Background Leser–Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser–Trélat syndrome, and was eventually found to have renal malignancy. Case presentation A 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs. Conclusions To the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser–Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser–Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.

BackgroundOsteoporosis and osteoporotic fracture pose a major public health problem in our aging population. Osteoporotic hip fractures carry an increased morbidity and mortality, with some difference seen between men and women. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remain underdiagnosed and undertreated.AimWe aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital.MethodsAll patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019-March 2021 were recruited and demographic data and clinical features were obtained.ResultsThere were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males were 74.1 ± 9.5 years, while the mean age for females were 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61, and subtrochanteric=1. There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, GIOP, renal disease, ADT, thyroid disorder, prostate cancer, and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). ConclusionThere were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.Trial registration: This study (Male osteoporotic hip fracture in Sarawak General Hospital) was registered with the Malaysian National Medical Research Register (NMRR). Trial registration number: NMRR-19-323-46068 IIR

BackgroundOsteoporosis and osteoporotic fracture pose a major public health problem in our aging population and carry an increased morbidity and mortality. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remain underdiagnosed and undertreated.AimWe aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital.MethodsAll patients diagnosed with osteoporotic hip fracture admitted from June 2019-March 2021 were recruited and demographic data and clinical features were obtained.ResultsThere were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males were 74.1 ± 9.5 years, while the mean age for females were 77.4 ± 9.1 years (p=0.06). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, GIOP, renal disease, ADT, thyroid disorder, prostate cancer, and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). ConclusionThere were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.Trial registration: This study (Male osteoporotic hip fracture in Sarawak General Hospital) was registered with the Malaysian National Medical Research Register (NMRR). Trial registration number: NMRR-19-323-46068 IIR