Author/Editor		Sinkovič, Andreja; Marinšek, Martin; Završnik, Matej
Title		Sindrom šoka pri bolnici s hipopituitarizmom zaradi tumorja hipofize
Translated title		Shock syndrome in a patient with hypopituitarism due to brain tumor
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 197-200
Language		slo
Abstract		Background. Shock syndrome is an acute tissue hypoperfusion. Early diagnosis and adequate symptomatic and causal treatment are mandatory. In spite of different etiologies (dehidration, bleeding, heart failure, sepsis), clinical signs and symptomes are similar (hypotension, tachicardia, tachipnoe, pallor, cold and wet skin, oliguria and metabolic acidosis). Rarely, the shock syndrome is the consequence of the adrenal insufficiency due to hypopituitarism caused by brain tumor where early treatment with hydrocortisone is urgent. Methods. This article presents a patient with a shock syndrome and multiorgan failure. Endocrinological testing and brain CT demonstrated an endocrinologically inactive tumor of hypophysis. The tumor was growing into adjacent hypophyseal tissue and causing hypopituitarism with secondary hypothyroidism and adrenal insufficiency and deficit of both gonadotropins and growth hormone. Conclusions. Primary or secondary adrenal insufficiency are among rare causes of shock syndrome. Whenever it is suspected, estimation of serum levels of cortisol and ACTH is necessary and immediate treatment with hydrocortisone should be instituted.
Summary		Izhodišča. Sindrom šoka je akutna težka motnja prekrvitve tkiv. Potrebno je hitro prepoznavanje in ustrezno simptomatsko in vzročno ukrepanje. Čeprav so vzroki za šok različni (dehidracija, krvavitev, odpoved srca, sepsa), so klinični simptomi in znaki podobni (hipotenzija, tahikardija, pospešeno dihanje, bledica, hladna in vlažna koža, oligurija, metabolična acidoza). Med redkimi vzroki je tudi odpoved nadledvičnice, bodisi primarna ali sekundarna, v sklopu hipopituitarizma zaradi tumorja hipofize, kjer je zgodnje zdravljenje s hidrokortizonom nujno. Metode. Opisan je primer bolnice s sindromom šoka in večorgansko odpovedjo, kjer je bil s hormonskim testiranjem in CT možganov dokazan hormonsko neaktivni tumor hipofize, ki je z vraščanjem v zdravo tkivo hipofize povzročil hipopituitarizem s sekundarno hipotirozo in odpovedjo nadledvičnice, znižanje gonadotropnih hormonov in rastnega hormona. Zaključki. Redek možen vzrok za šok je tudi insuficienca nadledvičnice, bodisi primarna ali sekundarna. Ob vsakem sumu je potrebno določiti serumske vrednosti kortizola in ACTH in nato takoj pričeti zdravljenje s hidrokortizonom.
Descriptors		PITUITARY NEOPLASMS HYPOPITUITARISM HYPOTHYROIDISM ADRENAL GLAND HYPOFUNCTION SHOCK AGED TOMOGRAPHY, X-RAY COMPUTED