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Introduction: Hypercalcemia is a rare finding in tuberculosis (TB). The prevalence varies from 2% to 48%. Elevation of 1,25(OH)2D is characteristic in hypercalcemia due to granulomatous disorders such as TB, but this has not been a consistent finding. We present a case of hypercalcemia due to TB with a normal 1,25(OH)2D. Case Presentation: A 35 year-old woman with newly diagnosed HIV was admitted for treatment of multidrug resistant granulomatous TB present in lungs, pleura and genitourinary tract. One week after admission, increase in serum calcium was noted with a peak at 14.2mg/dL. Further work-up showed normal 1,25(OH)2D 55pg/mL, 25(OH)D 17ng/mL, PTH 6.7pg/mL, 24h urine calcium 256 mg/24h, and normal PTHrP, thyroid function tests, serum and urine protein electrophoresis, morning cortisol and serum creatinine. Physical exam was remarkable for dry skin and mucosa, and reduced breath sounds in lung fields. Intravenous hydration was started, but the serum calcium continued to increase. At this point, prednisone 20 mg daily was started. Serum calcium has decreased to less than 11mg/dl and 1,25(OH)2D to 41 pg/mL after two weeks of therapy. Discussion: Classic laboratory findings in hypercalcemia due to granulomatous diseases are suppressed PTH, elevated 1,25(OH)2D and normal 25(OH)D. The reason behind increased 1,25(OH)2D levels in TB is the generation of cathelicidins to potentiate macrophage killing of Mycobacterium tuberculosis. Lymphocytes, monocytes, and macrophages outside of the granuloma, as well as pulmonary alveolar macrophages (PAMs) within the granuloma, drive the metabolism of 25(OH)D to 1,25(OH)2D via PAM 25(OH)D3-1 alpha hydroxylase. However, Sullivan et al (1987) highlighted four cases of active TB with low 1,25(OH)2D. Parker et al (1984) and Ryzen et al (1985), reported a case of coccidioidomycosis and leprosy respectively, both with low 1,25(OH)2D. Falk et al (2007) described a case of sarcoidosis with normal levels of 1,25(OH)2D. There are potential causes of inappropriately normal 1,25(OH)2D. One possibility is an inappropriately low baseline 1,25(OH)2D with an increase to normal values when the disease is active. A second potential cause is rifampin or isoniazid induced hypocalcitriolemia. A third possibility is a decrease in Vitamin D Binding Protein (

Introduction Dopamine agonists are the first line treatment for prolactinoma, however, for those who fail medical treatment, transsphenoidal endoscopic endonasal resection (TSS) is the next therapeutic option. Prolactin levels after surgery have been correlated with recurrence of the disease, but is not clear at what time frame these levels should be measured and what levels suggest a higher risk of disease recurrence. We present a case of dopamine agonist-resistant prolactinoma with recurrence after TSS. Case Presentation A 30 year-old female with history of asthma was referred to our endocrinology clinic for treatment of a dopamine agonist-resistant prolactinoma. She was diagnosed six years prior to presentation in our clinic. Her initial symptoms were irregular menses with progression to amenorrhea and galactorrhea. Prolactin levels were >400 mUI/mL. Pituitary MRI showed a 5mm sellar mass. She was started on bromocriptine but due to severe nasal congestion, it was switched to cabergoline. Cabergoline dose was increased up to 3.5mg twice a week, with resolution of her presenting symptoms. Despite this high dose and initial symptom amelioration, prolactin levels remained elevated, ranging between 160-180 mUI/mL, and caused several side effects, including pain in fingers, lack of concentration, and memory impairment. New laboratory values showed prolactin 170 mUI/mL, FSH 1.9 mUI/mL, LH <0.12 IU/L, normal cosyntropin stimulation test, TSH and IGF-1. A repeat pituitary MRI revealed a 1.6 x 1.5 x 1.2 cm adenoma in the right aspect of the pituitary gland, with no compression of the optic chiasm. The patient underwent a TSS. Four days following surgery, prolactin levels were 23.3 mUI/mL, one month after surgery 56.5 mUI/mL and two months after 172.5 mUI/mL. She denies recurrence of symptoms. Discussion Low prolactin levels after surgery are associated with low recurrence of prolactinoma. Amar et al (2002, 222 patients and 5 years follow-up) noted that prolactin levels less than 10 ng/ml on postoperative day one (POD1) predict a 100% cure rate in patients with microadenomas, and 93% in patients with macroadenomas. Levels between 10-20 ng/ml on POD 1 had size dependent cure rate, with microadenomas having a 100% cure rate and 0% cure rate in macroadenomas. In contrast, a cure is not likely to be obtained in patients with levels >20 ng/mL (0% cure rate). Feigenman et al (1996, 339 women and follow-up of 4-9.2 years) concluded that POD 1 prolactin concentration of 20 ng/mL or less had a recurrence of 26%, but if less than 5 ng/mL, the cure rate was as high as 84%. Serri et al (1983, 44 women with follow-up of 4.7-7.7 years) showed that prolactin higher than 9 ng/mL were at greater risk to relapse. Conclusion We demonstrate the predictive nature of a five day postoperative prolactin level elevation and its prognostic correlation with disease recurrence

Intentional deception, as is common in the performance of magic tricks, can provide valuable insight into the mechanisms of perception and action. Much of the recent investigations into this form of deception revolve around the attention of the observer. Here, we present experiments designed to investigate the contributions of the performer to the act of deception. An experienced magician and a naïve novice performed a classic sleight known as the French Drop. Video recordings of the performance were used to measure the quality of the deception-e.g., if a non-magician observer could discriminate instances where the sleight was performed (a deceptive performance) from those where it was not (a veridical performace). During the performance we recorded the trajectory of the hands and measured muscle activity via EMG to help understand the biomechanical mechanisms of this deception. We show that expertise plays a major role in the quality of the deception and that there are significant variations in the motion and muscular behaviors between successful and unsuccessful performances. Smooth, minimal movements with an exaggerated faux-transfer of muscular tension were characteristic of better deception. This finding is consistent with anecdotal reports and the magic performance literature.