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Deng-Huang Su

Publications and source records attributed to Deng-Huang Su.

15 recordsLinked to original sources
PubMed2006

Secondary hyperparathyroidism as a palpable intrathyroid parathyroid gland in a patient with hypophosphatemic osteomalacia.

Secondary hyperparathyroidism is sometimes seen in patients with hypophosphatemic osteomalacia after long-term oral phosphate therapy. Parathyroidectomy is sometimes needed for the correction of hypercalcemia in these patients, and is rarely performed in patients without hypercalcemia. A 46-year-old female patient had hypophosphatemic osteomalacia with unknown cause and secondary hyperparathyroidism. A palpable neck mass developed after long-term oral phosphate therapy. An intrathyroid parathyroid gland was confirmed through partial thyroidectomy and parathyroidectomy. Renal phosphate wasting decreased strongly, and serum parathyroid hormone was in the normal range after the operation. A correction of secondary hyperparathyroidism may partially overcome hyperphosphaturia in some patients with hypophosphatemic rickets.

Female↗
PubMed2006

Hypopituitarism: a sequela of severe hypoxic encephalopathy.

BACKGROUND/PURPOSE: Central diabetes insipidus (DI) is an established phenomenon after hypoxic encephalopathy or brain death, but hypopituitarism is seldom described. This study investigated the characteristics of 11 patients with DI and hypopituitarism which developed after severe hypoxic encephalopathy. METHODS: The medical records of patients with DI and hypopituitarism after severe hypoxic encephalopathy from 1997 to 2002 were retrospectively reviewed. Eleven patients with DI and hypopituitarism after severe hypoxic episodes were included. Demographic data, primary diagnosis, the time of onset of DI, the time of diagnosis of hypopituitarism, the presence of symptoms of hypopituitarism, and outcome of these patients were analyzed. RESULTS: Eleven patients comprising nine females and two males aged 47.4 +/- 19.3 years (range, 24-74 years) were included. The mean interval from the precipitating event to the onset of DI was 60 +/- 46 hours (range, 11-131 hours). The mean interval from the precipitating event to the diagnosis of hypopituitarism was 423 +/- 182 hours (range, 132-672 hours). The average duration of hospitalization was 63 +/- 35 days (range, 9-113 days). The overall mortality rate during hospitalization was 45%. Four patients died of sepsis and one died of heart failure due to acute myocardial infarction. CONCLUSION: The development of DI after severe hypoxic encephalopathy is a sign of severe brain damage. It usually ensues immediately or days after loss of brain stem reflexes. Hypopituitarism developed several weeks later than DI in these patients. Recognition and treatment of these deficiencies may prevent organ dysfunction.

Adrenocorticotropic Hormone↗
PubMed2006

Long-term primary medical therapy with somatostatin analogs in acromegaly.

To cure acromegalic patients, transsphenoidal surgery is considered first, especially for microadenoma. However, less than 50% of patients with macroadenoma achieve satisfactory biochemical control. Moreover, surgery may cause hypopituitarism. Medical therapy may offer the prospect of near normalization of growth hormone (GH)/insulin-like growth factor-1 levels with substantial tumor shrinkage in a significant number of patients. Here, we report two cases of acromegaly under treatment with somatostatin analogs alone for more than 10 years. Case 1 was a 54-year-old man with a pituitary macroadenoma. He received 4 years of octreotide treatment followed by 6 years of prolonged-release (PR) lanreotide resulting in normal GH level. Case 2 was a 60-year-old woman with a 1.3 cm pituitary tumor. She received 8 years of octreotide treatment followed by 6 years of PR lanreotide resulting in subnormal GH level and gallbladder sludge. She had received bilateral total hip replacement for hip osteoarthritis at the age of 59 years. These cases illustrate that long-term treatment with somatostatin analogs offers an alternative choice in selected acromegalic patients, such as those with pituitary tumor who cannot be cured by surgery, those who have unacceptable anesthetic risk and those who refuse surgery.

Acromegaly↗
PubMed2006

Septic cavernous sinus thrombosis: an unusual and fatal disease.

