Endocrinology, Diabetes and Metabolism Case Reports最新文献

{"title":"Semaglutide therapy and iatrogenic thyrotoxicosis.","authors":"Maxim John Levy Barnett, Sarah Eidbo, Ana Rivadeneira","doi":"10.1530/EDM-25-0065","DOIUrl":"https://doi.org/10.1530/EDM-25-0065","url":null,"abstract":"<p><strong>Summary: </strong>Levothyroxine is the backbone of hypothyroidism treatment. The dosage of levothyroxine varies; however, as an estimate, an average adult patient will require 1.6 micrograms per kilogram of body weight. We present the case of a patient with hypothyroidism, controlled on a stable dosage of levothyroxine, who subsequently began semaglutide therapy for obesity. She developed rapid weight loss and presented with palpitations as her main symptoms. Both clinical and biochemical analyses demonstrated new hyperthyroidism. With the weight loss, it was deemed that her levothyroxine dosage was no longer appropriate for her new weight and was over-suppressing her thyroid function (iatrogenic hyperthyroidism), requiring a dosage reduction. With follow-up, both clinical assessment and biochemical studies noted a reduction in the suppression of the thyroid axis. This case highlights the importance of considering a dosage reduction of levothyroxine when patients lose significant weight (such as with concurrent obesity medications), to prevent iatrogenic hyperthyroidism.</p><p><strong>Learning points: </strong>Weight loss (pharmacological or surgical) can be associated with a reduction in TSH; it is unclear whether this is directly related to the reduction in body mass index. Hypothyroid patients on levothyroxine who are treated for obesity should be monitored for clinical and biochemical evidence of hyperthyroidism, and clinicians should anticipate that a dosage reduction may be required. The mechanism leading to iatrogenic hyperthyroidism in hypothyroid patients with weight loss therapy is unknown but believed to occur either from increased absorption of the medication or as a result of the weight loss itself (posing a supratherapeutic level of levothyroxine).</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-risk pregnancy complicated by craniopharyngioma: diagnosis in the context of visual impairment and tumor resection during pregnancy following IVF.","authors":"Yuki Tsujimoto, Kenji Yamashiro, Yui Watanabe, Haruna Okubo, Akihiro Hasegawa, Ryosuke Mori, Osamu Samura, Yudo Ishii, Rimei Nishimura","doi":"10.1530/EDM-25-0028","DOIUrl":"https://doi.org/10.1530/EDM-25-0028","url":null,"abstract":"<p><strong>Summary: </strong>This report describes the case of a 37-year-old woman diagnosed with a craniopharyngioma during pregnancy. The patient initially presented with visual impairment at 15 weeks of gestation, and MRI revealed a cystic suprasellar tumor. Endocrine evaluation indicated central hypothyroidism, and central adrenal insufficiency could not be definitively ruled out based on a basal 08:00 h cortisol, as the patient was pregnant and treatment with hydrocortisone was initiated empirically. Hydrocortisone 10 mg/day and levothyroxine 25 µg/day were initiated, but rapid visual deterioration and polyuria by 21 weeks necessitated surgical intervention. She underwent successful treatment with endoscopic transsphenoidal surgery during the second trimester. Adrenal function was assessed on postoperative day 7 based on baseline values, but hydrocortisone was maintained given the risk during pregnancy. At 6 weeks after surgery, pituitary hormones were reassessed, and hydrocortisone, levothyroxine, and desmopressin were continued. Arginine vasopressin deficiency was diagnosed based on polyuria, hypotonic urine, and response to desmopressin, as formal testing was high risk both before and after surgery. Postoperatively, endocrine status was monitored, and pregnancy progressed uneventfully. She underwent an elective cesarean section at 38 weeks of gestation. At 6 months postpartum, MRI revealed residual tumor along the pituitary stalk extending from the right optic chiasm. At 9 months postpartum, the patient had persistent central hypothyroidism, hypogonadism, and newly diagnosed adult GH deficiency. Normal adrenal function allowed discontinuation of hydrocortisone. GH therapy was planned pending tumor assessment. This case underscores the importance of a multidisciplinary approach involving obstetrics, neurosurgery, and endocrinology in managing craniopharyngiomas during pregnancy.