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Mads Ryø Jochumsen, Peter Iversen and Anne Kirstine Arveschoug

cancer. 11-C-Met PET might have a role as a novel diagnostic procedure in thyroid cancer and in qualifying whether cold thyroid nodules with Sestamibi uptake are suspicious of malignancy or not. Case presentation A 66-year-old woman with a known

Open access

Deep Dutta, Chitra Selvan, Manoj Kumar, Saumik Datta, Ram Narayan Das, Sujoy Ghosh, Satinath Mukhopadhyay and Subhankar Chowdhury

setting of inconclusive neck USG and Tc 99m sestamibi imaging (8) . FNA-iPTH is considered positive and diagnostic of parathyroid adenoma if FNA-iPTH level is higher than serum iPTH of the patient (9) . FNA-iPTH was negative in our patient. However

Open access

Betty Korljan Jelaska, Sanja Baršić Ostojić, Nina Berović and Višnja Kokić

hyperuricaemia. She came to our clinic at the age of 22 years for the diagnostic evaluation of arterial hypertension and dyslipidaemia. Her weight was initially 80 kg, height was 157 cm and BMI was 32.5. The levels of uric acid were 425 nmol/l, LDL 3 mmol/l, HDL

Open access

N F Lenders and J R Greenfield

approximately 160 cases reported in the literature ( 2 ). Differentiating between adrenal tumour types poses a significant diagnostic challenge. Serum biochemistry determines the presence of adrenal hormone excess. Distinguishing between benign and malignant

Open access

Nishant Raizada, S H Rahaman, D Kandasamy and V P Jyotsna

Summary

Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycaemia, which is known to occur in association with the use of sulfhydryl-containing drugs and autoimmune disorders. We describe a patient with hitherto an unreported association of IAS with ankylosing spondylitis. We have also performed and described a simplified method of polyethylene glycol (PEG) precipitation of an insulin bound antibody in the serum.

Learning points

  • IAS should be considered in differential diagnosis of endogenous hyperinsulinemic hypoglycaemia.
  • Ankylosing spondylitis can be associated with IAS apart from several other autoimmune diseases.
  • Very high serum insulin levels (100–10 000 μU/ml) are frequently seen in IAS.
  • When faced with very high serum insulin before suspecting insulinoma, it is advisable that PEG precipitation of serum be done to identify antibody bound insulin.
  • A clinical suspicion of IAS can avoid expensive imaging and unnecessary surgery in affected patients.

Open access

E Bahaeldein and M J Brassill

diagnostic tool to help confirm an ovarian source of androgen excess. Available algorithms have recommended combined adrenal and ovarian venous sampling if imaging is inconclusive ( 3 , 4 ). This procedure is technically difficult however, and requires an

Open access

S Vimalesvaran, S Narayanaswamy, L Yang, J K Prague, A Buckley, A D Miras, S Franks, K Meeran and W S Dhillo

amenorrhoea. PCOS is the commonest endocrine condition in women of reproductive age and affects approximately 6–8% of this age group ( 3 ). It remains a complex and heterogeneous condition. The three main diagnostic classification systems at present are the

Open access

Takatoshi Anno, Hideaki Kaneto, Ryo Shigemoto, Fumiko Kawasaki, Yasuhiro Kawai, Noriyo Urata, Hirofumi Kawamoto, Kohei Kaku and Niro Okimoto

Summary

Hypoglycemia is induced by many causes, especially over-dose of insulin or oral hypoglycemic agents in diabetic subjects. In such a case, hyperinsulinemic hypoglycemia is usually observed. On the other hand, it is important to classify secondary hypoglycemia and hypoinsulinemic hypoglycemia. Liver injury-induced hypoglycemia is one of the causes of hypoinsulinemic hypoglycemia but rarely observed in clinical practice. Herein, we experienced similar 2 cases of non-diabetic hypoinsulinemic hypoglycemia. Both of them were elderly subjects with low body weight. Furthermore, it is likely that hypoinsulinemic hypoglycemia in both subjects was triggered by severe liver injury, at least in part, due to possible limited liver glycogen store. In elderly subjects with low body weight and/or malnutrition, metabolism in the liver is reduced and glycogen accumulation is decreased. Such alteration brings out acute and marked liver injury, which finally leads to the onset of severe hypoglycemia. It is known that not only liver injury but also multiple organ failure could be induced due to extreme emaciation in subjects. It is likely that in elderly subjects with low body weight and/or malnutrition, multiple organ failure including liver failure could be induced due to the similar reason. Therefore, we should be very careful of such subjects in order to avoid the development of multiple organ failure which leads to life-threatening situations. In conclusion, we should keep in mind the possibility of hypoinsulinemic hypoglycemia when we examine severe liver injury, especially in elderly or starving subjects with low body weight and limited liver glycogen stores.

Learning points:

  • It is important to classify secondary hypoglycemia and hypoinsulinemic hypoglycemia.
  • Liver injury-induced hypoglycemia is one of the causes of hypoinsulinemic hypoglycemia but rarely observed in everyday clinical practice.
  • Herein, we reported similar 2 cases of hypoinsulinemic hypoglycemia without diabetes presumably triggered by severe liver injury.
  • In both cases, hypoglycemia was improved by glucose infusion, although their liver injury was not improved.
  • We should keep in mind the possibility of hypoinsulinemic hypoglycemia when we examine severe liver injury, especially in elderly subjects with low body weight.
Open access

Taiba Zornitzki, Hadara Rubinfeld, Lyudmila Lysyy, Tal Schiller, Véronique Raverot, Ilan Shimon and Hilla Knobler

-site chemiluminescent immunoenzymatic assay (Immulite 2000 Calcitonin, Siemens Medical Solutions Diagnostic Ltd., Lanberis, Gwynedd, UK). Human GH concentrations in the pituitary cell culture were measured by RIA (hGH-IRMA kit; DIA source ImmunoAssays, Louvain

Open access

Peter Novodvorsky, Emma Walkinshaw, Waliur Rahman, Valerie Gordon, Karen Towse, Sarah Mitchell, Dinesh Selvarajah, Priya Madhuvrata and Alia Munir

Background Bariatric surgery represents a very effective method in the treatment of morbid obesity and related complications. Bariatric procedures induce major changes in the structure and function of the gastrointestinal tract leading to