BACKGROUND: Septic cavernous sinus thrombosis (CST) is a rare and fatal disease. Clinical presentations in the early stage are nonspecific, and the sensitivity of cranial axial computed tomography (CT) with thick section is low. This study analyzed the clinical manifestation and neuroimaging findings in patients with septic CST in a medical center in Taiwan. METHODS: This retrospective case series included nine patients with septic CST who had typical symptoms and clinical course, evidence of infection, and imaging studies which demonstrated cavernous sinus lesion, and who were treated between 1995 and 2003 at National Taiwan University Hospital. RESULTS: Seven (77.8 %) patients were more than 50 years old. Five (55.6%) had diabetes, and three (33.3%) had hematologic diseases. All cases were associated with paranasal sinusitis. The most frequent initial symptom was headache (66.7%), followed by ophthalmic complaints (diplopia or ophthalmoplegia, 55.6%; blurred vision or blindness, 55.6%), and ptosis (44.4%). Initial cranial images failed to identify CTS in all patients. Subsequent magnetic resonance imaging (MRI) or coronal contrast-enhanced CT (CECT) with thin section confirmed the diagnosis. Fungi were the most common pathogens (55.6%). The inhospital case-fatality rate was high (44.4%). CONCLUSION: Due to the high case-fatality rate and low yield rate of blood cultures, fungal CST should be suspected in an immunocompromised patient with ophthalmic complaints that progress from one eye to the other. Coronal thin-section CECT may be a useful alternative to MRI as a diagnostic modality for this condition.

Adolescent↗
PubMed2005

Rare presentation of endocrine pancreatic tumor: a case of diffuse glucagonoma without metastasis and necrolytic migratory erythema.

Glucagonoma is a very rare endocrine pancreatic tumor. At diagnosis, most glucagonomas are malignant and often metastatic. Suspicion of glucagonoma is based on characteristic presentations known as "glucagonoma syndrome". Glucagonoma is often found in the pancreatic body and/or tail and is usually large enough to be localized by computed tomography. We report a case of diffuse glucagonoma necrolytic migratory erythema (NME) in a 45-year-old man with mild diabetes mellitus, mild anemia, and weight loss over 1.5 years. Diffused enlarged pancreas was noted on abdominal ultrasonography incidentally during a routine health check-up. The levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were within normal limits. No enlarged lymph node or extrapancreatic tumor mass was found by several imaging studies. Total pancreatectomy was performed, and the pathology revealed glucagon-producing islet cells and intrapancreatic vascular emboli of tumor cells. He died due to internal bleeding and sepsis after surgery. Presentation of diffuse malignant glucagonoma with tumor emboli but no metastasis or NME is unusual.

Glucagonoma↗
PubMed2005

Post-traumatic anterior and posterior pituitary dysfunction.

BACKGROUND AND PURPOSE: The recognition of hypopituitarism after head trauma is important because related neurobehavioral problems can be alleviated by hormone replacement. This study investigated the clinical presentations and imaging findings of patients with hypopituitarism developing after head trauma. METHODS: We retrospectively reviewed the medical records of patients with hypopituitarism from 1982 through 2002. Data on disease history and hormone deficiencies of patients with hypopituitarism which developed after head trauma were analyzed. RESULTS: Eighteen patients with hypopituitarism or diabetes insipidus (DI) due to head trauma, including 11 men and 7 women, were identified. Head trauma thus accounted for the etiology in 2.8% of all 635 patients with a diagnosis of hypopituitarism during the study period. The major cause of head trauma was road accident (n = 11, 61%). Ten of the patients (56%) had lost consciousness after the head injury. The duration from head trauma to the onset of symptoms of hypopituitarism ranged from < 1 month to 15 years. Sex hormone (61%) and growth hormone (56%) were the most common hormone deficiencies, followed by corticotropin deficiency (39%) and thyrotropin deficiency (22.2%). DI developed in 9 patients (50%) and 5 of these patients had only DI without anterior hypopituitarism. Routine skull radiograph did not show abnormal signs. Among the 10 patients with magnetic resonance imaging of the pituitary gland, a small or atrophic anterior lobe was seen in patients with anterior hypopituitarism. Loss of bright signal intensity from the pituitary posterior lobe on T1-weighted magnetic resonance imaging was seen in all 3 patients with DI. An ectopic posterior lobe could be seen in 2 patients with hypopituitarism without DI. CONCLUSIONS: Identification of head trauma as the etiology of hypopituitarism may be overlooked if there is a long delay in onset after trauma. DI is a common early complication. Since anterior hypopituitarism can develop decades after the episode of head trauma, monitoring for endocrine dysfunction during follow-up of these patients is important.

