Spontaneous idiopathic bilateral adrenal haemorrhage: a rare cause of abdominal pain.

We describe a case of a 62-year-old woman with a history of chronic obstructive pulmonary disease and gastro-oesophageal reflux disease who presented to the emergency department with left lower quadrant abdominal pain, flank pain with nausea and no history of preceding trauma. The patient had finished a course of azithromycin and oral methylprednisolone 1 day prior to presentation. Abdominal and pelvic CT scan identified changes suggestive of bilateral adrenal haemorrhage. The patient did not show signs of acute adrenal insufficiency but was started on steroid replacement therapy because of concerns about possible disease progression. All recognised causes of adrenal haemorrhage were excluded suggesting this was a case of spontaneous idiopathic bilateral adrenal haemorrhage, a rarely reported phenomenon in the literature. The patient was discharged after clinical improvement following 6 days in hospital, taking oral steroid replacement.

Optical coherence tomography-based continuous noninvasive glucose monitoring in patients with diabetes.

OBJECTIVE: The objective of this feasibility study was to test an optical coherence tomography (OCT)-based system for noninvasive, accurate, and continuous monitoring of blood (as opposed to interstitial) glucose concentration in subjects with diabetes. OCT uses low coherence light with precise depth focusing ability to measure changes in the microvasculature structure for glucose detection. RESEARCH DESIGN AND METHODS: Thirty-three subjects with diabetes had blood glucose concentrations evaluated using simultaneous capillary and OCT-based device (Sentris-100, GlucoLight, Bethlehem, PA) measurements. Subjects received a 50-g carbohydrate load at the start of the study period. Two glucose values with 60 mg separation were used to calibrate the OCT system. Six subjects were excluded (two because of hardware and/or software failures at study initiation, two because of sensor connection problems, and two others because of problems with disposable device positioning on the skin). Of the 27 subjects who completed the study, 12 had type 1 diabetes, and 15 had type 2 diabetes. Statistical analysis included plotting of the Clarke error grid, comparison to International Organization for Standardization (ISO) standards for glucose monitoring systems, and calculation of the Pearson correlation coefficient. RESULTS: Based on a total of 236 matched points, Clarke error grid analysis indicated 83% in zone A, 16% in zone B, and <1% in zones C and D. ISO standards comparison showed 83% of OCT estimates were within 20% of the reference value for blood glucoses >75 mg/dL. No conclusions can be made about blood glucose estimates in the <75 mg/dL range since no low reference values occurred. The Pearson correlation coefficient comparing OCT versus capillary blood glucose was 0.85 (95% confidence interval 0.81-0.88, P < 0.0001). Mean relative absolute deviation was 11.5%, and median relative absolute deviation was 8.2%. CONCLUSIONS: This study demonstrated that the OCT system shows acceptable accuracy in the prediction of blood glucose levels in subjects with both type 1 and type 2 diabetes. Future efforts will evaluate the accuracy of the system in the hypoglycemic range.

Peroxisome proliferator-activated receptors increase human sebum production.

Sebum production is key in the pathophysiology of acne, an extremely common condition, which when severe, may require treatment with isotretinoin, a known teratogen. Apart from isotretinoin and hormonal therapy, no agents are available to reduce sebum. Increasing our understanding of the regulation of sebum production is a milestone in identifying alternative therapeutic targets. Studies in sebocytes and human sebaceous glands indicate that agonists of peroxisome proliferator-activated receptors (PPARs) alter sebaceous lipid production. The goal of this study is to verify the expression and activity of PPARs in human skin and SEB-1 sebocytes and to assess the effects of PPAR ligands on sebum production in patients. To investigate the contribution of each receptor subtype to sebum production, lipogenesis assays were performed in SEB-1 sebocytes that were treated with PPAR ligands and isotretinoin. Isotretinoin significantly decreased lipogenesis, while the PPARalpha agonist-GW7647, PPARdelta agonist-GW0742, PPARalpha/delta agonist-GW2433, PPARgamma agonist rosiglitazone, and the pan-agonist-GW4148, increased lipogenesis. Patients treated with thiazolidinediones or fibrates had significant increases in sebum production (37 and 77%, respectively) when compared to age-, disease-, and sex-matched controls. These data indicate that PPARs play a role in regulating sebum production and that selective modulation of their activity may represent a novel therapeutic strategy for the treatment of acne.