Diagnostic approach in children with unusual symptoms of acquired hypothyroidism. When to look for pituitary hyperplasia?

2016 ◽  
Vol 29 (3) ◽  
Author(s):  
Mirjana Kocova ◽  
Nikolina Zdraveska ◽  
Rozana Kacarska ◽  
Elena Kochova
Keyword(s):  
Pericardial Effusion ◽  
Clinical Assessment ◽  
Autoimmune Thyroiditis ◽  
Clinical Presentation ◽  
Diagnostic Procedures ◽  
Diagnostic Approach ◽  
Growth Delay ◽  
Pituitary Hyperplasia ◽  
Unusual Symptoms

AbstractPituitary hyperplasia secondary to primary longstanding hypothyroidism has been reported in the literature in adults and rarely in children.Here we present the clinical presentation and diagnostic procedures in eight children with pituitary hyperplasia due to autoimmune thyroiditis, highlighting common findings, such as growth delay, fatigue or gaining weight, but also exceptional findings such as pericardial effusion, rhabdomyolysis, isolated hypertrichosis, and Van Wyk-Grumbach syndrome, which have rarely or never been described.Surprisingly no thyroid enlargement was detected. We discuss the unusual presenting signs of autoimmune thyroiditis that should raise the suspicion of pituitary hyperplasia. We suggest that a more elaborate clinical assessment and even modification of the diagnostic approach to autoimmune thyroiditis is needed in order to avoid its serious complications.

scholarly journals Acute calcific periarthritis secondary to calcium hydroxyapatite crystal deposition in the wrist: a case report

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Joseph A Walker ◽  
Elizabeth R McLean ◽  
Raymond E Anakwe
Keyword(s):  
Case Report ◽  
Clinical Presentation ◽  
Diagnostic Procedures ◽  
Calcium Hydroxyapatite ◽  
Wrist Pain ◽  
Crystal Deposition ◽  
Joint Aspiration ◽  
Hydroxyapatite Crystal ◽  
Inflammatory Drugs ◽  
Calcific Periarthritis

ABSTRACT Acute calcific periarthritis (ACP) is an unusual cause of monoarticular pain characterised by the deposition of calcium hydroxyapatite in the peri-articular and intra-articular tissues. Although the most commonly affected joint is the shoulder, other joints may be involved, including the wrist. This case report describes a 57-year-old female presenting with wrist pain and swelling associated with amorphous calcification overlying the lunate. The patient improved with the use of non-steroidal anti-inflammatory drugs and splinting. Clinician awareness of the clinical presentation and radiographic features of ACP is important to reduce unnecessary invasive diagnostic procedures such as joint aspiration.

scholarly journals Complicated staphylococcal pericarditis in a child: a case report

2020 ◽  
Vol 7 (11) ◽  
pp. 2252
Author(s):  
Fehmida Sultana ◽  
Deepti Jujaray ◽  
Ravi P. V. Kiran
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Early Identification ◽  
Clinical Presentation ◽  
Paediatric Population ◽  
Acute Pericarditis ◽  
Life Threatening

Although primary pericarditis is unusually experienced and diagnosed in paediatric population, it has probable life threatening sequel. This case report presents a case of complicated community acquired staphylococcal pericarditis, which illustrates how evasive the diagnosis of pericardial effusion can be. Early identification of pericarditis and pericardial effusion is vital to enable emergent intervention to enhance prognosis and alleviate mortality. The purpose of this report is to probe into the etiology of acute pericarditis and also to review the clinical presentation, the management and complications connected with acute pericarditis. 

scholarly journals Normocytic Normochromic Anemia Revealed an Early Onset Hashimoto’s Hypothyroidism in an Infant: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Manal Mustafa Khadora ◽  
Maysa Saleh ◽  
Rawah Idres ◽  
Sura Ahmed Al-Doory ◽  
Mahmoud Ahmed Radaideh
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Autoimmune Thyroiditis ◽  
Subclinical Hypothyroidism ◽  
Early Onset ◽  
Clinical Presentation ◽  
Primary Hypothyroidism ◽  
Normocytic Normochromic Anemia ◽  
Wide Range ◽  
Normochromic Anemia

