Pitfalls in the follow-up of cervical and mediastinal goitres: role of CT imaging.

Four patients with cervical and mediastinal goitres were described. Routine investigation in these patients, including chest X-rays, oesophageal and tracheal X-rays and scintigraphy of the thyroid gland, failed to show significant changes over the years, or underestimated the true extent of the goitres. Three of the goitres caused severe mediastinal compression, evident only on computed tomography (CT) imaging, and requiring urgent surgery.

Congenital hereditary hypothyroidism--prenatal diagnosis and treatment.

Intrauterine diagnosis of congenital hypothyroidism was established on the basis of TSH concentration in amniotic fluid in the 22nd week of gestation for the offspring of a couple both known to have an iodide organification defect. Prenatal treatment consisted of intramniotic injections of 500 mcg Na-1-thyroxine, which was administered from the first amniocentesis until one week before delivery. Following delivery, the diagnosis was confirmed by the elevated level of TSH, 60.

The protracted effect of o,p'-DDD in Cushing's disease and its impact on adrenal morphogenesis of young human embryo.

We hereby present a patient with Cushing's disease who became pregnant while being treated with o,p'-DDD and underwent a therapeutic abortion in view of the known embryotoxicity and placental transfer of this drug. Biopsy of adipose tissue in this patient showed it to be the storage site of considerable quantities of o,p'-DDD. Serum levels of o,p'-DDD determined in this patient initially four months after withdrawal of treatment and in another similar case three months after withdrawal were about 20 times higher than those found in untreated patients and reached control values only about 20 months later.

Lymphoma presenting with adrenal insufficiency. Adrenal enlargement on computed tomographic scanning as a clue to diagnosis.

A 73-year-old woman who presented with primary adrenal insufficiency and enlarged adrenal glands on computed tomographic scanning was ultimately found to have a large-cell lymphoma that had initially involved the adrenals and the stomach. A search of the English language medical literature revealed only seven other cases of lymphoma presenting with hypoadrenalism, none of which involved the stomach. As in this case, in most of those cases adrenal enlargement was documented on computed tomographic scanning.

Decreased semen quality in a male infected with malaria.

A 33-year-old male of proven fertility suffered six attacks of malaria while resident in an African country. For this he received anti-malarial drugs. Semen analysis performed after the fourth attack, and repeated during the following 2 years after his return to Israel, revealed severe oligozoospermia, necrozoospermia and occasionally even azoospermia.

Cushing's disease coexisting with a single macronodule simulating adenoma of the adrenal cortex.

A rare case of Cushing's disease coexisting with a single macronodule simulating adenoma of the adrenal cortex is presented. The basal and dynamic tests supported the diagnosis of Cushing's disease, whereas the CT-scan, ultrasound and iodocholesterol uptake were suggestive of a left adrenal adenoma. Treatment consisted of extirpation of the nodular gland followed by pituitary irradiation.

Spontaneous postpartum regression of pituitary mass with return of function.

A 37-year-old woman undergoing endocrine evaluation during her seventh pregnancy because of headaches, weakness, and hyponatremia was found to have central hypoadrenalism and hypothyroidism. Computed tomography showed a pituitary mass with suprasellar extension but her visual fields were intact. She was treated conservatively with hydrocortisone acetate and levothyroxine sodium until 38 weeks of gestation, when healthy twins were delivered by cesarean section.

Leydig's and sertoli cells. Their fine structures in three cases of Klinefelter's syndrome.

Testicular biopsy specimens obtained from three patients with Klinefelter's syndrome were studied by light and electron microscopy. Of note in the ultrastructural findings were the absence of annulate lamellae in the Sertoli cells and the abnormal mitochondria, the presence of microcrystalline formations, and the absence of the crystals of Reinke in Leydig's cells. It is suggested that the impaired hormonal function of the testes in Klinefelter's syndrome may be related to the absence of annulate lamella in the Sertoli cells and the presence of microcrystal formations in Leydig's cells.

Pyrexia of unknown origin. Presenting sign of hypothalamic hypopituitarism.

A 62-year-old man was admitted to hospital 10 times over 12 years because of pyrexia of unknown origin. Hypothalamic hypopituitarism was diagnosed by dynamic tests including clomiphene, LRH, TRH and chlorpromazine stimulation. Lack of ACTH was demonstrated by long and short tetracosactrin tests.

Transitory hypoadrenalism due to long-term treatment with antiovulatory compounds.

A considerable number of women receiving antiovulatory compounds or estrogens complain of weakness and fatigability, suggesting a state of clinical hypoadrenalism. For this reason, levels of plasma ACTH and plasma cortisol were determined in 25 women with such complaints both during treatment and at various intervals after cessation of this treatment. The results obtained showed that there was a significant inhibition of ACTH secretion during long-term treatment with antiovulatory compounds or estrogens, and in half of the cases, there was a delay in normalization of the pituitary-adrenal axis following interruption of the drug, supporting a state of transitory hypoadrenalism.

Unilateral adrenalectomy and pituitary irradiation in the treatment of ACTH-dependent Cushing's disease in children and adolescents.

In four juvenile patients with Cushing's disease, the therapeutic approach used was unilateral adrenalectomy followed by irradiation of the pituitary. The follow-up time of these patients has ranged from 1.5 to 10 years.

Pregnancy in a case of Nelson's syndrome.

A woman suffering from Cushing's disease from the age of 17 who had been treated consecutively with pituitary irradiation, bilateral partial adrenalectomy and o,p'-DDD (Mitotane, USP) presented the clinical picture of Nelson's syndrome (hypoadrenalism with secondary hypersecretion of ACTH and MSH) at the age of 32. Under substitution therapy with corticoids she became pregnant for the first time at the age of 38. The course of the pregnancy was normal and at term she was delivered of a normal child by Cesarean section.

Aseptic necrosis of head of femur: presenting manifestation in Cushing's disease.

Aseptic necrosis of bone is a known complication of corticosteroid therapy. We report a case of aseptic necrosis of the femoral head as a presenting symptom of Cushing's disease. The case demonstrates that endogenous steroids, like exogenous steroids, may bear the same relationship to the pathogenesis of aseptic necrosis of bone.

Secondary pituitary insufficiency: report of three cases of ectopia or hemiagenesis of the thyroid gland.

Three patients with clinical and laboratory manifestations suggestive of pituitary insufficiency due to the presence of a pituitary tumor were found to have long-standing myxedema. The insidious appearance of the signs of hypothyroidism was explained by the cause of their disease--an ectopic thyroid gland in two patients and hemiagenesis of the thyroid in the third. Early recognition and treatment of such cases is important.