Identifying Trends in Undiagnosed Diabetes in U.S. Adults

Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections

Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

Do Sugar-Sweetened Beverages Cause Obesity and Diabetes?

Moderate Alcohol Intake and Cardiometabolic Risk in Adults With Type 2 Diabetes

Cushing Syndrome Secondary to Ectopic ACTH Production in Pregnancy: A Case Report | Annals of Internal Medicine: Clinical Cases

Ectopic adrenocorticotropic hormone production is an extremely rare cause of Cushing syndrome in pregnancy and is associated with significant morbidity. A 37-year-old multiparous woman at 32 weeks’ gestation presented with hypertension, anasarca, hypokalemia, and fetal distress requiring an urgent cesarean section. Her adrenocorticotropic hormone and cortisol levels were elevated, and high-dose dexamethasone failed to suppress them, suggesting ectopic adrenocorticotropic hormone production. Multimodality imaging did not identify a source, and she had urgent bilateral adrenalectomy for refractory severe hypercortisolism. Ectopic Cushing syndrome in pregnancy requires a high index of suspicion for diagnostic testing and prompt treatment to minimize maternal and fetal complications.

Ivermectin-Clorsulon Overdose in Attempting Coronavirus Disease 2019 Prophylaxis: A Case Report | Annals of Internal Medicine: Clinical Cases

With aims of coronavirus disease 2019 (COVID-19) prophylaxis, a 60-year-old woman ingested a formulation of ivermectin and clorsulon, intended for veterinarian use, that contained 30 times the U.S. Food and Drug Administration–approved dose of ivermectin (5.4 mg/kg). She developed altered mental status requiring intubation. Symptoms were similar to other cases of supratherapeutic ivermectin ingestion. Misinformation propagated about COVID-19 prophylaxis and treatment has led to adverse effects both from misuse of medications and disregard of proven options.

Spontaneous Ectopic Paraumbilical Variceal Bleeding in a Patient With Cirrhosis | Annals of Internal Medicine: Clinical Cases

Ectopic variceal hemorrhage is a rare sequela of portal hypertension, accounting for 5% of variceal bleeding events. Although mortality rates are high for this condition, there is no established management protocol. We present a patient case of spontaneous external hemorrhage from an ectopic paraumbilical varicosity in the setting of portal hypertension secondary to decompensated alcoholic cirrhosis that was treated effectively with transjugular intrahepatic portosystemic shunt placement.

A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR) | Annals of Internal Medicine: Clinical Cases

Aortic aneurysms are focal dilations of more than 50% the normal aortic diameter; giant abdominal aortic aneurysms (AAAs) have diameters greater than or equal to 10 cm and are rare clinical entities. We present a case of an elderly man with an AAA with a 14.6-cm diameter, treated successfully with endovascular repair (EVAR). AAAs pose anatomical challenges for EVAR because of their narrow necks, extreme angulation, and dislocation of intra-abdominal organs. A literature review shows only 5 EVARs have been attempted for the repair of giant AAAs; 4 were successful. With the technical advancement and careful patient selection, successful EVAR of giant AAAs is possible.

Autopsy Case of Colonic Plasmablastic Lymphoma Exhibiting Unique Endoscopic Phenotypic Changes During Ulcerative Colitis Therapy | Annals of Internal Medicine: Clinical Cases

Plasmablastic lymphoma (PBL), a rare and aggressive CD20-negative B-cell lymphoma, has been increasingly recognized in individuals who are HIV-negative and who are also immunosuppressed. To our knowledge, we report the first autopsy case of a 74-year-old woman with ulcerative colitis (UC) who developed colonic PBL under immunosuppressive therapy. Serial colonoscopies demonstrated a morphologic transformation from serpiginous ulcers to elevated lesions. The patient ultimately died because of carcinomatous lymphangitis. Autopsy showed widespread metastases and numerous flat elevated lesions with lobulations throughout the colon. This case demonstrates a unique endoscopic phenotypic transition in colonic PBL, suggesting the importance of careful monitoring for timely diagnosis in immunosuppressed UC patients.

