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Background@#Fatty liver is associated with increased risk of developing type 2 diabetes. We aimed to evaluate whether the severity of hepatic steatosis is associated with incident diabetes. @*Methods@#We conducted a longitudinal analysis using data from 1,798 participants who underwent a comprehensive health checkup and abdominal computed tomography (CT). We assessed the association between baseline liver attenuation value on non-contrast CT images and risk of incident diabetes. All the participants were categorized into three groups based on the baseline liver attenuation value on non-contrast CT images: without hepatic steatosis (>57 Hounsfield unit [HU]), mild hepatic steatosis (41–57 HU), and moderate to severe hepatic steatosis (≤40 HU). @*Results@#During a median follow-up period of 5 years, 6.0% of the study participants progressed to diabetes. The incidence of diabetes was 17.3% in the moderate to severe hepatic steatosis group, 9.0% in the mild steatosis group, and 2.9% in those without hepatic steatosis. In a multivariate adjustment model, as compared with participants without hepatic steatosis, those with moderate to severe steatosis had a hazard ratio (HR) of 3.24 (95% confidence interval [CI], 1.64 to 4.2) for the development of diabetes, and those in the mild steatosis group had a HR of 2.33 (95% CI, 1.42 to 3.80). One standard deviation decrease in mean CT attenuation values of the liver was associated with a 40% increase in the development of diabetes (multivariate adjusted HR, 1.40; 95% CI, 1.2 to 1.63). @*Conclusion@#We found a positive association between severity of hepatic steatosis and risk of incident diabetes. Greater severity of steatosis was associated with a higher risk of incident diabetes.
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Background@#High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. @*Methods@#We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS).We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. @*Results@#From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. @*Conclusion@#We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.
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Background/Aims@#Few studies have addressed the relationship between the occurrence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) and hospital case volume or endoscopist’s experience with inconsistent results. The aim of our study was to investigate the impact of hospital case volume and endoscopist’s experience on the AEs associated with ERCP and to analyze patient- and procedure-related risk factors for post-ERCP AEs. @*Methods@#From January 2015 to December 2015, we prospectively enrolled patients with naïve papilla who underwent ERCP at six centers. Patient- and procedure-related variables were recorded on data collection sheets at the time of and after ERCP. @*Results@#A total of 1,191 patients (median age, 71 years) were consecutively enrolled. The overall success rate of biliary cannulation was 96.6%. Overall, 244 patients (20.5%) experienced post-ERCP AEs, including pancreatitis (9.0%), bleeding (11.8%), perforation (0.4%), cholangitis (1.2%), and others (0.9%). While post-ERCP pancreatitis (PEP) was more common when the procedure was performed by less experienced endoscopists, bleeding was more common in high-volume centers and by less experienced endoscopists. Multivariate analysis showed that a less experience in ERCP was significantly associated with PEP (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.050 to 2.531; p=0.030) and post-ERCP bleeding (OR, 1.439; 95% CI, 1.003 to 2.062; p=0.048). @*Conclusions@#Our study demonstrated that overall AEs following ERCP were associated with the experience of the endoscopist. To minimize post-ERCP AEs, rigorous training with a sufficient case volume is required, and treatment strategies should be modified according to the endoscopist’s expertise.
