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Adrenal incidentalomas are commonly encountered because of the widespread use of high-resolution cross-sectional imaging. Adrenal incidentalomas may be benign or malignant, and also may demonstrate hormonal hypersecretion, so all patients with adrenal masses should undergo further assessment. Clinicians should have a basic understanding of adrenal incidentalomas, their workup, and when follow-up and referral are warranted.

Limited research exists on mentorship’s impact on advanced practice registered nurses (APRNs). In this study, 632 APRNs were surveyed at a single academic medical center and its associated health system. Results indicate that those with mentors were twice as likely to mentor others and achieve academic rank. Mentorship has an impact for APRNs and promotes academic and professional development.

To understand the transition from microscopic surgery (MS) to endoscopic surgery (ES) on the pituitary across the United States, we assessed a single institution practicing both procedures to discern advantages and disadvantages for each.

Hyperprolactinemia has been described as resulting from medically necessary exogenous hormone therapy (HT). However, as the knowledge of HT has evolved, when and why serum prolactin levels should be assessed in individuals with a transgender gender modality (TG) on HT has been questioned. Hyperprolactinemia is common and has a broad differential diagnosis. Hyperprolactinemia in TG individuals has been most associated with cyproterone acetate and estradiol, often not clinically significant. Routine monitoring should not be considered in TG individuals on HT unless clinically indicated when specific signs or symptoms of hyperprolactinemia (hypogonadism, galactorrhea) are present, and if present, HT discontinuation is unnecessary.

Primary care topics among people with a transgender gender modality (TG) extend beyond the provision of pubertal suppression and exogenous sex steroids to include cardiovascular health, cancer screenings, prevention of human immunodeficiency virus, bone health, and mental health, among other topics, some of which contribute to disparate mortality rates. The need for optimization of medical comorbidities, behavioral factors, the need for support, and a consistent personal narrative reinforces the perspective that Physician Associates/Assistants (PA) practicing in primary care settings play an essential role in the health and well-being of TG patients. This article presents an overview of primary care topics related to TG patients and emphasizes the importance of primary care for this population.

Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000–2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36–80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months–4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

Background: Gestational diabetes mellitus (GDM) is a common complication of pregnancy that carries lasting risks. For women who have a history of GDM, the risk of developing type 2 diabetes mellitus (T2DM) increases by 50 to 60%. To monitor and prevent the development of T2DM, guidelines suggest screening those with a history of GDM at 6-weeks and 3-years post-delivery. For patients with abnormal lab results at the 6-week mark, it is advised to complete lab work sooner, at the 1-year mark. Data suggests that these guidelines are not being followed globally, and most do not receive adequate screening for T2DM.Methods: A retroactive chart review of 203 women between 18 and 55 years old with a past medical history significant for GDM was conducted to determine if patients with GDM completed screening for T2DM at 6-week, 1-year, and 3-year timestamps post-delivery. Patient demographics (age, race, ethnicity, language), clinical characteristics (body mass index), provider gender, and whether prediabetes or T2DM developed were recorded. Patients who did not complete the required follow-up received educational materials via the online portal system, and hemoglobin A1c (HbA1c) screening tests were ordered.Results: Ninety days post-intervention, 38 patients (50%) completed the HbA1c screening test, which exceeded our goal of a 5% improvement. Age and BMI 1-year postpartum were found to be significant factors in whether a patient completed HbA1c screening, with 16/18 (89%) completing screening with a healthy BMI 1-year postpartum (18.5 ≤ BMI < 25.0) but only 11/41 (27%) completing screening for patients under 40 years with an unhealthy BMI 1-year postpartum. Of the 38 patients who completed HbA1c screening, 9 (23.7%) had abnormal screening results.Conclusion: Follow-up surveillance for T2DM among women with a history of GDM is poor. Electronic health records can be used to identify and rectify gaps in care. Dissemination of standardized educational materials and electronic order entry for patients improved screening between the handoff from obstetrics to primary care.