Presentation
A 20-year-old woman, gravida 1 para 0, presented at 27 4/7 weeks of gestation with sudden-onset right upper quadrant and flank pain. [ncbi.nlm.nih.gov]
A comprehensive textbook of adult emergency medicine for trainee doctors - covers all the problems likely to present to a trainee in the emergency department. [books.google.com]
Gastrointestinal
- Right Upper Quadrant Pain
We report a case of a 29-year-old pregnant woman at the twenty-fourth week of gestation that presented with an acute episode of severe localized right upper quadrant pain. [ncbi.nlm.nih.gov]
On examination the patient looked unwell and in pain. She was tender in the right upper quadrant and epigastric region with voluntary guarding in those areas. [epostersonline.com]
- Recurrent Abdominal Pain
Case history: A 55-year woman presented with 1-week history of recurrent abdominal pain and tenderness in left upper quadrant and loin. There was no pigmentation of the skin or mucous membranes. [endocrine-abstracts.org]
Liver, Gall & Pancreas
- Murphy's Sign
Clinical assessment revealed sepsis with RUQ tenderness and positive Murphy's sign. Laboratory results showed raised inflammatory markers, along with renal and liver impairment. CT showed bilateral adrenal infarction and inferior vena cava thrombus. [ncbi.nlm.nih.gov]
Fetus
- Spontaneous Rupture of Membranes
At 32 weeks she experienced spontaneous rupture of membranes. One week later she delivered vaginally and remained anticoagulated for the puerperium. [ncbi.nlm.nih.gov]
Urogenital
- Flank Pain
A 29-year-old woman, gravida 2 para 1, presented at 17 5/7 weeks of gestation with sudden-onset right abdominal and flank pain and again at 35 5/7 weeks of gestation with sudden-onset severe left flank and upper quadrant pain. [ncbi.nlm.nih.gov]
[…] or flank pain Confusion, loss of consciousness, or coma Dehydration Dizziness or light-headedness Fatigue, severe weakness Headache High fever Loss of appetite Low blood pressure Nausea, vomiting Rapid heart rate Rapid respiratory rate Slow, sluggish [adrenal-insufficiency.nz]
Adrenal hemorrhage often causes abdominal or flank pain and fever; CT scan of the abdomen reveals high-density bilateral adrenal masses. [unboundmedicine.com]
Adrenal infarction is a rare cause of flank pain. It is usually due to thrombosis of the main adrenal vein or secondary to microvascular thrombosis within the parenchyma of the adrenal gland. [epostersonline.com]
Workup
Initial radiologic investigation in the workup of primary hyperaldosteronism is high-resolution, thin-slice (2 mm-2.5 mm) adrenal CT scanning with contrast. Aldosteronomas tend to be small and may not always be seen on CT or MRI scans. [healio.com]
Microbiology
- Treponema Pallidum
The results of autoantibody screening, including Treponema pallidum haemagglutination, Veneral Disease Experimental Laboratory test, antinuclear and anti-DNA antibodies, cryoglobulin, and rheumatoid factor were negative. [ard.bmj.com]
Treatment
You will need to go to the hospital for treatment and monitoring. If infection or another medical problem caused the crisis, you may need additional treatment. [adrenal-insufficiency.nz]
Also has boxes featuring controversial areas of treatment. Practical and clinically orientated. Major changes to resuscitation guidelines. Complete rewriting of ENT section. [books.google.com]
In addition, prolonged glucocorticoid treatment is associated with downregulation of the glucocorticoid receptor and suppression of the HPA axis, affecting systemic inflammation after discontinuing treatment. [clinicaladvisor.com]
Both opportunistic agents and their drug treatment can lead to adrenal insufficiency, which occurs commonly in critically ill patients with HIV infection. [aafp.org]
Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events. metadata References J. Michiels, Z. Berneman, W. Schroyens, G. [dial.uclouvain.be]
Prognosis
Outlook (Prognosis) Shock may occur if treatment is not provided early, and it can be life threatening. [adrenal-insufficiency.nz]
The prognosis for any patient with adrenal insufficiency will depend on the underlying cause. In those patients in whom the prognosis is not affected by the underlying pathology, replacement therapy should result in a return to health. [patient.info]
