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Gland Surgery Jul 2019This chapter describes the use of fluorescence via indocyanine green (ICG) in minimally invasive adrenal surgery (laparoscopic and robotic). ICG is a non-toxic dye that... (Review)
Review
This chapter describes the use of fluorescence via indocyanine green (ICG) in minimally invasive adrenal surgery (laparoscopic and robotic). ICG is a non-toxic dye that can aid identification of vascular structures and parenchymal tissue planes in real time. The primary utility of ICG fluorescence in adrenal surgery is to help delineate the margins of resection, to guide a more precise operation. In particular, for patients with bilateral adrenal disease or a heredity associated with high risk of recurrence (e.g., VHL, MEN2a) this may facilitate subtotal adrenal resection (e.g., cortical sparing adrenalectomy), obviating the incidence of iatrogenic adrenal insufficiency and its numerous sequelae including lifelong hormone supplementation, osteoporosis and risk of Addisonian crisis.
PubMed: 31404180
DOI: 10.21037/gs.2019.03.01 -
Neuro-ophthalmology (Aeolus Press) 2021A 3-month-old boy was referred for assessment and management of apparently absent ocular globes. Ocular examination showed small orbits with apparently absent globes,...
A 3-month-old boy was referred for assessment and management of apparently absent ocular globes. Ocular examination showed small orbits with apparently absent globes, small conjunctival cul-de-sac, shallow fornices, microblepharon and sunken eyelids. Magnetic resonance imaging of the orbit and brain revealed bilateral extreme microphthalmia, replacement of the optic nerves by disorganised rudimentary tissue tufts, hypoplastic orbits and extraocular muscles, an absent septum pellucidum and an absent corpus callosum. A pituitary hormonal essay showed decreased adrenocorticotropic hormone and thyroid-stimulating hormone. Septo-optic dysplasia has been rarely reported to be associated with microphthalmia. Timely treatment with hydrocortisone and levothyroxine is essential to prevent Addisonian crisis from the stress and pain that may accompany insertion of socket expanders.
PubMed: 34483412
DOI: 10.1080/01658107.2020.1791910 -
Gland Surgery Feb 2020Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that secrete excess catecholamines leading to secondary hypertension and cardiovascular... (Review)
Review
Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that secrete excess catecholamines leading to secondary hypertension and cardiovascular morbidity. Once biochemical testing with either 24-hour urinary fractioned metanephrines or plasma free metanephrines confirms the diagnosis, patients are optimized with adequate hydration to maintain their intravascular volume and the appropriate antihypertensive medications are initiated for optimal blood pressure control. Genetic testing and imaging is performed to determine the extent of adrenalectomy and the optimal surgical approach. Surgical approaches include transabdominal or retroperitoneal minimally invasive approaches, and transabdominal open approaches. Factors that influence the surgical approach include germline genetic test results, the size of the tumor, body mass index, surgeon experience, and the likelihood of malignancy. The extent of adrenalectomy is based on germline genetic findings. Patients with syndromes such as von Hippel Lindau (VHL) or multiple endocrine neoplasia 2 (MEN 2) benefit from cortical-sparing adrenalectomy to avoid chronic steroid replacement and the risk of Addisonian crisis. Postoperative management includes hemodynamic monitoring and assessment for signs of hypoglycemia. Outcomes after surgery show improved blood pressure control in most patients and normalization of blood pressure in about a third of patients. Long-term follow-up is required for all patients to assess for recurrence.
PubMed: 32206597
DOI: 10.21037/gs.2019.10.20 -
Revista Da Associacao Medica Brasileira... Nov 2016Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably. (Review)
Review
INTRODUCTION:
Acute adrenal insufficiency or addisonian crisis is a rare comorbidity in emergency; however, if not properly diagnosed and treated, it may progress unfavorably.
OBJECTIVE:
To alert all health professionals about the diagnosis and correct treatment of this complication.
METHOD:
We performed an extensive search of the medical literature using specific search tools, retrieving 20 articles on the topic.
RESULTS:
Addisonian crisis is a difficult diagnosis due to the unspecificity of its signs and symptoms. Nevertheless, it can be suspected in patients who enter the emergency room with complaints of abdominal pain, hypotension unresponsive to volume or vasopressor agents, clouding, and torpor. This situation may be associated with symptoms suggestive of chronic adrenal insufficiency such as hyperpigmentation, salt craving, and association with autoimmune diseases such as vitiligo and Hashimoto's thyroiditis. Hemodynamically stable patients may undergo more accurate diagnostic methods to confirm or rule out addisonian crisis. Delay to perform diagnostic tests should be avoided, in any circumstances, and unstable patients should be immediately medicated with intravenous glucocorticoid, even before confirmatory tests.
CONCLUSION:
Acute adrenal insufficiency is a severe disease that is difficult to diagnose. It should be part of the differential diagnosis in cases of hypotensive patient who is unresponsive to vasoactive agents. Therefore, whenever this complication is considered, health professionals should aim specifically at this pathology.
Topics: Acute Disease; Addison Disease; Adrenal Insufficiency; Clinical Protocols; Diagnosis, Differential; Emergency Medical Services; Humans; Hypotension
PubMed: 27992012
DOI: 10.1590/1806-9282.62.08.728 -
BMJ Case Reports Oct 2015Iatrogenic adrenal insufficiency is a potential harmful side effect of treatment with corticosteroids. It manifests itself when an insufficient cortisol response to...
