South Dakota medicine : the journal of the South Dakota State Medical Association最新文献

{"title":"A Case of Q fever: What Does the South Dakota Clinician Need to Know?","authors":"Angela Roberts, Michael Roberts, Ibrahim Ahmed, Randall Lamfers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Q fever is a reportable, zoonotic infection caused by Coxiella burnetii. It can present as either an acute or chronic infection. Acute Q fever is frequently asymptomatic or presents with nonspecific symptoms, making the diagnosis challenging. In the chronic state it will manifest as localized infection such as endocarditis, which is the most common. South Dakota has the highest incidence of Q fever in the U.S. with 12.4 cases per million people. We present a case of a patient in their 50s with mild hepatitis and persistent fevers and eventually was diagnosed with Q fever. The patient had no known exposures. The Q fever was diagnosed using Karius testing, liver biopsy, and serology. The patient was treated with doxycycline and improved. This case highlights diagnostic challenges and management considerations for South Dakota clinicians.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 5","pages":"229-231"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621744","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":"Abstract: Incidence of Pathogens in First Episode of Diabetic Foot Infections and Frequency of Empiric Coverage of Pathogens in Emergency Department and on Hospital Admission: A Retrospective Cohort Study.","authors":"Mykayla Vollmer, Thaddaus Hellwig, Angela Roberts, Ibrahim Ahmed","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot infections (DFIs) are a common complication of diabetes mellitus and a leading cause of hospitalization. Due to the polymicrobial nature of these infections and delays in aerobic and anaerobic culture results, patients are often started on broad-spectrum antibiotics, which may lead to unnecessary antimicrobial use. The purpose of this study was to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and anaerobic organisms in DFIs. Secondary endpoints evaluated the frequency of empiric antibiotic coverage for these organisms in both the emergency department (ED) and on initial hospital admission.</p><p><strong>Methods: </strong>This single-center retrospective study reviewed medical records over a five-year period for patients admitted with an initial DFI. The incidence of positive cultures for MRSA, Pseudomonas, and anaerobic organisms was compared with the frequency of empiric antimicrobial coverage for each. The incidence of these organisms was also compared between patients with and without hospitalization within the prior 90 days.</p><p><strong>Results: </strong>Of the 184 patients in the study, 102 patients (55.43%) had cultures positive for one or more of the following: MRSA (17.0%), Pseudomonas (5.40%), and/or anaerobic organisms (45.10%). In the ED, 117 patients (63.59%) were treated empirically for MRSA, 111 patients (60.30%) were treated empirically for Pseudomonas, and 82 patients (44.60%) were treated empirically for anaerobes. On admission, 164 patients (89.10%) were treated empirically for MRSA, 140 patients (76.10%) were treated empirically for Pseudomonas, and 115 patients (62.50%) were treated empirically for anaerobes.</p><p><strong>Conclusion: </strong>The study demonstrated rates of MRSA and Pseudomonas consistent with prior literature. However, rates of anaerobic organisms, which have historically been less studied in DFIs, were prominent. Despite this, empiric antimicrobial coverage for anaerobes was lowest among the organisms studied. This study may help guide clinicians in considering organism incidence and in selecting empiric parenteral antibiotic therapy.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s46"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621710","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":"Abstract: Nitrous Oxide-Induced Neuropathy from Misuse of Dental Supply: A Case Report.","authors":"Jeffrey Schuch, Matthew Schmitz, Justin Persson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Nitrous oxide (N₂O) is a widely used inhaled anesthetic that has seen increasing recreational misuse in recent years. Chronic exposure can inactivate vitamin B12 through oxidation of its cobalt core, resulting in functional deficiency and subsequent neurologic injury. Because serum vitamin B12 levels may remain within the normal range, diagnosis can be delayed if clinicians are unaware of this mechanism. Increased recognition of N₂O-associated neurotoxicity is essential as misuse becomes more prevalent.</p><p><strong>Case report: </strong>We present the case of a 55-year-old woman with a history of daily N₂O inhalation obtained through the dental industry who presented to a family medicine clinic with acute-onset peripheral neuropathy, ataxia, and sensory disturbances. Laboratory evaluation demonstrated elevated methylmalonic acid and homocysteine levels despite normal serum vitamin B12, consistent with functional deficiency. Neurologic examination revealed diminished distal vibration and temperature sensation, areflexia, and a neuropathic gait. Nerve conduction studies were largely normal. Management included cessation of N₂O exposure, vitamin B12 repletion, and symptomatic supportive care.</p><p><strong>Conclusion: </strong>N₂O-induced neurotoxicity should be considered in patients presenting with new-onset neuropathy or gait disturbance and a history of possible exposure, even when serum vitamin B12 levels are normal. Recognition of functional vitamin B12 deficiency through elevated methylmalonic acid and homocysteine is critical for accurate diagnosis. Early identification and prompt cessation of N₂O exposure with vitamin B12 supplementation may prevent progression and improve neurologic outcomes.