scholarly journals Obojestranska krvavitev v nadledvičnico: vzrok visoki zgodnji zlatenici in akutni primarni insuficienci nadledvičnic pri novorojenčku

2018 ◽  
Vol 87 (3-4) ◽  
Author(s):  
Petja Fister ◽  
Marta Žnidaršič Eržen ◽  
Primož Kotnik ◽  
Mojca Tomažič
Keyword(s):  
Gestational Diabetes ◽  
Adrenal Insufficiency ◽  
Clinical Case ◽  
Adrenal Glands ◽  
Clinical Signs ◽  
Term Neonate ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Life Threatening ◽  
Threatening Situation

Adrenal bleeding in a newborn is rare. The cause of bleeding is unknown, most likely due to several factors. Bleeding may be minimal with no clinical signs or fulminant with acute adrenal insufficiency, which is a life-threatening situation that requires immediate detection and treatment.In this paper we represent a clinical case of a term neonate born to the mother with gestational diabetes, who was hospitalised due to high early hyperbilirubinemia. Significant bleeding in both adrenal glands was identified by ultrasound and primary adrenal insufficiency diagnosed. We discuss possible causes, the diagnostic clues, the treatment of disease and its prognosis.

scholarly journals Case Report: Neonatal Cholestasis as Early Manifestation of Primary Adrenal Insufficiency

2021 ◽  
Vol 9 ◽  
Author(s):  
Fabiola Di Dato ◽  
Donatella Capalbo ◽  
Rita Mirra ◽  
Francesca Del Vecchio Blanco ◽  
Mariacarolina Salerno ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Early Recognition ◽  
Clinical Signs ◽  
Underlying Disease ◽  
Neonatal Cholestasis ◽  
Primary Adrenal Insufficiency ◽  
Single Episode ◽  
Life Threatening ◽  
Glucocorticoid Deficiency ◽  
Specific Symptoms

Neonatal cholestasis (NC) may be due to multiple surgical and non-surgical causes, some of which are potentially fatal. The list of potential causes of NC is long, and the systematic search for each of them is challenging in infants, especially when overt signs of underlying disease are lacking. Endocrinological diseases as causes of NC are rare and sometimes misdiagnosed. We report the case of an infant with prolonged cholestatic jaundice due to adrenal insufficiency suspected because of a single episode of hypoglycemia occurring at birth in the absence of clinical signs of adrenal impairment. Clinical exome analysis identified a new homozygous variant in MC2R gene as a putative responsible for familial glucocorticoid deficiency (FGD). Adrenal insufficiency should always be considered in all cholestatic infants, even in the absence of specific symptoms, since early recognition and treatment is essential to prevent life-threatening events.

scholarly journals Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

2021 ◽  
Author(s):  
Iza F R Machado ◽  
Isabel Q Menezes ◽  
Sabrina R Figueiredo ◽  
Fernando Morbeck Almeida Coelho ◽  
Debora R B Terrabuio ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Insufficiency ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Case Reports ◽  
Serum Cortisol ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Infarction ◽  
New Onset

Abstract Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

scholarly journals A case of late manifestation of primary adrenal insufficiency in the autoimmune polyglandular syndrome type 1

2019 ◽  
Vol 47 (2) ◽  
pp. 175-179
Author(s):  
V. V. Troshina ◽  
T. A. Grebennikova ◽  
Zh. E. Belaya
Keyword(s):  
Adrenal Insufficiency ◽  
Clinical Case ◽  
Clinical Symptoms ◽  
Syndrome Type ◽  
Primary Adrenal Insufficiency ◽  
Autoimmune Polyglandular Syndrome ◽  
Autoimmune Polyendocrine Syndrome ◽  
Autoimmune Polyglandular Syndrome Type ◽  
Timely Treatment

The article describes a clinical case of primary adrenal insufficiency which manifested at an atypically advanced age. Primary adrenal insufficiency combined with other clinical symptoms suggested the autoimmune polyendocrine syndrome type 1. Subsequently, the diagnosis was confirmed by the results of genetic testing. The particulars of the clinical case include the age of patient at manifestation of the disease (49  years). The lack of treatment resulted in dramatic clinical decompensation. This clinical case is intended to draw clinicians' attention to the necessity of detection of primary adrenal insufficiency and appropriate and timely treatment. Taking into account eventual diagnostic problems, it is necessary to raise awareness about this disease among practicing doctors of various specialties.

