Wolfram syndrome it’s a rare autosomal genetic disease. Also, kwon as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). Its classified as one of infancy onset diabetes mellitus non autoimmune causes, its presentation generally happens at an early age; other characteristics of the disease are insipidus diabetes, optic atrophy, neurosensorial deafness, psychiatric alterations and other neurodegenerative disorders.

Introduction: Cyclic Cushing's syndrome is a not widely known pathology with low incidence; however, an increase in the number of cases has been observed in recent years. The intermittent clinical symptoms and discordant laboratory results make it a complicated diagnosis; therefore, close follow-up is crucial. We describe a case of ectopic cyclic Cushing's syndrome in a woman in her seventies who presented weight gain, proximal myopathy, moderate hypokalemia and uncontrolled hypertension; in the first evaluation hypercortisolism was found, however, 2 months later cortisol presented normal levels. Subsequently, a close follow-up was carried out and the study protocol was continued once the presence of 3 peaks and 2 valleys was demonstrated, obtaining compatible values for ectopic ACTH-dependent cyclic Cushing's syndrome. In thoracoabdominal MRI a spiculated lesion was found in the left basal lung field surrounding 25% of the aorta. Due to the location of the lesion, the patient refused surgical treatment, being currently under adequate control with the use of ketoconazole and octreotide injections. Conclusions: The possibility of cyclic Cushing's syndrome diagnosis should be kept in mind in those patients with symptoms suggestive of Cushing's syndrome that remit sporadically and whose laboratory studies show intermittent results of hypercortisolism and normocortisolism, since early identification allows opportune treatment and therefore better prognosis.

Proteus syndrome is a rare, complex, and progressive disorder characterized by tissue overgrowth, deformities, and vascular anomalies. We present a case of a 56-year-old patient with Proteus syndrome who underwent successful incision and drainage an ulcerative lesion on a Cerebriform connective tissue nevus on the left plantar surface under spinal anesthesia. The patient had a history of mild lumbar scoliosis and a previous hospitalization for pulmonary embolism. Due to the patient's difficult airway and increased risk of thromboembolism, spinal anesthesia was chosen as the anesthetic technique. The procedure was carried out without complications, and the patient had a satisfactory postoperative recovery.

Spontaneous intracranial hypotension (SIH) is an uncommon disorder caused by cerebrospinal fluid (CSF) leaks in the spine. Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with cervical epidural blood patch (EBP) and burr hole drainage of the hematoma. A 41-year old male presented with severe headache after drinking alcohol over several weeks. Brain magnetic resonance imaging (MRI) showed features typical of SIH. But, further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak. Despite lumbar EBP, the patient’s orthostatic headache recurred and developed acute subdural hematoma(SDH) to require burr hole drainage for hematoma evacuation. After surgery, the patient’s mental state improved, and the amount of SDH decreased, but he still complained of severe orthostatic headache. We performed EBP at cervico-thoracic junction level. The headache was rapidly relieved and the SDH was completely absorbed. In this case, we aim to remind clinicians that cervical EBP should be considered management for SIH as an alternative to the repeated lumbar blood patch.