OBJECTIVE: To describe two patients with diabetic ketoacidosis and positive ethylene glycol levels and to call attention to the possibility of a false-positive ethylene glycol determination in patients with ketoacidosis. METHODS: Clinical manifestations and laboratory tests in the two patients were summarized. Serum specimens for both patients were analyzed for ethylene glycol, serum ketones, glucose, osmolality, pH, and electrolytes. RESULTS: Respective laboratory findings in our two patients were as follows: serum glucose levels, 56.4 and 45.7 mmol/L; serum acetone, positive in 1:80 and 1:128 dilution; serum osmolality, 366 and 377 mmol/kg; pH, 6.9 and 7.2; and ethylene glycol, 3.46 and 2.45 mmol/L. CONCLUSION: Neither of these two elderly women had ingested ethylene glycol; nevertheless, both had positive results for ethylene glycol on a blood toxicology screen. Review of the literature demonstrates that false-positive ethylene glycol levels can be detected in patients with ketoacidosis. This information is documented in this report and should alert practicing physicians to such a possibility.

Journal Article↗

PubMedDate not supplied

Successful therapy for a mixed thyrotropin-and prolactin-secreting pituitary macroadenoma with cabergoline.

OBJECTIVE: To describe the first case of a mixed thyrotropin (TSH)- and prolactin-secreting pituitary macroadenoma that responded to therapy with cabergoline. METHODS: We present a case report with clinical, laboratory, and radiologic details. RESULTS: An 84-year-old woman with central hyperthyroidism due to a mixed TSH- and prolactin-secreting pituitary macroadenoma was successfully treated with orally administered cabergoline, 0.25 mg twice per week. Serial assays of thyroid and pituitary hormones were done, and magnetic resonance imaging of the pituitary was performed before and 16 weeks after initiation of cabergoline therapy. The patient had complete resolution of the increased pituitary hormone indices within 6 weeks after implementation of therapy, and these results were sustained for more than 16 weeks. A magnetic resonance imaging scan showed no change in tumor size at 16 weeks of therapy. CONCLUSION: When medical treatment of TSH-secreting tumors is considered, choices of efficacious drugs are limited. To our knowledge, this report describes the first case of a long-acting dopamine agonist used successfully to control hypersecretion of a mixed TSH- and prolactin-secreting macroadenoma. Oral administration of cabergoline twice a week was effective, convenient, and well tolerated. Further evaluation of cabergoline, when indicated as medical therapy for TSH-secreting tumors, is warranted.

Journal Article↗

PubMedDate not supplied

Anticardiolipin antibodies in Hashimoto's disease.

OBJECTIVE: To ascertain the presence and significance of anticardiolipin antibodies in patients with Hashimoto's disease. METHODS: We studied 19 patients (15 women and 4 men; age range, 26 to 79 years) with Hashimoto's disease. IgA, IgG, and IgM anticardiolipin antibodies were measured by enzyme-linked immunosorbent assay. RESULTS: Of the 19 study patients, 4 (21%) tested positive for anticardiolipin antibodies (IgG in 2 and IgM in 2). Patients with anticardiolipin antibodies did not exhibit a higher titer of antithyroglobulin or anti-thyroid peroxidase antibodies in comparison with patients without anticardiolipin antibodies. Moreover, no relationship was found between anticardiolipin antibody levels and thyroid hormone replacement therapy. None of the patients with high levels of IgG or IgM anticardiolipin antibodies had clinical features of the antiphospholipid syndrome. CONCLUSION: Our results showed an increased incidence of anticardiolipin antibodies in patients with Hashimoto's disease. The presence of these antibodies may be a nonspecific marker of activation of the immune system.

Adult↗

PubMedDate not supplied

Hypercalcemia associated with squamous cell carcinoma of tongue.

OBJECTIVE: To present a case and to review the relationship between tumor production of parathyroid hormone-related protein (PTHrP) and hypercalcemia in oral squamous cell carcinoma (SCC), with emphasis on tongue cancer. METHODS: We describe a patient with advanced, locally invasive SCC of the tongue in whom hypercalcemia developed as a result of PTHrP production by the tumor. In addition, the medical literature regarding PTHrP and hypercalcemia associated with malignant disease is reviewed. RESULTS: A 65-year-old man, who was admitted to the hospital because of one episode of unresponsiveness, was found to have a large, necrotic, ulcerated lesion overlying the left mandibular area. After biopsy of the tumor and total body imaging, he was diagnosed with advanced, locally invasive, poorly differentiated SCC of the tongue, stage T4 N1 M0. On admission, the serum calcium concentration was 12.5 mg/dL (normal range, 8.5 to 10.7), and the serum albumin level was 2.2 g/dL (normal range, 3.5 to 5.5). The serum intact parathyroid hormone level was 26 pg/mL (normal range, 10 to 65); the PTHrP level was 13.1 pmol/L (normal, <1.3). Hypercalcemia attributable to production of PTHrP by the tongue SCC was diagnosed. Initial treatment of the hypercalcemia with vigorous hydration yielded a limited response. Intravenous administration of pamidronate initially decreased the serum calcium level to 5.2 mg/dL, but then it progressively increased to 8.6 mg/dL during the next 4 weeks. The patient refused further treatment and died after 1 month. CONCLUSION: To our knowledge, this is the first case of hypercalcemia associated with SCC of the tongue in which the serum PTHrP level was measured and reported to be high. It should be measured in other similar cases.

Aged↗

PubMedDate not supplied

Ectopic primary hyperparathyroidism.

OBJECTIVE: To review an unusual case of ectopic primary hyperparathyroidism. METHODS: We present a case report, including longitudinal results of laboratory studies, and comment on the difficulties with standard imaging techniques, interpretation of parathyroid pathologic findings, and use of invasive localization techniques. RESULTS: A 74-year-old woman underwent repeated assessments because of hypercalcemia. When standard parathyroid 99mTc sestamibi imaging was negative for adenoma and initial surgical exploration of the neck and removal of 3' parathyroid glands were unsuccessful in correcting the hyperparathyroidism, the ectopic adenoma was ultimately localized on an extended-field 99mTc sestamibi scan in the region of the right dome of the diaphragm. The localization was confirmed by selective venous sampling and angiography. The ectopic parathyroid adenoma was embolized, and 1 month later, the serum calcium level was normal. CONCLUSION: Ectopic lesions should be considered when standard imaging techniques are nonrevealing and standard neck exploration fails to disclose a parathyroid adenoma in a patient with persistent hypercalcemia. Selective venous sampling and angiography can assist in localization of ectopic parathyroid adenomas.

Adenoma↗