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Purpose@#Although imatinib-induced hepatotoxicity may aggravate the patient’s clinical condition and alter the treatment plan, the underlying mechanism of and factors influencing imatinibinduced hepatotoxicity have rarely been investigated. The purpose of this study was to investigate factors affecting on the incidence of hepatotoxicity within 90 days after starting imatinib treatment and time to onset of imatinib-induced hepatotoxicity. @*Materials and Methods@#We retrospectively evaluated the records of 177 patients receiving imatinib from October 2012 to September 2017. The analyzed factors included sex, age, body weight, body surface area, underlying disease, and concomitant drugs. @*Results@#The proportion of patients with hepatotoxicity within 90 days after imatinib administration was 33.9%. Proton pump inhibitors (PPIs) increased the incidence of hepatotoxicity approximately 3.8-fold and doubled the hazard of time to reach hepatotoxicity. Patients with liver disease or hepatitis B virus (HBV) carriers had a more than 8-fold higher risk of hepatotoxicity and a 5.2-fold increased hazard of hepatotoxicity compared to those without liver disease or HBV. Patients with body weight under 55 kg had a 2.2-fold higher risk for occurrence of hepatotoxicity. Patients with an imatinib dose > 400 mg had a 2.3-fold increased hazard of time to reach hepatotoxicity compared to those with an imatinib dose ≤ 400 mg. @*Conclusion@#The findings of this study suggest that the use of PPIs and presence of liver disease or HBV were associated with imatinib-induced hepatotoxicity. Thus, close liver function monitoring is recommended, especially in patients with liver impairment or using PPIs.
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Background@#Most meta-analyses of risk factors for severe or critical outcomes in patients with COVID-19 only included studies conducted in China and this causes difficulties in generalization. Therefore, this study aimed to systematically evaluate the risk factors in patients with COVID-19 from various countries. @*Methods@#PubMed, Embase, and Web of Science were searched for studies published on the mortality risk in patients with COVID-19 from January 1 to May 7, 2020. Pooled estimates were calculated as odds ratio (OR) with 95% confidence interval (CI) using the random-effects model. @*Results@#We analyzed data from seven studies involving 26,542 patients in total in this systematic review and meta-analysis. Among the patients, 2,337 deaths were recorded (8.8%). Elderly patients and males showed significantly higher mortality rates than young patients and females; the OR values were 3.6 (95% CI 2.5-5.1) and 1.2 (95% CI 1.0-1.3), respectively. Among comorbidities, hypertension (OR 2.3, 95% CI 1.1-4.6), diabetes (OR 2.2, 95% CI 1.2-3.9), cardiovascular disease (OR 3.1, 95% CI 1.5-6.3), chronic obstructive pulmonary disease (OR 4.4, 95% CI 1.7-11.5), and chronic kidney disease (OR 4.2, 95% CI 2.0-8.6) were significantly associated with increased mortalities. @*Conclusion@#This meta-analysis, involving a huge global sample, employed a systematic method for synthesizing quantitative results of studies on the risk factors for mortality in patients with COVID-19. It is helpful for clinicians to identify patients with poor prognosis and improve the allocation of health resources to patients who need them most.
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Background@#Although the identification of clinical and laboratory features in pediatric COVID-19 patients is essential in establishing an appropriate treatment plan, a systematic review and meta-analysis on the topic has yet to be reported. @*Methods@#We searched MEDLINE, Embase, and Web of Science to access clinical and laboratory characteristics as well as clinical outcomes of children with COVID-19 infection. A meta-analysis using random-effect model was performed to estimate pooled prevalence and 95% confidence intervals. @*Results@#Among the 532 studies initially collected, 12 articles were finally included in the meta-analysis. Among the investigated 320 pediatric patients with COVID-19, fever (48.2%) and cough (39.3%) were the most common symptoms.Almost one third of patients (30.4%) were asymptomatic. In laboratory findings, only 11.4% of pediatric patients experienced lymphocytopenia. Increased inflammatory markers including c-reactive protein (18.6%) and procalcitonin (32.4%) were observed.Only a few patients needed mechanical ventilation and intensive care support, and only one death was reported. @*Conclusion@#Pediatric patients with COVID-19 infection exhibited milder symptoms and more favorable outcomes compared to adults. However, considering the high rate of asymptomatic pediatric patients, close monitoring is required to prevent community infection in asymptomatic conditions and hidden disease progression.
