Autoantibodies to insulinoma-associated antigen 2 (IA2) are well-established biomarkers of islet autoimmunity, supporting the diagnosis and risk stratification of type 1 diabetes (T1D). This study presents the analytical and clinical evaluation of a newly developed bridge-type Anti-IA2 ELISA (Euroimmun), which is CE-marked under the European In Vitro Diagnostic Regulation (IVDR) and compatible with fully automated processing platforms. The analytical performance was assessed through precision, detection capability, linearity, and interference studies. Diagnostic accuracy testing and method comparison with the predecessor ELISA and the Medipan CentAK anti-IA2 M radioimmunoassay were performed using serum samples from patients with T1D (median age at diagnosis: 11 years; median diabetes duration: 4 years), latent autoimmune diabetes in adults, or Addison's disease, as well as samples from non-T1D control groups and the Islet Autoantibody Standardization Program (IASP). The assay demonstrated low intra-/inter-lot imprecision (CVs ≤ 3.2%), detection limits in the low IU/mL range, linearity over the measuring range (10-2000 IU/mL), and no interference from hemolytic, lipemic, or icteric sample conditions. Sensitivity was 53.8% in the clinical T1D cohort (56.5% in newly diagnosed patients), and 76.0% in IASP case samples. Specificity in non-T1D controls reached 98.4%. Agreement with the predecessor ELISA was almost perfect (94.7%; κ = 0.873). Compared with the radioimmunoassay, substantial agreement (82.4-83.8%; κ ≥ 0.637) was observed, and the ELISA identified more anti-IA2-positive T1D samples. In conclusion, the new Anti-IA2 ELISA combines strong analytical and diagnostic performance with a fully automated workflow enabling standardized end-to-end processing. These features support implementation in high-throughput routine diagnostics. Prospective validation in larger and population-representative cohorts is warranted to further assess the assay's suitability for potential future use in large-scale screening aimed at improving early detection and risk assessment in autoimmune diabetes.

Although lymphoma may involve the adrenal glands as part of a generalised disease process, primary adrenal lymphoma is a rare entity. We present the case of a man in his late 60s who was admitted via the emergency department with clinical features consistent with adrenal failure. Initial investigations demonstrated anaemia, hypercalcaemia and adrenal insufficiency. Further biochemical work-up showed no evidence of an autoimmune or congenital aetiology of adrenal failure, and diagnostic imaging revealed bilateral adrenal enlargement. Adrenal biopsy revealed a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete metabolic remission following first-line immunochemotherapy, though adrenal function remained compromised. We review the published literature and discuss diagnostic challenges in patients presenting with adrenal insufficiency of unclear aetiology.

Vitiligo is a dermatological disease characterized by focal disappearance of the melanin pigment on the skin and mucous membranes of a person. Despite the variety of proposed hypotheses for the development of this pathology, the central role belongs to the autoimmune mechanism of melanocyte damage.Analysis of the results of numerous international studies confirms a pronounced tendency towards an increase in the prevalence of endocrine autoimmune diseases among patients with vitiligo compared to the general population. Such diseases include, first of all, autoimmune thyroiditis, Graves' disease, type I diabetes mellitus and autoimmune adrenal insufficiency. Some studies confirm a high frequency of vitiligo combination with multiendocrine autoimmune syndromes.This review is aimed at systematizing the available scientific literature on the frequency of occurrence and characteristics of associated autoimmune endocrine disorders in individuals suffering from vitiligo.

