having adrenal insufficiency. Addressing hormonal status may limit further treatment burden for a COVID-19 infected patient. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.49-64

scholarly journals Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Pejman Cohan
Keyword(s):  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Adrenal Adenoma ◽  
Serum Cortisol ◽  
Pharmacological Therapy ◽  
Secondary Adrenal Insufficiency ◽  
Unilateral Adrenalectomy ◽  
Undetectable Serum ◽  
Biochemical Testing ◽  
Acth Secreting

Context. Transient secondary adrenal insufficiency (SAI) is an expected complication following successful adenomectomy of ACTH-secreting pituitary adenomas or unilateral adrenalectomy for cortisol-secreting adrenal adenomas. To date, no pharmacological therapy has been shown to hasten recovery of the hypothalamic-pituitary-adrenal (HPA) axis in this clinical scenario.Case Description. A 33-year-old woman underwent uncomplicated unilateral adrenalectomy for a 3.7 cm cortisol-secreting adrenal adenoma. Postoperatively, she developed SAI and was placed on hydrocortisone 15 mg/day, given in divided doses. In the ensuing six years, the patient’s HPA axis failed to recover and she remained corticosteroid-dependent. Quarterly biochemical testing (after withholding hydrocortisone for 18 hours) consistently yielded undetectable serum cortisol and subnormal plasma ACTH levels. While she was on hydrocortisone 15 mg/day, mifepristone was initiated and gradually titrated to a maintenance dose of 600 mg/day after 5 months. Rapid recovery of the HPA axis was subsequently noted with ACTH rising into the supranormal range at 4 months followed by a subsequent rise in cortisol levels into the normal range. After 6 months, the dose of hydrocortisone and mifepristone was lowered and both were ultimately stopped after 8 months. The HPA axis remains normal after an additional 16 months of follow-up.Conclusion. Mifepristone successfully restored the HPA axis in a woman with prolonged secondary adrenal insufficiency (SAI) after adrenalectomy for Cushing’s syndrome (CS).

scholarly journals SUN-276 Pembrolizumab-Induced Secondary Adrenal Insufficiency Presenting as Severe Hyponatremia in an 80-Year-Old Male

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Leslie Daphne R Kawaji ◽  
Mary Grace M Villanueva ◽  
Michael L Villa
Keyword(s):  
Adverse Events ◽  
Adrenal Insufficiency ◽  
Endocrine System ◽  
Stage Iv ◽  
Blood Chemistry ◽  
Oral Feeding ◽  
Low Grade ◽  
Thyroid Function Tests ◽  
Secondary Adrenal Insufficiency ◽  
Severe Hyponatremia

Abstract Background Pembrolizumab is an anti-programmed death 1 (PD-1) antibody designed to incite an immune response against malignant cells. By virtue of this mechanism of action, its use has given rise to immune-related adverse events including those affecting the endocrine system. Adrenal insufficiency can occur rarely with anti-PD-1 therapy, and symptoms are usually non-specific. Clinical Case An 80-year-old male, known case of non-small cell lung cancer stage IV presented with a 2-week history of progressive body weakness with anorexia, shortness of breath and low-grade fever. He had just received the 4th cycle of pembrolizumab prior to the onset of symptoms. Past medical history was significant for hypertension and type 2 diabetes mellitus which were both controlled, and pulmonary tuberculosis with completed treatment. On physical examination, he was drowsy but oriented. He was normotensive (110/70 mmHg) and tachypneic (28 cpm) with rales on both lung fields. Baseline capillary glucose level was 107 mg/dL. Chest radiograph showed hazy opacities in the right upper to middle region. Blood chemistry revealed severe hyponatremia (114 mmol/L, NV 135-145 mmol/L) and low serum osmolality (247 mOsm/kg, NV 280-300 mOsm/kg). Random (taken 1230H) ACTH and cortisol were <5.00 pg/mL (NV <46 pg/mL) and 2.00 μg/dL (NV 4.30-22.40 μg/dL), respectively. Such levels were judged to be low in the background of an acute illness. Thyroid function tests were normal – TSH 0.993 μIU/mL (NV 0.55-4.78 uIU/mL), FT3 3.890 pg/mL (2.30-4.20 pg/mL), FT4 1.450 ng/dL (0.89-1.76 ng/dL). Magnetic resonance imaging of the pituitary gland did not show abnormal parenchymal enhancement or enlargement. Pembrolizumab-induced secondary adrenal insufficiency was the most probable cause of the hyponatremia. He was started on IV hydrocortisone, as well as piperacillin-tazobactam for pneumonia. Oxygen support via nasal cannula was given. Feeding via nasogastric tube was decided to ensure nutrition and prevent aspiration. He was transferred to the intensive care unit for careful monitoring. Serum sodium level was corrected gradually, with marked clinical improvement thereafter. Within 48 hours, he was transferred to regular room and oral feeding commenced. Hydrocortisone was shifted to prednisone on discharge, with steroid tapering schedule and close follow-up with endocrinologist advised. Conclusion We presented a case of secondary adrenal insufficiency which likely resulted from hypophysitis induced by pembrolizumab. Hypophysitis following anti-PD1 treatment occurs in <1% of patients on immunotherapy. In such cases, ACTH deficiency is usually isolated and pituitary imaging is frequently normal. Since more patients are being placed on immune-checkpoint inhibition, clinicians should be vigilant for these adverse events, particularly the endocrinopathies which may have non-specific symptoms and may be irreversible.

