- |||||||||| hydrocortisone / Generic mfg.
Clinical: Pulsatile Subcutaneous Hydrocortisone Replacement in Primary Adrenal Insufficiency. (Pubmed Central) - May 13, 2023
It was superior to both continuous pump and oral therapy in maintaining normal ACTH levels throughout the 24-hours cycle. Our results demonstrate a low free cortisol bioavailability on thrice daily oral replacement therapy compared to both types of subcutaneous infusion.
- |||||||||| hydrocortisone / Generic mfg.
Journal: The Timing of Initiating Hydrocortisone and Long-term Mortality in Septic Shock. (Pubmed Central) - May 12, 2023
Lack of knowledge about the disease and delays in diagnosis and treatment may pose risks of life-threatening asphyxia, suffering due to unpredictable symptoms and major impairment in quality of life of these patients. In patients with septic shock, initiating hydrocortisone >12 hours after vasopressor use was associated with an increased risk of both short-term and long-term mortality, and a prolonged length of hospital stay.
- |||||||||| hydrocortisone / Generic mfg.
Journal: Inhibitory Effect of Jinkui Shenqi Pills on Glucocorticoid-Enhanced Axial Length Elongation in Experimentally Myopic Guinea Pigs. (Pubmed Central) - May 12, 2023
In patients with septic shock, initiating hydrocortisone >12 hours after vasopressor use was associated with an increased risk of both short-term and long-term mortality, and a prolonged length of hospital stay. JKSQP exhibited a significant inhibitory effect on axial length elongation with decreased expression of AREG in the retina, and normalized 4 HPAA-associated plasma hormones and the expression of cAMP and cGMP in GC-enhanced myopic guinea pigs.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
High degree AV block and Sinus arrest: cardiovascular manifestations of Myxedema Coma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2497;
Few cases of sinus or cardiac arrest associated to Myxedema coma have been reported in the literature. In this case, the patient developed high-degree AV block with concomitant sinus arrest despite prompt initiation of intravenous thyroid hormone.
- |||||||||| Repatha (evolocumab) / Amgen, Astellas
Repatha Induced Thyroid Storm (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2167;
By day 9 of therapy, patient was transitioned to methimazole 30mg daily with discontinuation of hydrocortisone and cholestyramine...PCSK9 inhibitor therapy immunological influence on thyroid remains unknown. This case shows the importance of thyroid function test follow up in patients on PCSK9 inhibitor therapy and the possibility of immunological influence on the thyroid.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Not JUST Severe Hypothyroidism: Recognizing Autoimmune Polyglandular Syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2159;
The 3 classic patterns are: Type 1 (most common): younger women, presents with candidiasis, hypoparathyroidism, and Addison's disease. Type 2: middle-aged women, Addison's disease, autoimmune thyroid disease and/or Type 1 diabetes.
- |||||||||| amiodarone / Generic mfg.
Myxedema Coma with an Unusual Pattern of Thyroid Function Tests due to Amiodarone-induced Hypothyroidism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2113;
We conclude that in patients treated with amiodarone, myxedema coma can still occur even if T4 levels are normal or elevated, likely due to decreased T4 to T3 conversion. In these cases, elevated TSH and a clinical picture consistent with severe hypothyroidism are more reliable indicators if the (free) T4 levels are unexpectedly elevated.
- |||||||||| Recognition and Treatment of Myxedema Coma in a Patient with Biochemical Subclinical Hypothyroidism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2109;
Use of the Myxedema Coma Score to confirm diagnosis of myxedema coma in this patient with clinical signs of myxedema coma but with biochemical subclinical hypothyroidism led to early treatment initiation and resolution of patient's symptoms. The case highlights the importance of prompt recognition of symptoms and treatment of myxedema coma despite discordant thyroid function tests.
- |||||||||| diltiazem / Generic mfg., hydrocortisone / Generic mfg., propranolol / Generic mfg.
Thyroid Storm and Recurrent Myopericarditis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2107;
Our patient's cardiac function improved rapidly after achieving euthyroidism by plasmapheresis. The treatment of hyperthyroidism is critical in preventing the recurrence of myopericarditis.
