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Immune-mediated insulin resistance should be considered in patients with increasing hyperglycemia despite high-dose insulin treatment. This article illustrates the differential diagnosis of insulin resistance and describes the features and management of the type B insulin resistance syndrome.
Women with Cushing's syndrome are often misdiagnosed as having polycystic ovarian syndrome. The authors highlight the importance of correctly diagnosing the two disorders and describe the clinical features and investigations that can help to distinguish them.
Postoperative diabetes insipidus usually occurs transiently, owing to temporary compromise of arginine vasopressin secretion. Sometimes, however, a triphasic pattern occurs: initial diabetes insipidus is followed by a period of inappropriate antidiuresis that finally culminates in chronic diabetes insipidus. The authors discuss the pathophysiology of this process and the importance of adjusting treatment according to the pattern of the disease.
Graves' orbitopathy is an inflammatory syndrome that affects orbital tissues in about half of patients with Graves' disease. Therapy should be planned on the basis of disease severity and activity. This case illustrates the therapeutic approach to a patient with severe, active Graves' orbitopathy complicated by optic neuropathy, and discusses treatment alternatives.
In patients with primary hyperparathyroidism, surgical removal of all pathologic parathyroid tissue is the only definitive therapy. This Case Study reports a patient with persistent hyperparathyroidism due to a second ectopic adenoma, necessitating preoperative localization studies and illustrating a number of aspects of the diagnosis and management of primary hyperparathyroidism.