AACE Clinical Case Reports最新文献

{"title":"Improvement of Glycogenic Hepatopathy With Minimal Corresponding Improvement of Glycemic Control in a Person With Type 1 Diabetes: Case Report and Literature Review","authors":"Joselyn Tessa Tonleu BS ,&nbsp;Nicolas A. Reyes MD ,&nbsp;Natalie D. Hillerson MD ,&nbsp;William B. Horton MD, MSc, FACP","doi":"10.1016/j.aace.2024.12.004","DOIUrl":"10.1016/j.aace.2024.12.004","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Glycogenic hepatopathy is characterized by diffuse glycogen accumulation in hepatocytes that leads to hepatomegaly and elevated transaminases. Notably, the condition is reversible as improving glycemic control has been shown to resolve glycogenic hepatopathy and provide symptomatic relief.</div></div><div><h3>Case Report</h3><div>A 30-year-old female with longstanding and poorly-controlled type 1 diabetes presented to her primary care physician for a routine follow-up visit. Routine lab work demonstrated hyperglycemia and elevated liver enzymes (alkaline phosphatase of 180 U/L, aspartate aminotransferase of 111 U/L, and alanine aminotransferase of 101 U/L). At laboratory reassessment 3 weeks later, liver function tests remained elevated and hepatic ultrasound was unrevealing. She was referred to gastroenterology for further evaluation and laboratory tests for viral and autoimmune hepatitis were negative while magnetic resonance imaging of the abdomen was unremarkable. Given the nondiagnostic work-up, liver biopsy was performed and pathology was consistent with glycogenic hepatopathy. She was referred to Endocrinology for improved glycemic control; however, liver enzymes normalized over the next several months despite minimal improvement in glycemic control. She was eventually transitioned to a closed-loop automated insulin delivery system and started dulaglutide for management of obesity. Subsequent A1c values significantly improved and liver enzymes remained within normal limits.</div></div><div><h3>Discussion</h3><div>This case raises awareness of an under recognized complication of type 1 diabetes and challenges conventional thinking about factors leading to its resolution.</div></div><div><h3>Conclusion</h3><div>Further investigation into the underlying pathophysiology of glycogenic hepatopathy is needed.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 113-116"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644017","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 Woman With Persistent Abdominal Pain in the Setting of a Solitary Fibrous Adrenal Tumor","authors":"Samuel Amankwah MD ,&nbsp;Maria Luzuriaga MD ,&nbsp;Krista Denning MD ,&nbsp;Logan Lawrence MS","doi":"10.1016/j.aace.2024.12.012","DOIUrl":"10.1016/j.aace.2024.12.012","url":null,"abstract":"<div><h3>Background/Objective</h3><div>We present a case of a woman with persistent abdominal pain, leading to the discovery of a rare solitary fibrous tumor (SFT) in the adrenal gland. The rarity of adrenal SFTs and their diagnostic challenges make this case noteworthy. The objective of this report is to describe a patient with an adrenal SFT, highlighting the unique diagnostic approach and management considerations for this rare condition.</div></div><div><h3>Case Report</h3><div>A 35-year-old woman presented with chronic abdominal pain and was referred to the endocrinology clinic for evaluation of an adrenal incidentaloma. Computed tomography imaging revealed a 4 cm homogeneous right adrenal mass, with precontrast Hounsfield units of 1 and an absolute contrast washout of 60%. A prior computed tomography scan from 6 years earlier showed a 1.5 cm adenoma with similar characteristics. Despite normal hormonal levels, the tumor's growth and the patient's symptoms prompted surgical referral. The patient underwent robotic-assisted laparoscopic right adrenalectomy. Pathological examination identified a well-circumscribed SFT, measuring 3.7 × 3.6 × 2.9 cm.</div></div><div><h3>Discussion</h3><div>Adrenal SFTs are rare, typically hormonally inactive, well-circumscribed masses that often present with abdominal pain. While more common in the pleura, adrenal SFTs can mimic other benign adrenal lesions on imaging, complicating diagnosis. Histopathology is essential for accurate diagnosis, and surgical resection remains the main treatment.</div></div><div><h3>Conclusion</h3><div>This case highlights the diagnostic challenges of adrenal SFTs, which can mimic other benign lesions. Despite significant growth, the tumor was histologically benign with low malignancy risk. Clinicians should consider adrenal SFTs in the differential diagnosis of incidental adrenal masses with atypical imaging features.