Adolescent↗
PubMed2005

Unusual presentation of thyrotoxicosis as bradycardia, acute renal failure and hyperuricemia in an elderly patient.

Bradycardia with renal system involvement in patients with thyrotoxicosis has rarely been reported. We report a 72-year-old woman with unusual presentations of sinus bradycardia and normothermia accompanied by acute renal failure and hyperuricemia in thyrotoxicosis. The electrocardiogram changes in this patient included sinus bradycardia (50 beats per minute), followed by atrial fibrillation (84 beats per minute), and finally sinus rhythm with T wave inversion (80 beats per minute). Her renal function and hyperuricemia completely recovered after appropriate antithyroid therapy. A high index of suspicion is needed for early diagnosis and antithyroid treatment in patients with unusual manifestations of thyrotoxicosis in general clinical practice.

Acute Kidney Injury↗
PubMed2004

Lanreotide treatment in a patient with interferon-associated Graves' ophthalmopathy.

BACKGROUND: We report a case of Graves' ophthalmopathy (GO) developed after the administration of interferon-alpha for chronic hepatitis C. METHODS: The GO was treated with lanreotide. RESULTS: A 47-year-old female patient presented with euthyroid GO with spontaneous retrobulbar pain, eyelid edema, conjunctival injection and eyelid retraction of the right eye and conjunctival injection of the left eye 6 months after administration of interferon-alpha for chronic hepatitis C. Orbital computed tomography revealed no involvement of extraorbital muscles and no increase in retrobulbar adipose tissue. Only soft tissue was involved. These symptoms subsided after 12 weeks of lanreotide treatment, except right eyelid retraction, which, however, disappeared later during follow-up. CONCLUSION: The use of interferon-alpha may be complicated by GO and lanreotide might be considered for GO if patients cannot accept steroid therapy.

Antiviral Agents↗
PubMed2003

Characteristics of Cushing's syndrome in Taiwanese.

BACKGROUND AND PURPOSE: Diagnosis and management of Cushing's syndrome is a challenge to the endocrinologist. This retrospective study investigated the etiology, clinical presentation, treatment and prognosis of endogenous Cushing's syndrome and compared the differences of prognostic factors between Cushing's disease patients with macroadenoma and microadenoma. METHODS: Data on disease history, physical examination, and biochemistry of Cushing's syndrome and factors related to the prognosis of Cushing's disease were analyzed. RESULTS: A total of 61 consecutive patients (52 women and 9 men) with endogenous Cushing's syndrome treated from January 1992 to July 2002 were included in this study. They comprised 31 cases of adrenal adenoma, 19 cases of Cushing's disease, 6 cases of ectopic adrenocorticotropin (ACTH) syndrome, 3 cases of adrenal carcinoma, 1 case of macronodular hyperplasia, and 1 case of micronodular hyperplasia. ACTH-independent Cushing's syndrome was the most frequent etiology in this series. The most common symptoms and signs were moon face (89%), weight gain (74%), buffalo hump (74%), and truncal obesity (72%). Hypercholesterolemia was noted in 27 of 45 patients (60.0%) checked for total serum cholesterol level. Elevation of serum lactate dehydrogenase was found in 29 (74.3%) of 39 patients assessed. Patients with adrenal adenoma had the highest cure rate. High residual (2/17, 11.8%) and recurrent rates (5/17, 29.4%) were found in patients with Cushing's disease. There were no significant differences in prognostic factors between Cushing's disease patients with macroadenoma and microadenoma. CONCLUSIONS: ACTH-independent Cushing's syndrome was the most frequent type of Cushing's syndrome in this series. The dyslipidemia and elevation of lactate dehydrogenase activity in this series indicated the need for routine laboratory testing in Cushing's syndrome patients. This study found no significant differences in prognostic factors between Cushing's disease patients with macroadenoma and microadenoma.

Adenoma↗
PubMed2002

Acute suppurative thyroiditis caused by Salmonella typhimurium: a case report and review of the literature.

