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Patient Demographics

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Ann-Elin Meling Stokland Department of Endocrinology, Stavanger University Hospital, Stavanger, Norway

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Anne Lise Dahle Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway

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Vidar Laurits Kloster Department of Radiology, Haugesund Hospital, Haugesund, Norway

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Torbjørn Nedrebø Department of Anaesthesia, Haraldsplass Deaconess Hospital, Bergen, Norway
Department of Clinical Science, University of Bergen, Bergen, Norway

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Bjørn Gunnar Nedrebø Department of Internal Medicine, Haugesund Hospital, Haugesund, Norway
Department of Clinical Science, University of Bergen, Bergen, Norway

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Summary

Myxedema coma is an important differential diagnosis in critically ill patients. Early diagnosis and treatment are paramount but challenging due to a lack of diagnostic criteria. We report a case about a patient who suffered from untreated hypothyroidism for several years. Before the correct diagnosis was made, he was admitted three times due to severe constipation. Eventually, he developed myxedema coma in connection with a urinary tract infection. The course was complicated by recurrent seizures, and neuroimaging showed bilateral hygromas. Hormone replacement therapy resulted in complete recovery and regression of hygromas. To the best of our knowledge, this is the first time hygroma is reported in association with myxedema coma.

Learning points

  • Myxedema coma is a difficult diagnosis to make due to a lack of diagnostic criteria.

  • Cardinal features include hypothermia, bradycardia, gastrointestinal symptoms, pericardial/pleural effusions and affection of CNS. Anemia and hyponatremia are common.

  • In case of suspected myxedema coma, neuroimaging should be a part of the evaluation in most cases.

  • There is a possible association between longstanding/severe hypothyroidism and hygroma.

Taxonomy:
Clinical Overview, Gland/Organ, Thyroid, Topic, Thyroid, Patient Demographics, Age, Geriatric, Gender, Male, Ethnicity, White, Country of Treatment, Norway, Related Disciplines, Neurology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-21-0067
Volume/Issue:
Volume 2021: Issue 1
Open access
Kaja Grønning Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway

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Archana Sharma Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway

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Maria Adele Mastroianni Department of Haematology, Akershus University Hospital, Lorenskog, Norway

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Bo Daniel Karlsson Department of Radiology, Akershus University Hospital, Lorenskog, Norway

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Eystein S Husebye Department of Clinical Science and K.G. Jebsen Center of Autoimmune Disorders, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

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Kristian Løvås Department of Clinical Science and K.G. Jebsen Center of Autoimmune Disorders, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

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Ingrid Nermoen Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

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Summary

Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. More than 90% is of B-cell origin. The condition is bilateral in up to 75% of cases, with adrenal insufficiency in two of three patients. We report two cases of adrenal insufficiency presenting at the age of 70 and 79 years, respectively. Both patients had negative 21-hydroxylase antibodies with bilateral adrenal lesions on CT. Biopsy showed B-cell lymphoma. One of the patients experienced intermittent disease regression on replacement dosage of glucocorticoids.

Learning points:

  • Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency.

  • Bilateral adrenal masses of unknown origin or in individuals with suspected extra-adrenal malignancy should be biopsied quickly when pheochromocytoma is excluded biochemically.

  • Steroid treatment before biopsy may affect diagnosis.

  • Adrenal insufficiency with negative 21-hydroxylase antibodies should be evaluated radiologically.

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Hormone, ACTH, Cortisol, Condition/ Syndrome, Adrenal insufficiency, Patient Demographics, Age, Geriatric, Gender, Male, Ethnicity, White, Country of Treatment, Norway, Diagnosis and Treatment, Signs and Symptoms, Abdominal discomfort, Anorexia, Arthralgia, Bowel movements - bleeding, Dizziness, Fatigue, Hyponatraemia, Hypotension, Nausea, Pyrexia, Renal failure, Tachycardia, Vomiting, Weight loss, Investigation, ACTH, ACTH stimulation, Adrenal antibodies, Biopsy, Cortisol, Creatinine (serum), CT scan, MRI, Potassium, Sodium, Urine osmolality, Intervention, Fluid repletion, Radiotherapy, Medication, Cortisone acetate, Doxorubicin, Fludrocortisone, Glucocorticoids, Hydrocortisone, Mineralocorticoids, Prednisolone, Rituximab, Sodium chloride, Related Disciplines, Oncology, Radiology/Rheumatology, Urology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-19-0131
Volume/Issue:
Volume 2020: Issue 1
Open access