Cushing's syndrome and chronic venous ulceration--a clinical challenge.

Cushing's syndrome is a condition caused by high levels of glucocorticoids, or most commonly as a result of prolonged exposure to exogenous steroids. Clinical features include diabetes, hypertension, obesity, skin atrophy, immune suppression and delayed wound healing. We report a patient with iatrogenic Cushing's syndrome, in whom long-term topical steroid therapy was used to treat varicose eczema, which contributed to the development of type 2 diabetes, morbid obesity, sleep apnoea and chronic wound sepsis.

Invasive breast cancer after initiation of testosterone replacement therapy in a man--a warning to endocrinologists.

Objective: To alert fellow endocrinologists of a rare side effect of testosterone therapy, for which men with hypogonadism must receive appropriate counseling and monitoring.

Methods: We present clinical features, laboratory data, and histopathologic findings in a man with hypogonadism who received testosterone replacement therapy.

Results: A 61-year-old man was referred to an endocrinologist after presenting to his general practitioner with erectile dysfunction and low libido.

Acute anuric renal failure secondary to intravenous immunoglobulin in diabetic nephropathy.

We present a case of acute renal failure in a diabetic patient who received intravenous immunoglobulin therapy. Vigam liquid immunoglobulin was used successfully to treat vancomycin induced toxic epidermal necrolysis, but 4 days later the patient became anuric. Renal function was restored after haemofiltration.

Prospective screening for coeliac disease in patients with Graves' hyperthyroidism using anti-gliadin and tissue transglutaminase antibodies.

Introduction: Coeliac disease (CD) is associated with autoimmune thyroid disease (AITD) although its prevalence among those with Graves' hyperthyroidism in the UK is unknown. We determined the prevalence and evaluated the role of screening for CD prospectively in a consecutive cohort of patients with Graves' hyperthyroidism using IgA class antibodies to gliadin (AGA) and tissue transglutaminase (anti-tTG).

Methods: All patients with Graves' hyperthyroidism attending the thyroid clinic over a 9-month period were offered screening for CD using AGA (normal < 3 mg/l) and anti-tTG (normal < 15 micro/ml).