アジソン病

Vitiligo is a dermatological disease characterized by focal disappearance of the melanin pigment on the skin and mucous membranes of a person. Despite the variety of proposed hypotheses for the development of this pathology, the central role belongs to the autoimmune mechanism of melanocyte damage.Analysis of the results of numerous international studies confirms a pronounced tendency towards an increase in the prevalence of endocrine autoimmune diseases among patients with vitiligo compared to the general population. Such diseases include, first of all, autoimmune thyroiditis, Graves' disease, type I diabetes mellitus and autoimmune adrenal insufficiency. Some studies confirm a high frequency of vitiligo combination with multiendocrine autoimmune syndromes.This review is aimed at systematizing the available scientific literature on the frequency of occurrence and characteristics of associated autoimmune endocrine disorders in individuals suffering from vitiligo.

BACKGROUND: Cardiovascular disease and cancer are leading causes of morbidity and mortality worldwide, with cancer survivors facing elevated cardiovascular risk due to shared risk factors and cardiotoxic treatments. Physical activity (PA) is a well-established strategy to improve cardiovascular health and survivorship outcomes; however, most cancer survivors do not meet recommended PA guidelines. Understanding multilevel influences on PA engagement and promotion is essential to improving implementation in cardio-oncology care. OBJECTIVE: This study aimed to examine barriers and facilitators to PA engagement and promotion in cancer survivorship from both survivor and medical team perspectives using the Capability, Opportunity, Motivation-Behavior (COM-B) framework. METHODS: A descriptive qualitative study was conducted with 12 cancer survivors and 12 medical team members involved in oncology care. Semistructured interviews explored experiences, perceptions, and practices related to PA across the cancer care continuum. Rapid qualitative analysis was used to identify themes, which were mapped to COM-B domains. Participants also completed surveys assessing PA, cardiovascular health (Life's Essential 8 [LE8]), and sociodemographic factors. RESULTS: Survivors had a mean age of 65.3 (SD 12.6) years and were evenly distributed by sex. PA engagement varied, with 42% (5/12) of survivors meeting recommended guidelines. The mean modified LE8-derived cardiovascular health score was 71.3 (SD 11.9), reflecting a standardized 6-domain composite (diet, PA, nicotine exposure, sleep, BMI, and blood pressure) calculated identically for all 12 participants. Across COM-B domains, physical limitation was the most commonly reported capability barrier (12/12 survivors), while current engagement in PA was the most prevalent capability facilitator (12/12 survivors). Opportunity was shaped by access to PA resources and social support, with social environment being the most frequently cited facilitator (12/12 survivors; 9/12 medical team members) and lack of access to PA resources being the most common barrier among medical team members (9/12). Motivation reflected perceived health outcomes as the most prevalent facilitator across both groups (12/12 survivors; 7/12 medical team members), alongside competing concerns such as safety and emotional responses. Medical team members' ability to promote PA was influenced by survivor readiness, clinical context, and resource availability. CONCLUSIONS: PA engagement in cardio-oncology is shaped by dynamic interactions among capability, opportunity, and motivation across survivor and medical team member contexts. Although PA is widely valued, sustained engagement remains limited due to fluctuating symptoms, environmental constraints, and clinical uncertainties. Interventions should prioritize flexible, survivor-centered approaches and incorporate supportive clinical communication and resource alignment to enhance PA across the survivorship trajectory.

Autoimmune polyglandular syndrome type 2 (APS-2) is a rare autoimmune disorder characterized by the coexistence of primary adrenal insufficiency with autoimmune thyroid disease and/or type 1 diabetes mellitus. Because its initial manifestations are often nonspecific, diagnosis may be substantially delayed until advanced disease or adrenal crisis develops. We report the case of a 28-year-old Portuguese woman living in California who presented with a nine-month history of progressive fatigue, unintentional weight loss, nausea, vomiting, abdominal pain, and a previous syncopal episode. Recognition of diffuse mucocutaneous hyperpigmentation involving the palmar creases and tongue prompted targeted endocrine investigation. Laboratory evaluation confirmed autoimmune primary adrenal insufficiency and autoimmune hypothyroidism, establishing the diagnosis of APS-2. Treatment with intravenous hydrocortisone and fluid resuscitation was followed by levothyroxine and fludrocortisone replacement, resulting in rapid clinical improvement, the normalization of biochemical abnormalities, and complete recovery. This case highlights the diagnostic value of meticulous physical examination in patients presenting with otherwise unexplained constitutional symptoms. Recognition of these characteristic physical findings may facilitate the early diagnosis of autoimmune primary adrenal insufficiency, enabling appropriate hormone replacement before progression to adrenal crisis.

Cytotoxic Lesions of the Corpus Callosum (CLOCCs) are transient splenial lesions typically triggered by infections, trauma, or metabolic disturbances. This report documents a unique case of a 13-year-old girl with CLOCCs secondary to Addison's disease, an association not previously reported. The patient initially presented with lethargy, fever, and hyperpigmentation of the skin and gingiva. Investigations revealed profound hyponatremia (121 mmol/L) and hypoosmolality, while a brain MRI confirmed a cytotoxic lesion in the splenium. Although meningoencephalitis was initially suspected, markedly elevated adrenocorticotropic hormone (ACTH) and low cortisol levels ultimately confirmed primary adrenal insufficiency. The pathogenesis likely involves cytotoxic edema and blood-brain barrier dysfunction driven by severe electrolyte imbalance and hypocortisolism. Following hydrocortisone replacement therapy and gradual sodium correction, the patient achieved a rapid clinical recovery. A follow-up MRI demonstrated complete resolution of the lesion within one week. This case highlights the importance of considering adrenal insufficiency in the differential diagnosis of reversible splenial lesions, particularly when physical signs like hyperpigmentation are present.

To assist clinicians transitioning patients from the hospital through the continuum of their ambulatory oxygen care needs, a multidisciplinary team of clinicians and patients used the Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend disease management for patients who are transitioning from the hospital to the home or domiciliary care on newly prescribed long-term oxygen therapy (LTOT) (strong recommendation, low certainty); (2) We recommend regular reassessments to determine the appropriateness of LTOT in adults who were recently discharged from the hospital setting (conditional recommendation, moderate certainty); (3) We suggest implementing a discharge coordination program to support the safe transition of adult patients requiring oxygen therapy (conditional recommendation, low certainty); (4) We suggest that assessments of the oxygen setting and device during rest and activity be conducted before the transition of an adult patient from the hospital to home or domiciliary care with an oxygen prescription (conditional recommendation, low certainty); (5) We suggest an evaluation of the domiciliary environment and activities of daily living, including an assessment of the risk of burns related to tobacco smoking or other ignition sources, for adult patients transitioning to home or domiciliary settings with a new oxygen prescription (conditional recommendation, low certainty); (6) We suggest offering peri-discharge education focused on the oxygen prescription to improve understanding and adherence to LTOT (conditional recommendation, low certainty).