FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2131990030> ?p ?o ?g. }

• W2131990030 endingPage "2442" @default.
• W2131990030 startingPage "2441" @default.
• W2131990030 abstract "To the Editor: The vague clinical presentations of adrenal insufficiency (AI) in elderly patients could be considered to be due to the aging process, which would then be overlooked and become life threatening.1 It may be that the coexistence of AI and thyroid insufficiency, which may result from pituitary failure, is greater than previously suspected.2 An older man with hypothyroid secondary to subclinical hypopituitarism, in whom thyroid hormone replacement eventually resulted in adrenal crisis, is reported. A 79-year-old man was referred to the Department of Geriatric Gastroenterology PLA General Hospital, Beijing, China, in February 2010 because of intermittent diarrhea and constipation for 7 months. He had lost 5 kg of weight over this period. In 1979, he had received a 45-Gy dose of local irradiation to the pituitary area because of pituitary adenoma. Follow-up was every 1 to 2 years thereafter until 1993. He felt well and returned to normal work without taking hormone replacement. He presented elsewhere in 2007 with lassitude and intolerance to cold. Hypothyroidism was diagnosed, and levothyroxine was prescribed. He had a history of hypertension, coronary heart disease, multiple lacunar infarction, and cognitive impairment for years. The patient was brought into the ward in a wheelchair and confined to bed. Vital signs were normal. His facial appearance was dull and apathetic. A 4- × 3-cm abdominal mass was palpable at the lower right quadrant, with no tenderness. A few hyperpigmented patches were noted on the anterior tibial surfaces. The remainder of the examination was unremarkable. Hemoglobin was 10.8 g/dL (normocytic). Urine and stool examinations and chemistry panels were normal. Plasma carcinoembryonic antigen and carbohydrate antigen 72–4 were high. Low plasma thyroxine and triiodothyronine concentrations were recorded. Plasma thyroid-stimulating hormone (TSH) concentration was normal. The patient experienced hyponatremia (118 mEq/L) during bowel preparation for colonoscopy, but this was corrected with fluid resuscitation and sodium chloride supplementation. Levothyroxine dosage was increased to 37.5 μg daily, which resulted in normal plasma thyroxine concentrations. Thirty-five days later, he developed hypotension (90/60 mmHg) accompanied by rapid atrial fibrillation and sweating. Laboratory investigation showed serum sodium 131 mEq/L (130–150 mEq/L), potassium 4.3 mEq/L (3.5–5.5 mEq/L), and glucose 122 mg/dL (62–110 mg/dL). His symptoms were initially attributed to hypovolemia and tachyarrhythmia. Intravenous hydration and anti-arrhythmia drugs returned his blood pressure to normal. Hours later, his situation worsened with a systolic blood pressure of less than 60 mmHg. Hypopituitarism and adrenal crisis was suspected. Intravenous hydrocortisone (100 mg) was initiated immediately, which corrected the hypotensive episodes. He was then given 600 mg of hydrocortisone (100 mg every 4 hours) for 24 hours. Plasma adrenocorticotropic hormone levels tested the day after the attack at midnight, 8:00 a.m., and 4:00 p.m. were undetectable. Plasma prolactin, luteinizing hormone, and follicle-stimulating hormone concentrations were low. A diagnosis of hypopituitarism was made. Parenteral hydrocortisone was tapered over 2 weeks and changed to a maintenance dose of oral prednisone. A recent survey of patients with AI found that more than 67% consulted at least three physicians and that 68% were initially received the wrong diagnosis.3 Some patients initially present with gastrointestinal symptoms such as abdominal cramps, nausea, vomiting, and diarrhea.4 This patient presented with an irregular disturbance of defecation, a mass at the lower right quadrant, and high serum tumor marker levels. These characteristics led us to focus initially on gastrointestinal disorders. Comorbidities such as multiple lacunar infarction and cognitive dysfunction also led to a failure to notice the symptoms of lethargy and memory difficulties. The diagnosis of AI is frequently overlooked in inpatients with hyponatremia.5 Hyponatremia after bowel preparation in this case was considered to be one of the common complications of bowel cleansing in older adults and was thus neglected at the time. Adrenocorticotropic hormone and TSH deficiencies are more frequently described in patients with previous tumors or surgical insults to the pituitary gland.6 This patient presented a TSH deficiency 28 years after radiation, which was longer than other similar reports documented. Primary hypopituitarism is not uncommon in older adults.7 Aging and radiation might have both contributed to his hypopituitarism. Although it is widely recognized that thyroid hormone precipitates adrenal crisis, few cases have been reported in the literature.8 In this case, the normal TSH level led to a delay in the recognition of accompanying pituitary failure. Apparently, he had subclinical AI when levothyroxine was initially prescribed, which became clinically manifest when the thyroxine dose was raised. Elderly patients should not be started on thyroxine replacement therapy until the possibility of hypopituitarism and adrenal deficiency has been excluded. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: GS Wang contributed to the conception and design, acquisition of data and preparation of the article. CH Cai and BY Wu revised for important intellectual content. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. The authors had a final approval of the version to be published. Sponsor's Role: NA." @default.