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Background@#The clinical outcomes of delayed radioiodine remnant ablation (RRA) therapy in patients with low-risk papillary thyroid carcinoma (PTC) are unclear. We aimed to evaluate the clinical impact of the interval between total thyroidectomy (TT) and RRA therapy in patients with low-risk PTC. @*Methods@#We included 526 patients who underwent TT and RRA for low-risk PTC with a primary tumor size of >1 cm between 2000 and 2012. Patients were divided into the early (3 months after TT considering other prognostic factors.
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Background@#Most meta-analyses of risk factors for severe or critical outcomes in patients with COVID-19 only included studies conducted in China and this causes difficulties in generalization. Therefore, this study aimed to systematically evaluate the risk factors in patients with COVID-19 from various countries. @*Methods@#PubMed, Embase, and Web of Science were searched for studies published on the mortality risk in patients with COVID-19 from January 1 to May 7, 2020. Pooled estimates were calculated as odds ratio (OR) with 95% confidence interval (CI) using the random-effects model. @*Results@#We analyzed data from seven studies involving 26,542 patients in total in this systematic review and meta-analysis. Among the patients, 2,337 deaths were recorded (8.8%). Elderly patients and males showed significantly higher mortality rates than young patients and females; the OR values were 3.6 (95% CI 2.5-5.1) and 1.2 (95% CI 1.0-1.3), respectively. Among comorbidities, hypertension (OR 2.3, 95% CI 1.1-4.6), diabetes (OR 2.2, 95% CI 1.2-3.9), cardiovascular disease (OR 3.1, 95% CI 1.5-6.3), chronic obstructive pulmonary disease (OR 4.4, 95% CI 1.7-11.5), and chronic kidney disease (OR 4.2, 95% CI 2.0-8.6) were significantly associated with increased mortalities. @*Conclusion@#This meta-analysis, involving a huge global sample, employed a systematic method for synthesizing quantitative results of studies on the risk factors for mortality in patients with COVID-19. It is helpful for clinicians to identify patients with poor prognosis and improve the allocation of health resources to patients who need them most.
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Background@#Although the identification of clinical and laboratory features in pediatric COVID-19 patients is essential in establishing an appropriate treatment plan, a systematic review and meta-analysis on the topic has yet to be reported. @*Methods@#We searched MEDLINE, Embase, and Web of Science to access clinical and laboratory characteristics as well as clinical outcomes of children with COVID-19 infection. A meta-analysis using random-effect model was performed to estimate pooled prevalence and 95% confidence intervals. @*Results@#Among the 532 studies initially collected, 12 articles were finally included in the meta-analysis. Among the investigated 320 pediatric patients with COVID-19, fever (48.2%) and cough (39.3%) were the most common symptoms.Almost one third of patients (30.4%) were asymptomatic. In laboratory findings, only 11.4% of pediatric patients experienced lymphocytopenia. Increased inflammatory markers including c-reactive protein (18.6%) and procalcitonin (32.4%) were observed.Only a few patients needed mechanical ventilation and intensive care support, and only one death was reported. @*Conclusion@#Pediatric patients with COVID-19 infection exhibited milder symptoms and more favorable outcomes compared to adults. However, considering the high rate of asymptomatic pediatric patients, close monitoring is required to prevent community infection in asymptomatic conditions and hidden disease progression.
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Background@#The clinical outcomes of delayed radioiodine remnant ablation (RRA) therapy in patients with low-risk papillary thyroid carcinoma (PTC) are unclear. We aimed to evaluate the clinical impact of the interval between total thyroidectomy (TT) and RRA therapy in patients with low-risk PTC. @*Methods@#We included 526 patients who underwent TT and RRA for low-risk PTC with a primary tumor size of >1 cm between 2000 and 2012. Patients were divided into the early (3 months after TT considering other prognostic factors.