scholarly journals Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Adele Latina ◽  
Massimo Terzolo ◽  
Anna Pia ◽  
Giuseppe Reimondo ◽  
Elena Castellano ◽  
...  
Keyword(s):  
Postmenopausal Woman ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Genetic Disease ◽  
Hip Replacement ◽  
Acute Intermittent Porphyria ◽  
Adrenal Hemorrhage ◽  
Primary Adrenal Insufficiency ◽  
Threatening Condition ◽  
Life Threatening

Adrenal insufficiency is a potentially life-threatening condition when it occurs acutely, as in adrenal hemorrhage. Generally it is not reversible and requires chronic replacement therapy. Acute intermittent porphyria (AIP) is a rare genetic disease characterized by alterations in heme biosynthesis that result in accumulation of precursors in tissues. A crisis can be triggered by many conditions such as surgery and infections. Symptoms are similar to those of acute hypoadrenalism. Moreover, both conditions are characterized by hyponatremia. We describe the case of a postmenopausal woman known to be affected by AIP who developed after surgery a primary adrenal insufficiency associated with adrenal enlargement; the latter completely reverted in six months.

scholarly journals Primary Adrenal Insufficiency due to Multidrug-Resistant Tuberculosis: A Case Report

2017 ◽  
Vol 7 (3) ◽  
pp. 235-237
Author(s):  
Sultana Marufa Shefin ◽  
Kazi Nazmul Hossain ◽  
Jamal Uddin Ahmed ◽  
Mohammad Mostafizur Rahman
Keyword(s):  
Adrenal Gland ◽  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Serum Cortisol ◽  
Needle Aspiration ◽  
Multidrug Resistant ◽  
Primary Adrenal Insufficiency ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Tuberculosis (TB) is a common infectious disease in developing countries like Bangladesh. Drug-resistant tuberculosis (DR-TB) poses a significant threat to the population. A relatively uncommon site of involvement of TB is adrenal gland, which is an important cause of chronic adrenal insufficiency. Here we present a case of a 40-year-old male with multidrug-resistant tuberculosis (MDR-TB) involving the adrenal glands. He was previously diagnosed as a case of disseminated TB involving lungs, right knee joint and lumbar spine and received anti-TB chemotherapy for several occasions and in different categories in last 12 years before this presentation. He presented with 4-month history of vomiting, diarrhea, generalized weakness, generalized pigmentation and postural hypotension. Investigations revealed hyponatremia with hyperkalemia. Adrenal insufficiency was suspected and serum cortisol was found to be low and serum adreno corticotropic hormone (ACTH) was high. On imaging there was bilateral adrenal enlargement. Fine needle aspiration cytology (FNAC) was done from adrenal gland which revealed granulomatous lesion suggestive of TB. Gene Xpert and culture-sensitivity of aspirated material for Mycobacterium tuberculosis revealed MDR-TB. Patient was finally diagnosed as a case of primary adrenal insufficiency due to MDR-TB of the adrenal glands and was treated with regime for MDR-TB for 20 months.Birdem Med J 2017; 7(3): 235-237

scholarly journals Primary adrenal insufficiency replacement therapy

2000 ◽  
Vol 46 (3) ◽  
pp. 31-45
Author(s):  
V. V. Fadeev ◽  
G. A. Melnichenko
Keyword(s):  
Heart Failure ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Adrenal Cortex ◽  
Adrenal Glands ◽  
Pathological Process ◽  
Clinical Syndrome ◽  
Primary Adrenal Insufficiency ◽  
Adrenal System ◽  
System 2

