Hypokalemic periodic paralysis.

Hypokalemic periodic paralysis is an unusual disease that may begin dramatically. Although terrifying to the patient, the attacks can usually be controlled if the proper diagnosis is made. Although much has been done to determine the pathogenesis, many questions remain unanswered.

Patellofemoral disorders: physical and radiographic evaluation. Part I: Physical examination.

Patellofemoral disorders present a diagnostic and therapeutic challenge to the orthopedic surgeon. By the sequential application of such basic diagnostic tools as inspection, palpation, and various measurements to a patient in standing, sitting, supine, and prone positions, a reproducible, comprehensive physical examination of the patellofemoral joint and entire lower extremity may be achieved.

Patellofemoral disorders: physical and radiographic evaluation. Part II: Radiographic examination.

Evaluation of the patient with patellofemoral complaints requires a comprehensive physical and radiologic investigation. The tangential view is most helpful in the evaluation of such patellofemoral disorders as chondromalacia, lateral patellar compression syndrome, and recurrent subluxation or dislocation. Commonly utilized tangential views include those described by Hughston, Merchant, Laurin, and Ficat. Multiple calculations available for quantitation of abnormal tangential views include the sulcus angle, congruence angle, lateral patellofemoral angle, patella index, and patellofemoral index. Lateral radiographic views commonly utilized to evaluate the patellofemoral joint for patella alta or infera include those described by Blumensaat, Labelle and Laurin, and Insall and Salvati. Utilization of all of the available patellofemoral radiographic views and calculations is impractical and unnecessary. However, to ensure diagnostic accuracy, a routine consisting of a reproducible radiographic technique and various, easily performed calculations that aid in diagnosis must be adopted.

Adrenal hemorrhage complicating anticoagulant therapy.

Anticoagulant-associated adrenal hemorrhage (AAH) is an infrequent complication of therapy. It is not usually diagnosed before death, but can be successfully treated if recognized. The case presented herein and the literature reviewed emphasize the pathogenesis, clinical picture, diagnosis, and treatment. This may be the first case with histologic study after long-term survival of the initial episode.

Hypopituitarism in diabetes mellitus.

A woman with stable diabetes presented with hypoglycemia and decreased insulin requirement. Further history suggested decreasing pituitary function. Laboratory tests confirmed pituitary deficiencies, associated with her increased insulin sensitivity. It may be helpful to be aware of this syndrome when dealing with diabetic patients who show decreasing insulin requirements.

Acute hormonal response to cigarette smoking.

Preliminary smoking studies using non-smokers were unsatisfactory because the subjects became obviously "ill" with nausea, pallor, sweating, etc. The rise in adrenocorticotropic hormone and growth hormone in these individuals could not be attributed to a cigarette effect as opposed to a nonspecific stress. A small number of female smokers seemed less consistent in their responses than did male subjects. The final study employing male, habitual smokers showed the following results: (1) A sharp rise in circulating cortisol occurred after two cigarettes which was maintained through the 2nd hour and fell slowly after the smoking period. (2) Circulating growth hormones also began to rise after two cigarettes, peaked at 1 hour, and then fell back to control levels while smoking continued. (3) Urinary catecholamines tended to be higher on smoking days than on nonsmoking days, but results were variable and of questionable significance. (4) Luteinizing hormone, follicle stimulating hormone, testosterone, and thyroid-stimulating hormone did not show any significant variations with smoking as compared to non-smoking.

Hypopituitarism: a complication of diabetes.

Hypopituitarism is a rarely reported accompaniment of diabetes mellitus. Autopsy studies suggest, however, that pituitary lesions are ten times more common in diabetics than in nondiabetics. Three cases of diabetes with hypopituitarism are reported. We believe that clinically important hypopituitarism may occur more commonly than is suspected in diabetes and that the diagnosis should be sought more aggressively.

Posttraumatic hypopituitarism: anterior pituitary insufficiency secondary to head trauma.

A 30-year-old woman, who was involved in an automobile accident two years before admission, presented with hypopituitarism. Deficits of ACTH, FSH, LH, GH, and borderline TSH were demonstrated. Normal TRF response and elevated prolactin levels indicated residual normal anterior pituitary tissue with inadequate hypothalamic control. We have briefly reviewed the subject of posttraumatic hypopituitarism.

Pituitary failure secondary to head trauma. Case report.

A patient presented with hypopituitarism, 2 years after severe head trauma. Deficits of growth-hormone, follicle-stimulating hormone, luteinizing hormone, and borderline thyroid-stimulating hormone (TSH) were demonstrated. Normal TSH-releasing hormone (TRH) response and elevated prolactin indicated viable anterior pituitary tissue with inadequate hypothalamic control. Precautions are suggested for recognition and treatment of this syndrome.