Endocrine disorders

The effect of thyroxine replacement therapy on bone mass continues to attract attention. Although the advice of the American Thyroid Association to normalize serum thyroxine and thyroid-stimulating hormone concentrations is recommended, even physiologic doses of thyroxine may have an adverse effect on bone mass. The diagnosis and treatment of osteomyelitis in the diabetic foot is aided by magnetic resonance imaging, and long-term review of cases of diabetic femoral neuropathy emphasizes the good prognosis. Adrenal insufficiency as a complication of antiphospholipid syndrome is reviewed, and a useful physical sign, the acromegalic rosary, rediscovered. The association of sex steroids, oral contraception, and parity with rheumatoid arthritis is discussed. The outcome of pregnancy in women with juvenile rheumatoid arthritis is good, and quiescent disease does not appear to be permanently reactivated. Calcium deficiency, rather than vitamin D deficiency, is a cause of rickets in some Nigerian children.