</p><p><strong>Learning points: </strong>Regardless of pregnancy planning, central hypogonadism should always be investigated with a brain MRI to determine its etiology, including the potential presence of a craniopharyngioma or other sellar/parasellar lesions. If a craniopharyngioma enlarges during pregnancy and causes visual impairment, surgical intervention can be performed through multidisciplinary collaboration. The mode of delivery in patients with panhypopituitarism should be carefully determined through multidisciplinary consultation between obstetricians and endocrinologists, with consideration of planned cesarean section as a potential option.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of an ABCC8 variant in a kindred with transient diazoxide responsive hyperinsulinism.","authors":"Ryan L Smith, Stephen I Stone","doi":"10.1530/EDM-24-0106","DOIUrl":"10.1530/EDM-24-0106","url":null,"abstract":"<p><strong>Summary: </strong>Congenital hyperinsulinism is a rare disorder characterized by hypoglycemia and inappropriately elevated insulin levels. The genetics of congenital hyperinsulinism is complex, with the most common cause being pathogenic variants in the ATP-sensitive potassium channel. Depending on the parent of origin, patients may present with focal or diffuse hyperinsulinism. Typically, patients with focal hyperinsulinism are non-responsive to diazoxide and likely progress to surgical therapy. However, there can be exceptions to these rules. We evaluated two siblings with congenital hyperinsulinism. Genetic testing identified a paternally inherited variant in ABCC8. One sibling had significant neonatal hypoglycemia requiring diazoxide for several years before weaning off daily diazoxide, whereas the second sibling experienced transitional hypoglycemia in the neonatal period but only requires diazoxide therapy during periods of intercurrent illness. This case highlights the importance of genetic testing for congenital hyperinsulinism.</p><p><strong>Learning points: </strong>The most common genetic cause of hyperinsulinism is gain-of-function variants in ABCC8 and KCNJ11, which make up the ATP-sensitive potassium channel (KATP). First-degree relatives of affected individuals should be considered for genetic testing. Parent-of-origin testing should be done to determine if the patient is likely to have focal or diffuse hyperinsulinism. Diazoxide is helpful for many patients with diffuse hyperinsulinism, and some patients with focal hyperinsulinism.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From genotype to phenotype: the impact of early management in pycnodysostosis.","authors":"Paulo Rafael Gonçalves da Silva Von Zuben, Sophia Zuppo de Sousa, Carolina Costa Figueiredo, Nara Michelle de Araújo Evangelista, Vânia Tonetto Fernandes, Patricia Salmona, Guido de Paula Colares Neto","doi":"10.1530/EDM-25-0025","DOIUrl":"10.1530/EDM-25-0025","url":null,"abstract":"<p><strong>Summary: </strong>Pycnodysostosis (PYCD) is an osteosclerotic skeletal dysplasia caused by mutations in the CTSK gene. We describe four cases, highlighting their clinical progression and therapeutic responses. Case 1 is a 2-year-old girl with non-consanguineous parents exhibiting short stature (Z-score: -3.23), slow growth (3 cm/year), wide fontanelles, small hands, and no fractures. She received cholecalciferol and calcium. Two CTSK variants (c.436G>C; p.Gly146Arg and c.721C>T; p.Arg241*) were identified. At age three, somatropin was initiated, leading to improved growth (8 cm/year) and a stature Z-score of -2.21, without fractures until age six. Case 2 is a 2-year-old boy, sibling of Case 1, presenting with similar findings (Z-score: -1.81). Carrying the same CTSK variants, he showed improved growth (3 cm/4 months) after growth hormone therapy. Case 3 is a 3-year-old boy with consanguineous parents having short stature (Z-score: -3.75), slow growth (2 cm/year), exophthalmos, bluish sclera, and multiple tibial fractures. A homozygous CTSK variant (c.953G>A; p.Cys318Tyr) was identified. Growth hormone at age six, alongside cholecalciferol and calcium, increased growth (7 cm/year) and improved stature (Z-score: -2.65). Case 4 is an 8-year-old girl with consanguineous parents having multiple fractures, exophthalmos, and severe growth impairment. Misdiagnosed with osteogenesis imperfecta, she received bisphosphonates, further compromising bone integrity. While genotype defines PYCD, early intervention can modulate its phenotype. Growth hormone, calcium, and cholecalciferol improved growth, whereas bisphosphonates negatively impacted bone quality.