Polimiopatia hipocalêmica e hipertensão secundária a hiperaldosteronismo primário felino / Hypokalemic polymyopathy and secondary hypertension to feline primary hyperaldosteronism

O hiperaldosteronismo se define pela hipersecreção de aldosterona pelas suprarrenais, resultando em excesso de sódio e redução de potássio sanguíneo. Esta hipersecreção deve-se à síntese autônoma de aldosterona por células adrenais hiperplásicas ou neoplásicas, que agem independentemente da estimulação pelo sistema renina-angiotensina. A doença acomete felinos de adultos maduros a idosos. O excesso de aldosterona culmina em hipertensão sistêmica e/ou hipocalemia, que levam à fraqueza muscular e alterações oculares. O diagnóstico é baseado em exames laboratoriais e de imagem, e o tratamento pode ser clínico ou cirúrgico. O prognóstico é considerado favorável quando as medicações são capazes de melhorar as manifestações clínicas ou quando é possível realizar o procedimento cirúrgico. O presente trabalho visa relatar o caso de um felino macho de 13 anos, castrado, sem raça definida, com hipocalemia persistente secundária a um presuntivo tumor adrenal.

Hyperaldosteronism is defined by the hypersecretion of aldosterone by the adrenal glands resulting in excess sodium and reduced blood potassium. This hypersecretion is due to the autonomous synthesis of aldosterone by hyperplastic or neoplastic adrenal cells, which act independently of stimulation by the renin-angiotensin system. The disease affects felines in the age group from mature adults to the elderly. The excess of aldosterone culminates in systemic hypertension and/or hypokalemia, which leads to muscle weakness and ocular changes. The diagnosis is based on laboratory and imaging tests and treatment can be clinical or surgical. The prognosis is considered favorable when the medications are able to improve the clinical manifestations or when it is possible to perform the surgical procedure. The present paper aims to report the case of a 13-year-old male cat, castrated, crossbred, with persistent hypokalemia secondary to a presumptive adrenal tumor.

Secuestro pulmonar extralobar infradiafragmático: a proposito de un caso / Extralobar Infradiaphragmatic Pulmonary sequestration: a case report

Se presenta un caso de secuestro pulmonar extralobar infradiafragmático como hallazgo ultrasonográfico prenatal, confirmado posteriormente por anatomía patológica.

We present a case of extralobar infradiaphragmatic pulmonary sequestration as prenatal ultrasonographic finding, subsequently confirmed by histopathology.

Hemorragia suprarrenal en recién nacidos / Adrenal hemorrhage in neonates

Patología que se diagnostica con frecuencia en los niños internados en terapia intensiva neonatal, y necesita un examen ecográfico adecuado para relacionar los hallazgos con otras patologías. Se describen su clasificación, etiología, y signos clínicos; así como su seguimiento ecográfico, y diagnóstico diferencial.

Open versus laparoscopic techniques in treatment of adrenal cyst: review of 19 cases

To study the effectiveness of laparoscopic management of adrenal cyst disease versus open surgery. Adrenal cysts are rare be benign lesions, mostly asymptomatic and nonfunctioning. Surgery is indicated when the cyst is functioning, the aspirate is haemorrhagic, cyst wall is irregular or if pheochromocytoma is suspected. 19 patients were admitted to Mansoura Urology and Nephrology Centre in Egypt between 1982 and 2005 with adrenal cyst disease and indicated adrenalectomy either surgically or laproscopically. Retrospective study on these cases as regarding the presentation, indication of intervention procedure, pre and postoperative complication and follow up. 10 cases had open adrenalectomy and 9 cases had laparoscopic transperitoneal adrenalectomy. The mean cyst size was 9.5 +/- 3.5 cm in the open technique while it was 8.3 +/- 3.9 in the laparoscopic technique. Hisopathology showed that 10 cases were haemorrhagic pseudocysts and 9 cases were endothelial cysts. The follow up showed that all cases were symptom free postoperatively without radiological evidence of recurrence. Only one case developed postoperative pulmonary infection and fever after laparoscopic adrenalectomy. Haemorrhagic pseudocysts presened 53%, while endothelial cysts presented 47% of cases. 84% of cases presented with ipsilateral upper quadrant abdominal pain. CT scanning succeeded to role out malignancy in 100% of our cases. Laparoscopic adrenalectomy is a safe and effective means of treatment with advantages of less blood loss, more cosmosis and less hospital stay over the open technique

Manejo actual de los pacientes con tumores suprarrenales incidentales (incidentalomas) / Actual management of the patients with incidental tumor adrenal (incidentalomes)

