CASE SUMMARY: A 59-year-old man presented with non-ST-segment elevation myocardial infarction complicated by cardiogenic shock. Despite successful percutaneous coronary intervention to critical left anterior descending and right coronary artery lesions, he remained in refractory shock requiring escalating inotropic support. Retrospective recognition of secondary hypothyroidism and a bitemporal visual field defect raised suspicion of pituitary insufficiency. Empiric hydrocortisone resulted in rapid hemodynamic recovery. Subsequent evaluation confirmed panhypopituitarism, whereas magnetic resonance imaging demonstrated a cystic sellar lesion compressing the pituitary gland.
DISCUSSION: Secondary adrenal insufficiency should be considered when shock persists despite successful revascularization and cardiac recovery.
TAKE-HOME MESSAGE: Early glucocorticoid replacement may be lifesaving and should not await hormonal confirmation when adrenal crisis is suspected.
METHODS: Housewives aged 18 to 59 years old from the MyBFF@home study were selected and pain was measured using the Visual Analogue Scale (VAS) questionnaire. VAS measured the pain intensity at different parts of the body (score of 0-10). Data were collected at base line, 3 months and 6 months among the housewives in both the control and intervention group. Pain scores and other variables (age, Body Mass Index (BMI) and waist circumference) were analysed using SPSS version 22.
RESULTS: A total of 328 housewives completed the VAS questionnaires at baseline, while 185 (56.4%) of housewives completed the VAS at 3 months and 6 months. A decreasing trend of mean pain score in both groups after 6 months was observed. However, the intervention group showed a consistent decreasing trend of pain score mainly for back pain. In the control group, there was a slight increment of score in back pain from baseline towards the 6 months period. Older housewives in both groups (aged 50 years and above) had a higher mean score of leg pain (2.86, SD: 2.82) compared to the other age group. Higher BMI was significantly associated with pain score in both groups.
CONCLUSION: There were some changes in the level of body pain among the housewives before and after the intervention. Older obese women had a higher pain score compared to younger obese women. Pain was associated with BMI and change in BMI appears to be beneficial in reducing body pain among overweight and obese individuals.