scholarly journals A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment

2021 ◽  
Author(s):  
Samaneh Nakhaee ◽  
Christopher Hoyte ◽  
Richard C. Dart ◽  
Masoumeh Askari ◽  
Roland J. Lamarine ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mechanism Of Action ◽  
Cardiopulmonary Arrest ◽  
Endocrine System ◽  
Multiple Organ ◽  
Adverse Outcomes ◽  
Low Grade ◽  
Organ Systems ◽  
Management Alternative

Abstract Aims As an analgesic that acts upon the central nervous system (CNS), tramadol has gained popularity in treating moderate to severe pain. Recently, it has been increasingly reported as a drug of misuse with intentional overdoses or intoxications. This review focuses on tramadol intoxication in humans and its effects on different systems. Subject and method This narrative review provides a comprehensive view of the pharmacokinetics, mechanism of action, and incidence of tramadol toxicity with an in-depth look at its side effects. In addition, the main approaches to the management of tramadol poisoning are described. Results Tramadol poisoning can affect multiple organ systems: gastrointestinal, central nervous system (seizure, CNS depression, low-grade coma, anxiety, and over time anoxic brain damage), cardiovascular system (palpitation, mild hypertension to life-threatening complications such as cardiopulmonary arrest), respiratory system, renal system (renal failure with higher doses of tramadol intoxication), musculoskeletal system (rhabdomyolysis), endocrine system (hypoglycemia), as well as, cause serotonin syndrome. Seizure, a serious nervous disturbance, is more common in tramadol intoxication than with other opioids. Fatal tramadol intoxications are uncommon, except in ingestion cases concurrent with other medications, particularly CNS depressants, most commonly benzodiazepines, and ethanol. Conclusion With the increasing popularity of tramadol, physicians must be aware of its adverse effects, substantial abuse potential, and drug interactions, to weigh its risk–benefit ratio for pain management. Alternative therapies might be considered in patients with a previous overdose history to reduce risks for adverse outcomes.

scholarly journals The pump, the exchanger, and the holy spirit: origins and 40-year evolution of ideas about the ouabain-Na+pump endocrine system

2018 ◽  
Vol 314 (1) ◽  
pp. C3-C26 ◽  
Author(s):  
Mordecai P. Blaustein
Keyword(s):  
Heart Failure ◽  
Holy Spirit ◽  
Kidney Development ◽  
Endocrine System ◽  
Multiple Organ ◽  
Renal Physiology ◽  
Natriuretic Hormone ◽  
Organ Systems ◽  
Key Factor ◽  
Evolution Of Ideas