Adrenal insufficiency is a clinical syndrome caused by insufficient secretion of hormones by the adrenal cortex, which is the result of a malfunction of one or more parts of the hypothalamic-pituitary-adrenal system [2]. Primary chronic adrenal insufficiency (1-CNI) develops as a result of the destruction of more than 90% of the cortex of both adrenal glands by a pathological process. The main causes of 1-CNN are currently autoimmune (80–85%) and tuberculosis (5–10%) destruction of the adrenal cortex [2, 3]. 1-CNN of the indicated etiology is better known as "Addison's disease." 1-CNN is a relatively rare disease (40-110 new cases per 1 million people per year) [2, 3], but it is of considerable importance in the practice of endocrinology. Without exception, all patients with a diagnosis of 1-chronic heart failure need lifelong replacement therapy with corticosteroids (CS), which will be discussed in this work.

scholarly journals THERAPY OF ENDOCRINE DISEASE: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe

2013 ◽  
Vol 169 (6) ◽  
pp. R165-R175 ◽  
Author(s):  
Ashley Grossman ◽  
Gudmundur Johannsson ◽  
Marcus Quinkler ◽  
Pierre Zelissen
Keyword(s):  
Adrenal Insufficiency ◽  
Clinical Signs ◽  
Adrenal Crisis ◽  
Dose Selection ◽  
Endocrine Disease ◽  
Once Daily ◽  
Mortality And Morbidity ◽  
Medical Need ◽  
Life Threatening

BackgroundConventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring.Objectivesi) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations.MethodsThe review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment.ResultsOptimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs.ConclusionsThis review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.

Androgen deficiency in women with adrenal insufficiency. Dehydroepiandrosterone. Review

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (4) ◽  
pp. 35-39
Author(s):  
N F Nuralieva ◽  
M Yu Yukina ◽  
E A Troshina ◽  
N M Platonova
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Dehydroepiandrosterone Sulfate ◽  
Malignant Neoplasms ◽  
Androgen Deficiency ◽  
Risk Of Death ◽  
Pathological Conditions ◽  
Increased Risk ◽  
Life Threatening

It is known that adrenal insufficiency (AI) is a severe life-threatening disease due to the exceptional role of glucocorticoids and mineralocorticoids in the human body. At the same time, according to some reports, the deficit of androgens synthesized by the adrenal cortex (dehydroepiandrosterone - DHEA and dehydroepiandrosterone sulfate - DHEAS) is associated with an increased risk of death, including increased risk of adverse cardiovascular events, development of osteoporosis, diabetes mellitus and malignant neoplasms. The main source of DHEA and DHEAS in females are adrenal glands, so women with hypocorticism have significantly reduced (down to undetectable) levels of these hormones. However, due to lack of a reliable evidence and, accordingly, clinical recommendations, correction of androgen deficiency in patients with AI is usually not performed. The review discusses the accumulated data on the physiological significance of DHEA and DHEAS, their role in the development of various pathological conditions, as well as safety and efficacy of these drugs.

Assessment of autoantibodies against 21-hydroxylase in the diagnosis of primary autoimmune adrenal insufficiency

2020 ◽  
Author(s):  
Leila Sozaeva ◽  
Nadezhda Makazan ◽  
Larisa Nikankina ◽  
Natalya Malysheva ◽  
Ekaterina Kuvaldina ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Patient Survival ◽  
Adrenal Crisis ◽  
Primary Adrenal Insufficiency ◽  
Adrenal Steroidogenesis ◽  
Threatening Condition ◽  
Life Threatening ◽  
The One

Primary adrenal insufficiency is manifested by a deficiency of adrenal cortex hormones and can lead to a life-threatening condition. Early diagnosis is key to patient survival. Auto-antibodies to one of the adrenal steroidogenesis enzymes, 21-hydroxylase, are an immunological marker of autoimmune adrenal insufficiency. On the one hand, the study of antibodies to 21-hydroxylase is a method that helps establish the etiology of the disease the autoimmune genesis of adrenal gland damage. On the other hand, the determination of autoantibodies to 21-hydroxylase is the only prognostic factor of the risk of adrenal insufficiency, which makes it possible to prevent the development of acute adrenal crisis. The article provides a brief literature review on autoantibodies to 21-hydroxylase and the pathogenesis of autoimmune adrenal insufficiency, and a series of clinical cases that illustrates the significant role of autoantibodies to 21-hydroxylase in diagnosis of adrenal insufficiency.

Sign in / Sign up

Export Citation Format

Share Document