Presentation
We describe a case of a newborn presenting with hypoglycaemia and cholestatic jaundice, who was found to have low cortisol and ACTH levels. [casereports.bmj.com]
At birth craniofacial dysmorphisms and left-side clubfoot were present. At the age of 2 months hepatitis was diagnosed on the basis of elevated bilirubin and liver enzymes levels. [abstracts.eurospe.org]
The 2 neonatal cases presented with hypoglycemia and in a state of “apparent death” at birth or hypothermia (29°C) at 6 days. [journals.plos.org]
We discuss the protean presentation of this rare but important condition, its treatment, associations, and possible aetiologies. [link.springer.com]
Gastrointestinal
- Nausea
TBX19 Gene - elite association - COSMIC cancer census association via MalaCards ACTH deficiency, isolated (IAD) [MIM:201400]: A disorder that is characterized by adrenal insufficiency symptoms, such as weight loss, lack of appetite (anorexia), weakness, nausea [genecards.org]
Adrenal insufficiency may mimic features of acute abdomen with abdominal tenderness, nausea, vomiting, and fever. 3. [slideshare.net]
Disease description An autosomal recessive disorder that is characterized by adrenal insufficiency symptoms, such as weight loss, lack of appetite (anorexia), weakness, nausea, vomiting and low blood pressure (hypotension). [uniprot.org]
Signs of under-replacement are the symptoms of Addison's disease persisting, ie fatigue, postural hypotension, nausea, weight loss, and salt craving. [patient.info]
Case 2 A 64-year-old-man visited our emergency room with nausea, vomiting, and dizziness after a recent history of upper respiratory infection. [synapse.koreamed.org]
Workup
An incidental adrenal mass must undergo a workup for hypersecretion. Surgical removal is indicated if the mass is functional or greater than 4-5 cm in size. [ocw.tufts.edu]
Treatment
The patient's cholestasis was present since birth until the treatment with hydrocortisone was started; following initiation of the treatment, the patient's condition improved significantly and both, his total and direct bilirubin levels started trending [casereports.bmj.com]
Rapidly consult with trusted authorities thanks to new expert-opinion treatment strategies and recommendations. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.com]
Otherwise treatment consists of replacement of the deficient sex steroids similar to treatment of hypogonadism from any cause. (See chapters on “Treatment of Male Hypogonadism” and on “Treatment of Female Hypogonadism”). [endocrinologyadvisor.com]
Treatment, which is experimental, must begin in the first several weeks of gestation. Treatment of nonclassic 21-hydroxylase deficiency depends on symptoms. If asymptomatic, no treatment is required. [msdmanuals.com]
Prognosis
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]
However, the prognosis for an untreated patient with adrenal insufficiency (Addison disease) is poor. [emedicine.medscape.com]
Biological diagnosis and how to obtain a more rapid diagnosis The vital prognosis is engaged by the ACTH deficiency, but diagnosis is difficult and sometimes missed: 6 of our 8 patients had previously been admitted to intensive care units at least once [journals.plos.org]
- Pituitary stalk interruption syndrome in 83 patients: novel HESX1 mutation and severe hormonal prognosis in malformative forms. [fr.ap-hm.fr]
Etiology
We conclude that the diagnosis of this condition may be difficult due to the varied clinical presentation and etiologies. References Irvine WJ, Barnes EW: Adrenocortical insufficiency. Clin Endocrinol Metab 1972;1:549–594. [karger.com]
Still another type of adrenal hypoplasia congenita, an autosomal recessive form of uncertain etiology, has also been described (OMIM 240200 ). [emedicine.medscape.com]
(See "Etiology and treatment of hypoaldosteronism (type 4 RTA)", section on Congenital adrenal hyperplasia and isolated hypoaldosteronism, which reviews the biosynthetic defects in this disorder). [enotes.tripod.com]
Symptoms and Signs Manifestations of growth hormone deficiency depend on the patient's age, the underlying etiology, and the specific hormone deficiencies. [merckmanuals.com]
Endogenous Cushing's may be due to a pituitary, adrenal or ectopic etiology. The workup involves the determination that the syndrome is present followed by testing to determine the specific etiology. [ocw.tufts.edu]
Epidemiology
Relevant External Links for TBX19 Genetic Association Database (GAD) TBX19 Human Genome Epidemiology (HuGE) Navigator TBX19 Atlas of Genetics and Cytogenetics in Oncology and Haematology: TBX19 No data available for Genatlas for TBX19 Gene A pituitary [genecards.org]
[…] androstenedione, and testosterone Every 3 months during infancy and every 3-6 months thereafter For assessment of mineralocorticoid replacement Blood pressure measurement Plasma renin/renin activity Aldosterone and potassium levels may also be helpful Background Epidemiology [arupconsult.com]
Epidemiology. AME is rare, having been identified in only approximately 40 patients worldwide in the past 20 years. [pnas.org]
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 Familial glucocorticoid deficiency (FGD) is a rare disease, and only isolated case reports are documented. [emedicine.medscape.com]
Pathophysiology
Dr Van Vliet's research interests focus on the molecular pathophysiology of and screening for congenital hypothyroidism, and on the management and outcome of affected children. [chusj.org]
Grossman, The pathophysiology of pituitary adenomas, Best Practice & Research Clinical Endocrinology & Metabolism, 23, 5, (525), (2009). [www3.interscience.wiley.com]
Cytochrome P450 oxidoreductase deficiency Hexose-6-phosphate dehydrogenase deficiency ( H6PD variant) PAPSS2 deficiency ( PAPSS2 variant) Congenital lipoid adrenal hyperplasia ( StAR variants) P450scc side chain cleavage enzyme deficiency ( CYP11A1 variant) Pathophysiology [arupconsult.com]
Prevention
Suggestions for prevention of adrenal crisis in patients at risk are provided for health care professionals and families. adrenal disorders morbidity/mortality adverse outcomes Accepted September 13, 2006. [pediatrics.aappublications.org]
With illness, corticosteroid dosages are increased (typically doubled or tripled) to prevent adrenal crisis. Mineralocorticoid replacement is not adjusted. [msdmanuals.com]
Hydrocortisone treatment (9 mg/m 2 /day) was started to prevent life-threatening complications. [frontiersin.org]
There is no evidence that treatment can prevent this autoimmune attack, which may also affect other organs in the same person. [netdoctor.co.uk]