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_NO TOC_
_NOTOC _
{{CMG}};{{AE}}{{Vbe}}
{{CMG}};{{AE}}{{Vbe}}


==Causes==
[[Hypogammaglobulinemia]] is caused by:


Immunodeficiency secondary to:
*[[Uremia]]
*Protein losing enteropathy
*[[Nephrotic syndrome]]
*Malnutrition
*Cirrhosis
*Hemodialysis
* Intestinal lymphangiectasia


* Protein-losing gastroenteropathy
*[[Nephrotic syndrome]]
*[[Thymoma]] <ref name="pmid29881497">{{cite journal |vauthors=Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD |title=[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome] |language=French |journal=Pan Afr Med J |volume=28 |issue= |pages=253 |date=2017 |pmid=29881497 |pmc=5989270 |doi=10.11604/pamj.2017.28.253.11352 |url=}}</ref>
* Medications :
** Gold
**D-Penicillamine
**Sulfasalazin
**Anticonvulsants
**Glucocorticoids
**Methotrexate
**Calcineurin inhibitors
** Rituximab<ref name="pmid29755528">{{cite journal |vauthors=Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M |title=Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura |journal=Case Rep Med |volume=2018 |issue= |pages=2096186 |date=2018 |pmid=29755528 |pmc=5884289 |doi=10.1155/2018/2096186 |url=}}</ref><ref name="pmid29752554">{{cite journal |vauthors=Farhat L, Dara J, Duberstein S, De A |title=Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report |journal=Drug Saf Case Rep |volume=5 |issue=1 |pages=22 |date=May 2018 |pmid=29752554 |pmc=5948191 |doi=10.1007/s40800-018-0087-y |url=}}</ref><ref name="pmid29627491">{{cite journal |vauthors=Thorlacius H, Jerkeman A, Marginean FE, Toth E |title=Colorectal malakoplakia in a patient with hypogammaglobulinemia |journal=Gastrointest. Endosc. |volume= |issue= |pages= |date=April 2018 |pmid=29627491 |doi=10.1016/j.gie.2018.04.001 |url=}}</ref>


==Classification of suicidal ideation==
* Environmental hazards:
** Ionizing radiation
{| class="wikitable"
**Toxins
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
|-


|'''Suicidal events'''
*Infections
Completed suicide
** Viral(Herpes, Measles)
 
**Bacterial(Mycobacterial)
|A self-injurious behavior that resulted in fatality and
**Parasitic(Malaria, helminthic infections)
was associated with at least some intent to die as a
result of the act.
 
 
|
example:1) After a long argument with his girlfriend, which resulted in the
end of their relationship, the patient collected a rope and rode his
bike to an isolated area where he fatally hanged himself. A suicide
note was later found. 2) After four documented attempts at suicide,
the patient stole his uncle’s gun and shot himself and was fatally injured
 
|-
|[[Suicide attempt]]
 
|A potentially self-injurious behavior, associated with
at least some intent to die, as a result of the act.
Evidence that the individual intended to kill him/
herself, at least to some degree, can be explicit or
inferred from the behavior or circumstance. A suicide
attempt may or may not result in actual injury
 
 
 
|'''Example''':fter a fight with her friends at school, in which they discontinued
speaking with her, the patient ingested approximately 16 aspirin
and eight other pills of different types on the school
grounds. She said that she deserved to die, which was why she
swallowed the pills. 2) The patient used a razor blade to lacerate
his wrists, his antecubital fossae, and his back bilaterally. He told
his therapist that the “the main objective was to stop feeling like
that,” and he knew that he could die but didn’t care. According to
the patient, he also ingested a bottle of rubbing alcohol because
in his health class he heard “that the medulla will get more suppressed
that way,” thereby increasing y increasing the chances that he would
be “successful” and die
 
|-
|[Preparatory acts
towards imminent suicidal behavior
|The individual takes steps to injure him- or herself,
but is stopped by self or others from starting the
self-injurious act before the potential for harm has begun
 
 
|
her had gone to school and retrieved a recent “bad” report card.
He was fearful of his father’s reaction. Upon his return home, a 5-
to 6-hour argument with his parents ensued, and he took a vegetable
(broad, sharp) knife and went to his room. He reported putting
the knife to his wrist but never puncturing the skin. 2) The patient
stated that he “couldn’t stand being depressed anymore”
and “wanted to die.” He decided to hang himself. He tied a telephone
cord to the door knob and placed the cord loosely around
his neck. Then, he stopped himself and did not follow through
with the attempt. 
|-
|[[Suicidal ideation]]
|Passive thoughts about wanting to be dead or active
thoughts about killing oneself, not accompanied
by preparatory behavior.a
|
* Active: The patient reported to the doctor that he was thinking
about hanging himself in the closet. He was taken to the hospital
and admitted.
* Passive: The patient reported ideas about wanting
to be dead but denied acting on these feelings.
 
