RESUMO
Pituitary adenomas are one of the most common intracranial tumors. Non-functioning macroadenomas are usually diagnosed when they cause symptoms due to the mass effect on surrounding structures. We present the case of a 48-year-old man who presented with a headache associated with ptosis of the right eye and right-sided blurry vision for three days. Initial computerized tomography (CT) scan of the head did not report a mass, acute infarct, or hemorrhage. He was given 325mg of aspirin for concern of a stroke while waiting for magnetic resonance imaging (MRI) of the brain, which was done the next day and revealed a pituitary macroadenoma with hemorrhage, mass effect, and compression of the optic chiasm consistent with pituitary apoplexy. He ultimately underwent trans-sphenoidal resection of the tumor; however, his surgery was delayed for five days as he had received a high dose of aspirin in the Emergency Room. His adrenocorticotropic hormone (ACTH), cortisol, and testosterone levels were found to be quite low. He was administered stress dose steroids peri-operatively and ultimately discharged on indefinite hydrocortisone therapy and endocrinology follow-up. Our case highlights a serious complication of pituitary adenomas that can occur called pituitary apoplexy which is caused by acute ischemic infarction or hemorrhage in the pituitary. It needs prompt identification and management. Our case also emphasizes the importance of recognizing pituitary apoplexy as one of the causes of sudden onset cranial nerve deficits, as it is a rare presentation of pituitary adenomas that can be taken for a stroke in the Emergency Department.
RESUMO
Bilateral adrenal hemorrhage is an extremely uncommon and life-threatening condition. It is caused by multiple etiologies, including antiphospholipid syndrome, disseminated histoplasmosis, trauma, severe stress, and granulomatous disease. The authors present a unique case of a 64-year-old alcoholic male, who was admitted after fall and right hip fracture. On day seven of admission, the patient started to develop hypotension, leukocytosis, and tachycardia. CT abdomen was done, which ruled out infectious causes, however, it showed bilateral adrenal hemorrhages. Patient adrenocorticotrophic hormone (ACTH) stimulation test was positive for adrenal insufficiency and was started on hydrocortisone replacement. Our case highlights the fact that adrenal insufficiency after bilateral adrenal hemorrhage can be slow and can manifest as late as seven days and prompt therapy with steroids is warranted to avoid life-threatening adrenal insufficiency.
RESUMO
INTRODUCTION: This systematic review aims to evaluate the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients undergoing right ventricular pacing. AREAS COVERED: A literature review was conducted using MeSH terms (Right ventricular pacing, Pacemaker-related cardiomyopathy, Pacemaker-induced cardiomyopathy) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library until October 2021. All data reporting the incidence of PICM after implantation of right-sided pacemakers or implantable cardioverter-defibrillator (ICD) were retrieved from the eligible studies. EXPERT OPINION: Out of 3,625 articles, 20 studies met the inclusion criteria that included 5,381 patients. . The mean age of the patients ranged between 55.8 ± 13.5 and 77.4 ± 10.8 years. The mean incidence of PICM was 25.7%. Mean ejection fraction (EF) at baseline ranged from 48 ± 1% and 62.1 ± 11.2%, while mean EF at follow-up ranged between 33.7 ± 7.4% and 53.2 ± 8.2%. Three studies reported a decline of >20% EF at follow-up. RV pacing was associated with a considerable risk of PICM, with biological factors, such as male gender, old age, increased QRS duration, and chronic RV pacing burden playing an important role in the development of disease.
