Thyrotoxic periodic paralysis in a Jamaican male patient

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed. (AU)

A retrospective study on hypothyroid patients

A retrospective study of 58 hypothyroid patients attending the Endocrine Clinic, University Hospital of the West Indies, Jamaica, between July and August 1989, was undertaken. The age range at initial presentation varied from one month to eighty-four years. The majority of cases (51 or 87.9 percent) were between 21 and 70 years. There were 50 females (86.2 percent) and 8 males (13.8 percent). The underlying causes were idiopathic hypothyroidism (35 or 60.3 percent), posthyroidectomy (13 or 22.4 percent), post 1 therapy (6 or 10.4 percent), panhypopituitarism (3 or 5.2 percent), hypophysectomy (1 or 1.7 percent). Biochemical parameters used in diagnosis were serum thyroxine (T4) and thyroid-stimulating hormone (TSH). Forty-six patients (79.2 percent) had elevated TSH, indicative of a high correlation of elevated TSH with hypothyroidism. Duration of symptomatology prior to diagnosis was one year in 27 patients (46.5 percent), 2 - 10 years in 23 (39.6 percent) and 10 years in 4 cases (6.9 percent). The major presenting signs and symptoms were lethargy (20 Or 34.5 percent), anemia (mixed normochromic, microcytic (16 or 27.6 percent), slow relaxation of tendon reflexes (16 or 27.6 percent), coarsening of skin (15 or 25.9 percent), weight gain 10 or 17. percent), hoarseness (9 or 15.5 percent) and psychiatric symptoms (7 or 12 percent). The known association of primary hypothyroidism with other autoimmune disorders was not borne out in this study. The time-lapse in diagnosis from symptomatology emphasized the need for clinicians to be more alert to the subtle and varied presentation of hypothyroidism (AU)

Malaria revisited: "Jamaican perspective" - abstract

A retrospective study of all reported smear-positive cases of malaria in Jamaica between 1966 and 1989 was undertaken. There were 76 cases of imported malaria. Fourteen (14) of these cases were seen and treated at the University Hospital of the West Indies or at the University Health Centre. The results and their implications are discussed (AU)

Disseminated infection caused by penicillin-resistant gonococci in two Jamaicans

Disseminated gonococcal infection due to penicillin-resistant organisms is very unusual. Two such cases occuring at the University Hospital of the West Indies are described. Implications for therapy are discussed (AU)

Cushing's syndrome and its differential at the University Hospital of the West Indies - abstract

Crushing's syndrome is a rare condition with a potential for morbidity and mortality. During a 20-year retrospective review of patients with the diagnosis confirmed at the University Hospital, 20 cases were seen. There were 5 men and 15 women with an age range of 15 to 60 years and a mean age of 27 years. Sixty per cent of cases were due to hyperplasia, 15 percent to adenoma, 10 percent to carcinoma and 5 percent(1 case) was of ectopic origin in a patient with bronchogenic carcinoma. The zona fasciculata was involved in 90 percent of cases of hyperplasia. The clinical features of these black patients were as described elsewhere but we noted hypopigmentation alone in 45 percent of patients, with hyperpigmentation in 33 percent. One female patient, age 38, had a 13-year history of hypertension and later developed psychiatric symptoms. A 30-year-old man, who had severe hypertension of recent onset, developed congestive cardiac failure, and an adenoma compressing the renal artery was found at laparotomy. Difficult to control diabetes mellitus in a 27-year-old female was followed 3 years later by the development of cushionoid features. The mean time interval between the onset ofsymptoms and the confirmation of the diagnosis was 2 years 8 months. Serum cortisol levels with loss of diurnal variation and the dexamethasone suppression tests are still quite useful in confirming the diagnosis. Urinary cortisol and serum ACTH levels are not available here. Venography is the commonest and better-used method for localisation. Ultrasonography recently available has so far not been found to be helpful. Sixteen patients underwent successful surgery; two were scheduled for surgery, and one refused. Three patients developed Nelson's syndrome 1 to 4 years after surgery and two of them died, one in the perioperative period after transphenoidal resection of the pituitary tumor. Twenty-seven patients investigated for cushing's Syndrome during the same study period showed the cause to be simple obesity in 21 and Stein-Leventhal Syndrome in 6. It is concluded that blacks in Jamaica with cushing's syndrome present with similar clinical features as elsewhere, except for hypopigmented skin lesions. The zona fasciculata site involved. The serum cortisol and dexamethasone suppression tests are satisfactory in establishing a diagnosis (AU)