An unusual clinical presentation of Sheehan's syndrome: Co-occurrence of bycitopenia, acute colonic pseudo-obstruction and acute renal failure

2008 ◽

Vol 3;11 (5;3) ◽

pp. 681-686

Author(s):

Thomas M. Larkin

Keyword(s):

Spinal Cord ◽

Renal Failure ◽

Acute Renal Failure ◽

Spinal Cord Stimulation ◽

Clinical Presentation ◽

Urinary Catheter ◽

Spinal Cord Stimulator ◽

Secondary Effects ◽

First Case ◽

History Of

Objective: This is the first case describing an episode of acute renal failure occurring during a spinal cord stimulation trial. Clinical Presentation: A 48-year-old male with a history of hypertension and 3 prior failed spine surgeries underwent a trial of spinal cord stimulation for uncontrolled bilateral lower extremity neuropathic pain. Two days after the placement of the percutaneous stimulator lead the patient returned complaining of 3 syncopal episodes. He was found to be hypotensive and in acute renal failure with a creatinine of 8.1 and a BUN of 83. Intervention: The stimulator lead was immediately removed. The patient was admitted to the intensive care unit and responded promptly to rehydration and placement of a urinary catheter. His renal and urological work-ups revealed no significant abnormalities. Conclusion: The development of the episode of acute renal failure may have been influenced by the secondary effects of spinal cord stimulation. Since acute renal failure has never been associated with the use of spinal cord stimulation, this singular example does not by itself demonstrate a relationship. However, if future episodes are seen, a link between the 2 events could be drawn. For now, it is not clear if the development of this patient’s acute renal failure could, in part, be attributed to the use of the spinal cord stimulator or if it was merely coincidental in nature. We do feel it is useful for the clinician to understand the pathophysiologic changes associated with spinal cord stimulation and to see how, at least in theory, there could be a connection. Key words: acute renal failure, spinal cord stimulation

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A Stepwise Diagnosis of Sarcoidosis Presenting with Renal Impairment and Hypercalcemia

BANTAO Journal ◽

10.2478/bj-2014-0012 ◽

2015 ◽

Vol 12 (1) ◽

pp. 56-61

Author(s):

Alper Alp ◽

Hakan Akdam ◽

Ibrahim Meteoglu ◽

Emel Ceylan ◽

Arzu Cengiz ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Renal Impairment ◽

Renal Disease ◽

Clinical Presentation ◽

Renal Involvement ◽

Granulomatous Disease ◽

Organ Function ◽

Immune Mediated ◽

Clinical Conditions

Abstract Sarcoidosis is a multisystem, immune-mediated, granulomatous disease. Clinical presentation of this disease may vary; in majority of cases (~90%) thoracic involvement is the leading sign. Although renal involvement is thought to be uncommon in sarcoidosis this entity may not be so rare. Hypercalcemia seems to be the most likely cause of sarcoidosis-associated renal disease, it can even cause acute renal failure in 1-2% of sarciodosis patients. Immediate treatment is appropriate whenever organ function is threatened or when symptoms are severe. We present a case of sarcoidosis with hypercalcemia excluding other clinical conditions, which may potentially confuse the diagnosis.

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Diagnosis Delayed but not Denied - Sheehan’s syndrome

Journal of Nepal Medical Association ◽

10.31729/jnma.2701 ◽

2015 ◽

Vol 53 (197) ◽

pp. 31-33 ◽

Cited By ~ 1

Author(s):

Vijayeshree Thyagaraj ◽

MJ Vinod Kumar

Keyword(s):

Developing Countries ◽

Renal Failure ◽

Postpartum Hemorrhage ◽

Rare Complication ◽

Obstetric Care ◽

Sheehan’S Syndrome ◽

Sheehan Syndrome ◽

Life Threatening ◽

Sheehan's Syndrome ◽

High Index Of Suspicion

Sheehan’s syndrome is a rare complication of postpartum hemorrhage. With advancement in obstetric care, Sheehan's syndrome has become uncommon except in developing countries. Here, we report a patient with Sheehan’s syndrome who escaped diagnosis for 22 years and presented with life threatening complications. This patient also had certain unusual features of Sheehan’s syndrome like pancytopenia and renal failure. A high index of suspicion is necessary in diagnosing such patients. Keywords: pancytopenia; renal failure; Sheehan syndrome.

