scholarly journals Case report of a phantom pheochromocytoma

2020 ◽  
Vol 30 (2) ◽  
pp. 325-330
Author(s):  
Caroline M Joyce ◽  
Audrey Melvin ◽  
Paula M O’Shea ◽  
Seán J Costelloe ◽  
Domhnall J O’Halloran
Keyword(s):  
Reference Intervals ◽  
Patient Anxiety ◽  
Biochemical Tests ◽  
Drug Interference ◽  
High Clinical Suspicion ◽  
Liquid Chromatography Tandem Mass ◽  
History Of ◽  
Plasma Metanephrines ◽  
Plasma Free Metanephrines ◽  
Test Probability

Plasma free metanephrines or urinary fractionated metanephrines are the biochemical tests of choice for the diagnosis of pheochromocytoma as they have greater sensitivity and specificity than catecholamines for pheochromocytoma detection. This case highlights the preanalytical factors which can influence metanephrine measurement and cause a false positive result. It describes a patient with a high pre-test probability of pheochromocytoma due to hypertension and a past medical history of adrenalectomy for a purported pheochromocytoma in her home country. When biochemical screening revealed grossly elevated urine normetanephrine in the presence of a previously identified right adrenal lesion, there was high clinical suspicion of a pheochromocytoma. However, functional imaging did not support this view which prompted additional testing with plasma metanephrines. Results for plasma and urine metanephrines were discordant and preanalytical drug interference was suspected. Patient medications were reviewed and sulfasalazine, an anti-inflammatory drug was identified as the most likely analytical interferent. Urinary fractionated metanephrines were re-analysed using liquid chromatography tandem mass spectrometry (LC-MS/MS) and all metanephrines were within their reference intervals. This case illustrates how method-specific analytical drug interference prompted unnecessary expensive imaging, heightened patient anxiety and resulted in lengthy investigations for what turned out to be a phantom pheochromocytoma.

scholarly journals Hyperandrogenism by Liquid Chromatography Tandem Mass Spectrometry in PCOS: Focus on Testosterone and Androstenedione

2020 ◽  
Vol 10 (1) ◽  
pp. 119
Author(s):  
Giorgia Grassi ◽  
Elisa Polledri ◽  
Silvia Fustinoni ◽  
Iacopo Chiodini ◽  
Ferruccio Ceriotti ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Liquid Chromatography ◽  
Polycystic Ovary ◽  
Free Testosterone ◽  
Reference Intervals ◽  
Model Assessment ◽  
Homeostatic Model Assessment ◽  
Liquid Chromatography Tandem Mass ◽  
And Control ◽  
The Impact

The identification of hyperandrogenism in polycystic ovary syndrome (PCOS) is concerning because of the poor accuracy of the androgen immunoassays (IA) and controversies regarding which androgens should be measured. The aim of our study was to evaluate the impact of the assessment of testosterone (T) and androstenedione (A) by liquid chromatography in tandem with mass spectrometry (LC/MS-MS), in the diagnosis of PCOS. We evaluated 131 patients referred for suspected PCOS. Fourteen patients in total were excluded, some because of other diagnosis (n = 7) or incomplete diagnostic workup (n = 7). We measured T and A both by IA and LC-MS/MS in the 117 subjects included. We calculated free T (fT) by the Vermeulen formula and recorded clinical and metabolic data. 73 healthy females served as controls to derive immunoassays (IA) and LC-MS/MS reference intervals for T, fT and A. PCOS was confirmed in 90 subjects by IA and in 93 (+3.3%) by LC-MS/MS. The prevalence of biochemical hyperandrogenism in PCOS by LC-MS/MS increased from 81.7% to 89.2% if A was also considered. The most frequently elevated androgens were fT (73.1%) and A (64.5%) and they had similar levels of accuracy in differentiating PCOS and controls (0.34 ng/dL, Sn 91% Sp 89%; 1.16 ng/mL, Sn 91% Sp 88%, respectively). Free testosterone correlated with body mass index (BMI), homeostatic model assessment (HOMA)-index, glycated hemoglobin (HbA1c), and sex-binding globulin (SHBG). The results confirm that LC-MS/MS is slightly more sensitive than IA in the diagnosis of PCOS with LC-MS/MS detecting higher levels of fT and A. Moreover, assessment of fT and A by LC-MS/MS had a similar level of accuracy in discriminating between PCOs and control subjects. Lastly, fT by LC-MS/MS correlates with adverse metabolic parameters.

scholarly journals Some notes on a historical perspective of panic disorder

2006 ◽  
Vol 55 (2) ◽  
pp. 154-160 ◽  
Author(s):  
Antonio Egidio Nardi
Keyword(s):  
Panic Disorder ◽  
20Th Century ◽  
19Th Century ◽  
Greek Mythology ◽  
Laboratory Studies ◽  
Biochemical Tests ◽  
Wide Range ◽  
Therapeutic Development ◽  
History Of ◽  
The 19Th Century