 
|}
 
==Classification of suicidal ideation==
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
|-
 
|''' Non-Suicidal events'''
Self-injurious
behavior, no
suicidal intent
 
|Self-injurious behavior associated with no intent to
die. The behavior is intended purely for other reasons,
either to relieve distress (often referred to as
“self-mutilation,” e.g., superficial cuts or scratches,
hitting/banging, or burns) or to effect change in
others or the environment
 
 
|
The patient was feeling ignored. She went into the family kitchen
where her mother and sister were talking. She took a knife out of
the drawer and made a cut on her arm. She denied that she
wanted to die at all (“not even a little”), but she just wanted them
to pay attention to her. 2) The patient reported feeling agitated
and anxious after a fight with her parents. She went into her
room, locked the door, and made several superficial cuts on the
inside of her arms. She stated that she felt relieved after cutting
herself and that she did not want to die. She reported that she
had done this before at times of distress and that it usually helped
her feel better. 3) The patient was in class, where a test was about
to begin, and stabbed himself with a pencil in order to be taken
to the nurse’s office. 4) A 14-year-old girl wrote her name on her
arm with a penknife and said that she often does so in order to reduce
her anxiety. 5) The patient was noted to have multiple superficial
burns on his arms. Upon questioning, he denied trying to kill himself
|-
|Other, no
deliberate
self-harm
 
|No evidence of any suicidality or deliberate self-injurious
behavior associated with the event. The
event is characterized as an accidental injury, psychiatric
or behavioral symptoms only, or medical
symptoms or procedure only
 
|1) The patient had a cut on the neck from shaving. 2) The patient
was hospitalized for worsening of OCD or depressive symptoms
with no suicidal thoughts or actions or 3) aggressive behavior.
4) Hospitalization was because of an infection, rhinoplasty, or
pregnancy
|}
 
==Classification of suicidal ideation==
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
|-
 
|''' Indeterminate or
potentially
suicidal events'''
Self-injurious
behavior,
suicidal intent
unknown
|Self-injurious behavior where associated intent to
die is unknown and cannot be inferred. The injury
or potential for injury is clear, but why the individual
engaged in that behavior is unclear.
 
 
| 1) The patient cut her wrists after an argument with her boyfriend.
2) The patient was angry at her husband. She took 10 to 15 diazepam
tablets and flushed the rest down the toilet. Her husband
called the police for help, and she was taken to the hospital. She
was groggy and stayed overnight in the hospital. 3) A 9-year-old
patient had spoken about suicide frequently. After learning that
his baseball coach was retiring, he began scratching his arm with
a pencil.
 
|-
|Not enough
information
 
|Insufficient information to determine whether the
event involved deliberate suicidal behavior or ideation.
There is reason to suspect the possibility of
suicidality but not enough to be confident that the
event was not something other, such as an accident
or psychiatric symptom. An injury sustained
on a place on the body consistent with deliberate
self-harm or suicidal behavior (e.g., wrists), without
any information as to how the injury was received,
would warrant placement in this category
 
|1) A child who “stabbed himself in [the] neck with a pencil.” The
event may have been deliberate as opposed to accidental, as suggested
by “stabbed,” but not enough information was provided to
determine whether the event was deliberate. 2) A cut on the neck.
 
 
 
 
|}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
===Causes by Organ System===
{|
 
 
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Mesothelioma]]
|-
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | [[Mesothelioma]]
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
|'''Drugs'''
|bgcolor="Beige"|Alcohol, Dextromethorphan, antihistamines at high doses,Barbiturates, Benzodiazepines, Cimetidine,Pergolide, Sodium oxybate,Anticholinergic drugs,Atropine, scopalamine, Jimson weed, Antidepressants, Antiepileptics,Isotretinoin, Varenicline, Ziconotide,Cocaine,Amphetamines, LSD, Psilocybin, Mescaline,
MDMA (ecstasy), PCP
 
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | [[Carcinoid]], [[Hypopituitarism]], [[Hypothyroidism]]
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" |
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | No underlying causes
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | No underlying causes
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | [[AIDS]],Leprosy, Malaria, Mumps, Flu, Lyme disease, Syphilis
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | [[Amyotropic lateral sclerosis]], [[Ewing's sarcoma]], [[Polyradiculitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" |  [[Multiple sclerosis]], [[Alzheimer's disease]], [[Parkinsons]], [[ Lewy bodydementia ]]
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | Brain tumor
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" |
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" | Hypocalcemia, Hypernatremia, Hyponatremia, Hypokalemia, Hypomagnesemia, Hypermagnesemia, Hypophosphatemia
 
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" | [[Lupus]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying cause
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | Sarcoidosis
|}
 
==References==
 
Posner K, Melvin GA, Stanley B, Oquendo MA, Gould M: Factors
in the assessment of suicidality in youth. CNS Spectr 2007; 12:
156–162

Latest revision as of 14:23, 3 August 2018


_NOTOC _ Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]

Causes

Hypogammaglobulinemia is caused by:

Immunodeficiency secondary to:

  • Protein-losing gastroenteropathy
  • Nephrotic syndrome
  • Thymoma [1]
  • Medications :
    • Gold
    • D-Penicillamine
    • Sulfasalazin
    • Anticonvulsants
    • Glucocorticoids
    • Methotrexate
    • Calcineurin inhibitors
    • Rituximab[2][3][4]
  • Environmental hazards:
    • Ionizing radiation
    • Toxins
  • Infections
    • Viral(Herpes, Measles)
    • Bacterial(Mycobacterial)
    • Parasitic(Malaria, helminthic infections)
  1. ↑ Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD (2017). "[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome]". Pan Afr Med J (in French). 28: 253. doi:10.11604/pamj.2017.28.253.11352. PMC 5989270. PMID 29881497.
  2. ↑ Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M (2018). "Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura". Case Rep Med. 2018: 2096186. doi:10.1155/2018/2096186. PMC 5884289. PMID 29755528.
  3. ↑ Farhat L, Dara J, Duberstein S, De A (May 2018). "Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report". Drug Saf Case Rep. 5 (1): 22. doi:10.1007/s40800-018-0087-y. PMC 5948191. PMID 29752554.
  4. ↑ Thorlacius H, Jerkeman A, Marginean FE, Toth E (April 2018). "Colorectal malakoplakia in a patient with hypogammaglobulinemia". Gastrointest. Endosc. doi:10.1016/j.gie.2018.04.001. PMID 29627491.
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