Nondiabetic Endocrine Emergencies 2: Hypoparathyroidism, Hyperparathyroidism, Myxedema Coma, And Thyroid Storm

2018 ◽  
Author(s):  
Jason J Lewis ◽  
Richard E Wolfe
Keyword(s):  
Multiorgan Failure ◽  
Signs And Symptoms ◽  
Metabolic Effects ◽  
Thyroid Storm ◽  
Emergency Setting ◽  
Course Of Illness ◽  
Myxedema Coma ◽  
Adrenergic Activity ◽  
Parathyroid Disease ◽  
History Of

Acute emergent presentations of the thyroid and parathyroids are rarer occurrences in the emergency department but essential to diagnose and treat early in the course of illness. Disorders of the parathyroids are typically related to circulating calcium levels and the metabolic effects thereof, whereas thyroid deficiency or excess can lead to profound shock, coma, hypothermia, hyperthermia, and death. The diagnosis of parathyroid disease should be considered in patients presenting with signs and symptoms consistent with hyper- or hypocalcemia. Myxedema coma should be considered in any patient presenting with evidence of severe sepsis or shock, particularly when there is a history of hypothyroidism. Thyroid storm should be suspected in any patient with unexplained increased adrenergic activity, hyperpyrexia, or multiorgan failure. Empirical treatment must begin prior to definitive diagnosis in all cases. This review demonstrates how to recognize and manage acute presentations of hypo- and hyperparathyroidism, myxedema coma, and thyroid storm in the emergency setting. Patients with nondiabetic endocrine emergencies may present in extremis, and immediate stabilization, typically without confirmatory testing, is necessary. Early intervention is key in treating such presentations. This review contains 3 figures, 8 tables and 28 references Key words: disorders of the parathyroids, hyperparathyroidism, hypoparathyroidism, hypothyroidism, myxedema coma, thyroid storm, thyrotoxicosis

Thyreotoxische Krise und Myxödemkoma

2018 ◽  
Vol 143 (06) ◽  
pp. 397-405 ◽  
Author(s):  
Malte Milkau ◽  
Friedhelm Sayk
Keyword(s):  
Thyroid Dysfunction ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnostic Tools ◽  
Thyroid Storm ◽  
Thyreotoxische Krise ◽  
Myxedema Coma ◽  
Clinical Forms ◽  
Medical Emergencies ◽  
Significant Mortality

AbstractThyroid storm and myxedema coma are the most severe clinical forms of thyroid dysfunction. While both hyper- and hypothyroidsm are common diseases, thyroid storm and myxedema coma are rare. Due to their unspecific signs and symptoms they are often difficult to diagnose. Both disorders are medical emergencies, which still show a significant mortality. The following article summarizes diagnostic tools and treatment options for these disorders

Diagnoses in Opposition: Thyroid Storm and Myxedema Coma

1992 ◽  
Vol 3 (2) ◽  
pp. 300-308 ◽  
Author(s):  
Loretta Spittle
Keyword(s):  
Patient Outcomes ◽  
Signs And Symptoms ◽  
Management Team ◽  
Thyroid Storm ◽  
Normal Thyroid ◽  
Myxedema Coma ◽  
Normal Thyroid Function ◽  
Life Threatening ◽  
Nursing Diagnoses

An overview of normal thyroid function is presented to facilitate the understanding of the pathophysiology of two life-threatening thyroid disorders: thyroid storm and myxedema coma. Signs and symptoms, medical management, nursing diagnoses and interventions, and expected patient outcomes are discussed, as is the important role of the nurse as an integral member of the management team

scholarly journals Type 2 Diabetes Decompensation as the Clinical Presentation of Thyroid Storm – Cause or Consequence?

2017 ◽  
Vol 13 (02) ◽  
pp. 99 ◽  
Author(s):  
Ana Margarida Monteiro ◽  
Cláudia Matta-Coelho ◽  
Vera Fernandes ◽  
Olinda Marques ◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Neurological Status ◽  
Thyroid Storm ◽  
Good Glycemic Control ◽  
Adequate Treatment ◽  
Intercurrent Illness ◽  
History Of

This case study aims to discuss the unusual forms of hyperthyroidism presentation, the nonspecific symptoms and precipitating events. A 70-year-old male was taken to the emergency department for hyperglycaemia, nausea, vomiting and altered mental status with a week of evolution. He had a past medical history of type 2 diabetes, hypertension and dyslipidemia. He had no history of any recent intercurrent illness or infection. At the emergency room, besides hyperglycaemia, ketonemia and slightly elevated C-reactive protein, the basic laboratory panel workup was normal, as was the head computed tomography. He was admitted for metabolic compensation and to study the altered neurological status. During hospitalisation, despite the good glycemic control, he had no improvements in neurological status. At day four of hospitalisation, thyrotoxicosis with thyroid storm criteria was diagnosed. He started on adequate treatment with complete clinical recovery. The associated morbidity and mortality of thyroid storm requires immediate recognition and treatment. Elderly patients are frequently misdiagnosed or diagnosed later due to fewer and less pronounced signs and symptoms.

