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      Subclinical hypothyroidism or central hypothyroidism—The danger of thyroid function misinterpretation

      case-report

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          Key Clinical Message

          Correct interpretation of thyroid function tests is critical to providing appropriate care to patients with suspected thyroid disease. It is particularly important to distinguish central hypothyroidism from other types due to the potential of concurrent secondary adrenal insufficiency and thus the need for immediate steroid replacement prior to commencing thyroxine.

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          Diagnosis and management of adrenal insufficiency.

          Irina Bancos, Stefanie Hahner, Jeremy W. Tomlinson … (2015)
          Adrenal insufficiency continues to be a challenge for patients, their physicians, and researchers. During the past decade, long-term studies have shown increased mortality and morbidity and impaired quality of life in patients with adrenal insufficiency. These findings might, at least partially, be due to the failure of glucocorticoid replacement therapy to closely resemble physiological diurnal secretion of cortisol. The potential effect of newly developed glucocorticoid drugs is a focus of research, as are the mechanisms potentially underlying increased morbidity and mortality. Adrenal crisis remains a threat to lives, and awareness and preventative measures now receive increasing attention. Awareness should be raised in medical teams and patients about adrenal insufficiency and management of adrenal crisis to improve clinical outcome.
          Article 0 comments Cited 140 times – based on 0 reviews     Review now
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            High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study.

            Stefanie Hahner, Christina Spinnler, Martin Fassnacht … (2015)
            Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI), which according to retrospective data represents a significant clinical complication. Here we aimed to prospectively assess incidence of AC and mortality associated with AC in patients with chronic AI.
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              DIAGNOSIS OF ENDOCRINE DISEASE: Primary empty sella: a comprehensive review.

              S. Chiloiro, A Giampietro, A. Bianchi … (2017)
              Primary empty sella (PES) is characterized by the herniation of the subarachnoid space within the sella, which is often associated with variable degrees of flattening of the pituitary gland in patients without previous pituitary pathologies. PES pathogenetic mechanisms are not well known but seem to be due to a sellar diaphragm incompetence, associated to the occurrence of upper sellar or pituitary factors, as intracranial hypertension and change of pituitary volume. As PES represents in a majority of cases, a neuroradiological findings without any clinical implication, the occurrence of endocrine, neurological and opthalmological symptoms, due to the above describes anatomical alteration, which delineates from the so called PES syndrome. Headache, irregular menses, overweight/obesity and visual disturbances compose the typical picture of PES syndrome and can be the manifestation of an intracranial hypertension, often associated with PES. Although hyperprolactinemia and growth hormone deficit represent the most common endocrine abnormalities, PES syndrome is characterized by heterogeneity both in clinical manifestation and hormonal alterations and can sometime reach severe extremes, as occurrence of papilledema, cerebrospinal fluid rhinorrhea and worsening of visual acuity. Consequently, a multidisciplinary approach, with the integration of endocrine, neurologic and ophthalmologic expertise, is strongly advocated and recommended for a properly diagnosis, management, treatment and follow-up of PES syndrome and all of the related abnormalities.
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                Author and article information

                Contributors
                Oluwaseun Anyiam:
                ORCID: http://orcid.org/0000-0003-2425-2299
                o.anyiam@nhs.net
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 21 August 2018
                Publication date Collection: October 2018
                Volume: 6
                Issue: 10 ( doiID: 10.1002/ccr3.2018.6.issue-10 )
                Pages: 1953-1957
                Affiliations
                [ 1 ] East and North Hertfordshire NHS Trust Stevenage Hertfordshire UK
                [ 2 ]Present address: Homerton University Hospital London UK
                Author notes
                [*] [* ] Correspondence: Oluwaseun Anyiam, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB UK ( o.anyiam@ 123456nhs.net ).
                Author information
                http://orcid.org/0000-0003-2425-2299
                Article
                Publisher ID: CCR31694
                DOI: 10.1002/ccr3.1694
                PMC ID: 6186879
                SO-VID: 4c3020fd-39b5-4b27-9052-a1500f083393
                Copyright © © 2018 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 February 2018
                Date revision received : 23 March 2018
                Date accepted : 25 May 2018
                Page count
                Figures: 2, Tables: 1, Pages: 5, Words: 2623
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                component-id ccr31694
                cover-date October 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.0.1 mode:remove_FC converted:15.10.2018

                Keywords: acute medicine,adrenal insufficiency,empty sella,endocrinology,hypothyroidism
                Data availability:
                Keywords: acute medicine, adrenal insufficiency, empty sella, endocrinology, hypothyroidism

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