Diagnosis and Treatment > Medication > Indapamide
You are looking at 1 - 4 of 4 items
Search for other papers by G Leksic in
Google Scholar
PubMed
Search for other papers by A M Alduk in
Google Scholar
PubMed
Search for other papers by V Molnar in
Google Scholar
PubMed
Search for other papers by A Haxhiu in
Google Scholar
PubMed
Search for other papers by A Balasko in
Google Scholar
PubMed
Search for other papers by N Knezevic in
Google Scholar
PubMed
Search for other papers by T Dusek in
Google Scholar
PubMed
Search for other papers by D Kastelan in
Google Scholar
PubMed
Summary
Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess.
Learning points:
-
CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH).
-
CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA).
-
AVS is the gold standard test for defining the PA subtype.
Search for other papers by Maria Mercedes Pineyro in
Google Scholar
PubMed
Search for other papers by Daiana Arrestia in
Google Scholar
PubMed
Search for other papers by Mariana Elhordoy in
Google Scholar
PubMed
Search for other papers by Ramiro Lima in
Google Scholar
PubMed
Search for other papers by Saul Wajskopf in
Google Scholar
PubMed
Search for other papers by Raul Pisabarro in
Google Scholar
PubMed
Search for other papers by Maria Pilar Serra in
Google Scholar
PubMed
Summary
Spontaneous reossification of the sellar floor after transsphenoidal surgery has been rarely reported. Strontium ranelate, a divalent strontium salt, has been shown to increase bone formation, increasing osteoblast activity. We describe an unusual case of a young patient with Cushing’s disease who was treated with strontium ranelate for low bone mass who experienced spontaneous sellar reossification after transsphenoidal surgery. A 21-year-old male presented with Cushing’s features. His past medical history included delayed puberty diagnosed at 16 years, treated with testosterone for 3 years without further work-up. He was diagnosed with Cushing’s disease initially treated with transsphenoidal surgery, which was not curative. The patient did not come to follow-up visits for more than 1 year. He was prescribed strontium ranelate 2 g orally once daily for low bone mass by an outside endocrinologist, which he received for more than 1 year. Two years after first surgery he was reevaluated and persisted with active Cushing’s disease. Magnetic resonance image revealed a left 4 mm hypointense mass, with sphenoid sinus occupation by a hyperintense material. At repeated transsphenoidal surgery, sellar bone had a very hard consistency; surgery was complicated and the patient died. Sellar reossification negatively impacted surgery outcomes in this patient. While this entity is possible after transsphenoidal surgery, it remains unclear whether strontium ranelate could have affected sellar ossification.
Learning points:
-
Delayed puberty can be a manifestation of Cushing’s syndrome. A complete history, physical examination and appropriate work-up should be performed before initiating any treatment.
-
Sellar reossification should always be taken into account when considering repeated transsphenoidal surgery. Detailed preoperative evaluation of bony structures by computed tomography ought to be performed in all cases of reoperation.
-
We speculate if strontium ranelate may have affected bone mineralization at the sellar floor. We strongly recommend that indications for prescribing this drug should be carefully followed.
Search for other papers by Ayanthi A Wijewardene in
Google Scholar
PubMed
Kolling Institute of Medical Research
Sydney Medical School, University of Sydney, Sydney, Australia
Search for other papers by Sarah J Glastras in
Google Scholar
PubMed
Sydney Medical School, University of Sydney, Sydney, Australia
Search for other papers by Diana L Learoyd in
Google Scholar
PubMed
Sydney Medical School, University of Sydney, Sydney, Australia
Search for other papers by Bruce G Robinson in
Google Scholar
PubMed
Sydney Medical School, University of Sydney, Sydney, Australia
Search for other papers by Venessa H M Tsang in
Google Scholar
PubMed
Summary
Medullary thyroid cancer (MTC) is a rare neuroendocrine tumour that originates from the parafollicular cells of the thyroid gland. The most common presentation of MTC is with a single nodule; however, by the time of diagnosis, most have spread to the surrounding cervical lymph nodes. Cushing’s syndrome is a rare complication of MTC and is due to ectopic adrenocorticotrophic hormone (ACTH) secretion by tumour cells. Cushing’s syndrome presents a challenging diagnostic and management issue in patients with MTC. Tyrosine kinase inhibitors (TKI) previously used for the management of metastatic MTC have become an important therapeutic option for the management of ectopic ACTH in metastatic MTC. The article describes three cases of ectopic ACTH secretion in MTC and addresses the significant diagnostic and management challenges related to Cushing’s syndrome in metastatic MTC.
Learning points:
-
Medullary thyroid cancer (MTC) is a rare neuroendocrine tumour.
-
Cushing’s syndrome is a rare complication of MTC that has a significant impact on patients’ morbidity and mortality.
-
Tyrosine kinase inhibitors (TKI) provide an important therapeutic option for the management of ectopic ACTH in metastatic MTC.
Search for other papers by Omayma Elshafie in
Google Scholar
PubMed
Search for other papers by Yahya Al Badaai in
Google Scholar
PubMed
Search for other papers by Khalifa Alwahaibi in
Google Scholar
PubMed
Search for other papers by Asim Qureshi in
Google Scholar
PubMed
Search for other papers by Samir Hussein in
Google Scholar
PubMed
Search for other papers by Faisal Al Azzri in
Google Scholar
PubMed
Search for other papers by Ali Almamari in
Google Scholar
PubMed
Search for other papers by Nicholas Woodhouse in
Google Scholar
PubMed
Summary
A 48-year-old hypertensive and diabetic patient presented with a 10-year history of progressive right facial pain, tinnitus, hearing loss, sweating, and palpitations. Investigations revealed a 5.6 cm vascular tumor at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20 mg od and amlodipine 10 mg od and 100 U of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP) was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE) level, 89 000 pmol/l, and chromogranin A (CgA) level, 279 μg/l. Meta-iodobenzylguanidine and octreotide scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100 μg 8 h, the NE level dropped progressively from 50 000 to 25 000 pmol/l and CgA from 279 to 25 μg/l. Treatment was therefore continued with labetalol 200 mg twice daily (bid) and long-acting octreotide-LA initially using 40 mg/month and later increasing to 80 mg/month. On this dose and with a reduced labetalol intake of 100 mg bid, BP was maintained at 130/70 and her symptoms resolved completely. CgA levels returned to normal in the first week and these were maintained throughout the 3 month treatment period. During tumor resection, there were minimal BP fluctuations during the 10 h procedure. We conclude that short-term high-dose octreotide-LA might prove valuable in the preoperative management of catecholamine-secreting tumors. To the best of our knowledge, this is the first report on the successful use of octreotide in a CSCBP.
Learning points
-
The value of octreotide scanning in the localization of extra-adrenal pheochromocytoma.
-
Control of catecholamine secretion using high-dose octreotide.
-
This is a report of a rare cause of secondary diabetes and hypertension.
