scholarly journals Pericardial Effusion as an Initial Presentation of Panhypopituitarism

2020 ◽  
Author(s):  
Rosa Alves ◽  
Sofia Alegria ◽  
Henrique Vara Luiz ◽  
Tiago Judas
Keyword(s):  
Pericardial Effusion ◽  
Incidental Finding ◽  
Hormone Replacement ◽  
Pericardial Tamponade ◽  
Adrenal Crisis ◽  
Secondary Hypothyroidism ◽  
Rare Manifestation ◽  
Initial Work ◽  
Life Threatening ◽  
Work Up

Pericardial effusion has a broad spectrum of clinical presentation, ranging from an incidental finding on imaging to a potentially fatal emergency such as pericardial tamponade, the most severe presentation. The authors present a case of a middle-aged male hospitalized due to shortness of breath. Initial work-up was positive for massive pericardial effusion with haemodynamic compromise. Additional study revealed panhypopituitarism. The acromegalic phenotype was suggestive of acromegaly secondary to pituitary adenoma, which had probably evolved to apoplexy. Hormone replacement was started with clinical improvement. At the 3-year follow-up, there was no evidence of recurrence of pericardial effusion. Panhypopituitarism is a relatively rare entity, but can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure. Pericardial effusion is an extremely rare manifestation of secondary hypothyroidism.

scholarly journals Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
M. Kirsch ◽  
C. Rimpau ◽  
C. H. Nickel ◽  
P. Baier
Keyword(s):  
Pericardial Effusion ◽  
Neurological Impairment ◽  
Pericardial Tamponade ◽  
Intracerebral Bleeding ◽  
Presenting Symptoms ◽  
Adverse Health Outcomes ◽  
Life Threatening ◽  
History Of ◽  
Tremendous Importance ◽  
Work Up

The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.

Nivolumab-Induced Pericardial Tamponade: A Case Report and Discussion

Cardiology ◽  
2016 ◽  
Vol 136 (1) ◽  
pp. 49-51 ◽  
Author(s):  
Igal Kushnir ◽  
Ido Wolf
Keyword(s):  
Pericardial Effusion ◽  
Cell Carcinoma ◽  
Checkpoint Inhibitors ◽  
Wide Spectrum ◽  
Corticosteroid Treatment ◽  
Pericardial Tamponade ◽  
Programmed Death ◽  
Proven Efficacy ◽  
Life Threatening ◽  
Programmed Death 1

Nivolumab, a programmed death 1 (PD1) inhibitor, belongs to a family of drugs known as immune checkpoint inhibitors that share a similar toxicity profile, which includes rash, pruritus, colitis, hepatitis, pneumonitis and thyroid dysfunction. Nivolumab has a proven efficacy in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. We present the case of a 67-year-old male patient with metastatic squamous cell carcinoma of the lung who suffered from a massive pericardial effusion secondary to treatment with nivolumab, which he began in June 2015. After five cycles the patient was hospitalized due to acute respiratory failure requiring mechanical ventilation. An echocardiogram revealed a massive pericardial effusion with tamponade. After pericardiocentesis and corticosteroid treatment, the patient's condition improved rapidly. A CT scan revealed a response of the tumor. Although anti-PD1 treatment is usually regarded as less toxic than chemotherapy, a wide spectrum of life-threatening immune-related side effects may still occur and clinical vigilance is required.

scholarly journals Pericardial Tamponade And Lung Adenocarcinoma: Case Report And Literature Review

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Irene Lozano-Díez ◽  
María López-Rodríguez ◽  
Laia Cagide-González ◽  
José Antonio Díaz-Peromingo
Keyword(s):  
Pericardial Effusion ◽  
Lung Adenocarcinoma ◽  
Previous History ◽  
Pericardial Tamponade ◽  
Neoplastic Disease ◽  
Healthy Patient ◽  
Lung Cancers ◽  
Life Threatening ◽  
History Of ◽  
Recurrent Pericardial Effusion

Pericardial effusion is the accumulation of fluid between the layers of the pericardium. I massive, pericardial tamponade and compression of the myocardium are life threatening conditions. The causes of pericardial effusion are varied, from idiopathic, neoplasms, iatrogenesis, and autoimmune. Pericardial tamponade can be a complication of neoplastic disease. Malignancy must be ruled out in every cardiac tamponade. Malignant etiology must be considered in patients with previous history of malignancy, pericarditis that does not respond to anti-inflammatory treatment, pericardial effusion that increases its amount rapidly, or recurrent pericardial effusion. Metastatic pericardial effusion due to lung cancer is not rare but not all lung cancers involve the same way the pericardium. In this paper, we present the case of a previously healthy patient with pericardial tamponade as presentation form of a lung adenocarcinoma and review the literature.

