Early Diagnosis of Addison Disease - Pigmentation as Sole Symptom

Summary: Early diagnosis of Addison's disease; pigmentation as sole symptom. A diagnosis of primary adrenocortical insufficiency was made in a shapely, suntanned girl whose sole complaint was increasing pigmentation. Plasma Cortisol was low in spite of markedly elevated levels of ACTH. Plasma Cortisol, urinary 17‐oxogenic steroids and urinary aldosterone did not respond to three days of ACTH stimulation. Addison's disease can be diagnosed and treated before development of anorexia, weight loss, weakness and other classical symptoms

Thyroid Stimulating Antibodies in Patients with Sub-Acute Thyroiditis

A radioreceptor assay was used to measure thyroid stimulating antibodies (TSAb) during the acute and recovery phases in 7 patients with subacute thyroiditis. High levels of TSAb were detected in 4 patients during the acute phase. # In two other patients, tests were borderline positive. In the latter two patients tests were negative by two weeks, whilst in the 4 patients with strongly positive tests initially, levels persisted for several weeks, falling to within the normal range by 3 months in the two patients in whom repeated tests were carried out. TSAb probably do not play a role in the transient hyperthyroidism commonly seen in this disorder, since the detection of TSAb did not correlate with clinical or biochemical evidence of hyperthyroidism. Thus, in this disorder, TSAb are apparently able to bind to thyroid membranes in vitro, but not stimulate the gland in vivo. On the other hand TSAb could possibly play a role in the recovery phase. The possible role of suppressor cells in the development of the transient immune abnormalities which are associated with temporary thyroid damage is discussed

Optic Disk Edema and Diabetes-Mellitus - a Case-Report with Review

Optic disc oedema is a neurological complication of diabetes mellitus. Typically, the patient is a young diabetic with minimal symptomatology but severe bilateral optic disc oedema discovered on routine eye examination. It is a relatively benign condition which on occasion can result in a residual visual deficit, but requires no specific intervention and represents a subgroup of anterior ischaemic optic neuropathy (AION). We present a patient with insulin dependent diabetes and asymptomatic bilateral optic disc oedema, with a brief review of the syndrome and its pathogenesis

Thyroid-Stimulating Antibodies in Patients with Auto-Immune Disorders

A radioreceptor assay was used to measure thyroid-stimulating antibody (TSAb) in 1) patients with Graves’ disease with untreated hyperthyroidism, selected for absence of clinically significant eye disease; 2) patients with Graves’ ophthalmopathy, with and without previously treated hyperthyroidism; 3) patients with other thyroid disorders; 4) patients with other autoimmune disorders; and 5) normal subjects. TSAb was detected in 14 of 15 (93%) patients with Graves’ hyperthyroidism and in 10 of 16 (63%) patients with Graves’ ophthalmopathy. Of the patients with Graves’ ophthalmopathy, TSAb was detected in 9 of 10 patients who had once been hyperthyroid and in only 1 of 6 patients who had never been hyperthyroid (euthyroid Graves’ disease). TSAb was detected in 1 patient with idiopathic Addison’s disease (autoimmune adrenalitis) and in 1 patient with juvenile diabetes mellitus (both of whom were euthyroid), and borderline levels were found in 1 patient with Sjögren’s syndrome and 1 patient with methyldopa-induced antired blood cell antibodies. TSAb was not detected in normal subjects or patients with other thyroid disorders. The conclusions are: 1) the test is very useful in the diagnosis of Graves’ disease; 2) Graves’ eye disease may be a frequently associated but separate disorder; and 3) because TSAb may be present in some euthyroid patients with other autoimmune disorders, TSAb production may occur primarily because of a disorder in the immune system