- N Engl J Med 2021; 384:e102
A 33-year-old woman presented with painless hyperpigmentation of her tongue. Cosyntropin stimulation testing revealed an insufficient change in cortisol levels, and a diagnosis of autoimmune adrenal insufficiency was made.
- N Engl J Med 2021; 384:2145-2152
A 61-year-old man with chronic knee pain was evaluated for elective total knee arthroplasty. During the preoperative visit, his blood pressure was 178/92 mm Hg. On day 1 after surgery, during physical therapy, his blood pressure increased to 216/99 mm Hg, with a heart rate of 141 beats per minute....
- N Engl J Med 2021; 384:1752-1752
A 54-year-old man presented with confusion, vomiting, and progressive hyperpigmentation of the skin. The early-morning cortisol level and the serum level of corticotropin confirmed a diagnosis of primary adrenal insufficiency, or Addison’s disease.
- N Engl J Med 2021; 384:e57
A 27-year-old pregnant woman at 32 weeks of gestation presented with new-onset diabetes, hypertension, and violaceous striae. Imaging showed an adrenal mass, and a diagnosis of adrenocortical carcinoma was made.
- N Engl J Med 2021; 384:1542-1551
An adrenal mass discovered in testing for another condition (an “incidentaloma”) warrants biochemical tests to detect pheochromocytoma, excess cortisol, and, in a patient with hypertension, primary hyperaldosteronism. Imaging may distinguish benign from malignant lesions. Small nonfunctioning adrenal tumors with low CT attenuation generally do not warrant intervention or long-term follow-up.
- N Engl J Med 2021; 384:1145-1155
A 16-year-old boy presented with headache, nausea, vomiting, and abdominal pain. He had been injured 17 months earlier in an ATV accident and again 2 months later while playing soccer. Since then, episodic headache had occurred. On evaluation, the pulse was 160 beats per minute, and the blood pressure 239/162...
- N Engl J Med 2021; 384:165-165
An 83-year-old man presented with fatigue, weight loss, and postural hypotension. Computed tomography of the abdomen revealed marked enlargement of both adrenal glands, and a diagnosis of primary adrenal lymphoma was made.
- N Engl J Med 2020; 382:180-189
An 11-year-old boy was evaluated at the hospital because of ongoing vomiting and weight loss. Endoscopic evaluation revealed erythema of the gastric antrum and moderately scalloped mucosa of the duodenum; 11 days later, the patient had a syncopal episode. The patient was admitted to the hospital, additional diagnostic tests were...
- N Engl J Med 2019; 381:852-861
Glucocorticoid replacement therapy prolongs the survival of patients with adrenal insufficiency, but life-threatening adrenal crises still develop in many such patients. This review examines the pathophysiology, epidemiology, and treatment of adrenal crises.
- N Engl J Med 2019; 380:1284-1286
The use of ivabradine, an If current inhibitor, to manage tachycardia and heart failure due to massive catecholamine release in a patient with a metastatic paraganglioma and β-adrenoceptor desensitization is reported.
- N Engl J Med 2018; 378:1259-1261
Four of five patients with paragangliomas and pheochromocytomas who had received a diagnosis of congenital cyanotic heart disease had mutant HIF-2α. This contrasts with the prevalence of mutant HIF-2 in these tumor types in the absence of cyanotic heart disease (6 to 10%).
- N Engl J Med 2018; 378:1043-1053
A 55-year-old woman presented with cardiogenic shock. Echocardiography revealed a left ventricular ejection fraction of 15% and apical ballooning; angiography revealed normal coronary arteries. She had episodes of hypotension and hypertension. A diagnosis was made.
- N Engl J Med 2018; 378:902-910
Increases in symptoms may occur before exacerbations fully develop. In a trial involving adults and adolescents, quadrupling the dose of inhaled glucocorticoids when symptoms occurred resulted in fewer severe asthma exacerbations than not increasing the dose. Increases in symptoms may occur before exacerbations fully develop. In two trials, when symptoms...
- N Engl J Med 2018; 378:891-901
Inhaled glucocorticoids may prevent a mild loss of asthma control from becoming a full exacerbation. In a randomized trial involving children, quintupling the daily dose at early signs of loss of asthma control did not result in a lower rate of severe asthma exacerbations. Increases in symptoms may occur before...
- N Engl J Med 2018; 378:950-952
Inhaled glucocorticoids are pivotal to achieve asthma control and disease stability in both children and adults; despite their use, with or without other treatments, many patients with asthma have ongoing episodic disease exacerbations.1 Often, these are linked to provocative factors such as viral or bacterial infections, nonadherence to...
- N Engl J Med 2017; 376:1451-1459
Only three biochemical tests — urinary free cortisol, plasma corticotropin, and plasma cortisol measurements — are needed to distinguish patients with Cushing’s syndrome from those with obesity or the metabolic syndrome.
- N Engl J Med 2017; 376:1159-1167
A 27-year-old woman presented with nausea, vomiting, and confusion. She was unable to answer questions and had a blood pressure of 73/54 mm Hg; laboratory testing revealed a blood sodium level of 104 mmol per liter. Diagnostic tests were performed.
- N Engl J Med 2015; 373:1429-1436
Somatic variants of the β-catenin gene were found in aldosterone-producing adenomas in two pregnant women. These adenomas expressed very high levels of two hormone receptors, which were presumably engaged by high levels of circulating cognate hormones.
- N Engl J Med 2015; 373:756-756
A 9-year-old boy presented with a history of asymptomatic soft, yellow papules measuring 3 to 12 mm on the tip of his tongue, along with chronic constipation and abdominal discomfort since infancy. Findings on histologic analysis of lesion samples were consistent with mucosal neuroma.
- N Engl J Med 2015; 372:492-494
Two cases are described in which adrenal hemorrhage was misdiagnosed as the result of too much anticoagulation when the cause was adrenal-vein thrombosis mediated by anti–platelet factor 4 antibodies.