A case of mediastinitis accompanied with hyperosmolar nonketotic coma

AbstractMediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling

Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature

Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey

Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and gener ally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D defciency can ensure safe and efective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D defciency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (>88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1,>150 ng/ mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. Results A total of 253 patients were included in the fnal analysis (female/male: 215/38; mean age, 51.5±15.6 years). The average serum 25(OH)D level was 119.9±33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8±0.7 (range, 8.1–13.1) mg/dL. Most (n=201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and cal cium levels. The serum 25(OH)D level was signifcantly higher in the symptomatic groups than in the asymptomatic groups (138.6±64 ng/mL vs. 117.7±31 ng/mL, p<0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000–1.500.000 IU) for treating vitamin D defciency/insufciency in a short time (1–3 months). The cut-of value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89–216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercal cemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and efective treatment of vitamin D defciency

Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs

Abstract Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing’s syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.</p

Iatrogenic Cushing's syndrome with inhaled steroid plus antidepressant drugs

Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing's syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP

A Case Report of Allgrove Syndrome with Neurological Involvement

Allgrove syndrome is a very rare seen disorder with an autosomal recessive trait. The three characteristics of disease are alacrima, achalasia and adrenal failure. Alacrimia is the first manifestation in most cases. Achalasia and adrenal failure are seen later. Neurological involvement is rare and usually occurs in older age. A women 22 years old admitted to our hospital with adrenal failure crisis. She had alacrimia and used teardrop for many years. Achalasia was diagnosed after evaluation of her dysphagia. Thus, diagnosis of Allgrove syndrome, was done. Autonomic cardiac dysfunction and peripheral motor neuropathy were detected. In conclusion, Allgrove syndrome is rare and has life threatening potential due to adrenal failure. Early diagnosis and appropriate treatment may improve life quality and expectancy. Patients with relevant symptoms should be evaluated for autonomic neuropathy. [Med-Science 2015; 4(3.000): 2570-4

Infantile-onset megalencephalic leucoencephalopathy in two siblings

Infantile-onset megalencephalic. leucoencephalopathy (IML) is a recently recognized autosomal recessive white matter disorder. Unlike other megalencephalic leucoencephalopathies, in patients with IML a mild clinical course, a slowly progressive delay in motor development and mild mental deterioration are typical. We report on two affected siblings who have typical clinical and radiological findings of IML. Cranial magnetic resonance imaging showed involvement of the capsula externa, extrema and interna, nucleus dentatus, cnrs cerebri, periventricular and subcortical white matter. In addition, bilateral cystic changes were determined predominantly in the temporal lobes. There were no clear biochemical or metabolic disturbances. In the present paper, we discuss the clinical and neuroimaging findings of IML

Clinical and Demographic Characteristics of 78 Patients with Adrenal Incidentaloma [Adrenal Insidentalomali 78 Hastanin Demografik ve Klinik Ozellikleri]

Adrenal incidentalomas (AIs) are adrenal lesions detected on abdominal imaging procedures or abdominal laparotomy that had been performed for unrelated reasons. AIs have become a common clinical concern as a result of widespread use of abdominal ultrasound, CT and MR imaging in clinical practice. The aim of this study was to evaluate the demographical and clinical data our patients with AI. This study included data from 78 patients (53 female 25 male) with AI those followed at Dicle University School of Medicine, Department of Endocrinology and Metabolism, between 2007 and 2013. Data collected from the records were physical and hormonal evaluation, diameter of the lesion, and the features of the lesion on radiological imaging. Also the results of serum cortisol, aldosterone, renin and 24 hour urinary metanephrine and normetanephrine were recorded. The average age of patients were 48.6 ±14.9 years. There was no significant difference in terms of localization of adenomas. Body mass index of patients were 28.54 ± 5.82. Of the patients, 45 (57.7%) were diagnosed as non-functional AI, 10 (12.8%) as subclinical Cushings syndrome, 11 (14,1%) as pheochromocytoma, 2(2.6%) as primary hyperaldosteronism, and 3(3.8%) as adrenal carcinoma. Ganglioneuroma was stated in 2 patients (2.6%), myelolipoma was stated in 1 patient (1.3%), adrenal adenoma was stated in 1 patient, adrenal cyst was stated in 1 patient, schwannoma was stated in 1 patient and neoplasia with small circular cells was stated in 1 patients. AIs are currently more frequently detected in clinical practice due to increased use of imaging techniques. Although the vast majority of AIs are benign and non-functioning, appropriate hormonal evaluation and imaging procedures must be performed. [Med-Science 2015; 4(2.000): 2181-95