</p><p><strong>Learning points: </strong>CTSK mutations define PYCD, but patients exhibit diverse skeletal features, necessitating individualized management. Despite normal IGF-1, growth hormone therapy enhances growth velocity and final height in selected PYCD cases. Bisphosphonates may worsen bone remodeling in PYCD, increasing fracture risk and impairing growth. The CTSK c.953G>A (p.Cys318Tyr) variant correlates with severe skeletal manifestations and variable treatment response.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 3","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of lanreotide autogel immediately after a single injection for thyrotropin-producing pituitary tumor.","authors":"Mayuko Sumitomo, Arina Miyoshi, Shuhei Baba, Hajime Sugawara, Shinji Obara, Norio Wada","doi":"10.1530/EDM-25-0020","DOIUrl":"10.1530/EDM-25-0020","url":null,"abstract":"<p><strong>Summary: </strong>We present the case of a 51-year-old man who was referred to our hospital due to abnormal thyroid function tests. Laboratory evaluations showed elevated serum free (F) T3 and free (F) T4 levels (9.05 pg/mL and 4.21 ng/dL, respectively), with a normal serum thyroid-stimulating hormone (TSH) level of 1.49 μIU/mL, indicating central hyperthyroidism. An 18 × 17 × 14 mm T1-weighted hypointense tumor was found on the left side of the pituitary gland, with low contrast enhancement during a cranial MRI. The TRH stimulation test revealed no TSH response. The administration of a single dose of octreotide reduced TSH levels. Following these findings, the patient was clinically diagnosed with a TSH-producing pituitary tumor (TSHoma). The patient was directed to our hospital's neurosurgery department for pituitary surgery and began preoperative treatment with lanreotide autogel (90 mg, subcutaneous injection). Four days after administration, FT3 and FT4 levels returned to normal. Seven days after administration, an MRI revealed a 50% reduction in tumor volume. Endoscopic pituitary surgery was performed 15 days after the initial administration and resulted in complete tumor resection. A histopathological examination confirmed the presence of a TSH-producing pituitary neuroendocrine tumor. Postoperatively, FT3 and FT4 levels stayed within the normal ranges. This case demonstrates how a single dose of lanreotide autogel not only normalized thyroid hormone levels but also resulted in rapid shrinkage of the pituitary tumor in TSHoma.</p><p><strong>Learning points: </strong>Preoperative treatment with somatostatin analogs for TSH-producing pituitary adenomas (TSHomas) aims to control thyroid function, preventing thyroid storm during surgery, and to reduce tumor size. We report a case of a TSHoma treated preoperatively with a single subcutaneous injection of lanreotide autogel (LAN-ATG). In this patient, thyroid function normalized and significant tumor shrinkage was observed within 1 week of LAN-ATG administration. This case demonstrates that significant therapeutic effects can be achieved within days after a single injection of LAN-ATG. This approach could facilitate earlier surgical intervention, potentially improving patient outcomes and optimizing preoperative management strategies.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Graves' disease in a patient with lymphocytic hypophysitis following glucocorticoid treatment.","authors":"Yuka Ono, Norio Wada, Shuhei Baba, Hajime Sugawara, Arina Miyoshi, Shinji Obara","doi":"10.1530/EDM-24-0145","DOIUrl":"10.1530/EDM-24-0145","url":null,"abstract":"<p><strong>Summary: </strong>We report the case of a 41-year-old Japanese woman with visual field disturbances during late pregnancy. At 39 weeks of gestation, she was diagnosed with bitemporal hemianopsia at the ophthalmology department. An MRI revealed a symmetrical pituitary gland enlargement, compressing the optic chiasm. An emergency cesarean section was performed immediately, resulting in the delivery of a male infant weighing 3,112 grams. Laboratory tests indicated low serum free thyroxine (T4), thyroid-stimulating hormone (TSH), cortisol, luteinizing hormone, and follicle-stimulating hormone. The patient was clinically diagnosed with lymphocytic hypophysitis (LHy). Due to her visual field impairment, she was administered 60 mg of prednisolone daily. After 2 days, her visual field impairment improved rapidly, leading to a gradual tapering of the dose. Six months after treatment initiation, an MRI showed shrinkage of the pituitary gland. Her prednisolone dose was reduced to 5 mg daily, and she was switched to hydrocortisone at 15 mg daily. Twelve months after starting treatment, the patient developed thyrotoxicosis. Testing revealed a positive TSH receptor antibody, resulting in a diagnosis of Graves' disease (GD). Treatment with thiamazole (15 mg daily) and potassium iodide (76 mg daily) was initiated, and her thyroid function normalized after 2 months. LHy is believed to have an autoimmune mechanism and is frequently associated with other autoimmune diseases; however, the development of GD is rare. Development of Graves' disease should be considered in patients with LHy, particularly during the postpartum period and the glucocorticoid treatment process.