Two pregnancies in a Cushing's syndrome. Case report

A case of patient with Cushing's syndrome due to an adrenal adenoma who conceived twice in the course of the disease is described. Pregnancy is known to be rare in these patients. When first seen she had some manifestations of Cushing's syndrome, but follow-up was lost prior to complete investigation. She conceived a few months later and gave birth to a 900 g premature liveborn infant. At the beginning of a second pregnancy, an adrenal adenoma was resected. The remainder of her pregnancy was uneventful and she delivered a normal fullterm 4 kg infant. Both children show normal physical and neurological development up to date. The patient presented herein illustrates the early diagnosis of Cushing's syndrome during pregnancy is extremely important, and early surgical treatment is indicated in order to avoid maternal and fetal complications.

Nutrition and somatomedin. XXI. Insulin-like growth factor-I and somatomedin inhibitor in streptozotocin-diabetic rats: relation to ketogenesis and gluconeogenesis

Diabetes is associated with a fall in serum insulin-like growth factor-I (IGF-1) and a rise in somatomedin inhibitor, a circulating factor(s) of approximately 30,000 MW that is released by the liver and can antagonize both somatomedin and insulin action. Levels of inhibitor correlate with levels of glucose, beta-hydroxybutyrate, and weight loss. To study pathways that could underlie the fall in IGF-1 and rise in inhibitor, the effects of metabolic inhibitors on circulating metabolic fuels, serum IGF-1, and serum somatomedin inhibitor activity were studied. Rats given streptozotocin exhibited weight loss of 14% +/- 0.1%, glucose 457 +/- 26 mg/dL, and beta-hydroxybutyrate (BOHB) 6.3 +/- 0.5 mmol/L. Somatomedin inhibitor was separated from IGF-1 by size exclusion HPLC at pH 3; IGF-1 was measured by RIA, and somatomedin inhibitor by cartilage bioassay. Diabetic animals exhibited a fall in IGF-1 to 76% of normal (P less than .02) and a rise in inhibitor to 270% of normal (P less than .01). 3-Mercaptopicolinic (3-MPA) acid, an inhibitor of gluconeogenesis, lowered glucose to 68 +/- 2 mg/dL and BOHB to 0.96 +/- 0.09 mmol/L (both P less than .01 v diabetic), but levels of inhibitor did not fall. Nicotinic acid, an inhibitor of lipolysis, did not affect glucose but reduced BOHB to 0.42 +/- 0.02 mmol/L; somatomedin inhibitor fell 19% below diabetic levels (NS) but remained above normal (P less than .01). In contrast, inhibition of fatty acid oxidation with methyl-2-tetradecylglycidate reduced glucose to 191 +/- 18 mg/dL but lowered BOHB to normal, 0.16 +/- 0.02 mmol/L, accompanied by normalization of somatomedin inhibitor levels (152% +/- 33% of normal, NS). Below 1.0 mmol/L BOHB, somatomedin inhibitor and BOHB were strongly correlated (r = .67, P less than .001); no comparable relation was found with glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

[Giant parasellar aneurysm simulating pituitary tumor]

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicating artery, are reported. The main findings were: headache (7/7), complex ophthalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicating artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar region remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.

[Renal function in patients with mucocutaneous leishmaniasis treated with pentavalent antimony compounds]

Avaliou-se a função renal em 10 pacientes com leishmaniose muco-cutânea tratados com glucantime (antimoniato de Meglumine, Rhodia) ou Pentostam (estibogluconato de sólio, Wellcome). Durante o uso das drogas, verificou-se a existência de um defeito na capacidade concentrante do rim, obtendo-se menores valores da osmolaridade urinária máxima e de depuração negativa máxima de água livre, neste período, em relação aos testes efetuados antes do tratamento. A capacidade de concentração urinária normalizou-se em 5, de 8 pacientes estudados no período de 15 a 30 dias, após a suspensão dos medicamentos, embora com valores de osmolaridade urinária máxima inferiores aos obtidos antes do tratamento. Em dois pacientes surgiu proteínúria, acima de 150 mg/dia, com o uso dos antimoniais, normalizando-se posteriormente. A depuração de creatinina endógena não se alterou significativamente com o uso das drogas. Os resultados sugerem que os antimoniais pentavalentes podem levar a uma disfunção tubular renal, caracterizada por um defeito na capacidade de concentrar a urina, reversível após a retirada dos medicamentos.

GAPO syndrome: report of three affected brothers

We present a sibship of three brothers affected with the GAPO syndrome. This is a rare and very characteristic autosomal-recessive trait whose main manifestations are growth retardation, alopecia, pseudo anodontia, and optic atrophy. So far nine affected individuals are known (4 males and 5 females). Two of them, the patient of Andersen and Pindborg cited in Tipton and Gorlin [1983] and one of the cases of Wajntal et al [1982], died at 39 and 37 years respectively.

[Hereditary hemorrhagic telangiectasia. Report of a case]

A case of hereditary hemorrhagic teleangiectasia (HHT) or Rendu-Osler-Weber disease with neurological involvement is reported. The patient presented a diffuse cortical dysfunction with seizures after a gastric haemorrhage disturbance. The authors could not find vascular malformations of brain or pulmonary arteriovenous fistula (PAVF), so a anoxic encephalopathy followed a shock or a microangiopathic dysfunction is postulated. The main neurological manifestations of HHT are discussed, emphasizing in the first place the role of the PAVF on the genesis of cerebral hypoxemia and brain abscess and occasionally a cerebral thrombosis caused by polycythemia and in the second place the vascular malformations of brain and spinal cord. The portal-systemic encephalopathy may also occur as a neurological complication in few cases.

Structural aberration of the X chromosome in a patient with gonadal dysgenesis: an approach to karyotype-phenotype correlation

An 18-year-old female with some stigmata of pure dysgenesis had a chromosome constitution of 46,X,dir dup(X) (pter leads to q27: :q21 leads to qter). The abnormal chromosome was always late replicating. The clinical and cytogenetic picture is compared with that of patients with X;X translocation and some problems of karyotype-phenotype correlation are discussed.

Trisomy 8 syndrome

Clinical and dermatoglyphic data on a male patient with complete trisomy 8 are reported and compared with those of other known cases of trisomy 8. The more discriminating findings for this condition are skeletal anomalies, restricted articular function, and speech problems.