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We present the case of a 19-year-old female who initially exhibited unilateral orbital symptoms and laboratory evidence of autoimmune thyroid involvement, consistent with a diagnosis of euthyroid Graves' orbitopathy (GO). She responded well to immunosuppressive therapy and remained clinically stable for two years. Subsequently, she developed fatigue, menstrual irregularities, and mild recurrent eye discomfort. Laboratory evaluation revealed biochemically severe hypothyroidism with elevated thyroid-stimulating hormone (TSH), low free thyroxine (FT4), and persistently high thyroid peroxidase antibodies (anti-TPO). Additional findings included iron deficiency anemia and vitamin D deficiency. Thyroid ultrasound confirmed features of autoimmune thyroiditis, and she was started on hormonal and micronutrient replacement therapy. This case highlights a rare clinical evolution from euthyroid GO to Hashimoto's thyroiditis (HT) and emphasizes the need for long-term follow-up in autoimmune thyroid conditions. It also suggests that micronutrient status may influence immune shifts and disease progression, underscoring the importance of addressing modifiable factors as part of comprehensive endocrine care.

Graves' orbitopathy (GO) is a common autoimmune disorder affecting the eye muscles and orbital tissues, often leading to eyelid edema. The potential role of liver enzymes in this condition remains unclear. We conducted a retrospective cross-sectional study on 303 GO patients from Wuhan Union Hospital between 2015 and 2025. Participants were grouped according to the presence of eyelid edema. Univariable and multivariable logistic regression models were applied to evaluate the associations between alanine transaminase (ALT), aspartate aminotransferase (AST), and eyelid edema, with adjustments for sex, age, and lymphocytes. Our analysis showed that lower ALT and AST levels were significantly associated with an increased likelihood of eyelid edema in the fully adjusted models (ALT per 10 U: OR = 0.813, 95% CI = 0.678-0.975; AST: OR = 0.681, 95% CI = 0.489-0.947). A linear dose-response relationship was observed: for each 10-unit decrease in ALT or AST, the observed prevalence of eyelid edema increased by 18.7%-31.9%. This study demonstrated an association between liver enzymes (AST and ALT) and eyelid edema in GO patients. The findings suggest a potential link between liver function and the pathogenesis of GO-related edema. Further prospective studies are required to clarify the causal relationship, explore the underlying mechanisms, and assess the clinical utility of liver enzymes as biomarkers for GO severity or progression.

This case report describes a 61-year-old male with Charcot-Marie-Tooth disease type 1A (CMT1A) who developed poorly controlled type 2 diabetes mellitus. The patient, with a history of CMT1A, was admitted for preoperative glycemic management prior to lumbar spinal stenosis surgery, exhibiting an HbA1c of 8.1%. Treatment with metformin had been insufficient. Considering potential insulin resistance due to decreased skeletal muscle mass from CMT and reduced mobility, a combination therapy of the DPP-4 inhibitor sitagliptin and the SGLT2 inhibitor empagliflozin was initiated post-surgery, alongside diet and exercise. Notably, this combination effectively improved glycemic control without reducing skeletal muscle mass. This suggests that the combination of a DPP-4 inhibitor and an SGLT2 inhibitor may be a viable therapeutic option for managing diabetes mellitus in patients with CMT, warranting further investigation in larger studies due to the rarity of this comorbidity. Long-term glycemic control is crucial for maintaining activities of daily living (ADLs) and quality of life (QOL) in these patients.

