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Hypertensive emergency is characterized by an acute elevation in blood pressure with evidence of impending or progressive acute target organ damage. Management relies mainly on intravenous medications guided by the type of target-organ damage, but there is considerable variability in practice regarding the choice of medications and optimal therapy. Such variables include the choice of agent and the blood pressure goal, but also underlying medical conditions. We report a case of hypertensive emergency in a 39-year-old-male with a rare genetic condition, UMOD-related autosomal dominant tubulointerstitial kidney disease which gave rise to adolescent gout, worsening kidney function over decades and treatment-resistant hypertension.

We present a case of acute psychosis in a patient with panhypopituitarism admitted for adrenal crisis secondary to insufficient glucocorticoid replacement. Three months prior, she was admitted for a similar episode of adrenal crisis and underwent intubation; however, at that time her mental status was normal with no reported episodes of delirium or psychosis. After extubation, she was found to have psychotic symptoms which waxed and waned and were vaguely responsive to antipsychotics. She was ultimately stabilized and discharged, only to return three months later after missing multiple doses of her prednisone. During her current presentation, she had a recurrence of her waxing and waning mental status, which was presumed to be an organic result of her prior hypotension and anoxia vs. a primary psychotic break. In retrospect, it was largely dependent upon whether she received her scheduled steroids. Once her adrenal crisis had passed her cognition improved with daily steroid replacement and antipsychotics were unnecessary.

Isolated pancreatic tuberculosis is an exceedingly rare condition, even in areas of the world where the disease is highly prevalent. Abdominal tuberculosis is a common form of extrapulmonary tuberculosis but involvement of the pancreas is very rare. We report a case of isolated pancreatic tuberculosis presenting as a pancreatic mass in a patient with persistent abdominal pain and jaundice. Clinically and radiologically, the mass mimicked a malignant pancreatic tumor with a vastly different prognostic implication and therapeutic approach. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) can provide valuable diagnostic information in this scenario. After the tissue showed evidence of acid-fast bacilli and the cultures showed growth of Mycobacterium tuberculosis, antituberculosis therapy was initiated. Conservative management is usually successful in alleviating symptoms and leading to a cure. The excellent response to ATT makes it imperative that these patients are diagnosed early and managed appropriately to avoid unnecessary surgery and associated morbidity.