- |||||||||| hydrocortisone / Generic mfg.
Serum Androstenedione as an Additive Biomarker in Ectopic Cushing's Syndrome Evaluation (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2055;
This steroidogenic profile has been reported in other ECS cases and attributed to differential effects of ectopic ACTH production on adrenal androgen biosynthesis (1). Although ECS is rare and the primary lesion can be difficult to identify, disproportionate elevation in androstenedione may prompt recognition of ECS and support early detection and management.REFERENCE: (1) Barbetta L, Dall'Asta C, Re T, Colombo P, Travaglini P, Ambrosi B. Androgen secretion in ectopic ACTH syndrome and in Cushing's disease: modifications before and after surgery.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Hyperthyroidism and Acromegaly in a Patient with a Mature Plurihormonal PIT1 Lineage PitNET/adenoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2054;
Discharge medications were hydrocortisone 10 mg AM and, 5 mg early afternoon and levothyroxine 50 mcg daily. This case demonstrates the potential for PitNETs to secrete multiple biologically active pituitary hormones, including prolactin, TSH and GH, highlighting the importance of maintaining an index of suspicion for pituitary causes in the evaluation of thyrotoxicosis and of considering the plurihormonal potential of PitNETs in patients presenting with multiple endocrinopathies.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
A Rare Cause Of SIADH: Leptomeningeal Deposits Metastatic From T-cell Proliferative Disorder (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2042;
Although the biopsies have been inclusive, if the patient has Non-Hodgkin's T cell lymphoma (NHL), leptomeningeal spread is a known complication of this disorder. The underlying mechanism that we propose behind SIADH in our patient is the leptomeningeal lesion located near the hypothalamus enhancing ADH release.
- |||||||||| cabergoline / Generic mfg., hydrocortisone / Generic mfg., desmopressin / Generic mfg.
Diabetes Insipidus - pituitary apoplexy or placental vasopressinase? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2037;
Apoplexy in pregnancy is very rare, occurring only in 1 in 10,000 gestations. The clinical presentation in this case suggests a low threshold to order pituitary imaging in cases presenting with concerning sign symptoms of increase intracranial pressure.
- |||||||||| Atypical Timing: Transient Diabetes Insipidus After Pituitary Apoplexy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2033;
Diagnosis of DI was suspected, but he refused water deprivation test or DDAVP therapy...When seen, it has been related to glucocorticoid use. This is an example of an atypical pituitary disorder requiring prompt recognition to prevent further complications.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
Is it Possible to Have Two Endocrinopathies from Checkpoint Inhibitor Therapy at the Same Time? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2030;
Introduction: Checkpoint inhibitor (CPI) therapy with ipilimumab and nivolumab has become commonly used in patients with metastatic melanoma...She was started on stress dose hydrocortisone which was weaned to a PO maintenance dose prior to discharge...Our case demonstrates that it is possible for multiple endocrinopathies to present simultaneously in the setting of CPI therapy and that delay in diagnosis can precipitate adrenal crises. Given the frequency with which endocrinopathies can occur with CPI therapy, appropriate screening and follow-up are recommended in order to provide prompt diagnosis and management of these patients.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
A Case of Pituitary Apoplexy in Late Pregnancy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2027;
Post-operative adverse events are not uncommon due to the high risk nature of these pregnancies. After surgery, most patients should experience some degree of vision improvement but many will continue to need hormone replacement.
- |||||||||| hydrocortisone / Generic mfg.
Late Surgical Management for Symptom Control in a Patient with History of Pituitary Apoplexy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2026;
In the recent past, conservative approaches have become more common in patients who are stable with little or no visual defects. The neurosurgical approach is usually reserved for patients with deteriorating mentation or worsening visual changes, but it can be used in patients with persistent severe symptoms.
