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Despoina Manousaki, Cheri Deal, Jean Jacques De Bruycker, Philippe Ovetchkine, Claude Mercier and Nathalie Alos

case supports the use of combination therapy when confronted with this diagnostic dilemma. Case presentation A previously healthy 15-year-old (Tanner 5) white female consulted for an altered state of consciousness and neck pain with a 2-week

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Chun-Han Lo and Ding-Ping Sun

Background Insulinoma, by definition, is the tumor of the pancreas that produces excessive amounts of insulin. In very few cases, insulin levels are low despite clinical evaluation suggestive of pancreatic adenoma. In cases with low insulin

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Seong Keat Cheah, David Halsall, Peter Barker, John Grant, Abraham Mathews, Shyam Seshadri and Singhan Krishnan

diagnostic challenge. Case presentation A frail 79-year-old lady with dementia presented with a 2-year history of frequent falls. These falls were not associated with loss of consciousness but preceded by dizzy spells. Due to a concomitant headache

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Natasha Shrikrishnapalasuriyar, Mirena Noyvirt, Philip Evans, Bethan Gibson, Elin Foden and Atul Kalhan

On day 3 of admission, she became restless, agitated with an altered level of consciousness and clinical features suggestive of global encephalopathy. CT head, lumbar puncture and initial septic screen were unremarkable. Further radiological

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Clarissa Ern Hui Fang, Mohammed Faraz Rafey, Aine Cunningham, Sean F Dinneen and Francis M Finucane

glomerular filtration rate of 26 mL/min 1.73/m 2 . Because of his altered level of consciousness, we performed CT and MRI brain and then lumbar puncture, all of which were normal. We noted an elevated alanine aminotransferase (ALT) level, most likely due to

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Niki Margari and Simon Page

hormone profiling demonstrated abnormal pituitary function along with suppression of gonadotrophin and testosterone levels. As such, the patient was started on cabergoline 500 μg twice weekly. The patient was observed on the ward for signs of CSF leakage

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S A A van den Berg and C G Krol

, resulting in an overproduction of incompletely processed precursors of IGF2 (Pro-IGF2 or big IGF2) ( 3 ). Pro-IGF2 and IGF2 augment peripheral glucose consumption and repress endogenous glucose, resulting in hypoglycaemia ( 4 ). At diagnosis, serum level of

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A Veltroni, G Zambon, S Cingarlini and M V Davì

loss of consciousness that occurred in the late postprandial phase. On admission, very low plasma glucose levels were found (fingerstick blood sugar: 21 mg/dL). She was treated with continuous infusions with 20% glucose and transferred to an Internal

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Chih-Ting Su and Yi-Chun Lin

. He was referred to our hospital for further survey of etiology of hypoglycemia. During hospitalization, several episodes of disturbed consciousness due to hypoglycemia recurred. Clinically, the patient had clear consciousness most of the time but

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Usman Javaid, Vikram Lal, Catherine Napier, Alison Burbridge and Richard Quinton

hypernatraemia ( Fig. 1 ), profuse sweating, confusion, intermittent low-grade pyrexia and reduced conscious level, all of which were initially attributed to urosepsis. There was no spontaneous oral fluid intake, but nursing staff and family were able to briefly