An Adrenocortical Carcinoma Evolving After Nine Years of Latency From a Small Adrenal Incidentaloma.

Adrenal incidentalomas (AIs) are common incidental findings in medical practice with clinical significance. Although most AIs are nonsecretory and nonmalignant, they require a short course of follow-up over one to two years to rule out malignancy or hormonal secretion according to clinical practice guidelines. However, this can result in some adrenocortical carcinomas (ACCs) being missed if they transform at a later stage or evolve slowly.

Novel Use of Calcimimetic Activity to Diagnose Primary Hyperparathyroidism in a Patient With Persistently Low-Normal Parathyroid Hormone Level.

Primary hyperparathyroidism (PHPT) is the most common etiology of hypercalcemia in the ambulatory setting and usually presents with an intact parathyroid hormone (PTH) level that is elevated or inappropriately near the upper limit of the laboratory reference range. However, PHPT with low-normal PTH level is reported in the peer-reviewed literature, and this atypical presentation may delay diagnosis of PHPT. We present a case of PHPT with persistently low-normal PTH level in which the PTH dependence of hypercalcemia was demonstrated by the response to treatment with the calcimimetic agent cinacalcet.

Use of artificial intelligence and machine learning for estimating malignancy risk of thyroid nodules.

Purpose Of Review: Current methods for thyroid nodule risk stratification are subjective, and artificial intelligence algorithms have been used to overcome this shortcoming. In this review, we summarize recent developments in the application of artificial intelligence algorithms for estimating the risks of malignancy in a thyroid nodule.

Recent Findings: Artificial intelligence have been used to predict malignancy in thyroid nodules using ultrasound images, cytopathology images, and molecular markers.

Implementation and challenges unique to teleretinal diabetic retinal screening (TDRS) in a private practice setting in the United States.

Purpose: Adherence rates to published guidelines for diabetic retinopathy (DR) screening is between 35 and 60%. We evaluate a teleretinal DR screening (TDRS) program in a private practice vertically integrated system to increase compliance with retinal screening.

Methods: A retrospective pre-post intervention longitudinal study was conducted in a private endocrinology practice using TDRS as the primary intervention.

Hepatic Involvement in Systemic Sarcoidosis.

BACKGROUND Sarcoidosis is a systemic disease that can affect any organ, including the liver. It is manifested by the presence of non-caseating granulomas within involved organs, most commonly the pulmonary, lymphatic, and hepatic system. Unlike pulmonary or lymphatic involvement, hepatic involvement is usually asymptomatic and it is underdiagnosed.

Impact of Pocket Insulin Dosing Guide on Utilization of Basal/Bolus Insulin by Internal Medicine Resident Physicians.

Introduction Basal/bolus insulin (BBI) is superior to sliding scale insulin (SSI) for diabetic patients admitted to hospital general medicine and surgery services, but little has been published on strategies to promote the utilization of BBI by resident physicians. New approaches that promote the effective management of hyperglycemia in hospitals need to be developed. Materials and methods  A prospective study with historical controls was conducted to evaluate the impact of a pocket insulin dosing guide on the diabetes management practices of internal medicine resident physicians at the Southern Illinois University (SIU) School of Medicine, rotating on general medicine.

Rhabdomyolysis Associated with Influenza A Virus Infection.

Influenza A associated with rhabdomyolysis has become more commonly recognized in recent years. It requires prompt recognition and treatment in order to prevent heme pigment-induced acute kidney injury. Here we report a 50-year-old female without a significant past medical history who presented with a one-week history of fevers, chills, fatigue, and generalized body aches.

Acute Pericarditis as a Presentation of Adrenal Insufficiency.

Acute pericarditis as a presenting sign of adrenal insufficiency is rarely reported. We present a rare case that highlights pericarditis as a clinical presentation of secondary adrenal insufficiency later complicated by cardiac tamponade. A 44-year-old lady who presented to the hospital with a one-day history of pleuritic chest pain and shortness of breath.

Association between blood glucose level and outcomes in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease.

Background: Increased blood glucose is associated with adverse clinical outcomes among patients with major illnesses. This study examined the association between blood glucose and adverse outcomes among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, for which limited prior data were available.

Methods: We studied a cohort of 209 hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.