Cushing’s syndrome due to an adrenocortical carcinoma

Abstract

Objective: A prospective regional survey was carried out to describe the current practice of temporary transvenous pacing in five hospitals in the Wessex region and identify factors that predispose to complications. Methods: Data were collected on patient characteristics, pacing indication and setting, operator grade, training, experience and supervision, venous access, procedure time, duration of pacing, complications, and eventual outcome. Results: A total of 144 procedures were performed on 111 patients (age 75 (12) I nsertion of a temporary transvenous pacemaker may be performed as an urgent procedure in the setting of acute haemodynamic collapse secondary to bradyarrhythmias or tachyarrhythmias, or as a prophylactic measure in high risk patients undergoing interventional procedures.1 The procedure may be performed in a wide range of settings, by operators with varying skills, training, technical knowledge, and experience. 3Previous studies have demonstrated high complication rates with little change over the last two decades.3-6 Studies performed in the UK were carried out before the introduction of the specialist registrar training grade. The present study was undertaken to determine whether the incidence of complications has changed with increasing physician numbers and a greater emphasis on subspecialty training. Operator and technical factors were also examined to identify current practices that may influence procedure outcome. METHODSBetween January and September 1999 a prospective study was performed at five hospitals in the Wessex region (four district general hospitals and the regional cardiothoracic centre). All temporary pacing procedures were performed after obtaining informed consent from the patient unless their condition or the urgency of the occasion necessitated immediate pacing. After each pacing procedure, a physician completed a form which documented demographic details, the indication for pacing, who performed and who supervised the procedure, plus operator experience and subspecialty. If more than one operator performed the procedure the most senior physician present was noted. Operator seniority in ascending order was house officer, senior house officer, registrar, specialist registrar, staff grade, and consultant. Experienced physicians were those who had performed at least 20 temporary pacing procedures, inexperienced physicians were those who had performed less than 20 procedures. Cardiologists/cardiology trainees were defined as those specialist registrars who were in a cardiology training programme, or consultants who had a specialist interest in cardiology. Procedure details, including venous access site, procedure duration, fluoroscopy time, sterile techniques, patient cooperation, and immediate outcomes and complications were noted. Ease of venous access was categorised into "first pass at a single venous site", "multiple stabs at a single venous site", and "multiple venous sites attempted".The form accompanied the patient throughout the duration of the temporary pacemaker per...

Cushing's Syndrome Caused by an Adrenocortical Carcinoma After a Bariatric Surgery: Case Report

“…Approximately 60% of adrenal carcinomas are functioning and 70% are manifested by Cushing syndrome, associated or not to virilization. Virilization and DHEA-S high levels are more associated to malign tumors 11 . In those tumors, the symptoms associated to the glucocorticoids excess develop fast (from 3 to 6 months) 2 .…”

“…Ki67 is the most powerful detector of the located or advanced disease and it can guide the treatment 1 . Adrenal carcinomas grow very fast and very often they present metastasis in the lungs and liver 11 . This patient's adrenalectomy did not show evidence of metastasis.…”