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Biomedical subjects

L J M de Heide

Publications and source records attributed to L J M de Heide.

5 recordsLinked to original sources
PubMed2005

[Pituitary apoplexy: an endocrinologic emergency].

A 32-year-old woman, a 73-year-old man and a 26-year-old pregnant woman presented with headache, vomiting, and variable presence of visual disturbances, impaired consciousness, and circulatory shock. All three had pituitary apoplexy. In the first patient lymphocytic hypophysitis was diagnosed, the second had a nonfunctional adenoma and the last patient probably also. All three patients were treated conservatively with full recovery of signs and symptoms. However pituitary insufficiency remained in all three. Pituitary apoplexy is an acute event with significant morbidity and mortality. The cause is a rapid expansion of, usually, a pre-existing, often not yet known, adenoma by massive haemorrhage or infarction. Pressure, among other things, causes hypopituitarism, meningism, compression of the chiasma opticum and visual disturbances. Although many predisposing factors have been identified, pituitary apoplexy is often an unpredictable event. Diagnosis is made by the typical clinical presentation, eye examination, MRI and by measuring pituitary hormones. Treatment is with suppletion of the deficient hormones and in selected patients by transsphenoidal decompression surgery.

Adenoma↗
PubMed2005

[A Somali man with a painful thyroid mass: thyroid tuberculosis].

A 21-year-old man from Somalia presented with a painful mass in the thyroid, 6 months offatigue, weight loss and fever. Two separate courses of antibiotics did not improve his condition. Thyroid function tests were normal. The chest X-ray showed an enlarged hilus with some pulmonary infiltration around it. The diagnosis ofthyroid tuberculosis was established by cytological, microbiological and PCR testing of a fine needle aspirate of a thyroid lymph node. Treatment with antituberculosis agents resulted in a complete clinical response. The differential diagnosis of a painful thyroid mass encompasses subacute granulomatous thyroiditis, infectious thyroiditis, radiation- or trauma-induced thyroiditis and haemorrhage in the thyroid lymph nodes. Although thyroid tuberculosis is mainly a disease of developing countries, increasing immigration can lead to a higher incidence of this rare form of extrapulmonary tuberculosis and should therefore also be considered in patients with a painful thyroid mass.

Adult↗
PubMed2005

Severe hypocalcaemia associated with extensive osteoblastic metastases in a patient with prostate cancer.

A patient with an untreated carcinoma of the prostate was admitted with dehydration, stupor and a surprisingly deep hypocalcaemia. The severe hypocalcaemia was largely attributed to extensive osteoblastic activity due to widespread skeletal metastases although contributing factors to the severity of the hypocalcaemia were a relative vitamin D deficiency, hypomagnesaemia and renal impairment, preventing the mounting of an adequate homeostatic response. There was significant clinical and biochemical improvement after antitumour treatment using androgen deprivation, and supplementation with calcium and vitamin D.

Adenocarcinoma↗
PubMed2004

Pituitary apoplexy presenting during pregnancy.

Pituitary apoplexy during pregnancy is a rare but serious event with significant morbidity and even possible mortality if not recognised in time. A 26-year-old woman was admitted with sudden onset of severe headache, vomiting, disturbed consciousness and photophobia. MRI showed a pituitary apoplexy. Adrenal insufficiency with circulatory shock was present together with deficiency of the other hormones produced by the adenohypophysis. After treatment with glucocorticoids, diabetes insipidus developed for which treatment was given. She was treated conservatively and the clinical picture improved in a few days, followed by an uneventful pregnancy and delivery. A second MRI showed regression of mass effect with tumour expanding into the left cavernous sinus. No signs of tumour progression or abnormal hormone secretion have occurred up to one year after the event. Complete pituitary insufficiency has remained. The literature on the subject is reviewed with special emphasis on the circumstances in which pituitary apoplexy occurred and on the treatment of this endocrine emergency. In conclusion, pituitary apoplexy is a rare complication of pregnancy. The severe consequences of missing the diagnosis underline the importance of this potentially lethal endocrine emergency.

Adult↗