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Published in: Journal of Medical Case Reports 1/2014

Open Access 01-12-2014 | Case report

Peri-portal lymphedema in association with an acute adrenal insufficiency: case report

Authors: Elamin Ibrahim Elamin Abdelgadir, Alaaeldin MK Bashier, Inas A Al Hameedi, Azza Abdulaziz, Sona Abuelkheir, Fatheya Alawadi

Published in: Journal of Medical Case Reports | Issue 1/2014

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Abstract

Introduction

We report the case of a patient with peri-portal lymphedema in association with severe adrenal insufficiency. To the best of our knowledge, this association was not previously reported in the literature. Peri-portal lymphedema is usually seen in cases such as blunt abdominal trauma, hepatic congestion and post–liver transplantation.

Case presentation

We present the case of a 28-year-old Indian man who presented to our hospital with adrenal crisis and was treated accordingly. Computed tomography of his abdomen showed evidence of peri-portal lymphedema (edema) with some free fluid collection. We excluded other causes of this pathology and followed the patient’s condition after steroid replacement therapy. We found no other contributing factors to the patient’s peri-portal lymphedema apart from the adrenal crisis, which was more consolidated when we followed the patient after steroid replacement therapy, during which follow-up computed tomography showed complete resolution of the pathology.

Conclusions

We conclude following an extensive MEDLINE® search that this is the first case to be reported for the association between peri-portal lymphedema and adrenal insufficiency, after having excluded all other causes of peri-portal lymphedema. This signifies reporting of this case as the first one in the medical literature.
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Literature
1.
go back to reference Aggarwal A, Kotru M, Sharma V, Sharma S: Adrenal insufficiency in primary adrenal lymphoma: innocuous presentation of a rare sinister illness. Niger J Clin Pract. 2011, 14: 115-117. 10.4103/1119-3077.79251.CrossRefPubMed Aggarwal A, Kotru M, Sharma V, Sharma S: Adrenal insufficiency in primary adrenal lymphoma: innocuous presentation of a rare sinister illness. Niger J Clin Pract. 2011, 14: 115-117. 10.4103/1119-3077.79251.CrossRefPubMed
3.
go back to reference Myers KA, Kline GA: Addison disease presenting with acute neurologic deterioration: a rare presentation yields new lessons from old observations in primary adrenal failure. Endocr Pract. 2010, 16: 433-436. 10.4158/EP09282.CR.CrossRefPubMed Myers KA, Kline GA: Addison disease presenting with acute neurologic deterioration: a rare presentation yields new lessons from old observations in primary adrenal failure. Endocr Pract. 2010, 16: 433-436. 10.4158/EP09282.CR.CrossRefPubMed
4.
go back to reference Roldan-Martin MB, Rodriguez-Ogando A, Sanchez-Galindo AC, Parente-Hernandez A, Luengo-Herrero V, Sanchez-Sanchez C: Rare presentation of shock and acute mesenteric ischaemia secondary to acute adrenal insufficiency in an 11-year-old male. J Paediatr Child Health. 2013, 49: 498-500. 10.1111/j.1440-1754.2012.02556.x.CrossRefPubMed Roldan-Martin MB, Rodriguez-Ogando A, Sanchez-Galindo AC, Parente-Hernandez A, Luengo-Herrero V, Sanchez-Sanchez C: Rare presentation of shock and acute mesenteric ischaemia secondary to acute adrenal insufficiency in an 11-year-old male. J Paediatr Child Health. 2013, 49: 498-500. 10.1111/j.1440-1754.2012.02556.x.CrossRefPubMed
5.
go back to reference Kunjal RA, Ramadoo RR, Teelucksingh S, Naraynsingh V: Adrenal insufficiency and bowel obstruction: an overlooked association. Case Rep Clin Med. 2013, 2: 111-114. 10.4236/crcm.2013.22029.CrossRef Kunjal RA, Ramadoo RR, Teelucksingh S, Naraynsingh V: Adrenal insufficiency and bowel obstruction: an overlooked association. Case Rep Clin Med. 2013, 2: 111-114. 10.4236/crcm.2013.22029.CrossRef
6.
go back to reference Boulton R, Hamilton MI, Dhillon AP, Kinloch JD, Burroughs AK: Subclinical Addison’s disease: a cause of persistent abnormalities in transaminase values. Gastroenterology. 1995, 109: 1324-1327. 10.1016/0016-5085(95)90595-2.CrossRefPubMed Boulton R, Hamilton MI, Dhillon AP, Kinloch JD, Burroughs AK: Subclinical Addison’s disease: a cause of persistent abnormalities in transaminase values. Gastroenterology. 1995, 109: 1324-1327. 10.1016/0016-5085(95)90595-2.CrossRefPubMed
