ANTHONY J. PICK, M.D.

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A man developed dangerously high calcium levels in his blood caused by an inflammatory breast condition (paraffinoma, a reaction to paraffin oil injection). His kidneys were failing and his vitamin D levels were abnormally high, which was making the calcium problem worse. When doctors gave him the steroid prednisone for 10 days, his calcium and vitamin D levels returned to normal and his kidney function improved significantly. This case shows that steroids can temporarily fix the calcium problem in paraffinoma patients while they wait for surgery or other permanent treatments, though the underlying condition remains serious.

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Researchers reviewed how insulin pumps—small devices that deliver insulin continuously under the skin—help people manage diabetes better than traditional injections or pens. Insulin pumps provide more precise and flexible dosing, improve long-term blood sugar control, reduce serious complications, and give patients more lifestyle freedom, but they require patients to learn carbohydrate counting and monitor their blood sugar regularly. Modern insulin pumps are now smaller, more discreet, smarter with better software, easier for doctors to analyze data from, and more likely to be covered by insurance, making them accessible to more patients and creating new opportunities for diabetes educators to help people live better lives with diabetes.

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Cushing disease occurs when a brain tumor produces excess hormones that cause the adrenal glands to release dangerously high levels of cortisol. While surgery is the preferred treatment, doctors can use medications to control cortisol levels before surgery, instead of surgery, or when surgery fails. The most effective medications work by blocking the enzymes that produce cortisol in the adrenal glands—ketoconazole is the best option, and doctors can add metyrapone or aminoglutethimide for stronger control. Other drug approaches, like trying to lower hormone signals from the brain or blocking cortisol's effects in the body, haven't worked as well or cause too many side effects. This matters because not all patients can have or tolerate surgery, so having reliable medication options means doctors can treat Cushing disease effectively in a broader range of patients.

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Cushing disease is caused by a tumor in the pituitary gland that triggers the body to produce too much cortisol, a hormone that causes serious health problems. Doctors diagnose this condition using a step-by-step approach: they start with a simple saliva test, confirm results with urine and blood tests, and use imaging scans and specialized blood tests from the pituitary area to pinpoint whether the tumor is actually in the pituitary or somewhere else in the body. Getting the right diagnosis matters because it determines whether surgery on the pituitary gland will fix the problem.

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Researchers studied mice prone to type 1 diabetes to understand how they lose the insulin-producing cells in their pancreas. They found that these mice start losing beta cells gradually over several weeks—even before showing signs of diabetes—and their bodies try to compensate by growing new beta cells faster than normal, but this isn't enough to keep up with the destruction. By the time diabetes appeared, the mice had lost about 70% of their beta cells and couldn't produce enough insulin, which is why their blood sugar skyrocketed. This matters because it shows diabetes doesn't happen suddenly; it's a slow decline in beta cell numbers and function that the body fails to overcome.

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Researchers studied mice with broken copies of a gene called HNF-1alpha to understand why mutations in this gene cause a form of diabetes in humans. They found that mice completely lacking this gene developed high blood sugar because their pancreas couldn't release enough insulin in response to glucose or other signals, even though they had a normal number of insulin-producing cells. This discovery shows that HNF-1alpha is essential for keeping pancreatic cells able to sense blood sugar and release insulin properly, which explains why people who inherit mutations in this gene develop early-onset diabetes.

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Researchers documented a rare case where a patient with dermatomyositis (an autoimmune disease affecting muscles and skin) developed constrictive pericarditis—a serious condition where the heart's protective lining thickens and restricts the heart's ability to pump blood. This is the first time doctors have reported this complication occurring together, even though it has been seen before in patients with similar autoimmune diseases like rheumatoid arthritis and lupus. The finding matters because doctors treating autoimmune disease patients need to watch for this heart condition, especially when patients show symptoms that might otherwise look like liver disease.

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Researchers studied a rare case of multiple myeloma where cancer cells in the bone marrow produced abnormal proteins but those proteins never appeared in the patient's blood. The cancer cells had an unusual structure with bubble-like protrusions on their surface that trapped the proteins inside the cell instead of releasing them into the bloodstream. This discovery explains why some myeloma patients lack the telltale abnormal proteins in their blood that doctors normally use to diagnose the disease.