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李 淑, 胡 黎, 张 蓉, 杨 琳, 奚 立, 刘 芳, 曹 云, 周 文, 程 国. [Acute heart failure in a neonate]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:321-324. [PMID: 38557387 PMCID: PMC10986385 DOI: 10.7499/j.issn.1008-8830.2311087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
The male patient, one day old, was admitted to the hospital due to hypoglycemia accompanied by apnea appearing six hours after birth. The patient had transient hypoglycemia early after birth, and acute heart failure suddenly occurred on the eighth day after birth. Laboratory tests showed significantly reduced levels of adrenocorticotropic hormone and cortisol, and pituitary magnetic resonance imaging was normal. Genetic testing results showed that the patient had probably pathogenic compound heterozygous mutations of the TBX19 gene (c.917-2A>G+c.608C>T), inherited respectively from the parents. The patient was conclusively diagnosed with congenital isolated adrenocorticotropic hormone deficiency caused by mutation of the TBX19 gene. Upon initiating hydrocortisone replacement therapy, cardiac function rapidly returned to normal. After being discharged, the patient continued with the hydrocortisone replacement therapy. By the 18-month follow-up, the patient was growing and developing well. In neonates, unexplained acute heart failure requires caution for possible endocrine hereditary metabolic diseases, and timely cortisol testing and genetic testing should be conducted.
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Affiliation(s)
| | | | | | - 琳 杨
- 国家儿童医学中心/复旦大学附属儿科医院,内分泌遗传代谢科
| | - 立 奚
- 国家儿童医学中心/复旦大学附属儿科医院,内分泌遗传代谢科
| | - 芳 刘
- 国家儿童医学中心/复旦大学附属儿科医院,心内科上海201102
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Koyama A, Ohtake Y, Yasuda K, Sakai K, Sakamoto R, Matsuoka H, Okumi H, Yasuda T. Avoiding diagnostic errors in psychosomatic medicine: a case series study. Biopsychosoc Med 2018; 12:4. [PMID: 29563965 PMCID: PMC5848591 DOI: 10.1186/s13030-018-0122-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/19/2018] [Indexed: 12/24/2022] Open
Abstract
Background Non-organic lesions or diseases of unknown origin are sometimes misdiagnosed as “psychogenic” disorders or “psychosomatic” diseases. For the quality of life and safety of patients, recent attention has focused on diagnostic error. The aim of this study was to clarify the factors that affected misdiagnoses in psychosomatic medicine by examining typical cases and to explore strategies that reduce diagnostic errors. Case presentation The study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman’s diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD). Conclusion This study showed that multiple factors related to misdiagnoses were combined and had a mutual influence. However, they can be summarized into two important clinical observations, diagnostic system-related problems and provider issues. Provider issues contain mainly cognitive biases such as Anchoring, Availability, Confirmation bias, Delayed diagnosis, and Representativeness. In order to avoid diagnostic errors, both a diagnostic system approach and the reduction of cognitive biases are needed. Psychosomatic medicine doctors should pay more attention to physical symptoms and systemic examination and can play an important role in accepting a perception of patients based on a good, non prejudicial patient/physician relationship.
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Affiliation(s)
- Atsuko Koyama
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
| | - Yoichi Ohtake
- General Internal Medicine, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku Sakai, Osaka, 593-8304 Japan
| | - Kanae Yasuda
- 3Department of Psychosomatic Medicine, Sakai Hospital, Kindai University, 2-7-1, Harayamadai, Minami-ku Sakai, Osaka, 590-0132 Japan
| | - Kiyohiro Sakai
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
| | - Ryo Sakamoto
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
| | - Hiromichi Matsuoka
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
| | - Hirokuni Okumi
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
| | - Toshiko Yasuda
- 1Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, 377-2, Ohno-higashi, Osaskasayama City, Osaka, 589-8511 Japan
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Oruch R, Pryme IF, Engelsen BA, Lund A. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency. Neuropsychiatr Dis Treat 2017; 13:161-175. [PMID: 28144147 PMCID: PMC5248946 DOI: 10.2147/ndt.s118438] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment.
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Affiliation(s)
- Ramadhan Oruch
- Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya
| | | | | | - Anders Lund
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway
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Goto Y, Tatsuzawa K, Aita K, Furuno Y, Kawabe T, Ohwada K, Sasajima H, Mineura K. Neurological symptoms in a patient with isolated adrenocorticotropin deficiency: case report and literature review. BMC Endocr Disord 2016; 16:2. [PMID: 26754976 PMCID: PMC4709961 DOI: 10.1186/s12902-015-0082-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Isolated adrenocorticotropic hormone (ACTH) deficiency is a pituitary disorder characterized by reduction only in the secretion of ACTH. Although the underlying mechanism remains to be elucidated, numbers of cases with this entity have been increasing. We experienced a case presenting with gait disturbance necessitating differential diagnosis from idiopathic normal pressure hydrocephalus (iNPH). CASE PRESENTATION A 69-year-old female with a complaint of difficulty walking and suspected to have iNPH at a prior hospital was referred to our department. For the prior three years, she had suffered from a progressive gait disturbance. Magnetic resonance imaging (MRI) revealed global ventricular dilatation. The typical features of the gait in iNPH cases were all identifiable. Neuropsychological dementia scale tests showed deterioration. However, the major feature of a disproportionately enlarged subarachnoid-space on MRI was not obvious. The patient developed progressively worsening fatigue during hospitalization. Her symptoms resembled those of hypothalamic-pituitary tumor patients. Serum ACTH and cortisol levels were low. While corticotrophin releasing hormone stress tests showed no response, other stress tests using thyrotropin releasing hormone, luteinizing hormone releasing hormone, and growth hormone releasing hormone yielded normal responses, indicating a diagnosis of isolated ACTH deficiency. We initiated corticosteroid therapy, and her gait disturbance improved promptly. CONCLUSION Isolated ACTH deficiency may have major significance to the differential diagnosis of iNPH. Early consideration of this entity is anticipated to facilitate making an early diagnosis.
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Affiliation(s)
- Yukihiro Goto
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kazunori Tatsuzawa
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kazuyasu Aita
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yuichi Furuno
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Takuya Kawabe
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kei Ohwada
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hiroyasu Sasajima
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Katsuyoshi Mineura
- Department of Neurosurgery, Kyoto Prefectural University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Kim HJ, Jung K. Somatic delusions, unusual presenting symptoms of isolated adrenocorticotropin deficiency. Gen Hosp Psychiatry 2015; 37:e1-2. [PMID: 25467074 DOI: 10.1016/j.genhosppsych.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Hee Jin Kim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
| | - Kyongyeun Jung
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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