THE NOVEL USE OF STEREOTACTIC RADIOTHERAPY FOR REMNANT ADRENAL TISSUE IN NELSON SYNDROME.

OBJECTIVE: Recurrent Cushing disease (CD) is a rare complication that occurs in patients who have undergone bilateral adrenalectomy (BLA). We report a case of recurrent CD in a patient with Nelson syndrome and adrenalectomy due to remnant adrenal tissue, and a novel treatment strategy using stereotactic body radiation therapy (SBRT) to the adrenal glands. METHODS: We report a case of recurrent CD in a woman with Nelson syndrome and adrenalectomy and describe her clinical course and management. We also include a literature review of CD management and adrenal radiation. RESULTS: The patient had persistent pituitary CD despite pituitary surgery and radiosurgery and underwent BLA. She developed recurrent CD due to a remnant adrenal gland post adrenalectomy. She then underwent SBRT to both adrenal beds to treat the remnant adrenal tissue. Her serum cortisol dropped rapidly after adrenal radiation and she experienced minimal side effects. She has been in remission for over 2 years. CONCLUSION: This is the first reported case of recurrent CD in a patient post adrenalectomy that was successfully treated with SBRT to the remnant adrenal tissue.

Catamenial diabetic ketoacidosis and catamenial hyperglycemia: case report and review of the literature.

BACKGROUND: Diabetic ketoacidosis (DKA), an acute and potentially life-threatening complication of diabetes mellitus, is frequently the result of a precipitating illness or nonadherence to treatment; however, despite a thorough history, physical, radiologic, and laboratory examination, a specific cause or precipitating event cannot be identified in a significant number of cases. AIMS: To report 2 cases of recurrent DKA, and hyperglycemic crisis, associated to the menstrual cycle, and provide a review of the medical literature. METHODS: The clinic and hospital medical records of 2 subjects with type 1 diabetes mellitus (T1DM) and unexplained DKA are reviewed. An electronic MEDLINE search of relevant medical literature published from 1965 to 2007 was performed; additionally, the reference lists of the identified articles and other sources, such as textbook chapters and meeting abstracts, were reviewed for related publications. RESULTS: To date there have been 7 reported cases in the literature demonstrating an association between menstruation and DKA. The 2 new cases presented here highlight the potentially significant changes in glucose metabolism that may occasionally be observed during the late luteal and decidual phases of the menstrual cycle; moreover, these cases underscore the importance of a thorough medical and gynecologic history when evaluating a patient with DKA. CONCLUSION: Through unclear mechanisms, some women with diabetes mellitus demonstrate significant changes in glucose control around the time of their menses, including DKA. Accordingly, we propose that the terms catamenial DKA and catamenial hyperglycemia be used to refer to these disorders and that catamenial DKA be included in the differential diagnosis list of causes or precipitating events that can lead to DKA.