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Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Nasobiliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted. [ABSTRACT FROM AUTHOR]

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures. Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant. Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse. [ABSTRACT FROM AUTHOR]