This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsible for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classifications began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.

scholarly journals Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 182-185
Author(s):  
Mahmoud Sadeghi-Haddad-Zavareh ◽  
Mohammad Reza Hasanjani Roushan ◽  
Zeinab Mohseni Afshar ◽  
Masomeh Bayani ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Transplant ◽  
Psoas Abscess ◽  
Miliary Tuberculosis ◽  
Caseous Necrosis ◽  
High Clinical Suspicion ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Current Report

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

scholarly journals Congenital urethral dilatation in cattle calves: Diagnosis and surgical intervention

2020 ◽  
Vol 13 (2) ◽  
pp. 261-265
Author(s):  
Magda Mahmoud Ali ◽  
Kamal Hany Hussein ◽  
Ahmed Sadek ◽  
Abdelbaset Eweda Abdelbaset
Keyword(s):  
Successful Outcome ◽  
Biochemical Tests ◽  
Local Infiltration Analgesia ◽  
Radiographic Findings ◽  
Local Infiltration ◽  
Urethral Dilatation ◽  
Bull Calves ◽  
Normal Diameter ◽  
History Of ◽  
Perineal Region

Background and Aim: Congenital anomalies of the urinary system are common affections in ruminants. Dilatation of the pelvic urethra is one of these affections in which the pelvic urethra dilated than normal diameter. This study aimed to explain the diagnosis and surgical treatment of urethral dilatation in cattle calves. Materials and Methods: Twenty-three bull calves (2-7 months old) were presented with a history of stranguria, tenesmus, and straining. Diagnosis of urethral dilatation was relied on the case history and clinical examination and was confirmed using survey and contrast radiography, ultrasonography, and biochemical tests. Treatment was done by urethrostomy under the effect of local infiltration analgesia. Results: Physical examination revealed the presence of an oval, firm, and painless swelling at the perineal region, starting just below the anus and extended to the base of the scrotum. The owners reported that the initial swelling size and severity of symptoms increased with the progress of animal age. Biochemical findings revealed non-significant changes in blood urea nitrogen and creatinine levels. Radiographic findings showed an oval radiopaque mass. However, a well-demarcated structure with acoustic enhancement was detected on ultrasonographic examination. Urethrostomy resulted in a successful outcome of all cases. Conclusion: Depending on these findings, ultrasonography is the most reliable diagnostic tool and urethrostomy is the intervention of choice with acceptable results for diagnosis and treatment of urethral dilatation in cattle calves, respectively.

scholarly journals SAT-509 Sudden Onset of Malabsorption

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gabriela Mroueh ◽  
James K Burks
Keyword(s):  
Medication Adherence ◽  
The Elderly ◽  
Sudden Onset ◽  
Primary Hypothyroidism ◽  
Caucasian Woman ◽  
Thyroid Function Tests ◽  
Autoimmune Hypothyroidism ◽  
High Clinical Suspicion ◽  
Immune Mediated ◽  
History Of

Abstract Celiac disease (CD) is an immune-mediated enteropathy caused by a reaction to gliadin which responds to a restriction to dietary gluten. It has been traditionally recognized in children and young adults, although, recently, detection in the elderly population has increased. CD occurs in 2–5% of patients with autoimmune hypothyroidism, and is more prevalent in this group than in the general population An 82-year-old Caucasian woman with primary hypothyroidism and a BMI of 16 is referred to our endocrinology clinic for help with the management of hypothyroidism. She had a history of well controlled hypothyroidism on weight-dosed levothyroxine for many years until several months prior when she developed sudden onset of diarrhea and weight loss. Since then, her thyroid function tests showed an elevated TSH despite medication adherence. Her levothyroxine dose was steadily increased to 300 mcg daily and yet, her TSH still remained elevated. Laboratory work up was done which revealed elevated transglutaminase antibodies, suggesting the diagnosis of CD. The patient refused an endoscopy for a tissue diagnosis. Even though the patient has been diagnosed with CD, she has trouble following a gluten free diet and still has intermittent diarrhea and high levothyroxine requirements. Although lack of medication adherence is common, it is important to exclude gastric or intestinal causes of malabsorption in patients with high thyroid replacement requirements. Elderly patients often have paucity of symptoms, so high clinical suspicion is necessary to diagnose these patients.