A 79-year-old woman with acute suppurative Salmonella thyroiditis is reported. She presented with fever and an enlarged, painful thyroid mass. Diagnosis was suspected by clinical symptoms and signs and confirmed by ultrasound, neck magnetic resonance imaging, aspiration cytology, and culture. The culture of fine-needle aspirate yielded Salmonella typhimurium. She was treated by parental antibiotics and surgical drainage. The source and route of infection remained unclear under a series of examinations. No piriform sinus fistula was evident on the imaging study. A hematogenous spread seems to be the most possible route.

Acute Disease↗
PubMedDate not supplied

Secondary infection and ischemic necrosis after fine needle aspiration for a painful papillary thyroid carcinoma: a case report.

BACKGROUND: Papillary thyroid carcinoma (PTC) is often asymptomatic and rarely presents as a painful goiter. Further, the thyroid gland is not easily infected. Therefore, acute suppurative thyroiditis (AST) is unusual. PTC is also seldom combined with AST. We report a case of painful PTC with secondary infection after fine needle aspiration (FNA). CASE: A 19-year-old girl complained of a painful goiter without skin change after an episode of upper airway infection. PTC was diagnosed according to the FNA cytology (FNAC) at another hospital. The goiter became more painful after FNA. The patient's second FNAC at our hospital revealed only many polymorphonuclear leukocytes (PMNs). Antibiotic treatment ameliorated the pain, but the goiter persisted. The third FNAC revealed some PMNs and papillary carcinomatous cells. After total thyroidectomy, pathology revealed ischemic necrosis with a focal PMN aggregation around the needle track and papillary carcinomatous cells nearby. According to the time sequence, secondary infection after FNA was suspected. CONCLUSION: A painful goiter is an unusual presentation of PTC. Although FNAC is feasible for studying a thyroid lesion, malignant cells might be missed when secoandary injection and ischemic necrosis occur after FNA. Therefore, aseptic procedures are necessary to prevent bacteria from seeding into the thyroid.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

Follicular variant of papillary thyroid carcinoma: diagnostic limitations of fine needle aspiration cytology.

OBJECTIVE: To study the diagnostic sensitivity and specificity of fine needle aspiration cytology (FNAC) offollicular variant of papillary thyroid carcinoma (FVPTC). STUDY DESIGN: The study group consisted of 390 papillary thyroid carcinoma (PTC) cases diagnosed histologically with thyroidectomy specimens. The FNAC and histopathologic classification were compared in terms of the appearance of FVPTC and non-FVPTC statistically with the chi squared test. Also, several features of the cytologic smears of FVPTC were reviewed. RESULTS: Twelve of the 390 PTC cases were classified as FVPTC histologically. Five of the 12 cases were also reported as FVPTC in the diagnosis by FNAC and the other 7 as the usual type of PTC (UTPTC). There was 1 case classified as UVPTC histologically but FVPTC cytologically. If we use histologic diagnosis as the gold standard, the sensitivity and specificity of FNAC diagnosis of FVPTC were 42% and 83%, respectively. CONCLUSION: FNAC may be a good tool for diagnosing PTC, but it is unreliable to differentiate between FVPTC and UTPTC.

Adolescent↗
PubMedDate not supplied

Determining when to operate on patients with Hashimoto's thyroiditis with nodular lesions: the role of ultrasound-guided fine needle aspiration cytology.

OBJECTIVE: To elucidate the role of ultrasound-guided fine needle aspiration cytology (FNAC) in determining whether to request an operation. STUDY DESIGN: Twenty-four consecutive patients (23 women and 1 man) with Hashimoto's thyroiditis combined with nodular lesions revealed by ultrasonography were included in the study. Ultrasound-guided FNAC was performed on their thyroid tissue compatible with Hashimoto's thyroiditis and nodular lesions. RESULTS: Two of 24 patients (8.3%) had papillary thyroid cancer, which was diagnosed from aspirates of 31 nodular lesions and confirmed by operative pathologic findings. CONCLUSION: If a patient with Hashimoto's thyroiditis has nodular lesions shown by ultrasonography, ultrasound-guided FNAC is helpful in elucidating the nature of the lesion and determining whether to request an operation.

Adult↗