A six-year-old girl with sexual precocity

Article Abstract:

The case of a six and one-half-year-old black girl is reported by the staff of the Massachusetts General Hospital. The girl was seen because of precocious breast development, mood swings, and vaginal bleeding. Measurement of circulating pituitary hormones which stimulate the ovaries were within normal range, but male and female steroid levels were elevated in the blood. No abnormality of the pituitary was seen by X-ray, but a large mass was found in the child's pelvis by using ultrasound imaging and a pelvic examination. A diagnosis of pseudoprecocity (isosexual precocity; sexual precocity without ovulation) was made. In this condition, cells of the ovary begin to produce sex hormones which are typical of an adult, however this happens without the usual pituitary gland stimulation. The occurrence in females is due to production of sex hormones by the ovary, or as a result of an ovarian tumor. The child had exploratory surgery and her right ovary and fallopian tube were removed. The ovary had been nearly replaced by a large ovarian follicle cyst. The tumor contained cells that were responsible for the release of steroid hormones. The etiology, diagnosis and treatment of isosexual precocity in general and in regard to this unusual case are discussed.

Health aspects, Diagnosis, Ovaries, Ovarian cysts, Endocrine gland diseases, Endocrine diseases, Precocious puberty, Boepple, Paul A., Young, Robert H.

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A 48-year-old woman with acute respiratory failure and a left suprarenal mass

Article Abstract:

A 48-year-old woman was admitted to the hospital because of lower back pain, coughing up of pink mucous and difficulty breathing. The patient had a previous history of heart attacks and headaches. X-ray examination of the kidneys revealed a mass above her left kidney. The patient continued to have difficulty breathing and assisted breathing with oxygen was initiated. A failure of lung function known as adult respiratory distress syndrome (ARDS) was the initial diagnosis. The most common cause of ARDS is infection. Although the patient had fever, high white blood cell count and cardiovascular collapse indicative of a severe infection, all cultures were negative and no infection was found. A tumor was found on one side of the adrenal gland, the organ which produces steroid hormones and catecholamine. Pheochromocytoma, a tumor affecting the secretion of epinephrine, a catecholamine which raises blood pressure and stimulates the heart, was ultimately diagnosed. The increase in catecholamine caused the ARDS in this patient. The tumor was removed and the patient remains well.

Acute respiratory distress syndrome, Adult respiratory distress syndrome, Pheochromocytoma, Endocrine gland tumors

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A 50-year-old man with alcoholic cirrhosis and gastrointestinal hemorrhage

Article Abstract:

A 50-year-old man with alcoholic cirrhosis was admitted to Massachusetts General Hospital because of bleeding in his gastrointestinal system. Bleeding in alcoholic individuals is common, as the blockage of blood through the veins in the liver leads to increased pressure throughout the venous system. This case was studied because the usual types of bleeding seen in alcoholic patients, particularly from vessels in the esophagus and stomach, were not evident. The study presents the hospital record of a patient who is slowly deteriorating without a definitive location of his bleeding being determined. On the basis of the record, a potential diagnosis of an unusual pattern of bleeding from vessels in the membranes which support the intestines (mesenteries) is suggested, and ultimately confirmed by the pathologist's autopsy report.

Complications and side effects, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Liver cirrhosis, Pancreatitis, Portal hypertension, Kelsey, Peter B., Fitzgibbon, James F.K.

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