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BACKGROUND@#Small-molecule tyrosine kinase inhibitors (TKIs) have had major impacts on anticancer therapy by targeting the catalytic activities of dysregulated tyrosine kinases. TKIs have not presented traditional toxicities; however, some serious adverse effects, including hepatotoxicity, have been documented in clinical trials and post-marketing surveillance. Although TKI-induced hepatotoxicity can cause severe clinical complications in patients, the underlying mechanism is still unclear.@*METHODS@#Studies on TKI-induced hepatotoxicity were identified by Pubmed search, and relevant articles were reviewed.@*RESULTS@#Immunoallergic reaction, cytochrome P (CYP) 450 polymorphisms, and formation of reactive metabolites are under consideration as mechanisms of TKI-induced hepatotoxicity. Host protein-drug metabolite conjugates are recognized as antigens by class II major histocompatibility complexes and are believed to cause liver injuries. Polymorphisms in CYP, which influences TKI metabolism, can slow TKI metabolism and may induce development of hepatotoxicity. The formation of reactive metabolites during drug metabolism can induce hepatotoxicity by directly causing cytotoxicity, leading to cell dysfunction, and indirect toxicity by mediating secondary immune reactions. Concurrent use of various medications with TKI can also cause hepatotoxicity by affecting drug transporter or enzyme activities.@*CONCLUSION@#Periodic monitoring of patients taking TKIs and risk/benefit reassessments though post marketing surveillance are necessary to prevent hepatotoxicity.
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OBJECTIVE: Fatty liver is associated with insulin resistance-related diseases, such as dyslipidemia, obesity, and type 2 diabetes. The aim of this study was to evaluate the association of dyslipidemia with fatty liver and assess the differences in these associations according to the degree of hepatic steatosis. METHODS: A total of 2,462 subjects (1,679 men and 783 women) who underwent a comprehensive health check-up (including abdominal computed tomography) from January 2010 to December 2013 were enrolled at Samsung Changwon Hospital Healthcare Center. The liver attenuation index (LAI), defined as the difference between mean hepatic and splenic attenuation, was used to assess the degree of hepatic steatosis. An LAI below 5 Hounsfield units was defined as fatty liver. RESULTS: We found that 32.2% of the study subjects had fatty liver. Serum low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG), and fasting blood glucose concentrations and glycated hemoglobin (HbA1c percentage) were significant greater in the fatty liver group compared with the non-fatty liver group, while serum high-density lipoprotein cholesterol (HDL-C) was significantly lower in the fatty liver group. Subjects with fatty liver had 1.7-fold greater risk of dyslipidemia than those without fatty liver after adjusting for age, sex, body mass index (BMI), and HbA1c. When individuals with fatty liver were analyzed by tertiles of LAI values, LDL-C, TG, fasting glucose, BMI, and HbA1c concentrations increased while HDL-C decreased with decreasing LAI tertiles. Compared with LAI tertile 3, the risk for dyslipidemia significantly increased with adjusted odds ratios of 1.42, and 1.81 in tertiles 2 and 1, respectively. CONCLUSION: Fatty liver was significantly associated with dyslipidemia and this association varied according to the degree of hepatic steatosis.
Subject(s)
Humans , Male , Blood Glucose , Body Mass Index , Cholesterol , Delivery of Health Care , Dyslipidemias , Fasting , Fatty Liver , Glucose , Glycated Hemoglobin , Insulin , Korea , Lipoproteins , Liver , Obesity , Odds Ratio , Tomography, Spiral Computed , TriglyceridesABSTRACT
BACKGROUND: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. METHODS: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. RESULTS: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. CONCLUSION: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.
