Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm...

A 25-year-old woman is described who had suspected hyperfunction of the adrenal cortex. She complained of fatiguability, excessive hair growth, and attacks of swelling of the face, hands, and ankles. Moreover she had a ;moon face', hypertension, a ;buffalo hump', and livid striae of the loins and hypogastrium. Adrenal function tests yielded values which could not be clearly interpreted. Operati...

Cushing's disease is considered a rare condition characterized by the hypersecretion of the adrenocorticotropic hormone (ACTH) due to a pituitary adenoma that ultimately causes endogenous hypercortisolism by stimulating the adrenal glands. The clinical signs suggesting Cushing's disease, such as obesity, moon face, hirsutism, and facial plethora are already present on presentation. Endogenous h...

To the Editor: Chikungunya fever was fi rst described in Tanganyika (now Tanzania) in 1952 and is now emerging in Southeast Asia. Chi-kungunya virus (CHIKV) infection, a self-limiting febrile illness, shares similarities with dengue fever such as headache and myalgia. Additionally , patients with CHIKV infection typically have arthralgia, arthritis, and tenosynovitis (1). Although usually benig...

An insulinoma is a rare tumour with an incidence of four cases per million per year in adults. The incidence in children is not established. There is limited literature available in children with insulinoma, and only one case is reported in association with Down's syndrome in adults. Insulinoma diagnosis is frequently missed in adults as well as in children. The Whipple triad is the most striki...

A 10-year-old boy who had been born in Pakistan, but had lived in England since the age of 9, initially presented to a paediatric hospital with nephrotic syndrome. He responded promptly to corticosteroids and was followed in outpatients. For 4 years he had several relapses of his nephrotic syndrome, which were successfully treated with courses of corticosteroids. After he had been abroad withou...

The concept of subclinical Cushing’s syndrome stands on the presence of adrenocorticotropic hormone-independent subclinical hypercortisolism without a clear Cushingoid phenotype and may be observed in patients with an incidentally found adrenal adenoma [1]. Kim et al. [2] found that the prevalence of subclinical Cushing’s syndrome in Korean patients with adrenal incidentaloma was 7.1% (19 of 26...

The nephrotic syndrome in childhood is usually of the minimal-change variety. At least 95% of children with this lesion respond to adequate corticosteroid treatment. Failure to respond is an indication for renal biopsy to exclude a more sinister glomerular lesion. We report the case of a boy whose failure to respond was not due to progressive glomerular disease but to a drug interaction. Case r...

SHORT COMMUNICATION Fig. 1. Cushingoid appearance. Typical " moon face " and facial hirsutism at admission (photograph reproduced with parental consent). Topical corticosteroids (TC) are used in several fields of medicine with universally recognized acceptable effectiveness and safety. TC are classified according to their potency, leading to different effectiveness, but also to different local ...

D URING the period 5/9/81 to 5/9/82. 27 consecutive liver transplantations were performed on 23 pediatric patients. Ages ranged from 7.5 months to 18 years. There were II males and 12 females. Four patients were adolescents (12-18 years). 6 patients were school age (5-10 years). and 13 were infants to preschools (7.5 months-4.5 years). Follow-up time ranged from 3.5 months to 15.5 months. Survi...