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Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2

We describe a case of a 40-year-old woman who was admitted to the intensive care unit with a rapid onset of dyspnea and orthopnea. She presented progressive weakness, weight loss and secondary amenorrhea during last year, while intermittent fever was present for the last two months. Initial biochemi...

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Autores principales: Vryonidou, Andromachi, Paschou, Stavroula A, Dimitropoulou, Fotini, Anagnostis, Panagiotis, Tzavara, Vasiliki, Katsivas, Apostolos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640567/
https://www.ncbi.nlm.nih.gov/pubmed/29062486
http://dx.doi.org/10.1530/EDM-17-0097
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author Vryonidou, Andromachi
Paschou, Stavroula A
Dimitropoulou, Fotini
Anagnostis, Panagiotis
Tzavara, Vasiliki
Katsivas, Apostolos
author_facet Vryonidou, Andromachi
Paschou, Stavroula A
Dimitropoulou, Fotini
Anagnostis, Panagiotis
Tzavara, Vasiliki
Katsivas, Apostolos
author_sort Vryonidou, Andromachi
collection PubMed
description We describe a case of a 40-year-old woman who was admitted to the intensive care unit with a rapid onset of dyspnea and orthopnea. She presented progressive weakness, weight loss and secondary amenorrhea during last year, while intermittent fever was present for the last two months. Initial biochemical evaluation showed anemia, hyponatremia and increased C-reactive protein levels. Clinical and echocardiographic evaluation revealed cardiac tamponade, which was treated with pericardiocentesis. Pleural fluid samples were negative for malignancy, tuberculosis or bacterial infection. Hormonal and serologic evaluation led to the diagnosis of autoimmune polyglandular syndrome (APS) type 2 (including primary adrenal insufficiency and autoimmune thyroiditis), possibly coexisting with systemic lupus erythematosus. After symptomatic rheumatologic treatment followed by replacement therapy with hydrocortisone and fludrocortisone, the patient fully recovered. In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered. Early diagnosis and non-invasive treatment can be life-saving. LEARNING POINTS: In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered. Early diagnosis and non-invasive treatment can be life-saving for these patients. Primary adrenal insufficiency requires lifelong replacement therapy with oral administration of 15–25 mg hydrocortisone in split doses and 50–200 µg fludrocortisone once daily.
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spelling pubmed-56405672017-10-23 Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2 Vryonidou, Andromachi Paschou, Stavroula A Dimitropoulou, Fotini Anagnostis, Panagiotis Tzavara, Vasiliki Katsivas, Apostolos Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease We describe a case of a 40-year-old woman who was admitted to the intensive care unit with a rapid onset of dyspnea and orthopnea. She presented progressive weakness, weight loss and secondary amenorrhea during last year, while intermittent fever was present for the last two months. Initial biochemical evaluation showed anemia, hyponatremia and increased C-reactive protein levels. Clinical and echocardiographic evaluation revealed cardiac tamponade, which was treated with pericardiocentesis. Pleural fluid samples were negative for malignancy, tuberculosis or bacterial infection. Hormonal and serologic evaluation led to the diagnosis of autoimmune polyglandular syndrome (APS) type 2 (including primary adrenal insufficiency and autoimmune thyroiditis), possibly coexisting with systemic lupus erythematosus. After symptomatic rheumatologic treatment followed by replacement therapy with hydrocortisone and fludrocortisone, the patient fully recovered. In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered. Early diagnosis and non-invasive treatment can be life-saving. LEARNING POINTS: In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered. Early diagnosis and non-invasive treatment can be life-saving for these patients. Primary adrenal insufficiency requires lifelong replacement therapy with oral administration of 15–25 mg hydrocortisone in split doses and 50–200 µg fludrocortisone once daily. Bioscientifica Ltd 2017-10-13 /pmc/articles/PMC5640567/ /pubmed/29062486 http://dx.doi.org/10.1530/EDM-17-0097 Text en © 2017 The authors http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Vryonidou, Andromachi
Paschou, Stavroula A
Dimitropoulou, Fotini
Anagnostis, Panagiotis
Tzavara, Vasiliki
Katsivas, Apostolos
Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title_full Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title_fullStr Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title_full_unstemmed Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title_short Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
title_sort cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640567/
https://www.ncbi.nlm.nih.gov/pubmed/29062486
http://dx.doi.org/10.1530/EDM-17-0097
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