Subject(s)
Humans , Cause of Death , Cohort Studies , Korea , Mortality , Neoplasm Metastasis , Neoplasm Recurrence, Local , Prognosis , Recurrence , Retrospective Studies , Seoul , Thyroid Gland , Thyroid NeoplasmsABSTRACT
BACKGROUND: The incidence of thyroid nodules has increased worldwide in recent years. Thyroid dysfunction is a potential risk factor for hypercholesterolemia, cardiovascular disease, osteoporosis, arrhythmia, and neuropsychiatric disease. This study investigated the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism in Koreans. METHODS: In this nationwide population-based cohort study, 51,834,660 subjects were included using the National Health Information database from 2006 to 2015, after the exclusion of subjects with thyroid cancer. RESULTS: The prevalence in Korea in 2015 of thyroid nodules, hypothyroidism in patients taking thyroid hormone, and hyperthyroidism in patients undergoing treatment was 15.82/1,000 population, 15.94/1,000 population, and 2.76/1,000 population, respectively. All these diseases were more prevalent among women than among men. The number of incident cases of these three thyroid diseases steadily increased from 2006 to 2012, and then decreased through 2015. The incidence of thyroid nodules, hypothyroidism treated with thyroid hormone, and treated hyperthyroidism was 6.79/1,000 population, 1.76/1,000 population, and 0.55/1,000 population, respectively, in Korea in 2015. The use of methimazole continuously increased, from 33% of total antithyroid drug prescriptions in 2006 to 74.4% in 2015, and it became the most frequently prescribed antithyroid drug in Korea. In contrast, the use of propylthiouracil continuously decreased. CONCLUSION: This was the first nationwide study of the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism to take into account recent changes and to include the current status of patients receiving treatment.
Subject(s)
Female , Humans , Male , Arrhythmias, Cardiac , Cardiovascular Diseases , Cohort Studies , Drug Prescriptions , Hypercholesterolemia , Hyperthyroidism , Hypothyroidism , Incidence , Korea , Methimazole , Osteoporosis , Prevalence , Propylthiouracil , Risk Factors , Thyroid Diseases , Thyroid Gland , Thyroid Neoplasms , Thyroid NoduleABSTRACT
BACKGROUND: Most patients with differentiated thyroid cancer (DTC) have a favorable prognosis. However, patients with DTC and initial distant metastasis have not been commonly found, and their clinical characteristics have seldom been reported. In this study, we analyzed the clinical features and prognosis of patients with DTC and initial distant metastasis in Korea. METHODS: We retrospectively reviewed the clinical data of 242 patients with DTC and initial distant metastasis treated from 1994 to 2013, collected from five tertiary hospitals in Korea. RESULTS: The patients' median age was 51 years, and 65% were women. They were followed for a median of 7 years. Lung was the most common site of distant metastasis: only lung 149 patients (62%), only bone 49 (20%), other single site one (pleura), and combined sites 43 (40 were lung and bone, two were bone and other site, and one was lung and other site). At the time of diagnosis, 50 patients (21%) had non-radioactive iodine (RAI) avidity. Five-year disease-specific survival (DSS) was 85% and 10-year DSS was 68%, which were better than those in previous studies. After multivariate analysis, old age, male sex, metastatic site, and histologic type (follicular type) were significant factors for poor prognosis. However, negative RAI avidity status was not a significant prognostic factor after adjusting for other variables. CONCLUSION: The prognosis of Korean patients with DTC and initial distant metastasis was better than in previous studies. Old age, male sex, metastasis site, and histologic type were significant prognostic factors.
Subject(s)
Female , Humans , Male , Diagnosis , Iodine , Korea , Lung , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Retrospective Studies , Tertiary Care Centers , Thyroid Gland , Thyroid NeoplasmsABSTRACT
Impaired insulin secretion and insulin resistance are the two main mechanisms leading to type 2 diabetes mellitus. Insulin exerts multiple effects upon target cells, especially skeletal muscle, liver, and adipose tissue. In general, insulin promotes storage of glucose and inhibits the breakdown of stored glycogen into glucose. The counter regulatory hormones glucagon, catecholamine, cortisol and growth hormone are released during hypoglycemia and under other stress conditions. These hormones have insulin-antagonistic effects both in the liver and in the peripheral tissues. A significant number of endocrine disorders is associated with varying degrees of glucose intolerance, with which sustained excess of these hormones is associated. Indeed, type 2 diabetes is frequently observed in patients with various hormonal diseases including acromegaly, Cushing syndrome, pheochromocytoma, hyperthyroidism, and glucagonoma. In particular, improvement of glycemic control following treatment for these hormonal diseases confirms a causal relationship between excess of these hormones and diabetes. In this review, there will be a discussion over these endocrine diseases in relation to diabetes.
