scholarly journals An Autopsy of Acute Adrenal Insufficiency Resulting from Infarction of Both Adrenal Glands, in a Pregnant Woman with Metastatic Carcinoma of the Breast

2021 ◽  
Author(s):  
Gwendolyn Fernandes ◽  
Sharada Datar
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Emergency Services ◽  
Kidney Injury ◽  
Metastatic Carcinoma ◽  
Electrolyte Imbalance ◽  
Medical Emergency ◽  
Carcinoma Of The Breast ◽  
Duct Carcinoma ◽  
Acute Adrenal Insufficiency

Acute Adrenal Insufficiency (AAI) is a life-threatening medical emergency, associated with high mortality, and requires early diagnosis and prompt management. This is an unusual case report of a 34-year-old female who was diagnosed with breast cancer, in the second trimester of pregnancy. She presented at 33 weeks gestation, in the emergency services, with convulsions, weakness, altered sensorium and high-grade infiltrating duct carcinoma of breast with liver metastasis. She had also received a single cycle of chemotherapy with adriamycin and cyclophosphamide, at 33 weeks of pregnancy. Her condition deteriorated within 12-16 hours, and she developed abdominal pain, generalised weakness and convulsions. The patient was induced into labour, which was complicated, and delivered a still born male child. She also developed acute kidney injury and severe electrolyte imbalance, and died within four days of admission. A complete postmortem examination was performed where the cause of death was AAI following infarction of both adrenal glands in a background of metastatic carcinoma of the breast. It is strongly suspected that chemotherapy with adriamycin and cyclophosphamide is the primary cause of AAI in the present case. However, the etiology could also be multifactorial as factors like, sepsis, intrauterine foetal death and Disseminated Intravascular Coagulation (DIC) were also present.

Adrenocortical Insufficiency: A Medical Emergency

1992 ◽  
Vol 3 (2) ◽  
pp. 319-330 ◽  
Author(s):  
Laura M. Lee ◽  
Julle Gumowski
Keyword(s):  
Adrenal Insufficiency ◽  
Stress Reduction ◽  
Hypovolemic Shock ◽  
Metastatic Carcinoma ◽  
Medical Emergency ◽  
Delay In Diagnosis ◽  
Acute Adrenal Insufficiency ◽  
Threatening Condition ◽  
Life Threatening ◽  
Clinical Awareness

Adrenal insufficiency is a deceptive disorder. Insidious in onset, chronic in nature, it can suddenly progress into an acute life-threatening condition that may mimic disorders of vastly different etiologies. The result can be a lethal delay in diagnosis. Prompt diagnosis and replacement of glucocorticoids and fluids are essential for survival. Acute adrenal insufficiency is frequently an exacerbation of an underlying chronic disorder of the adrenal cortex or pituitary gland. Yet any patient who has been treated with suppressive doses of glucocorticoids (e.g., Cortisol, prednisone), experienced overwhelming sepsis, has received anticoagulant therapy, or has endstage metastatic carcinoma may suddenly develop adrenal insufficiency along with its deadly sequela of hypovolemic shock, hyperkalemia, hyponatremia, and hypoglycemia. Successful management of this condition requires not only a heightened clinical awareness of adrenal insufficiency, but effective stress reduction interventions and a thorough patient and family teaching program to support lifelong control of the disease

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 Adrenal coma hormone therapy case

2021 ◽  
Vol 43 (3) ◽  
pp. 52-53
Author(s):  
Kots I. Kots
Keyword(s):  
Infectious Diseases ◽  
Hormone Therapy ◽  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Vascular Thrombosis ◽  
Complete Destruction ◽  
Acute Adrenal Insufficiency

When diagnosing various coma, one should bear in mind the possibility of coma due to acute adrenal insufficiency, which develops as a result of partial or complete destruction of the adrenal glands in infectious diseases, adrenal hemorrhages, adrenal vascular thrombosis or surgery on the adrenal glands.

scholarly journals ANTIBODY PRODUCTION AFTER PARTIAL ADRENALECTOMY IN GUINEA PIGS

1918 ◽  
Vol 27 (6) ◽  
pp. 725-738 ◽  
Author(s):  
Frederick L. Gates
Keyword(s):  
Antibody Response ◽  
Adrenal Insufficiency ◽  
Guinea Pigs ◽  
Antibody Formation ◽  
Adrenal Glands ◽  
The Body ◽  
Partial Adrenalectomy ◽  
Adrenal Tissue ◽  
Acute Adrenal Insufficiency

