ABSTRACT
Hyponatremia is a common complication in patients undergoing neurosurgery. If undiagnosed, it has a negative prognostic impact. The two dominant causes of refractory hyponatremia include syndrome of inappropriate ADH secretion (SIADH) and cerebral salt wasting syndrome (CSWS). Discrimination between the two types of disease is not always obvious. We present a case of undiagnosed chronic hyponatremia caused by CSWS after neurosurgery, which not only resulted in a longer hospital stay but also slowed the patient's postoperative recovery. Meticulous clinical evaluation and the performance of appropriate laboratory tests are therefore essential not only for decisive treatment, but also for the establishment of comprehensive diagnostic algorithms that allow timely diagnosis and decisive therapy. LEARNING POINTS: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt-wasting syndrome (CSWS) are in general associated to refractory hyponatremia especially in patients with neurologic disorders.Extracellular fluid (ECF) assessment is the key to distinguish between SIADH and CSWS.Nevertheless, measurement of the ECF volume is not sufficient to determine the correct etiology and more established diagnostic algorithms are required.
ABSTRACT
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterised by skin rash together with visceral organ involvement, lymphadenopathy, eosinophilia and atypical lymphocytosis. The syndrome is clinically heterogeneous, making diagnosis challenging. It has an annual incidence of 2 per 100,000 population and a mortality rate of 2-10%. We describe the first case of DRESS induced by certolizumab, a biologic disease-modifying antirheumatic drug (bioDMARD). LEARNING POINTS: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is an uncommon and under-reported syndrome.Its recognition is critical for treatment, especially in the emergency setting where most patients first present.In the case of unexplained fever, lymphadenopathy, cutaneous rash and characteristic laboratory findings (e.g., eosinophilia), after infectious causes have been ruled out, clinicians should always keep DRESS in mind and consider possible recent intake of a triggering drug.
ABSTRACT
Adrenomedullin (AM) is a novel peptide, first isolated from human phaeochromocytoma, which elicits a long-lasting vasorelaxant activity. Recently, it has been reported that endothelial cells produce AM and that immunoreactive AM plasma levels may be elevated in human arterial hypertension, although the exact pathophysiological role of AM remains to be established. The aim of our study was to determine the relationship between the components of the enin-angiotensin-aldosterone system (RAAS) and plasma AM levels in patients with low-, medium- or high- renin essential hypertension. The study groups included 10 patients with low-renin essential hypertension (average age 42+15 years), nine patients with medium-renin essential hypertension (46+13 years), 11 patients with high-renin essential hypertension (42+14 years) and 12 healthy subjects (43+11 years). Our results demonstrated that the mean AM values of all patients with essential hypertension were 10.85+3.14 pg/ml; there was a statistical correlation (r=0.705; p<0.001) between plasma renin activity (PRA) and AM levels in hypertensives. In patients with high-renin essential hypertension, plasma AM levels (14.2+2.2 pg/ml) were significantly higher (p<0.001) than those of healthy subjects (8.7+2.1 pg/ml), patients with medium-renin essential hypertension (8.5+1.4 pg/ml), and patients with low-renin essential hypertension (9.1+1.5 pg/ml). There was no statistical difference in AM concentrations between medium- and low-renin hypertensive patients. In conclusion, we have found that, in hypertensive patients, plasma AM levels were increased only in high-renin individuals, suggesting a role of AM in this particular form of human essential hypertension.
