scholarly journals Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature

2008 ◽  
Vol 158 (3) ◽  
pp. 423-429 ◽  
Author(s):  
Alejandro L Rosas ◽  
Anna A Kasperlik-Zaluska ◽  
Lucyna Papierska ◽  
Barbara Lee Bass ◽  
Karel Pacak ◽  
...  
Keyword(s):  
Hypertensive Crisis ◽  
Fatal Outcome ◽  
Adrenal Incidentaloma ◽  
High Dose ◽  
High Dose Dexamethasone ◽  
Pheochromocytoma Multisystem Crisis ◽  
Life Threatening ◽  
Adrenal Masses ◽  
Pre Treatment ◽  
Hypertensive Crises

ContextPheochromocytoma crisis (PC) is a rare life-threatening endocrine emergency that may present spontaneously or can be unmasked by ‘triggers’, including certain medications that provoke the release of catecholamines by tumors. Several isolated cases of PC have been reported after administration of exogenous glucocorticoids; evidence that these drugs cause adverse events in patients with pheochromocytoma is mainly anecdotal.PatientsWe report four cases of PC most likely induced by glucocorticoids and review seven previous reports in the literature linking steroid administration to the development of PC.ResultsIn four new cases reported here, glucocorticoid administration was associated with a fatal outcome in one case, a pheochromocytoma multisystem crisis in another, and serious hypertensive crises in two others. Two patients had incidental adrenal masses and were undergoing high-dose dexamethasone suppression tests (DST).ConclusionsExogenous glucocorticoids may unpredictably trigger PC. Pheochromocytoma should be included in the differential diagnosis of any patient who develops a hypertensive crisis, cardiac failure, tachycardia, headache, and abdominal or chest pain after receiving exogenous glucocorticoids. Glucocorticoid induced PC is frequently associated with hemorrhagic pheochromocytoma. Although exogenous glucocorticoids cause serious complications unpredictably, they should be avoided or administered only if necessary and with caution in patients with known or suspected pheochromocytoma. During the investigation of incidental adrenal masses, pheochromocytoma should ideally be ruled out before administering glucocorticoids. However, no cases have been reported with 1 mg of dexamethasone when given as a DST in patients with pheochromocytoma; larger doses, as low as 2 mg of dexamethasone, may trigger a PC. A patient with pheochromocytoma presenting as an adrenal incidentaloma may also be at risk if exposed to glucocorticoids given as pre-treatment in case of allergy to contrast media.

scholarly journals Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to Salmonella typhi Bacteremia

2022 ◽  
pp. 263394472110610
Author(s):  
Sruti P. Nair ◽  
Aravind Reghukumar ◽  
Athul Gurudas ◽  
Kiran Kumar V. Sasidharan ◽  
Sreekumar Sivadasan
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Past History ◽  
Fatal Outcome ◽  
Systemic Infection ◽  
Salmonella Typhi ◽  
High Dose ◽  
Uncontrolled Diabetes ◽  
Life Threatening ◽  
History Of

Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.

Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

2010 ◽  
Vol 00 (04) ◽  
pp. 85
Author(s):  
Valeria Magarotto ◽  
Antonio Palumbo ◽  
◽  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
New Drugs ◽  
High Dose ◽  
Standard Drug ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

scholarly journals THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

scholarly journals Severe immune thrombocytopenic purpura in critical COVID-19: a case report

2020 ◽  
Author(s):  
Valérie Lévesque ◽  
Émilie Milaire ◽  
Daniel Corsilli ◽  
Benjamin Rioux-Massé ◽  
François Martin Carrier
Keyword(s):  
Immune Thrombocytopenic Purpura ◽  
Immune Thrombocytopenia ◽  
Clinical Manifestations ◽  
High Dose ◽  
New Disease ◽  
First Line ◽  
Thrombocytopenic Purpura ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Hematological Manifestations

Abstract Purpose: COVID-19 is a new disease with many undescribed clinical manifestations. Material and methods: We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient.Results: A patient presented a severe episode of immune thrombocytopenia (< 10 x 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high dose dexamethasone to observe an increase in platelet count. Conclusion: COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.

Functional Plasticity in CD4+ CD25+ CD127- Treg Population in Primary Immune Thrombocytopenia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3470-3470 ◽  
Author(s):  
Boting Wu ◽  
Yanxia Zhan ◽  
Feng Li ◽  
Luya Cheng ◽  
Shanhua Zou ◽  
...  
Keyword(s):  
Gene Expression ◽  
T Helper Cells ◽  
Foxp3 Expression ◽  
Post Treatment ◽  
High Dose ◽  
T Helper ◽  
Functional Plasticity ◽  
Helper Cells ◽  
High Dose Dexamethasone ◽  
Pre Treatment

