Surgical treatment is a safe and effective treatment for acromegaly and remains the first choice of treatment for most acromegalic patients. The results of this centre compare favourably with series from other centres. We have demonstrated improved results, both in terms of post operative growth hormone values and pituitary function tests with time and increasing neurosurgical experience. We conclude that outcome for the surgical treatment for acromegaly is best achieved with one surgeon specialising in pituitary surgery. Improved operative outcome thus achieved has major cost implications and avoids the necessity for consideration of postoperative radiotherapy and the use of expensive growth hormone suppressing drugs in the postoperative period.

Case report 17p11-q21 [2]. Hypercalciuria has occasionally been reported [3]. The condition has been diagnosed from age A 40-year-old man was referred with hypertension and microscopic haematuria. His mother and sister had 2 weeks to adulthood. The primary lesion is increased chloride reabsorption in the ascending loop of Henle, Gordon's syndrome. His blood pressure was 190/115 mmHg, his potassium 6.0 mmol/L, creatinine leading to inhibition of the renin-aldosterone axis. Lack of sodium in the distal convoluted tubule, with a relative 87 mmol/L, bicarbonate 21 mmol/L and calcium 2.29 mmol/L. IVU and ultrasonography showed a 4 cm hypoaldosteronism, leads to decreased potassium secretion. Hypertension is caused by increased total body stone in the left kidney. The stone was treated successfully with combined ESWL and percutaneous nephrolisodium stores. To our knowledge, this is the first reported case of recurrent renal calculus formation in Gordon's thotomy with ultrasonic disintegration. Analysis confirmed a mixed calcium oxalate and phosphate stone.syndrome. The syndrome is probably more prevalent than the literature suggests. Renal stones, hyperkalaemia Investigation showed hypercalciuria at 11.4 mmol/24 h and normal urinary oxalate, cystine and citrate; the and hypertension in the presence of a normal serum creatinine should raise the possibility. Life-long therapy urinary pH was 6.6. Creatinine clearance was normal (95 mL/min), and recumbent and ambulant renin with thiazide diuretics is eCective in controlling all the main features. plasma levels were both 0.30 ng/mL per hour (normal levels 0.98-4.18 and 0.51-2.64, respectively). The aldosterone recumbent and ambulant levels were 137 and 120 pg/mL, respectively (normal level both no stone recurred within 9 months. His urinary calcium J Pediatr 1974; 85: 355-8 excretion rate reduced dramatically to 2.50 mmol/24 h; at his own insistence, he remains on a low-calcium diet.

A previously well 52-year-old gentleman presented with a 2-week history of itch, jaundice, lethargy, pale stools and dark urine. He had no risk factors for liver disease. On systematic questioning, the only new addition to his diet was an acai berry supplement drink to promote weight loss. Blood tests revealed markedly raised bilirubin and ALP, and slightly raised AST and ALT. Ferritin was also raised but was felt to represent an acute phase reactant. The remaining liver screen was unremarkable. Imaging showed a 12 mm hemangioma in segment VII of the liver but was otherwise normal, with no ductal dilatation noted. ERCP revealed normal ducts. Liver biopsy was performed and this revealed hepatocellular and canalicular cholestasis with minimal parenchymal inflammation. Portal tracts were inflamed with lymphocytes. Findings were felt to be consistent with ductal obstruction or drug reaction. Overall findings were felt to be in keeping with a drug reaction secondary to the acai berry supplement. He had been commenced on prednisolone, ursodeoxycholic acid, cholestyramine, lansoprazole and chlorphenamine in a district general hospital prior to transfer to the Liver Unit. On arrival, naltrexone was added to the regimen. His bilirubin peaked at 284 µmol/L but soon decreased, and returned to normal levels within 2 months. High levels of D-aspartate are found in these berries, and this amino acid is involved in a pituitary pathway involved in stimulation of testosterone production. Alongside anabolic steroids, androgenic steroids have also been shown to be involved in development of cholestatic jaundice. Beta-sitosterol is also found in the berries and is a precursor of boldenone which is an anabolic steroid. These steroid pathways are among the hypotheses for development of cholestatic jaundice in this gentleman.