- |||||||||| Opdivo (nivolumab) / Ono Pharma, BMS, Yervoy (ipilimumab) / Ono Pharma, BMS
Check Point Inhibitor Induced Hypophysitis/Hypopituitarism (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2023;
These agents can cause immune-mediated pituitary lesions( hypopituitarism/hypothyroidism). These drugs can cause a spectrum of issues ranging from single hormone deficiency to pan-hypopituitarism.
- |||||||||| Lymphocytic Hypophysitis Presenting as Hypoprolactinemia in a Post-Partum Female (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2018;
Twelve months following her initial diagnosis, the patient did not demonstrate normalization of anterior pituitary function and required ongoing treatment for hypopituitarism. While hypoprolactinemia is atypical of hypophysitis, it is imperative to consider alternative pituitary pathology such as lymphocytic hypophysitis in the post-partum female when the clinical history is suspicious.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Pituitary stalk interruption syndrome presenting as short stature: A case report (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2016;
Signs and symptoms may not be evident in the neonatal and infancy period, therefore diagnosis is often delayed. Early diagnosis and treatment are crucial for preventing adverse effects of long-term hormonal deficiencies and improving the quality of life.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
Clinical Implications Due to Long-term Delayed Diagnosis of Macroprolactinemia (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2003;
This will not only help to avoid unnecessary testing and costs but will protect the psychological and emotional well-being of the patient. Our case serves as a good example of the benefit that could have been derived from early testing for macroprolactinemia.
- |||||||||| leuprolide acetate for depot suspension / Generic mfg., hydrocortisone / Generic mfg., bicalutamide / Generic mfg.
GnRH agonist Induced Pituitary Apoplexy in a patient with Gonadotropinoma. (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_2001;
A week prior to starting Lupron therapy he was started on bicalutamide therapy...Hydrocortisone was tapered and stopped 6 weeks after transsphenoidal surgery...The majority of pituitary apoplexy develops in patients with previous undiagnosed pituitary adenomas. Should patients get central imaging to screen for pituitary macroadenoma before Lupron treatments to prevent this potentially life-threatening complication?
- |||||||||| hydrocortisone / Generic mfg.
Functional Gonadotrophin secreting adenoma with elevated testosterone- A rare entity (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1999;
We present a rare case of gonadotroph PitNet with elevated testosterone levels not associated with a recognizable clinical syndrome of sex hormone excess. The standard therapy for gonadotropin-secreting macroadenomas is trans-sphenoidal surgery.2-3 Early diagnosis is essential for timely and appropriate management.
- |||||||||| hydrocortisone / Generic mfg.
Two Cases of Familial Polyglandular Autoimmune Syndrome Type II Presenting with Adrenal Insufficiency Precipitated by SARS-CoV-2 Infection (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1994;
Patient's sodium was repleted and she was tapered from stress-dose to physiologic steroid dosing and was discharged on hydrocortisone and fludrocortisone.About 6 months later, Patient 2, a 25-year-old male and the son of Patient 1 presented to the emergency department with complaint of a week of nausea and vomiting, and three months of generalized fatigue...This case was an interesting presentation where SARS-CoV-2 infection likely precipitated the symptoms and acute effects of adrenal insufficiency. Additionally, knowledge of the patient's family history resulted in rapid diagnosis and management of the patient's underlying pathophysiology.
- |||||||||| hydrocortisone / Generic mfg., escitalopram / Generic mfg.
Can Selective Serotonin Reuptake Inhibitors Unmask Underlying Polyglandular Autoimmune Syndrome Type II? (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1987;
Hyponatremia is one of the manifestations of adrenal insufficiency which can be inevitably missed or misdiagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) as both can manifest as euvolemic hyponatremia and inappropriate urinary Na concentration. This case demonstrates the importance of thorough investigation of underlying etiologies of patients with symptomatic hyponatremia who are also at risk SIADH secondary to SSRIs use.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
A Case of Cushing Syndrome and Hyperandrogenism Secondary to an Adrenal Cortical Oncocytoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1986;
They may or may not be functional, and in this case, the tumor secreted both androgens and cortisol. Although androgen-secreting tumors are frequently malignant, such as adrenocortical carcinomas, androgen-secreting oncocytomas are generally considered benign.
