ABSTRACT
Introduction: Acromegaly is an uncommon pituitary disorder with an incidence of six per million persons. While hypertension is often encountered in these patients, heart failure rarely is seen with an incidence rate under 10%. We describe a case of an individual who was diagnosed with acromegaly after an acute exacerbation of heart failure with subsequent management requiring an LVAD to perform Transsphenoidal Surgery (TSS). Case Description: 37-year-old male otherwise healthy initially presented to an emergency room and was found to be in acute heart failure exacerbation. Concerning acromegaly features included macrognathia, enlarged hands and feet, swollen phalanges, widened spacing of teeth, and frontal bossing. IGF-1 level was found 455 ng/mL. MRI showed a 10mm macroadenoma. A right heart catheterization showed elevated filling pressures. Cardiac MRI showed no defects or enhancement. Endomyocardial biopsy showed no inflammatory infiltrates or evidence of infiltrative diseases. Patient had an ejection fraction of 15% corroborated by cardiac MRI along with the presence of aortic root dilatation and mitral regurgitation. The patient started on 0.5mg of Cabergoline twice weekly and 120mg weekly Lanreotide injections. Patient stabilized with plans for further close monitoring and outpatient neurosurgical evaluation. The COVID-19 pandemic and insurance gaps led the patient to spend two years off his medicines and he was unable to be seen by his medical team. Patient was seen by our system after recurrent hospitalizations for heart failure at our sister hospital, AICD was unable to be placed due to the patient's anatomy, he was placed on wearable cardiac defibrillator and required milrinone infusion for progression to end-stage heart failure with cardiac cachexia. At our institution, the patient was evaluated for Orthotopic Heart Transplant (OHT) but due to active GH secreting macroadenoma there was concern for OHT failure without TSS. Decision was made to utilize LVAD as Bridge-to-Transplant for OHT so the patient could be stabilized and safely undergo TSS. The patient tolerated surgeries well and is currently on the active transplant list. Discussion(s): Heart failure is an uncommon presentation of severe acromegaly requiring multidisciplinary management. We describe a case of a patient who initially presented with heart failure too unstable for surgery. Due to the COVID-19 pandemic the patient's disease progressed resulting in end-stage heart failure requiring LVAD placement for further treatment. We would like to draw attention to the use of LVAD placement in acromegalic patients who develop severe cardiovascular disease who are not candidates for OHT.Copyright © 2023
ABSTRACT
Aims: To determine the severity of deficiency and the presenting features Introduction: Vitamin D insufficiency affects almost 50% of the population worldwide. An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency (VDD). This pandemic of hypovitaminosis D can mainly be attributed to lifestyle and environmental factors that reduce exposure to sunlight, which is required for ultraviolet-B (UVB)-induced vitamin D production in the skin. The high prevalence of vitamin D insufficiency is a particularly important public health issue because hypovitaminosis D is an independent risk factor for total mortality in the general population. Many health care providers have increased their recommendations for vitamin D supplementation to at least 1000 IU. Methodology: this study was done over a span of 10 months from September 2021 to July 2022 This was a retrospective descriptive study in which data were recorded for all patients aged from 6 months to 12 years of age with features suggestive of vitamin D deficiency seen in Dr DY Patil Medical College and Hospital, Pune for a period of 10 months The Health Research and ethics committee of Dr DY Patil Medical College and Hospital, Pune approved the study and waived the requirement for the informed consent. A total of 69 patients were included in this study. Result(s): 69 patients were included in the study out of which 39 were males { 56.52%} and 30 were females { 43.48%}. the main presenting feature was bowing of legs { 31.9%} followed by difficulty in walking in 15.9% Out of 69 children 53 had severe deficiency, 13 had mild to moderate deficiency and 3 had optimum levels of vitamin D. 28 children belonged to the age group of 1-5 years followed by 18 children in age group of 5-10 years and 11 children in age group less than 1 year and 10-15 years Out of the entire study group 56 children had bony deformities and 13 had neurodevelopmental presentation Conclusion(s): the above results emphasise the fact that due to covid most of the children were restricted to stay indoors for several months leading to vitamin D deficiency in them. it also emphasis the fact that regular screening of children should be done with respect to vitamin D levels and also other micronutrients and children should be encouraged to have some amount of sun exposure to get natural supplementation of vitamin D and also be supplemented at desired intervals so that they adequate amount of vitamin D levels. Copyright © 2023 Ubiquity Press. All rights reserved.