JCEM case reportsPub Date : 2025-02-25eCollection Date: 2025-03-01DOI: 10.1210/jcemcr/luae204
Minh T Pham, John D Mahan, Summit H Shah, Steven I Estes, Stephen G Kaler
{"title":"Late-Onset Progressive Osseous Heteroplasia: 2 Unrelated Cases and Use of Positron Emission Tomography for Diagnosis.","authors":"Minh T Pham, John D Mahan, Summit H Shah, Steven I Estes, Stephen G Kaler","doi":"10.1210/jcemcr/luae204","DOIUrl":"10.1210/jcemcr/luae204","url":null,"abstract":"<p><p>Progressive osseous heteroplasia (POH) is a rare autosomal-dominant hereditary bone disorder caused by inactivating pathogenic variants in <i>GNAS1</i>. POH is characterized by progressive cutaneous ossification and heterotopic ossification in skeletal muscles and subdermal connective tissues. Understanding of the natural history and phenotypic heterogeneity of the illness is incomplete. We report 2 affected male subjects with a milder than usual clinical course, highlight their clinical presentations and molecular correlates, and propose sodium <sup>18</sup>F-fluorine positron emission tomography (PET) scanning as a sensitive technique for POH diagnosis and management.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 3","pages":"luae204"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506555","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}
JCEM case reportsPub Date : 2025-02-12eCollection Date: 2025-03-01DOI: 10.1210/jcemcr/luaf018
Freddy J K Toloza, Armando Filie, Mark Raffeld, Electron Kebebew, Joanna Klubo-Gwiezdzinska, Sriram Gubbi
{"title":"Rapidly Growing Thyroid Schwannoma: Diagnostic Challenges and Management Strategies.","authors":"Freddy J K Toloza, Armando Filie, Mark Raffeld, Electron Kebebew, Joanna Klubo-Gwiezdzinska, Sriram Gubbi","doi":"10.1210/jcemcr/luaf018","DOIUrl":"10.1210/jcemcr/luaf018","url":null,"abstract":"<p><p>Thyroid nodules are one of the most commonly encountered conditions in clinical endocrinology. Most thyroid nodules are of epithelial origin. However, primary thyroid mesenchymal tumors (TMTs), arising from the mesenchymal tissue, are being increasingly recognized. More than 20 different forms of benign and malignant TMTs have been described in the literature. Thyroid schwannoma is an extremely rare type of TMT, with only a few cases reported to date, accounting for less than 1% of all schwannomas. It primarily affects adults, with no significant sex predilection, and is often discovered incidentally during evaluation for thyroid nodules. Due to its rarity, the clinical presentation and natural history remain poorly understood, underscoring the importance of histopathological examination for accurate diagnosis and management. We describe a case of a patient with thyroid schwannoma who was diagnosed and managed at our center, contributing valuable insights to the limited body of knowledge on this rare entity. This is followed by a detailed description of the clinical features, diagnosis, and management of thyroid schwannomas.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 3","pages":"luaf018"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411962","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}
JCEM case reportsPub Date : 2025-02-05eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luaf001
Noa Tal, Serguei Bannykh, Thomas Learch, Adam N Mamelak, Odelia Cooper
{"title":"Avascular Necrosis in Patients With Cushing Syndrome.","authors":"Noa Tal, Serguei Bannykh, Thomas Learch, Adam N Mamelak, Odelia Cooper","doi":"10.1210/jcemcr/luaf001","DOIUrl":"10.1210/jcemcr/luaf001","url":null,"abstract":"<p><p>Cushing syndrome (CS) results from prolonged exposure to excess glucocorticoids, leading to a range of clinical manifestations including avascular necrosis (AVN), a rare complication of CS. Although AVN is often associated with exogenous glucocorticoid treatment, it can occur in endogenous CS but may be unrecognized because of its rarity and possibly from a subclinical presentation. We describe a case of a 71-year-old male with florid Cushing disease who initially presented with bilateral hip AVN and later developed bilateral shoulder AVN despite achieving biochemical remission following transsphenoidal surgery and adjuvant stereotactic photon radiosurgery. AVN in endogenous CS is underreported, and guidance on routine screening is lacking. Our case underscores the importance of considering AVN in patients with CS, especially in those with persistent or recurrent joint symptoms and markedly elevated cortisol levels. Early detection of AVN is crucial as it can lead to irreversible joint damage and disability if untreated. Screening strategies should be explored to identify high-risk patients who are diagnosed with CS for timely intervention, thereby preventing long-term morbidity associated with AVN.