scholarly journals Sudden Cardiac Arrest in a Patient With Myxedema Coma and COVID-19

2020 ◽  
Vol 4 (10) ◽  
Author(s):  
Neal M Dixit ◽  
Katie P Truong ◽  
Soniya V Rabadia ◽  
David Li ◽  
Pratyaksh K Srivastava ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multiorgan Failure ◽  
Sudden Cardiac Arrest ◽  
Thyroid Peroxidase ◽  
Cardiac Morbidity ◽  
Myxedema Coma ◽  
First Case ◽  
Thyroid Peroxidase Antibody ◽  
Escape Rhythm ◽  
History Of

Abstract SARS-CoV-2 infection is associated with significant lung and cardiac morbidity but there is a limited understanding of the endocrine manifestations of coronavirus disease 2019 (COVID-19). Although thyrotoxicosis due to subacute thyroiditis has been reported in COVID-19, it is unknown whether SARS-CoV-2 infection can also lead to decompensated hypothyroidism. We present the first case of myxedema coma (MC) in COVID-19 and we discuss how SARS-CoV-2 may have precipitated multiorgan damage and sudden cardiac arrest in our patient. A 69-year-old woman with a history of small cell lung cancer presented with hypothermia, hypotension, decreased respiratory rate, and a Glasgow Coma Scale score of 5. The patient was intubated and administered vasopressors. Laboratory investigation showed elevated thyrotropin, very low free thyroxine, elevated thyroid peroxidase antibody, and markedly elevated inflammatory markers. SARS-CoV-2 test was positive. Computed tomography showed pulmonary embolism and peripheral ground-glass opacities in the lungs. The patient was diagnosed with myxedema coma with concomitant COVID-19. While treatment with intravenous hydrocortisone and levothyroxine were begun the patient developed a junctional escape rhythm. Eight minutes later, the patient became pulseless and was eventually resuscitated. Echocardiogram following the arrest showed evidence of right heart dysfunction. She died 2 days later of multiorgan failure. This is the first report of SARS-CoV-2 infection with MC. Sudden cardiac arrest likely resulted from the presence of viral pneumonia, cardiac arrhythmia, pulmonary emboli, and MC—all of which were associated with the patient’s SARS-CoV-2 infection.

Bowel Perforation Caused by Peritoneal Shunt Catheters:Diagnosis and Treatment

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-76-ONS-82 ◽  
Author(s):  
Matthieu Vinchon ◽  
Marc Baroncini ◽  
Thines Laurent ◽  
Dhellemmes Patrick
Keyword(s):  
Bowel Perforation ◽  
Multiorgan Failure ◽  
Correct Diagnosis ◽  
Previous History ◽  
Signs And Symptoms ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
History Of ◽  
Shunt Removal ◽  
Spastic Tetraparesis

Abstract OBJECTIVE: The peritoneum is the preferred site for insertion of shunts used for the treatment of hydrocephalus. Bowel perforation by peritoneal catheters (BPPC) is a rare but devastating complication. Its pathophysiology, diagnosis, and treatment are debated. METHODS: Retrospective review of cases of BPPC in a series of 1956 patients having a peritoneal catheter followed up for a mean duration of 10.0 years. RESULTS: Nineteen observations of BPPC, representing 1.0% of the total series. Nine of 19 patients were nonambulatory, and nine of 19 had a previous history of meningeal infection. At the time of diagnosis, only three of the 19 patients had anal extrusion of the catheter, 14 had fever, nine had abdominal signs and symptoms, and six had cutaneous signs of infection. Radiological investigations were often negative or inconclusive. In seven of the patients, the initial diagnosis was shunt failure, and BPPC was diagnosed only during shunt revision. Once the correct diagnosis was made, the treatment was total shunt removal, external drainage, and antibiotic therapy for 2 weeks. Three patients, all severely impaired before BPPC, died, one of meningeal sepsis, the others of multiorgan failure related to spastic tetraparesis. Three were considered shunt-independent, two had a ventriculoatrial shunt, and the others had a new shunt with a peritoneal catheter without complication. CONCLUSION: BPPC is a neurosurgical emergency. Anal extrusion is present in only a minority of patients; the diagnosis of BPPC is often difficult, delayed, and its incidence is likely underestimated. The majority of patients can be treated with a new peritoneal shunt after cure of the infection.