Two prescient 1953 publications set the stage for the elucidation of a novel endocrine system: Schatzmann’s report that cardiotonic steroids (CTSs) are all Na+pump inhibitors, and Szent-Gyorgi’s suggestion that there is an endogenous “missing screw” in heart failure that CTSs like digoxin may replace. In 1977 I postulated that an endogenous Na+pump inhibitor acts as a natriuretic hormone and simultaneously elevates blood pressure (BP) in salt-dependent hypertension. This hypothesis was based on the idea that excess renal salt retention promoted the secretion of a CTS-like hormone that inhibits renal Na+pumps and salt reabsorption. The hormone also inhibits arterial Na+pumps, elevates myocyte Na+and promotes Na/Ca exchanger-mediated Ca2+gain. This enhances vasoconstriction and arterial tone—the hallmark of hypertension. Here I describe how those ideas led to the discovery that the CTS-like hormone is endogenous ouabain (EO), a key factor in the pathogenesis of hypertension and heart failure. Seminal observations that underlie the still-emerging picture of the EO-Na+pump endocrine system in the physiology and pathophysiology of multiple organ systems are summarized. Milestones include: 1) cloning the Na+pump isoforms and physiological studies of mutated pumps in mice; 2) discovery that Na+pumps are also EO-triggered signaling molecules; 3) demonstration that ouabain, but not digoxin, is hypertensinogenic; 4) elucidation of EO’s roles in kidney development and cardiovascular and renal physiology and pathophysiology; 5) discovery of “brain ouabain”, a component of a novel hypothalamic neuromodulatory pathway; and 6) finding that EO and its brain receptors modulate behavior and learning.

scholarly journals A standard diagnostic and education procedure for nurses in recognizing the symptoms of aging man

2017 ◽  
Vol 16 (1) ◽  
pp. 36-43
Author(s):  
Agnieszka Korol ◽  
Elżbieta Krajewska-Kułak
Keyword(s):  
Quality Assurance ◽  
Aging Process ◽  
Endocrine System ◽  
Multiple Organ ◽  
Organ Systems ◽  
Male Menopause ◽  
Male Hormones

AbstractIntroduction. In the aging process a weakening of the multiple organ systems and endocrine system occur, which in turn, leads to male hormones deficiency – androgens release, including testosterone. It is believed that the year-to-year, women awareness of the menopausal problems increases, however, their knowledge of the consequences of menopause is still insufficient. Unfortunately, only a small percentage of the population is aware that the same problem can also affect men. Male menopause symptoms are still largely an area of social taboo subject, which is not discussed at all or very little. As a consequence, men are not informed, enlightened, and therefore also ready for the changes that are to take place in themselves and their lives.Aim. To develop a standard nurses preparation for diagnostic and education procedure concerning the aging man.Methods. The standard was created with recommendations of The European Quality Assurance Network.Results. The development of diagnostic and education procedure for nurses in the realm of identifying symptoms of male aging.

scholarly journals Recovery of the Hypothalamo-Pituitary-Adrenal Axis After Transsphenoidal Adenomectomy for Non–ACTH-Secreting Macroadenomas

2019 ◽  
Vol 104 (11) ◽  
pp. 5316-5324 ◽  
Author(s):  
Riccardo Pofi ◽  
Sonali Gunatilake ◽  
Victoria Macgregor ◽  
Brian Shine ◽  
Robin Joseph ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Secondary Adrenal Insufficiency ◽  
Baseline Cortisol ◽  
Transsphenoidal Adenomectomy ◽  
Synacthen Test ◽  
Acth Secreting ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis ◽  
Hpa Function

Abstract Context Secondary adrenal insufficiency is a potential complication of transsphenoidal adenomectomy (TSA). Most centers test recovery of the hypothalamo-pituitary-adrenal (HPA) axis after TSA, but, to our knowledge, there are no data predicting likelihood of recovery or the frequency of later recovery of HPA function. Objective To assess timing and predictors of HPA axis recovery after TSA. Design Single-center, retrospective analysis of consecutive pituitary surgeries performed between February 2015 and September 2018. Patients Patients (N = 109) with short Synacthen test (SST) data before and at sequential time points after TSA. Main outcome measures Recovery of HPA axis function at 6 weeks, and 3, 6, and 9 to12 months after TSA. Results Preoperative SST indicated adrenal insufficiency in 21.1% Among these patients, 34.8% recovered by 6 weeks after TSA. Among the 65.2% (n = 15) remaining, 13.3% and 20% recovered at 3 months and 9 to 12 months, respectively. Of the 29% of patients with adrenal insufficiency at the 6-week SST, 16%, 12%, and 6% subsequently recovered at 3, 6, and 9 to 12 months, respectively. Preoperative SST 30-minute cortisol, postoperative day 8 cortisol, and 6-week postoperative SST baseline cortisol levels above or below 430 nmol/L [15.5 μg/dL; AUC ROC, 0.86]; 160 nmol/L (5.8 μg/dL; AUC ROC, 0.75); and 180 nmol/L (6.5 μg/dL; AUC ROC, 0.88), were identified as cutoffs for predicting 6-week HPA recovery. No patients with all three cutoffs below the threshold recovered within 12 months after TSA, whereas 92% with all cutoffs above the threshold recovered HPA function within 6 weeks (OR, 12.200; 95% CI, 5.268 to 28.255). Conclusion HPA axis recovery can occur as late as 9 to 12 months after TSA, demonstrating the need for periodic reassessment of patients who initially have SST-determined adrenal insufficiency after TSA. Pre- and postoperative SST values can guide which patients are likely to recover function and potentially avoid unnecessary lifelong glucocorticoid replacement.