Thunderclap headache

2020 ◽  
pp. 307-313
Author(s):  
Hille Koppen ◽  
Agnes van Sonderen ◽  
Sebastiaan F.T.M. de Bruijn
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Sudden Onset ◽  
Severe Headache ◽  
Thunderclap Headache ◽  
Cerebral Vasoconstriction ◽  
Initial Work ◽  
Life Threatening ◽  
Work Up ◽  
Neurologically Intact

Severe headache of sudden onset is relatively common, especially in emergency departments, and has an extensive differential. Neurovascular disorders often present with thunderclap headache. Although the initial work-up is focused to exclude subarachnoid haemorrhage, several other serious life-threatening disorders must be considered, such as cerebral venous sinus thrombosis and stroke. Furthermore, other causes like reversible cerebral vasoconstriction syndrome are recognized more and more. In this chapter the work-up of alert, neurologically intact patients presenting with an acute and severe headache, not related to trauma, will be described.

scholarly journals A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Hans A. Reyes ◽  
Julie Islam ◽  
Soheila Talebi ◽  
Eder Cativo ◽  
Savi Mushiyev ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Thoracoscopic Surgery ◽  
Young Female ◽  
Pleural Effusions ◽  
Pericardial Window ◽  
Pericardial Disease ◽  
Diffuse Abdominal Pain ◽  
Viral Aetiology ◽  
Initial Work ◽  
Work Up

Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

scholarly journals Pseudohypoaldosteronism in a Neonate Presenting as Life-Threatening Hyperkalemia

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Najya A. Attia ◽  
Yousef I. Marzouk
Keyword(s):  
Cardiac Arrest ◽  
Hormone Replacement ◽  
Hypovolemic Shock ◽  
Delayed Diagnosis ◽  
Plasma Renin ◽  
Adrenal Crisis ◽  
Sudden Infant ◽  
High Potassium ◽  
Life Threatening

Context. Pseudohypoaldosteronism type 1 (PHA1) is a life-threatening disease that causes severe hyperkalemia and cardiac arrest if not treated appropriately or if diagnosis is missed.Objective.To report a case of a newborn with vomiting and lethargy, ultimately diagnosed with pseudohypoaldosteronism.Patient.This case presented to the ED at an age of 14 days in hypovolemic shock. There was a family history of sudden infant death, her sister who was diagnosed with CAH and passed away at 3 months of age despite regular hormone replacement. Our patient had cardiac arrest in ED, due to hyperkalemia; while receiving fluid boluses, cardiopulmonary resuscitation was initiated. After stabilization, diagnostic workup demonstrated persistently low sodium, acidosis, and high potassium, which required peritoneal dialysis. Based on these findings, the patient was diagnosed with CAH. It turned out later that the patient had PHA1. Two years later, the patient had a new sibling with the same disease diagnosed at birth and started immediately on treatment without any complication.Conclusions and Outcome.This case highlights the significant diagnostic and therapeutic challenges in treating children with PHA1. Adrenal crisis is not always CAH; delayed diagnosis can lead to complication and even death. The presence of high plasma renin activity, aldosterone, and cortisol, along with the presence of hyponatremia and hyperkalemia, established the diagnosis of PHA type 1 and ruled out CAH.

scholarly journals Corticosteroids Replacement in a Patient With Panhypopituitarism and COVID-19 Infection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A578-A579
Author(s):  
Gowri Karuppasamy ◽  
Zaina Abdelhalim Alamer ◽  
Samman Rose ◽  
Ibrahim Abdulla Al-Janahi
Keyword(s):  
Pituitary Adenoma ◽  
Adrenal Insufficiency ◽  
Hormone Replacement ◽  
Hypogonadotropic Hypogonadism ◽  
Adrenal Crisis ◽  
High Dose ◽  
Pituitary Hormone ◽  
Secondary Hypothyroidism ◽  
Stress Dose

