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1.
JCEM Case Rep ; 1(1): luac026, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37908258

RESUMO

A 21-year-old female presented to the hospital with acute onset left pelvic pain that began while urinating. Ultrasound of the pelvis revealed a 1.7 cm structure within the bladder wall. Follow-up imaging with magnetic resonance imaging confirmed a 1.9 cm mass in the urinary bladder wall. Cystoscopy with transurethral resection was performed. Histopathology of the obtained tissue confirmed the diagnosis of paraganglioma. Laboratory evaluation revealed evidence of catecholamine excess with elevated urine norepinephrine, urine normetanephrine, and plasma free normetanephrine. Functional imaging with Ga-DOTATATE positron emission tomography-computed tomography (PET-CT) revealed increased uptake in the region of the known mass without findings of metastasis. Genetic testing revealed succinate dehydrogenase A mutation, consistent with paraganglioma syndrome 5. The patient was treated with alpha-adrenergic blockade prior to partial cystectomy. Urinary bladder paraganglioma is a rare entity. The diagnosis requires a high index of clinical suspicion due to variable presentation. Hypertension and other signs of catecholamine excess, especially in relation to micturition, are important clues. Despite evidence of catecholamine excess in most patients with bladder paraganglioma, the majority are diagnosed after biopsy, indicating a need for improved diagnostic strategies in this patient population. Early diagnosis and treatment are essential to prevent potentially lethal cardiac complications and tumor metastasis.

2.
Cureus ; 14(4): e24436, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35637822

RESUMO

Acromegaly is a rare condition characterized by excessive secretion of growth hormone from a pituitary tumor. It can affect multiple systems and can be fatal with cardiac dysfunction being the most common cause of death in these patients. Autonomic dysfunction is a less studied subject in patients with acromegaly, and the exact pathophysiology is still unclear. Here we present a case of a patient with persistent orthostatic hypotension, who was found to have acromegaly and pituitary adenoma upon further evaluation. Her orthostatic symptoms failed to improve with conservative measures and medical management, but unexpectedly resolved after transsphenoidal hypophysectomy was performed.

3.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563687

RESUMO

Pituitary apoplexy (PA) is an endocrine emergency presenting with headache, visual and hormonal disturbances. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare after PA. A 64-year-old woman presented with acute frontal headache and nausea with normal neurological examination. Labs included normal sodium and creatinine. Echo showed new-onset congestive heart failure (CHF) and MRI of the brain revealed PA. She had normal cortisol levels and low thyroid stimulating hormone with normal thyroxine (T4) levels. During her hospitalisation, patient developed hyponatraemia. Initially, this was attributed to CHF and she was treated with tolvaptan with normalisation of sodium. One week later, she was readmitted with diarrhoea and hyponatraemia. She was euvolaemic on examination indicating compensated CHF. Despite fluid challenge, patient had no improvement of sodium levels. The diagnosis of SIADH was made. Clinicians should suspect SIADH in patients with hyponatraemia in the setting of PA with normal T4 and cortisol levels.


Assuntos
Hiponatremia/diagnóstico , Síndrome de Secreção Inadequada de HAD/diagnóstico , Apoplexia Hipofisária/diagnóstico , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Humanos , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Apoplexia Hipofisária/terapia , Síndrome
4.
Heart Fail Clin ; 8(4): 513-22, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22999236

RESUMO

Glucose lowering should be approached by managing overall cardiovascular risk. Glycemic goals should be individualized based on duration of diabetes, preexisting cardiovascular disease, age, and life expectancy. Intensive glycemic control has consistently been shown to produce a substantial benefit for preventing long-term microvascular complications in both type 1 and type 2 diabetes mellitus. Although cardiovascular disease is the major cause of death in patients with diabetes, microvascular complications cause substantial morbidity and disability. Thus, it is apparent that additional strategies on multimodal treatment options are necessary to promote effective management and prevention of diabetic complications.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/patologia , Diabetes Mellitus Tipo 2/metabolismo , Resultado do Tratamento , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Complicações do Diabetes , Diabetes Mellitus Tipo 1 , Progressão da Doença , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia , Incidência , Fatores de Risco , Estados Unidos/epidemiologia
5.
J Diabetes Complications ; 26(6): 470-5, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22770941

