John H. Helzberg

Hepatocellular Carcinoma: An Unusual Course With Hyperthyroidism and Inappropriate Thyroid-Stimulating Hormone Production

A 61-yr-old woman was found to have multicentric hepatocellular carcinoma associated with clinical hyperthyroidism. Marked elevations in serum thyroid-stimulating hormone, T4, T3, and free T4 were documented. These values increased with tumor progression. It is postulated that this patients hepatoma produced a substance stimulating thyroid-stimulating hormone synthesis and secretion with resultant inappropriate thyroid-stimulating hormone production and thyrotoxicosis. This unusual association of hepatocellular carcinoma with clinical and biochemical evidence of hyperthyroidism and inappropriate thyroid-stimulating hormone production has not been previously reported.

Peritoneovenous shunts in malignant ascites

SummaryA 51-year-old woman with malignant ascites secondary to hepatocellular carcinoma had a peritoneovenous (Le Veen) shunt inserted with effective control of ascites and amelioration of symptoms. The results of 12 recent series evaluating the efficacy of peritoneovenous shunts in the treatment of 198 patients with malignant ascites were reviewed. Peritoneovenous shunts effectively controlled malignant ascites in 77% of patients. Complications occurred in 25%, although the majority of these were related to shunt occlusion and transient congestive heart failure.

NON-ALCOHOLIC FATTY LIVER DISEASE BUT NOT EPICARDIAL FAT IS ASSOCIATED WITH CORONARY ARTERY CALCIFICATION

Epicardial adipose tissue (EAT), thoracic adipose tissue (TAT) and visceral abdominal fat may be predictive of coronary artery disease (CAD). Using a coronary calcium score (CCS) >100, we prospectively examined whether EAT, TAT, and non-alcoholic fatty liver disease (NAFLD) as determined from non-