AACE Clinical Case Reports最新文献

{"title":"Combined Treatment With Leuprolide Acetate and Burosumab in X-linked Hypophosphatemia and Precocious Puberty: A Therapeutic Response","authors":"Gustavo Tempone Cardoso Penna MS ,&nbsp;Carolina Costa Figueiredo MD, MSc ,&nbsp;Nara Michelle de Araújo Evangelista MD, MSc ,&nbsp;Vânia de Fátima Tonetto Fernandes MD, PhD ,&nbsp;Patricia Salmona MD ,&nbsp;Guido de Paula Colares Neto MD, PhD","doi":"10.1016/j.aace.2024.09.004","DOIUrl":"10.1016/j.aace.2024.09.004","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Individuals with X-linked hypophosphatemia (XLH) generally experience normal puberty. However, the prevalence of central precocious puberty (CPP) in patients with XLH seems to be similar to that of the general population, and CPP may similarly impact their predicted final height.</div></div><div><h3>Case Report</h3><div>A female patient was diagnosed with XLH at 3 years old and received regular calcitriol and sodium-potassium phosphate treatment until age six. During this period, she showed increased growth velocity and improved height Z-score (from −2.38 SD to −1.95 SD). At 6 years and 11 months, she was diagnosed with idiopathic CPP, marked by thelarche, a growth spurt, and advanced bone age, resulting in a decreased predicted final height Z-score. She began pubertal blockade with leuprolide acetate and transitioned from conventional XLH treatment to burosumab. The combination of these treatments led to stabilized bone age, normalized growth velocity, and improved final height prediction without side effects or negative impacts on bone health during treatment.</div></div><div><h3>Discussion</h3><div>Although the prevalence of CPP in XLH patients has not been extensively studied, CPP in XLH may affect final height and worsen rickets by increasing mineral demands during growth spurts. Thus, CPP can be treated in patients with XLH, who may have compromised height outcomes, using synthetic gonadotropin-releasing hormone analogs.</div></div><div><h3>Conclusion</h3><div>In the described XLH patient with CPP, the combined use of gonadotropin-releasing hormone analogs and burosumab was a safe strategy to stabilize pubertal progression and bone age, minimize anthropometric loss, and avoid exacerbating bone deformities.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 18-23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078408","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":"Pituitary Stalk Interruption Syndrome: A Case and Literature Review","authors":"Anuja Choure MD ,&nbsp;Leena Shahla MD","doi":"10.1016/j.aace.2024.09.007","DOIUrl":"10.1016/j.aace.2024.09.007","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Pituitary stalk interruption syndrome (PSIS) is a rare congenital disorder that is characterized by a triad including a thin or interrupted pituitary stalk, absent or ectopic posterior lobe, and agenesis or dysgenesis of anterior lobe.</div><div>PSIS is typically diagnosed in childhood. The objective of this report is to describe a patient with PSIS whose diagnosis was missed until adulthood.</div></div><div><h3>Case Report</h3><div>A 42-year-old-female presented for evaluation of premature menopause, weight loss, and occasional dizziness. On examination she had short stature and absent secondary sexual features. Laboratory tests were consistent with hypopituitarism with follicle stimulating hormone 0.5 mIU/mL (16.7-113); luteinizing hormone 1.2 mIU/mL (10.8-58.6); prolactin 10.4 ng/mL (2.7-19.6); estradiol 20 pg/mL; cortisol 2 mcg/dL (6.7-22.6); adrenocorticotropic hormone 18 pg/mL (6-50); thyroid stimulating hormone 10.33 uIU/mL (0.28-3.8); free T4 0.41 ng/dL (0.58-1.64); insulin like growth factor-1 −3.7 SD (17 ng/mL) (52-328); and adrenocorticotropic hormone stimulation confirmed secondary adrenal insufficiency. The magnetic resonance imaging of the brain revealed an ectopic posterior pituitary with a partially empty sella, absence of the pituitary stalk, and a small anterior pituitary. The patient was initiated on replacement hormones with improvement in her symptoms.</div></div><div><h3>Discussion</h3><div>PSIS is a rare condition with uncertain pathogenesis and variable presentation requiring a high index of suspicion and presenting with multiple anterior pituitary hormone deficiencies. Diagnosis is confirmed by a dedicated pituitary magnetic resonance imaging, and treatment is tailored to the hormonal deficiency detected.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of early diagnosis of PSIS, which presents with multiple anterior pituitary hormonal deficiencies, but diagnosis can remain elusive unless dedicated brain imaging is performed.