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf001"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257526","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}
JCEM case reportsPub Date : 2025-02-05eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luae253
Lily Deng, Laura Galganski, Mansa Krishnamurthy
{"title":"Retained Continuous Glucose Monitor Sensor Wire Fragments Presenting as a Swollen Nodule of the Thigh.","authors":"Lily Deng, Laura Galganski, Mansa Krishnamurthy","doi":"10.1210/jcemcr/luae253","DOIUrl":"10.1210/jcemcr/luae253","url":null,"abstract":"<p><p>A 2-year-old male with genetic-negative, diazoxide-responsive hyperinsulinism presented with a knot in his left, lateral thigh. His hypoglycemia was managed with diazoxide, chlorothiazide, and monitoring via a Dexcom G6 continuous glucose monitor (CGM). X-ray showed 3 metallic wire foreign bodies, consistent with retained Dexcom sensor wires. He was referred to surgery for foreign body removal. Intraoperative fluoroscopy revealed 4 pieces of wire. Two superficial pieces were removed, but 2 small pieces deep to the fascia remained because of significant risk of injury or bleeding if removal was attempted. We present this case to increase awareness in the literature regarding retention of CGM wires. Raised nodules at sites of CGM insertion without fluctuation or erythema and persistent pain should raise suspicion for retention of sensor wires.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luae253"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257531","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}
JCEM case reportsPub Date : 2025-02-04eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luaf003
Jordan C LeSarge, Hani Rjoob, Kristin K Clemens, Stan Van Uum, Laila C Schenkel, Tayyab S Khan
{"title":"A Novel and Rare Pathogenic Gene Variant in 2 Patients With Multiple Endocrine Neoplasia Type 1 (MEN-1) Syndrome.","authors":"Jordan C LeSarge, Hani Rjoob, Kristin K Clemens, Stan Van Uum, Laila C Schenkel, Tayyab S Khan","doi":"10.1210/jcemcr/luaf003","DOIUrl":"10.1210/jcemcr/luaf003","url":null,"abstract":"<p><p>Multiple endocrine neoplasia type 1 (MEN-1) is a syndrome characterized by development of tumors including parathyroid adenomas, duodenopancreatic neuroendocrine tumors, and pituitary adenomas. We describe 1 patient with a novel and another with a rare pathogenic MEN-1 variant. Case 1 was a 61-year-old woman with recurrent hypercalcemia who ultimately required a subtotal parathyroidectomy, with a thymectomy revealing a thymoma. She then developed a gastrinoma requiring pancreatectomy and also had a biochemically nonfunctioning sellar mass. Genetic testing found a novel <i>MEN1:c.1192delC, p.(Gln398Argfs*47)</i> pathogenic variant. Case 2 was a 38-year-old woman with a family history of MEN-1, who had recurrent hypercalcemia and nephrolithiasis requiring a subtotal parathyroidectomy. She had a macroprolactinoma, but no pancreatic lesions. Genetic testing found a rare <i>MEN1:c.784-9G > A</i> pathogenic variant. MEN-1 syndrome should be considered in patients presenting with 1 or more classical MEN-1-associated tumors based on clinical suspicion.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf003"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191407","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}
JCEM case reportsPub Date : 2025-02-04eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luae237
Run Ting Chin, Shao Feng Mok