Autoimmune thyroiditis is very rare etiology of primary hypothyroidism in infancy. Hypothyroidism has a wide range of clinical presentation, from subclinical hypothyroidism to overt type. It is unclear what pathological mechanisms connect thyroid function and erythropoiesis or how thyroid disease can contribute to anemia. We report a 12-month-old infant who presented with anemia associated with early onset of overt autoimmune thyroiditis. The peculiarity of our case enables us to draw attention of physician to consider acquired hypothyroidism in the differential diagnosis of unexplained anemia even if the neonatal screening is normal and congenital hypothyroidism is a remote possibility.

scholarly journals Chikungunya neonatal: A neglected disease

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Suyen Heizer Villela ◽  
◽  
Giuliana Villela Pereira ◽  
Maria Elisabeth Lopes Moreira ◽  
◽  
...  
Keyword(s):  
Virus Infection ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Clinical Assessment ◽  
Chikungunya Virus ◽  
Clinical Presentation ◽  
Case Series ◽  
Significant Morbidity ◽  
Case Series Report ◽  
Series Report

Chikungunya virus infection is an emerging arbovirus with a global distribution that can cause significant morbidity and also death in infected fetuses and neonates. Unfortunately, there is still lack of data about the incidence of Chikungunya in pregnant women and the consequences for their fetus. This is a case series report including clinical presentation, images and clinical assessment. Keywords: Chikungunya; neonatal; vertical transmission.

Abnormal vaginal bleeding in women with venous thromboembolism treated with apixaban or warfarin

2017 ◽  
Vol 117 (04) ◽  
pp. 809-815 ◽  
Author(s):  
Suzanne Bleker ◽  
Barbara Hutten ◽  
Anne Timmermans ◽  
Harry Büller ◽  
Saskia Middeldorp ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Diagnostic Tests ◽  
Vaginal Bleeding ◽  
Clinical Presentation ◽  
Diagnostic Procedures ◽  
Absolute Number ◽  
Bleeding Events ◽  
Warfarin Group ◽  
Bleeding Episodes ◽  
Abnormal Vaginal Bleeding

SummaryAbnormal vaginal bleeding can complicate direct oral anticoagulant (DOAC) treatment. We aimed to investigate the characteristics of abnormal vaginal bleeding in patients with venous thromboembolism (VTE) receiving apixaban or enoxaparin/warfarin. Data were derived from the AMPLIFY trial. We compared the incidence of abnormal vaginal bleeding between patients in both treatment arms and collected information on clinical presentation, diagnostic procedures, management and outcomes. In the AMPLIFY trial, 1122 women were treated with apixaban and 1106 received enoxaparin/warfarin. A clinically relevant non-major (CRNM) vaginal bleeding occurred in 28 (2.5 %) apixaban and 24 (2.1 %) enoxaparin/warfarin recipients (odds ratio [OR] 1.2, 95 % confidence interval [CI] 0.7–2.0). Of all CRNM bleeds, 28 of 62 (45 %) and 24 of 120 (20 %) were of vaginal origin in the apixaban and enoxaparin/warfarin group, respectively (OR 3.4; 95 % CI 1.8–6.7). Premenopausal vaginal bleeds on apixaban were characterised by more prolonged bleeding (OR 2.3; 95 %CI 0.5–11). In both pre- and postmenopausal vaginal bleeds, diagnostic tests were performed in six (21 %) and in seven (29 %) apixaban and enoxaparin/ warfarin treated patients, respectively. Medical treatment was deemed not necessary in 16 (57 %) apixaban and 16 (67 %) enoxaparin/warfarin recipients. The severity of clinical presentation and course of the bleeds was mild in 75 % of the cases in both groups. In conclusion, although the absolute number of vaginal bleeding events is comparable between apixaban and enoxaparin/warfarin recipients, the relative occurrence of vaginal bleeds is higher in apixaban-treated women. The characteristics and severity of bleeding episodes were comparable in both treatment arms.