Iatrogenic adrenal insufficiency is a potential harmful side effect of treatment with corticosteroids. It manifests itself when an insufficient cortisol response to biological stress leads to an Addisonian crisis: a life-threatening situation. We describe a case of a patient who developed an Addisonian crisis after inappropriate discontinuation of budesonide (a topical steroid used in Crohn's disease) treatment. Iatrogenic adrenal insufficiency due to budesonide use has been rarely reported. Prescribers should be aware of the resulting risk for an Addisonian crisis.
Topics: Adrenal Insufficiency; Budesonide; Crohn Disease; Glucocorticoids; Humans; Iatrogenic Disease; Male; Middle Aged; Withholding Treatment
PubMed: 26430235
DOI: 10.1136/bcr-2015-212216 -
The Canadian Veterinary Journal = La... May 2023Primary objectives of this study were to determine presenting complaints, physical examination, clinicopathologic findings, and hospitalization time of dogs with...
OBJECTIVE
Primary objectives of this study were to determine presenting complaints, physical examination, clinicopathologic findings, and hospitalization time of dogs with spontaneous hypoadrenocorticism presenting with critical disease; and to compare those end points to dogs with a more stable presentation. Secondary objectives were to evaluate the shock index and to identify precipitating stressors.
ANIMALS
Eighty-four dogs at the Western College of Veterinary Medicine between 1998 and 2018 were included.
PROCEDURE
Data were retrieved from the medical records.
RESULTS
Collapse and depression were more common among critically ill dogs. Hyperlactatemia was rare despite a diagnosis of hypovolemic shock, and a shock index was ineffective in this patient subset. Isosthenuria, total hypocalcemia, and more severe acidosis were more common ( < 0.05) in critical dogs. Owner separation was the most common precipitating stressor.
CONCLUSION AND CLINICAL RELEVANCE
We concluded that the critical Addisonian dog has unique characteristics that may aid in early disease identification.
Topics: Dogs; Animals; Dog Diseases; Adrenal Insufficiency; Acidosis
PubMed: 37138712
DOI: No ID Found -
Frontiers in Veterinary Science 2021To determine whether administration of intravenous hydrocortisone is a safe and effective alternative treatment in comparison to the traditional treatment with...
Comparison of Hydrocortisone Continuous Rate Infusion and Prednisolone or Dexamethasone Administration for Treatment of Acute Hypoadrenocortical (Addisonian) Crisis in Dogs.
OBJECTIVES
To determine whether administration of intravenous hydrocortisone is a safe and effective alternative treatment in comparison to the traditional treatment with prednisolone/dexamethasone in dogs presenting with Addisonian crisis; and to assess if there is any advantage of the former over the latter in normalisation of electrolyte imbalances and in hospitalisation length in these dogs.
METHODS
Medical records of client-owned dogs with hypoadrenocorticism were retrospectively reviewed. Time until normalisation of sodium and potassium concentration, intravenous fluid needs over the first 24 h and hospitalisation length were compared between hydrocortisone and prednisolone/dexamethasone treated dogs.
RESULTS
Twenty-five dogs met the inclusion criteria; 13 received hydrocortisone and 12 prednisolone/dexamethasone. Intravenous hydrocortisone was well-tolerated but failed to prove superiority in terms of time to normalisation of sodium and potassium concentration. Interestingly, potassium normalised in all dogs prior to discharge, but sodium did not in 1/11 hydrocortisone and 5/9 prednisolone/dexamethasone treated dogs with initial hyponatraemia ( = 0.05). Hydrocortisone treated dogs, however, had more electrolyte re-checks [hydrocortisone treated dogs, median (range): 4 (2-16); prednisolone/dexamethasone treated dogs: 2 (0-6); = 0.001]. There was no difference in intravenous fluid needs over the first 24 h but hydrocortisone treated dogs had longer hospitalisation [hydrocortisone: 81 (45-309) h; prednisolone/dexamethasone: 52 (22-138) h; = 0.01].
CLINICAL SIGNIFICANCE
Intravenous hydrocortisone is well-tolerated and safe, but no clear additional benefit over traditional glucocorticoid replacement could be identified. Also, it might result in longer hospitalisation time and more intensive monitoring.
PubMed: 35146018
DOI: 10.3389/fvets.2021.818515 -
BMJ Case Reports Mar 2018A 67-year-old Caucasian woman with no prior medical history was admitted to our hospital with complaints of generalised weakness, nausea, diarrhoea and weight loss. The...
A 67-year-old Caucasian woman with no prior medical history was admitted to our hospital with complaints of generalised weakness, nausea, diarrhoea and weight loss. The patient suffered from tachycardia and hypotension. Blood tests revealed Graves' thyrotoxicosis and the patient was treated accordingly. However, patient's health continued to decline rapidly and further tests revealed a concomitant Addisonian crisis. Additional treatment with corticosteroids led to a full recovery. It is well known that autoimmune endocrine disorders tend to cluster. However, the presentation is usually sequential in time. This case reports the highly rare simultaneous presentation of Addison's disease and Graves' thyrotoxicosis. It also provides several suggestions to help establish the diagnoses.
Topics: Addison Disease; Adrenocorticotropic Hormone; Aged; Biomarkers; Blood Urea Nitrogen; Creatinine; Female; Graves Disease; Humans; Thyrotoxicosis
PubMed: 29507013
DOI: 10.1136/bcr-2017-222355