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Massive 4-Gland Parathyroid Hyperplasia Initially Detected as a Parathyroid Adenoma [Case Report]
Nicolich-Henkin, Sophie; Goldstein, Michael B; Roellke, Emma; Bilezikian, John P; Rothberger, Gary D
Parathyroid adenoma (PA) and parathyroid hyperplasia (PH) are common causes of primary hyperparathyroidism (PHPT), for which the only definitive treatment is surgery. Abnormalities in the parathyroid glands can be identified with various imaging modalities including ultrasound (US), sestamibi scan (MIBI), 4-dimensional computed tomography (4D-CT), and positron emission tomography/computed tomography (PET/CT). While it is not uncommon for parathyroid pathology to be undetected on imaging, this is more typical of low-volume hyperplasia and smaller-sized adenomas. We present the case of a 65-year-old man with PHPT who initially had a solitary parathyroid mass detected by US, but who was ultimately discovered to have massive PH with hyperplastic glands not visualized on US or MIBI. This atypical presentation may help guide providers in decisions on ordering and interpreting various imaging modalities for patients with PHPT. In this case, 4D-CT was the only modality in which large hyperplastic glands were identified, suggesting superior sensitivity. This case also highlights the importance of intraoperative parathyroid hormone testing to aid in diagnostic prediction.
PMCID:10768879
PMID: 38188905
ISSN: 2755-1520
CID: 5637092
Glycemic Management in Insulin-Naive Patients in the Inpatient Setting
Goldstein, Michael B; Islam, Shahidul; Nicolich-Henkin, Sophie; Bellavia, Lauren; Klek, Stanislaw
OBJECTIVE/UNASSIGNED:The ideal inpatient insulin regimen efficiently attains the target blood glucose range, effectively treats hyperglycemia, and minimizes the risk of hypoglycemia. The objective of this study was to compare glycemic targets achieved by using correctional monotherapy (CM) and basal-bolus therapy (BBT) in insulin-naive patients in the inpatient setting to determine optimal blood glucose management for these patients. DESIGN/UNASSIGNED:This was a retrospective observational cohort study of 792 patients with diabetes not on home insulin therapy who were admitted to an academic hospital over a 5.5-month period. The percentages of hyperglycemic and hypoglycemic values in each group were compared. RESULTS/UNASSIGNED:= 0.301). CONCLUSION/UNASSIGNED:Utilizing BBT in insulin-naive patients admitted to the hospital within the first 24 hours of insulin administration results in lower rates of hyperglycemia without higher rates of hypoglycemia when compared with CM.
PMCID:11093763
PMID: 38756429
ISSN: 1040-9165
CID: 5733672
Proportion of Malignancy and Evaluation of Sonographic Features of Thyroid Nodules Classified As Highly Suspicious Using ACR TI-RADS Criteria
Hussain, Najia; Goldstein, Michael B; Zakher, Mariam; Katz, Douglas S; Brandler, Tamar C; Islam, Shahidul; Rothberger, Gary D
OBJECTIVES/OBJECTIVE:The reported malignancy rate of highly suspicious thyroid nodules based on the ACR TI-RADS criteria (TI-RADS category 5 [TR5]) varies widely. The objective of our study was to determine the rate of malignancy of TR5 nodules at our institution. We also aimed to determine the predictive values of individual sonographic features, as well as the correlation of total points assigned to a nodule and rate of malignancy. METHODS:Our single-institution retrospective study evaluated 450 TR5 nodules that had cytology results available, in 399 patients over a 1-year period. Sonographic features and total TI-RADS points were determined by the interpreting radiologist. Statistical analyses included logistic regression models to find factors associated with increased odds of malignancy, and computing sensitivity, specificity, positive and negative predictive values of various individual sonographic features. RESULTS:Of the 450 nodules, 95 (21.1%, 95% exact confidence interval 17.4-25.2%) were malignant. Each additional TI-RADS point increased the odds of malignancy (adjusted odds ratio 1.35, 95% confidence interval 1.13-1.60, P < .001). "Very hypoechoic" was the sonographic feature with the highest specificity and positive predictive value for malignancy (95.5 and 44.8%, respectively), while "punctate echogenic foci" had the lowest positive predictive value (20.0%). CONCLUSIONS:The rate of malignancy of TR5 nodules at our institution was 21.1%, which is lower than other malignancy rates reported in the literature. The total number of points assigned on the basis of the TI-RADS criteria was positively associated with malignancy, which indicates that TR5 should be viewed as a spectrum of risk.
