Insuficiência adrenal primária no adulto: 150 anos depois de Addison

Silva, Regina do Carmo; Castro, Margaret de; Kater, Cláudio E.; Cunha, Andréa Aparecida; Moraes, Andréia M. de; Alvarenga, Daniela B. de; Moreira, Ayrton Custódio; Elias, Lucila Leico Kagohara

doi:10.1590/s0004-27302004000500019

Cited by 15 publications

(13 citation statements)

References 71 publications

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“…A anfotericina B continua sendo a droga de eleição para as formas graves e para as falhas de tratamento 13 21 23 . Não foi possível esclarecer se a doença de Addison desenvolvida em um paciente após a introdução da terapia antimicótica, foi de origem auto-imune, ou devida à adrenalite granulomatosa causada pela PCM 22 . A taxa de co-infecção PCM/HIV/aids foi pequena 3 14 18 , talvez por ter sido pouco investigada, uma vez que a padronização de rotinas para suspeição e diagnóstico de HIV/aids só ocorreu após 1984.…”

Section: Discussionunclassified

Paracoccidioidomicose no Hospital Universitário de Brasília

Campos

Penna

Castro

et al. 2008

Rev. Soc. Bras. Med. Trop.

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RESUMOForam estudados 76 pacientes com paracoccidioidomicose, assistidos no Hospital Universitário de Brasília, entre 1984 e 2005. O gênero masculino representou 82,9% e a média de idade foi 42 anos. Atividades agropecuárias caracterizaram 54,9% dos pacientes. Entre pacientes com a forma crônica, 87% eram tabagistas e 55,3% etilistas. Em 71 pacientes sem co-infecção por HIV/aids: a) houve recidiva da paracoccidioidomicose em 21 (29,6%); b) a forma crônica ou mista acometeu 77,5% dos pacientes, com predominância de comprometimento orofaríngeo (70,9%) e pulmonar (67,3%), além de lesões linfonodais (29,8%), laríngeas (27,3%) e cutâneas (16,4%); c) na forma aguda/subaguda, predominou o comprometimento linfonodal (81,3%), seguido por lesões cutâneas (43,8%), resultando doença grave em 62,5% e moderada em 37,5%. Cinco pacientes tinham coinfecção por HIV/aids, dos quais três tiveram a infecção fúngica disseminada associada a acentuada imunodepressão. Palavras-chaves:Paracoccidioidomicose. Região Centro-Oeste. Distrito Federal.Distrito Federal. ABSTRACTSeventy-six paracoccidioidomycosis patients attended at the university hospital of Brasília from 1984 to 2005 were studied. 82.9% were male and the mean age was 42 years. 54.9% of the patients were engaged in farming activities. Among the patients with the chronic form, 87% were smokers and 55.3% consumed alcohol. Among 71 patients without HIV/AIDS coinfection: a) paracoccidioidomycosis was recurrent in 21 (29.6%); b) the chronic or mixed form affected 77.5% of patients, predominantly in the oropharynx (70.9%) and lungs (67.3%), with lymph node lesions in 29.8%, laryngeal lesions in 27.3% and cutaneous lesions in 16.4%; c) in the acute/subacute form, lymph node lesions predominated (81.3%), followed by cutaneous lesions in 43.8%, which resulted in severe disease in 62.5% and moderate disease in 37.5%. Five patients had HIV/AIDS coinfection and three of them presented disseminated fungal infection together with marked immunosuppression.

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Section: Discussionunclassified

Paracoccidioidomicose no Hospital Universitário de Brasília

Campos

Penna

Castro

et al. 2008

Rev. Soc. Bras. Med. Trop.

