Journal of Case Reports in Practice
Volume:7 Issue: 3, Jul 2019

Cushing’s syndrome occurs due to chronic exposure to excess glucocorticoid. This disorder can be classified into ACTH-dependent and ACTH-independent based on any etiology. There are very rare accessible reports concerning the autonomous increase of cortisol secretion following a long-standing overproduction of ACTH in long term Cushing’s disease. This report deals with the persistence of some symptoms and clinical signs dependent on Cushing’s syndrome despite the ablation of pituitary adenoma in Cushing’s disease.This incident occurred to a woman as a result of the excess autonomous cortisol secretion from the adrenal tumor which was, apparently, caused by a long-lasting ACTH-stimulation. The adrenal computed tomography scanning of the patient revealed a large mass in the right adrenal gland. Then, she underwent right adrenalectomy. The carried out follow up revealed her complete recovery.

The prevalence of hypoparathyroidism in the USA is 37 out of 100,000. Hypoparathyroidism is divided into primary and acquired. It occurs when there is inadequate secretion of PTH leading to the decrease of calcium as well as the increase of phosphate level. Coexistence of any cases of hypoparathyroidism, Graves’ disease and papillary thyroid carcinoma (PTC) has never been reported in the literature before. The rare case introduced here is a 42 years old woman with the history of primary hypoparathyroidism since 18 years ago that developed Graves’ disease about 14 years after the onset of the disorder and underwent a thyroid surgery due to PTC 2 years later.

Infant botulism is an uncommon neuromuscular condition that is the result of neurotoxins that block smooth muscle and skeletal function and autonomic function from colonization of intestinal Clostridium botulinum. The majority of those infected are often less than six months old who present with poor feeding, weight loss, constipation, and hypotonic. A 7-week-old male was brought to the Emergency Department (ED) for complaints of poor feeding. The mother stated that the baby had not been acting normally, had been feeding poorly, and had weight loss over a one-week period. On examination, the patient appeared to be lethargic and floppy. The initial workup included a complete blood count (CBC), complete metabolic panel (CMP), urinalysis, brain MRI, and lumbar puncture which all were within normal limits. Due to symptoms, BIG-IV therapy was initiated. A stool sample was obtained and was positive for Clostridium botulinum toxin A. The infant started to show improvement in feeding and muscle tone over the next several days and was discharged home on day ten. Frequently patients with infant botulism may not show all of these symptoms at once, which can make it difficult for providers to diagnose correctly. Although infant botulism does occur worldwide it has a higher prevalence in North American from ingestion of dust near activities that disrupts the soil such as agriculture or ingestion of raw honey. The treatment for infant botulism is an orphan drug, BIG-IV, which has significantly reduced the mortality and morbidity of this disease.