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 29-31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078430","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":"Successful Multimodal Management of an Aggressive Functional Gonadotropic Pituitary Macroadenoma","authors":"Jeffrey J. Feng MS ,&nbsp;Sophie M. Cannon MD ,&nbsp;Stephanie K. Cheok MD ,&nbsp;Mark S. Shiroishi MD ,&nbsp;Kyle M. Hurth MD, PhD ,&nbsp;Anna J. Mathew MD ,&nbsp;Gabriel Zada MD ,&nbsp;John D. Carmichael MD","doi":"10.1016/j.aace.2024.09.003","DOIUrl":"10.1016/j.aace.2024.09.003","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Although most gonadotroph cell–derived pituitary adenomas (PAs) give rise to nonfunctional PAs, hormonally active functional gonadotroph adenomas (FGAs) are exceedingly rare. We present a case of a giant and invasive functional gonadotropic pituitary macroadenoma treated with endoscopic transsphenoidal surgery and subsequent postoperative radiotherapy.</div></div><div><h3>Case Report</h3><div>A 54-year-old man presented with gradually worsening vision over 1 year. Magnetic resonance imaging demonstrated a 5.2-cm sellar and suprasellar mass with cavernous sinus invasion, mass effect on the optic chiasm, and extension into the sphenoid sinus, nasal cavity, and clivus. Preoperative workup was remarkable for erythrocytosis without sleep apnea and increased levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and testosterone. Immunohistochemistry results following endoscopic transsphenoidal resection confirmed dominant staining for steroidogenic factor-1, FSH, and LH. Postoperatively, the patient’s FSH level decreased, whereas the LH level normalized within 1 week. The free testosterone level normalized at 9 months. The patient underwent radiotherapy for a small amount of residual tumor in the right cavernous sinus and has demonstrated no evidence of disease or hormonal progression.</div></div><div><h3>Discussion</h3><div>There is no consensus on FGA-specific management that differs from the management of nonfunctional PAs; surgery is recommended when vision is impacted. The invasive nature of the tumor presented in this case is rare and limited safe gross total resection, requiring adjuvant radiotherapy.</div></div><div><h3>Conclusion</h3><div>FGAs are rare, and those of similar size and extent of invasion as in our case are even more so. In addition to surgical resection, consideration of adjunct therapies including radiation and multidisciplinary physician involvement are vital in achieving clinical improvement and remission while preventing possible progression and recurrence.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 14-17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078433","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":"Tongue Bumps as a Manifestation of Underlying Endocrine Neoplasia","authors":"Mona Vahidi Rad MD ,&nbsp;Austin DeHart MD ,&nbsp;Aditi Kumar MBBS ,&nbsp;Pablo Angulo DO ,&nbsp;Anna Sandstrom MD ,&nbsp;Robert Gonsalves DO","doi":"10.1016/j.aace.2024.09.005","DOIUrl":"10.1016/j.aace.2024.09.005","url":null,"abstract":"","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 77-78"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078356","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":"Finding the Culprit: Cushing Syndrome Secondary to Lung Carcinoid Tumor","authors":"Richard Vaca MD ,&nbsp;Nirali A. Shah MD","doi":"10.1016/j.aace.2024.09.002","DOIUrl":"10.1016/j.aace.2024.09.002","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Cushing syndrome resulting from ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) is a rare condition, and its occurrence in adolescents is even more uncommon, representing &lt;1% of cases. We describe a case of EAS from a lung carcinoid tumor leading to Cushing syndrome in a young woman, which was successfully treated with excision of the tumor.</div></div><div><h3>Case Report</h3><div>An 18-year-old woman presented with mood disturbances, weight gain, and fatigue for 6 months. Workup revealed high levels of urinary free cortisol (&gt;900 μg/dL; normal range, &lt;45 μg/dL) and midnight salivary cortisol (0.755 μg/dL; normal range, &lt;0.09 μg/dL). The ACTH and cortisol levels remained elevated after a low-dose dexamethasone suppression test. Magnetic resonance imaging of the pituitary gland did not reveal any adenoma and inferior petrosal sinus sampling showed no central-to-peripheral gradient. A diagnosis of EAS was made. Subsequent body imaging noted a 1-cm lung nodule. Due to symptoms of severe hypercortisolism including hypokalemia and worsening mood changes, the patient was started on metyrapone as a bridge to surgery. A few weeks later, the patient underwent successful surgical resection, after which symptoms promptly resolved. Pathology report later confirmed an atypical lung carcinoid tumor. The patient remained in remission at 1-year follow-up.