RESUMEN
A 56-year-old female with evidence of multisystem involvement due to sarcoidosis presented with acute renal failure. Percutaneous renal biopsy revealed sarcoid granulomatous infiltration of the renal parenchyma. Steroid therapy resulted in a prompt improvement of renal function. A review of the literature has disclosed 16 similar cases. Pertinent clinical and laboratory data and treatment regimens are discussed.
Asunto(s)
Lesión Renal Aguda/etiología , Granuloma/etiología , Enfermedades Renales/etiología , Sarcoidosis/complicaciones , Femenino , Granuloma/patología , Humanos , Riñón/patología , Enfermedades Renales/patología , Ganglios Linfáticos/patología , Persona de Mediana Edad , Necrosis , Sarcoidosis/patologíaRESUMEN
Hypothalamic pituitary function was studied in 13 patients with myasthenia gravis. Gonadotropin, TSH, and prolactin dynamics were investigated using conventional provocative stimuli. No consistent abnormality was found in either gonadotropin or prolactin release. Abnormal TSH responses to TRH administration was present in six of the 13 patients in association with normal free thyroxine indices and the absence of antithyroid antibodies. This latter observation is relevant when the association of myasthenia gravis with hyperthyroidism, thyroiditis and hypothyroidism is considered.
Asunto(s)
Sistema Hipotálamo-Hipofisario/fisiopatología , Miastenia Gravis/fisiopatología , Adolescente , Adulto , Anciano , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Masculino , Menopausia , Persona de Mediana Edad , Prolactina/sangre , Tirotropina/sangre , Hormona Liberadora de TirotropinaRESUMEN
Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.
Asunto(s)
Insuficiencia Suprarrenal/diagnóstico , Adolescente , Hiperplasia Suprarrenal Congénita/complicaciones , Insuficiencia Suprarrenal/etiología , Hormona Adrenocorticotrópica/deficiencia , Adulto , Anciano , Femenino , Hemorragia/complicaciones , Humanos , Hipercalcemia/complicaciones , Hipopituitarismo/complicaciones , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Trastornos de la Pigmentación/etiología , Tuberculosis/complicacionesAsunto(s)
Antitiroideos/efectos adversos , Artritis Reumatoide/inducido químicamente , Hipertiroidismo/tratamiento farmacológico , Adulto , Artritis Reumatoide/sangre , Proteínas del Sistema Complemento/análisis , Femenino , Humanos , Metimazol/efectos adversos , Propiltiouracilo/efectos adversos , Tiroxina/sangre , Triyodotironina/sangreRESUMEN
An 81-yr-old male with pulmonary emphysema was hospitalized because of malnutrition and hypoglycemia. This patient developed ventilatory failure requiring mechanical assistance 12 h after initiation of iv hyperalimentation. Severe hypophosphatemia (0.1 mg/dl), mild hypocalcemia, hypomagnesemia, and hypokalemia were subsequently and concomitantly documented. Repeated attempts to wean him from the respirator failed until hypophosphatemia was corrected. When difficulties are encountered in weaning patients from mechanical ventilation, attention should be directed toward detection of hypophosphatemia. This may be crucial in the presence of chronic lung disease.
Asunto(s)
Fosfatos/deficiencia , Insuficiencia Respiratoria/etiología , Anciano , Humanos , Masculino , Fosfatos/sangre , Insuficiencia Respiratoria/fisiopatologíaRESUMEN
A leiomyoma of the small bowel produced laboratory features of hyperparathyroidism which disappeared promptly after tumour resection. Hypercalcaemia, hypophosphatemia, hyperchloremia, elevated chloride/phosphorus ratio, increased urinary cyclic AMP, and blood levels of immunoreactive parathormone were present. Electron microscopy showed dense round granules in the tumour cells.