Relative adrenal insufficiency in post-transplant lymphoproliferative disorder.

Post-transplant lymphoproliferative disorder is treated with rapid decrement of immunosuppressive therapy. This cannot be achieved with ease in patients on long-term glucocorticoid therapy, as chronically suppressed adrenal glands may not be capable of mounting adequate response to stress. A 52-year-old Caucasian male presented with fever, orthostatic hypotension, lymphadenopathy and hyponatraemia. Serum cortisol levels were within normal levels with a sub optimal response to stimulation by ACTH. Hyponatraemia and orthostasis responded poorly to fluid restriction, saline and salt repletion but corrected after increasing the steroid dose. The normal baseline cortisol levels represented a stimulated adrenal gland, however, the ACTH stimulation had inadequate response. This sub optimal stimulation and a good response to increased steroids suggest the presence of relative or occult adrenal insufficiency. Relative adrenal insufficiency must be considered in patients who have received prolonged glucocorticoid therapy and have symptoms such as hypotension and/or hyponatraemia.

The impact of Schistosoma haematobium infection and of praziquantel treatment on the growth of primary school children in Bertoua, Cameroon

The association between urinary schistosomiasis and anaemia among infected children remains controversial. The purpose of this study was to determine the impact of schistosoma haematobium infection and treatment with praziquantel on hemoglobin levels among male children aged 6-15 years in Bertoua. Urine examination of 2665 children revealed an infection rate of 23.9 per cent. Children with moderate infection were randomly selected into treatment (238) and placebo (198) groups. Among uninfected children; 174 were randomly selected to serve as controls. Malaria; geohelminth infections and hemoglobin levels were determined before and six months after praziquantel/placebo intervention