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Query: UMLS:C0042963 (vomiting)
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Three boys, aged 5, 11 and 14 years, were admitted due to vomiting, fatigue and dehydration, and a 10-year-old boy was admitted due to circulatory and respiratory insufficiency. Two had Addison's disease, one had a late presentation of congenital adrenal hypoplasia due to a DAX-1 mutation and in one adrenal insufficiency was the first manifestation ofadrenoleukodystrophia. The boys recovered after treatment. It is important to recognise the symptoms of adrenal insufficiency, because treatment can be life-saving. After the initial diagnosis the underlying pathology should be sought.
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PMID:[Primary adrenal insufficiency in children]. 1594 Sep 15

Similar symptoms make the differential diagnosis of anorexia nervosa and Addison's disease difficult at times: vomiting, weight loss, hypotension, depressed mood, reduced drive, and increased irritability can occur in both disorders. Psychological factors are then frequently presumed to be causative, so that the diagnosis of Addison's disease is made only years after the onset of the disease. Against this background, our case report presents important differential features, particularly with regard to consultative psychiatry.
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PMID:[Differential diagnosis of anorexia nervosa and depression. A case report of Addison's disease in a female patient]. 1604 36

Addisonian crisis represents a state of acute adrenocortical insufficiency and occurs in patient with Addison's disease who are exposed to stress of infection, surgery, trauma, vomiting and diarrhea. We present a case with a 39-year-old female patient who admitted to the hospital with Addisonian crisis and, interestingly, her electrocardiograph showed ST depression and inverted T waves on inferior and V4-V6 leads. She did not have a history of angina pectoris and coronary artery disease, and her cardiac enzymes were normal. Exercise stress testing and echocardiographic assessment revealed normal findings. When faced with such a patient who has hypotension and ischemic ECG changes without having underlying angina, Addisonian crisis should be considered in differential diagnosis.
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PMID:Inverted T waves in patient with Addisonian crisis. 1633 1

In literature different cases of polyglandular autoimmune type II syndrome (PGA II) are reported, where Addison's disease is associated with gonadal insufficiency. The lack in the production of sexual steroids causes a severe postmenopausal osteoporosis. The case we report is related to a 38-year-old woman we met in 1988 and who was suffering from deep asthenia, cramps, cutaneous hyperpigmentation, nausea, vomiting, abdominal pain, weight loss and hypotension. The biochemical data were indicative for autoimmune adrenal failure. Between 1988 and 1997 the patient developed a progressive insufficiency of other endocrine glands, leading to the classic feature of PGA II. In 1998, this clinical status was complicated by a severe osteoporosis. We thought that the sudden decrease in the bony mineral density was due to the lack of the protective role played by adrenal gland androgens in postmenopausal osteoporosis. They would directly act on the bony tissue, independently from oestrogens peripheral conversion, thus producing a stimulant effect on the bone formation. A new therapeutical approach, in case of osteoporosis, is today represented by DHEA replacement therapy in women showing low hormone levels.
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PMID:Polyglandular autoimmune endocrine insufficiency complicated by severe osteoporosis. 1721 95

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. In the normal individual, both disseminated histoplasmosis and symptomatic adrenal histoplasmosis are rare. Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with a 7-month history of generalized body weakness, easy fatigue, and frequent attacks of vomiting and diarrhea. Physical examination and laboratory investigations confirmed the diagnosis of Addison's disease due to Histoplasma capsulatum var duboisii infection of the adrenal glands. He was treated with intravenous hydrocortisone, followed by oral prednisolone and itraconazole.
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PMID:Addison's disease due to Histoplasma duboisii infection of the adrenal glands. 1852 76

1. Balance studies have been made on three dogs before and after adrenalectomy, performed in two stages. 2. It has been shown that the sodium concentration of the blood decreases in adrenalectomized dogs, as is true in patients suffering from Addison's disease and in cats experimentally adrenalectomized. 3. There are also decreases in the chloride and bicarbonate concentrations which together are approximately equivalent to the decrease in sodium. 4. An increase in the potassium concentration of the blood occurs after adrenalectomy, as reported in other studies. There is no obvious correlation of this change with changes in potassium balances. 5. The balance studies show a striking loss of sodium from the body during the development of adrenal insufficiency. This loss of Na results from an increased excretion of sodium in the urine and is not complicated by loss of base as a result of vomiting or diarrhea. 6. Following adrenalectomy, both the total amount of sodium and its concentration in the urine are markedly increased. This increase in concentration of sodium occurs in spite of an augmented urine volume. 7. The behavior of the chloride ion following adrenalectomy parallels that of the sodium ion, but the loss is not equivalent. 8. During the period of accumulation of non-protein nitrogen in the blood, the rate of water excretion by the kidney is even greater than before removal of the adrenal glands. 9. The possibility of a regulatory effect of the adrenal glands upon sodium metabolism and renal function has been discussed.
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PMID:ELECTROLYTE BALANCE STUDIES IN ADRENALECTOMIZED DOGS WITH PARTICULAR REFERENCE TO THE EXCRETION OF SODIUM. 1987 Jan 61

