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1.
Rev Med Chil ; 145(7): 941-944, 2017 Jul.
Article in Spanish | MEDLINE | ID: mdl-29182204

ABSTRACT

Symptoms of hypopituitarism are usually chronic and nonspecific, but rarely the disease can have acute and life threatening manifestations. We report a 53 years old female with a pituitary adenoma that was admitted to our hospital because of syncope. The electrocardiogram showed sinus bradycardia with a prolonged QT interval. Frequent runs of non-sustained polymorphic ventricular tachycardia were noted on telemetry. The patient had a history of severe acute headaches in the previous days and laboratory tests revealed severe secondary hypothyroidism, adrenal insufficiency and a decrease in pituitary hormones. A magnetic resonance imaging of the head showed changes in the size and contrast enhancement of the adenoma. A diagnosis of hypopituitarism secondary to pituitary apoplexy was made and treatment with hydrocortisone and, subsequently, levothyroxine was started. Hormonal disorders such as hypothyroidism, adrenal insufficiency or hypopituitarism should be considered as unusual causes for reversible cardiomyopathy, long QT syndrome and ventricular arrhythmias.


Subject(s)
Adenoma/complications , Hypopituitarism/complications , Long QT Syndrome/etiology , Pituitary Neoplasms/complications , Tachycardia, Ventricular/etiology , Electrocardiography , Female , Humans , Long QT Syndrome/diagnosis , Magnetic Resonance Imaging , Middle Aged , Tachycardia, Ventricular/diagnosis
2.
Rev. méd. Chile ; 145(7): 941-944, jul. 2017. graf
Article in Spanish | LILACS | ID: biblio-902567

ABSTRACT

Symptoms of hypopituitarism are usually chronic and nonspecific, but rarely the disease can have acute and life threatening manifestations. We report a 53 years old female with a pituitary adenoma that was admitted to our hospital because of syncope. The electrocardiogram showed sinus bradycardia with a prolonged QT interval. Frequent runs of non-sustained polymorphic ventricular tachycardia were noted on telemetry. The patient had a history of severe acute headaches in the previous days and laboratory tests revealed severe secondary hypothyroidism, adrenal insufficiency and a decrease in pituitary hormones. A magnetic resonance imaging of the head showed changes in the size and contrast enhancement of the adenoma. A diagnosis of hypopituitarism secondary to pituitary apoplexy was made and treatment with hydrocortisone and, subsequently, levothyroxine was started. Hormonal disorders such as hypothyroidism, adrenal insufficiency or hypopituitarism should be considered as unusual causes for reversible cardiomyopathy, long QT syndrome and ventricular arrhythmias.


Subject(s)
Humans , Female , Middle Aged , Pituitary Neoplasms/complications , Long QT Syndrome/etiology , Adenoma/complications , Tachycardia, Ventricular/etiology , Hypopituitarism/complications , Long QT Syndrome/diagnosis , Magnetic Resonance Imaging , Tachycardia, Ventricular/diagnosis , Electrocardiography
5.
Med Clin (Barc) ; 119(11): 401-4, 2002 Oct 05.
Article in Spanish | MEDLINE | ID: mdl-12381272

ABSTRACT

BACKGROUND: White coat hypertension (WCH) is a prevalent clinical situation which requires a therapeutic management different from persistent hypertension (PH). To distinguish between patients with WCH and uncertain hypertension from patients with PH, an ambulatory blood pressure monitoring (ABPM) is usually indicated, yet it is not available in primary care. Thereby, predictors of WCH on the basis of pre-test (pre-ABPM) clinical characteristics have been suggested. However, little is known about the predictors of PH. The aim of this study was to ascertain predictors of PH in patients referred from the primary care due to suspicion of WCH or uncertain hypertension. PATIENTS AND METHOD: A 24-hours ABPM was performed in 230 consecutive patients referred from primary care because of suspicion of WCH or uncertain hypertension. WCH was defined as an increased office BP with a mean daytime BP, as measured by ABPM, < 135/85 mmHg. Uncertain hypertension was diagnosed when patients had had episodic (2 or more) office BP >140 and/or 90 mmHg together with normal BP determinations. Patients with increased office BP with a mean daytime BP [by ABPM]3 135/85 mmHg were considered as having PH. RESULTS: In 178 patients, ABPM was successful. Eighty-six patients (48.3%) had PH and the remainder (92 patients; 51.7%) were considered as having WCH. In the PH group, there were more males (67.4% vs 43.5%; p < 0.001), patients were older (42.8 [11.8] years vs 35.7 [11.2] years), there were more smokers (39.5 vs 26.1%; p = 0.056), they consumed more alcohol (p = 0.001) and coffee (p < 0.001) and they had higher levels of hemoglobin (p = 0.001) and creatinine (p = 0.003) and lower levels of uric acid (p<0.001) than the WCH group. Also they had an office BP and an ambulatory BP higher than WCH patients. A multivariate logistic regression analysis revealed that PH was significantly associated with a male gender (odds ratio [OR] = 3.26; confidence interval [CI]: 1.54-6.88; p = 0.001), office systolic BP > 145 mmHg (OR = 6.53; CI, 2.67-16.11; p < 0.001), age (> 35 years) (OR = 5.03; CI, 2.35-10.78; p < 0.001) and smoking (OR = 3.07; CI, 1.38-6.84; p = 0.005). CONCLUSIONS: Our findings indicate that in patients referred from primary care due to suspicion of WCH or uncertain hypertension, the prevalence of PH was 48.3%. PH was more frequent among men older than 35 years, smokers and those with an ambulatory systolic BP > 145 mmHg.


