RESUMEN
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Asunto(s)
Adulto , Femenino , Humanos , Insuficiencia Suprarrenal/diagnóstico , Encéfalo/diagnóstico por imagen , Depresión/etiología , Degeneración Hepatolenticular/complicaciones , Hipopituitarismo/complicaciones , Hipotiroidismo/diagnóstico , Cirrosis Hepática/complicaciones , Imagen por Resonancia Magnética , Esteroides/uso terapéutico , Hormona Liberadora de Tirotropina/uso terapéuticoRESUMEN
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.
Asunto(s)
Adulto , Femenino , Humanos , Insuficiencia Suprarrenal/diagnóstico , Encéfalo/diagnóstico por imagen , Depresión/etiología , Degeneración Hepatolenticular/complicaciones , Hipopituitarismo/complicaciones , Hipotiroidismo/diagnóstico , Cirrosis Hepática/complicaciones , Imagen por Resonancia Magnética , Esteroides/uso terapéutico , Hormona Liberadora de Tirotropina/uso terapéuticoRESUMEN
BACKGROUND: The ankle brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral arterial disease (PAD). However the diagnostic criterion of 0.9 has shown variable accuracy for identification of stenosis. We investigated more specific and sensitive diagnostic criterion of ABI for the diagnosis of PAD. METHODS: Among 5,379 patients who performed ABI test, 398 patients with abnormal ABI results or PAD symptoms underwent computed tomography angiography to confirm PAD. Each ABI results were compared with its sensitivity, specificity, positive and negative predictive values. ROC analysis and cross-tabulation analysis were performed to yield proper ABI criterion. RESULTS: ABI of 0.9 showed very high level of sensitivity (92.2%) and very low specificity(59.3%). ABI of 0.84 showed high level of specificity (81.4%), sensitivity (82.2%) and diagnostic correspondent rate (0.607). CONCLUSION: The ABI of 0.84 could be more accurate and useful diagnostic Criterion for identifying PAD.