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 138-142"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644570","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":"Abnormal Antithyroglobulin Antibody in a Woman With Papillary Thyroid Carcinoma Receiving Intravenous Immunoglobulin Treatment","authors":"Verdah Ahmad MD,&nbsp;Sara Lubitz MD","doi":"10.1016/j.aace.2024.12.010","DOIUrl":"10.1016/j.aace.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Thyroglobulin and antithyroglobulin antibodies are used in the surveillance of differentiated thyroid carcinomas. In patients with differentiated thyroid carcinoma who require intravenous immunoglobulin for autoimmune or malignant conditions, surveillance of antithyroglobulin antibodies is challenging. We present a case of a patient with papillary thyroid carcinoma who showed fluctuating antithyroglobulin antibody levels while receiving intravenous immunoglobulin.</div></div><div><h3>Case Presentation</h3><div>A 41-year-old woman underwent total thyroidectomy, central and left modified neck dissection, and radioactive iodine ablation for multifocal papillary thyroid carcinoma with features of oncocytic and warthin-like variant and metastasis to 1 of 28 left lateral and 1 of 10 central lymph nodes. Ten years later, she contracted COVID-19 and developed COVID-19-associated encephalopathy for which she received intravenous immunoglobulin for 7 months. Five months after intravenous immunoglobulin initiation, surveillance thyroglobulin was &lt;0.8 ng/mL (liquid chromatography with mass spectrometry, &lt;0.4 ng/mL) and antithyroglobulin antibodies increased from undetectable to 97 IU/mL (chemiluminescent immunoassay, ≤1 IU/mL). After the final intravenous immunoglobulin dose, antithyroglobulin antibody levels progressively decreased, reaching 1 IU/mL (chemiluminescent immunoassay, ≤1 IU/mL) 6 months posttreatment. Neck ultrasounds showed no evidence of disease recurrence.</div></div><div><h3>Discussion</h3><div>Intravenous immunoglobulin can affect monitoring of patients with differentiated thyroid carcinomas due to passive transfer of pooled donor antibodies, including antithyroglobulin antibodies. Newly detectable antithyroglobulin antibodies in this patient were likely due to measured donor antithyroglobulin antibodies via intravenous immunoglobulin rather than cancer recurrence.</div></div><div><h3>Conclusion</h3><div>In patients with differentiated thyroid carcinomas receiving intravenous immunoglobulin, the presence of donor antithyroglobulin antibodies should be considered when antithyroglobulin antibodies are newly detectable.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 131-133"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644021","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":"Skeletal Muscle Mass and Body Weight Fall Proportionally With Use of Dual Glucagon-Like Peptide 1/Glucose-Dependent Insulinotropic Polypeptide Receptor Agonist Tirzepatide: Case Report and Review of Literature","authors":"Jessica Zinn MS, RD, CDN, CDCES,&nbsp;Leonid Poretsky MD","doi":"10.1016/j.aace.2024.12.001","DOIUrl":"10.1016/j.aace.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>Multiple studies have demonstrated that treatment with tirzepatide results in significant improvement in HgbA1c as well as meaningful weight loss. Although the loss of skeletal muscle mass has been well described with the use of glucagon-like peptide 1 receptor agonists, there is little information regarding the effect of dual glucagon-like peptide 1/glucose-dependent insulinotropic polypeptide receptor agonist tirzepatide on skeletal muscle mass.</div></div><div><h3>Methods</h3><div>We performed serial body composition measurements in a 68-year-old male who presented with a body mass index of 31.2 kg/m2 and hemoglobin A1c of 5.9%. Treatment with tirzepatide resulted in a reduction of weight by 28.7 lbs, a decrease in body mass index to 26.8 kg/m2, and normalization of A1c (5.3%). The patient, however, also experienced a 9.9 lb loss of skeletal muscle mass, which was proportionate to a reduction in body weight - approximately 15% from the initial value for both. Muscle mass loss constituted 34% of the total body weight loss.</div></div><div><h3>Results</h3><div>To our knowledge this is the first report of multiple serial body composition measurements in a patient on treatment with tirzepatide. The time course and the magnitude of the loss of body weight, fat mass and skeletal muscle mass are detailed.</div></div><div><h3>Conclusion</h3><div>We propose that, in addition to weight measurements, serial body composition assessments should be obtained in patients on tirzepatide. If this is not available, our findings suggest that, at least in some cases, the percent of muscle mass lost is similar to the percent reduction of total body weight.