Fungal infections in Cushing's syndrome.
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Cushing Syndrome↗
Biomedical subjects
J W Findling
Publications and source records attributed to J W Findling.
Indomethacin-induced hyperkalemia in three patients with gouty arthritis.
We describe three patients in whom severe, life-threatening hyperkalemia and renal insufficiency developed after treatment of acute gouty arthritis with indomethacin. This complication may result from an inhibition of prostaglandin synthesis and consequent hyporeninemic hypoaidosteronism. Careful attention to renal function and potassium balance in patients receiving indomethacin or other nonsteroidal anti-inflammatory agents, particularly in those patients with diabetes mellitus or preexisting renal disease, will help prevent this potentially serious complication.
Acute Disease↗
Fulminant gram-negative bacillemia (DF-2) following a dog bite in an asplenic woman.
In a 56 year old woman, shock, disseminated intravascular coagulation, symmetrical peripheral gangrene and the adult respiratory distress syndrome developed following a dog bite. She suffered from chronic alcoholism and was asplenic. The newly described gram-negative bacillus (DF-2) was isolated from the initial blood cultures on the eighth hospital day when she was recovering from the illness. Penicillin G, clindamycin, or both (administered intravenously in large doses), and therapy directed toward the severe complications appeared responsible for her successful outcome.
Alcoholism↗
Use of a two-site immunoradiometric assay to resolve a factitious elevation of ACTH in primary pigmented nodular adrenocortical disease.
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Adrenal Glands↗
Autoimmune Addison's disease after treatment with interleukin-2 and tumor-infiltrating lymphocytes.
Autoimmune thyroiditis with hypothyroidism is a well-known complication of immunotherapy with interleukin-2 (IL-2) with or without lymphokine-activated killer (LAK) cells. To date, however, no cases of IL-2/LAK-induced autoimmune adrenalitis with adrenal insufficiency have been reported. We describe a patient who developed primary adrenal insufficiency following IL-2/tumor-infiltrating lymphocytes (TIL) immunotherapy for renal cell carcinoma. A 64-year-old male with renal cell carcinoma metastatic to bone, skin, lung, and the central nervous system presented for IL-2/TIL treatment. Nine months earlier, he had undergone a right nephrectomy and adrenalectomy. He had already received two courses of IL-2 and one course of IL-4 following surgery. Dynamic studies of adrenal function performed prior to IL-2/TIL immunotherapy demonstrated intact cortisol and aldosterone responses to ACTH as well as negative adrenal antibodies. One week after IL-2/TIL therapy, the patient developed a nonanion gap metabolic acidosis, hypotension and hypoglycemia. Adrenocortical function was re-evaluated demonstrating blunted cortisol and aldosterone responses to ACTH with an elevated plasma ACTH confirming the presence of primary adrenal insufficiency. Adrenal antibodies were now positive. Hydrocortisone and fludrocortisone were given with a good clinical response. We suggest immunotherapy with IL-2/TIL may cause adrenal insufficiency by activating autoimmune adrenalitis.
Journal Article↗
Factitious Cushing's syndrome: discovery with use of a sensitive immunoradiometric assay for corticotropin.
Factitious Cushing's syndrome is an unusual problem that may be clinically and biochemically indistinguishable from endogenous hypercortisolism. Results of biochemical studies may be misleading because of cross-reactivity of synthetic corticosteroids or their metabolites with plasma or urine cortisol. Because of its lack of specificity, radioimmunoassay (RIA) for corticotropin (adrenocorticotropic hormone or ACTH) may not show completely suppressed results in patients with surreptitious use of glucocorticoids. A new sensitive and specific immunoradiometric assay (IRMA) for ACTH demonstrates reliably suppressed levels after administration of glucocorticoids. In this report, we describe a 37-year-old woman with typical clinical and biochemical features of ACTH-dependent hypercortisolism. Metabolic evaluation had shown urinary free cortisol excretion of 7,499 nmol/day and plasma ACTH-RIA levels of 13.2 and 33.0 pmol/L on two separate occasions. The use of IRMA for the measurement of ACTH during inferior petrosal sinus sampling revealed a very low peripheral ACTH concentration (=0.4 pmol/L) and a considerably blunted response to ovine corticotropin-releasing hormone, findings that suggested ACTH-independent Cushing's syndrome. Plasma samples obtained during inferior petrosal sinus sampling were assayed for prednisolone and showed a concentration of 360 nmol/L; thus, the presence of factitious Cushing's syndrome was confirmed. Some commercial ACTH-RIA measurements may be unreliable in distinguishing ACTH-dependent from ACTH-independent hypercortisolism. ACTH-IRMA levels are low in patients with ACTH-independent Cushing's syndrome and will be helpful in identifying factitious Cushing's syndrome.
Journal Article↗
Results of a community thyroid screening program: who will benefit?
OBJECTIVE: To describe the results of a community-based thyroid screening program. METHODS: We review the recruitment process, the screening questionnaire, the laboratory procedure, and the data analysis. RESULTS: News media advertisements and facility-sponsored communications were used to recruit 1,176 participants, each of whom completed a health questionnaire and had blood withdrawn for a thyroid-stimulating hormone (TSH) assay. Most participants were female (78%), Caucasian (92%), and age 50 years or older (61%). Data from 1,139 participants were analyzed. Abnormal TSH values were found in 107 participants: TSH was low in 21 (2%) and elevated in 86 (8%). Elevated TSH values occurred in 8% of females, 7% of males, 8% of Caucasians, and 7% of Hispanics. Although the percentage of elevated TSH values tended to increase with advancing age, primarily in females, 5% of participants younger than 50 years of age had an elevated TSH. No associations were apparent between abnormal TSH values and health maintenance organization membership, self-rating of overall health, or presence of thyroid-related symptoms. Participants who rated their overall health as "excellent" or "very good" accounted for 48% of the TSH values >12 microIU/mL. CONCLUSION: Experience gained from the conduct of this screening program may help shape the expectations of future screening programs that use disease awareness and self-motivation and provide insights into program design that may maximize participation by the desired target audiences.
Journal Article↗