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s44-s45"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621712","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":"Abstract: What the Skin Reveals: A Reflection on Dermatologic Disease and Structural Vulnerability.","authors":"Kiley Medler, Rilie Curd","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A man experiencing homelessness presented to the emergency department with extensive involvement of ulcerative lesions. On examination, the lesions were painful, numerous, crusted, and deeply ulcerated. At first the diagnosis was thought to be cellulitis but was later confirmed after an infectious disease consult to be Group A Streptococcus ecthyma. Ecthyma is a deep-seated skin infection commonly referred to as \"deep impetigo\". While the diagnosis of ecthyma was straightforward, the encounter prompted reflection of the unique role dermatology plays in revealing the intersection between disease and circumstance. Skin disease is uniquely visible. Unlike many internal illnesses, dermatologic conditions are displayed on the body's surface where biological processes and social realities often converge. In patients experiencing housing instability, crowded living conditions, limited access to hygiene facilities, wound care, and consistent medical follow-up can allow minor trauma or superficial infection to progress into more extensive disease. In this case, the patient's lesions were not simply the result of bacterial invasion but also a reflection of structural vulnerability. Research has shown that patients experiencing homelessness are at a significantly higher risk of ecthyma. For clinicians, dermatologic examination requires more than pattern recognition. It invites attention to the broader narrative on the skin. Lesions become more than diagnostic clues; they are markers of lived experience and structural vulnerability. While antibiotic therapy addressed the immediate infection, the encounter underscored how social context can shape the presentation and severity of dermatologic disease. This experience highlights the importance of approaching dermatologic findings with both clinical precision and humanistic awareness. Recognizing the stories skin can tell may deepen clinicians' understanding of their patients and the social conditions that influence health. Furthermore, it invites clinicians not only to treat dermatologic disease but also to advocate for greater health equity and address the structural conditions that influence skin health.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s39-s40"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621766","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":"Abstract: Commercial Tobacco Use and Perceptions in a Great Plains Tribal Community: Cross-Sectional Survey Analysis.","authors":"Brant Hannahs, Connor Corsinin, Anna Tillery, Rae O'Leary","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Commercial tobacco use is a significant public health concern in American Indian communities. Updated, community-specific data are essential to inform culturally grounded tobacco control and policy initiatives. This study describes commercial tobacco use patterns, cessation behaviors, and policy perceptions among adult members of the Cheyenne River Sioux Tribe (CRST) in 2022.</p><p><strong>Methods: </strong>A survey was conducted among 400 adult CRST members in 2022. Participants reported tobacco behaviors, quit attempts, cessation methods, sacred tobacco practices, perceptions of Tribal smoke-free policy, and the impact of COVID-19 on tobacco use.</p><p><strong>Results: </strong>Commercial tobacco use was highly prevalent (58.5%). Cigarette and poly-tobacco use were more common among participants reporting lower income (p>0.001) and lower educational attainment (p=0.014). Most tobacco users reported at least one quit attempt (62.5%). Family/community resources were frequently cited as sources of quit support, pharmacologic aids and healthcare providers were less commonly utilized. Sacred tobacco use was common (60%) and did not differ significantly by commercial tobacco use status.</p><p><strong>Conclusions: </strong>Commercial tobacco use among CRST adults is prevalent and socially patterned, despite high levels of quit intent. Findings highlight the need for culturally grounded, multi-product cessation strategies and strengthened integration between policy initiatives and accessible community-based support services.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s32"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621883","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":"Abstract: Cultivating Leadership Identity through Short-term Mentorship: A Retrospective Cross-Sectional Study Examining an Outreach Event for Women in Medicine.","authors":"Kathryn Hammer, Hope McMaster, Kiley Medler, DenYelle Baete Kenyon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Women pursuing careers in medicine are often highly motivated to participate in mentorship opportunities to develop leadership skills and encourage the growth of prospective women in medicine. Longitudinal near-peer mentorship has been shown to support leadership identity development and produce positive mentor outcomes, including increased professional skills and confidence. Acknowledging the logistical barriers to longitudinal mentoring programs, such as scheduling constraints and competing priorities, our project seeks to explore whether short-term mentorship outreach activities may offer a feasible model for female medical students to engage in experiential leadership identity development and attain benefits associated with the mentor role.