- |||||||||| hydrocortisone / Generic mfg.
The Clinical Impacts of Bi-allelic Germline Pathogenic Variant in TP53 in Two Patients With Li-Fraumeni Syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1981;
There is a previous case description in the literature of a patient with a homozygous p.R337H mutation in TP53 who developed ACC at an early age and he did not develop other neoplasms during 8 years of follow-up. These two cases draw your attention to the early age for the development of choroid plexus carcinoma and adrenocortical tumors as well as the published case by Giacomazzi et al.
- |||||||||| thyroxine / Generic mfg., hydrocortisone / Generic mfg.
Polyglandular Autoimmune Syndrome Type 2 Presenting with Severe Hyponatremia (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1980;
Oral hydrocortisone replacement therapy was started prior to discharge...Early diagnosis of AI is important prior to initiation of levothyroxine, as treatment of hypothyroidism may exacerbate AI...Timely diagnosis of associated AI requires high index of suspicion in such patients, particularly in patients with signs or symptoms which may overlap with hypothyroidism, such as hyponatremia in our patient. AI should be considered in any patient who presents with hyponatremia, even those who lack other classic features such as hypotension, hyperkalemia, and hypoglycemia.
- |||||||||| dexamethasone / Generic mfg., hydrocortisone / Generic mfg.
Unconventional Pre-Operative Management of Congenital Adrenal Hyperplasia (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1979;
Dexamethasone 0.25 mg was then added at bedtime and the patient was finally able to achieve restoration of menses, resolution of salt cravings and hormonal profile control with decreases in renin to 23.02 pg/mL, androstenedione to < 0.30 ng/mL, TT to 11 ng/dL and 17-OHprog to 3.15 ng/mL.Alternative treatment strategies are sometimes warranted to achieve control of CAH. In this patient with prominent androgen excess and amenorrhea who failed to meet goals on high doses of hydrocortisone and fludrocortisone, combination therapy with a small dose of long-acting glucocorticoid at bedtime achieved the desired goal.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD)
Concurrent Adrenal Insufficiency and Hyperthyroidism in a Breast Cancer Patient Treated With Pembrolizumab Therapy (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1978;
She was initiated on IV hydrocortisone...She was started on beta blockers and methimazole with the goal of optimizing her thyroid function prior to her elective mastectomy...Very few cases of Anti-PD1-induced thyroid dysfunction have been reported, however further testing in our patient confirmed hyperthyroidism from a toxic thyroid nodule. With the increasing popularity of these drugs, endocrinological complications are on the rise, and we as clinicians need to be vigilant and intervene at an early stage to prevent irreversible and fatal outcomes.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
A combination of Klinefelter syndrome and the classic form of congenital dysfunction of the adrenal cortex: clinical case (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1976;
Hormone replacement therapy with testosterone preparations was not prescribed until surgical treatment of neoplasm of the right testicle will be performed.Conclusion. We have demonstrated a combination of two endocrine pathologies and serious mistakes were made in the management of this patient that requires a multidisciplinary approach, which improves the prognosis and quality of life of these patients.
- |||||||||| Keytruda (pembrolizumab) / Merck (MSD), Lysodren (mitotane) / HRA Pharma
New Onset Heart Failure in a Patient with Rapidly Progressive Adrenocortical Carcinoma (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1974;
This is particularly important for patients with a relatively unremarkable history and new onset heart failure with dyspnea on exertion. In these cases, mitotane can be used for hypercortisolism associated with ACC.
- |||||||||| metformin / Generic mfg., hydrocortisone / Generic mfg., spironolactone / Generic mfg.
Case of Metabolic Resolution of Non-Classic Congenital Adrenal Hyperplasia Post Roux-En-Y Gastric Bypass (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1972;
Presently, GC therapy remains the only available treatment for CAH; however, long-term GC therapy has the potential for myriad possible complications and side effects. Our case presents elective bariatric surgery as a potential and unique treatment option for patients with classic or non-classic CAH who have associated morbid obesity.