Prognosis The prognosis of patients with CIRCI is largely dependent on that of the underlying disease. [clinicaladvisor.com]
The prognosis of acute bilateral adrenal hemorrhage remains good so long as patients undergo appropriate treatment, including anticoagulation and corticosteroid replacement therapy. [consultant360.com]
Prognosis & Response totherapyLife expectancy is usually normal with good compliance.It is important to make sure that pt is taking medications regularly and knowledgeable about his condition.BP without orthostatic hypotension, normal lytes, PRA 28. [slideshare.net]
Etiology
Etiology of hypercortisolism In the etiology, we differentiate between exogenous hypercortisolism stemming from long-term treatment with glucocorticosteroids, and an endogenous increased production and secretion of cortisol or ACTH. [lecturio.com]
Other Tests That May Prove Helpful Diagnostically For the etiology of adrenal insufficiency acute or chronic several other tests are helpful. [endocrinologyadvisor.com]
Less common etiologies include adrenoleukodystrophy that causes adrenal failure in young men and drugs such as ketoconazole and etomidate that inhibit steroid hormone synthesis. [unboundmedicine.com]
Classified as primary or secondary in etiology, but both types can lead to adrenal crisis. [emdocs.net]
Etiology Primary Adrenal Insufficiency Adrenal Hemorrhage/Infarction/Loss Anti-Phospholipid Antibody Syndrome (see Anti-Phospholipid Antibody Syndrome, [[Anti-Phospholipid Antibody Syndrome]]) Bilateral Adrenalectomy : after bilateral nephrectomy or in [mdnxs.com]
Epidemiology
found in 40% of primary adrenal insufficiency cases at initial presentation Hyponatremia (see Hyponatremia, [[Hyponatremia]]) Epidemiology : found in 80% of primary adrenal insufficiency cases at initial presentation Mechanism : primariliy caused by [mdnxs.com]
EPIDEMIOLOGY Prevalence: 12 per 100,000 persons Incidence: 0.5 per 100,000 persons Age: may occur at any age, with peak incidence in the fourth decade Sex: Autoimmune causes: female predominance Non-autoimmune causes: equal sex distribution 10. [slideshare.net]
Epidemiology There is increasing evidence that in many critically ill patients activation of the HPA axis and the release of cortisol is impaired (AI). [clinicaladvisor.com]
Epidemiology [ 1, 2 ] Primary insufficiency - this is a relatively rare condition. The annual incidence is about 1 in 10,000 people, with a prevalence in the UK of about 8,400. Across Europe, prevalence is estimated as 93-144 per million. [patient.info]
Epidemiology Frequency United States Adrenal hemorrhage has been reported in 0.3-1.8% of unselected cases in autopsy studies, although extensive bilateral adrenal hemorrhage may be present in 15% of individuals who die of shock. [emedicine.medscape.com]
Pathophysiology
Pathophysiology The mechanisms leading to inadequate cortisol production during critical illness are complex and poorly understood and likely include decreased production of CRH, ACTH, and cortisol. [clinicaladvisor.com]
The pathophysiology of this is not yet clear. It involves reduction in the production of glucocorticoids as well as reduced effect. [patient.info]
For new insights we searched original articles after 2008; to explain relevant pathophysiology we also used published review articles. [karger.com]
Pathophysiology Although the precise mechanisms leading to adrenal hemorrhage are unclear in nontraumatic cases, available evidence has implicated adrenocorticotropic hormone (ACTH), adrenal vein spasm and thrombosis, and the normally limited venous drainage [emedicine.medscape.com]
Based on the pathophysiological considerations, an increase in cortisol after stimulation by ACTH with a primary adrenal cortex insufficiency is not possible. [lecturio.com]
Prevention
The patient was anticoagulated to prevent contralateral thrombosis. At 32 weeks she experienced spontaneous rupture of membranes. One week later she delivered vaginally and remained anticoagulated for the puerperium. [ncbi.nlm.nih.gov]
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.de]
Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events. metadata References J. Michiels, Z. Berneman, W. Schroyens, G. [dial.uclouvain.be]