Prolactinomas are among the most common pituitary adenomas. The typical symptoms of hyperprolactinemia associated with a prolactinomaprimarily include symptoms of hypogonadism resulting from the suppression of the hypothalamic-pituitary-gonadal axis.In men and postmenopausal women, symptoms related to the mass effect of the tumor usually predominate. In some cases, however,prolactinomas may initially present with atypical symptoms, which can make it difficult to establish the correct diagnosis. An extensive literature search covering the past 30 years was conducted using the PubMed database. The following search terms were applied: "macroprolactinoma", "atypical prolactinoma", and "giant prolactinoma manifestations". Only atypical cases of pituitary macroadenomasassociated with laboratory-confirmed hyperprolactinemia (prolactin concentrations > 100 ng/mL) were included. In ourstudy, we also included 3 cases of macroprolactinoma with an atypical presentation at the time of diagnosis, which we encountered inour department. Overall, 15 articles met the inclusion criteria. Including the cases described in this study, 28 patients with macroprolactinoma presenting with atypical symptoms at diagnosis were identified. Most patients were men, and the majority were aged 40-60 years. The most commonatypical manifestations included neurological symptoms such as epilepsy, cranial nerve palsy, hydrocephalus or behavioral disorders,as well as otolaryngological symptoms such as recurrent epistaxis or nasal obstruction. Macroprolactinomas were most commonlymisdiagnosed as skull base tumors, sinonasal malignancies, or primary neurological disorders. In most cases, the initiation of dopamineagonist therapy led to rapid clinical improvement and partial or complete tumor regression, even in cases of giant macroprolactinomas. A proportion of well- or moderately differentiated olfactory neuroblastomas may, in fact, be misdiagnosed macroprolactinomas. If other endocrine tumors are present, the typical symptoms of hyperprolactinemia may be masked. In some cases, macroprolactinomas are diagnosedwhen the condition becomes life-threatening. Serum prolactin levels should be measured in any patient with a sellar or parasellar tumor.

Osteoporosis is a significant health concern among postmenopausal women owing to its association with increased fracturerisk and morbidity. Although traditional risk factors such as hormonal changes, dietary intake, and physical activity have been extensivelyinvestigated, the role of muscle mass, particularly abdominal muscle mass, in bone health remains incompletely understood. This studyaimed to investigate the association between abdominal muscle mass, as measured by computed tomography (CT), and osteoporosis inpostmenopausal Korean women.

The incidence of thyroid cancer has increased dramatically over the past four decades, making it the most common endocrine malignancy worldwide. Although well-differentiated thyroid carcinomas generally exhibit excellent survival rates following standard surgical and radioactive iodine interventions, the clinical management of high-risk variants, recurrent disease, and indeterminate nodules remains a significant challenge. Historically, the evaluation of thyroid nodules has relied on B-mode ultrasonography and fine-needle aspiration biopsy (FNAB). However, spatial and temporal tumor heterogeneity, coupled with the high rate of indeterminate cytology (Bethesda Categories III and IV), often leads to unnecessary diagnostic thyroidectomies. In recent years, liquid biopsy has emerged as a promising diagnostic approach, offering a non-invasive, dynamic, and comprehensive method for disease monitoring. This comprehensive review evaluates the biological mechanisms and clinical utility of circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), extracellular vesicles (EVs), and non-coding RNAs in thyroid oncology. Furthermore, it explores the clinical role of commercial molecular diagnostic panels (e.g., Afirma GSC, ThyroSeq v3) in guiding surgical decisions. This review highlights the diagnostic synergy achieved when these molecular biomarkers are integrated with advanced radiological modalities - including strain elastography, quantitative region-of-interest (ROI) analysis, ACR TI-RADS, and cross-sectional volumetric tracking - as well as nuclear medicine techniques like technetium-99m MIBI scintigraphy. Emerging applications of artificial intelligence and radiomics in image analysis, alongside the concept of minimal residual disease monitoring, are also discussed. Ultimately, we emphasize the need for a multidisciplinary team (MDT) approach in translating these multi-omics and multimodal imaging data into precision medicine, while acknowledging current limitations and charting future directions.

A distinct form of diabetes occurring in lean, young individuals with a history of undernutrition was first described in the 1950s asa paradoxical combination of severe hyperglycemia, low body weight, and the absence of ketosis. Historically termed malnutrition-relateddiabetes mellitus (MRDM), it was recognized as a separate entity by the World Health Organization (WHO) in 1985 but was removedfrom formal classification in 1999 due to insufficient mechanistic evidence. Over the following two decades, research in low- and middle-income countries revealed unique metabolic traits of malnutrition-associateddiabetes, distinguishing it from type 1 and type 2 diabetes. In 2025, the International Diabetes Federation (IDF) formally endorsed recognitionof type 5 diabetes mellitus (T5DM), which is estimated to affect approximately 20-25 million people worldwide and predominantlyaffects young individuals with low body mass index living in low- and middle-income countries. T5DM is characterized by impaired insulin secretion, preserved insulin sensitivity, resistance to ketosis despite severe hyperglycemia, and absence of autoimmune markers. Early-life undernutrition is increasingly recognized as a factor disrupting pancreatic organogenesisand β-cell development, resulting in persistent structural deficits and limited functional β-cell reserve in adulthood. Effective management necessitates an integrated nutritional and pharmacological approach. Incorrectly classifying the condition as type 1diabetes may lead to unnecessary lifelong intensive insulin therapy, while misclassification as type 2 diabetes may lead to an inappropriatefocus on insulin resistance-targeted therapies. Although T5DM is most commonly reported in low- and middle-income countries, awareness is essential in high-income settings, particularly among migrant populations from regions affected by chronic undernutrition. Further research is needed to develop standardized diagnostic criteria, improve prevention strategies, and establish evidence-based treatment guidelines.

Hypophosphatemic rickets (HR) are a heterogeneous group of disorders characterized by chronic hypophosphatemia, impaired mineralizationof bone and growth plates, and lifelong skeletal complications. This review summarizes the current knowledge on genetic and acquiredforms of HR in children, including X-linked hypophosphatemia (XLH), autosomal dominant and recessive forms, tumor-induced osteomalacia,and other rare syndromes. Clinical presentation typically includes limb deformities, growth retardation, bone pain, and dentalabnormalities, while complications in adulthood may involve osteomalacia, enthesopathies, and cardiovascular issues. Diagnosis relies ondetailed medical history, physical examination, biochemical evaluation, radiological imaging, and genetic testing. We propose a diagnosticalgorithm for children to facilitate early recognition, appropriate differentiation of FGF23-dependent and -independent forms, and timely intervention. The review also outlines conventional and targeted therapies, highlighting the role of burosumab in FGF23-mediated formsand the need for individualized management in rare or FGF23-independent HR. Early diagnosis and a multidisciplinary approach arecrucial to optimize outcomes and improve quality of life.