Presentar la experiencia en el manejo actual de los pacientes con tumores suprarrenales incidentales. Estudio retrospectivo de 8 historias clínicas de pacientes con tumor suprarrenal incidental. Consulta privada del autor y Servicio de Radiodiagnóstico del Instituto Urológico San Roman. De los pacientes diagnósticados por tomografía computada 5 (62,5 por ciento) eran mujeres y 3 (37,5 por ciento) hombres; edad entre 18 y 13 años, promedio 53,62 años. Tres (37,5 por ciento) con lesiones malignas primarias extrasuprarrenales concurrentes; 3(37,5 adenomas corticales uno de los cuales con esta lesión suprarrenal hiperfuncionante identificada; 1 (12,5 por ciento) mielolipoma; 1 (12,5 por ciento) paciente con hipertensión maligna al cual se le diagnósticó un feocromocitoma. El uso generalizado de la ultrasonografía computarizada, resonancia magnetica y angiografía para valorar las manifestaciones abdominales, ha conducido al descubrimiento casual de diversos datos no sospechados, como los tumores suprarrenales incidentales conocidos como incidentalomas que tiene una frecuencia que varía entre 0,3 y 5 por ciento de los pacientes que se someten a estudio tomográfico del abdomen. Si se excluyen los pacientes que tienen lesiones malignas primarias extrasuprarrenales concurrentes, hemorragia suprarrenal y lesiones suprarrenales hiperfuncionales identificadas, la prevalencia de estos incidentalomas verdaderos variará entre 0,6 y 1,4 por ciento

Extraovarian endocrine abnormalities in north Indian women with premature ovarian failure.

BACKGROUND. Premature ovarian failure is a rare syndrome characterized by cessation of menstruation before 35 years of age associated with an elevated gonadotropin level (serum follicle stimulating hormone > 40 IU/L) and oestrogen deficiency. Premature ovarian failure is often the result of an autoimmune process and involvement of other endocrine glands has been reported but available studies are hampered by a lack of uniformity in diagnostic criteria. METHODS. The endocrine profile of 37 north Indian women with premature ovarian failure was studied. The investigations included measurement of serum follicle stimulating hormone, luteinizing hormone, oestradiol, prolactin, total thyroxine, total triiodothyronine and thyroid stimulating hormone. To assess adrenocortical reserve, adrenocorticotropic hormone stimulated plasma cortisol levels were estimated. RESULTS. Eighteen (49%) patients had extraovarian endocrine abnormalities. Eight (22%) had abnormal thyroid function tests and 12 of 29 (41%) patients tested for adrenocortical reserve showed impaired response of plasma cortisol to adrenocorticotropic hormone stimulation. CONCLUSION. Extraovarian endocrine (especially adrenocortical) involvement is frequent in patients with premature ovarian failure. Because none of the patients had overt clinical evidence of thyroid or adrenocortical disease, we suggest that tests for thyroid and adrenal function be performed routinely in females presenting with premature ovarian failure.

MURCS association and hypothalamic anovulation

Se describe un nuevo caso de la asociación de MURCS (aplasia de ductos müllerianos, aplasia renal y displasia de las somitas cérvico-torácicas) en un paciente de 18 años de edad. Además de presentar otras características fenotípicas alteradas, se documentó la presencia de anovulación crónica hipotalámica. Las concentraciones basales de prolactina, tirotrofina, hormona de crecimiento, cortisol y estradiol se encontraron dentro de los límites de referencia para mujeres adultas. A la estimulación con TRH y ACTH se observaron respuestas dentro de los límites de referencia en términos de tirotrofina y cortisol respectivamente. Las concentraciones basales de LH y FSH, así como la estimulación con LHRH, demostraron disociación de ambas gonadotropinas. Los valores basales de progesterona se encontraron, a lo largo de un mes, en concentraciones acordes con la fase folicular. Esto último condujo al diagnóstico de anovulación crónica hipotalámica la cual fue confirmada mediante la inducción de ovulación con citrato de clomifeno. Este hallazgo demuestra la importancia de llevar a cabo evaluaciones endocrinológicas detalladas en pacientes con el diagnóstico de MURCS, con el fin de prevenir y/o tratar alteraciones secundarias a deficiencias endocrinológicas

X-linked congenital adrenal hypoplasia: proposal pathogenesis.

Two male infants with hyperpigmentation, vomiting, lethargy and weight loss were reported. Hypoglycemia, hyponatremia, hypochloremia, hyperkalemia and metabolic acidosis were suggestive diagnosis of salt losing adrenocortical insufficiency. The absence of ambiguous genitalia, low 24 hour urinary 17 KS and pregnanetriol excretion precluded congenital adrenal hyperplasia. Low basal levels of plasma aldosterone and cortisol and low 24 hour urinary 17 OHCS excretion with disability to increase their corticosteroid secretions after ACTH stimulation as well as furosemide and theophylline infusions were supportive for the diagnosis of congenital adrenal hypoplasia. The definitive diagnosis was confirmed by ultrasonogram and computerized tomography. Family histories suggested X-linked recessive inheritance in these reported cases. Evidence of progressive postnatal adrenocortical degeneration was documented by progressive deterioration of adrenocortical functions beginning from mineralocorticoid to total corticosteroid deficiencies. The increased brain serotonin synthesis as the associated pathology of X-linked congenital adrenal hypoplasia was proposed on the basis of elevated basal plasma GH and PRL levels in the reported cases, taken together with an incidence of congenital LH deficiency and persistent ACTH hypersecretion in corticosteroid treated patients reported elsewhere.