scholarly journals Coexistence of Primary Hyperaldosteronism and Graves’ Disease, a Rare Combination of Endocrine Disorders: Is It beyond a Coincidence—A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
S. S. C. Gunatilake ◽  
U. Bulugahapitiya
Keyword(s):  
Case Report ◽  
Adrenal Adenoma ◽  
Underlying Mechanism ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Endocrine Disorders ◽  
Sri Lankan ◽  
Underlying Mechanisms

Background. Primary hyperaldosteronism is a known cause for secondary hypertension. In addition to its effect on blood pressure, aldosterone exhibits proinflammatory actions and plays a role in immunomodulation/development of autoimmunity. Recent researches also suggest significant thyroid dysfunction among patients with hyperaldosteronism, but exact causal relationship is not established. Autoimmune hyperthyroidism (Graves’ disease) and primary hyperaldosteronism rarely coexist but underlying mechanisms associating the two are still unclear.Case Presentation. A 32-year-old Sri Lankan female was evaluated for new onset hypertension in association with hypokalemia. She also had features of hyperthyroidism together with high TSH receptor antibodies suggestive of Graves’ disease. On evaluation of persistent hypokalemia and hypertension, primary hyperaldosteronism due to right-sided adrenal adenoma was diagnosed. She was rendered euthyroid with antithyroid drugs followed by right-sided adrenalectomy. Antithyroid drugs were continued up to 12 months, after which the patient entered remission of Graves’ disease.Conclusion. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist and this case report adds to the limited number of cases documented in the literature. Underlying mechanism associating the two is still unclear but possibilities of autoimmune mechanisms and autoantibodies warrant further evaluation and research.

scholarly journals Development of Hypothyroidism with Thyroid Stimulation Blocking Antibody long after Treatment with Antithyroid Drugs in a Patient with Hyperthyroid Graves' Disease: A Case Report.

1993 ◽  
Vol 40 (2) ◽  
pp. 227-230 ◽  
Author(s):  
YOSHIO KASUGA ◽  
AKIRA SUGENOYA ◽  
SHINYA KOBAYASHI ◽  
TADAHIRO SHIMIZU ◽  
HIROSHI ONUMA ◽  
...  
Keyword(s):  
Case Report ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Blocking Antibody

scholarly journals In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism

2020 ◽  
Vol 16 (4) ◽  
pp. 557-563
Author(s):  
O. V. Tsygankova ◽  
T. I. Batluk ◽  
L. D. Latyntseva ◽  
E. V. Akhmerova ◽  
N. M. Akhmedzhanov
Keyword(s):  
Adrenal Adenoma ◽  
Renin Angiotensin System ◽  
Correct Choice ◽  
Secondary Hypertension ◽  
Diagnostic Methods ◽  
Primary Hyperaldosteronism ◽  
Refractory Hypertension ◽  
Aldosterone Production ◽  
Surgical Tactics ◽  
Saline Test

Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.

scholarly journals SAT-LB301 Hyperaldosteronism From Adrenal Adenoma in a Young Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Francisco Javier Lopez Maldonado ◽  
Angel Alfonso Mayorga León ◽  
Alondra Rodriguez Gonzalez ◽  
Eduardo Rafael León Milán ◽  
Carlos Alfonso Morales Chinchillas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Symptoms ◽  
Adrenal Adenoma ◽  
Secondary Hypertension ◽  
Primary Hyperaldosteronism ◽  
Blurred Vision ◽  
Plasma Aldosterone Concentration ◽  
Unilateral Adrenalectomy ◽  
Blood Pressure Elevation ◽  
Cardiovascular Morbidity And Mortality

