A rare case of hemichorea in the setting of non-ketotic hyperglycaemia with subtle radiological changes: a case report.

Movement disorders have been associated with hyperglycaemia including chorea, hemiballismus and choreoathetosis. In almost all documented cases, there is an association between clinical and radiological findings. We report a case of an 82-year-old man with hemichorea in the setting of hyperglycaemia and poorly controlled type 2 diabetes. He had subtle striatal changes on his radiology, and with intravenous fluids and insulin, his involuntary movements resolved on day 4, which correlated with improvement in glycaemic control. He was followed up through our local insulin stabilization programme after discharge.

Case report: Primary empty Sella causing secondary adrenal insufficiency and severe yet asymptomatic hyponatremia.

A 61-year-old man presented with incidental hyponatraemia to 118 mmol/L, to which he was asymptomatic. Diagnostic workup revealed a partially empty sella turcica on magnetic resonance imaging. He had associated secondary adrenal insufficiency but other hormonal axes were relatively unaffected. Treatment with cortisol replacement promptly resolved the hyponatraemia.

Conversion of Primary Hypothyroidism to Hyperthyroidism: A Case Report.

A 51-year-old Caucasian male developed Graves' thyrotoxicosis following long-standing treatment for hypothyroidism. After a short period of treatment with carbimazole, he developed agranulocytosis and required total thyroidectomy. In this relevant case report, we review several pathogenetic mechanisms that explain the transformation of autoimmune hypothyroidism into Graves' disease and the possible approaches to the management of agranulocytosis secondary to antithyroid medications. Further studies are required to determine the best way to manage severe thyrotoxicosis when agranulocytosis develops due to antithyroid medications.

Efficacy and safety of ultra-long-acting insulin degludec.

All patients with type 1 diabetes and significant numbers of those with type 2 diabetes are treated with insulin. Nonadherence to insulin regimen can impact glycaemic control. Insulin degludec is a new generation, ultra-long-acting basal insulin that forms soluble multihexamers at the injection site that slowly release insulin degludec monomers into the circulation giving a prolonged duration of action. Insulin degludec may provide a safe and convenient dosing option for patients who require some flexibility in adhering to an insulin regimen according to their lifestyle or circumstances. In this review we focus on the early phases of insulin degludec development.

Insulin degludec--a new-generation basal insulin.

Insulin degludec may provide dosing options for patients who, because of their lifestyle, require some flexibility in adhering to an insulin regimen, and it may also reduce the risk of hypoglycemia compared with the basal insulins that are currently available.

The bioavailability of eicosapentaenoic acid from reconstituted triglyceride fish oil is higher than that obtained from the triglyceride and monoglyceride forms.

Omega 3 fatty acids have healthcare benefits, but their absorption characteristics are not well defined, particularly for strategies to improve their bioavailability. We performed a double blind study comparing the bioavailability of 20% eicosapentaenoic acid in 4.5 grams of: natural triglyceride, reconstituted triglyceride, enzymatically synthesized triglyceride, monoglyceride and diglyceride. Seven healthy volunteers were given the supplements on five occasions while repeated measurements of eicosapentaenoic acid were taken to calculate the area under the curve for the next 24 hours. There was a significant difference between the mean of calculated area under the curve of eicosapentaenoic acid from reconstituted triglyceride (30.2) and that of the enzymatically synthesized triglyceride (11.9) and monoglyceride (13.4), z=-2.36 and -2.19, respectively, p<0.05. In summary, eicosapentaenoic acid bioavailability of chemically reconstituted triglycerides was better than that obtained from enzymatically synthesized triglyceride and monoglyceride.

Enhanced bioavailability of eicosapentaenoic acid from fish oil after encapsulation within plant spore exines as microcapsules.

Benefits of eicosapentaenoic acid (EPA) can be enhanced by raising their bioavailability through microencapsulation. Pollen can be emptied to form hollow shells, known as exines, and then used to encapsulate material, such as oils in a dry powder form. Six healthy volunteers ingested 4.6 g of fish oil containing 20% EPA in the form of ethyl ester first alone and then as 1:1 microencapsulated powder of exines and fish oil. Serum bioavailability of EPA was measured by area under curve (AUC(0-24)). The mean AUC(0-24) of EPA from ethyl ester with exine (M = 19.7, SD = 4.3) was significantly higher than ethyl ester without exines (M = 2, SD = 1.4, p < 0.01).The bioavailability of EPA is enhanced by encapsulation by pollen exines.

Secondary amenorrhoea due to pheochromocytoma: a case report.

INTRODUCTION: Pheochromocytoma is a chromaffin cell catecholamine-secreting tumour originating from the adrenal medulla. CASE PRESENTATION: We report here an unusual presentation of pheochromocytoma with secondary amenorrhoea and its resolution after medical treatment with the alpha adrenergic blocker, Phenoxybenzamine. CONCLUSION: Pheochromocytoma is a rare cause of secondary amenorrhoea.

Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease.

OBJECTIVE: Recent trials suggest that using ergot-derived dopamine agonists such as cabergoline in the treatment of Parkinson's disease is associated with an increased risk of valvular heart disease. However, the dose of cabergoline used to treat hyperprolactinaemia is considerably less than that used in Parkinson's disease. DESIGN AND METHODS: A cross-sectional comparative assessment. Forty-four patients treated with cabergoline for hyperprolactinaemia underwent transthoracic echocardiography and were compared with 566 sequential subjects complaining of palpitations, taken from a contemporary echocardiography database. RESULTS: The mean cumulative dose of cabergoline in the cases was 311 mg. There was no significant, severe or moderate, right- or left-sided valvular regurgitation in either group. Left heart: in the mitral and aortic valves, the rate of mild and trivial valvular regurgitation was not different between the two groups. Right heart: mild tricuspid and pulmonary regurgitation on colour Doppler alone was increased significantly in the cabergoline group, odds ratios of 3.1 and 7.8 respectively (95% confidence interval 1.0-9.6 and 0.8-78.4, P=0.04 and P<0.0001 respectively). CONCLUSION: Cabergoline at doses sufficient to suppress hyperprolactinaemia for a period of 3-4 years is not associated with an increased risk of clinically significant valvular regurgitation.