SMAD4 juvenile polyposis syndrome and hereditary haemorrhagic telangiectasia presenting in a middle-aged man as a large fungating gastric mass, polyposis in both upper and lower GI tract and iron deficiency anaemia, with no known family history

2020 ◽  
Vol 13 (12) ◽  
pp. e236855
Author(s):  
Wendy Chang ◽  
Patricia Renaut ◽  
Casper Pretorius
Keyword(s):  
Family History ◽  
Autosomal Dominant ◽  
Signs And Symptoms ◽  
Juvenile Polyposis ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Gi Tract ◽  
Juvenile Polyposis Syndrome ◽  
Polyposis Syndrome ◽  
History Of ◽  
Gastric Mass

Juvenile polyposis syndrome (JPS) and hereditary haemorrhagic telangiectasia (HHT) are rare autosomal dominant diseases, where symptoms manifest at childhood. A 32-year-old man with no family history of JPS or HHT with SMAD4 gene mutation who developed signs and symptoms only at the age of 32, when he was an adult. In this article, we highlight the steps taken to diagnose this rare pathology, explain its pathophysiology and management.

scholarly journals Endometriosis Mimicking a Cecum Mass with Complete Bowel Obstruction: An Infrequent Cause of Acute Abdomen

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Gabriel A. Molina ◽  
Darwin R. Ramos ◽  
Alberto Yu ◽  
Patricio A. Paute ◽  
Paul S. Llerena ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Preoperative Diagnosis ◽  
Malignant Tumors ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Intestinal Involvement ◽  
History Of ◽  
Ovarian Abscess ◽  
Fertile Women

Endometriosis is a common entity among fertile women which unfortunately manifests through variable symptomatology. Intestinal involvement in endometriosis is quite common and can simulate several diseases such as Crohn’s disease, appendicitis, tubo-ovarian abscess, or malignant tumors. Intestinal obstruction due to endometriosis is rare, and preoperative diagnosis is difficult because the signs and symptoms are nonspecific and can be easily confused. In the case of patients without a history of endometriosis, diagnosis is further complicated. We present a case of a 41-year-old female patient. She presented to the emergency room with complete bowel obstruction and a mass in the cecum. Surgery was decided, and the patient underwent full recovery. Endometriosis was the final diagnosis for the observed condition.

scholarly journals Retrospective analysis of the clinical presentation and imaging of eight primary benign mediastinal schwannomas

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ramiro Sandoval-Macias ◽  
Irving Daniel Ortiz-Sanchez ◽  
Ana Lilia Remirez-Castellanos ◽  
Luis Mora-Hernandez ◽  
Candelaria Cordova-Uscanga ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Signs And Symptoms ◽  
Cystic Degeneration ◽  
Imaging Features ◽  
Posterolateral Thoracotomy ◽  
Accurate Analysis ◽  
Cystic Changes ◽  
History Of ◽  
Histology And Immunohistochemistry

Abstract Objective Mediastinal schwannomas are sometimes confused with other neoplasms during initial radiological studies, especially when there is a history of cancer in another area. In these cases, a more accurate analysis using computed tomography (CT) or even magnetic resonance (MRI) is required. Our study aimed to perform a retrospective analysis of the clinical and imaging features for a series of patients with mediastinal schwannomas that were confirmed by histology and immunohistochemistry. Results We found eight patients, five men and three women, with an average age of 51 years for this study. The main signs and symptoms at diagnosis were chest pain, dyspnea, cough, and dysphagia. CT showed that the tumor was located in the posterior compartment of the chest in 7/8 cases. Tumors > 10 cm were more heterogeneous and showed cystic changes. All patients underwent posterolateral thoracotomy, and radiological follow-up showed no evidence of recurrence. Histological analysis was considered the gold standard to confirm diagnosis, along with at least one neurogenic IHC marker. In conclusion, mediastinal schwannomas are benign encapsulated tumors. According to CT, schwannomas > 10 cm show cystic degeneration more frequently. Posterolateral thoracotomy allows complete resection and is considered the surgical approach of choice.

Lyme Disease: Acute Focal Meningoencephalitis in a Child

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 931-934
Author(s):  
HENRY M. FEDER ◽  
EDWIN L. ZALNERAITIS ◽  
LOUIS REIK
Keyword(s):  
Nervous System ◽  
Case Report ◽  
Lyme Disease ◽  
Signs And Symptoms ◽  
Brain Parenchyma ◽  
Tick Bite ◽  
System Involvement ◽  
History Of ◽  
Csf Pleocytosis ◽  
The Brain

Nervous system involvement in Lyme disease was originally described as meningitis, cranial neuritis, and radiculoneuritis,1-3 but Lyme disease can also involve the brain parenchyma. We describe a child whose first manifestation of Lyme disease was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis. CASE REPORT A 7-year-old boy was hospitalized Aug 27, 1985, because of hemiparesis. Six weeks prior to admission he had vacationed at Old Lyme, CT. There was no history of rash or tick bite. He had been well until eight hours prior to admission when fever and headache developed.

Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

2021 ◽  
Vol 14 (8) ◽  
pp. e243370
Author(s):  
John Leso ◽  
Majd Al-Ahmad ◽  
Drinnon O Hand
Keyword(s):  
Tricuspid Valve ◽  
Patent Foramen Ovale ◽  
Klebsiella Oxytoca ◽  
Signs And Symptoms ◽  
Foramen Ovale ◽  
Surgical Debulking ◽  
History Of ◽  
Infectious Disease Specialists ◽  
High Index Of Suspicion ◽  
Pfo Closure

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

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