SKIN BIOPSY AND THYROTROPHIN ASSAY IN CHILDREN WITH ENDOCRINE DISORDERS, ESPECIALLY HYPOTHYROIDISM

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

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Obtaining a Skin Biopsy Specimen and Interpreting the Results

Dermatologic Clinics ◽

10.1016/s0733-8635(18)30203-1 ◽

1994 ◽

Vol 12 (1) ◽

pp. 83-91 ◽

Cited By ~ 9

Author(s):

Ronald P. Rapini

Keyword(s):

Skin Biopsy ◽

Biopsy Specimen ◽

Skin Biopsy Specimen

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Assessment of endocrine disorders of the hypothalamicpituitary axis by nuclear medicine techniques

Nuklearmedizin ◽

10.1055/s-0038-1625645 ◽

2002 ◽

Vol 41 (02) ◽

pp. 80-90 ◽

Cited By ~ 2

Author(s):

F. Jockenhövel ◽

P. Theissen ◽

M. Dietlein ◽

W. Krone ◽

H. Schicha ◽

...

Keyword(s):

Nuclear Medicine ◽

Pituitary Adenomas ◽

Dopamine D2 Receptor ◽

Somatostatin Receptor ◽

D2 Receptor ◽

Ectopic Acth Syndrome ◽

Endocrine Disorders ◽

Ectopic Acth ◽

Number Of Patients ◽

Hypothalamic Pituitary Axis

SummaryThe following article reviews nuclear medicine techniques which can be used for assessment of endocrine disorders of the hypothalamic-pituitary axis. For planar and SPECT imaging somatostatin-receptor- and dopamine- D2-receptor-scintigraphy are the most widely distributed techniques. These nuclear medicine techniques may be indicated in selected cases to answer differential diagnostic problems. They can be helpful to search for presence and localization of receptor positive tissue. Furthermore they can detect metastasis in the rare cases of a pituitary carcinoma. Scintigraphy with Gallium-67 is suitable for further diagnostic evaluation in suspected hypophysitis. Other SPECT radiopharmaca do not have relevant clinical significance. F-18-FDG as PET radiopharmacon is not ideal because obvious pituitary adenomas could not be visualized. Other PET radiopharmaca including C-11-methionine, C-11-tyrosine, F-18-fluoroethylspiperone, C-11-methylspiperone, and C-11-raclopride are available in specialized centers only. Overall indications for nuclear medicine in studies for the assessment of endocrine disorders of the hypothalamic-pituitary-axis are rare. Original studies often report only about a small number of patients. According to the authors’ opinion the relevance of nuclear medicine in studies of clinically important endocrinologic fields, e. g. localization of small ACTH-producing pituitary adenomas, tumor localization in ectopic ACTH syndrome, localization of recurrent pituitary tissue, assessment of small incidentalomas, can not be definitely given yet.

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Rashes in immunocompromised cancer patients. The diagnostic yield of skin biopsy and its effects on therapy

Archives of Dermatology ◽

10.1001/archderm.129.2.175 ◽

1993 ◽

Vol 129 (2) ◽

pp. 175-181 ◽

Cited By ~ 1

Author(s):

M. M. Chren

Keyword(s):

Skin Biopsy ◽

Cancer Patients ◽

Diagnostic Yield

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Cutaneous T-cell lymphoma. Evaluation of pretreatment skin biopsy specimens by a panel of pathologists

Archives of Dermatology ◽

10.1001/archderm.128.4.501 ◽

1992 ◽

Vol 128 (4) ◽

pp. 501-507 ◽

Cited By ~ 16

Author(s):

J. E. Olerud

Keyword(s):

T Cell ◽

Skin Biopsy ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Cutaneous T Cell Lymphoma ◽

Biopsy Specimens

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Cytomegalovirus-induced cytopathic changes in skin biopsy specimens: clinicopathologic study in patients with the acquired immunodeficiency syndrome and an active extracutaneous cytomegalovirus infection

Archives of Dermatology ◽

10.1001/archderm.128.11.1552 ◽

1992 ◽

Vol 128 (11) ◽

pp. 1552-1553 ◽

Cited By ~ 5

Author(s):

V. Garcia-Patos

Keyword(s):

Skin Biopsy ◽

Acquired Immunodeficiency Syndrome ◽

Cytomegalovirus Infection ◽

Clinicopathologic Study ◽

Biopsy Specimens ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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PITUITARY-ADRENAL RECOVERY FOLLOWING LONG-TERM CORTICOSTEROID THERAPY

Acta Endocrinologica ◽

10.1530/acta.0.0510063 ◽

1966 ◽

Vol 51 (1) ◽

pp. 63-70 ◽

Cited By ~ 4

Author(s):

P. F. Roe ◽

D. M. Mitchell ◽

G. W. Pennington

Keyword(s):

Corticosteroid Therapy ◽

Adrenocortical Function ◽

Endocrine Disorders ◽

Marked Rise ◽

Underlying Condition ◽

Normal Limits ◽

Small Rise ◽

The Mean ◽

Corticosteroid Drugs

ABSTRACT Adrenocortical function was assessed in 20 patients receiving long-term corticosteroid drugs for a variety of non-endocrine disorders. In all cases plasma 17-hydroxycorticosteroids (17-OHCS) levels were within or above normal limits 48 hours after abruptly stopping their drugs and a further marked rise occurred in 7 patients given metyrapone for 24 h. Urinary 17-OHCS excretion did not show a parallel rise. Taking the group as a whole, a small rise in the mean output occurred 48 hours after stopping therapy, and a further slightly greater rise followed metyrapone. 3 patients had a relapse of their underlying condition during the test in spite of normal plasma and urinary 17-OHCS levels.

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