[Autoimmune polyglandular syndrome type 3 diagnosed with cerebral venous sinus thrombosis: a case report].

A 67-year-old woman with a history of diabetes mellitus was admitted to our hospital with convulsions due to bilateral frontal subcortical hemorrhages. MR venography showed a defect in the superior sagittal sinus, and thrombi were demonstrated in the same lesion with head MRI three-dimensional turbo spin echo T1-weighted imaging. She was diagnosed with cerebral venous sinus thrombosis. As precipitating factors, we found high levels of free T3 and T4, low levels of thyroid stimulating hormone, anti-thyroid stimulating hormone receptor antibody, and anti-glutamic acid decarboxylase antibody with her. We diagnosed her with autoimmune polyglandular syndrome type 3 with Graves' disease and slowly progressive type 1 diabetes mellitus. Since she also had nonvalvular atrial fibrillation, she was treated with apixaban subsequently to intravenous unfractionated heparin in the acute phase, resulting in partial regression of the thrombi. Autoimmune polyglandular syndrome should be considered when multiple endocrine disorders are identified as precipitating factors for cerebral venous sinus thrombosis.

Seasonal variation of severe hypoglycemia in hospitalized patients 60 years of age or older presenting to an emergency center hospital between 2004 and 2010.

OBJECTIVE: To investigate the seasonal variation of severe hypoglycemia in hospitalized elderly patients. METHODS: Among the patients hospitalized in our department between 2004 and 2010, we analyzed the records of 67 patients who required emergency admission for severe hypoglycemia and were aged 60 years or older. Comparisons were made between those admitted during the warm season (April-September) and those in the cold season (October-March). PATIENTS: The mean age of the 67 patients was 76±8 years, including 45 men and 22 women. Twenty-four patients were admitted in the warm season and 43 patients were admitted in the cold season, with the average annual number being 3.4±1.9 and 6.1±2.8, respectively (p<0.05). RESULTS: Admissions for patients taking insulin showed no significant difference between the warm and cold season. In contrast, significantly fewer patients taking oral hypoglycemic agents were admitted in the warm season than in the cold season (5 vs. 22, p<0.05). Among them, 26 patients (96%) were taking sulfonylurea, and anorexia associated with acute infections was the main cause of severe hypoglycemia. In the warm season, all of the patients were discharged without complications, while 8 patients had complications in the cold season. CONCLUSION: A seasonal variation regarding hospitalization was observed for severe hypoglycemia among the patients 60 years of age or older, with a higher incidence in the cold season than the warm season, and anorexia related to infections in patients taking sulfonylureas was responsible for this variation. Accordingly, careful management of acute illness is needed for patients using sulfonylureas, especially during the cold season.