Hyperthyroidism following primary hypothyroidism in middle-aged man

We present and discuss the clinical case of middle aged man who initially diagnosed with primary hypothyroidism and then progressed into hyperthyroid state, besides describing the case scenario; we also discuss the possible underlying immunological mechanisms

complicated case of prolactinoma

The clinical course of a forty-two year old lady who was diagnosed having pituitary prolactinoma, treated with dopaminergic agonists, surgery and radiation therapy is presented. This report describes the clinical progression, laboratory and imaging findings and treatments offered throughout the course

Retrospective review of glycaemic, lipid and blood pressure control in patients with type 2 diabetes in a major UAE hospital

To evaluate to -what extent Tawam Hospital Diabetes Clinic is achieving internationally accepted targets for gly-caemic control [HbAlc], lipid control, and blood pressure [BP] control. The study was conducted at Tawam Hospital Diabetes Clinic in 2004. 10% of the clinic population was selected by systematic randomization. We looked at HbAlc, lipids and BP control. We also reviewed the prescribing patterns. We retrospectively compared these variables over a two year period. Results were analyzed by SPSS statistical program. We also compared our results with other centers. A total of 99 files were reviewed and entered in this observational study. A target of HbAlc of < 7% was achieved in 27% of cases, and target BP of <130/80 mmHg was achieved in 52% of patients in this cohort. Target LDL cholesterol < 2.6 mmol/L was achieved in 29% of cases. The glycaemic control and lipid profile compared unfavorably with some centers despite higher use of oral hypoglycaemic agents, insulin and statins. BP control however, compared favourably with other centers

Artifactual hypercalcaemia in multiple myeloma

We present the clinical course and laboratory findings of a 65 year-old woman with diabetes, osteoporosis and multiple traumatic fractures, who was found to have asymptomatic hypercalcaemia. Extensive work-up disclosed the diagnosis of multiple myeloma. Intact parathyroid hormone was normal despite severe hypercalcaemia. Aggressive treatment with hydration, furosemide, glucocorticoids, bisphosphonate and calcitonin failed to normalize serum calcium level. Free calcium level was only minimally elevated. A normal intact PTH in the face of high corrected serum calcium and the presence of elevated serum proteins should alert the treating physician to the possibility of artifactual hypercalcaemia

Ibn'Sina Rounds

We continue these excerpts from the case records of Dr Abubakr, current resident to that august, testy and infinitely wise consultant physician, Dr Ibn Sina. The Ibn Sina Rounds are presentations of actual clinical situations with a moral and teaching value

fatal cause of cushing's syndrome

Polycystic ovarian syndrome [PCOS] and idiopathic hirsutism are the most common causes of excessive hair growth and might well account for up to 98% of all cases. The objective of evaluating hirsute women is to rule out serious conditions that can cause hirsutism such as congenital adrenal hyperplasia, Gushing's syndrome and ovarian or adrenal malignancies. We herein present a 21-year-old single woman who presented with rapid onset of hirsutism, virilization and Cushingoid features. Laboratory investigations confirmednon-suppressible high cortisol level with low ACTH. Imaging studies revealed a large adrenal mass invading the neighboring structures. Surgical pathology report confirmed an advanced adrenocortical carcinoma

Ibn'Sina rounds

We continue these excerpts from the case records of Dr Abubakr current resident to that august, testy and infinitely wise consultant physician, Dr Ibn'Sina. The Ibn'Sina Rounds are presentations of actual clinical situations with a moral and teaching value

Primary hyperparathyroidism in breast cancer

The coexistence of primary hyperparathyroidism and breast cancer is herein reported to emphasize the proper work-up for patients with hypercalcaemia. We present the clinical, laboratory', radiological and pathology findings and describe the clinical course of the patient. A 49-year-old Arab female with a recent diagnosis of right breast cancer was evaluated because of persistent hypercalcaemia despite repealed intravenous pamidronate treatment. Evaluation revealed hypercalcaemia with elevated intact parathyroid hormone [PTH].Parathyroid scan and neck ultrasound were suggestive of double parathyroid adenomas. The patient underwent resection of the right lower and left upper parathyroid glands. Three months later, she remained hypercalcaemic with high intact parathyroid hormone level. Primary hyperparathyroidism and breast cancer may possibly coexist. Therefore PTH level must be checked in the evaluation of hypercalcaemia in breast cancer patients. Neck exploration is superior to imaging in localising the "anatomic" aetiology of hyperparathyroidism