Internal medicine
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Case Reports
Pituitary apoplexy after subtotal thyroidectomy in an acromegalic patient with a large goiter.
A case of pituitary apoplexy occurring after subtotal thyroidectomy in an acromegalic woman with a large adenomatous goiter is described. The patient had severe apnea because the large goiter was causing airway compression. ⋯ The serum levels of growth hormone and somatomedin-C spontaneously normalized seventeen days after this episode and have remained normal for two years. Pituitary apoplexy was thought to have caused the observed results without deterioration of the pituitary function.
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A case of cibenzoline-induced myasthenia-like syndrome is reported. A 67-year-old woman with renal failure and no previous disorder of neuromuscular junction complained of fatigue during climbing up a flight of stairs and experiencing heavy eyelids after administration of 100 mg/day of cibenzoline. ⋯ The peak cibenzoline concentration was still high even after the dose reduction (666.4 ng/ml). In conclusion, cibenzoline, at a high plasma level, may induce myasthenia-like syndrome without any disorder of the neuromuscular junction.
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A patient with a history of cerebrovascular disease, hypertension, and previous gastrectomy developed metabolic alkalosis and myoclonus. His medications included the anti-hypertensive agents nicardipine hydrochloride, delapril, prazosin; dihydroergotoxin and ticlopidine for cerebral infarction; estazolam for insomnia; azuren-L-glutamine compound and S-M powder. ⋯ This antacid is commonly used in Japan. This is the first report of a case of metabolic alkalosis and myoclonus secondary to ingestion of a commercially available antacid in Japan.