RESUMO

OBJECTIVE: We compared the effect of the long acting basal insulin analog detemir with neutral protamine Hagedorn (NPH) insulin, and normal saline on recovery from vascular injury (balloon catheter mediated) in an animal model of insulin resistance. METHODS: Female Zucker fatty rats were administered NPH/detemir/saline for 7 days following which, they underwent balloon catheter mediated injury of left carotid artery, and were continued on the respective regimen for an additional 21 days when they were sacrificed. We evaluated the injured carotid artery for intimal hyperplasia (Intima/Media ratio) and also, aortic arch protein for markers of oxidative stress and inflammation, in addition to expression and phosphorylation of eNOS using well established methods. RESULTS: There was a significant difference in intimal hyperplasia (Intima/Media ratio) between control and detemir treated rats (1.3±0.09, 0.82±0.08; p<0.001) whereas the IM ratio in NPH treated rats was not significantly different from saline (1.17±0.1). Expression of p-eNOS (ser-1177) in both NPH and insulin detemir (1.3±0.15, 1.11±0.12) was significantly higher than controls (0.56±0.13; p<0.05). We did not find significant differences in the expression of MnSOD, eNOS and NFκB-p65. CONCLUSION: We conclude that in insulin resistant states, treatment with Insulin detemir but not NPH is associated with less intimal hyperplasia, although both insulins increased eNOS phosphorylation.


Assuntos
Artérias Carótidas/efeitos dos fármacos , Doenças das Artérias Carótidas/prevenção & controle , Angiopatias Diabéticas/prevenção & controle , Modelos Animais de Doenças , Hipoglicemiantes/uso terapêutico , Resistência à Insulina , Insulina de Ação Prolongada/uso terapêutico , Animais , Artérias Carótidas/imunologia , Artérias Carótidas/metabolismo , Artérias Carótidas/patologia , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/imunologia , Doenças das Artérias Carótidas/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/imunologia , Angiopatias Diabéticas/metabolismo , Angiopatias Diabéticas/patologia , Feminino , Hiperplasia , Insulina Detemir , Insulina Isófana/uso terapêutico , Óxido Nítrico Sintase Tipo III/metabolismo , Obesidade/complicações , Estresse Oxidativo/efeitos dos fármacos , Fosforilação/efeitos dos fármacos , Processamento de Proteína Pós-Traducional/efeitos dos fármacos , Ratos , Ratos Zucker , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/imunologia , Túnica Íntima/metabolismo , Túnica Íntima/patologia
6.
Expert Opin Drug Saf ; 10(2): 305-10, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21244342

RESUMO

INTRODUCTION: Patients with hypercholesterolemia and type 2 diabetes mellitus often require multiple medications to attain their LDL-C and A1C goals. Colesevelam, a bile acid sequestrant (BAS), which was FDA approved 10 years ago for the reduction of LDL-C in patients with dyslipidemia is also the only BAS that is approved for glycemic control in adults with type 2 diabetes to date. From both the physician and patient standpoint, safety and tolerability are the most important factors when considering initiating pharmacological therapy. Several randomized controlled studies have examined the safety, tolerability and efficacy of colesevelam over the last decade. AREAS COVERED: This manuscript focuses on the safety and tolerability based on the evaluation of data obtained from several human randomized controlled studies. In addition, the pharmacology, pharmacodynamics and key clinical efficacy data are reviewed using research articles accessed through MEDLINE/PubMed (2000 - 2010). EXPERT OPINION: Current data suggest that colesevelam is safe, well tolerated and offers the potential for improved adherence. Colesevelam is a valid option for long-term therapy for patients with hypercholesterolemia and type 2 diabetes. It can be used in combination with HMG-CoA reductase inhibitors for hypercholesterolemia, not controlled at their cholesterol goals with HMG-CoA reductase inhibitors, and should be considered in patients with type 2 diabetes mellitus with concomitant hypercholesterolemia to improve both risk factors.


Assuntos
Alilamina/análogos & derivados , Anticolesterolemiantes/efeitos adversos , Hipercolesterolemia/tratamento farmacológico , Adulto , Alilamina/administração & dosagem , Alilamina/efeitos adversos , Alilamina/uso terapêutico , Animais , Anticolesterolemiantes/administração & dosagem , Anticolesterolemiantes/uso terapêutico , Cloridrato de Colesevelam , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Quimioterapia Combinada , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto
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