Abstract Introduction Primary aldosteronism (PA) is the most common cause of secondary hypertension (HTN) that is often underdiagnosed. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex- matched patients with essential HTN and the same degree of blood pressure elevation. We present a case of a 17-year old male with primary hyperaldosteronism. Case Report 17-year-old male with no past medical history presented to the emergency department referring bitemporal cephalea, pain in left arm, dyspnea, heart palpitations, a blood pressure (BP) of 220/110 mmHg and a serum potassium of 1.5mmol/L (n. 3.5-5). The patient was admitted to the hospital for better handling of his BP, potassium repositions, monitoring and further management. During hospitalization he referred leg cramps, asthenia, adynamia, nausea, cephalea, and blurred vision. Physical examination demonstrated decreased muscle strength, jugular regurgitation II and hyperreflexia on lower extremities. Thyroid and pulmonary examinations were normal. BP continued elevated despite the concurrent use of 3 antihypertensive drug classes (ARA2, BB, CCB), referred to endocrinologist after being diagnosed with resistant hypertension suspecting of a primary hyperaldosteronism. Lab tests were run obtaining a plasma aldosterone concentration 44ng/dl (n. 4-31), plasma active renin (PRA) 0.05ng/ml/hr (n. 0.2-1.6), aldosterone/PAR ratio 880 (<25 normal). Suprarenal CT scan revealed right suprarenal lesion 2.2 x 2.1 cm, round appearance, hypodense (14 HU) compatible with an adenoma. He underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor was compatible with a benign adenoma. Patient was discharged with a regularized blood pressure without antihypertensives and normokalemic. No clinical symptoms were reported in follow-up. ConclusionPrimary aldosteronism (PA) is the most common form of secondary hypertension (HTN) with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. PA is characterized by hypertension, hypokalemia, suppressed plasma renin and increased aldosterone excretion. Aldosterone producing adenomas (APAS) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The most sensitive screening test for PA is the aldosterone-to-renin ratio. After case confirmation, all patients with PA should undergo adrenal CT as the initial study. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist.

scholarly journals Acute Lymphoblastic Leukemia Complicating Graves’ Disease in a Sudanese Adolescent Girl: A Case Report and Exploration of the Underlying Mechanism Possibilities

2021 ◽  
Author(s):  
Ghassan Faisal Fadlalbari ◽  
Samar Sabir Hassan ◽  
Asmahan T Abdallah ◽  
Samar Omer Abusamra ◽  
Abeer Mohamed Abdalrhman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Case Report ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Cells ◽  
Lymphoblastic Leukemia ◽  
Harmful Effect ◽  
Febrile Illness ◽  
Underlying Mechanism ◽  
Graves Disease ◽  
Autoimmune Reaction

Abstract Background: Graves’ Disease (GD) related bone marrow injury presents usually as agranulocytosis or less commonly as pancytopenia. However, acute lymphoblastic leukemia (ALL) has been reported recently in an adult patient with GD. The underlying pathogenesis is not fully understood. Nevertheless, the harmful effect of anti-thyroid drugs or autoimmune reaction to bone marrow cells is anticipated to be the causative factors. Case report: A 16.5-year-old Sudanese girl with GD was on carbimazole for the first fourteen months of her illness, with irregular follow up, then it was withdrawn because she developed hypothyroidism for which she was put on thyroxine. Meanwhile, she developed severe anemia without fever which necessitated blood transfusion. Eight months later, she presented with thyrotoxicosis relapse, febrile illness and pancytopenia which was proved to be ALL on bone marrow examination. Conclusion: ALL must be considered when encountering a GD patient with pancytopenia.

scholarly journals Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

2015 ◽  
Vol 2015 ◽  
Author(s):  
V Larouche ◽  
L Snell ◽  
D V Morris
Keyword(s):  
Radioactive Iodine ◽  
Psychiatric Symptoms ◽  
Adrenal Adenoma ◽  
Primary Hyperaldosteronism ◽  
Graves Disease ◽  
List Type ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia ◽  
Acute Hypothyroidism ◽  
Radioactive Iodine Ablation

Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism. Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease. Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging. Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically. The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

scholarly journals HIPERTIROIDISMEE GRAVES DISEASE:CASE REPORT

2020 ◽  
Vol 6 (1) ◽  
pp. 30-35
Author(s):  
Putri Rahayu Srikandi
Keyword(s):  
Case Report ◽  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Physical Examination ◽  
Clinical Condition ◽  
Laboratory Tests ◽  
Clinical Manifestations ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyroid Hormone Levels

AbstractAbstrak:Hipertiroid adalah kondisi klinis yang disebabkan peningkatan sintesis dan sekresi hormone oleh kelenjar tiroid, sedangkan tirotoksikosis mengacu pada manifestasi klinis.  Penyakit graves merupakan penyebab hipertiroid yang paling sering ditemukan sekitar 60-80% dari semua kasus tirotoksikosis di seluruh dunia. Pada laporan kasus ini akan dibahas pasien Ny. NMS berusia 56 tahun datang dengan keluhan dada berdebar-debar yang dirasakan sejak 3 minggu yang lalu dan pada pemeriksaan fisik didapatkan adanya pembesaran kelenjar tiroid dan indeks Wayne pada kasus ini didapatkan  21. Pada pemeriksaan laboratorium didapatkan kadar Tyroid Stimulating Hormone (TSH) 0,005 uIU/ml, , dan free Tiroksin (fT4) 7,77mg/dl. Penatalaksanaan pada kasus ini yaitu pasien diberikan tyrozol  3x10 mg sehari dan propanolol 3x10mg. Kata kunci: graves, hipertiroidism, tirotoksikosis AbstractHipertiroidisme is a clinical condition caused by increased synthesis and secretion of hormones by the thyroid gland. Thyrotoxicosis is defined as clinical manifestations related to increased thyroid hormone levels. Graves' disease (GD) persists as the most frequently encountered etiology of hipertiroidisme causing approximately 60-80% of all cases of thyrotoxicosis worldwide. In this case report we will discuss woman patient Mrs.NMS aged 56 years with complaints of palpitations felt since three weeks ago and physical examination found enlargement of the thyroid gland and Wayne index in this case obtained 21. In laboratory tests found levels of TSH 0.005 uIU/ml and T4 7.77 mg/dl. Principle in the treatment of hipertiroidisme is suppressing the production of thyroid hormone by using antithyroid drugs. Management in this case that the patient is given 3x10 mg Thyrozol and propranolol 3x10 mg. Keywords: graves, hipertiroidisme, thyrotoxicosis

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
Author(s):  
J. Dressler ◽  
F. Grünwald ◽  
B. Leisner ◽  
E. Moser ◽  
Chr. Reiners ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Diseases ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Co Morbidity ◽  
History Of ◽  
Individual Decisions ◽  
Prophylactic Use ◽  
Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

Contrasting underlying mechanisms of different barrier coating types

TAPPI Journal ◽  
2018 ◽  
Vol 17 (01) ◽  
pp. 31-37
Author(s):  
Bryan McCulloch ◽  
John Roper ◽  
Kaitlin Rosen
Keyword(s):  
Food Packaging ◽  
Underlying Mechanism ◽  
Consumer Products ◽  
Mechanical Degradation ◽  
Design Rules ◽  
Barrier Coatings ◽  
Barrier Materials ◽  
Barrier Coating ◽  
Coating Type ◽  
Underlying Mechanisms

Barrier coatings are used in applications including food packaging, dry goods, and consumer products to prevent transport of different compounds either through or into paper and paperboard substrates. These coatings are useful in packaging to contain active ingredients, such as fragrances, or to protect contents from detrimental substances, such as oxygen, water, grease, or other chemicals of concern. They also are used to prevent visual changes or mechanical degradation that might occur if the paper becomes saturated. The performance and underlying mechanism depends on the barrier coating type and, in particular, on whether the barrier coating is designed to prevent diffusive or capillary transport. Estimates on the basis of fundamental transport phenomena and data from a broad screening of different barrier materials can be used to understand the limits of various approaches to construct barrier coatings. These estimates also can be used to create basic design rules for general classes of barrier coatings.

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