By cooling fresh suprarenal gland tissue immediately on removal from the animal, and by defatting, and mincing the same at low temperatures, and drying at 37 degrees C. with the least loss of time, a preparation is obtained which in daily doses of 3 grm. per os, is effective in restoring a large measure of health to sufferers from Addison's disease.It is essential that a potent extract of suprarenal cortex be available for (a) restoring the patient sufficiently to enable whole gland treatment to be instituted and (b) to treat any return of abdominal symptoms or circulatory collapse induced by intercurrent illness or failure to retain the whole gland through vomiting.It is desirable to increase the intake of sodium chloride to 10 to 15 grm. daily.Neither saline alone, nor cortical extract alone produces the same effective result as whole suprarenal gland prepared as above administered per os.Commercial preparations of whole suprarenal can be entirely without effect.Subcutaneous injection of adrenalin in a phase of weakness may have disastrous results.Trials, using the whole gland preparation on normal subjects, further establish the observations of Rowntree, that the gastric musculature is stimulated by injection of whole suprarenal gland. In certain cases, considerable elevation of blood-pressure may also result.
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PMID:The Treatment of Addison's Disease by Whole Adrenal Gland: (Section of Therapeutics and Pharmacology). 1999 Mar 13

Type 1 diabetes mellitus (T1DM) results from autoimmune destruction of insulin-producing beta cells and is characterised by the presence of insulitis and &and beta-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome. Fifteen to 30% of T1DM subjects have autoimmune thyroid disease (Hashimoto's or Graves' disease), 5 to 10% are diagnosed with autoimmune gastritis and/or pernicious anaemia (AIG /PA), 4 to 9% present with coeliac disease (CD), 0.5% have Addison's disease (AD), and 2 to 10% show vitiligo. These diseases are characterised by the presence of autoantibodies against thyroid peroxidase (for Hashimoto's thyroiditis), TSH receptor (for Graves' disease), parietal cell or intrinsic factor (for AIG /PA), tissue transglutaminase (for CD), and 21-hydroxylase (for AD). Early detection of antibodies and latent organ-specific dysfunction is advocated to alert physicians to take appropriate action in order to prevent full-blown disease. Hashimoto's hypothyroidism may cause weight gain, hyperlipidaemia, goitre, and may affect diabetes control, menses, and pregnancy outcome. In contrast, Graves' hyperthyroidism may induce weight loss, atrial fibrillation, heat intolerance, and ophthalmopathy. Autoimmune gastritis may manifest via iron deficiency or vitamin B12 deficiency anaemia with fatigue and painful neuropathy. Clinical features of coeliac disease include abdominal discomfort, growth abnormalities, infertility, low bone mineralisation, and iron deficiency anaemia. Adrenal insufficiency may cause vomiting, anorexia, hypoglycaemia, malaise, fatigue, muscular weakness, hyperkalaemia, hypotension, and generalised hyperpigmentation. Here we will review prevalence, pathogenetic factors, clinical features, and suggestions for screening, follow-up and treatment of patients with T1DM and/or autoimmune polyglandular syndrome.
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PMID:Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. 2000 14

Primary adrenal insufficiency is an endocrine disorder characterized by cortisol and aldosterone deficiency caused by destruction of the adrenal cortex. Adrenal crisis is a medical emergency with acute symptoms: nausea, vomiting, abdominal pain, fever, hypoglycemia, seizures, hypovolemic shock, and cardiovascular failure. It occurs in patients with chronic adrenal insufficiency who are exposed to additional stress, such as infection, trauma, or surgical procedures. Dental infection is a possible cause of adrenal crisis in patients with chronic adrenal insufficiency, so pediatric endocrinologists and pediatric dentists should be aware of this risk. The purpose of this report was to present a 6-year-old patient in whom Addison disease was diagnosed through adrenal crisis provoked by dental infection. The patient was treated with intravenous rehydration, intravenous hydrocortisone and antibiotics, and extraction of the infected primary tooth. Multidisciplinary approach and collaboration between the pediatric endocrinologist and the pediatric dentist are necessary to enable adequate medical and dental treatment in children with primary adrenal insufficiency.
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PMID:Adrenal crisis provoked by dental infection: case report and review of the literature. 2067 14

The authors present the case of a 6-year-old boy with a good neurological outcome from extreme hyponatraemia caused by autoimmune hypoadrenalism. He presented with 1 week of reduced appetite, lethargy, vomiting and one episode of diarrhoea. He was described as being slightly unsteady on his feet. Clinically he was alert, although intermittently confused, with dry mucous membranes and sunken eyes. Serum sodium was 96 mmol/l with normal serum potassium and renal function. He was initially treated with 3% saline intravenously, and his serum sodium increased to 128 mmol/l by day 3. He developed slurred speech and ataxia on day 4, although MRI brain showed no evidence of pontine myelinosis, and the symptoms resolved over 1 week. A Synacthen test on day 10 confirmed a diagnosis of Addison's disease and he was commenced on hydrocortisone and fludrocortisone replacement therapy. At 5 months follow-up there are no obvious neurological or developmental sequelae.
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PMID:Extreme hyponatraemia with intact neurological outcome in a young child with Addison's disease. 2267 34


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