[Achalasia, alacrima without adrenal insufficiency with peripheral and autonomic neurological dysfunction (Allgrove's syndrome)]. / Acalasia, alacrima sin insuficiencia suprarrenal, con disfunción neurológica periférica y autonómica (síndrome de Allgrove).

OBJECTIVE: To present a patient with Allgrove's syndrome and peripheral and autonomic neurological dysfunction. This pathological entity has not been previously reported in national medical literature. BACKGROUND: Allgrove's syndrome is comprised of achalasia, alacrima and adrenal insufficiency. It is a rare disease. Some isolated cases have been informed in the literature. The most extensive series was published by Grant et al in 1993. In this study, 20 patients from various european countries were analyzed. METHOD: We describe a patient with diagnosis suggestive of Allgrove's syndrome and expose the results of a review of the medical literature concerning this syndrome. We emphasize in neurological dysfunction of these patients. Such abnormalities are not actually well defined in this syndrome. RESULTS: A twelve-year-old male patient was admitted to the hospital for dysphagia. A diagnosis of achalasia was performed with endoscopy and esophagogram and confirmed with esophageal manometry. Physical examination showed alacrima and neurological dysfunction. Stimulation of adrenal function with ACTH (Cortosin) was normal. Neurologic examination revealed: peripheral neuropathy, autonomic dysfunction; corticospinal, psychomotor and intellectual impairment. CONCLUSION: Allgrove's syndrome must be in mind in physicians who see children with achalasia. Nevertheless adrenal insufficiency is not always present in cases when diagnosis is performed. It may appear several years afterwards. Neurological dysfunction seems to be the most prominent feature.

[Magnetic resonance diagnosis of insulinoma]. / Diagnóstico de insulinoma por resonancia magnética.

OBJECTIVE: The purpose of this report is to highlight the use of the magnetic resonance imaging in the detection of very small tumors of the pancreas. BACKGROUND: The computed axial tomography and angiography have been the traditional methods in the detection of neoplasms of the pancreas, mostly vascular lesions, both lacking the tissue characterization and contrast; the magnetic resonance scan was performed to rule out a pancreatic tumor in a 37 year old female patient with hypoglycemia, previously treated for seizures. RESULTS: A 1.0 cm nodular hypointense lesion was seen in the union of the body and the tail of the pancreas, confirmed by surgery and pathology as an insular cell tumor. CONCLUSION: Given its axial and tissue contrast resolution, as demonstrated in our case, the magnetic resonance imaging has became the gold standard in the identification of very small tumors of the pancreas.