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An 82-year-old woman attended our outpatient clinic because of a swollen right arm and hoarseness. Upon raising both arms, the patient developed a red and swollen face (Pemberton's sign). An MRI of the thorax showed a large intrathoracic goitre, which compressed venous structures and limited blood flow even when she lowered her arms.

In a 79-year-old female, a markedly elevated alkaline phosphatase level was found by chance. She had noticed her hats had become too small. Clinical examination revealed a large skull with frontal bossing. Bone scintigraphy showed increased activity of bone metabolism in the skull. These three findings combined are considered a classic example of Paget's disease.

A 56-years-old woman was admitted to the emergency department because of fatigue since 6 weeks. Laboratory investigation revealed pancytopenia with teardrop cells and hypersegmentation. Teardrop cells are a characteristic finding in myelofibrosis, but in this case they were caused by severe vitamin B12 deficiency.

In patients with hyperglycaemia plus obesity and cardiovascular disease, the diagnosis of type 2 diabetes mellitus is likely to be made and this is usually followed by the start of antihyperglycaemic therapy. This pragmatic approach, however, does not always turn out to be the correct one. We describe two patients with occult conditions that had caused or aggravated diabetes mellitus (DM): a 46-year-old man with acromegaly and a 41-year-old woman with Cushing's disease. After neurosurgeries were performed, the requirement for antihyperglycaemic treatment markedly decreased (case 2) or even disappeared (case 1). Physicians treating patients with DM should ask themselves what the cause of the disease could be; the recognition and treatment of that underlying condition may substantially decrease the amount of insulin required and may even cause the disappearance of DM altogether.

A 65-year-old woman was admitted to our hospital with progressive confusion and hypersomnia. During admission she became comatose which was found to be caused by hepatic encephalopathy. Fifteen years earlier she had undergone a Whipple's pancreaticoduodenectomy for an adenocarcinoma of the pancreatic head. She had developed secondary endo- and exocrine pancreas insufficiency and a fatty liver. Non-alcoholic fatty liver disease (NAFLD) is a little-known late complication of a pancreaticoduodenectomy, possibly caused by postoperative exocrine pancreas insufficiency. NAFLD may lead to non-alcoholic steatohepatitis (NASH) which can ultimately result in liver cirrhosis. There have been no previous reports in the literature of hepatic encephalopathy presenting as liver failure secondary to NASH following pancreaticoduodenectomy.