Background. Iatrogenic Cushing’s syndrome is commonly seen as a complication of chronic steroid use. While most often associated with the use of prescription oral steroids, rare cases result from unintentional steroid exposure. In particular, numerous complementary and alternative medicines have been found to contain steroids not previously known to users. Case Presentation. Here, we present a case of iatrogenic Cushing’s syndrome caused by prolonged ingestion of dexamethasone found within an over-the-counter arthritis supplement called Artri King. Conclusion. A thorough history of medication use to include over-the-counter medications and supplements may be required to identify the source of exogenous glucocorticoids in iatrogenic Cushing’s syndrome.

Colin Dunn

Joshua Amaya

Patrick Green

A Case of Iatrogenic Cushing’s Syndrome following Use of an Over-the-Counter Arthritis Supplement

Background. Sitosterolemia is a relatively rare metabolism lipid disorder, with about 110 cases worldwide and only a few known cases from the Middle East. Sitosterolemia is characterized by excessive uptake of phytosterols and their deposition in various tissues, leading to complications. Mutations in the ABCG5 and ABCG8 genes are associated with pathological changes in sitosterolemia. Case Presentation. An adult patient from Saudi Arabia with dyslipidemia who did not respond to statin therapy. Based on genetic testing, the patient was eventually diagnosed with sitosterolemia. Ezetimibe significantly improved his cholesterol levels. Conclusion. The diagnosis of sitosterolemia is confirmed by the detection of high-phytosterol levels and pathological mutation in the ABCG5 and ABCG8 genes. Treatment of sitosterolemia is based on dietary changes and drugs to inhibit cholesterol absorption, such as ezetimibe.

Moeber M. Mahzari

Sitosterolemia: A Case Report and a Concise Literature Review

Brachymetacarpia and brachymetatarsia are unique clinical entities associated with numerous rare conditions. Primary hypoparathyroidism is distinct from pseudohypoparathyroidism and pseudopseudohypoparathyroidism by lacking skeletal changes such as short metacarpals or metatarsals. Here, we present a case of a 64-year-old patient with brachymetacarpia and brachymetatarsia presented with hypocalcemic symptoms and signs, bilateral cataracts, and basal ganglia calcifications, subsequently diagnosed with idiopathic primary hypoparathyroidism. This is a rare case describing such an infrequent observation of brachymetacarpia and brachymetatarsia in primary idiopathic hypoparathyroidism.

Parackrama Karunathilake

Arun Rajaratnam

W. K. S. Kularatne

A Rare Observation of Brachymetacarpia and Brachymetatarsia in a Patient with Primary Idiopathic Hypoparathyroidism

Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that occurs in both type 1 and type 2 diabetes mellitus. Here, we describe the case of a 49 year-old male patient with type 2 diabetes mellitus who presented to the emergency department with complaints of epigastric abdominal pain and intractable vomiting. He had been on sodium-glucose transport protein 2 inhibitors (SGLT2i) for 7 months. Considering the clinical exam and lab findings with a glucose level of 229, a diagnosis of euglycemic DKA was made. He was treated according to DKA protocol and discharged. The relationship between SGLT2 inhibitors and euglycemic DKA remains to be explored; given the absence of clinically significant hyperglycemia during the presentation, a delay in diagnosis may be observed. After an extensive literature review, we introduce our case presentation in the setting of gastroparesis in comparison to previous reports and suggest future improvements in terms of early clinical suspicion for euglycemic DKA.

Caroline Wojtas

Alex P. Rasarmos

Naja Naddaf

Sodium-Glucose Transport Protein 2 Inhibitors Association with Euglycemic Diabetic Ketoacidosis

Objective. Diagnosis of giant pheochromocytoma is difficult; patients often lack the classic triad and presence of gross biochemical positivity. At times, presence of sympathetic stimulant drugs can further complicate the clinical picture. Here, we present a case of giant “functional” pheochromocytoma with a history of amphetamine use. Case Description. 37-year-old female presented with a 1-day history of abdominal pain. CT abdomen identified a 12.5 cm heterogeneously enhancing left adrenal mass. Plasma/urine catecholamine and metanephrine levels were markedly elevated with evidence of elevated serum/urine cortisol. However, the patient’s subsequent urine toxicology was found to be positive for amphetamines, which she later admitted to using, 1 week prior to admission. Repeat biochemical workup after 1 week drug washout period showed improvement in both catecholamine and cortisol levels. Given the high degree of suspicion for PCC, an open laparoscopic adrenalectomy was performed with histology confirming SDHB gene mutation positive giant pheochromocytoma. Discussion. Diagnosis of PCC in a patient with a history of amphetamine abuse remains an enigma, to which addition of it being a giant PCC that are rare and typically silent further confounds the clinical picture as seen in this case. Conclusion. PCC could be termed a “chameleon” tumor given its varied clinical presentations and lack of standardized biochemical and radiological data (giant, pheochromocytoma, and amphetamine).

Shreya Amin

Matthew Gilbert

Kaitlyn Barrett

Giant Pheochromocytoma Diagnosis Confounded by Amphetamine Use

Systemically administered glucocorticoids constitute an essential part of the immunosuppressive regimen for transplant recipients, yet their known risks of causing hyperglycemia or posttransplant diabetes require close monitoring and minimisation of use, when possible, to prevent detrimental effects on patient morbidity and graft survival. Topical glucocorticoids, on the other hand, are rarely considered to affect glucose metabolism and therefore seldomly monitored, despite their wide and in some cases, long-term use. We report a case of a renal transplant recipient presenting with acute hyperosmolar hyperglycemia after treatment with topical glucocorticoids and present a mini review of the literature.

Simon Bøtker

Henrik Birn

Lara Aygen Øzbay

Topical Glucocorticoid Use and the Risk of Posttransplant Diabetes

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Case Reports in Endocrinology publishes case reports and case series related to the endocrine system and its associated diseases.

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Case Reports in Endocrinology - Table of contents 2023

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Case Reports in Endocrinology publishes case reports and case series related to the endocrine system and its associated diseases.

Case Reports in Endocrinology