</p><p><strong>Methods: </strong>We will host an outreach event providing female medical students at the University of South Dakota Sanford School of Medicine (SSOM) an opportunity to serve as mentors to South Dakota undergraduate and high school women interested in pursuing careers in medicine. During the event, mentors will lead skills simulations and participate in discussions about medical education and experiences as women in medicine. Post-event surveys will be completed by participating medical students to evaluate the effectiveness of this one-time outreach event, especially as it pertains to the short-term practice of leadership and development of leadership identity.</p><p><strong>Expected results: </strong>We anticipate that participation in this outreach event, scheduled on April 9 in Sioux Falls, will result in survey data which will demonstrate that this event provides an opportunity for women at SSOM to practice leadership skills, build confidence in leading, and grow in their identity as physician leaders. Findings may help improve future programming offered by SSOM's chapter of Women in Medicine and Science.</p><p><strong>Conclusions: </strong>Short-term mentorship outreach events may provide a practical avenue for female medical students to grow in their leadership identity and attain benefits of the mentor role while supporting the next generation of women in medicine.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s38"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621899","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":"Abstract: Clinic Patient Perspectives on Organ Donation and Transplantation in Rural Northern Great Plains: A Prospective Survey.","authors":"Rebecca Hofer, Abbey Rieber, Benjamin Limburg, Sujit Vijay Sakpal","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>More than 100,000 patients are on the U.S. transplant waitlist, with proportionally fewer organ donations coming from rural areas. Optimization of donation services in rural and frontier communities could address this discrepancy. We sought to better understand attitudes, knowledge, and concerns regarding organ donation and transplantation among frontier populations by surveying patients in the United States Great Plains region.</p><p><strong>Methods: </strong>A 15-item survey was distributed for voluntary completion to patients ≥18 years at three rural clinics in the Great Plains from July 2025 to January 2026. The survey included questions on demographics, exposure to and knowledge of organ donation, and attitudes regarding organ donation and transplantation. A total knowledge score was created by scoring participants' accuracy in selecting which organs/tissues can be donated. Statistical analyses included Fisher exact and Mann Whitney U testing, as well as a multiple logistic regression. A p-value of ≤0.05 was considered significant.</p><p><strong>Results: </strong>Among 101 respondents (74.3% female, 77.2% registered donors), 90.1% were White and 7.9% were Native American/Alaska Native (NA/AN). Registered donors had significantly higher knowledge scores than non-donors (p=0.0012). Men were more likely to limit transplant acceptance to donations from friends/relatives (p=0.024), while NA/AN respondents showed higher willingness for unconditional living donation (p=0.039). Multivariable regression identified knowledge score as the sole independent predictor of donor status amongst variables surveyed (OR 1.48; 95% CI 1.13-1.99). The primary concern with donation reported was fear of health complications (37.5%) and the most requested intervention was more information on the donation process (18.1%).</p><p><strong>Conclusion: </strong>Medical literacy appears to be positively associated with organ donor status in this population. Sex-, race-, and education-specific differences in donation attitudes exist and may inform targeted interventions. Addressing knowledge gaps and specific concerns through education and outreach could provide a strategy to increase donation rates in rural populations.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s34-s35"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621906","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":"Abstract: Atraumatic Scalp Seroma in an Adolescent: A Case Report.","authors":"Jaelyn Morehead, Mason Crow, Ryder Grantham, Will Brown, April Willman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Seromas are localized collections of serous fluid that most commonly arise following surgical intervention or significant trauma that disrupts lymphatic channels and create potential dead space. Outside of these contexts, seroma formation is uncommon. In pediatric patients, scalp fluid collections are more frequently associated with birth-related injury, hematoma, infection, or neoplastic processes, and reports of atraumatic scalp seromas in adolescents remain rare.</p><p><strong>Case report: </strong>A previously healthy 14-year-old male presented with painless swelling over the superior scalp first noticed three days prior. Five days before presentation, he had fallen from a four-wheeler while mowing but reported wearing a helmet and denied head impact, loss of consciousness, or friction injury. He also denied headache, visual disturbance, or systemic symptoms. Physical examination demonstrated a 9×6 cm soft, fluctuant swelling over the left superior scalp without erythema, ecchymosis, or visible skin disruption. Neurologic examination was normal. Given the lesion's size and the recent fall history, noncontrast head CT was obtained to exclude intracranial injury or hematoma. Imaging demonstrated an approximately 10×5×1 cm crescentic fluid collection within the scalp along the left convexity, most consistent with a seroma, with no abnormalities of the calvarium or intracranial structures. The patient was managed expectantly, and the swelling resolved completely without development of additional symptoms by ten-week follow-up.