By careful aseptic operation it was found possible to remove approximately three-quarters to seven-eighths of the adrenal tissue of guinea pigs without causing symptoms of adrenal insufficiency. Guinea pigs were immunized to Bacillus typhosus or to hen corpuscles at varying intervals before or after the operation, and the curves of antibody formation traced for 2 to 3 months after immunization. Comparisons with the antibody curves of control animals similarly immunized fail to show that the adrenalectomy had any influence upon the rise or persistence of antibodies in the blood. For the purposes of the study it was not deemed necessary to produce an acute adrenal insufficiency. If the adrenal glands were the site of antibody formation or played an essential part in immunity processes, it does not seem probable that the small remainder of adrenal tissue left in situ to sustain life would affect quantitatively the antibody response to a given antigen injection as do the entire normal glands. We therefore interpret the experiments to indicate that not only are the adrenal glands not one of the important sources of typhoid agglutinins, or of hemagglutinins or hemolysins, but they play no essential part in the mechanism by which these antibodies are produced and maintained in the body.

A Meta-Analysis of Extracorporeal Anticoagulants in Pediatric Continuous Kidney Replacement Therapy

2021 ◽  
pp. 088506662199275
Author(s):  
Rupesh Raina ◽  
Nirav Agrawal ◽  
Kirsten Kusumi ◽  
Avisha Pandey ◽  
Abhishek Tibrewal ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Electrolyte Imbalance ◽  
Therapeutic Modality ◽  
Regional Citrate Anticoagulation ◽  
Increased Risk ◽  
Study Results ◽  
Significant Difference ◽  
Kidney Replacement Therapy

Objective: Continuous kidney replacement therapy (CKRT) is the primary therapeutic modality utilized in hemodynamically unstable patients with severe acute kidney injury. As the circuit is extracorporeal, it poses an increased risk of blood clotting and circuit loss; frequent circuit losses affect the provider’s ability to provide optimal treatment. The objective of this meta-analysis is to evaluate the safety and efficacy of the extracorporeal anticoagulants in the pediatric CKRT population. Data Sources: We conducted a literature search on PubMed/Medline and Embase for relevant citations. Study Selection: Studies were included if they involved patients under the age of 18 years undergoing CKRT, with the use of anticoagulation (heparin, citrate, or prostacyclin) as a part of therapy. Only English articles were included in the study. Data Extraction: Initial search yielded 58 articles and a total of 24 articles were included and reviewed. A meta-analysis was performed focusing on the safety and effectiveness of regional citrate anticoagulation (RCA) vs unfractionated heparin (UFH) anticoagulants in children. Data Synthesis: RCA had statistically significantly longer circuit life of 50.65 hours vs. UFH of 42.10 hours. Two major adverse effects metabolic alkalosis and electrolyte imbalance seen more commonly in RCA compared to UFH. There was not a significant difference in the risk of systemic bleeding when comparing RCA vs. UFH. Conclusion: RCA is the preferred anticoagulant over UFH due to its significantly longer circuit life, although vigilant circuit monitoring is required due to the increased risk of electrolyte disturbances. Prostacyclin was not included in the meta-analysis due to the lack of data in pediatric patients. Additional studies are needed to strengthen the study results further.

scholarly journals Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
L. Quénéhervé ◽  
D. Drui ◽  
J. Blin ◽  
M. Péré ◽  
E. Coron ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Adrenal Insufficiency ◽  
Gastrointestinal Symptoms ◽  
Control Group ◽  
Non Profit ◽  
Acute Adrenal Insufficiency ◽  
Irritable Bowel ◽  
Rome Iv

AbstractGastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association “Adrenals” (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.

Areolar Sebaceous Hyperplasia With Underlying Primary Duct Carcinoma of the Breast in a Woman With Donohue Syndrome (Leprechaunism)

2012 ◽  
Vol 34 (2) ◽  
pp. e15-e18 ◽  
Author(s):  
Angel Fernandez-Flores ◽  
Saul Valerdiz ◽  
Luis G. Crespo ◽  
Purificacion Rodriguez-Cernuda
Keyword(s):  
Carcinoma Of The Breast ◽  
Duct Carcinoma ◽  
Donohue Syndrome
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