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Functional metastatic adrenocortical carcinoma is an uncommon cause of Cushing's syndrome, which rarely responds to conventional treatment. A patient presenting with Cushing's syndrome secondary to adrenocortical carcinoma underwent surgical resection. Postoperatively, she developed metastatic disease resistant to conventional chemotherapy. Octreotide, a somatostatin analogue which is effective in the treatment of several types of neuroendocrine tumour, was tried to ameliorate her secretory symptoms, but without any therapeutic effect.

A 37-year-old female, weighing 194.1 kg, is described. Her gross obesity was in part due to a massive ovarian dermoid cyst weighing at least 42 kg, which had been overlooked in the past. A dermoid tumour of this size has not previously been reported. The possible presence of cystic ovarian tumours should be considered in patients presenting with severe generalized obesity.

Between April and October 1983, 443 subjects were offered a month's course of Modifast by their general practitioners. Modifast is a very low calorie formula diet containing 1.7MJ (410 kcal) and 70g protein per day. Results available on 335 of these individuals indicate that 217 completed a four week course and achieved an average weight loss of 6.6 kg, whilst those that did not complete the course achieved a 2.6 kg weight loss. Concurrent disease was present in 44.5% of subjects. The product was rated on average, tolerable, but side effects, albeit generally minor and transient, were reported by one third. Nearly two-thirds of the initially hypertensive patients became normotensive. Modified fasting is an acceptable and effective initial approach to weight loss in general practice.