Lipid lowering inefficacy of high-dose statin therapy due to concurrent use of phenytoin.

HMG-CoA reductase inhibitors ("statins") are the most commonly prescribed lipid lowering agents. Most of the statins are metabolized by the CYP450 cytochrome system. A number of medications either induce or inhibit this system which leads to changes in the bioavailability of the statins and the potential for either an increase in adverse effects or reduction in efficacy.

Low serum alkaline phosphatase activity and pathologic fracture: case report and brief review of hypophosphatasia diagnosed in adulthood.

Objective: To describe an elderly patient with low serum alkaline phosphatase (ALP) activity detected after a pathologic fracture and to characterize hypophosphatasia in adult patients.

Methods: We present a case report of a 64-year-old woman, who was referred after sustaining an atraumatic femoral fracture treated successfully with intramedullary nailing. Clinical, biochemical, radiologic, and molecular studies explore the differential diagnosis of her hypophosphatasemia, and the features, diagnosis, and management of the adult form of hypophosphatasia are reviewed.

Macroprolactinemia in a patient with infertility and hyperprolactinemia.

A significant number of patients with hyperprolactinemia have macroprolactinemia, a condition characterized by the preponderance of big-big prolactin with normal levels of free prolactin. As macroprolactin does not have biologic activity, such patients do not require further investigations or treatment for hyperprolactinemia. The case of a patient with hyperprolactinemia diagnosed during investigation of secondary infertility is presented.

Evaluation and treatment of osteoporosis in patients with a fragility hip fracture.

Objective: To determine whether patients with fragility hip fractures underwent assessment and treatment of osteoporosis during initial hospitalization or recommendations for such intervention were made to the primary care provider (PCP) at the time of hospital dismissal.

Methods: A review of medical records of patients admitted with a low-impact hip fracture to the Royal University Hospital in Saskatoon, Saskatchewan, Canada, was performed to determine whether recommendations were made to evaluate for or treat osteoporosis. In addition, a questionnaire was sent to the orthopedic surgeons practicing at the hospital to help identify barriers to widespread diagnosis and treatment of osteoporosis in such patients.

Celiac disease occurring in a patient with hypoparathyroidism and autoimmune thyroid disease.

Patients with an underlying autoimmune endocrine disorder are at an increased risk of developing other autoimmune diseases. We describe a patient with idiopathic autoimmune hypoparathyroidism who developed hyperthyroidism due to Graves disease and subsequently was diagnosed with celiac disease. Malabsorption of L-thyroxine was the only clue regarding the presence of celiac disease.

Reversible hypercalcemia and hyperparathyroidism associated with lithium therapy: case report and review of literature.

Objective: To present a case of reversible hypercalcemia and hyperparathyroidism associated with lithium therapy and to discuss the pathophysiology and management of this condition.

Methods: The clinical and laboratory findings in a patient with lithium-induced hypercalcemia are presented. A PubMed search for associated English language articles (with use of the key words lithium, hypercalcemia, and hyperparathyroidism) was conducted, and the relevant literature to date was reviewed.

Acromegaly as an endocrine form of myopathy: case report and review of literature.

Objective: To describe a case of muscle weakness in a patient with acromegaly and to review the pathophysiologic features of this disorder.

Methods: We present the clinical, laboratory, electromyographic, and muscle biopsy findings in our patient and review related reports in the literature.

Results: A 58-year-old woman with acromegaly presented with complaints of bilateral hip pain, weakness, and instability 8 months after transsphenoidal resection of a growth hormone (GH)-secreting pituitary macroadenoma.

Multiple myeloma presenting with recurrent hypercalcemia in a patient with a history of primary hyperparathyroidism: report of case and review of literature.

Objective: To report a case of primary hyperparathyroidism (PHPT) that presented with recurrent hypercalcemia due to multiple myeloma after successful parathyroidectomy.

Methods: The initial manifestations, investigations, and postoperative follow-up of a case of hypercalcemia due to PHPT are described. The studies performed for evaluation for recurrent hypercalcemia and the subsequent diagnosis of multiple myeloma are discussed.

A case of congestive heart failure due to reversible dilated cardiomyopathy caused by hyperthyroidism.

Thyrotoxicosis is an uncommon cause of low-output congestive heart failure. The case of a 41-year-old male who presented with severe symptomatic congestive heart failure, and was subsequently diagnosed with dilated cardiomyopathy secondary to hyperthyroidism, is presented. The cause of his hyperthyroidism was Graves disease.

Adrenomyeloneuropathy as a cause of primary adrenal insufficiency and spastic paraparesis.

Adrenomyeloneuropathy is a varient of adrenoleukodystrophy, both of which are rare inherited disorders of peroxisomes characterized by the accumulation of very-long-chain fatty acids in plasma, the central and peripheral nervous systems, adrenal glands and testes, which leads to dysfunction of these organs and systems. In this article, we describe an illustrative case of adrenomyeloneuropathy and discuss the clinical presentation, diagnosis and management of the 2 disorders.