Objectives: Adrenal gland hypertrophy can be related to acute stress with abnormal adrenal function tests. It may not always need treatment. Material and methods: An acute presentation of adrenal gland hypertrophy following an abdominal emergency, with subsequent hypoadrenalism was investigated. Results: Adrenal medullary and cortical function fully recovered without treatment.
Conclusions:We postulate that the adrenal glands became enlarged and hypertrophied during an acute stress event, possibly caused by acute adrenal medullary hypersecretion and subsequent cortical hyposecretion. A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present. CT scan remains an important diagnostic tool.
LEARNING POINTS• Abnormal adrenocortical function tests and hypertrophy can occur in an acutely ill patient as a stress response.• It is possible to have both hypersecretion and hyposecretion of adrenal hormones.• A wait and watch policy should be followed if no other clinical symptoms and signs of adrenal disease are present in an acutely ill patient. KEYWORDS Adrenal gland hypertrophy, transient adrenal insufficiency, reversible adrenal dysfunction, transient adrenal medullary hyperactivity, stress related hypertension.
INTRODUCTIONThe adrenal medulla and cortex participate in the response to acute stress
Bilateral adrenal haemorrhage should be considered as a differential diagnosis in patients presenting with non-specific symptoms and hypotension postoperatively.
Abstract:Objectives: Primary adrenal insufficiency AI is regarded as a progressive disease needing lifelong replacement therapy, but this may not always be the case.
Material and methods:A non--acute presentation of AI following a hypotensive episode caused by blood loss was investigated.Results: Adrenal function fully recovered without treatment.
Conclusions: There should be a high index of suspicion and a low threshold for performing tests ofadrenal function in survivors of critical illness and severe hypotensive episodes.
A 75year old gentleman had an uncomplicated right total hip replacement for osteoarthritis and his warfarin for atrial fibrillation was restarted on the third post-operative day before discharge. A week later, he was admitted with watery diarrhoea and vomiting. On examination, he was clinically dehydrated, blood pressure 96/64mmHg and mild peri-umbilical tenderness. Laboratory tests revealed; sodium 130mmol/L (134-145), potassium 5.6mmol/L (3.5 -5.3), urea 14.8mmol/L (baseline 6) and creatinine 171umol/L (baseline 80). INR was 4.6.
A 76 year old gentleman not known to be diabetic presented with confusion and agitation. On admission he had a blood glucose reading of 2.1mmol/l and clinical examination confirmed an abdominal mass. He was initially resuscitated with intravenous dextrose but continued to experience hypoglycemic episodes. Urine sulphonylurea, serum insulin, pro-insulin and c-peptide levels tested at the time of hypoglycemia were satisfactory. There was no ketonaemia and the short synacthen test showed adequate response. His IGF 2 and IGF2:IGF1 ratio was elevated. An abdominal Ultrasound and CT scan were inconclusive as to the nature of the mass, so biopsy and histology were organized which confirmed a spindle cell neoplasm. To maintain euglycaemia, he had dietician input for complex carbohydrate meals and regular scheduled snacks, but as this failed to sustain his euglycaemia, he was then started on steroid therapy. He had a good response to the dexamethasone. Unfortunately, as curative therapy of the spindle cell tumor was not an option for him, he was referred for palliative follow-up.
Objectives: To highlight the occurrence of Hashimoto's encephalopathy -a steroid--responsive encephalopathy associated with elevated antithyroid antibodies.
Material and methods:We describe a clinically and biochemically euthyroid patient with an encephalopathy presenting with headache, mild confusion and personality changes for 6 weeks and tonic-clonic seizures upon admission
Results: There was no obvious infective or metabolic cause. The patient had a high titre of antithyroid antibodies andresponded to steroid therapy.
Conclusion:This uncommon disease needs to be considered in patients presenting with neurological symptoms that remain unexplained after routine standard investigations, even when the patient is euthyroid. Early diagnosis is important, as this is a treatable condition.
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