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범뇌하수체저하증의 호르몬 대체요법 중단 후 발생한 스트레스 심근병증
남승완 ( Seoung Wan Nam ),이준원 ( Jun-won Lee ),심정한 ( Jeong Han Sim ),백현성 ( Hyun Sung Pack ),임창조 ( Changjo Im ),임정수 ( Jung Soo Lim ),안성균 ( Sung Gyun Ahn ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.2
Stress induced cardiomyopathy (SC) is characterized by transient left ventricular (LV) dysfunction in the absence of coronary artery disease. We report on a patient with panhypopituitarism who developed SC resulting from withdrawal of hormonal replacement therapy (HRT). A 52-year-old male visited our hospital for progressively worsening dyspnea. The patient had discontinued HRT 7 days ago, which had been administered for 18 months after transsphenoidal adenomectomy for pituitary macroadenoma. Initial electrocardiogram showed marked sinus bradycardia. Transthoracic echocardiography showed apical ballooning with an LV ejection fraction of 25%. No significant obstructive lesions were observed on coronary angiography. With a clinical diagnosis of SC associated with panhypopituitarism, HRT was restarted, including glucocorticoid and thyroxine, along with standard heart failure management. His LV function had normalized at 2-month follow-up. He remains asymptomatic and administration of beta-blocker and angiotensin converting enzyme inhibitor were discontinued He currently only requires HRT.
성재호 ( Jae Ho Seong ),김현식 ( Hyun Sik Kim ),강용석 ( Yong Seok Kang ),하성삼 ( Seung Sam Ha ),남승완 ( Seoung Wan Nam ),박정은 ( Jeong Eun Park ),한용재 ( Yong Jae Han ),공지현 ( Jee Hyun Kong ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.2
Unlike most animals, humans are unable to synthesize vitamin C and dependent on vitamin C from vegetables or fruits. Vitamin C deficiency may lead to hyperkeratosis of hair follicles, gingivitis, anemia, arthritis, general fatigue, and depression, and may cause bleeding within the soft tissues. The diagnosis of scurvy can often overlooked because it is rarely encountered in present-day society. A 54-year-old male admitted hospital because of right leg pain due to huge hematoma. He had no trauma and medication history. He`s been unemployed, and rarely eating vegetable and fruit for decades. We could see huge painful hematoma of right thigh. Erythematous and swollen gingiva was also noted. His coagulation profiles were within normal limits. However his blood cell count, the concentration of vitamin C and folate were low. As we diagnosed as scurvy, we supplied vitamin C and folic acid to him. This treatment leads to rapid reversal of scorbutic changes. Scurvy should be considered as a differential diagnosis in the setting of hemorrhagic disease, and detailed history taking is necessary. Along with literature review, we report a case of scurvy accompanied by pancytopenia whose clinical and hematologic symptoms improved with administration of vitamin and folic acid.