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 98-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644014","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":"Bilateral Adrenal Nodules in the Setting of Disseminated Fungal Infection: An Important Consideration for Appropriate Management of Adrenal Pathology","authors":"Bailey N. Johnson MD ,&nbsp;Signe Braafladt MD ,&nbsp;John-Paul Lavik MD, PhD ,&nbsp;Lillian Walton BS ,&nbsp;Alexandria D. McDow MD, FACS","doi":"10.1016/j.aace.2024.12.003","DOIUrl":"10.1016/j.aace.2024.12.003","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Increased utilization of cross-sectional imaging has led to a rise in diagnosis of incidental adrenal lesions. Physicians in many clinical settings are increasingly faced with addressing these incidental lesions by initiating the correct workup, diagnosis, and long-term follow-up plan. Our objective was to demonstrate the importance of maintaining a broad differential and completing a thorough workup in determining the correct treatment plan for patients with bilateral adrenal lesions.</div></div><div><h3>Case Report</h3><div>We present 2 patients who recently completed chemotherapy for lymphoma, found to have new bilateral adrenal lesions on postchemotherapy imaging. Urine antigen and/or adrenal biopsy was performed to confirm the diagnosis of disseminated fungal infection. This diagnosis has major implications on the treatment plan, which includes antifungal therapy instead of surgical management or additional chemotherapy. Cross-sectional imaging after initiation of antifungal treatment demonstrated decreasing size of nodules.</div></div><div><h3>Discussion</h3><div>A broad differential is critical when working up and developing treatment plans for adrenal nodules, specifically considering a fungal etiology in the setting of immunosuppression or primary extra-adrenal malignancy.</div></div><div><h3>Conclusion</h3><div>Incidentally found adrenal lesions are becoming more common, and in turn, the obligation for appropriate management of adrenal pathology not only falls to medical and surgical endocrinologists but also to general practitioners. It is prudent to consider atypical etiologies including disseminated fungal infection prior to surgical excision or initiation of chemotherapy as those treatment strategies would not benefit select patients.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 107-112"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644016","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":"Mild Thyrotoxicosis due to Seronegative Graves’ Disease or Disseminated Thyroid Autonomy","authors":"Gael Charbonne MD ,&nbsp;Fatima Hallak MD ,&nbsp;Alma Elizabeth Rivera Cruz MD ,&nbsp;Stephen Devitt McDonald MD","doi":"10.1016/j.aace.2024.12.002","DOIUrl":"10.1016/j.aace.2024.12.002","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Disseminated thyroid autonomy (DTA) and seronegative Graves’ disease are rare causes of hyperthyroidism with similar clinical presentations. This case report highlights the diagnostic challenges between these entities.</div></div><div><h3>Case Presentation</h3><div>A 35-year-old male presented with palpitations, diaphoresis, and a small goiter. His TSH was 0.249 mIU/L (reference: 0.45–4.5 mIU/L) and free T4 was 3.0 ng/dL (reference: 0.88–1.77 ng/dL). Thyroid peroxidase antibodies, TRAb, and TSI were repeatedly negative. Ultrasound showed a diffusely enlarged thyroid, and radioactive iodine uptake was 35% (reference: 10% to 35%) with thyroid scintigraphy revealing diffusely increased uptake, indicating a hyperfunctioning thyroid without nodules. Treatment with Methimazole 5 mg daily resolved symptoms within 6 months.</div></div><div><h3>Discussion</h3><div>Thyroid biopsy can help distinguish DTA from seronegative Graves disease. DTA is marked by nodular hyperplasia without lymphocytic infiltration, indicating a non-autoimmune nature, while seronegative Graves’ disease exhibits diffuse follicular hyperplasia with lymphocytic infiltration, just as typical Graves’ disease despite undetectable autoatibodies. The possibility of false-negative TRAb results complicates diagnosis, with up to 22% of patients initially diagnosed with DTA later testing TRAb-positive upon retesting. Some cases of DTA may involve TSH receptor gene mutations.</div></div><div><h3>Conclusion</h3><div>This case highlights the complexity of distinguishing DTA, seronegative Graves’ disease and typical Graves’ disease with initial false negative testing. A systematic approach with repeat testing and, when feasible, biopsy, is critical to distinguish these entities. Further studies with histologic analysis are needed to clarify outcomes and develop tailored managements, as these conditions have different remission rates and are driven by different mechanisms.