Carney complex: a rare cause of Cushing syndrome in pregnancy.

BACKGROUND: Carney complex is a rare, autosomal-dominant, multisystem disorder characterized by endocrine overactivity, spotty skin pigmentation, and myxomas. CASE: We present the case of a 24-year-old primigravid woman with a pregnancy complicated by Carney complex. At 18 weeks of gestation, severe hypertension developed. Medical history was significant for chronic hypertension, nephrolithiasis, and an atrial myxoma excised in 2011. She had Cushingoid features, an elevated 24-hour urine free cortisol, and a cutaneous myxoma. At 26 weeks of gestation, superimposed preeclampsia developed. She underwent a primary classical cesarean delivery, delivering a live female weighing 650 g. CONCLUSION: Carney complex is a rare cause of hypercortisolism and hypertension during pregnancy. It should be considered when features of Cushing syndrome and severe hypertension are present.

Predictors of physical functional disability at 5 to 6 years after heart transplantation.

BACKGROUND: Few reports were found in the literature that examined predictors of physical functional disability after heart transplantation. Therefore, the purpose of this study was to (1) describe physical functional disability, (2) identify differences in physical functional disability by demographic and clinical variables, and (3) identify predictors of physical functional disability at 5 to 6 years after heart transplantation. METHODS: A nonrandom sample of 311 patients (approximately 60 years of age, 78% male, and 90% Caucasian) who were 5 to 6 years post-heart transplantation were investigated. Patients completed 8 reliable and valid quality-of-life instruments via self-report. Data analyses included descriptive statistics, chi-square, independent t-tests, correlations, and stepwise multiple regression. Level of significance was set at p = 0.05. RESULTS: The level of physical functional disability was low at 5 to 6 years after heart transplantation, yet 59% of patients reported having physical disability. Women experienced more functional disability than men, and patients with comorbidities (i.e., diabetes mellitus and orthopedic problems) experienced more functional disability than patients without these comorbidities. At 5 to 6 years after heart transplantation, 70% of variance in physical functional disability was explained by activities of daily living, symptoms, comorbidities, psychologic status, and resource utilization variables. CONCLUSIONS: At 5 to 6 years after heart transplantation, most patients experienced low levels of physical functional disability. Differences in physical functional disability were identified by both demographic characteristics and clinical variables. Predictors of physical functional disability included activities of daily living and symptoms, and clinical, psychologic, and resource utilization variables. Knowledge of factors related to physical disability long-term after heart transplantation provides direction for the development of strategies to assist patients to reduce their level of disability or function adequately despite their disability.