Persistent Hypoxemia on Home Sleep Apnea Testing Prompting Further Evaluation for Pulmonary Embolism: A Case Report | Annals of Internal Medicine: Clinical Cases

Obstructive sleep apnea is a condition characterized by recurrent upper airway collapse during sleep, which may be associated with sleep disruption and repetitive oxygen desaturations. It is diagnosed by nocturnal in-lab polysomnography or home sleep apnea testing. We present a case of an otherwise healthy individual who had home sleep apnea testing that revealed persistent, unexplained hypoxemia which, on further investigation, was found to be due to a saddle pulmonary embolism.

Coexistence of Wild-Type Transthyretin Cardiac Amyloidosis and Monoclonal Gammopathy in a Patient With Polycythemia Vera | Annals of Internal Medicine: Clinical Cases

Polycythemia vera is a type of myeloproliferative neoplasm characterized by panmyelosis, with a predominant increase in erythrocyte mass. In contrast, monoclonal gammopathy of undetermined significance is classified as a premalignant plasma cell disorder and is characterized by elevated levels of monoclonal γ-globulin without associated bone lesions or clinical symptoms. Here, we present a case of the concurrent presence of wild-type transthyretin cardiac amyloidosis—not the amyloid light-chain type—and monoclonal gammopathy of undetermined significance in a patient with polycythemia vera. This case underscores the crucial importance of preforming histologic subtyping to ensure accurate diagnosis in older patients with undiagnosed cardiac amyloidosis.

Report of Concomitant Intracranial Cysts in Unrelated Patients With Heterozygous Germline NF1 Pathogenic Variants | Annals of Internal Medicine: Clinical Cases

Neurofibromatosis 1 (NF1) is one of the most common genetic diseases of the central nervous system. The nature of intracranial lesions that are associated with NF1 are yet to be fully defined. Arachnoid, velum interpositum, and odontogenic cysts are among the more common intracranial cystic lesions that can be congenital. Although odontogenic cysts are well known to be associated with Gorlin–Goltz syndrome, the possibilities of other genetic disorders in patients with odontogenic and other intracranial cystic lesions have continued to stir research interests. Here, we report 2 cases of unrelated patients, each patient having concurrent intracranial cystic lesions in the setting of a diagnosis of NF1. Individual I had concomitant arachnoid and odontogenic cysts in parallel with a novel heterozygous germline NF1 pathogenic frameshift variant, NF1 [NM_000267.3] c.40del (p.Val14Serfs*10). Individual II had concomitant arachnoid and vellum interpositum cysts in the context of a heterozygous likely pathogenic NF1 germline variant [NF1 (NM_000267.3) c.4265C>T, p.(Ser1422Leu)]. Our observations suggest that clinicians should consider NF1 among the differential diagnosis for intracranial cystic lesions such as arachnoid, vellum interpositum, and odontogenic cysts.

Targetable Immune Dysregulation in a Patient With Heart Failure: Cardiovascular Manifestations of CTLA-4 Deficiency Improve With Evolocumab | Annals of Internal Medicine: Clinical Cases

We report the case of a 76-year-old man with germline CTLA-4 deficiency manifesting as multivessel coronary artery disease, heart failure with mid-range ejection fraction, and an aortic root aneurysm. New York Heart Association (NYHA) class 3 functional limitation was disproportionate to ischemic burden despite guideline-directed medical therapy. Statin intolerance prompted initiation of evolocumab, a PCSK9 inhibitor. Within 3 weeks, the patient's symptoms improved to NYHA class 1, suggesting a rapid immunomodulatory effect. This case illustrates targetable cardiomyopathy mediated by CTLA-4 deficiency, supports exploring PCSK9 inhibition for the management of immune-driven heart failure, and emphasizes genetic evaluation in unexplained cardiomyopathy.

Mad Honey Mimicking Acute Coronary Syndrome | Annals of Internal Medicine: Clinical Cases

A 56-year-old Nepalese man presented to the hospital with syncope, bradycardia, and hypotension. Throughout his admission, he was hemodynamically unstable, with associated electrocardiographic changes and fluctuations in consciousness. This followed the unintentional overdose of the traditional medicine “mad honey” containing grayanotoxins with hallucinogenic properties. Following treatment with an anticholinergic infusion, he made a full recovery within 48 hours. This case underlines the importance of considering atypical causes for presentations such as bradycardia and hypotension, especially in patients from cultures where mad honey usage is common, and highlights the potential adverse events of this traditional medicine to be life-threatening.