</p><p><strong>Learning points: </strong>Females with lymphocytic hypophysitis often experience local symptoms, such as visual field disorders, when pregnant. This condition is frequently associated with autoimmune diseases, particularly autoimmune thyroid disorders. However, reports explicitly linking it to Graves' disease have been limited. The postpartum period is considered a trigger of the onset of Graves' disease. In addition, the high-dose glucocorticoid treatment and its tapering may affect it.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hypoglycaemic 'Peter Pan': a paediatric disease in an adult patient?","authors":"Shannon McCarthy, Mark Kotowicz","doi":"10.1530/EDM-23-0140","DOIUrl":"10.1530/EDM-23-0140","url":null,"abstract":"<p><strong>Summary: </strong>A 56-year-old male presented to hospital with vomiting and was admitted for management of suspected aspiration pneumonia. His medical history was significant for a diagnosis of cerebral palsy and intellectual disability and he had suffered regular generalised tonic-clonic seizures (GTCS) since birth, despite multimodal anticonvulsant treatment. During his admission, his capillary blood glucose was noted to be 1.6 mmol/L during a seizure. Subsequent investigations confirmed hyperinsulinaemic hypoglycaemia secondary to diffuse pancreatic nesidioblastosis. His seizure disorder completely resolved when management of nesidioblastosis achieved consistent normoglycaemia.</p><p><strong>Learning points: </strong>All patients who suffer seizure should have a blood glucose measured. Unrecognised hypoglycaemia in a neonate or infant confers a high risk of subsequent neurological damage. Persistent hyperinsulinaemic hypoglycaemia (PHH) in adults is highly likely to be caused by insulinoma, but diffuse pancreatic hyperinsulinism, particularly after bariatric surgery, should also be considered. Medical therapy of endogenous hyperinsulinaemic hypoglycaemia is complex, requiring intensive monitoring.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double mutation for multiple endocrine neoplasia associated with congenital adrenal hyperplasia.","authors":"Watrusy Lima de Oliveira, Eloilda Maria de Aguiar Silva, Carlos Eduardo de Melo Oliveira, Wellington Alves Filho, Maria Cecília Martins Costa, Renata Carvalho de Alencar, Carla Antoniana de Almeida Vieira, Ana Rosa Pinto Quidute","doi":"10.1530/EDM-24-0047","DOIUrl":"10.1530/EDM-24-0047","url":null,"abstract":"<p><strong>Summary: </strong>A 39 year old female with signs of hyperandrogenism, was diagnosed with congenital adrenal hyperplasia after a cortrosyn test. Abdominal tomography showed a nodular image in the right adrenal gland, measuring 1.9 × 3.1 cm, 26 UH. Screening for Cushing's syndrome and pheochromocytoma was negative. Due to the maternal family history of MEN2A, RET gene testing was performed (positive), and screening for medullary thyroid carcinoma (MTC) with calcitonin was <2 pg/mL. As the patient's father passed away due to complications of peptic ulcers and hailed from a region with high rates of MEN1, PTH and calcium levels were checked, confirming the diagnosis of primary hyperparathyroidism (pHPT). Genetic investigation for MEN1 was positive, and an MRI of the pituitary gland revealed a non-producing macroadenoma. Management of pHPT and total prophylactic thyroidectomy were recommended, with an expectant approach regarding the adrenal lesion. Histopathological examination of the thyroid revealed papillary microcarcinoma in the right lobe and parafollicular cell hyperplasia in two foci, with immunohistochemistry consistent with MTC.</p><p><strong>Learning points: </strong>There may be the coexistence of three rare and complex genetic syndromes in a single patient. Multiple endocrine neoplasia syndromes describe a group of heterogeneous diseases. Hyperparathyroidism is common among multiple endocrine neoplasia syndromes.