Abstract Background: Hypopituitarism refers to complete or partial insufficiency of pituitary hormone secretion and patients require lifelong hormone replacement. Those with ACTH deficiency rely on exogenous glucocorticoids and at times of intercurrent illness require stress doses to prevent an adrenal crisis. The benefits and adverse effects of corticosteroids for treatment of COVID-19 pneumonia are currently under investigation. We report our experience in a patient with COVID-19 pneumonia who received high dose corticosteroids for panhypopituitarism. Clinical Case: A 51-year-old man presented with one-week history of fever and generalized weakness. He had been diagnosed with a non-functional pituitary macro-adenoma causing panhypopituitarism 1 year ago when he developed generalized tonic-clonic seizures. He underwent trans-sphenoidal resection of the pituitary adenoma. However, he then discontinued his hormonal therapy and was lost to follow up. He had postural hypotension but was not tachypneic or hypoxemic. He tested positive for COVID-19 and chest x-ray showed prominent bilateral broncho-vascular markings; he was hospitalized as mild COVID-19 pneumonia. Laboratory investigations revealed secondary adrenal insufficiency, secondary hypothyroidism and hypogonadotropic hypogonadism. MRI of the pituitary now showed persistence of the pituitary macroadenoma, measuring 3.5 x 3.7 x 2.4 cm in dimensions, causing sellar obliteration and left cavernous sinus invasion. Treatment with stress dose steroids, Hydrocortisone 50 mg 4 times daily was initiated, followed by thyroid hormone replacement with Levothyroxine 125 mcg daily. He also received antivirals and supportive care for COVID-19, guided by local hospital protocol. After significant clinical improvement, steroids were tapered down and he was discharged on a maintenance dose of 20 mg hydrocortisone per day in divided doses. The patient was stable at outpatient follow up after one month. He was started on testosterone replacement for erectile dysfunction due to hypogonadotropic hypogonadism. He was offered surgery for complete resection of the residual pituitary adenoma, but he declined and preferred to continue medical therapy. Conclusion: Hypopituitarism is associated with significant morbidity and premature mortality, a key risk factor being cortisol deficiency. Adrenal crisis is a life-threatening medical emergency and remains an important cause of death in patients with adrenal insufficiency. These patients are also vulnerable to develop severe complications from COVID-19 infection due to the absence of normal cortisol responses to stress. Despite receiving stress dose corticosteroids, this high-risk patient recovered from COVID-19 pneumonia without complications. These findings support the use of corticosteroids when necessary for treatment of coexisting conditions in patients with COVID-19.

scholarly journals Pericardial effusion as a complication of chronic graft versus host disease

2018 ◽  
Vol 11 (1) ◽  
pp. e227507
Author(s):  
Keaton Nasser ◽  
Kshipra Joshi ◽  
Ella Starobinska
Keyword(s):  
Pericardial Effusion ◽  
Graft Versus Host Disease ◽  
Marrow Transplant ◽  
Unrelated Donor ◽  
Host Disease ◽  
Allogenic Bone ◽  
Graft Versus Host ◽  
Large Pericardial Effusion ◽  
Life Threatening ◽  
Work Up

A 24-year-old man with previous matched unrelated donor allogenic bone marrow transplant for aplastic anaemia and chronic graft versus host disease on steroid taper presented with progressively worsening anasarca. CT revealed large pericardial effusion, while echocardiogram was concerning for early tamponade physiology. He underwent emergent pericardiocentesis with pericardial drain placement. Extensive rheumatological and infectious work-up was unrevealing with patient’s presentation attributed to pericardial graft versus host disease. This highlights the need of physicians to be aware of pericardial serositis as a complication of graft versus host disease due to its life-threatening complications, which require immediate intervention.

scholarly journals Findings in an Elderly Patient after a Fall

2017 ◽  
Vol 24 (3) ◽  
pp. 51-54
Author(s):  
Qasem M. Aljabr
Keyword(s):  
Computed Tomography ◽  
Neck Pain ◽  
Treatment Options ◽  
Limited Range ◽  
Computed Tomography Scan ◽  
Limited Range Of Motion ◽  
Initial Work ◽  
Life Threatening ◽  
Work Up ◽  
Tomography Scan

A 76-year-old male presented with neck pain beginning a month earlier, when he tripped over a ledge while exiting his truck. The patient landed on his face and lost consciousness. In the emergency room, the initial work up, including a head computed tomography scan, came back negative, but the fall work-up was incomplete. He was discharged with a physical therapy appointment to manage his neck pain but did not go. The patient’s pain continued for another four weeks before he went to the clinic. The pain was located at the midline of his posterior cervical spine with limited range of motion. He was otherwise asymptomatic. A more comprehensive fall assessment and work-up was completed. An immediate neck computed tomography scan was ordered and revealed subacute Stage 2 odontoid fractures. The patient was placed in a neck collar. An urgent appointment with the neurosurgery clinic was requested. The neurosurgeon reviewed the neck computed tomography scan; a follow up by magnetic resonance imaging confirmed the findings. After discussing treatment options, the patient agreed to proceed with fusion surgery. This case demonstrates the importance of performing a complete fall assessment and workup to ensure early detection and prevention of serious or life-threatening injuries.

The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

2016 ◽  
Vol 19 (1) ◽  
pp. 023 ◽  
Author(s):  
Mehmet Yildirim ◽  
Recep Ustaalioglu ◽  
Murat Erkan ◽  
Bala Basak Oven Ustaalioglu ◽  
Hatice Demirbag ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Thoracoscopic Surgery ◽  
Pericardial Tamponade ◽  
Pericardial Fluid ◽  
Pathological Examination ◽  
Common Disease ◽  
Pericardial Window ◽  
Surgical Interventions ◽  
History Of ◽  
Recurrent Pericardial Effusion

<strong>Background:</strong> Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. <br /><strong>Methods:</strong> We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. <br /><strong>Results:</strong> Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. <br /><strong>Conclusion:</strong> Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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