Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.
Adrenalectomy ; Adrenocortical Adenoma ; Aldosterone ; Alkalosis ; Humans ; Hyperaldosteronism ; Hypertension ; Hyperthyroidism* ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Incidence ; Japan ; Lower Extremity ; Middle Aged ; Paralysis ; Plasma ; Prognosis ; Renin ; Thyroid Gland

Purpose: We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy. Methods: We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP. Results: There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed. Conclusion MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

Hypercalcemia due to hyperparathyroidism is rarely associated with acute pancreatitis. But, the relationship between hypercalcemia and pancreatitis still remains controvesial. Ectopic parathyroid adenoma with cystic change is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. We report a case of mediastinal parathyroid adenoma with cystic change associated with acute pancreatitis. A 54-year-old male presented with epigastric pain for 3 days. The serum calcium, phosphate, elastase were 16.8mg/dL, 1.1 mg/dL, 2772.0 ng/mL respectively and his parathyroid hormone level in serum was 651.84 pg/mL. Chest CT showed a mediastinal mass with well defined inhomogenously enhanced density located between SVC and aorta. The patient was diagnosed to hyperparathyroidism with acute pancreatitis due to mediastinal parathyroid adenoma with cystic change, and was surgically removed. The surgical biopsy showed parathyroid adenoma with cystic change. After operation his general condition was improved and serum calcium, phosphate, amylase, lipase level were normalized.
Amylases ; Aorta ; Biopsy ; Calcium ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Lipase ; Male ; Mediastinal Cyst* ; Mediastinum ; Middle Aged ; Neck ; Pancreatic Elastase ; Pancreatitis* ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Tomography, X-Ray Computed

Exposure to early stressful adverse life events such as maternal and social separation plays an essential role in the development of the nervous system. Adolescent Sprague-Dawley rats that were separated on postnatal day 14 from their dam and litters (maternal social separation, MSS) showed hyperactivity and anxiolytic behavior in the open field test, elevated plus-maze test, and forced-swim test. Biologically, the number of astrocytes was significantly increased in the prefrontal cortex of MSS adolescent rats. The hyperactive and anxiolytic phenotype and biological alteration produced by this MSS protocol may provide a useful animal model for investigating the neurobiology of psychiatric disorders of childhood-onset diseases, such as attention deficient hyperactive disorder.
Adolescent ; Animals ; Astrocytes ; Humans ; Models, Animal ; Nervous System ; Neurobiology ; Phenotype ; Prefrontal Cortex ; Rats ; Rats, Sprague-Dawley