[Diabetic ketoacidosis in a patient with acromegaly, a case report]

Although impaired glucose tolerance affects 36% and overt diabetes mellitus can be seen in 30% of cases with acromegaly, diabetic ketoacidosis is rarely reported in patients with this disease. We present an unusual complication of acromegaly: a 22 year old woman with amenorrhea [6 month age] and blurred vision of left eye [4 month ago] referred to Ghaem neurology clinic in Mashhad. With a growth hormone [GH] level of = 100 ng/ml, Insulin like growth Factor-1 [IGF-1] =1560 ng/ ml and pituitary macro adenoma in magnetic resonance imaging [MRI], she was candidated for surgery. A few hours before surgery she had dyspnea, loss of consciousness, fever and with blood sugar [BS] =500 mg/ml, Hco3 = 2.4, PH=7.06 and keton in urine. Diabetic ketoacidosis was diagnosed. The patient was treated with high dose of insulin [500 IU/day] and hydration. After octerotide administration the need for insulin decreased and after pituitary adenectomy, there was no need for insulin therapy and the patient was discharged on metformin [one tablet per day]

[Clinical and Para clinical Findings of leptospirosis in Mazandaran, June-September 2004]

Leptospirosis is an uncommon widespread spirochetal zoonoses caused by the members of the genus leptospira. Human disease is acquired by coming into contact with urine or tissues of infected animals, or through contaminated water and soil, thus is an occupational disease particularly in farmers, slaughterhouse workers and fishermen. The goal of this study was to evaluate the clinical and Paraclinical findings of leptospirosis cases in Mazandaran. In this cross-sectional descriptive study, patients with high suspicion to leptospirosis presenting to Imam Khomeini and Razi hospitals of Sari and Qaemshahr from June to September 2004 with positive serology finding [MAT] were enrolled. Demographic, clinical and Paraclinical data for each patient were recorded. From 63 patients suspicious for leptospirosis, 36 had positive serologic test. The mean age of the positive patients [25 male, 11 female] was 34.2 +/- 13.77 [range 14-64 years old]. Most cases [86.1%] were farmers and 83.4% villagers. 55.6% of the patients presented in July. Fever and chills were the main complaints in 42.9% of the cases and fever, weakness, headache, anorexia and mialgia were seen in 96.6%, 96.6%, 93.1%, 89.7% and 85% respectively. Thrombocytopenia and leucopenia were noticed in 45.7% and 33.4% of the patients respectively. AST and ALT in 51.7% and 55.2% of patients were above the normal upper limit. Weil's syndrome and ileus occurred in 7 [19.5%] and one [2.8%] cases respectively. The classic history of fever, weakness, headache, anorexia and mialgia in villagers and farmers in warm months should raise the possibility of leptospirosis