RESUMO
Infiltrative dermopathy is an uncommon manifestation of Graves’ disease frequently involving the lower extremities. The pretibial area is most commonly involved. Rarely the fingers, hands, elbows, arms, or face are affected. Skin thickening is the characteristic abnormality. Localized myxedema is an autoimmune manifestation of Graves’ disease. Here, we report the case of a 45-year-old who presented with thyroid-associated orbitopathy and localized myxoedema over both the shoulders. In a patient who has long-standing hyperthyroidism, the diagnosis of infiltrative dermopathy is usually confirmed by the location, non-pitting nature, and distinct borders of the lesions. As most of these lesions are asymptomatic, no specific therapy is required
RESUMO
Down syndrome (DS) is one of the most common chromosomal disorders. Although genitourinary anomalies, such as a cryptorchidism, micropenis, posterior urethral valves, and hypospadias, have been recognized as complications, the association of ambiguous genitalia with DS has been rarely reported. We report the case of a 1-year-old baby; assigned male sex at birth who was the first child born of a non-consanguineous marriage, by vaginal delivery at term with a birth weight of 2.2 kg. The baby had clinical features suggestive of DS with a micropenis, penoscrotal hypospadias, and incompletely fused labial-scrotal folds with palpable gonads. The external masculinization score was 3/12. The child was reared as a male and hormonal investigations were suggestive of androgen insensitivity. Karyotype was 47, XY, +21.
RESUMO
Pattern of endocrine changes in moderate to severely ill patients in a medical intensive care unit, correlation with the severity of illness and whether these changes can predict outcome of the critically ill patients were evaluated and studied in 80 patients admitted with acute physiology and chronic health evaluation (APACHE) II score >10 and without any pre-existing endocrinopathies or on drugs likely to affect the endocrine axis. Adrenal insufficiency was present in 45%, and mortality was higher in those with lower (<15 microg/dl) and higher (>30 microg/dl) serum cortisol. Sick euthyroid syndrome was detected in 80%, and those with low mean T3 (<0.6 ng/ml), free T4 (<0.89 ng/dl) and total T4 (<4 microg/dl) and had increased mortality. Hypotestosteronaemia was found in 92% of men and was significantly associated with severity of illness in men. Though prolactin is the first hormone to be elevated, there was no correlation between prolactin and severity of illness or mortality.