ABSTRACT
Gastrointestinal (GI) bleeding, is the life threating presentation of many diseases in emergency room. Aortoenteric fistula (AEF) is one of the rare causes of GI bleeding that can be fatal if not diagnosed and treated promptly. We present a case of a86 years old hypertensive male with the history of fresh bleeding per rectum, dizziness, fatigability and palpitation for last 12 hours who came to the emergency room in January 2015 He was stabilized and resuscitated. On lab investigation and abdominal CT scan he was diagnosed as aortic aneurysm with AEF. The related pathology, diagnosis and management of the disorder has been discussed in this case report.
Subject(s)
Aorta, Abdominal/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/complications , Intestine, Small/diagnostic imaging , Vascular Fistula/complications , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Diagnosis, Differential , Gastrointestinal Hemorrhage/diagnosis , Humans , Intestinal Fistula/diagnosis , Male , Tomography, X-Ray Computed , Vascular Fistula/diagnosisABSTRACT
OBJECTIVE: To describe the etiology, functional status and short term outcome of patients with pituitary lesions (PL). METHODS: Brain or pituitary MRI reports of 3753 patients were analyzed for PL over the period of 2000 to 2007, done at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. MRIs with reported PL and all those ordered by Endocrinologists with or without pituitary abnormalities, were included in the analysis. This made a total of 338 (9%) MRI reports. PL were defined as pituitary tumors, cysts, haemorrhage, hypoplasia; and empty sella. Patients with these PL, were analyzed for symptoms, hormonal profile and short term outcome in the hospital retrospectively. RESULTS: In the analysis of 338 MRI reports, 23% had normal pituitary gland on MRI examination. Hypogonadotrophic hypogonadism was the commonest (38.5%) endocrine abnormality seen with normal pituitary MRI, followed by hypopituitarism (5.1%). Most common PL identified were macroadenoma (38.7%), empty sella (16.5%) and microadenoma (12.7%). Patients with macroadenoma had 58% of non-functional tumours while 19.1% had hypopituitrism, 17.6% had acromegaly and 17.5% had prolactinoma. Majority of these lesions were causing headache and visual symptoms (42.7%) and were treated with surgery (75.5%). Patients with microadenoma included 39.5% prolactinomas, 18.6% cushing disease, 14% acromegaly, 4.7% hypogonadotrophic hypogonadism and 2.3% hypopituitrism. Majority of these lesions were treated with drugs and 37.3% were treated with surgery. In empty sella patients, 32% patients had endocrine abnormalities among which 21.4% had hypopituitrism, 2% had hypogonadotrophic hypogonadism, and only 6% patients had normal endocrine workup. A significant number of patients (62.5%) never had endocrine hormonal checkup. CONCLUSION: Although PL are less common entities (9% in 3,753 reports) but they are associated with significant endocrinal abnormalities and need prompt treatment. Empty sella, which is not considered as a distinct abnormality, is also associated with significant endocrine deficiencies.
