Case Study in 2009

Initial diagnosis of insulinoma requires demonstration of inappropriately elevated insulin levels and concurrent hypoglycemia in the absence of administration of exogenous insulin or sulphonylureas. This article presents the case of a patient with insulinoma, who presented with hypoglycemia without coinciding evident hyperinsulinemia according to current guidelines. The article details current diagnostic criteria and highlights the role of clinical judgment in the investigation and management of cases, which do not conform to an expected pattern.

Charcot arthropathy of the neuropathic foot and ankle is characterized by bone and joint destruction and deformities that may lead to ulcer, soft tissue infection, osteomyelitis and amputation. This article reviews the evaluation and treatment of this condition, highlighted by a clinical case of a man with type 2 diabetes mellitus who had Charcot collapse of the longitudinal arch, rocker bottom deformity and plantar ulcer.

This case illustrates some of the difficulties in treating anovulatory women with polycystic ovary syndrome, which is the most common cause of anovulatory infertility. Insulin resistance is a contributing factor to the pathogenesis of the syndrome. Assisted conception therapy is an effective treatment for women with polycystic ovary syndrome who are refractory to standard ovulation induction therapies or who have co-existing infertility factors. However, women with polycystic ovaries are particularly sensitive to stimulation with gonadotropins and have an increased risk of developing ovarian hyperstimulation syndrome.

This article presents the case of a child with pseudohypoparathyroidism type 1a and associated endocrinopathies, namely, growth hormone deficiency, hypothyroidism, parathyroid hormone resistance and insulin resistance. The article details the natural history and management of these endocrinopathies, including the controversy over growth-hormone therapy, and potential mechanisms for insulin resistance in pseudohypoparathyroidism type 1a.

Gastroparesis is a complication of diabetes mellitus that is associated with prolonged periods of suboptimal glycemic control. This article describes a patient who had diabetic gastroparesis that was unresponsive to conventional treatments. Her severe vomiting was successfully controlled by use of the antiemetic drug aprepitant for 4 months before a gastric electrical stimulation device was fitted.

Childhood obesity is a serious public health concern. This Case Study discusses the evaluation and treatment of a child with obesity. The article details how careful assessment can exclude genetic causes of obesity in most children and outlines how children without genetic causes of the condition can benefit from individualized lifestyle modification programs.

Generalized arterial calcification of infancy is a rare and often fatal genetic disorder, for which no formalized treatment approach exists. This article describes a case where treatment with nitrogen-containing bisphosphonates resulted in normalization of the arterial structure.