</div></div><div><h3>Discussion</h3><div>Medical therapy aids in managing severe hypercortisolism in ACTH-secreting tumors until definitive surgical treatment can be undertaken.</div></div><div><h3>Conclusion</h3><div>This case underscores the critical importance of promptly recognizing EAS and the resulting severe hypercortisolism symptoms because early surgical intervention can lead to a cure.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 10-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078418","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":"Micronutrient Deficiency and Wernicke’s Encephalopathy in the Setting of Over the Counter Transcutaneous Multivitamin Patch Use Following Bariatric Surgery","authors":"Hisham Mohammed Babu MBBS,&nbsp;Andrew J. Spiro MD,&nbsp;Thanh D. Hoang DO,&nbsp;Mohamed K.M. Shakir MD","doi":"10.1016/j.aace.2024.10.001","DOIUrl":"10.1016/j.aace.2024.10.001","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Thiamine deficiency, which may occur following bariatric surgery, can lead to the development of Wernicke’s encephalopathy (WE). This case report describes a patient developing WE postbariatric surgery, due to the use of over-the-counter transcutaneous multivitamin patch rather than recommended vitamin tablets.</div></div><div><h3>Case Report</h3><div>A 61-year-old female presented with 45 pounds of weight gain over the past year with a body mass index of 39.58 kg/m². She underwent lifestyle modification and treatment with dulaglutide with limited success. After evaluation and counseling, the patient underwent Roux-en-Y gastric bypass surgery and was prescribed thiamine, cholecalciferol, vitamin B12, and multivitamin tablets postoperatively. Eight months later, she presented to the emergency room with confusion, bilateral lower extremity weakness, paresthesia, and ataxia. Neurological examination revealed disorientation, nystagmus, and bilateral lateral rectus palsies. She reported using transcutaneous multivitamin patches instead of the recommended oral supplementation. The clinical features, low serum thiamine level of 1.28 μg/dL (reference 2.5–7.5 μg/dL), and resolution of symptoms following supplementation confirmed the diagnosis of WE.</div></div><div><h3>Discussion</h3><div>Obesity often predisposes individuals to multiple nutritional deficiencies. It is critical that these patients take adequate vitamin supplementation before and after bariatric surgery. Thiamine deficiency can present as WE due to inappropriate supplementation such as use of a transcutaneous patch as seen in our patient.</div></div><div><h3>Conclusion</h3><div>Adequate nutritional counseling and supplementation before and after bariatric surgery is required to prevent complications. Transcutaneous patch as a mode of multivitamin supplementation is questionable in its current state and should be avoided.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 36-39"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078425","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":"Should Methoxytyramine Routinely Be Included in the Guidelines for Biochemical Assessment of Pheochromocytomas and Paragangliomas?","authors":"Ann T. Sweeney MD,&nbsp;Michael A. Blake MB, BCh,&nbsp;Sina Jasim MD, MPH,&nbsp;Karel Pacak MD, PhD, DSc","doi":"10.1016/j.aace.2024.11.005","DOIUrl":"10.1016/j.aace.2024.11.005","url":null,"abstract":"","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 3-4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078431","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":"Hypogonadism in a Man With Cystic Fibrosis and an Unusually Low Serum Testosterone: A Cautionary Tale","authors":"Khemaporn Lertdetkajorn MD ,&nbsp;Crystal Cobb DO ,&nbsp;Rebecca J. Kapolka MD ,&nbsp;William R. Hunt MD ,&nbsp;Vin Tangpricha MD, PhD","doi":"10.1016/j.aace.2024.09.008","DOIUrl":"10.1016/j.aace.2024.09.008","url":null,"abstract":"<div><h3>Background/Objective</h3><div>Men with cystic fibrosis (CF) have a high prevalence of low testosterone levels. A recent retrospective study demonstrated a quarter of a cohort of men with CF had serum testosterone levels below 300 ng/dL. The evaluation of hypogonadism is of increasing clinical importance in order to prevent unfavorable outcomes. Herein we present a 31-year-old man with CF and a relatively low serum testosterone value who was found to have an additional unsuspected cause of male hypogonadism.