Perspectives of family members on planning end-of-life care in the older palliative patient

C

Advance care planning in terminally ill and frail older persons : acceptance of dying and balancing experiences, trust and control

C

Anterior hypopituitarism in a patient with amyloidosis secondary to Crohn's disease: a case report.

Amyloid infiltration of endocrine glands has been reported, mostly in the thyroid, pancreas, adrenals, and testes, but affected patients do not frequently exhibit overt endocrine insufficiency. Here we report the case of a patient with complete anterior hypopituitarism probably due to a known systemic amyloidosis. Our male Caucasian patient was diagnosed with Crohn's disease at the age of 22 years. At the age of 37, he developed secondary renal amyloidosis, which resulted in end-stage renal failure. He received a living-donor kidney transplant at the age of 57, without initial complication. Two months later, he developed extreme fatigue, weight loss, and dyspnea. A hormonal evaluation demonstrated complete anterior pituitary insufficiency. A pituitary magnetic resonance imaging was performed and showed a diffusely hypointense anterior gland on both T1-weighted and T2-weighted images with reduced gadolinium enhancement, highly suggestive of amyloid infiltration of the pituitary. Treatment was initiated with levothyroxine, orally administered hydrocortisone, and testosterone enanthate, rapidly allowing progressive marked clinical improvement and nearly complete resolution of symptoms. Pituitary amyloid infiltration should be considered in patients with a known systemic amyloidosis who develop symptoms of hypopituitarism and magnetic resonance imaging features compatible with protein deposits

Characterisation of an interference affecting the triiodothyronine measurement on two different immunoassays.

We report a case of falsely elevated triiodothyronine (T3) due to anti-T3 antibody interference in two immunoassays (Cobas 8000 e602® module (Roche Diagnostics) and Architect® i2000 (Abbott)). The interference was investigated using various laboratory methods including the search for heterophilic antibodies, biotin detection and the polyethylene glycol precipitation of potential interfering macromolecules. The presence of anti-T3 autoantibodies was detected and measured by radioimmunoprecipitation. Our investigations confirmed the clinical suspicion of a falsely elevated free T3. No further explorations or unnecessary treatments were conducted for this patient after identification of the interference. This underlines the importance of implementing systematic analytical procedures in laboratories for the search of suspected interferences

OSTEOSARCOMA WITH EXTENSIVE CALCIFIED PLEURAL METASTASES AT DIAGNOSIS

We report the case of an 18 year old woman presenting with shortness of breath and pain in the left shoulder. Imaging of the lungs revealed pleural effusion and calcification of the left pleura. An osteosarcoma of the left humerus was the final diagnosis. A review of the literature reveals that calcified pleural metastatic disease in cases of osteosarcoma has been infrequently reported. Other causes of pleural calcification are briefly discussed