Optimized procedures for diagnostic testing for pheochromocytoma and paraganglioma in patients on hemodialysis 

2021 ◽  
Author(s):  
Christina Pamporaki ◽  
Aleksander Prejbisz ◽  
Robert Małecki ◽  
Frank Pistrosch ◽  
Mirko Peitzsch ◽  
...  
Keyword(s):  
Venous Blood ◽  
Diagnostic Testing ◽  
Reference Intervals ◽  
Mass Spectrometric ◽  
Specific Reference ◽  
Optimal Sampling ◽  
Optimal Conditions ◽  
Sampling Conditions ◽  
Spectrometric Measurements ◽  
Plasma Metanephrines

Abstract Background Diagnosis of pheochromocytomas and paragangliomas in patients receiving hemodialysis is troublesome. Aim To establish optimal conditions for blood sampling for mass spectrometric measurements of normetanephrine, metanephrine and 3-methoxytyramine in patients on hemodialysis and specific reference intervals for plasma metanephrines under the most optimal sampling conditions. Methods Blood was sampled before and near the end of dialysis, including different sampling sites in 170 patients on hemodialysis. Results Plasma normetanephrine concentrations were lower (P < 0.0001) and metanephrine concentrations higher (P < 0.0001) in shunt than in venous blood, with no differences for 3-methyxytyramine. Normetanephrine, metanephrine and 3-methoxytyramine concentrations in shunt and venous blood were lower (P < 0.0001) near the end than before hemodialysis. Upper cut-offs for normetanephrine were 34% lower when the blood was drawn from the shunt and near the end of hemodialysis compared to blood drawn before hemodialysis. Conclusion This study establishes optimal sampling conditions using blood from the dialysis shunt near the end of hemodialysis with optimal reference intervals for plasma metanephrines for the diagnosis of pheochromocytomas/paragangliomas among patients on hemodialysis.

scholarly journals Audit of safety, efficacy, and cost-effectiveness of local anaesthetic cystodiathermy

2010 ◽  
Vol 92 (8) ◽  
pp. 706-709 ◽  
Author(s):  
Kim Davenport ◽  
Francis X Keeley ◽  
Anthony G Timoney
Keyword(s):  
Cost Effectiveness ◽  
Local Anaesthetic ◽  
Past History ◽  
Transitional Cell ◽  
General Anaesthetic ◽  
Patient Anxiety ◽  
Bladder Transitional Cell Carcinoma ◽  
Flexible Cystoscopy ◽  
History Of

INTRODUCTION The aim of this study was to audit our experience of cystodiathermy under local anaesthetic (LA) at the time of flexible cystoscopy for recurrent superficial bladder transitional cell carcinoma (TCC). PATIENTS AND METHODS A total of 264 flexible cystoscopies were performed on patients with a past history of TCC. The number and site of recurrences were recorded and selected patients were offered cystodiathermy. Patient tolerability was noted. At follow-up, any recurrence was recorded. RESULTS Eighty patients (30%) had 91 procedures showing one or more recurrences. Fifty-one of the 80 patients (64%) were treated with cystodiathermy under LA. All completed treatment. Forty-five (88%) tolerated the procedure well. Forty-seven (92%) treatments were completed within 5 min. At a median follow-up of 15 weeks, 30 (59%) treated patients had no recurrence and three (6%) had recurrence at the site of treatment. CONCLUSIONS LA cystodiathermy is an effective and well-tolerated alternative to general anaesthetic cystodiathermy that enables treatment at the time of detection and may, thereby, reduce patient anxiety.

scholarly journals Inappropriate testing for the diagnosis of coronary artery disease

2015 ◽  
Vol 9 (3) ◽  
Author(s):  
Giuseppe Di Pasquale ◽  
Gloria Vassilikì Coutsoumbas ◽  
Silvia Zagnoni
Keyword(s):  
Diagnostic Testing ◽  
Calcium Score ◽  
Clinical Suspicion ◽  
Diabetic Patients ◽  
Non Invasive ◽  
High Clinical Suspicion ◽  
Probability Testing ◽  
Artery Disease ◽  
Asymptomatic Subjects ◽  
Test Probability

In the last three decades also in our country it has been a huge growth of the use of non invasive testing for diagnosis of CAD. Therefore, appropriateness of prescription in diagnostic testing is crucial. Clinical evaluation is mandatory before a diagnostic test, including the evaluation of pre-test probability of the disease based on symptoms, age, sex and cardiovascular risk factors. The main benefit of testing is in patients with an intermediate pre-test probability. Testing for diagnosis of CAD is rarely appropriate in asymptomatic subjects, except for ECG exercise test in intermediate and high risk individuals, while stress or anatomic imaging is preferable in higher risk individuals. Coronary calcium score should not be used as screening test in asymptomatic subjects, except for excluding CAD in those with low pre-test probability. As far as diabetic patients is concerned, available evidence indicates an unfavorable risk-benefit ratio of extensive CAD screening, except in the presence of high clinical suspicion.

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