[ ISSN : 3067-9486 ]
Graves’ orbitopathy; Graves’ disease; Mucocoele; Proptosis; Exophthalmos
Orbitopathy is an inflammatory disorder affecting orbital and per orbital tissue. It can manifest itself with proptosis. The main cause of proptosis in adults is Graves’ Orbitopathy (GO). Recognition of GO does not exclude other causes of exophthalmos and differential diagnosis is sometimes required. The case presents the patient with Graves Disease (GD), admitted to the Department of Endocrinology due to the symptoms of active orbitopathy. The patient had significant proptosis (right eye-30mm, left eye29mm). Computed tomography showed thickening of oculomotor muscles in both eyes but also a mucous cyst localized in the right frontal sinus. The patient underwent endoscopic, intranasal removal of the lesion. Due to active, moderate to severe orbitopathy, he underwent treatment with 12 weekly pulses of intravenous methylprednisolone, followed by a 3-month prednisone therapy and orbital radiotherapy. The case describes the patient with two coexisting pathologies. Each of them could manifest itself with proptosis. The main cause of proptosis is GO. Physicians must bear in mind that in case of atypical course of GO and lack of improvement, or worsening during corticosteroid treatment, differential diagnosis should be considered. It is worth emphasizing that one of the reasons of proptosis may be a mucocoele (mucous retention cyst).
Katarzyna T, Beata R and Piotr M. Mucocoele and Graves’ Orbitopathy as the Causes of Proptosis in One Patient. SM J Endocrinol Metab. 2015;1(1):1005.
Orbitopathy is an inflammatory disorder affecting orbital and per orbital tissue. It can manifest itself with proptosis. The main cause of proptosis in adults is Graves’ Orbitopathy (GO). However, recognition of GO does not exclude other causes of exophthalmos and sometimes differential diagnosis is needed. We should take into consideration further diagnosis in patients with: unilateral exophthalmos, atypical course of GO, lack of improvement or worsening during corticosteroid treatment. One of the reasons of exophthalmos may be a mucocoele (mucous retention cyst).
A 55-year-old patient with hyperthyroidism due to Graves’ Disease (GD), diagnosed in 2010, treated with antithyroid drug from December 2010, was admitted to the Department of Endocrinology in 2011 due to the symptoms of GO lasting from the beginning of 2011. Physical examination revealed signs of active inflammation assessed in the Clinical Activity Score (CAS) as 5/7 in Right Eye (RE) and in Left Eye (LE).The patient had significant proptosis (RE-30mm, LE-29mm) and lagophthalmos in both eyes (3mm). The patient did not have any clinical signs of Dysthyroid Optic Neuropathy (DON). On admission, we diagnosed active, moderate to severe GO according to European Group on Graves’ orbitopathy [1]. We performed Computed Tomography (CT) of the orbits that showed thickening of oculomotor muscles and mucous cyst localized in the right frontal sinus of the size: 21x19x20mm (Figure 1). It was distending the wall of the sinus, penetrating to the upper-medial orbital wall. The cyst was modeling media loculomotor muscle and reached nervous-vascular bunch, but without the signs of compression. The lateral wall of the sinus was significantly thin, partially invisible - the possibility of its destruction was described (Figure 2).
Due to active, moderate to severe GO, the patient underwent a treatment with weekly pulses of intravenous methylprednisolone (ivMP) (6x500mg, 6x250mg), followed by a 3-month prednisone therapy and orbital radiotherapy.
Unfortunately, in the beginning of 2013, the patient noticed a deterioration of visual acuity and colour vision. On ophthalmologist examination, visual acuity was assessed as 0.9 and 1.0 for RE and LE respectively. The patient did not recognize all Ishihara plates with both eyes. The diagnosis of bilateral DON was established. The patient received ivMP pulses (3x1000mg) on three consecutive days. Due to lack of improvement the patient was qualified for endoscopic bilateral intranasal orbital decompression. As a continuation of implemented treatment the patient received another course of 12 ivMP pulses followed by a 3-month prednisone therapy. In the final assessment, we did not find any clinical signs of DON. On physical examination there are, however, still signs of active inflammation- assessed in CAS scale as 3/7 in both eyes. Lack of satisfactory treatment effects is probably caused by smoking cigarettes throughout the whole treatment period.
