scholarly journals Systemic Manifestation of Miliary Tuberculosis in Patient With Advanced Diabetic Retinopathy Presenting With Electrolyte Imbalance, Seizures, and Adrenal Insufficiency

Cureus ◽  
2022 ◽  
Author(s):  
Zahid Khan ◽  
Davina Jugnarain ◽  
Bashir Mahamud ◽  
Animesh Gupta ◽  
Shirin Patel ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Adrenal Insufficiency ◽  
Miliary Tuberculosis ◽  
Electrolyte Imbalance ◽  
Systemic Manifestation

Adrenocortical Insufficiency in the Critically Ill Patient

1992 ◽  
Vol 3 (3) ◽  
pp. 705-713
Author(s):  
Carol Diane Epstein
Keyword(s):  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Primary Diagnosis ◽  
Critical Care Nurses ◽  
Electrolyte Imbalance ◽  
Critically Ill Patient ◽  
Patient Assessment ◽  
Multiple Organs ◽  
Adrenocortical Failure

The fluid and electrolyte imbalances associated with adrenocortical failure affect multiple physiologic systems in the critically ill patient. Because of its widespread effect, the objective signs of adrenocortical failure may escape recognition. In the context of shock states affecting the function of multiple organs that have been previously diagnosed, empirical evidence suggesting the presence of adrenal insufficiency may be attributed to the primary diagnosis and illness. However, it is most important that critical care nurses question whether adequate adrenal function is present. When effective patient assessment and management are standard components of care, adrenocortical dysfunction may be reversed, while failure to assess for signs of adrenal insufficiency may lead to irreversible patient outcomes. This paper describes phenomena of adrenocortical failure in critically ill patients and presents the problems of fluid and electrolyte imbalance that accompany them

scholarly journals Empty Sella Syndrome in a Postmenopausal Woman

2012 ◽  
Vol 2 (1) ◽  
pp. 52-55
Author(s):  
Sultana Marufa Shefin ◽  
Nazmul Kabir Qureshi
Keyword(s):  
Postmenopausal Woman ◽  
Adrenal Insufficiency ◽  
Postural Hypotension ◽  
Empty Sella ◽  
Electrolyte Imbalance ◽  
Diabetic Woman ◽  
Premature Menopause ◽  
Early Menopause ◽  
Empty Sella Syndrome ◽  
Parasellar Region

A 50-year-old, prematurely postmenopausal diabetic woman was admitted in the Endocrinology department of BIRDEM with the complaints of vomiting, loose motion, lethargy, profound weakness. Previously she suffered from several episodes of electrolyte imbalance and after investigations adrenal insufficiency was diagnosed on 2010. No evaluation was done for her premature menopause. During this episode of illness, she was found with postural hypotension, hyponatremia, dyslipidemia and panhypopituitarism. MRI of sella and parasellar region was done which revealed features suggestive of empty sella. This case gives insight that early menopause warrants proper evaluation and during evaluation, along with other factors hypopituitarism should be considered as an etiology for this condition. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12362 Birdem Med J 2012; 2(1) 52-55

scholarly journals An Autopsy of Acute Adrenal Insufficiency Resulting from Infarction of Both Adrenal Glands, in a Pregnant Woman with Metastatic Carcinoma of the Breast

2021 ◽  
Author(s):  
Gwendolyn Fernandes ◽  
Sharada Datar
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Glands ◽  
Emergency Services ◽  
Kidney Injury ◽  
Metastatic Carcinoma ◽  
Electrolyte Imbalance ◽  
Medical Emergency ◽  
Carcinoma Of The Breast ◽  
Duct Carcinoma ◽  
Acute Adrenal Insufficiency

Acute Adrenal Insufficiency (AAI) is a life-threatening medical emergency, associated with high mortality, and requires early diagnosis and prompt management. This is an unusual case report of a 34-year-old female who was diagnosed with breast cancer, in the second trimester of pregnancy. She presented at 33 weeks gestation, in the emergency services, with convulsions, weakness, altered sensorium and high-grade infiltrating duct carcinoma of breast with liver metastasis. She had also received a single cycle of chemotherapy with adriamycin and cyclophosphamide, at 33 weeks of pregnancy. Her condition deteriorated within 12-16 hours, and she developed abdominal pain, generalised weakness and convulsions. The patient was induced into labour, which was complicated, and delivered a still born male child. She also developed acute kidney injury and severe electrolyte imbalance, and died within four days of admission. A complete postmortem examination was performed where the cause of death was AAI following infarction of both adrenal glands in a background of metastatic carcinoma of the breast. It is strongly suspected that chemotherapy with adriamycin and cyclophosphamide is the primary cause of AAI in the present case. However, the etiology could also be multifactorial as factors like, sepsis, intrauterine foetal death and Disseminated Intravascular Coagulation (DIC) were also present.

scholarly journals Adrenal Insufficiency

2016 ◽  
pp. 43-48
Author(s):  
SM Ashrafuzzaman ◽  
Muhammad Abdur Rahim
Keyword(s):  
Weight Loss ◽  
Adrenal Insufficiency ◽  
Adrenal Cortex ◽  
High Index ◽  
Electrolyte Imbalance ◽  
Adrenal Crisis ◽  
Adrenal Androgen ◽  
Primary Adrenal Insufficiency ◽  
Short Acting ◽  
High Index Of Suspicion

