Introduction. The use of propylthiouracil can be associated with mild adverse reactions, but severe complications such as agranulocytosis and vasculitis can also be seen. Direct toxicity and immune-mediated induction of anti-neutrophile cytoplasmic antibodies have been described as possible mechanisms responsible for agranulocytosis. The majority of vasculitis is antimyeloperoxidase antibodies associated, but the exact mechanism for anti-neutrophile cytoplasmic antibodies-associated vasculitis as an adverse effect of propylthiouracil treatment is still unclear. Case report. We presented a 61-year-old female patient with Graves? disease who experienced a fever and throat pain two weeks after propylthiouracil therapy was initiated. Agranulocytosis alongside basal left-sided pneumonia was noted. Propylthiouracil was discontinued, and the treatment with broad-spectrum antibiotics was started, as well as Lugol?s solution, methylprednisolone, and granulocyte-colony stimulating factor. Further course of treatment was complicated by the occurrence of a generalized erythematous-papillomatous rash. The patient was diagnosed with agranulocytosis and antimyeloperoxidase, anti-neutrophile cytoplasmic antibodies positive vasculitis as an adverse effect of propylthiouracil. Conclusion. Patients presenting with concomitant agranulocytosis and anti-neutrophile cytoplasmic antibodies-associated vasculitis as a complication of propylthiouracil therapy for Graves? disease are rare in clinical practice. Prompt discontinuation of the antithyroid drug is of great importance to reduce damage to target organs. Similarities in the pathogenesis of both conditions could be the potential explanation for these two adverse events occurring at the same time, which points out the need for a deeper understanding of this topic.

Introduction. Sheehan syndrome (ShS) is (pan)hypopituitarism because of postpartum pituitary infarction due to massive obstetrical hemorrhage. Enlargement of the pituitary gland, smaller sellar region, disseminated intravascular coagulation (DIC) or autoimmunity are predisposing factors. The absence of lactation after labor and inability to resume the menstrual cycle later are presenting symptoms. Some of patients with Sheehan's syndrome have a sudden onset of severe hypopituitarism immediately after labor, most often in the form of severe hyponatremia. Central adrenal insufficiency is the most usual cause of hyponatremia, although in some cases the syndrome of inappropriate antidiuretic hormone secretion has been also described. Case outline. The female patient, 39-year-old, was admitted to the Intensive Care Unit due to severe hyponatremia with neurological symptoms (Na 103 mmol/L, Cl 72 mmol/L, K 3.7 mmol/L), and absence of lactation. Previously, on the sixth postpartum day, she was admitted to the Obstetrics and Gynecology Clinic due to severe headache, nausea, vomiting, and blurred vision. The symptoms persist from the labor, which was complicated with severe hemorrhage (1000 ml) due to obstetric complications. Treatment began with the 3% hypertonic saline solution with restriction of fluid intake. In regard to panhypopituitarism, replacement therapy with hydrocortisone and levothyroxine was initiated. Diabetes insipidus was excluded. Growth hormone replacement therapy and combination of progesterone and progestogens was started during follow-up. Conclusion. Early diagnosis of Sheehan's syndrome is essential. Pituitary insufficiency in these patients has a great diversity in presentation, that can sometimes result in coma and death.

Background/Objectives: Detection of adrenal tumors is increasing, mainly due to the widespread use and improved availability of radiological imaging. Their occurrence increases with age, and recent studies have reported a substantial increase in detection rates over the past few decades. This study aimed to describe the clinical spectrum and management of adrenal tumors in a real-world tertiary referral setting. Methods: This retrospective observational study was conducted to characterize the clinical presentation, diagnostic evaluation, management, and pathological spectrum of adrenal tumors treated at the University Clinical Center of Vojvodina between January 2020 and December 2025. This study included 862 patients with adrenal tumors from the outpatient clinic, day hospital, and hospital ward of the Clinic for Endocrinology, Diabetes, and Metabolic Disorders, University Clinical Center of Vojvodina, from January 2020 to December 2025. Results: Mean age was 60.73 ± 11.51 (range 19–90) years. Peak prevalence was observed in the seventh decade of life. Accordingly, 86.5% of tumors were smaller than 4 cm, 50.3% of tumors were detected in the left adrenal gland, and 14.4% were bilateral. Non-functioning tumors accounted for 85.3% of cases, while tumors showing biochemical cortisol autonomy, aldosterone-secreting tumors, and catecholamine-secreting tumors accounted for 5.7%, 4.4%, and 4.6%, respectively. CT-based assessment of tumors showed that 88.6% were adenomas, while 3.2% were cases of pheochromocytoma, 2.6% metastasis, 2.1% carcinoma, and, in smaller percentages, cysts, myelolipoma, macro- and micronodular hyperplasia, and other types. Tumor histopathology (n = 121) showed adenoma, pheochromocytoma, and metastasis as the most common (45.5%, 24%, and 10.7%, respectively). Patients with malignant lesions were significantly older than those with benign lesions (p < 0.01) and pheochromocytoma (p < 0.01). In the subgroup with histopathological diagnosis (n = 121), histopathology was significantly associated with tumor size (χ²(4) = 19.80, p < 0.001), which may reflect selection for surgery or biopsy. The mean age of patients with benign tumors, pheochromocytoma, and malignant tumors was 52.34 ± 13.86, 51.07 ± 12.35, and 63.73 ± 12.38, respectively. In the tissue-diagnosed subgroup, right-sided localization was more frequent among malignant tumors (p = 0.035), although the small number of cases warrants cautious interpretation. Conclusions: In our cohort, most adrenal tumors were benign and non-functioning, while hormonally active and malignant lesions represented a smaller but clinically important proportion requiring specialized evaluation and management. These findings provide real-world insights into adrenal tumor care in a tertiary referral setting and support the need for standardized data collection and prospective multicenter studies.