Multiple Myeloma (MM) is a disease characterized by the increase of plasma cells in bone marrow or in other tissues and increased production of abnormal immunoglobulin (Ig) or Ig parts. In this report, we aimed to present a case of myeloma whom showed in our clinic with complaints of diarrhea, vomiting, fatigue and difficulty in walking. A 68- year-old male patient presented with diarrhea, fatigue, nausea, vomiting, and loss of appetite. He had splenomegaly in physical examination. Laboratory test revealed erythrocyte sedimentation rate: 4 mm/h and corrected calcium: 11.1 mg/dl. In conclusion, despite it is rare, multiple myeloma case may present with normal erythrocyte sedimentation rate and serum immunoglobulin levels. Anemia, bone lesions and hypercalcemia in an elderly may prompt diagnostic effort for multiple myeloma.

A 23-year-old young man with a transfusion-dependent thalassemia major presented to internal medicine outpatient clinic of our institution. His complaints included fatigue and abdominal pain for 1-2 days. He needed blood transfusions in every two weeks. On admission, he had a fever that not responded to empiric antibiotics. General condition of the patient deteriorated rapidly and he died in intensive care unit of our institution. In conclusion, physicians should aware of serious infectious caused by such microorganisms in patients with iron overload and proper antimicrobial therapy should be initiate at once.

Overuse of antidiabetic medications is the most common cause of hypoglycemia in diabetic subjects. Here, we report a case of hypoglycemia associated with sulfonylurea administration. An 83-year-old female patient was admitted to the emergency department with complaints of loss of consciousness and fainting. The patient’s blood glucose level was of 33 mg/dL, and she received emergency treatment with an intravenous 10% dextrose solution. In conclusion, sulfonylureas in combination with antidiabetic therapy increase the risk of hypoglycemic events in elderly patients with renal failure. Therefore, we suggest that physicians should closely monitor these patients for hypoglycemia and, preferably, use drugs that have less hypoglycemia side effects.

Primary hyperaldosteronism (PHA) is a syndrome characterized by increased aldosterone release andsuppressed renin-angiotensin cascade. Hypertension, alteration in potassium homeostasis, and target tissuedamage are characteristic features of the disease. The importance of recognizing PHA is due to the fact that ithas a very negative cardiovascular and renal effect which can result in death. In this case report, we presenta patient with resistant hypokalemia whom consequently diagnosed with PHA. A 54-year-old female patientwho was scheduled for operation due to congenital hip dislocation was found to have decreased serum potassiumin her preoperative laboratory tests. Therefore, the patient was referred to the internal medicine outpatientclinic with a serum potassium value of 2.1 mmol/L. Her systolic and diastolic blood pressures were 150 and90 mmHg, respectively. On electrocardiogram, prominent U waves were noted. Therefore, potassium replacementwas initiated at once by intravenous route. The potassium value in spot urine was 12.4 mmol/L. A 24 hoururine collected and urinary potassium excretion in 24 hours of urine was detected as 15 mmol/L, which meanstranstubular potassium gradient was greater than 4 mmol/L. Since she was hypertensive during clinical followup in the ward, hypertension along with hypokalemia raised the clinical suspicion of hyperaldosteronism.Serum aldosterone renin ratio was measured as 155 %. A computerized tomography scan revealed (22 × 16 mm)neoplasm which was suggestive of adrenal adenoma in the right adrenal gland. Cushing Syndrome was ruledout with a normal cortisol level and pheochromocytoma was ruled out by normal levels of metanephrine in the24 hours of urine. Spironolactone 50 mg was initiated and serum potassium was raised to normal range. Shescheduled for unilateral adrenalectomy and discharged with full recovery of hypokalemia. Since PHA has undesiredcardiovascular and renal effects which may increase mortality and morbidity, establishing the diagnosisas soon as possible is crucial. Hypertensive patients with hypokalemia or adrenal incidentaloma or obstructivesleep apnea syndrome, resistant hypertensive subjects, patients with moderate or severe hypertension, and hypertensive patients with a family history of PHA should undergo screening for PHA. In conclusion, we suggestthat PHA should be kept in mind in differential diagnosis of the patients with hypertension and hypokalemia.