Autoimmune polyglandular syndrome type 2 (APS-2) is a rare autoimmune disorder characterized by the coexistence of primary adrenal insufficiency with autoimmune thyroid disease and/or type 1 diabetes mellitus. Because its initial manifestations are often nonspecific, diagnosis may be substantially delayed until advanced disease or adrenal crisis develops. We report the case of a 28-year-old Portuguese woman living in California who presented with a nine-month history of progressive fatigue, unintentional weight loss, nausea, vomiting, abdominal pain, and a previous syncopal episode. Recognition of diffuse mucocutaneous hyperpigmentation involving the palmar creases and tongue prompted targeted endocrine investigation. Laboratory evaluation confirmed autoimmune primary adrenal insufficiency and autoimmune hypothyroidism, establishing the diagnosis of APS-2. Treatment with intravenous hydrocortisone and fluid resuscitation was followed by levothyroxine and fludrocortisone replacement, resulting in rapid clinical improvement, the normalization of biochemical abnormalities, and complete recovery. This case highlights the diagnostic value of meticulous physical examination in patients presenting with otherwise unexplained constitutional symptoms. Recognition of these characteristic physical findings may facilitate the early diagnosis of autoimmune primary adrenal insufficiency, enabling appropriate hormone replacement before progression to adrenal crisis.

Cytotoxic Lesions of the Corpus Callosum (CLOCCs) are transient splenial lesions typically triggered by infections, trauma, or metabolic disturbances. This report documents a unique case of a 13-year-old girl with CLOCCs secondary to Addison's disease, an association not previously reported. The patient initially presented with lethargy, fever, and hyperpigmentation of the skin and gingiva. Investigations revealed profound hyponatremia (121 mmol/L) and hypoosmolality, while a brain MRI confirmed a cytotoxic lesion in the splenium. Although meningoencephalitis was initially suspected, markedly elevated adrenocorticotropic hormone (ACTH) and low cortisol levels ultimately confirmed primary adrenal insufficiency. The pathogenesis likely involves cytotoxic edema and blood-brain barrier dysfunction driven by severe electrolyte imbalance and hypocortisolism. Following hydrocortisone replacement therapy and gradual sodium correction, the patient achieved a rapid clinical recovery. A follow-up MRI demonstrated complete resolution of the lesion within one week. This case highlights the importance of considering adrenal insufficiency in the differential diagnosis of reversible splenial lesions, particularly when physical signs like hyperpigmentation are present.

To assist clinicians transitioning patients from the hospital through the continuum of their ambulatory oxygen care needs, a multidisciplinary team of clinicians and patients used the Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend disease management for patients who are transitioning from the hospital to the home or domiciliary care on newly prescribed long-term oxygen therapy (LTOT) (strong recommendation, low certainty); (2) We recommend regular reassessments to determine the appropriateness of LTOT in adults who were recently discharged from the hospital setting (conditional recommendation, moderate certainty); (3) We suggest implementing a discharge coordination program to support the safe transition of adult patients requiring oxygen therapy (conditional recommendation, low certainty); (4) We suggest that assessments of the oxygen setting and device during rest and activity be conducted before the transition of an adult patient from the hospital to home or domiciliary care with an oxygen prescription (conditional recommendation, low certainty); (5) We suggest an evaluation of the domiciliary environment and activities of daily living, including an assessment of the risk of burns related to tobacco smoking or other ignition sources, for adult patients transitioning to home or domiciliary settings with a new oxygen prescription (conditional recommendation, low certainty); (6) We suggest offering peri-discharge education focused on the oxygen prescription to improve understanding and adherence to LTOT (conditional recommendation, low certainty).

Community-acquired pneumonia (CAP) is the seventh leading cause of death in the United States, and the cost of these hospitalizations is estimated to cost up to $9 billion in the United States (US) dollars each year. Thirty-day hospital mortality associated with CAP has been estimated to be as high as 22% and is the leading cause of death amongst all infectious diseases. Streptococcus pneumoniae is the bacterium that has historically been the most common pathogen to cause CAP worldwide. In the era before antibiotics, S. pneumoniae was estimated to be the cause of 95% of all cases of pneumonia. Currently, however, S. pneumoniae accounts for up to 15% of pneumonia cases in the United States and 27% of cases worldwide today. Blood cultures are positive in only 20% to 25% of all pneumonia cases that are caused by S. pneumonia making it a challenging diagnosis for the clinician.