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Hypopituitarism in older adults
Patients with hypopituitarism may present with many different signs and symptoms which result from reduced secretion of one or more of pituitary hormones. Severe hyponatremia and hypoglycemia are rare but potentially life threatening presenting clinical features of hypopituitarism. As these abnormalities are completely restored with replacement therapy and patients are often undiagnosed until admission, a high clinical suspicion is necessary to diagnose a patient with hypopituitarism. We present five cases exhibiting rare symptoms of hypopituitarism?severe hyponatremia, hypoglycemia and osteoporosis?as the only presenting feature; these cases illustrate that hypopituitarism must be considered in the differential diagnosis of these abnormalities, especially in older patients.
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Headache, palpitations, sweating, and high anxiety
A 43-year-old white man presents for reevaluation of recurrent episodes of palpitations, diaphoresis, headache, and acute anxiety. At the initial visit 2 years ago, the patient complained of episodic palpitations with vague chest pain, which would last for several minutes and then subside. At that time his BP was 120/72 mm Hg. A follow-up stress test had negative results. The patient continued to have paroxysmal spells lasting about 15 minutes of palpitations, diaphoresis, headache, nausea, and apprehensiveness several times a month. Following the gradual resolution of these symptoms, he reported feeling weak and washed-out. At one point he was hospitalized for rapid atrial fibrillation, which converted back to normal sinus rhythm after medical treatment.
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Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus
Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis.
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New therapies to achieve glycemic control and weight loss in T2DM
Today's management of type 2 diabetes mellitus is supported by an array of therapeutic agents, including new drugs approved in 2005 that can promote weight loss along with glycemic control—pramlintide and exenatide—and an inhaled insulin, which was approved in 2006.
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