 Nocturnal hypoglycemia (NH) is a major clinical concern in insulin-treated diabetes due to blunted autonomic responses and reduced awareness of hypoglycemia during sleep. We investigated the association between NH and early morning fasting cortisol levels in this population.  This case-control study included 30 insulin-treated adults with type 1 diabetes (n = 22) or advanced type 2 diabetes (n = 8) and depleted endogenous insulin secretion. Glucose profiles were assessed using intermittently scanned continuous glucose monitoring. NH was defined as glucose levels <70 mg/dL between 00:00 and 06:00. Fasting-morning serum cortisol, plasma glucagon, and serum C-peptide levels were also measured. The clinical and biochemical parameters were compared between patients with and without NH.  NH occurred in 15 of 30 patients (50.0%), including three (10.0%) with level 2 hypoglycemia (<54 mg/dL). There were no significant differences between the groups in terms of age, diabetes type, disease duration, HbA1c level, body mass index (BMI), insulin dose, or C-peptide level. However, fasting cortisol levels were significantly lower in patients with NH. Logistic regression analysis showed that lower cortisol levels were independently associated with NH (odds ratio: 0.708; 95% confidence interval: 0.52-0.97; p < 0.05). Receiver operating characteristic curve analysis identified a cortisol threshold of 10.7 μg/dL for predicting NH (area under the curve = 0.79, sensitivity = 0.73, specificity = 0.80).  Lower early morning cortisol levels may serve as an independent risk factor for NH in patients with insulin-treated diabetes. Cortisol measurements may help identify individuals at risk of asymptomatic NH.

Type 2 diabetes (T2D) requires rigorous glycemic control to prevent complications, but traditional self-monitoring of blood glucose (SMBG) offers limited insights. Real-time continuous glucose monitoring (RT-CGM) provides dynamic data to optimize management, although its efficacy in T2D remains debated. This systematic review synthesizes evidence from randomized controlled trials (RCTs) to evaluate RT-CGM's impact on glycemic outcomes in adults with T2D. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched PubMed, Scopus, Web of Science, and ClinicalTrials.gov (2015-2025) for RCTs comparing RT-CGM to SMBG/usual care in non-pregnant adults with T2D. Eleven studies met the inclusion criteria. Data were extracted for HbA1c, time in range (TIR), hypoglycemia, and safety. Risk of bias was assessed using Cochrane RoB 2. RT-CGM significantly improved TIR and reduced HbA1c in insulin-treated patients, although benefits varied by intervention frequency and patient subgroup. Episodic use required multiple sessions for sustained HbA1c reduction. Non-insulin-treated cohorts saw smaller HbA1c changes but improved glycemic variability. Treatment satisfaction was consistently higher with RT-CGM. Safety profiles were favorable, with no severe device-related adverse events. RT-CGM enhances glycemic control in T2D, particularly for insulin-treated patients, with structured use yielding the greatest benefits. Clinicians should prioritize individualized protocols and patient education. Future research should address long-term efficacy and cost-effectiveness.

Vitamin D deficiency (VDD) and anemia are common public health problems around the world. Recent data points to a biological connection between these disorders, especially in relation to vitamin D's function in controlling iron and hepcidin metabolism. The study aims to do a comprehensive review of the literature on the relationship between adult populations' anemia and VDD. PubMed, Web of Science, Scopus, and Embase were all thoroughly searched. Included were observational studies evaluating the connection between adult anemia and vitamin D levels. Six studies were included, with a total of 10,953 participants, and 2690 (24.6%) of them were men. The range of VDD prevalence was 18.8% to 87.1%, with a total prevalence of 5479 (50%). Among the participants with VDD, 2041 (37.2%) had anemia. Anemia was shown to be more common in those with VDD in every study. Mean hemoglobin, ferritin, and red blood cell counts were consistently lower in VDD groups. In the majority of studies, the connection persisted even after controlling for covariates. There is strong evidence supporting an association between VDD and increased risk of anemia. These results support more interventional research to evaluate the potential benefits of including vitamin D screening in anemia workups and the benefits of vitamin D supplementation in anemic persons.

 Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder frequently associated with obesity, leading to increased risks of cardiovascular and renal complications. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, has emerged as a promising therapeutic agent for improving glycemic control and promoting weight reduction. However, evaluating its safety and efficacy in obese T2DM patients remains essential, particularly in real-world clinical settings. This study aimed to assess the safety and efficacy of dapagliflozin in obese patients with type 2 diabetes mellitus (T2DM) by assessing adverse event profiles and the reduction in HbA1c levels over the treatment period.  This 12-month prospective, multicenter observational study was conducted from April 2023 to April 2024 at BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders) General Hospital, Dhaka, and affiliated healthcare centers in Bangladesh. One thousand five hundred patients with type 2 diabetes mellitus and a body mass index (BMI) ≥30 kg/m² were consecutively enrolled from outpatient clinics. Eligibility was based on a confirmed diagnosis of type 2 diabetes and the recent initiation of dapagliflozin therapy. Patients received 5 mg or 10 mg of dapagliflozin daily, either as monotherapy or in combination with other antidiabetic agents. Physicians made all treatment decisions independently as part of routine clinical care. Clinical and laboratory data were extracted from medical records using a standardized case record form. Outcomes included changes in glycemic and lipid parameters at baseline, three, six, and 12 months, and the frequency of adverse events. Statistical analyses were performed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY), with statistical significance set at p < 0.05.  The study showed a statistically significant reduction in mean glycated hemoglobin levels from 8.1 ± 1.7 at baseline to 7.3 ± 1.4 after six months of treatment (p<0.0001). Adverse events were reported in 240 (16%) patients, with the most common being 90 (37.5%) cases of fatigue and hypoglycemia each. Urinary tract infection was observed in 60 (25%) cases, vulvovaginal pruritus and dysuria in 30 (12.5%) cases. A total of 30 (12.5%) patients developed diabetic ketoacidosis (DKA), primarily those with a long-standing history of diabetes (≥10 years) and prior hypertension.  Dapagliflozin appears to be an effective therapeutic option for the management of type 2 diabetes in obese individuals, contributing to improvements in glycemic control and metabolic parameters. When administered alone or in combination with other antidiabetic agents, it was associated with favorable clinical outcomes and an acceptable safety profile, supporting its utility in routine clinical practice.

Metformin, a first-line agent in the treatment of type 2 diabetes mellitus, is widely favored for its efficacy and safety profile; however, under conditions of impaired renal function, it can lead to metformin-associated lactic acidosis (MALA), a rare but life-threatening complication. The diagnosis requires careful exclusion of other causes of lactic acidosis, such as sepsis or hypoperfusion, which can mimic MALA. We present a case of an 88-year-old female with type 2 diabetes and chronic kidney disease (CKD) stage III who developed severe lactic acidosis and encephalopathy in the setting of acute kidney injury and recent infection. The patient's condition rapidly deteriorated despite broad-spectrum antibiotics and hemodynamic support. Emergent dialysis resulted in significant clinical and biochemical improvement, supporting a diagnosis of MALA. This case emphasizes the importance of early recognition of MALA, particularly in vulnerable populations with evolving renal dysfunction. We present the pathophysiology, diagnostic approach, and management strategies for MALA. The timely initiation of renal replacement therapy remains critical for reversing metabolic derangements and improving outcomes.

Congenital hyperinsulinism (CHI) is a rare but significant cause of persistent neonatal hypoglycemia (NH), associated with a high risk of neurological complications if not promptly treated. This condition is characterized by inappropriate insulin secretion, often of genetic origin, independent of blood glucose levels. We report the case of a male macrosomic newborn admitted on the second day of life for respiratory distress, generalized seizures, and severe hypoglycemia (1.4 mmol/L) unresponsive to intravenous glucose therapy. Laboratory investigations revealed elevated insulin and C-peptide levels, absence of ketone bodies, and a positive response to the glucagon stimulation test. Echocardiography showed hypertrophic cardiomyopathy without functional impairment. Due to limited resources, neither [18F]-fluoro-L-DOPA PET imaging nor genetic testing could be performed. Treatment with a combination of diazoxide and octreotide led to partial improvement, but the clinical course was unfavorable, with the infant dying at four months of age due to sepsis. This case highlights the diagnostic and therapeutic challenges of CHI in resource-limited settings. Through this clinical observation and a review of the literature, we emphasize the importance of a rigorous diagnostic approach and early, multidisciplinary, and tailored management to reduce the morbidity and mortality associated with this rare condition.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used for the treatment of type 2 diabetes mellitus. Recently, their association with drug-induced bullous pemphigoid (BP) has attracted increasing attention. In this report, we present a case of an 84-year-old woman who developed BP after COVID-19 infection while taking a DPP-4 inhibitor. The temporal relationship between drug administration, viral infection, and onset of autoimmune disease indicates a possible interaction between COVID-19-induced immune dysregulation and DPP-4 inhibition. The coexistence of these factors may increase the risk of developing BP in older patients with diabetes, which warrants careful monitoring.