A patient with multiple phaeochromocytomas and visual loss

A young man was diagnosed with Von Hippel-Lindau (VHL) disease. We report the details of his case and review the relevant literature.Keywords: multiple phaeochromocytomas, visual los

Leiomyoma: A rare cause of adrenal incidentaloma

A 40-year-old, treatment-naïve, human immunodeficiency virus- (HIV) positive male was found to have a large right adrenal incidentaloma on ultrasound of the abdomen, which was confirmed on adrenal computed tomography imaging. The laboratory workup excluded functionality of the mass lesion. As the radiological examination of the mass raised the suspicion of a non-benign lesion, the patient underwent a right adrenalectomy. Histology, supported by a panel of immunohistochemical stains, confirmed the diagnosis of an adrenal leiomyoma. Most of the reported cases of adrenal leiomyomas in the literature are of patients with HIV and/or latent Epstein-Barr virus infections. This case illustrates that benign tumours, such as leiomyomas, can mimic the imaging phenotype of adrenal cortical carcinomas, and should be included in the differential diagnosis of adrenal incidentalomas, especially in the HIV-positive population

Pulmonary hypertension and thyrotoxicosis

Thyrotoxicosis is listed as a cause of pulmonary arterial hypertension (PAH). The aetiopathogenesis remains largely uncertain, but an autoimmune mechanism has been postulated, among others. In this setting, other causes of PAH need to be actively sought and excluded prior to attributing it to the thyrotoxicosis. The importance of recognising this condition is that it is usually reversible with restoration of a euthyroid state. We describe three patients who presented with thyrotoxicosis and features of PAH in whom other causes were excluded with various investigations. We also demonstrated reversibility of the pulmonary hypertension upon restoration of a normal thyroid state

Case Study: Telangiectatic osteosarcoma, a rare complication of Paget’s disease of bone

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The relative efficacy of nine osteoporosis medications for reducing the rate of fractures in post-menopausal women

<p>Abstract</p> <p>Background</p> <p>In the absence of head-to-head trials, indirect comparisons of randomized placebo-controlled trials may provide a viable option to assess relative efficacy. The purpose was to estimate the relative efficacy of reduction of fractures in post-menopausal women, and to assess robustness of the results.</p> <p>Methods</p> <p>A systematic literature review of multiple databases identified randomized placebo-controlled trials with nine drugs for post-menopausal women. Odds ratio and 95% credibility intervals for the rates of hip, non-vertebral, vertebral, and wrist fractures for each drug and between drugs were derived using a Bayesian approach. A drug was ranked as the most efficacious if it had the highest posterior odds ratio, or had the highest effect size.</p> <p>Results</p> <p>30 studies including 59,209 patients reported fracture rates for nine drugs: alendronate (6 studies), denosumab (1 study), etidronate (8 studies), ibandronate (4 studies), raloxifene (1 study), risedronate (7 studies), strontium (2 study), teriparatide (1 study), and zoledronic acid (1 study). The drugs with the highest probability of reducing non-vertebral fractures was etidronate and teriparatide while the drugs with the highest probability of reducing vertebral, hip or wrist fractures were teriparatide, zoledronic acid and denosumab. The drugs with the largest effect size for vertebral fractures were zoledronic acid, teriparatide and denosumab, while the drugs with the highest effect size for non-vertebral, hip or wrist fractures were alendronate or risedronate. Estimates were consistent between Bayesian and classical approaches.</p> <p>Conclusion</p> <p>Teriparatide, zoledronic acid and denosumab have the highest probabilities of being most efficacious for non-vertebral and vertebral fractures, and having the greatest effect sizes. The estimates from indirect comparisons were robust to differences in methodology.</p

The metabolic syndrome, insulin resistance and cardiovascular disease

GesondheidswetenskappeInterne GeneeskundePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Diabetes and endocrinology: therapy 2006

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Diabetes - all eyes on RSA

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The metabolic syndrome - pathogenesis, clinical features and management

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Joint Consensus: Hormone therapy in postmenopausal osteoporosis: 2008

Until 2002, hormone [replacement] therapy (HT) was first-line therapy for prevention (and treatment) of postmenopausal osteoporosis (PMOP). It was thought that any risks associated with HT were far outweighed by potential long-term benefits (mainly cardiovascular protection). Although there were rumblings from some smaller studies at the turn of the millennium, the Women's Health Initiative (WHI) results, published in 2002, changed the way in which we managed PMOP. In this large randomised study, there was now strong prospective evidence that HT did indeed decrease fracture risk at all major sites. However, the expected benefits in cardiovascular risk were not substantiated. Thereafter, the pendulum swung dramatically away from HT in PMOP; but newer evidence over the last 18 months is causing the pendulum to move back towards a central position. We now review the place of HT in postmenopausal osteoporosis in two parts: firstly, the accumulated evidence for bone protection and, secondly, the current benefits versus risk perspective, as well as up-to-date recommendations for its use.. JEMDSA Vol. 13 (1) 2008: pp. 8-1