Two diabetic women (case 1, 75 years old; case 2, 49 years old) being treated with glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) showed no suppression of cortisol secretion on a dexamethasone suppression test (DST). However, its secretion was suppressed after switching from GLP-1 RAs to insulin. We also checked the cortisol secretion by a DST in five consecutive inpatients (case 3-7) being treated with GLP-1 RAs. The coefficients of R-R interval variation at rest and during deep breathing were lower in the two false-positive cases (case 1 and 2) than in the five true-negative cases (case 3-6). GLP-1 RAs can be switched to insulin in order to eliminate the slow absorption effect of dexamethasone by GLP-1 RAs if a DST is planned in diabetic patients receiving GLP-1 RAs.

Ectopic ACTH syndrome (EAS) is a potentially fatal endocrine disease that results from a variety of neuroendocrine tumors (NETs), such as small cell lung cancer (SCLC) and bronchial typical carcinoid. Typical carcinoid is usually slow growing, not associated with plasma progastrin releasing peptide (ProGRP) elevation. Here, we report a 47-year-old female smoker with progressive typical carcinoid and plasma ProGRP elevation. Several types of Cushingoid features were found on physical examination. In addition, laboratory examination showed elevated plasma ACTH and serum cortisol levels. These findings indicated ACTH-dependent Cushing's syndrome. Moreover, the serum cortisol level was not suppressed by overnight high-dose dexamethasone treatment, suggesting the presence of an extra-pituitary tumor. Contrast-enhanced brain MRI revealed no pituitary adenoma, which also supported the idea that EAS occurred in the present case. Strikingly, chest computed tomographic (CT) scan showed a single 18-mm peripheral nodule in the right middle lobe of the lung. Tumor marker analysis revealed an elevation in plasma ProGRP. These data suggested a possibility that SCLC secreted ACTH and caused EAS in this patient. Of note, the plasma ACTH level was increased (1.7 fold) in l-desamino-8-D-arginine vasopressin (DDAVP) test, also suggesting the specific clinical feature in this case. After additional imaging examinations, we performed surgical resection with the suspicion of limited SCLC. As a result, pathological examination revealed a vasopressin receptor Ib (V1b) receptor-negative bronchial typical carcinoid with ACTH production and mediastinal lymphatic metastasis. In summary, we present a case of EAS caused by progressive bronchial typical carcinoid with plasma ProGRP elevation. We propose a novel subtype of lung typical carcinoid.

We investigated the relationships between early social-communication behaviors and maladaptive behaviors in children with autism spectrum disorders (ASD). Fi y-three children with both intellectual disabilities and developmental disorders including ASD participated in the current study. e results of a stepwise multiple regression showed that frequency of initiating joint attention and rate of positive a ect expression were independent negative predictors of internalizing problems; severity of ASD symptom and frequency of requests were positive predictors, and rate of positive a ect expression was a negative predictor, of v-scale score for externalizing problems. ese results demonstrated that di erent types of early social-communication behaviors in uence di erent kinds of maladaptive behaviors in children with ASD. In particular, positive a ect expression with communication was a negative predictor of both internalizing and externalizing problems. It is critical that we explore how maladaptive behaviors develop in children with ASD, with a particular focus on the development of early socialcommunication.

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Falck-Ytter et al. 2012 ASD RJA Falck-Ytter et al. 2012 RJA RJA Navab et al. 2012 Joint attention is one predictor of later social-communication behaviors of children with autism spectrum disorder. In the present study, joint attention behavior was divided into 2 categories: initiating joint attention (IJA), including the child's pointing, and responsiveness to joint attention (RJA), including gaze-following and pointing-following. Recently, research on eye-tracking responsiveness to joint attention in babies and toddlers has increased. However, we found few published studies that established the validity of eye-tracking assessment as a measure of responsiveness to joint attention. The present study evaluated the validity of an eye-tracking measure of responsiveness to joint attention by analyzing relations between eye-tracking measures and measures of joint attention, language skills, and symptoms of autism as reported by the parents of 60 young children with developmental disorders, including autism spectrum disorder. The correlations between the measures of parent-reported joint attention and the eye-tracking measures of responsiveness to joint attention were statistically signifıcant. The present study thus supports the validity of eye-tracking measures of responsiveness to joint attention. The correlations among the eye-tracking measures of responsiveness to joint attention and the children's reported language skills and symptoms of autism were statistically signifıcant, even when chronological age and developmental age were controlled. Eye-tracking may provide a useful measure of joint attention in young children, especially of responsiveness to joint attention, and may enable early detection of autism spectrum disorder in young children.