In May 2013, due to a three-year period of antithyroid drug treatment, complete normalization of serum TSH receptor antibodies and stabilization of euthyroidism, the treatment was discontinued. The patient remains in clinical and hormonal euthyroidism.
There are many diseases that can manifest themselves with proptosis. Most of them are listed in the Table 1 [2].
The differential diagnosis of proptosis is broad and includes a wide range of mass lesions that derive from orbits, the cranium, sinuses, and paranasal space. The main cause of proptosis is GO. Physicians must be aware of the possibility of coexistence of several pathologies.
The patient described above had two coexisting diseases, and each of them could manifest with proptosis. In case of atypical course of GO or lack of improvement or worsening during corticosteroid treatment it is necessary to verify the diagnosis. It is worth remembering that one of the reasons of exophthalmos may be a mucocoele.
Rodríguez-Gutiérrez R, Zapata-Rivera MA, Rodriguez-Velver KV, Montes-Villarreal J and Villarreal-Perez JZ. OPEN Giant Cystic Prolactinoma in a Woman: Do not Forget the Hook Effect. SM J Endocrinol Metab. 2015;1(1):1001.
René Rodríguez-Gutiérrez*, Maria Azucena Zapata-Rivera, Karla Victoria Rodriguez-Velver, Juan Montes-Villarreal and Jesus Zacarias Villarreal-Perez
Extracellular signal-regulated kinase-1/2 (ERK1/2) activation and expression and proliferating cell nuclear antigen (PCNA) content in normal tissues, benign and malignant (metastatic and not metastatic) human thyroid tumors were studied. In malignant tumors and follicular adenoma tissue increased PCNA expression was observed, and the amount of antigen in tumor tissue, except for follicular carcinoma, exceeded the amount in the conditionally normal tissue. Importantly, in encapsulated papillary carcinomas this excess was 85%, while in nonencapsulated, metastatic tumors PCNA content was on average more than 3 times above normal, and in the cases of most aggressive tumors with metastases in lungs – even 4 times. Total ERK content was significantly lower in tumors compared to normal tissue, except goiter. Activation of the ERK was almost completely suppressed in tumors but not in normal tissue. Thus, ERK activation is not associated with proliferative processes in thyroid tumor tissue. PCNA amount in thyroid tissue could serve as one of diagnostic and prognostic markers, and development of effective antigen inhibitors may be a promising trend in thyroid cancer treatment.
Guda BB, Pushkarev VM*, Pushkarev VV, Kovalenko A Ye, Taraschenko YM, Kovzun OI and Tronko MD
Hypothyroidism can present with variety of clinical features. But bleeding manifestations as a sole atypical presentation of hypothyroidism is extremely rare. Hemostatic disorder may be a manifestation of several underlying etiology. Here we have reported a case where a 14 yr old girl who initially presented with bleeding diathesis without any other symptoms suggestive of thyroid dysfunction but later found to be suffering from severe hypothyroidism after investigations.
Mukherjee Sudeb¹*, Datta Suhana², Datta Nath Pramatha³, and Maisnam Indira⁴
Turner syndrome (TS) involves 45XO monosomy while TS variants are mostly 45XO/46XY or 45XO/46XX (with phenotype varying from female to male).
Mara Carsote¹* and Ana Valea²
Current scientific evidence indicates the association between the elevation of triglycerides (TG), the decrease the High Density Lipoprotein Cholesterol HDLC and the increase in cardiovascular risk.
Jesus E Millan Nunez-Cortes¹* and Joaquin J Millan Perez²
Introduction: Vitamin D Deficiency (VDD) in health care workers is thought to be widely prevalent due to poor sunlight exposure due to the nature of their work. However, there is limited information of the vitamin D status in them. Hence this study was undertaken to assess vitamin D status in health care workers based on their nature of work and employment in the hospital.
Material and Methods: The study was carried in 229 healthy health care workers in a tertiary care hospital. These subjects, who were divided in six groups as per their employability: Group-1 (Medical Officers- 37), Group-2 (Nursing Officers-44), Group-3 (O.T. staff-36), Group-4 (Nursing assistant Acute ward- 38), Group-5 (Nursing assistants Non-acute wards-37) and Group-6 (Ambulance assistants-37). They underwent clinical, biochemical and hormonal evaluation for serum 25 (OH) D, iPTH, BsALP and osteocalcin levels.