• W2131990030 created "2016-06-24" @default.
• W2131990030 creator A5051674686 @default.
• W2131990030 creator A5074742089 @default.
• W2131990030 creator A5087583168 @default.
• W2131990030 date "2010-12-01" @default.
• W2131990030 modified "2023-10-18" @default.
• W2131990030 title "THYROID HORMONES PRECIPITATE SUBCLINICAL HYPOPITUITARISM RESULTED IN ADRENAL CRISIS" @default.
• W2131990030 cites W2049084340 @default.
• W2131990030 cites W2095898506 @default.
• W2131990030 cites W2158930864 @default.
• W2131990030 cites W4249152248 @default.
• W2131990030 doi "https://doi.org/10.1111/j.1532-5415.2010.03188.x" @default.
• W2131990030 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21143455" @default.
• W2131990030 hasPublicationYear "2010" @default.
• W2131990030 type Work @default.
• W2131990030 sameAs 2131990030 @default.
• W2131990030 citedByCount "6" @default.
• W2131990030 countsByYear W21319900302012 @default.
• W2131990030 countsByYear W21319900302014 @default.
• W2131990030 countsByYear W21319900302016 @default.
• W2131990030 countsByYear W21319900302019 @default.
• W2131990030 countsByYear W21319900302020 @default.
• W2131990030 crossrefType "journal-article" @default.
• W2131990030 hasAuthorship W2131990030A5051674686 @default.
• W2131990030 hasAuthorship W2131990030A5074742089 @default.
• W2131990030 hasAuthorship W2131990030A5087583168 @default.
• W2131990030 hasBestOaLocation W21319900301 @default.
• W2131990030 hasConcept C113280763 @default.
• W2131990030 hasConcept C126322002 @default.
• W2131990030 hasConcept C141071460 @default.
• W2131990030 hasConcept C187212893 @default.
• W2131990030 hasConcept C2775883008 @default.
• W2131990030 hasConcept C2778129406 @default.
• W2131990030 hasConcept C2778491484 @default.
• W2131990030 hasConcept C2778808452 @default.
• W2131990030 hasConcept C526584372 @default.
• W2131990030 hasConcept C71924100 @default.
• W2131990030 hasConceptScore W2131990030C113280763 @default.
• W2131990030 hasConceptScore W2131990030C126322002 @default.
• W2131990030 hasConceptScore W2131990030C141071460 @default.
• W2131990030 hasConceptScore W2131990030C187212893 @default.
• W2131990030 hasConceptScore W2131990030C2775883008 @default.
• W2131990030 hasConceptScore W2131990030C2778129406 @default.
• W2131990030 hasConceptScore W2131990030C2778491484 @default.
• W2131990030 hasConceptScore W2131990030C2778808452 @default.
• W2131990030 hasConceptScore W2131990030C526584372 @default.
• W2131990030 hasConceptScore W2131990030C71924100 @default.
• W2131990030 hasIssue "12" @default.
• W2131990030 hasLocation W21319900301 @default.
• W2131990030 hasLocation W21319900302 @default.
• W2131990030 hasOpenAccess W2131990030 @default.
• W2131990030 hasPrimaryLocation W21319900301 @default.
• W2131990030 hasRelatedWork W2003148536 @default.
• W2131990030 hasRelatedWork W2007102687 @default.
• W2131990030 hasRelatedWork W2131990030 @default.
• W2131990030 hasRelatedWork W2400210064 @default.
• W2131990030 hasRelatedWork W2922396447 @default.
• W2131990030 hasRelatedWork W3081453574 @default.
• W2131990030 hasRelatedWork W3118145432 @default.
• W2131990030 hasRelatedWork W3186754545 @default.
• W2131990030 hasRelatedWork W4283700057 @default.
• W2131990030 hasRelatedWork W4308134192 @default.
• W2131990030 hasVolume "58" @default.
• W2131990030 isParatext "false" @default.
• W2131990030 isRetracted "false" @default.
• W2131990030 magId "2131990030" @default.
• W2131990030 workType "article" @default.