{"title":"46,XX Testicular Disorder of Sex Development (DSD) Presenting With Male Hypogonadism.","authors":"Run Ting Chin, Shao Feng Mok","doi":"10.1210/jcemcr/luae237","DOIUrl":"10.1210/jcemcr/luae237","url":null,"abstract":"<p><p>Disorders of sex development are genetically complex, and phenotypes range from hypospadias to completely masculinized or feminized genitalia with a discordant karyotype. They arise as a result of alterations in gonad formation (sex determination stage) or function (sex differentiation stage). Reaching a specific diagnosis with the aid of molecular technologies is important for individualized management, genetic counseling, and prognostic prediction for fertility and risk of tumor development. This case report describes a young adult male who was referred initially with concern for Klinefelter syndrome based on a commercial genetic test. His laboratory investigations revealed hypergonadotropic hypogonadism, azoospermia, and a chromosomal karyotype of 46,XX. He was eventually diagnosed with 46,XX testicular disorder of sex development. He was initiated on testosterone replacement therapy and offered adoption and use of donor sperm for artificial reproduction techniques.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luae237"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191404","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}
JCEM case reportsPub Date : 2025-02-04eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luaf011
Jeremy A Knott, Andrea R Horvath, Thaw D Htet
{"title":"Diagnostic Challenges in a Case of Refractory Severe Hypercalcemia Due to Splenic Sarcoidosis.","authors":"Jeremy A Knott, Andrea R Horvath, Thaw D Htet","doi":"10.1210/jcemcr/luaf011","DOIUrl":"10.1210/jcemcr/luaf011","url":null,"abstract":"<p><p>Hypercalcemia is frequently encountered in clinical practice; however, sarcoidosis-induced hypercalcemia is relatively uncommon and requires careful evaluation, particularly when initial investigations are inconclusive or the hypercalcemia is refractory to standard treatment. We present a complex case of a 60-year-old female with chronic stage IV diabetic nephropathy who presented with acute severe asymptomatic hypercalcemia resulting from splenic sarcoidosis confirmed on splenic biopsy. Despite commencement of prednisone therapy, her hypercalcemia persisted. IV fluid therapy was complicated by fluid overload from chronic renal disease. Ketoconazole was trialed as second-line therapy with no initial improvement. Our case illustrates the diagnostic and therapeutic challenges associated with asymptomatic hypercalcemia attributed to systemic sarcoidosis on a background of chronic renal impairment. It underscores the importance of considering systemic sarcoidosis as a potential etiology in cases of acute PTH-independent hypercalcemia resistant to initial therapy.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf011"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191409","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":"Concomitant Exacerbation of Graves Orbitopathy and Double-Seronegative Myasthenia Gravis after SARS-CoV-2 Infection.","authors":"Yuto Nakano, Ken Takeshima, Yasushi Furukawa, Shuhei Morita, Mayumi Sakata, Taka-Aki Matsuoka","doi":"10.1210/jcemcr/luaf019","DOIUrl":"10.1210/jcemcr/luaf019","url":null,"abstract":"<p><p>SARS-CoV-2 infection could trigger autoimmune disease. We report a case of concomitant exacerbation of Graves orbitopathy (GO) and myasthenia gravis (MG) after SARS-CoV-2 infection. A 43-year-old woman had diplopia, proptosis, and swollen eyelids. Blood tests showed thyrotoxicosis and positive thyroid-stimulating hormone receptor antibodies, and orbital magnetic resonance imaging (MRI) showed enlarged extraocular muscles. She was therefore referred to our hospital with diagnosis of GO. Methylprednisolone pulse therapy (MPT) in combination with orbital radiotherapy were performed for 3 weeks, and ocular symptoms improved. At 41 weeks, the patient was infected with SARS-CoV-2 and felt sudden worsening of diplopia and ptosis. MRI showed an enlarged right inferior rectus muscle. MPT and orbital radiotherapy were performed again for 3 weeks for the suspected GO, but there was insufficient improvement of the ptosis. Serum antiacetylcholine receptor and anti-muscle-specific tyrosine kinase antibodies were negative, but the patient was further evaluated with repetitive nerve stimulation test and ice pack test, and diagnosis was double-seronegative MG. Pyridostigmine treatment led to dramatic improvement of the ptosis. SARS-CoV-2 infection could exacerbate MG as well as GO. Careful diagnosis is required for ocular symptoms after SARS-CoV-2 infection, especially when there is double-seronegative MG.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf019"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070044","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}
