Secondary Resistance to dopamine agonist after thirteen months of successful treatment in a 42 years old man.

Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas. Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs. However secondary resistance to dopamine agonists therapy has also been described in patients who were initially responsive to treatment, either with Cabergoline or Bromocriptine but later develop dopamine agonist resistance, with elevated prolactin levels and sometimes an enlarging tumor volume several years afterwards. We report a case of a male patient with prolactinoma who developed drug resistance 13 months after initial dopamine agonist therapy.

The cardiology and endocrinology connection between amiodarone and thyrotoxicosis: case report and review of the literature.

Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and less commonly amiodarone-induced thyrotoxicosis (AIT). There are two main forms of AIT. Type 1 AIT, a form of io-dine-induced hyperthyroidism, and type 2, a drug-induced destructive thyroiditis. Type 1 AIT develops on individuals with underlying thyroid disease. Treatment of Type 1 AIT includes the use of antithyroid drugs and discontinuation of amiodarone. Type 2 AIT is commonly self-limiting in nature. In this article wedescribe a patient with Amiodarone-induced thyrotoxicosis discussing its clinical features and medical therapeutic approach.

Uncommon cause of acute abdominal pain at the emergency room: epiploic appendagitis.

This is a case of 49 year-old-female with left lower quadrant pain. Initial diagnosis of acute diverticulitis entertained and treated accordingly. Diagnosis of epiploic appendagitis was done by abdominal CT-Scan. Epiploic appendagitis is commonly misdiagnosed as diverticulitis and appendicitis. Non-invasive studies may lead to early diagnosis avoiding unnecessary hospitalizations, antibiotic therapy and surgical intervention.

Clinical and thyroid ultrasound evaluation in an asymptomatic adult Puerto Rican population: The San Juan city hospital experience Coromoto A. Pale.

OBJECTIVES: to determine the prevalence of thyroid disease in an asymptomatic Puerto Rican adult population within an iodine sufficient area. Correlate the clinical thyroic features during palpation with thyroid sonographic findings. Relate gender, laboratory data, and family history with the presence or absence of thyroid pathology. METHODS: Cross-sectional, descriptive, comparative study performed during the period of February 2008-January 2009 in an asymptomatic Puerto Rican copulation. The study sample size consisted of 110 adult participants, employees of the San Juan City Hospital in apparent good health. A questionnaire emphasizing relevant personal and family thyroid pathology (benign and malignant) was obtained. A complete physical examination was performed emphasizing thyroid gland palpation, utilizing a posterior approach. for detection of any abnormal thyroid features. All participants underwent thyroid ultrasonographic (US) examination and blood sampling for ultrasensitive TSH and antiperoxidase antibodies. Subjects with thyroid nodules over one centimeter, found on thyroid US, were encouraged to undergo fine-needle aspiration biopsy (FNAB). RESULTS: The prevalence of thyroid pathology detected by palpation was 52.72% and 38.23% by US. The most frequent thyroid pathology found on palpation was goiter (41.37%) and multinodular goiter (64.85%). Twenty-four percent (24%) of the participants with normal findings on palpation had abnormal findings by US and 33.33% of those met criteria for FNAB. In sixteen patients with abnormal US, only six agreed to have FNAB, all were reported negative for malignancy. CONCLUSION: Our results suggest that routine thyroid US should be seriously considered for all patients with suspected thyroid disease. Statistical analysis demonstrated a significant correlation between palpation findings performed by an experience physician and thyroid ultrasonography results. Even in patients with negative family history of thyroid pathology, abnormal thyroid ultrasound abnormalities were detected in 35.73%. To our knowledge this is the first study done in Puerto Rico, comparing thyroid palpation and ultrasonographic findings.

Right lower quadrant abdominal pain in an immunocompromised patient: importance for an urgent diagnosis and treatment.

This is a case of a 34 years old male Hispanic patient with history of AIDS who presented to the ER with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. Acute appendicitis, Clostridium Difficile Colitis and Ischemic Colitis were the most important clinical conditions to consider in the differential diagnosis. Abdominal CT with IV contrast demonstrated thickening of the ascending colonic wall a finding highly suggestive of a transmural inflammatory necrotizing colitis of infectious etiology. Broad-spectrum antibiotic therapy, cancidas and ganciclovir were started with mark clinical improvement. IgG antibodies against CMV were elevated. Typhlitis is a serious illness that affects patients with impairment in immunity. It is important to include it in the differential diagnosis of an HIV/AIDS patient that presents with RLQ pain and fever. Contrast enhanced CT-Scan is mandatory to establish the diagnosis and to differentiate typhlitis from other intra-abdominal pathologies. Therapy needs to be individualized.

An unusual cause of muscle weakness: a diagnostic challenge.

We report a case of 24 year-old-female presenting with bilateral leg heaviness sensation and difficult walking of one-day duration. Over the past three months she developed progressive and frequent tingling sensation on her hands accompanied by headache and increased thirst. Hypokalemia was identified and treated with resolution of symptoms. She was later found to have Graves' disease. After propranolol and radioiodine therapy no further episodes were reported. Thyrotoxic hypokalemic periodic paralysis is an alarming, potentially lethal, and rare complication of hyperthyroidism. The pathogenesis is uncertain. Because the condition is rare, it is frequently overlooked and misdiagnosed on presentation. It is important to recognize these clinical settings in hypokalemic patients in order to promptly start adequate medical therapy and avoid the lethal complications caused by prolonged sustained potassium depletion.