- N Engl J Med 2022; 387:356-365
A 49-year-old man with a family history of diabetes was evaluated because of hypoglycemia. Two hours earlier, he had been found on the floor, obtunded and making nonpurposeful movements. A diagnostic test was performed.
- N Engl J Med 2022; 387:e5
A 78-year-old man with type 2 diabetes presented with hemiballism of the left arm and leg (shown in a video). Evaluation revealed hyperglycemia and an area of increased density in the right basal ganglia on imaging.
- N Engl J Med 2022; 387:261-269
A 34-year-old woman presented with hypercortisolism resulting from a metastatic pancreatic neuroendocrine tumor. Chest CT revealed patchy consolidation with cavitation and tree-in-bud opacities. Management decisions were made.
- N Engl J Med 2022; 386:2161-2164
State efforts to prohibit gender-affirming care place physicians’ duties to avoid discrimination, protect privacy, meet standards of care, fulfill reporting requirements, and avoid committing crimes in direct conflict with one another.
- N Engl J Med 2022; 386:2130-2136
An 85-year-old woman was brought to the emergency department by emergency medical services after losing consciousness. The loss of consciousness occurred approximately 45 minutes after the patient finished eating dinner and was preceded by a sudden onset of sweating, palpitations, and a cold feeling. She had had similar but milder...
- N Engl J Med 2022; 386:e56
A 67-year-old man presented with a 1-month history of dyspnea and diarrhea. Thickened, stiff tricuspid-valve leaflets and tricuspid regurgitation were seen on transthoracic echocardiography (shown in videos), and abdominal imaging showed liver masses.
- N Engl J Med 2022; 386:1467-1469
This interactive feature about the use of bisphosphonates to treat osteoporosis offers a case vignette accompanied by two essays, one supporting continuation of bisphosphonate therapy beyond 5 years and the other supporting a “drug holiday.”
- N Engl J Med 2022; 386:1443-1451
Cancer-associated hypercalcemia often occurs late in the course of solid-tumor development and is associated with a poor prognosis. Treatment includes intravenous hydration followed by antiresorptive agents, typically intravenous bisphosphonates. Successful management ultimately depends on effective treatment of the underlying cancer.
- N Engl J Med 2022; 386:1155-1164
Management of type 1 diabetes mellitus in children involves close family support and glucose monitoring. Improved means of insulin administration include newer pumps or smart pens that receive data from continuous glucose monitoring and can assist in calculation of insulin doses.
- N Engl J Med 2022; 386:e22
A 31-year-old man presented with progressive digital clubbing and bony proliferation of his fingers and toes. Evaluation for secondary causes was negative, and primary hypertrophic osteoarthropathy was diagnosed.
- N Engl J Med 2022; 386:768-779
Adipose tissue can more than double in mass and then return to baseline. This review discusses the functional roles of human white and brown adipose tissue and its excess in obesity, as well as its far-reaching, complementary physiological roles in the endocrine system.
- N Engl J Med 2022; 386:209-219
In a multicenter, randomized, crossover trial involving children 1 to 7 years of age with type 1 diabetes, a closed-loop system was compared with sensor-augmented pump therapy in random order. The closed-loop system improved glycemic control in very young children with type 1 diabetes, without increasing the time spent in...
- N Engl J Med 2021; 385:1981-1993
Salt intake is associated with blood pressure, but the relationship is complex. This review highlights the interplay among renal salt transport, salt storage in the skin and interstitium, vascular adaptation to changes in the salt concentration, and neurohormonal signaling.
- N Engl J Med 2021; 385:1974-1980
In this article, the authors discuss two cases of acquired PTH resistance secondary to serum PTH1-receptor autoantibodies that block PTH binding and signaling. In both cases, there were also other manifestations of autoimmunity. The presence of PTH1-receptor autoantibodies should be considered in patients with acquired PTH resistance.
- N Engl J Med 2021; 385:1604-1613
A 14-year-old girl presented with progressive swelling of the jaw. Six weeks before this admission, a nonpainful lump in the left lower jaw developed. The mass increased in size, and swelling of the left side of the face and neck developed. A biopsy specimen from the mass showed abundant giant...
- N Engl J Med 2021; 385:1510-1510
A 32-year-old man presented with lower back pain, joint stiffness, and tooth discoloration. Work-up showed osteosclerosis and elevated serum and urinary fluoride levels. Skeletal fluorosis was diagnosed.
- N Engl J Med 2021; 385:189-191
In this letter, the investigators report that continuous subcutaneous infusion of parathyroid hormone (1-34) in six patients who were between the ages of 5 weeks and 22 years and who had autosomal dominant hypocalcemia type 1 caused by mutations in the calcium-sensing receptor ameliorated hypocalcemic seizures.
- 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:e71
A 25-year-old man presented with sudden limb paralysis. Laboratory studies revealed a potassium level of 1.6 mmol per liter. A diagnosis of thyrotoxic periodic paralysis was made; supplementation with potassium and phosphate was initiated, which resulted in abatement of the arm and leg weakness. Videos show arm and leg movement...