SUMMARY The treatment of choice for gastric acid hypersecretion in MEN type I has now changed from total gastrectomy to the long‐term administration of H 2 receptor blockers or similar agents. However, the importance of parathyroidectomy for the concomitant hypercalcaemia is not fully realized. A case is reported of a subject with MEN type I, who was initially treated with parathyroidectomy and H 2 receptor blockade. Following parathyroidectomy, there was a rapid fall of the markedly elevated gastrin levels to the upper limit of the normal range. During follow‐up of 2–5 years, there has been no increase in serum gastrin, and the subject's gastric symptoms have resolved, despite the cessation of H2 blockade. Infusion of calcium to pre‐operative levels and superimposed secretin stimulation after this period of time closely reproduced the pre‐operative hypergastrinaemia. On screening, the subject's only child was found to have hypercalcaemia but normal serum gastrin levels and pituitary function; parathyroidectomy has been carried out. No abnormality of gastrin secretion has been found during follow‐up. This case highlights the importance of early parathyroidectomy in this syndrome.
Abstract The flare up of retinopathy and neuropathy at a the of improvement in diabetic control is recognized but the subsequent clinical course of these patients is not well described. We report the case of a 26 year old insulin‐dependent diabetic in whom retinopathy and neuropathy presented at a time when his control was improved after a long period of pr control. There was a well documented and progressive improvement in retinopathy, peripheral and autonomic neuropathy over the subsequent years and he is now clinically free of complications seven years later. This case suggests a benign course for complications which present at a time of tightening of diabetic control.
Abstract Hypothyroidism is a common disorder, which is mainly treated in primary rather than secondary care. Once daily thyroxine replacement restores euthyroidism in most patients; some patients, however, remain hypothyroid despite adequate thyroxine replacement. Non-compliance is the most common cause of lack of response to thyroxine treatment. We describe two cases of primary hypothyroidism in which daily thyroxine treatment did not restore biochemical euthyroidism but once weekly thyroxine treatment was successful. In addition we review the evidence and discuss the differential diagnosis of lack of response to thyroxine treatment. Once weekly thyroxine treatment can be a safe, well-tolerated, and effective therapy for patients with non-compliance.
A patient with acid maltase deficiency was treated with a high protein diet for 7 months. Protein turnover expressed in terms of lean body mass was shown to be increased in this patient before the diet but was markedly reduced following the diet. The patient improved clinically whilst on the diet both subjectively and in terms of mobility, breathing and reduced peripheral cyanosis at rest.
A 71-year-old woman, who had been taking lansoprazole for 18 months for dyspepsia, presented with vomiting, thought to be due to gallstones, and was found to have severe hypomagnesaemia. She was treated with intravenous and then oral magnesium, and discharged, but was soon readmitted with symptoms due to hypomagnesaemia, and again treated with magnesium supplementation. No other recognised cause for hypomagnesaemia was found. Because of recent reports of hypomagnesaemia due to other proton pump inhibitors, lansoprazole was changed to ranitidine. Her symptoms resolved and the serum magnesium returned to normal. Oral magnesium supplementation was stopped with no return of symptoms or hypomagnesaemia. Such an association must be borne in mind with suggestive symptoms in patients on long term proton pump inhibitors; their cessation or change to H(2) receptor antagonists is likely to correct the situation rapidly.
Phaeochromocytomas are chromaffin cell tumours which are well recognised to present with hypertension and symptoms of catecholamine excess. These tumours, although rare, are important not to be missed, as left untreated they may result in devastating consequence. The first step in investigating phaeochromocytomas is to prove catecholamines excess biochemically. We report a patient with phaeochromocytoma in which repeated urine and plasma samples failed to detect excess catecholamines levels.
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