64-year-old woman • hot flashes, facial flushing, excessive sweating, and palpitations • daily headaches • history of hypertension • Dx?

► hot flashes, facial flushing, excessive sweating, and palpitations ► daily headaches ► history of hypertension.

Coexistence of Cushing Disease With a Solitary Adrenocorticotrophic Hormone-Dependent Adrenal Adenoma.

Objective: We report a 49-year-old woman who had minimal features of Cushing syndrome and an incidentally discovered adrenal adenoma. She was subsequently diagnosed with pituitary-dependent Cushing syndrome.

Methods: Laboratory and imaging studies including serum cortisol, plasma adrenocorticotrophic hormone (ACTH), high dose dexamethasone test, corticotropin-releasing hormone test, computed tomography (CT) scan, and magnetic resonance imaging were performed.

Asymptomatic and Biochemically Silent Pheochromocytoma with Characteristic Findings on Imaging.

Pheochromocytomas are tumors that originate from the chromaffin tissue of the adrenal medulla and commonly produce catecholamines. The diagnosis is typically established by the measurement of catecholamines or their metabolites in urine or plasma, and tumors are localized with the use of radiographic and scintigraphic studies. Pheochromocytomas can occur in asymptomatic patients, and the preferred treatment is surgical removal of the tumor.

Successful Long-Term Medical Management of Unresectable Insulinomas.

In this paper, we present two patients with unresectable insulinomas and a literature review. Patient 1: A 58-year-old woman was diagnosed at age 42, with an insulinoma in the pancreatic tail and hepatic metastasis. She underwent distal pancreatectomy, splenectomy, hepatic wedge resection, and chemoembolization, with resolution of her symptoms.

Diarrhea as an Initial Presentation in Patients with Medullary Thyroid Cancer: Delaying the Diagnosis.

Tumoral secretion of various molecular factors, such as calcitonin (Ct), can cause diarrhea in patients with medullary thyroid cancer (MTC). We report 3 patients (age 26-38 years, serum Ct levels ranging from 2,890 to 52,894 ng/L) with chronic diarrhea, and the diagnosis of MTC was delayed. Diarrheal symptoms improved after thyroid surgery.

ARTIFACTS AFFECTING DUAL-ENERGY X-RAY ABSORPTIOMETRY MEASUREMENTS.

Objective: To present 3 cases in which the presence of artifacts altered the dual-energy X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the lumbar field.

Methods: Clinical presentation and literature review.

Results: The first patient was a 49-year-old premenopausal woman with a spinal cord stimulator implanted in her lumbar spine.

An Atypical HNF4A Mutation Which Does Not Conform to the Classic Presentation of HNF4A-MODY.

Objective: To present the case of an atypical Hepatocyte Nuclear Factor 4 Alpha mutation that is not consistent with the classically published presentation of -Mature Onset Diabetes of the Young (MODY).

Methods: Clinical presentation and literature review.

Results: A 43-year-old nonobese man was referred to the endocrinology clinic for evaluation of elevated fasting blood glucose (FBG) measurements.

Energetic challenges unmask the role of ovarian hormones in orchestrating ingestive and sex behaviors.

Effects of ovarian hormones on sex and ingestive behavior are well studied, and yet, their role in diverting attention from food to sex has not been examined directly, possibly because these functions are masked under conditions of excessive food abundance typical of the laboratory. Female Syrian hamsters were either fed ad libitum or food-restricted to 75% of their ad libitum intake for 8days and then tested every day of the estrous cycle for their preference for males versus food, food hoarding and food intake in an apparatus designed to mimic aspects of their natural habitat. The food-restricted, but not the fed females, varied significantly over the estrous cycle in appetitive behaviors, which included their preference for males versus food and in the amount of food hoarded, with low food hoarding and high male preference on the night of ovulation.