CASE 4 Progressive Diabetic Nephropathy Case Description

This 39-yr-old woman was diagnosed with type 1 diabetes mellitus at the age of 7 yr, during an evaluation for chicken pox. Presenting symptoms included weight loss and frequent urination and was found to be in ketoacidosis. Complications from diabetes at present include neuropathy, nephropathy, and proliferative retinopathy. Her only other medical problem is hypertension. Her proteinuria was initially diagnosed in 1980 (age 20) on a routine urinalysis when hospitalized for a staphylococcal...

Discussion

This patient had a long-standing history of amenorrhea and a severely atrophic vagina suggesting hypoestrogenism. Because there were no signs of another endocrine disorder, and no history to suggest an anatomic abnormality, the differential diagnosis was primarily limited to disease processes of the hypothalamic-pituitary-gonadal axis. The differential diagnosis included premature ovarian failure (POF), a lesion of the hypothalamic-pitu-itary region, and hypothalamic chronic anovulation. POF...

Info

Had been noticing a progressive increase in shoe size, as well as swelling of her hands and coarsening of her facial features. One year before, she had been diagnosed with high blood pressure and glucose intolerance, but did not follow any specific treatment for these conditions. She had a positive family history of type 2 diabetes. She also complained of occasional hot flushes but her menses were regular. She has had four uneventful term pregnancies (the last one 15 yr ago), and none of her...

Kelly L Wirfel MD Douglas B Evans MD Jeffery E Lee MD Helmuth Goepfert MD and Robert F Gagel MD

Case 1 What is the Appropriate Management of an Older Patient Found to be at Risk for Medullary Thyroid Carcinoma Case 2 Sporadic vs Hereditary Medullary Thyroid Carcinoma Is Family History a Reliable Indicator for Excluding Hereditary Disease Case 3 Differential Diagnoses of Combined Islet Cell Tumor and Pheochromocytoma CASE 1 WHAT IS THE APPROPRIATE MANAGEMENT OF AN OLDER PATIENT FOUND TO BE AT RISK FOR MEDULLARY THYROID CARCINOMA An 80-yr-old white man who had been treated for primary...

Case Description

An 80-yr-old man with a past history of myocardial infarction (MI) and ventricular arrhythmias presented to his internist with a 1 mo history of weight loss (approximately 15 lbs.) and weakness. He had been treated with amiodarone 200 mg bid for approximately 24 mo. Thyroid function tests had been normal 6 mo earlier, but now showed a suppressed serum TSH of < 0.02 mU L. In consultation with his cardiologist, it was felt not appropriate to discontinue the amiodarone, and the patient was...

Bart L Clarke md and Sundeep Khosla md

Case 1 Primary Hyperparathyroidism Case 2 Hypercalcemia Case 3 Familial Hypocalciuric Hypercalcemia with Recurrent Pancreatitis CASE 1 PRIMARY HYPERPARATHYROIDISM Case Description A 62-yr-old woman presented in the outpatient clinic with a serum calcium of 10.6 mg dL (normal, 8.9-10.1 mg dL) and phosphate of 2.8 mg dL (normal, 2.5-4.5 mg dL). Her serum total alkaline phosphatase was 160 U L (normal, 108-282 U L), and serum creatinine 0.8 mg dL (normal, 0.6-0.9 mg dL). Her whole-molecule...

CASE 5 Postirradiation Insular Thyroid Cancer Case Description

A 69-yr-old man with a history of external beam radiation therapy for acne as a teenager presented in July 1991 with superior vena cava syndrome thought owing to an enlarged thyroid. Although he could not date the onset of his symptoms precisely, his arm swelling seemed to have appeared over a few weeks. He underwent neck surgery at his local hospital where the surgeon found an invasive thyroid tumor that he considered Fig. 6. A black and white photograph of an H amp E stained slide from the...

Elena I Barengolts md and Subhash C Kukreja md

Case 1 Parathyroid Autotransplantation in Postsurgical Hypoparathyroidism Case 2 Hypoparathyroidism During Pregnancy Case 3 Osteoblastic Metastases in Prostate Cancer CASE 1 PARATHYROID AUTOTRANSPLANTATION IN POSTSURGICAL HYPOPARATHYROIDISM This 33-yr-old man presented with recurrent kidney stones and hypercalcemia, and was diagnosed as having primary hyperparathyroidism serum Ca 10-12 mg dL, serum PTH 95 pg mL . Further work-up demonstrated a growth hormone and prolactin secreting pituitary...

CASE 1 Cushings Disease Difficulties In Diagnosis Case Description

A 38-yr-old woman was referred because of a 75-lb weight gain over the past 7 yr. She has noticed some increasing facial fullness and has had some problems with climbing stairs. She has had insomnia and nocturia for the past 3 yr and complains of some easy bruisability. She recently suffered a stress fracture in her right foot. She has maintained normal menstrual periods, but has had a decreased libido. She complains of emotional lability over the past 2 yr. She denied any history of diabetes,...

CASE 1 A Rapidly Expanding Adrenal Mass Case Description

A 43-yr-old male initially presented to his primary care physician with the complaint of 3 d of right-sided abdominal pain. The pain was dull, located diffusely in the right upper quadrant of his abdomen and flank, and at times penetrated to the back. He denied any relation of the pain to food intake. In addition, he denied any jaundice, nausea, vomiting, fevers, or chills. His exam was unremarkable with the exception of mild right upper quadrant abdominal pain with moderate palpation. His...