</div></div><div><h3>Case Report</h3><div>The patient was a 31-year-old man with history of CF who was referred to endocrinology clinic for the evaluation of hypogonadism. Serum testing revealed a total testosterone of 175 ng/mL (296-1377), luteinizing hormone 2.8 mIU/mL (1.2-8.6), and a prolactin of 341 ng/mL (3-13). A brain magnetic resonance imaging was obtained, which revealed a 1 cm hypoenhancing left sellar lesion. He was started on cabergoline. His testosterone increased to 707 ng/dL after a year on cabergoline treatment. His prolactin decreased to 12 ng/mL after a year of treatment. The pituitary adenoma decreased 50% in size 2 years after cabergoline was initiated.</div></div><div><h3>Discussion</h3><div>The most common etiologies of CF are recurrent infections, chronic inflammation, and glucocorticoid administration, which lead to both hypothalamic-pituitary dysregulation and primary hypogonadism. However, other less common causes of hypogonadism can also be found in CF.</div></div><div><h3>Conclusion</h3><div>We suggest that all men with cystic fibrosis found to have hypogonadism undergo additional evaluation for causes of hypogonadism prior to treatment with testosterone.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 32-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078421","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":"Swelling of the Right Arm During a Nuclear Medicine Therapy for Metastatic Pheochromocytoma","authors":"Run Yu MD, PhD ,&nbsp;Linda Gardner BSN ,&nbsp;Zachary Ells BS ,&nbsp;Magnus Dahlbom PhD ,&nbsp;Ali Salavati MD, MPH ,&nbsp;Shadfar Bahri MD","doi":"10.1016/j.aace.2024.11.003","DOIUrl":"10.1016/j.aace.2024.11.003","url":null,"abstract":"","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 75-76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078438","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":"Two Cases of Composite Pheochromocytoma-Ganglioneuromas With Plasma Metanephrine Levels in the Subclinical Range Pheochromocytoma-Ganglioneuroma","authors":"Mayssam El Najjar MD ,&nbsp;Elie Naous MD ,&nbsp;Caroline Blake ,&nbsp;Aysegul Bulut MD ,&nbsp;Alexander Perepletchikov MD ,&nbsp;Ann T. Sweeney MD","doi":"10.1016/j.aace.2024.10.003","DOIUrl":"10.1016/j.aace.2024.10.003","url":null,"abstract":"<div><h3>Background/Objective</h3><div>In &lt;10% of cases, pheochromocytomas coexist with other tumors, most commonly ganglioneuromas, and are termed composite pheochromocytoma-ganglioneuromas. We present 2 cases of composite pheochromocytoma-ganglioneuromas and review the diagnosis and management of these rare tumors.</div></div><div><h3>Case Report</h3><div>Patient 1 and patient 2 were 35-year-old and 45-year-old woman, respectively. Patient 1 presented with a history of controlled hypertension and symptoms of anxiety along with palpitations, diaphoresis, and flushing. Patient 2 complained of abdominal pain and underwent abdominal computed tomography (CT) imaging. Patient 1 and patient 2 had metanephrine levels of 76 pg/mL and 61 pg/mL (normal &lt;57 pg/mL), respectively, and normetanephrine levels of 161 pg/mL and 116 pg/mL (normal &lt; 148 pg/mL), respectively. CT scans depicted right adrenal masses in both cases: patient 1 had a 2.3 × 2.6 cm mass measuring 36 Hounsfield units on noncontrast CT imaging and patient 2 had a 4.5 × 3.5 cm right adrenal mass measuring 73 Hounsfield units on contrast CT imaging. Both patients underwent laparoscopic robotic adrenalectomies without complications. The pathologic analyses of both cases revealed composite pheochromocytoma-ganglioneuroma tumors. Surveillance at 1 year in both patients demonstrated no evidence of recurrence.</div></div><div><h3>Discussion</h3><div>The clinical and radiological presentation of composite pheochromocytoma-ganglioneuromas mirrors pheochromocytomas. The diagnosis relies on histopathological analysis. Treatment of pheochromocytoma-ganglioneuromas is complete surgical excision in a high-volume center with adrenal expertise and is associated with an overall excellent prognosis. The probability of recurrence is low, and distant metastases have rarely been reported.</div></div><div><h3>Conclusion</h3><div>Pheochromocytoma-ganglioneuromas may present with plasma metanephrine levels in the subclinical range. As with isolated pheochromocytomas, lifetime surveillance is critical for composite pheochromocytoma-ganglioneuromas.</div></div>","PeriodicalId":7051,"journal":{"name":"AACE Clinical Case Reports","volume":"11 1","pages":"Pages 45-48"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078360","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}