Metastatic paraganglioma presenting with spinal cord compression requiring urgent surgery.

We report a rare case of a functional bladder paraganglioma diagnosed in a young man who presented with acute compressive thoracic myelopathy secondary to vertebral metastasis. A histological diagnosis of a metastatic paraganglioma was made following biopsy of a rib lesion. CT revealed a lesion in the inferior wall of the bladder, which demonstrated avid uptake on 68Ga-DOTATATE PET/CT. Serum metanephrine levels were more than 40 times the upper limit of normal. The patient was hypertensive and treatment with doxazosin was initiated. In view of neurological deterioration, he required urgent spinal decompression to preserve neurological function and prevent permanent paraplegia. Despite inadequate alpha-blockade, surgery was successful, and the perioperative course was uneventful. Alpha-blockade was subsequently optimised. Treatment with cyclophosphamide, vincristine and dacarbazine was started but, in view of disease progression, treatment was subsequently changed to sunitinib.

Biochemically silent phaeochromocytoma presenting with non-specific loin pain.

A 55-year-old woman presented with a 4-month history of right-sided non-specific loin pain and 6 kg weight loss. A CT scan of the abdomen and pelvis showed an incidental 4.5 cm right-sided adrenal lesion which was not typical of an adrenal adenoma. This was further confirmed on MRI of the adrenals. Biochemical investigations to investigate for a functional adrenal lesion included serum catecholamines and metanephrines, an aldosterone to renin ratio and an overnight dexamethasone suppression test. These were all negative. A laparoscopic adrenalectomy was performed in view of the large size of the lesion. Histology was consistent with a phaeochromocytoma, which confirmed the diagnosis of a non-secreting phaeochromocytoma. Non-secreting phaeochromocytomas are rare and usually found in patients with known genetic mutations. Adrenal lesions not related to any mutations similar to our case are even rarer and reported even less in the literature.

A current perspective into young female sex hormone replacement: a review.

INTRODUCTION: Hormone replacement in females with hypogonadism is advocated to address the various clinical aspects of estrogen deficiency. AREAS COVERED: This article focuses on hormone replacement in young females with hypogonadism, including a rationale as to why hormone replacement in such patients differs from treatment in postmenopausal females, a summary of symptoms encountered by females with hypogonadism and a comprehensive discussion of the various treatment options available, specifically focusing on the latest advances in the subject. A Medline search was conducted using different combinations of relevant keywords, giving preference to recent publications. EXPERT OPINION: Whilst traditionally oral contraceptive pills (containing ethynyl estradiol) were commonly used as a form of hormone replacement, it is now increasingly recognized that this is not the optimal treatment option. Physiological hormone replacement with transdermal estradiol is found to be superior. Evidence suggests that micronized progesterone may be associated with fewer side effects, although its effect on endometrial protection is not yet proven. Synthetic progestins confer varying degrees of androgenic and thromboembolic properties which should be kept in mind when prescribing individualized treatment. Further studies in different sub-cohorts of female patients with hypogonadism might help address the specific needs of individual patients.

Predictors and generation of risk equations for albuminuria progression in type 2 diabetes.

BACKGROUND: Diabetes is the most common cause of end-stage renal disease and is associated with increased mortality. Although only a proportion of type 2 diabetic subjects develop albuminuria or progress, it is not currently possible to identify those patients who will develop this complication or who will progress. AIM: The aim of the study was to identify baseline risk factors for the development and progression of albuminuria in a cohort with type 2 diabetes and use this data to generate risk equations. PATIENTS AND METHODS: Type 2 diabetic subjects who had albumin-creatinine ratio (ACR) measurement in 2007 - 2008 were recruited and followed-up for 8 years. RESULTS: 260 patients were included in the study. Of all the normoalbuminuric and microalbuminuric patients, 24.3% progressed. Baseline HbA1c, white cell count (WCC), smoking, and duration of diabetes were associated with progression of albuminuria stage in univariate analysis. Duration of diabetes (p = 0.034) was independently associated with progression in binary logistic regression. Baseline HbA1c (p = 0.002), age (p = 0.01), serum creatinine (p = 0.02), serum potassium (p = 0.04), serum urea (p = 0.0004), WCC (p = 0.02), serum triglycerides (p = 0.02), systolic blood pressure (p = 0.02), and duration of diabetes (p = 0.003) were positively correlated with percentage change (% change) in ACR, whilst baseline estimated glomerular filtration rate (eGFR) (p = 0.03), serum sodium (p = 0.04), hemoglobin (p = 0.0006), and hematocrit (p = 0.0002) were negatively correlated in Spearman correlation. Duration of diabetes (p = 0.025) and baseline HbA1c (p = 0.02) were independently associated with % change in ACR in multivariate analysis. Based on these results, novel risk equations were generated. CONCLUSIONS: We have identified baseline characteristics associated with progression of renal disease in type 2 diabetic subjects and generated equations to estimate the risk of progression. If validated in other populations, these equations might be useful in predicting risk of progression in clinical practice.