Sporadic thyroiditis is a condition similar in clinical course to postpartum thyroiditis, but it is not associated with pregnancy[11].. Suppurative thyroiditis is an infection of the thy
Trang 1about 5% to 10% of all women[12] This is followed by a hypothyroid state with a return to baseline after about 1 year, although some women may develop permanent hypothyroidism There is usually a small, nontender goiter, and symptoms are usually mild, the result of either the hyperthyroid
or hypothyroid state There is approximately a 70% chance of recurrence in subsequent pregnancies in those who had postpartum thyroiditis with their first pregnancy[12]
Sporadic thyroiditis is a condition similar in clinical course to postpartum thyroiditis, but it is not associated with pregnancy[11] Up to 20% of these patients eventually develop lasting hypothyroidism
Suppurative thyroiditis is an infection of the thyroid gland typically caused by a bacterial infection, and less commonly by fungal, mycobacte-rial, or parasitic infections[11] Although rare, it is more common in those with pre-existing thyroid disease and in immunocompromised patients Clinical features include a painful thyroid gland (anterior neck pain with erythema), fever, dysphagia, and dysphonia
Amiodarone-induced thyroiditis is associated with either symptomatic or asymptomatic hyperthyroidism It occurs in about 10% of patients in iodine-deficient areas, and less commonly in iodine-replete areas [7] The mechanism of thyroid dysfunction from the use of amiodarone is caused either by the release of the iodine from the drug itself or by the development
of destructive thyroiditis Individuals with underlying autoimmunity are at increased risk for developing hyperthyroidism if they are taking amiodar-one Nodular and multinodular goiters, which are more common in the elderly, are a predisposing factor for amiodarone-induced thyroiditis[7]
Clinical features
Thyroid hormone affects nearly every organ system in the body Patients with elevated thyroid hormone present in a hypermetabolic state with signs
of increased b-adrenergic activity Severity of the symptoms and signs of thyrotoxicosis are related to the duration of the disease, the magnitude of thyroid hormone excess, and age [13] Although the diagnosis is frequently straightforward in patients with overt features of hyperthyroidism, a high degree of clinical suspicion has to be exercised in those with subtle clinical features of hyperthyroidism
History
Constitutional
Many nonspecific complaints are common, particularly when hyperthy-roidism is not yet advanced or when it occurs in the elderly Complaints such as fatigue, nervousness, or anxiety can lead one to consider a
Trang 2Recognition and Management of
Adrenal Emergencies
Susan P Torrey, MDa,b
a Tufts University School of Medicine, 136 Harrison Avenue Boston, MA 02111, USA
b Department of Emergency Medicine, Baystate Medical Center,
759 Chestnut Street, Springfield, MA 01199, USA
Case 1 A 52-year-old woman presents to the emergency department (ED) with the chief complaint of palpitations, sweating, and chest tightness This has been a recurrent problem for the patient over the prior 6 months She has been treated with benzodiazepines by her primary care provider Although the symptoms are improving on presentation to the ED, she says she felt like she was going to die PMH is otherwise negative She does not smoke and denies drug or regular alcohol use Exam in the ED includes: vital signs: 188/104, 108, 20, 98.8F, oxygen saturation 98%; lungs: clear without wheeze or rales; cardiac: regular without murmur; abdomen: soft, nontender; neurologic: nonfocal exam Is this simply another presentation
of an anxiety attack in the ED?
Pheochromocytomas
Pheochromocytomas are notorious but rare catecholamine-secreting tumors of neuroectodermal origin There are several clinical issues of importance to emergency physicians, ranging from the potential for presentation as a hypertensive emergency to the recognition of more subtle symptoms masquerading as yet another anxiety attack Although pheo-chromocytoma will be diagnosed or treated infrequently in the emergency
ED, it is an important entity to consider in the differential diagnosis of several presentations
Pheochromocytomas can occur anywhere along the sympathetic chain, although 85% to 90% are discovered within the adrenal gland In adults, at least 10% are extra-adrenal; 10% are bilateral, and 10% are malignant, with
E-mail address: susan.torrey@bhs.org
0733-8627/05/$ - see front matterÓ 2005 Elsevier Inc All rights reserved.
Trang 3Bone and Mineral Metabolism
John Sarko, MD
Department of Emergency Medicine, Maricopa Medical Center,
2601 E Roosevelt Street, Phoenix, AZ 85008, USA
In addition to providing strength, support for the body, and serving as the attachment for muscles to allow movement to occur, bone is extremely active on a metabolic level and is important in the regulation of several endocrine functions It is the major source of calcium; it buffers against acidosis, and can adsorb toxins and heavy metals Calcium, phosphate, and magnesium are minerals vital to the function of all cells They are tightly regulated by several hormones, and disorders in their metabolism are common In this article, bone structure and function, and mineral metabolism are reviewed Conditions leading to bone loss are discussed,
as diseases increasing bone density are rare and less likely to be encountered
by emergency physicians
Bone and bone metabolism
Anatomy of bone
Bone comprises approximately 14% of the adult weight Two types of bone exist: cortical (compact) and cancellous (spongy)[1] Compact bone comprises 85% of the skeleton, is strong, solid, and very organized Its basic structural unit is the Haversian system (osteon), a cylindrical entity that runs along the long axis of the bone (see Fig 1) It is comprised of concentric rings of matrix called lamellae, which contain small holes called lacunae with an osteocyte in each The center of the Haversian system is an opening called the Haversian canal, which contains blood vessels and nerves Haversian canals and lacunae are connected to each other by canaliculi that are oriented parallel to the horizontal axis of the bone
Cancellous (spongy) bone makes up 15% of the skeleton, and most bones contain at least some of each type The vertebrae are predominately
E-mail address: sarkoj@yahoo.com
0733-8627/05/$ - see front matterÓ 2005 Elsevier Inc All rights reserved.