</p><p><strong>Conclusion: </strong>This case highlights an uncommon presentation of scalp seroma in an adolescent without a clear traumatic or surgical precipitant. Although posttraumatic entities such as Morel-Lavallée lesions are well described, they are typically associated with high-energy shearing injury and characteristic imaging findings that were absent in this patient. Recognition that benign, self-limited seromas may occur in the absence of significant trauma is important when evaluating pediatric scalp masses and may help avoid unnecessary invasive diagnostic testing or intervention when clinical and radiographic features are reassuring.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s25"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621954","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":"Abstract: Unexplained Microcytosis in a 40-Year-Old Male: Case Report of a Missed Opportunity for Early Colorectal Cancer Diagnosis.","authors":"Kennedy Forest, Prajith Raj Ramesh, Jyotroop Kaur, Ahmed T Kurdi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>In the United States, colorectal cancer ranks as the third most commonly diagnosed malignancy and the second leading cause of cancer-related death in both men and women. Colorectal cancer incidence is rising among people under the age of 50 who account for an estimated 13% of cases. Colon cancer typically develops slowly over the course of five to ten years, so primary care physicians should maintain a high index of suspicion for early clinical indicators of potential malignancy to promote timely detection.</p><p><strong>Case report: </strong>We report the case of a 40-year-old male with a history of morbid obesity (BMI 54 kg/m2), type 2 diabetes mellitus, and hypertension with isolated microcytosis (MCV 77.1 fL, hemoglobin 13.9 g/dL) and iron deficiency (iron 35 ug/dL, ferritin 68 ng/mL) during an annual wellness visit. The patient re-established care five years later and reported intermittent rectal bleeding that he owed to hemorrhoids. Labs were notable for iron deficiency anemia (hemoglobin 11.7 g/dL, MCV 69.2 fL, iron 17 ug/dL, ferritin 26 ng/mL). Colonoscopy revealed a partially obstructing infiltrating and circumferential tumor in the descending colon and several large, scattered pedunculated polyps. Biopsies confirmed invasive adenocarcinoma with intact expression of mismatch repair genes. Staging CT scan was unable to localize a colonic mass but identified clustered enlarged metastatic lymph nodes. Stage IIIb colon adenocarcinoma (cT3 cN1b cM0) was treated with neoadjuvant chemotherapy (mFOLFOX 6) followed by a left hemicolectomy eight months after the diagnosis with remission.</p><p><strong>Conclusion: </strong>Iron deficiency anemia is a well-known clinical indicator for colorectal cancer. Any early signs of anemia including isolated microcytosis in men or post-menopausal women should be further investigated for gastrointestinal blood loss. With rising incidence of colorectal cancer in younger adults, laboratory abnormalities warrant thorough evaluation as they may be the only indicator of occult blood loss from malignancy.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s28"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621769","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":"Abstract: The Preeclampsia Mimic: A Case Report of Cyclic Cushing's Disease Unmasked in the Postpartum Period.","authors":"Jaelyn Morehead, Ruby Hawks, Carolyn Gilbertson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Cushing's disease in pregnancy is rare and frequently underrecognized due to clinical overlap with physiologic gestational changes and hypertensive disorders of pregnancy, particularly preeclampsia. Delayed diagnosis may result in prolonged maternal morbidity and inappropriate management.</p><p><strong>Case report: </strong>A 30-year-old gravida 2, para 1 woman delivered at 37 weeks' gestation via induced vaginal delivery for preeclampsia without severe features. Her immediate postpartum course was unremarkable. At 12 weeks postpartum, she developed persistent proteinuria with associated hypercalciuria and hyperuricosuria despite preserved renal function. Over the following weeks, she developed hypokalemia, leukocytosis, and progressive cushingoid features including facial rounding, dorsocervical fat pad, central obesity, proximal muscle weakness, hypertension, easy bruising, hirsutism, and frequent falls. Endocrine evaluation revealed markedly elevated serum and urinary cortisol levels with concomitant hyperandrogenism. Magnetic resonance imaging demonstrated a 9-mm pituitary adenoma with evidence of hemorrhage. She was diagnosed with cyclic Cushing's disease with intermittent adrenal insufficiency and initiated on glucocorticoid replacement therapy. Transsphenoidal resection of the adenoma was performed at 26 weeks postpartum, resulting in improvement in blood pressure and clinical symptoms. At one year postpartum, she remained clinically stable on glucocorticoid replacement therapy.</p><p><strong>Conclusion: </strong>This case highlights the importance of maintaining a broad differential diagnosis in patients with hypertensive disorders of pregnancy. Persistent hypertension, proteinuria, and metabolic abnormalities should prompt evaluation for underlying endocrinopathies such as Cushing's disease. Early recognition and multidisciplinary management are critical to optimizing maternal outcomes and avoiding misattribution of symptoms to preeclampsia alone. Emerging biomarkers, including sFlt-1/PlGF ratios, may further aid in distinguishing preeclampsia from alternative pathologic processes.</p>","PeriodicalId":39219,"journal":{"name":"South Dakota medicine : the journal of the South Dakota State Medical Association","volume":"79 suppl 5","pages":"s40-s41"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621792","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}