Abstract Background As the most prevalent acquired bleeding disorder in adults, primary immune thrombocytopenia (ITP) and its underlying immune aberrations have been intensely investigated. Beyond the previously described Th1/Th2 imbalance, the role of Th17/Treg dysregulation has become the focus of attention. It was reported by our group that Tregs from untreated ITP patients demonstrated decreased IL-10 secretion and compromised control upon over-activated T effector cells (Li et al. 2015). The mechanism of Treg dysregulation under autoimmunity conditions is yet to be revealed. It has been recently argued by several research groups that the functional plasticity of Treg cell linage is dynamically regulated under inflammation via instability of Foxp3 expression, which means that Tregs can lose Foxp3 expression to gain effector T cell function in inflammatory milieu. The present study evaluated phenotypic features and gene expression traits of purified CD4+ T helper cells from ITP patients before and after glycocorticoids treatment, thus intending to investigate Treg functional plasticity among ITP patients. Methods CD4+ T helper cells were obtained via magnetic activated cell sorting from peripheral blood of 8 primary ITP patients before and after glycocorticoids treatment and 4 healthy volunteers. The phenotypic features were determined by FACS Canto II system with surface staining of CD25 and CD127, as well as cytoplasmic staining of IFN-γ and IL-17. Gene expression profiling was performed via QIAGEN Human T Helper Cell Differentiation PCR Array. Results The pre-treatment platelet count was (7±7)*109/L among 8 ITP patients (2 males and 6 females, median age 57.0 years), and the post-treatment platelet count was restored to (158±63)*109/L after high-dose dexamethasone regimen (40mg/d*4d). Gene expression profiling revealed that Foxp3 (-2.8 folds, p=0.001), TNF (-4.0 folds, p=0.003), and Stat1 (-2.3 folds, p=0.001) levels were significantly down-regulated among untreated ITP patients, while IL-17A (3.6 folds, p=0.05) was up-regulated with marginal statistical significance. The percentage of CD25+ CD127- population in CD4+ cells was similar among 3 groups (pre-treatment ITP: 3.1±0.6%, post-treatment ITP: 3.2±0.7%, health control: 3.4±0.8%). Among CD4+ CD25+ CD127- population, the percentage of IL-17+ cells was elevated in pre-treatment ITP patients (2.9±1.8% vs. 1.4±0.2%, p=0.17), and significantly decreased after high-dose dexamethasone regimen (1.5±1.1% vs. 2.9±1.8%, p=0.035), while the percentage of IFN-γ+ cells was similar among 3 groups (pre-treatment ITP: 18.5±12.6%, post-treatment ITP: 11.1±9.5%, health control: 18.5±3.8%). Conclusions Among primary ITP patients, Foxp3 expression was significantly decreased in their CD4+ T helper cells, which was inconsistent with the almost stable CD4+ CD25+ CD127- percentages determined by flow cytometry between ITP patients and healthy volunteers. Within the Treg population, we demonstrated elevated IL-17 expressing cells in pre-treatment ITP patients, which could be restored after high-dose dexamethasone regimen. These findings favored the argument of the functional plasticity of Treg cell linage during autoimmunity, and corresponded to Th17 dysregulation previously described in primary ITP. Disclosures No relevant conflicts of interest to declare.

scholarly journals Treatment of Pediatric Life Threatening Amitriptilin Intoxication with Plasma Exchange

2021 ◽  
Vol 8 (1) ◽  
pp. 01-03
Author(s):  
Deniz Karakaya
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Plasma Exchange ◽  
Fatal Outcome ◽  
Gastric Lavage ◽  
Volume Of Distribution ◽  
Tricyclic Antidepressant ◽  
High Dose ◽  
Life Threatening ◽  
The Central Nervous System

Tricyclic antidepressant (TCA) overdose is one of the most common causes of serious drug poisoning in children. Amitriptyline is a major TCA drug that is used widely. Tricyclic antidepressant intoxications are very important because of their severe adverse effects and probable fatal outcomes. It may cause cardiovascular, respiratory and neurological side effects. Poisoning results in hypotension, cardiac dysrhythmia, depression of the central nervous system (CNS) and seizures. The most common effects on the central nervous system are agitation, lethargy, seizures, and coma. Cardiovascular toxicities manifest itself especially with electrocardiographic (ECG) abnormalities, arrhythmias, and refractory hypotension and they are the leading cause of fatal outcome. Treatments in TCA overdose are mainly conservative including gastric lavage, activated charcoal and vasopressors for hypotension, sodium bicarbonate for dysrhythmias, and benzodiazepines for seizures. Magnesium sulfate (MgSO4) also has an effective role in the treatment of fatal cardiac arrhythmias occurring in high-dose amitriptyline intoxication. Intravenous lipid emulsions have been increasingly studied as antidotes to reverse acute, life-threatening drug toxicity. Unpredictable and poor results with hemoperfusion (HP) and hemodialysis (HD) should be expected, as the drug binds rapidly to tissues and has a large volume of distribution. But beside it, in the last few years, HP has been successfully used in severe TCA overdose, especially in patients with persistent respiratory, cardiac, and neurologic symptoms. Besides all these, recently, plasma exchange, have been increasingly used. A reduction of plasma levels by 63% after plasmapheresis in TCA poisoning has been reported. Here, we report a successful treatment of plasma exchange 3 year patient with amitriptyline overdose who had arrhythmias and seizures that wasn't respond all to conservative therapies.

