A middle aged woman with isolated ACTH deficiency associated with transient growth hormone deficiency.

Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary adrenal insufficiency with low levels of serum cortisol, decreased production of ACTH, adequate secretion of other pituitary hormones and normal pituitary structure on radioimaging. The prevalence of IAD as a cause of secondary adrenal insufficiency has not been determined. Impairment of growth hormone (GH) secretion has been noted in 20 to 30% of patients with IAD which is normalized after glucocorticoid replacement. We report the case of a 50 years-old female with symptoms and laboratory results suggestive of adrenal insufficiency. Insulin tolerance test confirmed ACTH and growth hormone deficiency. The rest of the anterior pituitary hormones were normal. A pituitary MRI was unremarkable. Glucocorticoid replacement therapy started and eight months afterwards glucagon stimulation test revealed persistent ACTH deficiency but nor- mal growth hormone secretion. IAD can present with nonspecific symptoms and could be potentially fatal in an acute stressful period. Prompt recognition is essential to decrease morbidity and mortality.

Overview of thyroid physiology: an essential for understanding familial euthyroid multinodular goiter.

Nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Familial forms of goiter in areas not known to feature iodine deficiency are much less common. However, not all individuals in the same iodine deficiency region develop goiter and iodine supplementation does not prevent goiter development in all treated individuals. The etiology of euthyroid goiter is still incompletely understood. It is assumed that the development of goiter depends on various interactions between genetic and environmental factors. We present an overview on the thyroid physiology, which is important for a better understanding of Familial Euthyroid Multinodular Goiter.

Diabetic myonecrosis: an atypical presentation.

Diabetic myonecrosis is a frequently unrecognized complication of longstanding and poorly controlled diabetes mellitus. The clinical presentation is swelling, pain, and tenderness of the involved muscle, most commonly the thigh muscles. Management consists of conservative measures including analgesia and rest. Short-term prognosis is good, but long-term prognosis is poor with most patients dying within 5 years. Failure to properly identify this condition will expose the patient to aggressive measures that could result in increased morbidity. To our knowledge this is the first case reported in which there was involvement of multiple muscle groups including upper and lower limbs.

An unusual presentation of herpes simplex in an immunocompromised patient.

Herpes simplex virus (HSV) is a host-adapted human pathogen. HSV-I usually infects non-genital sites at a variety of locations. HSV-2 primarily involves genitalia. Both types can cause genital and orofacial infections, which are clinically indistinguishable. Initial HSV infection is usually asymptomatic or mild and self-limited, but instead of disappearing from the body during convalescence, the virus establishes a latent infection that persists for life. Rarely, there is severe visceral dissemination. This is a case report of an unusual presentation of herpes simplex in an immunocompromised adult patient with generalized skin lesions on the entire body. To our knowledge, this is the first case reported in the literature of a disseminated herpes simplex in a patient with history of non-Hodgkin Lymphoma. Generalized HSV infection in immunodeficient adult patients could be fatal in spite of antiviral therapy. Early recognition of this entity is essential to expedite appropriate treatment and avoid future complications.