Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Medication

You are looking at 1 - 3 of 3 items for :

  • Beta-blockers x
Clear All
Hui Yi Ng Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia

Search for other papers by Hui Yi Ng in
Google Scholar
PubMed Close
,
Divya Namboodiri Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia

Search for other papers by Divya Namboodiri in
Google Scholar
PubMed Close
,
Diana Learoyd University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Reserve Road St Leonards, New South Wales, Australia

Search for other papers by Diana Learoyd in
Google Scholar
PubMed Close
,
Andrew Davidson Department of Neurosurgery, Level 2, Macquarie University, 2 Technology Place Macquarie University, New South Wales, Australia

Search for other papers by Andrew Davidson in
Google Scholar
PubMed Close
,
Bernard Champion Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia

Search for other papers by Bernard Champion in
Google Scholar
PubMed Close
, and
Veronica Preda Department of Clinical Medicine, Level 4, Macquarie University, 2 Technology Place, Macquarie University, New South Wales, Australia

Search for other papers by Veronica Preda in
Google Scholar
PubMed Close

Summary

Co-secreting thyrotropin/growth hormone (GH) pituitary adenomas are rare; their clinical presentation and long-term management are challenging. There is also a paucity of long-term data. Due to the cell of origin, these can behave as aggressive tumours. We report a case of a pituitary plurihormonal pit-1-derived macroadenoma, with overt clinical hyperthyroidism and minimal GH excess symptoms. The diagnosis was confirmed by pathology showing elevated thyroid and GH axes with failure of physiological GH suppression, elevated pituitary glycoprotein hormone alpha subunit (αGSU) and macroadenoma on imaging. Pre-operatively the patient was rendered euthyroid with carbimazole and underwent successful transphenoidal adenomectomy (TSA) with surgical cure. Histopathology displayed an elevated Ki-67 of 5.2%, necessitating long-term follow-up.

Learning points:

  • Thyrotropinomas are rare and likely under-diagnosed due to under-recognition of secondary hyperthyroidism.

  • Thyrotropinomas and other plurihormonal pit-1-derived adenomas are more aggressive adenomas according to WHO guidelines.

  • Co-secretion occurs in 30% of thyrotropinomas, requiring diligent investigation and long-term follow-up of complications.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, GH, IGF1, Prolactin, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Acromegaly, Goitre (multinodular), Hyperthyroidism, Hypogonadism, Pituitary adenoma, Plurihormonal pituitary adenoma, Thyrotrophic adenoma, Patient Demographics, Age, Adult, Gender, Male, Ethnicity, White, Country of Treatment, Australia, Diagnosis and Treatment, Signs and Symptoms, Anxiety, Dizziness, Goitre, Headache, Heat intolerance, Hypertension, Hyperthyroidism, Hypogonadism, Insomnia, Osteopenia, Palpitations, Tachycardia, Ventricular hypertrophy, Investigation, Angiography, Blood pressure, BMI, Bone mineral density, DEXA scan, Echocardiogram, FT3, FT4, GH, GH suppression, Haematoxylin and eosin staining, Heart rate, Histopathology, IGF1, Immunostaining, MRI, Pituitary function, Sex hormone binding globulin, SHBG, Thyroid function, Thyroid ultrasonography, TRH stimulation, Triiodothyronine (T3) suppression, TSH, Intervention, Resection of tumour, Transsphenoidal surgery, Medication, Aspirin, Beta-blockers, Carbimazole, Metoprolol, Statins, Related Disciplines, Surgery, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-19-0068
Volume/Issue:
Volume 2019: Issue 1
Open access
Varalaxmi Bhavani Nannaka Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, New York, USA

Search for other papers by Varalaxmi Bhavani Nannaka in
Google Scholar
PubMed Close
and
Dmitry Lvovsky Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, New York, USA