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Rhabdomyolysis Associated with Cocaine Intoxication

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808802201008 ◽

1988 ◽

Vol 22 (10) ◽

pp. 778-780 ◽

Cited By ~ 7

Author(s):

Hilary A. Skluth ◽

John E. Clark ◽

George L. Ehringer

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Clinical Presentation ◽

Elevated Serum ◽

Serum Concentrations ◽

Muscle Enzymes ◽

Toxic Reaction

A case of a patient who had an acutely toxic reaction to cocaine ingestion and later developed acute renal failure secondary to rhabdomyolysis is described. Evidence of rhabdomyolysis was noted by the combination of myalgia, urine discoloration, and elevated serum concentrations of muscle enzymes. Although the mechanism of the rhabdomyolysis is unknown, the clinical presentation resembled that of a norepinephrine-induced vasoconstrictive effect that alters the metabolic demands of the muscle in such a way that the muscle is damaged.

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Acute Renal Failure

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808602000602 ◽

1986 ◽

Vol 20 (6) ◽

pp. 421-438 ◽

Cited By ~ 16

Author(s):

Henry J. Mann ◽

David W. Fuhs ◽

Carl A. Hemstrom

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Animal Models ◽

Supportive Care ◽

Clinical Presentation ◽

Urine Volume ◽

Preventive Therapy ◽

Experimental Therapy ◽

Animal Data ◽

Prevention And Treatment

Acute renal failure (ARF) is common among critically ill patients and renal dysfunction is often associated with the multisystem organ failure syndrome. The mortality of ARF remains high but animal data indicate that prevention and early treatment may decrease the morbidity and mortality. This review defines ARF based on urine volume, laboratory parameters, and clinical presentation. The pathophysiology of prerenal, postrenal, and intrinsic ART are differentiated and diagnostic criteria provided. Preventive therapy, supportive care, and proposed treatments are outlined. Studies examining the prevention and treatment of ARF in animal models and trials in humans are evaluated. Mannitol 0.5–1 g/kg, furosemide 0.5–1 mg/kg initially, and dopamine 1–5 μg/kg/min are effective in preventing or decreasing the severity of ARF in animal models. In humans these drugs are effective at maintaining urine output in various clinical situations and converting oliguria to nonoliguria in some patients; however, increased survival has not been adequately proven as of yet. Dialysis and experimental therapy are briefly discussed.

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Sheehan's syndrome in modern times: a nationwide retrospective study in Iceland

Acta Endocrinologica ◽

10.1530/eje-10-1004 ◽

2011 ◽

Vol 164 (3) ◽

pp. 349-354 ◽

Cited By ~ 19

Author(s):

Hallgerdur Lind Kristjansdottir ◽

Sigrun Perla Bodvarsdottir ◽

Helga Agusta Sigurjonsdottir

Keyword(s):

Clinical Presentation ◽

Correct Diagnosis ◽

Diagnostic Delay ◽

Obstetric Care ◽

Developed Countries ◽

Population Based ◽

Sheehan’S Syndrome ◽

Significance Level ◽

Modern Times ◽

Sheehan's Syndrome

Background and objectiveHalf a century ago the prevalence of Sheehan's syndrome (SS) was 10–20 per 100 000 women. With better obstetric help the prevalence is assumed to have decreased, especially in developed countries. The aim of this study is to estimate the prevalence of SS in modern times in Iceland.DesignWe studied the prevalence of SS in 2009 in a nationwide retrospective population-based study.MethodsAll patients with diagnosed SS were identified, and information regarding obstetric care, clinical presentation and hormonal assays was collected. Correlation was calculated with Kendall's tau-b. Significance level: P<0.05.ResultsEight women were identified with SS; thus, the prevalence of SS in 2009 was 5.1 per 100 000 women. The mean age at delivery and diagnosis was 33.0 and 36.6 respectively, resulting in a diagnostic delay (DD) of 1–240 months. Four women had low blood pressure during delivery, and five had massive blood loss (>1000 ml). Six had complicated deliveries. The most common clinical presentation was failure to lactate and failure to resume menstruation. The patients had three to five failing pituitary axis. There was no correlation between bleeding at delivery or the number of hormonal axes affected and DD.ConclusionThe prevalence of SS in Iceland was higher than we expected in a country with modern obstetric care. Long DD and incidental diagnosis indicate that women might be lacking correct diagnosis and treatment, and thus the prevalence of SS is even higher. As SS is easily diagnosed and treatable, but can be life-threatening if unrecognised, doctors need to be aware of the disease.

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