Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
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Hyperglycemia is a common feature of the critically ill and has been associated with increased mortality. In this review, we give an overview of studies associating critical illness-induced hyperglycemia with adverse outcome and describe how mortality and morbidity are affected when blood glucose levels are strictly controlled to normoglycemia with intensive insulin therapy. ⋯ These data support the generalized implementation of a strict blood glucose control management with intensive insulin therapy in adult surgical as well as medical ICU patients.
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To report a case of a follicle-stimulating hormone (FSH)-secreting pituitary adenoma, which manifested with oligomenorrhea, dysmenorrhea, and multiple bilateral ovarian cysts. ⋯ Although very uncommon, gonadotropin-secreting pituitary adenomas should be considered in the differential diagnosis of new-onset oligomenorrhea and dysmenorrhea, especially if associated with multicystic ovaries on ultrasound study, even in the absence of elevated levels of serum gonadotropins. Furthermore, we propose that it may be acceptable to withhold adjuvant radiotherapy in patients who are asymptomatic after transsphenoidal surgical excision of these tumors.
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Case Reports
Difficulties in diagnosing and managing coexisting primary hypothyroidism and resistance to thyroid hormone.
To report a case of resistance to thyroid hormone compounded by autoimmune primary hypothyroidism and to discuss the unusual pattern of results of thyroid function tests. ⋯ This patient has an interesting combination of autoimmune primary hypothyroidism and resistance to thyroid hormone. Levothyroxine replacement therapy was complicated by the nonspecificity of symptoms and the lack of an established TSH target value in this condition. Consideration should be given to using the affected family members' mean TSH level, when available, as a target guide for replacement therapy.
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Case Reports
Impending cardiac tamponade as a primary presentation of hypothyroidism: case report and review of literature.
To describe a patient who presented with pericardial effusion and impending cardiac tamponade attributable to hypothyroidism. ⋯ From our review of the literature, we conclude that impending cardiac tamponade is a rare initial manifestation of hypothyroidism. A high index of suspicion must be maintained for timely diagnosis of pericardial tamponade followed by prompt intervention. Recurrent pericardial effusions are common, necessitating close follow-up. Treatment of the hypothyroidism with levothyroxine is imperative.