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 102-106"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644015","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":"Somatostatin Receptor 2 Negative Pheochromocytoma Masked by Normal Adrenal Gland on Gallium-68 DOTATATE","authors":"Sanghwa E. Park MD ,&nbsp;Thanh D. Hoang DO ,&nbsp;Derek J. Stocker MD ,&nbsp;Mohamed K.M. Shakir MD ,&nbsp;Andrew J. Spiro MD","doi":"10.1016/j.aace.2024.12.011","DOIUrl":"10.1016/j.aace.2024.12.011","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Gallium-68 DOTATATE (⁶⁸Ga-DOTATATE) positron emission tomography/computed tomography (CT) is a somatostatin receptor (SSTR)-based imaging with high sensitivity that can be used for detection of pheochromocytomas and paragangliomas. We report a pheochromocytoma with negative SSTR2 expression and low uptake on ⁶⁸Ga-DOTATATE, whose detection was masked by the uptake of normal adrenal tissue.</div></div><div><h3>Case Report</h3><div>A 50-year-old man presented with a right adrenal incidentaloma. He had mildly elevated plasma normetanephrine levels of 194 pg/mL (ref. 0-145 pg/mL). Adrenal CT scan showed a right 1.9-cm lesion with unenhanced attenuation of 38 Hounsfield units. ⁶⁸Ga-DOTATATE showed a 1.9-cm right adrenal lesion and reported diffuse uptake in the adrenal glands, with maximum standardized uptake value (SUVmax) of 17.23 on the right and SUVmax of 22.78 on the left. After a 2-year interval, plasma normetanephrine level increased to 420 pg/mL (ref. 0-136.8 pg/mL). Adrenal CT scan showed the right adrenal lesion increased in size to 2.6 cm. He underwent right adrenalectomy, and pathology reported a 2.3-cm pheochromocytoma. Subsequent review of the initial ⁶⁸Ga-DOTATATE identified the pheochromocytoma as a photopenic area in the right adrenal gland with 7.73 SUVmax. Tissue staining was negative for SSTR2 expression. Genetic testing was negative for pheochromocytoma syndromes.</div></div><div><h3>Discussion</h3><div>Although ⁶⁸Ga-DOTATATE has strong affinity for SSTR2, some pheochromocytomas have low expression of SSTR2. The negative SSTR2 expression, small lesion size, and background uptake of the adrenal gland can affect the detection of pheochromocytoma.</div></div><div><h3>Conclusion</h3><div>⁶⁸Ga-DOTATATE may have limitations when evaluating small pheochromocytomas or other neuroendocrine tumors with low SSTR2 expression.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 134-137"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644569","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":"Beyond Glucose Levels: Redefining Diabetic Ketoacidosis—A Case of Hypoglycemic Diabetic Ketoacidosis","authors":"Guy I. Sydney MD","doi":"10.1016/j.aace.2025.01.001","DOIUrl":"10.1016/j.aace.2025.01.001","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Diabetic ketoacidosis (DKA) is a life-threatening condition typically diagnosed by the presence of hyperglycemia, acidemia, and ketonemia. A subset of patients may develop ketoacidosis without the traditionally increased glucose levels in a condition known as euglycemic DKA. This article describes an atypical presentation of DKA with concomitant hypoglycemia in a condition termed hypoglycemic DKA.</div></div><div><h3>Case Report</h3><div>A 74-year-old woman with a history of hypertension, type 2 diabetes mellitus (treated with empagliflozin), and hypothyroidism, presented from an outlying hospital due to concern for acute gallstone pancreatitis and choledocholithiasis. On arrival, laboratory evaluation revealed an anion gap of 16 mEq/L (reference range, 6-12 mEq/L), bicarbonate level of 11 mEq/L (reference range, 21-31 mEq/L), serum glucose level of 57 mg/dL (reference range, 70-105 mg/dL), beta-hydroxybutyrate level of 1.7 mmol/L (reference range, &lt;0.6 mmol/L), and urinalysis demonstrating a ketone level of &gt;80 mg/dL (reference range, &lt;3.49 mg/dL). The patient was treated according to the institution DKA protocol, with resolution of her DKA.</div></div><div><h3>Discussion</h3><div>The case presented highlights a manifestation of DKA characterized by a concurrent state of hypoglycemia in a patient treated with a sodium-glucose cotransporter 2 inhibitor, an atypical and likely underreported phenomenon.</div></div><div><h3>Conclusion</h3><div>Clinicians should maintain a high level of suspicion for DKA in patients with metabolic acidosis and ketosis, irrespective of their glucose levels, in particular in those treated with sodium-glucose cotransporter 2 inhibitors. Additionally, redefining these cases as drug-induced ketoacidosis may assist in preventing delayed diagnosis and management.