- |||||||||| hydrocortisone / Generic mfg.
Primary Adrenal Insufficiency due to Coccidiomycosis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1961;
He was given high dose IVhydrocortisone which was tapered to PO Hydrocortisone 15mg QAMand 5mg QPM...The left adrenal gland was unremarkable on this scan.Alpha and beta blockade were instituted, and the patient underwent aright adrenalectomy.Pathology showed:Necrotizing granulomatous inflammation and coccidioides-likeorganisms on GMS stain.His coccidioides serum antibodies were positive.He was referred to infectious diseases and was started on fluconazole400mg daily. He is doing well.Clinical LessonsDisseminated coccidiomycosis is a rare cause of infectious adrenalitis,but it should remain on the differential diagnosis of primary adrenalinsufficiency, especially in endemic areas.
- |||||||||| hydrocortisone / Generic mfg., itraconazole / Generic mfg.
Primary Adrenal Insufficiency as Presenting Symptom of Disseminated Histoplasmosis and Cryptococcus Co-Infection in Immunocompetent Patient (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1960;
He is doing well.Clinical LessonsDisseminated coccidiomycosis is a rare cause of infectious adrenalitis,but it should remain on the differential diagnosis of primary adrenalinsufficiency, especially in endemic areas. She was subsequently started on Hydrocortisone and her shock resolved...She started treatment with Amphotericin B for 4 weeks followed by Itraconazole for maintenance therapy...Although autoimmune adrenalitis is the most common cause of primary adrenal insufficiency in the US, this case highlights the importance of evaluating for other potential causes such as infectious sources, which can be treated and potentially have adrenal recovery.
- |||||||||| Clinical course of late-onset adrenal insufficiency due to treatment of childhood acute lymphoblastic leukemia. (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1950;
Soon after starting hormonal replacement therapy with hydrocortisone, his general conditions improved...According to his medical records at the time, he underwent induction therapy with vincristine-prednisone in 1977, maintenance therapy with 6-mercaptopurine, and radiation therapy to the central nervous system of 25 Gy in 1983...This case highlights the importance of long-term follow-up of cancer survivors after irradiation and the delayed presentation of adrenal insufficiency. This is the first report of the subsequent treatment course of late-onset adrenal insufficiency that developed 30 years after irradiation for childhood central nervous system ALL.
- |||||||||| Metopirone (metyrapone) / HRA Pharma
Ectopic ACTH syndrome (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1948;
He required 4 antihypertensives, insulin, and metyrapone was initiated for hypercortisolism...He was started on hydrocortisone and fludrocortisone...She was started on ketoconazole and antihypertensives...Bilateral surgical adrenalectomy may be needed when symptoms are not controlled by medical management. Early and rapid control of Cushing's Syndrome is important to facilitate antineoplastic treatment of the underlying tumor.
- |||||||||| prednisone / Generic mfg., hydrocortisone / Generic mfg.
A Case of Pulmonary Embolism Presenting as Adrenal Crisis (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1946;
Hyponatremia can be seen among patients with PE, occurring at rates of 21 to 26%.1 In contrast, secondary adrenal insufficiency presents with euvolemic hyponatremia, and uncommonly hypoglycemia. Hyperkalemia is not typically seen.
- |||||||||| Mycobutin (rifabutin) / Pfizer, Lupin
Rifampin Induced Adrenal Insufficiency (ENDOExpo) - May 11, 2023 - Abstract #ENDO2023ENDO_1940;
The patient was discharged with stable vital signs on isoniazid 300 mg daily, ethambutol 800 mg daily, moxifloxacin 400 mg daily, and hydrocortisone 30 mg every 12 hours with plans to follow-up with the State Department of Health, internal medicine, and endocrinology.ConclusionMany drugs are known to cause adrenal insufficiency...Classically, adrenal insufficiency has been associated with infiltration of the adrenal glands or pituitary gland with Mycobacterium tuberculosis. This case, however, shows further clinical evidence of adrenal insufficiency caused by rifampin therapy and highlights the need for further research to be done to study this adverse effect.
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