A rare cause of Cushing's syndrome demonstrates analytical discrepancies between the Roche E170 and Bayer Centaur testosterone assays.

The initial biochemical investigations of a female patient with suspected Cushing's syndrome revealed abnormal endocrine results, including a marked elevation of serum testosterone. Overnight and low-dose dexamethasone suppression tests confirmed the diagnosis of Cushing's syndrome. Imaging investigations revealed an appearance compatible with adrenocortical carcinoma with metastases in the lungs and liver. This tumour is a rare cause of Cushing's syndrome. Two different automated testosterone immunoassays were used during the investigation of this patient, and analytical discrepancies in the patient's testosterone results were found. The two assays used, as well as potential causes of the difference in results will be discussed.

Latent autoimmune diabetes in adults: increased awareness will aid diagnosis.

Latent autoimmune diabetes iln adults (LADA) is the term used for patients with non-insulin dependent diabetes who progress to insulin dependency as their pancreatic secretion of insulin fails. Diagnosis is based on adult age at the time of diabetes, the presence of serum autoantibodies to pancreatic antigens and the absence of a requirement for insulin at diagnosis. High titres of serum glutamic acid decarboxylase (GAD) antibodies act as a marker for LADA. Serum C-peptide concentrations are also lower in autoimmune diabetic patients. The best treatment for patients with LADA is not clear, but early insulin treatment may prevent pancreatic beta-cell failure.

Using Medline to achieve an evidence-based approach to diagnostic clinical biochemistry.

Medline is the US National Library of Medicine database that is used for searching the medical biochemistry literature. The database is structured using medical subject subheadings (MeSH terms) to classify the content of references; indexing is done manually using MeSH terms as key words. Searching the database effectively means finding the maximum number of relevant references together with the minimum number of irrelevant ones. This article is aimed at explaining the limitations of Medline and suggesting some solutions to key problems. The goal is that users can improve their literature search technique by employing a structured approach. As usual, asking relevant questions before starting a search is essential.