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Yael R Nobel, Maya B Lodish, Margarita Raygada, Jaydira Del Rivero, Fabio R Faucz, Smita B Abraham, Charalampos Lyssikatos, Elena Belyavskaya, Constantine A Stratakis, and Mihail Zilbermint

potassium level of 6.6 mmol/l (reference range: 3.5–5.1 mmol/l) and heart rate of 150 beats/min. Hyperkalemia was treated with fluid repletion and sodium polystyrene sulfonate, and she was referred to our clinic. The patient's presentation at this age was

Open access

Raku Son, Masahiko Nagahama, Fumiaki Tanemoto, Yugo Ito, Fumika Taki, Ryosuke Tsugitomi, and Masaaki Nakayama

/mL, and 457.4 pg/mL, respectively. His antidiuresis hormone (ADH) was elevated at 1.7 pg/mL despite hyponatremia. Further calculations revealed that the patient had been administered 3000 mL fluid per day, including total parental nutrition and antibiotics

Open access

Cliona Small, Aoife M Egan, El Muntasir Elhadi, Michael W O’Reilly, Aine Cunningham, and Francis M Finucane

obstruction, notwithstanding his normal lactate level. The standard protocol for managing DKA was initiated with fluid resuscitation, electrolyte repletion and intravenous insulin prior to laparoscopic mesh repair of his hernia. He required in excess of 100

Open access

Snezana Burmazovic, Christoph Henzen, Lukas Brander, and Luca Cioccari

. Treatment The initial diagnosis of HHS was made in the emergency department, and the patient was treated with intravenous volume repletion consisting of 1000 mL of 5% dextrose in water (D5W), 1000 mL of 0.45% saline and 3000 mL of a balanced crystalloid

Open access

E Sanz-Sapera, S Sarria-Estrada, F Arikan, and B Biagetti

remodelled the pituitary fossa. The pituitary gland is displaced to the left (head arrow). The sphenoid sinus has mucosal thickening (black arrow). Treatment Urgent treatment with intravenous glucocorticoids and fluids was initiated, headache

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Ruben H Willemsen, Violeta Delgado-Carballar, Daniela Elleri, Ajay Thankamony, G A Amos Burke, James C Nicholson, and David B Dunger

, haemorrhage, cerebral malignancies and other cerebral diseases), drugs, pulmonary disease and ectopic production of ADH (malignancies) ( 1 ). The first-line treatment consists of fluid restriction in asymptomatic children. More severe forms with neurological

Open access

Benedetta Zampetti, Roberto Attanasio, and Renato Cozzi

.5 After 2 months 139 4.5 0.05 58 Hypopituitarism was hypothesized, prompting evaluation of serum cortisol at 12 pm (0.6 µg/L, nv at 07:00–10:00 h: 0.62–1.8) and FT4 (16.2 ng/L, nv: 9.2–17). Fluid resuscitation and hydrocortisone, 100

Open access

Marta Araujo Castro, Ainhoa Abad López, Luz Martín Fragueiro, and Nuria Palacios García


The 85% of cases of primary hyperparathyroidism (PHPT) are due to parathyroid adenomas (PA) and less than 1% to parathyroid carcinomas (PC). The PA usually measure <2 cm, weigh <1 g and generate a mild PHPT, whereas the PC usually exceeds these dimensions and are associated with a severe PHPT. However, giant PA (GPA), which is defined as those larger than 3 g, has been documented. Those may be associated with very high levels of PTH and calcium. In these cases, their differentiation before and after surgery with PC is very difficult. We present a case of severe PHPT associated with a large parathyroid lesion, and we discuss the differential aspects between the GPA and PC.

Learning points:

  • In parathyroid lesions larger than 2 cm, the differential diagnosis between GPA and PC should be considered.
  • Pre and postsurgical differentiation between GPA and PC is difficult; however, there are clinical, analytical and radiographic characteristics that may be useful.
  • The depth/width ratio larger or smaller than 1 seems to be the most discriminatory ultrasound parameter for the differential diagnosis.
  • Loss of staining for parafibromin has a specificity of 99% for the diagnosis of PC.
  • The simultaneous presence of several histological characteristics, according to the classification of Schantz and Castleman, is frequent in PC and rare in GPA.
Open access

Ved Bhushan Arya, Jennifer Kalitsi, Ann Hickey, Sarah E Flanagan, and Ritika R Kapoor

from 2.3 mmol/L to 7.3 mmol/L, also in keeping with HH. Lower dose diazoxide (2.5 mg/kg/day) was started, after which glucagon infusion and intravenous fluids were quickly weaned. Despite lower doses, hyperglycaemia developed, necessitating further

Open access

Sarah W Y Poon, Karen K Y Leung, and Joanna Y L Tung

, fasting results in robust decline in TG levels and allows gradual clearance of existing chylomicrons. Likewise, our patient had significant drop in TG level after 11 h of fasting. Adequate hydration should be maintained with intravenous fluid. No fat diet