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 148-150"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644572","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":"Recurrent Pericarditis in a Woman With Acromegaly Responding Favorably to Transsphenoidal Surgery","authors":"Samantha Jacobson MSc ,&nbsp;Jonathan-Raphaël Stetco ,&nbsp;Natasha Garfield MD, FRCPC","doi":"10.1016/j.aace.2025.01.002","DOIUrl":"10.1016/j.aace.2025.01.002","url":null,"abstract":"<div><h3>Objective</h3><div>Acromegaly is associated with increased insulin-like growth factor 1 (IGF-1), promoting systemic inflammation and cardiovascular complications. We present a patient with acromegaly who developed recurrent pericarditis, resolving soon after somatotroph pituitary adenoma resection. The objective of this report is to describe a case of uncontrolled acromegaly with recurrent, unexplained pericarditis.</div></div><div><h3>Case Report</h3><div>A 46-year-old woman was referred after a neurologist identified a 9 mm pituitary lesion on magnetic resonance imaging. Laboratory tests showed elevated IGF-1 of 52.3 nmol/mL (12.3–32.9 nmol/L), a nonsuppressible growth hormone (GH) level of 3.8 mcg/L (&lt;0.4 mcg/L) after a 75 g oral glucose tolerance test, confirming acromegaly. One-year postdiagnosis, the patient developed pleuritic chest pain from pericarditis with moderate-to-severe pericardial effusion. Symptoms resolved with nonsteroidal antiinflammatory drugs, colchicine and pericardiocentesis. Over 3 years she experienced multiple episodes of recurrent pericarditis. A comprehensive diagnostic workup, including rheumatologic and infectious evaluations, was negative. After transsphenoidal adenoma resection, IGF-1 normalized, and medical therapy was discontinued. Pericarditis recurred 2 months postoperatively but has not occurred again over 12 years of acromegaly remission.</div></div><div><h3>Discussion</h3><div>Hypersecretion of GH in acromegaly leads to elevated IGF-1 levels, which affect inflammatory responses. IGF-1 can promote systemic inflammation through proinflammatory cytokines, its effects may vary depending on tissue type. In this case, resolution of pericarditis following IGF-1 normalization suggests that elevated IGF-1 levels may mediate the inflammatory process in the pericardium.</div></div><div><h3>Conclusion</h3><div>The case suggests that acromegaly may predispose some patients to pericarditis, but its frequency and underlying pathogenesis remain unclear.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 151-154"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644573","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":"Ovarian Hyperthecosis Presenting as Polycythemia","authors":"Gayatri Jaiswal MD,&nbsp;Fnu Varsha MD,&nbsp;Patricia Bononi MD,&nbsp;Christina Dimech MD,&nbsp;Ashni Dharia MD","doi":"10.1016/j.aace.2024.11.008","DOIUrl":"10.1016/j.aace.2024.11.008","url":null,"abstract":"<div><h3>Background/Objective</h3><div>A 58-year-old postmenopausal woman presented with polycythemia on routine laboratory examinations along with long-standing hirsutism. The objective of this report is to highlight polycythemia as a rare presenting feature of ovarian hyperthecosis (OH).</div></div><div><h3>Case Report</h3><div>A 58-year-old woman presented with elevated hemoglobin and hematocrit levels in the primary care setting on routine laboratory examinations. On further workup, she was found to have elevated testosterone levels. Further history was relevant for excessive facial hair, frontal hair loss, and deepened voice. Examination findings were consistent with significant hirsutism. Adrenal and ovarian imaging was negative for tumor. The patient elected to have laparoscopic bilateral oophorectomy, which revealed OH on surgical pathology. After 2 months of surgery, the total testosterone levels became normal, and polycythemia resolved.</div></div><div><h3>Discussion</h3><div>In a postmenopausal woman, hirsutism with virilization should generally prompt urgent investigation because these signs are associated with malignant androgen-secreting tumors of the adrenal gland and ovaries. However, these symptoms can also be the result of benign causes such as OH.</div></div><div><h3>Conclusion</h3><div>This case is a rare illustration of OH in a postmenopausal woman presenting with polycythemia secondary to severe hyperandrogenism. Suspicion for this condition is crucial in evaluation for rare causes of polycythemia because if left untreated, it can lead to increased morbidity and mortality.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 2","pages":"Pages 89-92"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644137","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}