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Case reports 1/2013

SCIENTIFIC REVIEWS

ORIGINAL ARTICLES

CASE REPORTS

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HYPOPITUITARISM DUE TO PITUITARY STALK AGENESIS – A REVIEW OF THE LITERATURE AND A CASE REPORT
V. Grozeva and M. Boyanov
Endocrinology Clinic, University Hospital Aleksandrovska
Department Internal Medicine, Faculty of Medicine, Medical University – Sofia

Summary: The pituitary stalk agenesis is a rare disorder, characterized by total insufficiency of anterior pituitary hormones. We describe a case of a woman with hypogonadotropic hypogonadism and primary hypothyroidism, diagnosed at the age of 15 because of lacking puberty. The imaging revealed pituitary stalk agenesis. In addition, secondary hypocorticism was proven. Moreover, data collected pointed at partial secondary hypothyroidism and hyposomatotropism. We comment on the lack of hyperprolactinemia and diabetes insipidus. The timely diagnosis and treatment of multiple pituitary hormone deficiencies are of vital importance for the growth and development. The patients with untreated hypopituitarism have elevated mortality rates due to cardiovascular and cerebrovascular events.
Key words: pituitary stalk, panhypopituitarism, agenesis

ACUTE RADIATION ESOPHAGITIS- A COMPLICATION IN PATIENTS WITH THORACIC MALIGNANCIES UNDERGOING RADIOTHERAPY
(Diagnosis and therapeutic problems with presentation of a clinical case)

P. Karagyozov, C. Minchev, R. Lazarov, G. Kirova and S. Stoynov
Tokuda Hospital Sofia
Summary: Radiation esophagitis is the most important dose-limiting acute toxicity during radiotherapy for thoracic malignancies.These toxicities can limit the maximum dose of radiation therapy (RT) and chemotherapy, and, thus, may limit the efficacy of treatment. The combination with chemotherapy increases the risk of developing an acute esophageal injury. The first symptoms of radiation esophagitis are dysphagia and odynophagia. They are seen usually 2-3 weeks after beginning of the therapy. The majority of patients do not develop severe complications and the symptoms resolve spontaneously for few weeks. Some of them, however, may develop severe esophagitis with complications, such as ulcers, stenosis, fistula, spontaneous esophageal perforation, severe bleeding. Histologically, acute radiation esophagitis is primarily due to effects on the basal epithelial layer. This causes a thinning of the mucosa, which can progress to denudation. The diagnosis is done by X-ray or better upper gastrointestinal endoscopy. Endoscopically, mucositis and ulceration may be observed. We present a clinical case with acute radiation esophagitis after definitive radiotherapy for pulmonary cancer and the evolution of the complications from acute inflammation and ulcers developed immediately after RT to aerodigestive fistula. We used PEG for enteral feeding in the acute phase with severe dysphagia and odynophagia and semicovered metal stent for treating the tracheoesophageal fistula. Three months after the complete closure of the fistula we removed the PEG-tube and the patient did not have any esophageal complains 6 months later. This is a typical case of acute esophageal injury after definitive RT. The dynamic endoscopic control is an important tool in order to diagnose the changes in the pathological findings and to choose the best treatment modality..
Key words: acute radiation esophagitis, definitive radiotherapy, lung cancer, complications, upper gastrointestinal endoscopy

MULTIDISCIPLINARY APPROACH TOWARDS PAIN AROUND THE RIGHT EYE --A CASE REPORT
K. Trifonova1, A. Stefanov2, K. Slaveykov1, Zl. Trifonov1 and L. Despotova-Toleva3
1Deparment of Ophthalmology and General Medicine, Trakia University Stara Zagora
2Department of Dermatology and Otorhinolaryngology, Trakia University Stara Zagora
3Department of General Medicine, Medical University – Plovdiv

Summary: A multidisciplinary approach is required during diagnosis of a patient with a headache, in which general practitioners, neurologists, neurosurgeons, psychiatrists, ophthalmologists, otorhinolaryngologists (ENT specialists) and dentists are involved. This paper aimed at building a differential diagnosis for a patient with pain in the right eye area. Clinical case report: A patient with pain in the area of the right eye was hospitalized in the department of ophthalmology because of borderline levels of intraocular pressure. After the consultations with neurologist and ENT specialist, a cyst in the maxillary sinus was found. The patient was referred to surgical treatment in the ENT department. Differential diagnosis for pain in the head is very complicated. Here comes the role of general practitioners in correctly referring the patients to the right specialists.
Key words: intraocular pressure, maxillary sinus, differential diagnosis

RESPIRATORY SYMPTOMS IN CHILDREN WITH GASTROESOPHAGEAL REFLUX DISEASE
M. Burlea, V. Lupu, G. Paduraru, Sm. Diaconescu and A. Ignat
Pediatrics Department, University of Medicine and Pharmacy „Gr. T. Popa”, Iasi, Romania
Summary: The Gastroesophageal Reflux Disease (GERD) is a frequent entity in pediatrics, which is still under-diagnosed (“the disease of the third millennium”). The polymorphic clinical symptoms are dominated not only by post-feeding vomiting, but in many cases also by respiratory symptoms (from night cough to apnea episodes, recurrent wheezing, aspiration pneumonia and even sudden death syndrome). The GERD therapy consists in: general measures, pharmacological and/or surgical therapy. The original drugs (prokinetic agents) have been replaced lately by the proton-pump inhibitors (PPIs), as these are considered medication able to generate the disappearance of the reflux symptoms in most cases. When GERD is associated with respiratory manifestations, the PPIs therapy is controversial. Therefore, the specialized literature is to be reviewed in order to highlight such cases of this complex disease.
Key words: gastroesophageal reflux, respiratory manifestations, child


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