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Phaeochromocytomas are rare cause of secondary hypertension with significant morbidity and mortality, if left untreated. Paroxysms with hypertension are considered as "textbook" presentations but atypical forms represent considerable diagnostic challenge. We report an unusual association between phaeochromocyotoma and post-exertional malignant arrhythmia in a normotensive subject.

The effects of replacement with recombinant human GH (hGH) on red cell plasma membrane fatty acid and cholesterol constituents were assessed in nine adult patients with growth hormone deficiency. They were treated with hGH in a dose of 0.125 U.kg-1.wk-1 for four weeks and at 0.25 U.kg-1.wk-1 thereafter for an overall mean duration 13.5 +/- 3.9 months (mean +/- SD). The relative proportions of the various phospholipid fatty acid constituents and the proportion of cholesterol in the phospholipid bilayer were assayed every six months. At the end of the study, the percentage of arachadonic acid (20:4) in membrane phospholipid was found to rise by an average of 3.7% (P < 0.05) and there appeared to be a nonsignificant trend showing an increase in highly unsaturated fatty acids, namely linoleate (18:2) and gamma linolenic acid (18:3) and a corresponding decrease in unsaturated fatty acids, namely palmitate (16:0) and stearate (18:0) and monounsaturated fatty acids such as palmitoleic acid (16:1), oleic acid (18:1) and oleic acid isomer (18:1 iso). In addition, the proportion of cholesterol in the plasma membrane i.e. the cholesterol/phospholipid ratio was found to decrease by 0.84% (P < 0.05). There was a significant increase in HbAlc from 4.85 +/- 0.51 to 4.94 +/- 0.45% (P < 0.01) by the end of the study.

A total of 748 patients on L-thyroxine with a suppressed serum TSH were requested to reduce their dose and this was achieved in 601 patients. Thyroxine dosage was reduced by 25 or 50 micrograms of L-thyroxine and patients were reviewed six months later. Of all 601 patients, 54.4% remained with a suppressed serum TSH despite dose reduction and in 5.8% an elevated serum TSH resulted. 25 micrograms reductions and 50 micrograms reductions were equally likely to result in an detectable but non-elevated serum TSH (42.8% vs 34.1% ns) but 25 micrograms reductions were less likely to result in an elevated serum TSH (3.8% vs 10.0% p < 0.01). Only 7/601 patients in the study (1.2%) appeared to require a dose of over 150 micrograms. If dose reduction is thought to be necessary for patients with a suppressed serum TSH, we would recommend 50 micrograms reductions if the original dose is 200 micrograms or more, and 25 micrograms reductions if the original dose is 175 micrograms or less.

A cerebral astrocytoma which had remained quiescent possibly for 12 years, presented with blackout, vasculitis and a lupus-like (L-E like) syndrome. The association between tumours and "L-E like" syndromes is reviewed briefly.