JCEM case reportsPub Date : 2025-01-28eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luaf006
Angelo Di Vincenzo, Eva Zabeo, Chiara Purificati, Marco Rossato
{"title":"Growth Hormone Increase Induced by Oral Administration of Melatonin in a Young Woman With Sleep Disturbances.","authors":"Angelo Di Vincenzo, Eva Zabeo, Chiara Purificati, Marco Rossato","doi":"10.1210/jcemcr/luaf006","DOIUrl":"10.1210/jcemcr/luaf006","url":null,"abstract":"<p><p>Growth hormone (GH) secretion by the pituitary is regulated by stimulatory and inhibitory pathways such as growth hormone releasing hormone (GHRH) and somatostatin, respectively, being also modulated by different neurotransmitters acting at the hypothalamic/pituitary level. The pineal gland hormone melatonin regulates GH secretion in many mammals, including humans, although its role in modulating GH secretion has been debated. We describe the case of a young woman chronically taking melatonin for sleep disturbances, referring to her general practitioner for flushing that appeared just after starting melatonin intake. Laboratory findings showed elevated plasma levels of GH and insulin-like growth factor-1 (IGF-1). She did not show clinical features resembling acromegaly. The evaluation of pituitary and pituitary end organ hormones showed normal plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), estradiol, free thyroid hormones, cortisol, and prolactin. Urinary 5-hydroxyindoleacetic acid levels were normal. One month after melatonin withdrawal, her plasma levels of GH, together with IGF-1, completely normalized. An oral glucose suppression test showed a normal response of GH secretion, further excluding an autonomous secretion. Physicians should be aware of the possible interference of melatonin on GH secretion to prevent misleading diagnosis of autonomous secretion thus avoiding valueless and costly clinical investigations.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf006"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061363","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}
JCEM case reportsPub Date : 2025-01-24eCollection Date: 2025-02-01DOI: 10.1210/jcemcr/luaf005
Darya Bondarenko, Franklin L Thelmo, Monika K Shirodkar
{"title":"Metastatic Insulinoma Managed With Continuous Glucose Monitoring in a Young Female Patient.","authors":"Darya Bondarenko, Franklin L Thelmo, Monika K Shirodkar","doi":"10.1210/jcemcr/luaf005","DOIUrl":"10.1210/jcemcr/luaf005","url":null,"abstract":"<p><p>Insulinomas are rare neuroendocrine neoplasms and causes of hypoglycemia. They present with neuroglycopenic symptoms, including confusion and seizures. Suspected diagnosis must be confirmed through bloodwork and imaging. The majority of insulinomas are benign and cured surgically; less than 10% of insulinomas are malignant. Malignant insulinomas present a unique and rare challenge in managing persistent hypoglycemia and tumor burden. We present a case of a young woman who presented with Whipple triad and high-grade masses in her pancreas, liver, and distant lymph node metastases on imaging. Insulinoma was diagnosed. Hypoglycemia was managed with continuous dextrose infusion, diazoxide, and lanreotide. She was discharged on medical management and a continuous glucose monitor. Her metastatic disease is being treated with a capecitabine and temozolomide (CAPTEM) regimen showing 30% reduction in tumor burden. In conjunction with the National Institutes of Health, she is undergoing evaluation with numerous neuroendocrine tumor surgeons for cytoreductive surgery.</p>","PeriodicalId":73540,"journal":{"name":"JCEM case reports","volume":"3 2","pages":"luaf005"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049010","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}