Acute watery diarrhea as the initial presenting feature of a pheochromocytoma in an 84-year-old female patient

We report the case of an 84-year-old woman who was initially admitted to the emergency room of our institution for frank dehydration caused by acute and severe secretory diarrheas along with acidosis and hypokalemia. After extensive gastrointestinal investigations, the etiology of the diarrhea remained unclear. Because clinical symptoms and ionogram parameters worsened, despite intravenous fluids and electrolyte replacement, an abdominal CT scan was performed and unexpectedly revealed a 4.5-cm mass in the right adrenal gland. Several separate 24-hour urine catecholamines were shown to be highly elevated. The diagnosis of pheochromocytoma was confirmed by MIBG scintigraphy and MRI. Before the admission, the patient never experienced symptoms suggestive of pheochromocytoma, except dry mouth and fear of impending death on several occasions. After 2 weeks, the diarrhea stopped abruptly and spontaneously without specific medication but after adequate rehydration. The patient subsequently underwent surgical removal of the adrenal medullary mass. Postoperatively, urinary catecholamines returned to normal values. Immunohistochemical study of the tumor confirmed the diagnosis of pheochromocytoma and revealed the presence of VIP-positive cells organized as islets in scattered areas of the tissue. This case illustrates the protean mode of presentation of pheochromocytoma, as well as the ability of medullary neural crest-derived cells to produce various neuropeptides potentially responsible for a large variety of symptoms.     

Ultrastructural changes in the cerebral cortex of an 100 1/2-year-old man

Age changes in fields 39 and 40 (after Broadman) have been studied in a 100 years and 6 months old man died from peritonitis resulted from the surgical intervention, performed in connection with strangulation of the hernia. In the medical history there were no ++neuro-physical signs. The material was taken in 1 h 15 min after clinical death had been stated. The results obtained have been compared with those studied in the brain of persons, who had not yet reached the age of 100 years and had not any signs of ++neuro-physical disturbances and died after urgent surgical interventions in the abdominal cavity. In this group of persons the material for investigation was taken in 15-30 min after clinical death had been stated. The technique for treatment the material, its preparation for electron-microscopical examination is identical. Immersion fixation has been applied. The material obtained from an old animal fixed by means of vital perfusion of 2.5% glutaraldehyde solution is also used. In the person of 100 years and 6 months old the changes do not practically differ from those obtained from persons of younger age, however, the time from the statement of clinical death up to obtaining the material essentially influences preservation of the synaptic apparatus components.     

Homozygosity for fragile site at 17p12 in a 28-year-old healthy man

Summary In a family two heterozygous children and a homozygous phenotypically normal father with a gragile site at 17p12 were discovered. This observation confirms the opinion that even homozygosity for this fragile site is phenotypically harmless.