PMID: 36106704
ISSN: 1550-9613
CID: 5336322
Insulin Requirements in Untreated Acromegaly: From 200 to 0 [Case Report]
Goldstein, Michael B; Bellavia, Lauren; Kurian, Tiffany; Klek, Stanislaw
We describe a patient with acromegaly presenting in diabetic ketoacidosis who was able to achieve euglycemia despite discontinuation of all antihyperglycemic therapy prior to surgical or medical treatment for his acromegaly. No previous cases of acromegaly presenting in diabetic ketoacidosis have reported glycemic normalization without antihyperglycemic therapy prior to acromegaly treatment. Our case highlights this unique outcome and postulates that pancreatic β-cell resiliency may be influential on insulin resistance since our patient achieved euglycemia despite a persistent state of excess growth hormone and insulin-like growth factor-1. Our case further emphasizes that consideration for acromegaly should be given in patients presenting with severe insulin resistance and pertinent medical history and physical examination features, and it emphasizes the dramatic range of insulin requirements in patients with acromegaly.
PMCID:10578379
PMID: 37908250
ISSN: 2755-1520
CID: 5736482
Utility of Thyroid Function Testing in the Inpatient Setting
Goldstein, Michael; Islam, Shahidul; Piccione, Julie; Migasiuk, Laura; Rothberger, Gary
BACKGROUND:Previous studies have reported low value of ordering inpatient thyroid function tests (TFTs), with few changes in clinical management resulting from these tests. This study was designed to evaluate how often testing TFTs during hospitalization leads to medication initiation or adjustment, and to determine if the frequency of medication initiation or adjustment differs based on the indication for testing. METHODS:This is a retrospective observational study of 2278 patients who had TFTs tested while admitted to an academic hospital during a 5-month period. Indications for ordering TFTs were determined by reviewing clinical documentation, and those with abnormal tests were reviewed to assess whether thyroid medication was initiated or adjusted. RESULTS:The percentage of abnormal TFTs that led to medication initiation or adjustment was 15.1%, 12.2%, and 6.0%, for those tested on the basis of history of functional thyroid disease, suspicion of thyroid dysfunction, and reasons not directly related to thyroid dysfunction, respectively. Overall, 63 patients were started on thyroid medication or had their thyroid medication dose adjusted, which represents 10.1% of those with abnormal TFTs and only 2.8% of those tested. CONCLUSION/CONCLUSIONS:Abnormal TFTs are common, but a disproportionate amount of tests are needed to find a small percentage of clinically significant thyroid dysfunction, of which only a low percentage lead to changes in management. Education on this topic should be provided to inpatient providers to limit thyroid function testing to instances in which they are clinically indicated and abnormal results would lead to changes in management.
PMID: 35793752
ISSN: 1530-891x
CID: 5280442
Correlation of hemoglobin A1c and outcomes in patients hospitalized with COVID-19
Patel, Amy J; Klek, Stanislaw P; Peragallo-Dittko, Virginia; Goldstein, Michael; Burdge, Eric; Nadile, Victoria; Ramadhar, Julia; Islam, Shahidul; Rothberger, Gary D
BACKGROUND:) level and poor outcomes in hospitalized patients with diabetes and COVID-19. METHODS:results for each patient were divided into quartiles; 5.1-6.7% (32-50 mmol/mol), 6.8-7.5% (51-58 mmol/mol), 7.6-8.9% (60-74 mmol/mol), and >9% (>75 mmol/mol). The primary outcome was in-hospital mortality. Secondary outcomes included admission to an intensive care unit, invasive mechanical ventilation, acute kidney injury, acute thrombosis, and length of hospital stay. RESULTS:Five hundred and six patients were included. The number of deaths within quartiles 1 through 4 were 30 (25%), 37 (27%), 34 (27%) and 24 (19%), respectively. There was no statistical difference in the primary or secondary outcomes between the quartiles except acute kidney injury was less frequent in quartile 4. CONCLUSIONS:should not be used for risk stratification in these patients.
PMCID:8286241
PMID: 34284145
ISSN: 1530-891x
CID: 4981152
ISOLATED PARAGANGLIOMA IN A PATIENT WITH VHL P.L163F MUTATION [Case Report]
Goldstein, Michael; Neril, Rebecca E; Rothberger, Gary D
OBJECTIVE:gene in a patient with isolated PGL. METHODS:gene mutation are described. A literature review is also presented. RESULTS:. Surveillance for other tumors associated with VHL disease has been negative thus far. Her cousin has not undergone genetic testing despite recommendations to do so. CONCLUSION/CONCLUSIONS:mutation may cause a VHL disease type 2C phenotype.
PMCID:7357614
PMID: 32671223
ISSN: 2376-0605
CID: 5523762