Search for other papers by Dmitry Lvovsky in
Google Scholar
PubMed Close

Summary

Angina pectoris in pregnancy is unusual and Prinzmetal’s angina is much rarer. It accounts for 2% of all cases of angina. It is caused by vasospasm, but the mechanism of spasm is unknown but has been linked with hyperthyroidism in some studies. Patients with thyrotoxicosis-induced acute myocardial infarction are unusual and almost all reported cases have been associated with Graves’ disease. Human chorionic gonadotropin hormone-induced hyperthyroidism occurs in about 1.4% of pregnant women, mostly when hCG levels are above 70–80 000 IU/L. Gestational transient thyrotoxicosis is transient and generally resolves spontaneously in the latter half of pregnancy, and specific antithyroid treatment is not required. Treatment with calcium channel blockers or nitrates reduces spasm in most of these patients. Overall, the prognosis for hyperthyroidism-associated coronary vasospasm is good. We describe a very rare case of an acute myocardial infarction in a 27-year-old female, at 9 weeks of gestation due to right coronary artery spasm secondary to gestational hyperthyroidism with free thyroxine of 7.7 ng/dL and TSH <0.07 IU/L.

Learning points:

  • AMI and cardiac arrest due to GTT despite optimal medical therapy is extremely rare.

  • Gestational hyperthyroidism should be considered in pregnant patients presenting with ACS-like symptoms especially in the setting of hyperemesis gravidarum.

  • Our case highlights the need for increased awareness of general medical community that GTT can lead to significant cardiac events. Novel methods of controlling GTT as well as medical interventions like ICD need further study.

Taxonomy:
Clinical Overview, Gland/Organ, Thyroid, Topic, Thyroid, Hormone, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Myocardial infarction, Thyrotoxicosis, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, Hispanic or Latino - Central American or South American, Country of Treatment, United States, Diagnosis and Treatment, Signs and Symptoms, Chest pain, Hyperthyroidism, Hypokalaemia, Hyponatraemia, Metabolic alkalosis, Myasthaenia, Myocardial infarction, Nausea, Tachycardia, Ventricular fibrillation, Vomiting, Investigation, Angiography, Bicarbonate, CT scan, Electrocardiogram, FT3, Liver function, Potassium, Sodium, Total T3, Total T4, Troponin, TSH, Intervention, Intra-cardiac defibrillator, Termination of pregnancy, Medication, Aspirin, Beta-blockers, Heparin, Statins, Related Disciplines, Cardiology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-16-0063
Volume/Issue:
Volume 2016: Issue 1
Open access
M S Draman Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

Search for other papers by M S Draman in
Google Scholar
PubMed Close
,
H Thabit Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

Search for other papers by H Thabit in
Google Scholar
PubMed Close
,
T J Kiernan Department of Cardiology, University of Limerick, Limerick, Ireland

Search for other papers by T J Kiernan in
Google Scholar
PubMed Close
,
J O'Neill Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

Search for other papers by J O'Neill in
Google Scholar
PubMed Close
,
S Sreenan Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

Search for other papers by S Sreenan in
Google Scholar
PubMed Close
, and
J H McDermott Department of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15

Search for other papers by J H McDermott in
Google Scholar
PubMed Close

Summary

Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points

  • Silent myocardial ischaemia (SMI) is an important clinical entity.

  • SMI is common and occurs with increased frequency in patients with diabetes.

  • SMI is an independent predictor of mortality.

  • Recognition may lead to early intervention.

Taxonomy:
Clinical Overview, Gland/Organ, Heart, Topic, Diabetes, Hormone, Insulin, Condition/ Syndrome, Diabetes mellitus type 2, Patient Demographics, Age, Adolescent/young adult, Gender, Male, Ethnicity, White, Country of Treatment, Ireland, Diagnosis and Treatment, Signs and Symptoms, Autonomic neuropathy, Myocardial infarction, Investigation, Angiography, Creatine kinase, Creatinine (serum), Electrocardiogram, Troponin, Medication, Aspirin, Beta-blockers, Clopidogrel, Related Disciplines, Cardiology, General practice, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-13-0058
Volume/Issue:
Volume 2013: Issue 1
Open access