scholarly journals Effects of SARS-CoV-2 on the endocrine system

2021 ◽  
Vol 5 (9) ◽  
pp. 575-578
Author(s):  
N.A. Petunina ◽  
◽  
A.S. Shkoda ◽  
M.E. Telnova ◽  
E.V. Goncharova ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Transmembrane Protein ◽  
Severe Disease ◽  
Endocrine System ◽  
Long Term Effects ◽  
Secondary Adrenal Insufficiency ◽  
Euthyroid Sick Syndrome ◽  
Obesity And Diabetes ◽  
Russian Medical

SARS-CoV-2 rapidly spread worldwide and resulted in an unprecedented pandemic. Considering the novelty of this disease, its potential effects on the endocrine system remain elusive. This virus is known to utilize the extracellular domain of angiotensin-converting enzyme (ACE) and transmembrane protein TMPRSS2. Broad expression of ACE-2 and TMPRSS2 is a potential cause of extrapulmonary manifestations of SARSCoV- 2, including endocrine ones. The most common presentations are direct or indirect damage of the endocrine part of the pancreas, hypothalamicpituitary- adrenal and hypothalamic-pituitary-thyroid axes, and possible long-term effects on the reproductive system. It was demonstrated that obesity and diabetes increase the risk of severe course and death in COVID-19. Similarly, patients with transitory hyperglycemia have a higher risk of severe disease course. Primary and secondary adrenal insufficiency of various origins potentially accounts for severity. The most common thyroid complications of the COVID-19 infection are euthyroid sick syndrome and transient destructive thyroiditis, including subacute thyroiditis. KEYWORDS: SARS-CoV-2, COVID-19, endocrinopathies, diabetes, adrenal insufficiency. FOR CITATION: Petunina N.A., Shkoda A.S., Telnova M.E. et al. Effects of SARS-CoV-2 on the endocrine system. Russian Medical Inquiry. 2021;5(9):575–578 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-575-578.

Microprobe analysis of inclusion bodies related to two benzofuran derivatives

1987 ◽  
Vol 45 ◽  
pp. 672-673
Author(s):  
T. L. Benning ◽  
P. Ingram ◽  
J. D. Shelburne
Keyword(s):  
Inclusion Bodies ◽  
Uranyl Acetate ◽  
Multiple Organ ◽  
High Dose ◽  
En Bloc ◽  
Tissue Samples ◽  
Transmission Electron ◽  
Organ Systems ◽  
Dense Inclusion ◽  
Melanin Complex

Two benzofuran derivatives, chlorpromazine and amiodarone, are known to produce inclusion bodies in human tissues. Prolonged high dose chlorpromazine therapy causes hyperpigmentation of the skin with electron-dense inclusion bodies present in dermal histiocytes and endothelial cells ultrastructurally. The nature of the deposits is not known although a drug-melanin complex has been hypothesized. Amiodarone may also cause cutaneous hyperpigmentation and lamellar lysosomal inclusion bodies have been demonstrated within the cells of multiple organ systems. These lamellar bodies are believed to be the product of an amiodarone-induced phospholipid storage disorder. We performed transmission electron microscopy (TEM) and energy dispersive x-ray microanalysis (EDXA) on tissue samples from patients treated with these drugs, attempting to detect the sulfur atom of chlorpromazine and the iodine atom of amiodarone within their respective inclusion bodies.A skin biopsy from a patient with hyperpigmentation due to prolonged chlorpromazine therapy was fixed in 4% glutaraldehyde and processed without osmium tetroxide or en bloc uranyl acetate for Epon embedding.

Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

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