Vitamin D deficiency has been correlated with non-scarring alopecia including alopecia areata or female pattern hair loss. It was theorized that hair loss secondary to vitamin D deficiency in patients susceptible to trichotillomania may exacerbate this obsessive-compulsive disorder. Though vitamin D deficiency is common, especially among patients suffering from neuropsychiatric disorders, its correlation with trichotillomania is not well reported. Two female patients suffering from trichotillomania defined by noticeable hair loss on the scalp through the Massachusetts General Hospital Hair Pulling Scale were treated to promote hair growth. Treatment included dietary supplementation with vitamin D3 1000 IU every day. It was found that in both patients treated with vitamin D3, marked improvements occurred over the span of 3 to 4 months. These included a reduction in obsessive compulsive disorder related hair loss as measured using the Massachusetts General Hospital Hair Pulling Scale, which correlated to their serum 25-hydroxyvitamin D levels. Experimental and clinical evidence is available to explain the underlying physiology and its probable relationship to trichotillomania's pathophysiology.

Objective: To report a case of hypertension secondary to ingestion of licorice root tea. Case Summary: A 46-year-old African American female with newly diagnosed stage 1 hypertension presented with a blood pressure measurement of 144/81 mm Hg and a reduced plasma potassium level of 3.2 mEq/L. The patient attempted lifestyle modifications prior to initiating an antihypertensive agent, but at a follow-up appointment, her blood pressure remained elevated. A current laboratory panel revealed a depressed morning plasma aldosterone concentration (PAC) of 5 ng/dL and low morning plasma renin activity (PRA) of 0.13 ng/mL/h. Later it was revealed that the patient regularly (1–2 cups/day) consumed “Yogi Calming” tea, a blend of herbs, including licorice root. The patient was advised to discontinue consumption of the herbal tea, and at a subsequent appointment, her blood pressure was 128/73 mm Hg and her laboratory panel had improved, including serum potassium concentration of 4.1 mEq/L, PAC of 6 ng/dL, and PRA of 0.19 ng/mL/h. Discussion: Excessive consumption of licorice has been well documented to cause pseudohyperaldosteronism, characterized by hypertension, hypokalemia, and suppressed plasma renin and aldosterone levels. Glycyrrhizin, the active ingredient in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2, an oxidase responsible for the conversion and inactivation of cortisol to cortisone. Chronic ingestion of licorice-containing foods has been demonstrated to cause pseudohyperaldosteronism. These include soft candies, lozenges, and dietary supplements, but licorice-containing teas have been infrequently described. Based on the Naranjo probability score, our patient's hypertension appears to have been a probable licorice-induced reaction secondary to a licorice-containing tea. Conclusions: Herbal and dietary supplements are frequently consumed by patients without full knowledge of the contents of the products or the impact on their health. In clinical practice, when hypertension is accompanied by hypokalemia and reduced PRA and PAC, licorice consumption should be investigated and causal hypertension ruled out.

Exenatide extended release (ER) is a glucagon-like peptide-1 (GLP-1) receptor agonist and is indicated for use in the treatment of type 2 diabetes mellitus. In a randomized phase II trial reviewing efficacy and safety of exenatide, most adverse events were mild to moderate in nature, and none required discontinuation of therapy.¹ Eosinophilia was not reported as an adverse drug reaction in the trial, nor is it specified in the package insert.^1,2 We report a case of eosinophilia secondary to exenatide extended-release use. A 52-year-old Caucasian female presented with uncontrolled type 2 diabetes mellitus. Her past medical history includes type 2 diabetes mellitus, hypertension, and hyperlipidemia. Her drug allergy profile consisted...

Purpose The effects of oral aloe vera on electrocardiographic and blood pressure measurements were evaluated. Methods In this double-blind, placebo-controlled, crossover study, healthy volunteers over age 18 years received either 1200 mg of oral aloe vera powder or matching placebo on day 1 of the study and the treatment not received during the first phase on day 8. In each phase, electrocardiographic variables, systolic blood pressure, and diastolic blood pressure were evaluated at baseline and one, three, five, and eight hours after treatment. The primary endpoint was the maximum posttreatment Q-Tc interval over eight hours in both groups. Results Sixteen participants were enrolled in the study, with a mean ± S.D. age of 25 ± 5 years. No significant differences in electrocardiographic or blood pressure measurements were observed. The maximum Q-Tc interval was 419 ± 17 milliseconds in the placebo group and 422 ± 17 milliseconds in the aloe-treated group. The maximum P-R intervals in the placebo- and aloe-treated groups were 166 ± 22 and 169 ± 25 milliseconds, respectively. The maximum QRS complex duration did not significantly differ between the placebo- and aloe-treated groups (89.4 ± 9 and 89.3 ± 9 milliseconds, respectively). The maximum systolic blood pressures in the placebo- and aloe-treated groups were 120 ± 16 and 120 ± 14 milliseconds, respectively. The maximum diastolic blood pressures in the placebo- and aloe-treated groups were 74 ± 10 and 75 ± 9 milliseconds, respectively. Conclusion A single dose of oral aloe vera had no effect on electrocardiographic or blood pressure measurements in young healthy volunteers.