Subject(s)
Humans , Acromegaly , Adipose Tissue , Cushing Syndrome , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Endocrine System Diseases , Glucagon , Glucagonoma , Glucose , Glucose Intolerance , Glycogen , Growth Hormone , Hydrocortisone , Hyperthyroidism , Hypoglycemia , Insulin , Insulin Resistance , Liver , Muscle, Skeletal , PheochromocytomaABSTRACT
BACKGROUND/AIMS: Previous studies have suggested that elevated serum vitamin D levels might protect against thyroid cancer. Elevated serum thyroid stimulating hormone levels and autoimmune thyroid disease (AITD) are suggested to be thyroid cancer promoting factors but have not been well controlled in previous studies. We designed the present study to evaluate whether serum vitamin D levels are associated with thyroid cancer in euthyroid patients with no clinical evidence of AITD. METHODS: This cross-sectional study included subjects who underwent routine health check-ups, including serum 25-hydroxy vitamin D3 (25(OH)D3) levels, anti-thyroid peroxidase antibody (TPO-Ab), and thyroid ultrasonography (US). Inclusion criteria were euthyroid, negative TPO-Ab, and no evidence of AITD by US findings. Thyroid cancer diagnoses were based on fine needle aspiration cytology and/or postsurgical histopathological findings. RESULTS: We enrolled 5,186 subjects (64% male, 37% female) in this study, including 53 patients (1%) with a diagnosis of thyroid cancer (33 males, 20 females). Mean 25(OH)D3 levels were similar between the thyroid cancer and control groups (p = 0.20). Subgroup analysis according to sex or seasonal variation also revealed no differences in 25(OH)D3 levels between the two groups. Based on the levels of 25(OH)D3, there was no significant difference in the prevalence of thyroid cancer; the prevalence was 0.71%, 0.94%, 1.40%, and 0.82% in the deficient, insufficient, sufficient, and excess groups, respectively (p = 0.64). CONCLUSIONS: The levels of serum 25(OH)D3 are not associated with thyroid cancer prevalence in euthyroid subjects with no clinical evidence of AITD.
Subject(s)
Humans , Male , Biopsy, Fine-Needle , Cholecalciferol , Cross-Sectional Studies , Diagnosis , Peroxidase , Prevalence , Seasons , Thyroid Diseases , Thyroid Gland , Thyroid Neoplasms , Thyrotropin , Ultrasonography , Vitamin D , VitaminsABSTRACT
Approximately 10–15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a 10.0×9.5×7.5 cm sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.
Subject(s)
Aged , Female , Humans , Adrenal Gland Neoplasms , Adrenal Glands , Back Pain , Catecholamines , Diagnosis , Follow-Up Studies , Iodine , Lymph Nodes , Magnetic Resonance Imaging , Metastasectomy , Neoplasm Metastasis , Norepinephrine , Pathology , Pheochromocytoma , Recurrence , SpineABSTRACT
Approximately 10–15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a 10.0×9.5×7.5 cm sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.
Subject(s)
Aged , Female , Humans , Adrenal Gland Neoplasms , Adrenal Glands , Back Pain , Catecholamines , Diagnosis , Follow-Up Studies , Iodine , Lymph Nodes , Magnetic Resonance Imaging , Metastasectomy , Neoplasm Metastasis , Norepinephrine , Pathology , Pheochromocytoma , Recurrence , SpineABSTRACT
BACKGROUND: Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness. CASE PRESENTATION: A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids. CONCLUSIONS: Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness.