The symptomatology of adenomyosis.

Adenomyosis is a poorly understood condition which has been called 'elusive' or 'enigmatic' because of the difficulty in diagnosis, the lack of agreement on definition, and also because of the vague and ill-defined pattern of symptoms which may accompany it. There is little doubt that some women with adenomyosis may experience troublesome, heavy menstrual bleeding, troublesome dysmenorrhoea, and sometimes a tender uterus. However, the frequency and severity with which these symptoms occur, and the proportion of adenomyosis sufferers who are completely asymptomatic, are quite unclear. The common association of adenomyosis with other pelvic pathologies is an additional factor which confuses the understanding of related symptoms. It is clear that there is no specific combination of symptoms caused by adenomyosis, although many of these women will undoubtedly suffer from very heavy menstrual periods. Now that moderate to severe degrees of adenomyosis can be diagnosed preoperatively with a fair degree of reliability by good-quality ultrasound or magnetic resonance imaging (MRI), there is an urgent need for multicentre collaboration to prospectively define symptomatology in a uniform manner, and then correlate this with specific findings on imaging (and compare with later surgical and pathological findings).

Abnormal movements associated with severe hyponatraemia.

An elderly woman with severe hyponatraemia manifested transient choreoathetoid movements of the upper extremities and dyskinetic movements of the face and mouth. She showed more than one type of hyponatraemia and a precise diagnosis was not possible. The movements were abolished with treatment of the hyponatraemia with no recurrence or sequelae.