7.
go back to reference Rizvi AA, Kerrick JG: Liver involvement and abnormal variables in undiagnosed Addison’s disease. Endocr Pract. 2001, 7: 184-188. 10.4158/EP.7.3.184.CrossRefPubMed Rizvi AA, Kerrick JG: Liver involvement and abnormal variables in undiagnosed Addison’s disease. Endocr Pract. 2001, 7: 184-188. 10.4158/EP.7.3.184.CrossRefPubMed
8.
go back to reference Olsson RG, Lindgren A, Zettergren L: Liver Involvement in Addison’s disease. Am J Gastroenterol. 1990, 85: 435-438.PubMed Olsson RG, Lindgren A, Zettergren L: Liver Involvement in Addison’s disease. Am J Gastroenterol. 1990, 85: 435-438.PubMed
9.
go back to reference O’Beirne J, Holmes M, Agarwal B, Bouloux P, Shaw S, Patch D, Burroughs A: Adrenal insufficiency in liver disease—What is the evidence?. J Hepatol. 2007, 47: 418-423.CrossRefPubMed O’Beirne J, Holmes M, Agarwal B, Bouloux P, Shaw S, Patch D, Burroughs A: Adrenal insufficiency in liver disease—What is the evidence?. J Hepatol. 2007, 47: 418-423.CrossRefPubMed
10.
go back to reference Ly JN, Miller FH: Periportal contrast enhancement and abnormal signal intensity on state-of-the-art MR images. AJR Am J Roentgenol. 2001, 176: 891-897. 10.2214/ajr.176.4.1760891.CrossRefPubMed Ly JN, Miller FH: Periportal contrast enhancement and abnormal signal intensity on state-of-the-art MR images. AJR Am J Roentgenol. 2001, 176: 891-897. 10.2214/ajr.176.4.1760891.CrossRefPubMed
11.
go back to reference Lee SH, Han YM, Choi KC, Kim CS, Lee SY, Chung GH, Sohn MH, Yang DH, Lee YW: [Periportal low-attenuation: a CT sign of lymphatic obstruction] [in Korean]. J Korean Radiol Soc. 1995, 33: 87-92. Korean Lee SH, Han YM, Choi KC, Kim CS, Lee SY, Chung GH, Sohn MH, Yang DH, Lee YW: [Periportal low-attenuation: a CT sign of lymphatic obstruction] [in Korean]. J Korean Radiol Soc. 1995, 33: 87-92. Korean
12.
go back to reference Patrick LE, Ball TI, Atkinson GO, Winn KJ: Paediatric blunt abdominal trauma: periportal tracking at CT. Radiology. 1992, 183: 689-691.CrossRefPubMed Patrick LE, Ball TI, Atkinson GO, Winn KJ: Paediatric blunt abdominal trauma: periportal tracking at CT. Radiology. 1992, 183: 689-691.CrossRefPubMed
13.
go back to reference Koslin DB, Stanley RJ, Berland LL, Shin MS, Dalton SC: Hepatic perivascular lymphedema: CT appearance. AJR Am J Roentgenol. 1988, 150: 111-113. 10.2214/ajr.150.1.111.CrossRefPubMed Koslin DB, Stanley RJ, Berland LL, Shin MS, Dalton SC: Hepatic perivascular lymphedema: CT appearance. AJR Am J Roentgenol. 1988, 150: 111-113. 10.2214/ajr.150.1.111.CrossRefPubMed
14.
go back to reference Cutler RE, Kleeman CR, Koplowitz J, Maxwell MH, Dowling JT: Mechanisms of impaired water excretion in adrenal and pituitary insufficiency. III. The effect of extracellular or plasma volume expansion, or both, on impaired diuresis. J Clin Invest. 1962, 41: 1524-1530. 10.1172/JCI104608.CrossRefPubMedPubMedCentral Cutler RE, Kleeman CR, Koplowitz J, Maxwell MH, Dowling JT: Mechanisms of impaired water excretion in adrenal and pituitary insufficiency. III. The effect of extracellular or plasma volume expansion, or both, on impaired diuresis. J Clin Invest. 1962, 41: 1524-1530. 10.1172/JCI104608.CrossRefPubMedPubMedCentral
15.
go back to reference Kleeman CR, Czaczkes JWV, Cutler R: Mechanisms of impaired water excretion in adrenal and pituitary insufficiency. IV. Antidiuretic hormone in primary and secondary adrenal insufficiency. J Clin Invest. 1964, 43: 1641-1648. 10.1172/JCI105039.CrossRefPubMedPubMedCentral Kleeman CR, Czaczkes JWV, Cutler R: Mechanisms of impaired water excretion in adrenal and pituitary insufficiency. IV. Antidiuretic hormone in primary and secondary adrenal insufficiency. J Clin Invest. 1964, 43: 1641-1648. 10.1172/JCI105039.CrossRefPubMedPubMedCentral
Metadata
Title
Peri-portal lymphedema in association with an acute adrenal insufficiency: case report
Authors
Elamin Ibrahim Elamin Abdelgadir
Alaaeldin MK Bashier
Inas A Al Hameedi
Azza Abdulaziz
Sona Abuelkheir
Fatheya Alawadi
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2014
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-8-98

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