- •State medical university of ukraine
- •Emergency medicine
- •Poltava, 2008
- •Igor p. Kajdashev m.D., Ph. D, Professor
- •Ionizing versus nonionizing radiation
- •Ionizing radiation: electromagnetic radiation
- •Ionizing radiation: particulate radiation
- •Irradiation, contamination, and incorporation
- •Vapor exposure
- •Imaging Studies:
- •Imaging Studies
- •Imaging Studies
- •Imaging Studies
- •Imaging Studies:
- •Ventricular fibrillation
- •Imaging Studies:
- •Symptoms
- •Physical examination
- •Chest X-rays, sputum cultures, and other tests
- •Community-acquired pneumonia
- •Hospital-acquired pneumonia
- •Treatment
- •Complications
- •Respiratory and circulatory failure
- •Pleural effusion, empyema, and abscess
- •Aetiology
- •Signs and symptoms
- •Diagnosis
- •Differential Diagnosis
- •First Aid Chest wound
- •Blast injury or tension
- •Clinical treatment
- •Imaging Studies:
- •Subtypes
- •Pathology
- •Classification
- •Renal failure classification
- •Imaging Studies:
- •Chronic renal failure
- •Acute or chronic renal failure
- •Acute complications
- •Hyperparathyroidism
- •Etiology
- •Signs and symptoms
- •Diagnosis
- •Treatment
- •Hypocalciemia Pathophysiology
- •Symptoms
- •Clinical signs
- •Addisonian crisis
- •Addisonian crisis
- •Symptoms
- •It can be asymptomatic, but the following symptoms can be present
- •Signs and symptoms
- •Diagnosis
- •Pheochromocytoma
- •Diagnosis
- •Symptoms
- •Causes Pituitary adenoma
- •Other tumors
- •Diagnosis
- •Hormonal
- •Radiological
- •Surgery
- •Signs and symptoms
- •Diagnosis
- •Treatment
- •Pathophysiology
- •Treatment Prehospital Care
- •Hemocoagulation desorders Hemophilia
- •Treatment
- •Causes There are a variety of causes of dic, all usually causing the release of chemicals into the blood that instigates the coagulation.
- •Treatment
- •Signs and symptoms
- •Diagnosis
- •Itp (verlgof disease0
- •Imaging Studies:
Pheochromocytoma
A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). Extra-adrenal paragangliomas (often described as extra-adrenal pheochromocytomas) are closely related, though less common, tumors that originate in the ganglia of the sympathetic nervous system and are named based upon the primary anatomical site of origin.
Diagnosis
The diagnosis can be established by measuring catecholamines and metanephrines in plasma or through a 24-hour urine collection. Care should be taken to rule out other causes of adrenergic (adrenalin-like) excess like hypoglycemia, stress, exercise, and drugs affecting the catecholamines like methyldopa, dopamine agonists, or ganglion blocking antihypertensives. Various foodstuffs (e.g. vanilla ice cream) can also affect the levels of urinary metanephrine and VMA (vanillyl mandelic acid). Imaging by computed tomography or a T2 weighted MRI of the head, neck, and chest, and abdomen can help localize the tumor. Tumors can also be located using Iodine-131 meta-iodobenzylguanidine (I131 MIBG) imaging.
One diagnostic test used in the past for a pheochromocytoma is to administer clonidine, a centrally-acting alpha-2 agonist used to treat high blood pressure. Clonidine mimics catecholamines in the brain, causing it to reduce the activity of the sympathetic nerves controlling the adrenal medulla. A healthy adrenal medulla will respond to the Clonidine suppression test by reducing catecholamine production; the lack of a response is evidence of pheochromocytoma.
Another test is for the clinician to press gently on the adrenal gland. A pheochromocytoma will often release a burst of catecholamines, with the associated signs and symptoms quickly following. This method is not recommended because of possible complications arising from a potentially massive release of catecholamines.
Pheochromocytomas occur most often during young-adult to mid-adult life. Less than 10% of pheochromocytomas are malignant (cancerous), bilateral or pediatric.
These tumors can form a pattern with other endocrine gland cancers which is labeled multiple endocrine neoplasia (MEN). Pheochromocytoma may occur in patients with MEN 2 and MEN 3. VHL (Von Hippel Lindau) patients may also develop these tumors.
Patients experiencing symptoms associated with pheochromocytoma should be aware that it is rare. However, it often goes undiagnosed until autopsy; therefore patients might wisely choose to take steps to provide a physician with important clues, such as recording whether blood pressure changes significantly during episodes of apparent anxiety.
Acromegaly
Acromegaly (from Greek akros "extreme" or "extremities" and megalos "large" - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). Most commonly it is a benign hGH producing tumor derived from a distinct type of cells (somatotrophs) and called pituitary adenoma.
Acromegaly most commonly affects middle-aged adults and can result in serious illness and premature death. Because of its insidious pathogenesis and slow progression, the disease is hard to diagnose in the early stages and is frequently missed for many years.