A 10-year-old girl presented to the pediatric clinic with headache and poor growth. On examination, her height was below the third percentile and her weight was at the tenth percentile. She had dry skin; testing showed no visual-field deficits. Laboratory studies showed a thyrotropin level of more than 150 μU per milliliter (normal range, 0.5 to 4.9), a free thyroxine level of 0.4 ng per deciliter (5.1 pmol per liter) (normal range, 0.8 to 1.4 ng per deciliter [10.3 to 18.0 pmol per liter]), and a prolactin level of 63 ng per milliliter (normal range, 3 to 28). The results of additional testing, which included the evaluation of levels of morning cortisol, gonadotropins, and insulin-like growth factor 1, were normal. Magnetic resonance imaging (MRI) of the head revealed a diffusely enhancing lesion in the sellar region extending to the optic chiasm (Panel A, arrow). A diagnosis of primary hypothyroidism with secondary pituitary hyperplasia was made, and the patient began receiving levothyroxine. Long-standing untreated primary hypothyroidism can cause pituitary hyperplasia owing to hormonal-feedback mechanisms through the hypothalamic–pituitary–thyroid axis. At 10 months of follow-up, the patient’s headaches had resolved, the thyrotropin level had normalized, and the patient had grown 6 cm in height. Repeated MRI of the head showed resolution of the pituitary enlargement (Panel B). This patient died to an orange slice, which is seen lodged in the trachea. 🍊
Death by accidental mechanical asphyxia in adults is infrequent and usually results from chocking/aspiration, entrapment, ligature strangulation by clothes catching in machinery (especially as occupational deaths) and, more frequently, sexual asphyxia.
Choking is an example of mechanical asphyxia and it involves the blockage of internal airways (posterior pharynx, larynx, trachea, and/or bronchi) by a foreign object. example to that is a toy balloon lodged in child's airway, food bolus impacted at epiglottis, or well, a huge orange slice. An 18-year-old man presented to the emergency department with chest pain. He had a history of Kawasaki’s disease, which had been diagnosed when he was 11 years of age. Despite treatment with intravenous immune globulin, coronary-artery aneurysms were detected on imaging (Panel A shows a coronary angiogram obtained 3 years before the current presentation). At the time of the current presentation, his medications included aspirin and warfarin. An electrocardiogram showed ST-segment elevations in leads V1 to V3. Emergency coronary angiography revealed occlusion of the left anterior descending artery (Panel B). Kawasaki’s disease is an acute, idiopathic, self-limiting vasculitis that primarily affects children. Clinical features include fever, nonexudative conjunctivitis in both eyes, mucositis, cervical lymphadenopathy, polymorphous rash, and changes in the hands and feet. Because not all these features are necessarily present and there is no specific diagnostic test for Kawasaki’s disease, the diagnosis may be missed in childhood or occur at such an early age that the adult patient has no recollection of illness. Affected children are at risk for cardiovascular complications. The patient underwent coronary-artery bypass surgery. At follow-up 3 years after presentation, he was doing well and had no further cardiac symptoms. Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe.Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face.Often there are periods of illness, called flares, and periods of remission during which there are few symptoms. The cause of SLE is not clear.It is thought to involve genetics together with environmental factors,female sex hormones, sunlight, smoking, vitamin D deficiency, and certain infections