Faculty Bibliography

A 48 year old man with extensive cutaneous and subcutaneous metastatic malignant melanoma responded to treatment by repeated plasma exchanges, partial surgical debulking of tumor masses, and intravenous Corynebacterium parvum. Circulating immune complexes were measured by the serum C1q binding method. Tumor regression coincided with serum C1q binding reduction to normal levels. Clinical relapse was preceeded by recurrent elevation of serum C1q binding activity

PIP: This letter briefly reports a case linking the appearance of overt diabetes mellitus to progestational therapy, and is intended as an addition to the literature associating insulin-dependent diabetes with progestational therapy. A 51-year-old white woman, who had undergone masectomy and prophylactic oophorectomy, had no history of glucose intolerance and was given Prednisolone (15 mg daily) postoophorectomy. Interval clinical evaluations of glucose levels were between 184 and 223 mg/dl during estrogen therapy. Tumor recurrence 12 years later forced withdrawal of estrogen therapy, and the patient was placed on trial therapy with megestrol acetate (40 mg, 4 times daily). 6 weeks after initiation of progestational therapy, the patient was admitted with a glucose level of 400 mg/dl and a 4+ acetone reading in her urine. Insulin therapy was instituted; megestrol acetate was withdrawn; but the diabetes was not reversed and insulin treatment continues. The author compares this case with others previously reported where medroxyprogesterone acetate was the progestational agent apparently causing irreversible diabetes mellitus. O