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring in a neonate with hyperinsulinemic hypoglycemia and ABCC8 gene mutation.","authors":"Patrycja Iwańczyk, Agata Majewska, Tadeusz Issat, Dorota Hoffman-Zacharska, Paweł Krajewski, Karolina Lipska-Karpińska","doi":"10.1530/EDM-25-0002","DOIUrl":"10.1530/EDM-25-0002","url":null,"abstract":"<p><strong>Summary: </strong>Neonatal hypoglycemia is a metabolic disorder affecting approximately 5-15% of newborns and is a risk factor for adverse neurological outcomes. The most common cause of hypoglycemia is hyperinsulinemic hypoglycemia (HH), which presents itself in two forms: transient and permanent. Permanent HH is associated with genetic factors, including monogenic forms such as ABCC8 gene mutation. In HH, proper glycemic monitoring is crucial for revealing all hypoglycemic events; therefore, continuous glucose monitoring (CGM) may benefit these patients. We report a case of a newborn with persistent severe hypoglycemia that was unresponsive to intravenous glucose administration. Due to frequent severe hypoglycemic events, we implemented CGM, decreasing the number of invasive procedures for assessing glucose concentration. Genetic testing revealed the presence of a heterozygous splicing variant in ABCC8. The patient qualified for positron emission tomography, and a diffuse form of HH was diagnosed. Consequently, the patient qualified for a full pancreatectomy. Neonatal hypoglycemia presents diagnostic challenges, as proper differential diagnosis is crucial for successful treatment. In cases of persistent HH, genetic testing should always be offered to exclude conditions requiring prompt treatment and to achieve a good long-term outcome. As some hypoglycemic events might be asymptomatic, CGM might be a better option for patients with HH, as it allows for the analysis of all glycemic fluctuations and, therefore, reduces the need for invasive procedures.</p><p><strong>Learning points: </strong>Persistent hypoglycemia in neonates requires differential diagnosis. In severe cases of HH not responding to diazoxide, positron emission tomography using 18F-fluoro-L-dihydroxyphenylalanine (18F-DOPA PET) is the test of choice to make diffuse/local HH differential diagnoses. Continuous glucose monitoring allows for quicker reaction during hypoglycemia and hyperglycemia, reducing possible complications that can affect the neonatal brain. Nowadays, there are many available resources that limit causing pain in neonates. There are reports of using CGM in neonates, but it is not registered.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-onset type 2 diabetes mellitus complicated by diabetic ketoacidosis: a sentinel presentation of advanced pancreatic adenocarcinoma.","authors":"Akbar Rasekhi Kazerouni, Sahar Ghahramani, Younes Khayyer, Shayan Yousufzai","doi":"10.1530/EDM-25-0026","DOIUrl":"10.1530/EDM-25-0026","url":null,"abstract":"<p><strong>Summary: </strong>Diabetic ketoacidosis (DKA), typically linked to type 1 diabetes or acute illness in type 2 diabetes, can rarely be triggered by pancreatic adenocarcinoma (PA). Though 80% of PA patients have glucose intolerance, DKA is exceptionally uncommon, with fewer than 20 documented cases. A 52-year-old woman with new-onset type 2 diabetes presented with altered mental status, abdominal pain, and 23 kg weight loss over 2 months. Labs confirmed DKA (glucose: 439 mg/dL, pH 7.1, ketonuria). Elevated tumor markers (CA19-9: >10,000 U/mL, CEA: 365 ng/mL) and imaging revealed a 4 cm pancreatic mass with metastases, biopsy-proven as PA. This case underscores PA as a rare but critical DKA precipitant in new-onset diabetes. Unexplained hyperglycemia, rapid weight loss, and markedly elevated tumor markers should prompt malignancy screening. Early multidisciplinary intervention may improve outcomes in this aggressive cancer. Clinicians must maintain high suspicion for occult PA in atypical DKA presentations.</p><p><strong>Learning points: </strong>Unexplained weight loss alongside newly-identified type 2 DM warrants thorough evaluation for occult malignancy. Elevated CA19-9 and CEA in the context of new-onset diabetes should raise suspicion for pancreatic malignancy. DKA may rarely serve as the initial manifestation of pancreatic cancer in newly-identified type 2 DM cases, necessitating a high index of clinical suspicion.</p>","PeriodicalId":37467,"journal":{"name":"Endocrinology, Diabetes and Metabolism Case Reports","volume":"2025 2","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}