scholarly journals Old syndrome–new approach: Mauriac syndrome treated with continuous insulin delivery

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878551 ◽  
Author(s):  
Mirjana Kocova ◽  
Liljana Milenkova
Keyword(s):  
Clinical Presentation ◽  
Glucose Monitoring ◽  
Insulin Delivery ◽  
Diabetes Mellitus Type 1 ◽  
Delayed Puberty ◽  
Growth Delay ◽  
New Approach ◽  
Mauriac Syndrome

Mauriac syndrome has rarely been reported in children and adolescents with a poorly controlled diabetes mellitus type 1. However, it still occurs despite the worldwide improvements of metabolic control. The risks have not been elucidated. We present a 13.5-year-old boy with a typical clinical presentation of Mauriac syndrome consisting of growth delay, cushingoid appearance, hepatomegaly, and delayed puberty. A stepwise correction of glycemic control was introduced using continuous insulin delivery. All symptoms improved during the 2.5-year follow-up. No retinopathy occurred. This patient with Mauriac syndrome followed with continuous glucose monitoring and treated with continuous insulin delivery, resulting in no retinopathy after 2.5 years of follow-up. We suggest that this approach should be recommended in patients with Mauriac syndrome.

scholarly journals Clinical presentation and diagnostic approach in cases of genitourinary tuberculosis

2008 ◽  
Vol 24 (3) ◽  
pp. 401 ◽  
Author(s):  
Rakesh Kapoor ◽  
MS Ansari ◽  
Anil Mandhani ◽  
Anil Gulia
Keyword(s):  
Clinical Presentation ◽  
Diagnostic Approach ◽  
Genitourinary Tuberculosis

scholarly journals Tolosa-Hunt syndrome: is it really necessary to show granuloma? - The report of eight cases

2017 ◽  
Vol 74 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Ana Podgorac ◽  
Jasna Zidverc-Trajkovic ◽  
Zagorka Jovanovic ◽  
Aleksandar Ristic ◽  
Aleksandra Radojicic ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Correct Diagnosis ◽  
Cranial Nerves ◽  
Granulomatous Inflammation ◽  
Diagnostic Procedures ◽  
Hunt Syndrome ◽  
Number Of Patients ◽  
Significant Difference

Introduction. Tolosa?Hunt syndrome (THS) is a rare entity, characterized by unilateral orbital pain associated with paresis of one or more of the oculomotor cranial nerves and caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. The low prevalence of THS with a broad spectrum of other disorders that could cause painful ophtalmoplegia resulted in a stricter diagnostic criteria of THS in the latest edition of the International Classification of Headache Disorders. Current criteria require demonstration of granuloma by magnetic resonance imaging or biopsy. The diagnosis could be difficult and the initiation of treatment delayed due to a high variablity of clinical presentation of TSH. Reducing the number of patients that, based on clinical presentation, could be classified as having THS, but do not fullfil all diagnostic criteria further complicates establishing of correct diagnosis. Case report. Hereby we presented eight patients diagnosed with and treated for THS. Inspite the exclusion of other causes of painful ophtalmoplegia, granuloma could not be demonstrated in a half of patients. Clinical presentation of THS in patients with and without shown granuloma, did not significantly differ concerning headache characteristics (localization, intensity, quality, duration preceding cranial nerve palsy, response to steroids), the affected cranial nerve, disease course and response to the treatment, as well as types of diagnostic procedures that were performed in ruling out other diseases from the extensive differential diagnosis of painful ophthalmoplegia. Conclusion. There is no significant difference between the THS patients with and without demonstrated granuloma.

Sign in / Sign up

Export Citation Format

Share Document