Sodium-glucose cotransporter 2 inhibitors: a practical guide for the Dutch cardiologist based on real-world experience.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors include a relatively new class of glucose-lowering drugs that reduce plasma glucose concentrations by inhibiting proximal tubular reabsorption of glucose in the kidney, while increasing its excretion in urine. Recent large randomised controlled trials have demonstrated that many of these agents reduce the occurrence of major adverse cardiovascular events, hospitalisation for heart failure, cardiovascular death and/or chronic kidney disease progression in patients with and without type 2 diabetes mellitus (DM2). Given their unique insulin-independent mode of action and favourable efficacy and adverse-event profile, SGLT2 inhibitors are promising and they offer an interesting therapeutic approach for the cardiologist to incorporate into routine practice.

Possible pitfalls in the workup of ectopic ACTH secretion illustrated by four rare cases.

In this case report, we highlight four different cases of ectopic adrenocorticotropic hormone (ACTH) secretion with different pitfalls in the diagnostic workup. Ectopic ACTH secretion (EAS) is an uncommon cause of Cushing's syndrome that accompanies a variety of tumours. It is associated with significant morbidity and mortality.

A woman with Cushing's syndrome after use of an Indonesian herb: a case report.

A 69-year-old woman developed Cushing's syndrome after long-term use of Sinatren, an Indonesian over the-counter drug, which was pharmacologically analysed three times before the correct content was discovered. After discontinuation she developed adrenal insufficiency, for which she needed substitution of steroids. Physicians should be aware of the presence of corticosteroids in over-the-counter products, that are not mentioned on the instruction leaflet.

Suspected thyroid stunning after radioiodine-131 scanning in a patient with a diffuse goiter.

A case of suspected thyroid stunning is presented in a previously hyperthyroid patient with a diffuse goiter, who had undergone a 185 MBq (131)I-NaI thyroid scan shortly before a (99m)Tc-pertechnetate scan. A less likely alternative hypothesis is the development of early hypothyroidism, 3.5 weeks after a modest (131)I dose.