scholarly journals THE PITFALL OF RELYING ON A SPHYGMOMANOMETER DURING A HYPERTENSIVE CRISIS

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Toh Leong Tan ◽  
Chuan Hun Ding
Keyword(s):  
Target Organ Damage ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
History Of ◽  
Chest X Ray ◽  
Hypertensive Crises ◽  
The Right

Hypertensive crises can be life-threatening if undiagnosed due to the risk of acute target organ damage. This is a case of a middle-aged woman with poorly controlled hypertension who presented with a 3-day history of dyspnea, orthopnea, and cough productive of frothy sputum. Repeated attempts to measure her blood pressure (BP) using both a mercury and an electronic sphygmomanometer were unsuccessful. However, when an arterial catheterization of the right radial artery was performed, her mean BP was 358/151 mm Hg. A chest X-ray revealed cardiomegaly with plethoric lung fields. Following a diagnosis of hypertensive emergency with acute pulmonary edema, a glyceryl trinitrate infusion at a dose of 20 mg/min was commenced and titrated in an escalating manner. She was also given a single dose of intravenous frusemide 40 mg. Her BP was successfully reduced by 25% within 3 h of presentation.

Adrenal incidentaloma: evaluation and management

2008 ◽  
Vol 61 (11) ◽  
pp. 1168-1173 ◽  
Author(s):  
P K Singh ◽  
H N Buch
Keyword(s):  
Surgical Intervention ◽  
Adrenal Incidentaloma ◽  
Adrenal Incidentalomas ◽  
Imaging Studies ◽  
Imaging Characteristics ◽  
Risk Of Malignancy ◽  
Life Threatening ◽  
History Of ◽  
Adrenal Masses

Adrenal incidentalomas are adrenal masses discovered incidental to imaging studies performed for reasons unrelated to adrenal pathology. Although most adrenal incidentalomas are non-functioning benign adenomas, their increasing prevalence presents diagnostic and therapeutic challenges. The assessment of adrenal incidentalomas is aimed at deciding whether or not the tumour should be surgically removed. Adrenalectomy is indicated for phaeochromocytoma, other symptomatic hormone-secreting tumours and those with a high risk of malignancy. Biochemical screening for tumour hypersecretion is mandatory in all adrenal incidentalomas, since hormone secreting tumours may be clinically silent. The diagnosis of phaeochromocytoma is of paramount importance because of its life-threatening complications. Non-functioning adrenal incidentalomas need assessment for risk of malignancy, and this is based on the size of the tumour and its imaging characteristics. An observational policy with periodic radiological and biochemical reassessment is pursued in patients with non-functioning incidentalomas with low malignancy risk. The duration and frequency of reassessment remains unclear, as the natural history of adrenal incidentalomas has yet to be clearly defined, and there is a lack of controlled studies comparing surgical intervention with observation. However, the possibility of acquiring autonomous hypersecretion or conversion to malignancy in an incidentaloma diagnosed to be a benign non-functioning lesion is very low, and most patients may be safely discharged after an initial follow-up period of 2 years.

Isolation of an Anti-fatigue Preparation from Cellulase-treated Maca by Hydroalcoholic Extraction

2017 ◽  
Vol 17 (1) ◽  
pp. 93-98
Author(s):  
Zheng Yue ◽  
Zhang Wen-Cheng ◽  
Wu Ze-Yu ◽  
Fu Chuan-Xiang ◽  
Gao Han ◽  
...  
Keyword(s):  
Positive Control ◽  
Glycogen Storage ◽  
Hepatic Glycogen ◽  
Time To Exhaustion ◽  
High Dose ◽  
Hydroalcoholic Extract ◽  
Swimming Time ◽  
Significant Difference ◽  
Pre Treatment ◽  
Better Than

The purpose of this study was to evaluate the anti-fatigue activity of maca hydroalcoholic extract (ME), which mainly contains macamides and polysaccharides. ME was prepared by circumfluence extraction with enzymatic pre-treatment. Anti-fatigue activity of ME was investigated in weight-loaded forced swimming mice, with pure macamides and commercially available maca tablet as positive control. Compared with normal group, pure macamides treatment group could prolong the swimming time to exhaustion, but there was no statistically significant difference (P > 0.05); while ME (middle-dose and high-dose groups) could effectively prolong the swimming durations (P < 0.05). Supplementation with pure macamides significantly decreased blood lactic acid (BLA), whereas ME significantly increased hepatic glycogen (HG), decreased BLA, and blood urea nitrogen (BUN) compared with those in normal control (P < 0.05). The results suggested that the anti-fatigue effect of ME was better than that of pure macamides, which can be explained by the increase of glycogen storage and the reduction of metabolites accumulation.

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