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“…Adrenal involvement tends to be asymptomatic, but as in adrenal tuberculosis, can lead to adrenal insufficiency if there is extensive bilateral involvement. Imaging findings are indistinguishable from those of adrenal tuberculosis ( Figure 7 ) ( 31 , 34 ) .…”

Section: Benign Lesionsmentioning

confidence: 85%

“…The prevalence of adrenal tuberculosis is not known; however, it is one of the leading causes of primary adrenal insufficiency in the developing world ( 31 , 32 ) . Imaging findings depend on the phase of infection.…”

Section: Benign Lesionsmentioning

confidence: 99%

“…Typical features include unilateral or bilateral enlarged, heterogeneously enhancing adrenal glands, with areas of necrosis in active disease, and calcification in late or resolving infection ( 32 , 33 ) . Tissue analysis is required to confirm the diagnosis, but treatment is often started empirically, supported by clinical findings of tuberculosis or positive skin testing ( 31 ) . Two of the most important differential considerations for adrenal tuberculosis, particularly in southern regions of South America, are histoplasmosis and paracoccidioidomycosis.…”

Section: Benign Lesionsmentioning

confidence: 99%

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Imaging of the adrenal gland lesions

et al. 2014

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With the steep increase in the use of cross-sectional imaging in recent years, the incidentally detected adrenal lesion, or "incidentaloma", has become an increasingly common diagnostic problem for the radiologist, and a need for an approach to classifying these lesions as benign, malignant or indeterminate with imaging has spurred an explosion of research. While most incidentalomas represent benign disease, typically an adenoma, the possibility of malignant involvement of the adrenal gland necessitates a reliance on imaging to inform management decisions. In this article, we review the literature on adrenal gland imaging, with particular emphasis on computed tomography, magnetic resonance imaging, and photon-emission tomography, and discuss how these findings relate to clinical practice. Emerging technologies, such as contrast-enhanced ultrasonography, dual-energy computed tomography, and magnetic resonance spectroscopic imaging will also be briefly addressed.

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“…A 24-hour free cortisone urine test is considered a good way to assess the adequacy of cortisone intake [29]. In Brazil, as there is no commercial availability of oral hydrocortisone, in situations of difficulty in handling this drug, it can be used prednisone at a dose of 5 -10 mg/day in single or fractionated doses [33].…”

Section: Treatment Of Adrenal Insufficiencymentioning

confidence: 99%

Adrenal Insufficiency by Adrenoleukodystrophy

Botelho¹,

Botelho²,

Rodrigues³

et al. 2020

Health

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The X-linked adrenoleukodystrophy (ALD) is a severe neurodegenerative disorder due to mutations in the ABCD1 gene. Objective: To report a case of a 19-year-old man with adrenal insufficiency due to adrenoleukodystrophy. Method: Case report and literature review. Result: A previously healthy 19-year-old male patient was admitted to the emergency room with nausea and vomiting for 5 days, who progressed to abdominal pain, severe asthenia, and fever (38.5˚C). He referred progressive darkening of the skin, oral mucosa, tongue and nail bed of the hands and feet, observed in the last 6 years. Emergency laboratory evaluation showed severe hyponatremia and hyperkalemia, which, together with decreased plasma cortisol, directed the investigation to causes of adrenal insufficiency. High ACTH (Adrenocorticotropic hormone) and very long chain fatty acid levels closed the diagnosis. Discussion: ALD is characterized by progressive demyelination in the central and peripheral nervous system and adrenal insufficiency consequence to the accumulation of very long chain fatty acids (VLCFA) in the adrenal. The overall incidence of ALD is 1:17,000. Adrenal insufficiency may be the first symptom of ALD in boys and adults. The diagnosis is based on the measurement of VLCFA plasma levels. Allogeneic bone marrow transplantation is the only treatment that provides a permanent cure when the procedure is performed at an early stage of brain demyelination, i.e. when patients are asymptomatic, although brain magnetic resonance imaging (MRI) is abnormal. Treatment of Addison's disease is obligatory, but does not change the course of neurological symptoms.

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Insuficiência adrenal primária no adulto: 150 anos depois de Addison

Cited by 15 publications

References 71 publications

Paracoccidioidomicose no Hospital Universitário de Brasília

Paracoccidioidomicose no Hospital Universitário de Brasília

Imaging of the adrenal gland lesions

Adrenal Insufficiency by Adrenoleukodystrophy

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