We report the case of a 34-year-old male Hispanic patient who presented with an 8-month history of polyuria and decreased libido. An evaluation revealed hypopituitarism, central diabetes insipidus, and a pituitary stalk lesion. No evidence of a neoplasm or an inflammatory/infiltrative disease was found. We treated the patient conservatively with steroid therapy. However, as a result of disease progression, transsphenoidal surgery was performed to obtain tissue for a pathological analysis. Histopathology revealed an intrasellar germinoma, confirmed by immunochemistry. Due to localized disease, radiotherapy was initiated and clinical improvement was noted. This case emphasizes the importance of histopathological analysis; for many physicians, the presentation of a pituitary stalk lesion in a young male adult creates a clinical conundrum. Although the most common etiologies are an inflammatory or secondary neoplasm, the possible presence of an intrasellar neoplasm should not be ruled out. In many cases, imaging characteristics and tumor markers may aid in the diagnosis without the need of an aggressive diagnostic approach. However, in this case, histopathological analysis was the only way to make a correct diagnosis and provide adequate treatment for the patient.

Classical papillary thyroid microcarcinoma (PTMC) is a variant of papillary thyroid carcinoma (PTC) known to have excellent prognosis. It has a mortality of 0.3%, even in the presence of distance metastasis. The latest American Thyroid Association guidelines state that although lobectomy is acceptable, active surveillance can be considered in the appropriate setting. We present the case of a 37-year-old female with a history of PTMC who underwent surgical management consisting of a total thyroidectomy. Although she has remained disease-free, her quality of life has been greatly affected by the sequelae of this procedure. This case serves as an excellent example of how first-line surgical treatment may result more harmful than the disease itself.Learning points:Papillary thyroid microcarcinoma (PTMC) has an excellent prognosis with a mortality of less than 1% even with the presence of distant metastases.Active surveillance is a reasonable management approach for appropriately selected patients.Patients should be thoroughly oriented about the risks and benefits of active surveillance vs immediate surgical treatment. This discussion should include the sequelae of surgery and potential impact on quality of life, especially in the younger population.More studies are needed for stratification of PTMC behavior to determine if conservative management is adequate for all patients with this specific disease variant.

No abstract

No abstract

Latent autoimmune diabetes in adults (LADA), is a recognized form of Diabetes Mellitus (DM), that initially presents in middle-aged adults and sometimes it is misdiagnosed as type 1 or 2 DM. However, patients often have autoantibodies directed against pancreatic islet-cells, and the progression to insulin dependence is much faster. Studies indicate that 10% of patients who present with Type 2 Diabetes Mellitus (T2DM) have a positive serum glutamic acid decarboxylase (GAD) antibody titer. The subsequent case report will demonstrate the progression of Gestational Diabetes, complicated with Diabetic Ketoacidosis (DKA) and later diagnosed with LADA due to positive GAD antibodies in a patient without history of autoimmune predisposition. It is important to address that DKA is an extremely rare complication of women with Gestational Diabetes, occurring in only about 0.5 -3.0 %. DKA usually is associated with T1DM but also it can occur in T2DM under extreme conditions, unwantedly on pregnancy could lead to a fetal mortality up to 35% and risks of preterm birth. The following case presents a 27 year old female G2P2A0 on week 25 of pregnancy that came to our institution after a high blood glucose level detected before performing routine 75g OGTT screening for Gestational Diabetes. Patient had a previous history of Gestational Diabetes four years ago and referred that after vaginal delivery blood glucose levels were within normal limits, but denied routine outpatient screening for DM after delivery. Patient referred that 1 week before arrival to the hospital developed a generalize weakness associated with anorexia, nausea, vomits, polydipsia and polyuria. Besides previous Gestational Diabetes, patient denied any other medical conditions and denied family history of autoimmune conditions as well. At physical examination pertinent findings were a BMI of 18.3, dry oral mucosa, fruity breath odor, drowsiness, and evidence of vaginosis at pelvic examination. At hospital arrival patient had ABGs with a pH of 7.2, with serum HCO3 in 7, serum glucose in 605, and large ketones fulfilling criteria for DKA. Patient was admitted to ICU for DKA management with success and subsequently discharged on tight subcutaneous insulin regimen. This case reveals the importance of screening for postpartum DM after a Gestational Diabetes, and when the diagnosis does not fit, further investigation should be made. Taking in consideration the previous case report, a focused family history, risk factors, and demographics an autoimmune workup should be ordered for patients who do not have the classic presentation of T2DM. This case made a statement in which early identification makes the difference, recertifying what studies have shown that identifying LADA early and initiating insulin therapy helps preserve beta cell function, improve quality of life and may prevent a potentially life threatening condition such as DKA.