Abstract. Corticosteroid treatment is frequently associated with psychiatric disturbances. These adverse effects are unusual with low dose of corticosteroid. We describe a patient who rapidly developed a steroid-induced psychosis with very low dose of prednisolone. A 48-year-old woman of Sheehan's syndrome was admitted to hospital with insomnia, euphoric moods and visual hallucinations. She had taken prednisolone (10 mg in the morning and 5 mg at night) for 6 days before admission. These symptoms appeared after first dose of prednisolone. A diagnosis of acute psychosis was made. After improvement of acute psychosis with discontinuation, re-administration of prednisolone at a dose of 2.5 mg per day gave rise to agitation and insomnia. She recovered completely by gradual dosage increase of short-acting corticosteroid after the discontinuation of prednisolone.

Abstract. An insulinoma is characterized by endogenous hyperinsulinemia and hypoglycemia. However, it has been reported that insulinomas with normal levels of plasma insulin and a normal insulin to glucose ratio occur in patients with hypoglycemia. Although overproduction of Insulin-like growth factor II (IGF-II) by non-islet cell tumors such as large mesenchymal tumors, can cause hypoglycemia, no cases of circulating plasma IGF-II from an islet cell tumor contributing to hypoglycemia have been reported. We report here a rare case of a pancreatic islet tumor in a patient with hypoglycemia that was associated with increased plasma IGF-II, which returned to normal after tumor resection. HYPOGLYCEMIA is a common medical condition with many causes. Although hypoglycemia is most common in patients with diabetes mellitus, it also occurs in patients with renal insufficiency, liver disease, congestive heart failure, autoimmune disorders or cancer [1]. An insulinoma, which is the most common type of islet cell tumor, is characterized by endogenous hyperinsulinemia and hypoglycemia [2]. However, insulinomas with normal levels of plasma insulin and a normal insulin to glucose ratio have been reported in hypoglycemic patients [3]. Insulin-like growth factor II is structurally and functionally related to insulin [4], and overproduction of IGF-II by non-islet cell tumors such as large mesenchymal or epithelial tumors, can cause hypoglycemia [5]. In addition, IGF-II also expressed by insulinproducing tumor cells in the pancreas, as well as some endocrine pancreatic tumors that also produce other peptides such as glucagons [6]. However, there have been no reports of circulating plasma IGF-II produced by islet cell tumor contributing to hypoglycemia.Here, we describe a rare case of a pancreatic islet cell tumor in a patient with hypoglycemia that was associated with increased plasma IGF-II levels, which returned to normal after tumor resection. Case ReportA 65-year old woman was admitted to our hospital after experiencing recurrent episodes of cold sweats and palpitation for 5 years. These symptoms developed when she was hungry or early in the morning, and then disappeared after eating. The incidence of these symptoms had gradually increased and she experienced general weakness and sweating the day before admission. At the time of admission, she was taking cilnidipine (10 mg/day) and irbesartan (150 mg/day) for arterial hypertension, and Hashimoto's thyroiditis had been detected 3 years prior to admission at our facility, but it was well-controlled without pharmacological treatment. She did not smoke or drink and had

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A goiter is among the most common presenting symptoms of patients with thyroid diseases and is usually caused by intrinsic thyroid problems. While direct invasion of the trachea by aggressive thyroid tumors is a well-known phenomenon, the reverse situation, that is, a primary tracheal neoplasm invading by direct extension into the thyroid gland, presenting with a goiter is very rare. Here, a case of a tracheal adenoid cystic carcinoma (ACC), presenting with a diffuse goiter, is reported. A 47-year-old woman presented with slowly growing anterior neck swelling. A physical examination showed a diffuse firm goiter. The patient was euthyroiditic, and serum negative for thyroid autoantibodies. Thyroid ultrasonography and neck CT revealed a doughnut-shaped mass, encircling the trachea and displacing the thyroid anteriorly. Ultrasonography-guided fine needle aspiration (FNA) was compatible with an ACC, and a subsequent surgical resection confirmed the diagnosis. Although the occurrence of a tracheal ACC invading the thyroid is rare, this case highlights the need to be aware of unusual lesions arising in the region of the thyroid. This knowledge will help in making the correct cytological diagnosis when these lesions are sampled by FNA (J Kor Soc Endocrinol 20:273～277, 2005). ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