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Endocrine diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Treatment of adrenal insufficiency is straightforward and largely empiric. Primary adrenal insufficiency obligates hormone replacement for both cortisol and aldosterone, whereas secondary adrenal insufficiency obligates replacement only for cortisol (since the renin–angiotensin–aldosterone axis is preserved). For cortisol replacement, a physiologically sound surrogate regimen is hydrocortisone 20mg orally in the morning and 10mg orally in the late afternoon; a pharmacologically equivalent alternative glucocorticoid such as cortisone acetate or prednisone may be substituted. As aldosterone surrogate, the synthetic mineralocorticoid fludrocortisone (Florinef) is used in a dose averaging 0.1mg (range 0.05–0.2 mg) orally each morning (67). The dose of fludrocortisone can be adjusted to maintain blood pressure and plasma potassium within the normal range. During labor and delivery, surgery, or severe intercurrent illness, supplemental glucocorticoid in doses intended to mimic natural stress-stimulated hypercortisolemia is prescribed. A traditional “stress” regimen is hydrocortisone 50mg intravenously every 8hours (63). At this dosage, hydrocortisone exhibits sufficient mineralocorticoid agonism that fludrocortisones is unnecessary.
Endocrine emergencies with skin manifestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Rate of onset and the severity of adrenal insufficiency dictate the clinical picture. Addisonian crisis (acute adrenal insufficiency or adrenal crisis) is an emergency manifesting as hypotension and acute circulatory failure. Other features include anorexia, nausea, vomiting, diarrhea, and occasionally, abdominal pain. Fever and hypoglycemia may occur.
Medical risks and management
Published in Alan Weiss, The Electroconvulsive Therapy Workbook, 2018
Chronic adrenal insufficiency is a rare endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones. It is recommended that consultation with an endocrinologist be undertaken before embarking on a course of ECT. Little is known about the impact of ECT on this condition with one case report, suggesting that these patients may require and a dose of cortisone before each treatment to improve the outcome of treatment due to the transient adrenocortical stimulation that occurs during treatment (Cumming and Kort, 1956) and another that demonstrated a successful outcome (Craddock and Zeller, 1952).
Lambert-Eaton myasthenic syndrome (LEMS) in a patient with lung cancer under treatment with pembrolizumab: a case study
Published in Journal of Chemotherapy, 2023
Jun Ho Lee, Sun Kyung Baek, Jae Joon Han, Hong Jun Kim, Yeon-Ah Lee, Dallah Yoo, Chi Hoon Maeng
Clinical features of previously reported ICI-related LEMS are summarized in Table 1. All of them were patients with lung cancer, and the causative agents were nivolumab, atezolizumab, and ipilimumab. Recently a case of pembrolizumab was also published [10]. One case reported that the Anti-P/Q type VGCC antibody was negative. The reported types of tumor and ICIs may reflect current practice because lung cancer is common and is one of the first tumors for which ICIs were introduced in clinical practice. As the use of ICI becomes more common, it might be expected that similar cases by other ICI (e.g., durvalumab or avelumab) in various types of cancer will be reported in the future. As expected, in most cases except one, neurological symptoms began after 5-12 months of ICI treatment. In some cases, other irAEs (cerebellar syndrome or MG) were also present. Of note, our patient was also concomitantly diagnosed with adrenal insufficiency. As the patient’s initial symptom was fatigue, the differential diagnosis of adrenal insufficiency and LEMS could be a challenge. Because adrenal insufficiency is a well-known irAE by immunotherapy, we also expected that the patient’s fatigue would improve soon after steroid supplementation. However, the symptoms were refractory, and his muscle weakness progressed. It is reasonable to assume that the adrenal insufficiency in this patient could be another irAE induced by pembrolizumab.
Approaches for development of LAG-3 inhibitors and the promise they hold as anticancer agents
Published in Expert Opinion on Drug Discovery, 2022
Martin Perez-Santos, Maricruz Anaya-Ruiz, Luis Villafaña-Diaz, Gabriela Sánchez Esgua
Treatment-related adverse events observed in at least 10% of patients were pruritus, fatigue, rash, hypothyroidism, diarrhea, and vitiligo. Treatment with antibodies can lead to immune-mediated adverse reactions, including pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, and myocarditis, among others. 3.7% of treated patients developed pneumonitis, which was resolved in 85% with corticosteroid treatment. Colitis occurred in 7% of treated patients and resolved in 83% with corticosteroid treatment. Hepatitis was found in 6% of the treated patients, which resulted in 70% after of corticosteroid treatment. Adrenal insufficiency occurred in 4% of patients, where 87% were treated with hormone replacement therapy and corticosteroids. Thyroiditis was present in 2.8% of treated patients, which resulted in 90% after corticosteroid treatment. Nephritis and renal dysfunction were observed in 2% of patients, which resolved in 71% with corticosteroid treatment. Dermatitis occurred in 9% of patients, resulting in 70% after corticosteroid treatment. Myocarditis was present in 1.7% of patients and was 100% resolved after treatment with corticosteroids.
The association between pre-transfusion hemoglobin levels and thalassemia complications
Published in Hematology, 2021
Wasuwit Wanchaitanawong, Adisak Tantiworawit, Pokpong Piriyakhuntorn, Thanawat Rattanathammethee, Sasinee Hantrakool, Chatree Chai-Adisaksopha, Ekarat Rattarittamrong, Lalita Norasetthada, Piangrawee Niprapan, Kanda Fanhchaksai, Pimlak Charoenkwan
All thalassemia patients in this cohort had been routinely evaluated by laboratory investigation to screen for thalassemia complications. A liver function test had been carried out every 3 months. Endocrine function was screened by fasting blood sugar and thyroid function test which were done annually. Plain x-ray or MRI had been done for suspected cases of EMH. Echocardiography had been carried out in patients who were suspect pulmonary hypertension or cardiomyopathy. Vascular investigation had been carried out for suspected cases of thrombosis from any site. Abdominal radiology was done for suspected cases of cholelithiasis, cirrhosis or HCC. Bone densitometry had been carried out in suspected cases of osteoporosis. Serum cortisol was done for the cases with suspected adrenal insufficiency. MRI for cardiac T2* and LIC had been done at least once in all patients.