Adrenal insufficiency means hypo-function of the adrenal cortex, usually glucocorticoid, may be associated with mineralocorticoid and rarely adrenal androgen. It can be categorized into two types: Primary adrenal insufficiency, or Addison’s disease (cortisol low and ACTH high) or secondary/ tertiary adrenal insufficiency due to pituitary or hypothalamic disorders (both cortisol and ACTH are low). Identification of etiology is very important for plan of treatment. The reported incidence of adrenal insufficiency varies greatly depending on the population studied, the test and cut off levels used, and the cause. Many patients may present with adrenal crisis, some of them have subtle symptoms, hyperpigmentation, hypotension, electrolyte imbalance, shock etc. Many of them have iatrogenic adrenal insufficiency with features of Cushing’s syndrome. So, the manifestations of adrenal insufficiency are numerous and nonspecific, and clinicians should have a high index of suspicion and be alert to see important diagnostic clues, such as hyponatremia, hyperkalemia, and hypotension (that are refractory to fluids and vasopressors), diarrhea, weight loss, vomiting, fever etc. without any clear causation. Treatment of adrenal insufficiency is usually life-long, of course based on etiology. Short acting glucocorticoid is better, like hydrocortisone. Patients may be treated with prednisolone. Patients should be provided a “steroid card”. Sometimes it is essential to take patients under “withdrawal protocol”.Birdem Med J 2015; 5(1) Supplement: 43-48

scholarly journals Lipid Profile and Electrolyte Imbalance are Associated with Diabetic Retinopathy in Bangladeshi Population

2020 ◽  
Vol 8 (3) ◽  
Author(s):  
Md. Golam Kabir ◽  
Deaniel Hossain ◽  
Suman Mohajan ◽  
Monsor Rahman
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
High Density Lipoprotein ◽  
Total Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Electrolyte Imbalance ◽  
Control Group ◽  
Low Density

Background: Diabetic retinopathy (DR) is a micro-vascular complication which is the main cause of blindness among people with Diabetes Mellitus. Identification and mitigation of the risk factors associated with DR will help to reduce the visual disability in diabetic subjects. Aims and objective: The study has been undertaken to explore the association of lipids profile and electrolytes with the diabetic retinopathy in Bangladeshi type 2 diabetic subjects. Material and methods: In the present study, 63 people diabetic with retinopathy (DR) and 80 people diabetic without retinopathy (DWR) were studied along with 92 healthy controls without family history diabetes and prediabetes. Anthropometric parameters, glucose, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, glycosylated haemoglobin (HbA1c) and electrolytes Na+, K+, Cl-, HCO3- were measured by standard methods.   Results: HbA1c of DWR group and DR group were 8.60±1.17 and 11.80±1.63 respectively. Total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c) were significantly higher (p<0.001) in both DWR and DR group compared to the healthy control. Triglyceride was significantly (p<0.001) higher in the DR group but no difference was found in DWR compared to the control group. K+ was significantly increased in the DR group. Na+, Cl-, HCO3- were significantly decreased in the DR group compared to control group. Conclusion: These results indicate that diabetic retinopathy patients exhibit dyslipidemia and electrolyte imbalance. Hypertriglyceridemia along with electrolyte imbalance is one the major risk factors toward the progression of diabetic retinopathy.

scholarly journals A rare case of hypopituitarism with psychosis

2013 ◽  
Vol 2013 ◽  
Author(s):  
M Nwokolo ◽  
J Fletcher
Keyword(s):  
Adrenal Insufficiency ◽  
Fluid Resuscitation ◽  
Dynamic Testing ◽  
Rare Complication ◽  
False Negative ◽  
Sella Turcica ◽  
Empty Sella ◽  
Electrolyte Imbalance ◽  
List Type ◽  
Presumptive Diagnosis

Summary A 46-year-old woman presented multiple times in a 4-month period with hypotension, sepsis, hypoglycaemia and psychosis. A low random cortisol in combination with her presenting complaint made adrenal insufficiency the likely diagnosis. Fluid resuscitation and i.v. steroid therapy led to clinical improvement; however, a short synacthen test (SST) demonstrated an apparently satisfactory cortisol response. The test was repeated on a later admission and revealed a peak cortisol level of 25 nmol/l (>550 nmol/l). Concurrent treatment with i.v. hydrocortisone had led to a false-negative SST. ACTH was <5 ng/l (>10 ng/l), indicating secondary adrenal failure. We discuss the challenges surrounding the diagnosis of adrenal insufficiency and hypopituitarism, the rare complication of psychosis and a presumptive diagnosis of autoimmune lymphocytic hypophysitis (ALH). Learning points Adrenocortical insufficiency must be considered in the shocked, hypovolaemic and hypoglycaemic patient with electrolyte imbalance. Rapid treatment with fluid resuscitation and i.v. corticosteroids is vital. Polymorphic presentations to multiple specialities are common. Generalised myalgia, abdominal pain and delirium are well recognised, psychosis is rare. A random cortisol can be taken with baseline bloods. Once the patient is stable, meticulous dynamic testing must follow to confirm the clinical diagnosis. The chronic disease progression of ALH is hypothesised to be expansion then atrophy of the pituitary gland resulting in empty sella turcica and hypopituitarism. If hypopituitarism is suspected, an ACTH deficiency should be treated prior to commencing thyroxine (T4) therapy as unopposed T4 may worsen features of cortisol deficiency.

Liver Biopsy Culture in the Diagnosis of Miliary Tuberculosis: A Case Report

1952 ◽  
Vol 22 (1) ◽  
pp. 124-127 ◽  
Author(s):  
John M. Rumball ◽  
George L. Baum
Keyword(s):  
Case Report ◽  
Liver Biopsy ◽  
Miliary Tuberculosis
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