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In 1975, scintigraphy revealed a 6.5 x 5 cm tumour in the region of the left adrenal in a 36-year-old man with known hypertension for 5 years (systolic pressure up to 250 mm Hg, diastolic up to 130 mm Hg). A laparotomy was performed for a suspected phaeochromocytoma. A tumour was located in the upper pole of the kidney and removed together with the kidney. The blood pressure quickly returned to normal after the operation: it remained stable for the following 17 years (between 130/80 to 150/90 mm Hg). Originally the tumour could not be clearly classified either clinically or histologically. But recently the paraffin-imbedded tumour specimen was re-examined by immunohistochemistry and in-situ hybridization. This identified a renin-producing tumour so that primary reninism was the cause of the arterial hypertension.

Recurrent hypovolaemic shock had been occurring over the last five and four years, respectively, in a 53-year-old woman and a 46-year-old man who had previously been healthy. The attacks were characterized by a tension feeling and sometimes oedema in the limbs, as well as increased thirst. Within a few hours sweating, tachycardia, orthostatic complaints and shock would occur. The woman's systolic blood pressure would fall to 70 mm Hg and the pulse rate rise to 150/min. The man's blood pressure was not measurable by sphygmomanometer during his first attack. Haematocrit rose to 61 and 71.5%, haemoglobin concentration to 20.7 and 21.3 g/dl, respectively. On administration of plasma expanders all abnormal clinical and biochemical changes quickly disappeared, only to recur within weeks or months. The cause of the condition is an increased permeability of the tissue capillaries, while renal, pulmonary and cerebral vessels apparently are unaffected. During ketotifen and tebonin (gingko biloba extract) administration to the man, he required no further hospitalization for nine months, after which he had three severe attacks. The woman had a severe attack of hypovolaemic shock one month on this treatment. The prognosis of capillary leak syndrome is bad.

Pious fraud, nothing but the naked truth or merciful borderline areas of hope and despair - Salus aegroti suprema lex! There is no absolute truth in doctor-patient dialogue for no such thing as absolute truth nor a sick-bed as such exists. Each bed houses its own patient, and each patient carries his specific truth which he shares with all his partners, thus breaking the isolation of his fate. Only in this way is it possible for all concerned to bear or help bear the heavy burden of life's last stretch.

Thyrotoxicosis is associated with hypomagnesemia. Therapy leads to restoration of serum magnesium concentration. The clinical significance of the disturbance in magnesium metabolism is discussed on results of two groups of patients with hyperthyroidism. One group of 7 patients with high serum thyroxine levels and mild clinical signs of thyrotoxicosis showed a normal magnesium concentration in serum. In a second group with further 7 patients serum magnesium level did not increase during therapy while thyroxine decreased in spite of lack of clinical improvement. The results suggest that serum magnesium concentration is primarily determined by 1-triiodothyronine.

By histochemical and histometrical methods the the effect of l-triiodothyronine on the zona glomerulosa from rat adrenal cortex was investigated. Glucose-6-phosphatedehydrogenase and 3-beta-OH-steroiddehydrogenase activities were determined in slices of adrenal cortex. No increase in activities of these enzymes was observed after treatment with l-triiodothyronine. In contrast, histometrical studies showed a significant enlargement of nuclei in the zona glomerulosa as well as in the zona fasciculata. This observation suggests enhanced secretory activity of both zones of the adrenal cortex of the rat.