Results: There were 229 health workers with a mean age of 35.5 ± 7.5 years (range 19-52 years). A total of 45 subjects (19.6%) had VDD [25(OH) D ng/ml], and 151 (65.9%) were vitamin D insufficient [25(0Hp 20-<30 ng/ml] and rest were Vitamin D Sufficient (VDI) [25(OH) D 230 ng/ml]. Nurses and operation theatre; Staff had higher prevalence of VDD and VDI than ambulance assistants. Serum 25(OH) D levels were negatively; Correlated with PTH (r -0.156, p <0.0001), BsALP (r -0.131, p < 0.001) and osteocalcin levels (r -0.129, p S' 0.001). Prevalence of secondary hyperparathyroidism increased from 30.46% to 58.35% from VDD.
Conclusion: Vitamin D insufficiency is universal in health care workers. Absence of a PTH, BsALP and osteocalcin response was observed in more than 40% of individuals with VDD, the cause of which merits further evaluation.
KS Brar¹* and MK Garg²
Background: There has been a large set of studies on potential prognostic factors in patients with renal cell carcinoma and venous tumour thrombus. However, the epidemiological evidence for the effect on survival of many them has not been consistent. Therefore, we conducted a literature review of the studies on the prognostic factors in patients with renal cancer and tumour thrombus extending into the venous system to identify determinants with the strongest predicting potential.
Methods: We performed a literature review by searching the PubMed database for articles published from its inception until November 2015 based on clinical relevanc
Results: There have been several anatomical, histological, clinical and molecular prognostic factors identified in patients with the renal cell carcinoma and tumour thrombus. Anatomical factors of the highest prognostic potential include extent of tumour thrombus, venous wall cancer invasion, and metastases to the regional lymph nodes or distant organs. Whereas the most important histological prognostic factors include renal cell carcinoma subtype, tumour grade and presence of tumour necrosis, sarcomatoid features, microvascular, as well as the renal collecting system cancer invasion. Both clinical and molecular determinants have received a very limited amount of attention in terms of prognostic usefulness in renal cell carcinoma patients with tumour thrombus.
Conclusion: Although several anatomical, histological, clinical and molecular factors have been associated with the prognosis in patients with renal cell carcinoma and venous tumour thrombus, in majority of cases the evidence is based on retrospective and limited in size studies. Therefore, further multicetre and prospective studies are needed to better understand determinants negatively affecting outcome in patients with renal cell carcinoma and tumour thrombus.
Tomasz Golabek¹*, Jakub Bukowczan², Mikolaj Przydacz¹, and Piotr L. Chlosta¹
Although a high body mass index is related to the development of cardiovascular risk factors, nowadays there are numerous evidences supporting the idea that the regional fat accumulation, its function and its endocrine products are more important than the excess of adiposity per se when considering the risk of cardiovascular disease development. In this review, we will focus on the function of the main adipokines and its role at cardiovascular level.
Sandra Feijóo-Bandín*, Diego Rodríguez-Penas, Vanessa García-Rúa, Ana Mosquera-Leal, José Ramón González-Juanatey, and Francisca Lago
Glycohemoglobin (HbA1c) is the N-terminal (1-deoxyfructosyl) valineglycation product of hemoglobin Hb A0 .
Urrechaga E*
Neuropathy and ischemia are the main disorders found in the ulceration underlying foot. The diabetic foot is the biggest complication of diabetes in the world. It estimates that 16 million of people in the carrying the United States of diabetes mellitus, about 15-20% will go to be hospitalized for complications of the diabetic foot. The inquiry concerning the physiopathologic alterations of the involved factors in the healing process of the carrier of diabetes mellitus and the complications generated for the vascular dysfunction still presents gaps. In this review, it was aimed to analyze the involved components in the tissue repair and its alterations in the diabetic patient. This is a descriptive study in which had analyzed articles indexed in the databases PUBMED and MEDLINE, in the period of 1930-2016. The study disclosed that some factors in the process of tissue regeneration, as the vascular endothelial growth factor and the fibroblast growth factor, could be altered to the hyperglycemic state. Moreover, the alterations of oxidative stress in special nitric oxide could influence negatively in the tissue repair.
José Carlos Tatmatsu-Rocha*