Subject(s)
Hypertension/diagnosis , Adolescent , Adult , Aged , Blood Pressure Monitoring, Ambulatory , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Predictive Value of Tests , Prevalence , Primary Health Care , Prospective Studies , Regression Analysis , Risk Factors , Severity of Illness Index , Smoking/epidemiology
6.
Med. clín (Ed. impr.) ; 119(11): 401-404, oct. 2002.
Article in Es | IBECS | ID: ibc-14946

ABSTRACT

FUNDAMENTO: La hipertensión de bata blanca (HBB) es una situación clínica prevalente que requiere un abordaje terapéutico distinto del de la hipertensión arterial mantenida (HTAm). La monitorización ambulatoria de la presión arterial (MAPA) está indicada para distinguir entre pacientes con HBB e hipertensión dudosa de los pacientes con HTAm. Sin embargo, esta técnica no está disponible en atención primaria (AP). Por esa razón, se han propuesto ciertos factores predictivos de HBB sobre la base de determinadas características clínicas previas a la MAPA. Menos conocidos son los factores predictivos de la HTAm. El objetivo de este estudio fue establecer factores predictivos de HTAm en pacientes derivados desde AP por sospecha de HBB o HTA dudosa. PACIENTES Y MÉTODO: Se realizó de forma consecutiva una MAPA a 230 pacientes derivados de AP por dudas diagnósticas de HBB e HTA dudosa. HBB se definió como una presión arterial (PA) elevada en consulta, pero con una cifra media diurna determinada mediante MAPA inferior a 130/85 mmHg. Se diagnosticó hipertensión dudosa cuando los pacientes habían tenido PA episódicas (dos o más) en consulta de más de 140/90 intercaladas con determinaciones normales de PA. Los pacientes con una PA elevada en consulta corroborada mediante MAPA (con PA media diurna igual o superior a 135/85 mmHg) fueron considerados HTAm. RESULTADOS: La MAPA fue correcta en 178 pacientes. Ochenta y seis (48,3 por ciento) tenían HTAm y el resto (92 pacientes; 51,7 por ciento) fue diagnosticado de HBB. En el grupo de pacientes con HTAm había más varones (67,4 frente al 43,5 por ciento; p < 0,001), los pacientes eran mayores (42,8 [11,8] frente a 35,7 [11,2] años), había más fumadores (39,5 frente al 26,1 por ciento; p = 0,056), bebían más alcohol (p = 0,001) y café (p < 0,001) y presentaban concentraciones de hemoglobina (p = 0,001) y creatinina (p = 0,003) más altas y de ácido úrico más bajas que el grupo de HBB. También tenían una PA, tanto de consulta como la registrada mediante MAPA, más alta que los pacientes con HBB. Un análisis de regresión logística multivariante encontró que la HTAm estaba asociada significativamente con el sexo masculino (odds ratio [OR] = 3,26; intervalo de confianza [IC], 1,54-6,88; p = 0,001), con una PA sistólica tomada en la consulta superior a 145 mmHg (OR = 6,53; IC, 2,67-16,11; p < 0,001), con la edad superior a 35 años (OR = 5,03; IC, 2,35-10,78; p < 0,001) y con el consumo de tabaco (OR = 3,07; IC, 1,38-6,84; p = 0,005). CONCLUSIONES: Nuestros hallazgos indican que en los pacientes derivados desde AP por sospecha de HBB o HTA dudosa, la prevalencia de HTAm es del 48,3 por ciento. La HTAm fue más frecuente en varones mayores de 35 años, fumadores y con una PA sistólica tomada en consulta de más de 145 mmHg. (AU)


Subject(s)
Middle Aged , Adult , Adolescent , Aged , Male , Female , Humans , Risk Factors , Tobacco Use Disorder , Helicobacter pylori , Prevalence , Helicobacter Infections , Blood Pressure Monitoring, Ambulatory , Primary Health Care , Prospective Studies , Regression Analysis , Antigens, Bacterial , Hypertension , Feces , Helicobacter Infections , Severity of Illness Index , Predictive Value of Tests
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