{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:08:16Z","timestamp":1789546096397,"version":"build-2803163510"},"reference-count":12,"publisher":"The Endocrine Society","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Catecholamine excess can disrupt glucose metabolism, but presentation with hyperosmolar hyperglycemic state and transient focal neurologic deficits is uncommon. A 37-year-old man with obesity, hypertension, and prediabetes presented with slurred speech and right arm weakness. Serum glucose was 1252\u2005mg\/dL (International System of Units (SI): 69.5\u2005mmol\/L) (reference range, 70-99\u2005mg\/dL [SI: 3.9-5.5\u2005mmol\/L]), serum osmolality was 325 mOsm\/kg (reference range, 275-295 mOsm\/kg), and hemoglobin A1c was 16.1% (SI: 152\u2005mmol\/mol) (reference range, 4.0-5.6% [SI: 20-38\u2005mmol\/mol]). Computed tomography angiography and perfusion imaging showed no cerebral ischemia, and the deficits resolved with correction of hyperosmolarity. Because of severe hypertension and abrupt deterioration in glycemic control, plasma metanephrines were measured and found to be markedly elevated, prompting imaging that identified an 8.4-cm right adrenal mass. After \u03b1-adrenergic blockade and glycemic optimization, robotic adrenalectomy was performed. Pathology confirmed a 9-cm pheochromocytoma with classic zellballen architecture and a Ki-67 index of approximately 1%. Within 3 weeks, hypertension and insulin-requiring diabetes resolved, allowing discontinuation of all antihypertensive and glucose-lowering medications. This case highlights pheochromocytoma as a reversible cause of severe dysglycemia and a probable metabolic stroke mimic.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag266","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:41:58Z","timestamp":1788522118000},"source":"Crossref","is-referenced-by-count":0,"title":["Pheochromocytoma presenting with hyperosmolar hyperglycemic state and transient stroke-like deficits"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8061-8081","authenticated-orcid":false,"given":"Alaa","family":"Almallouhi","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, Naples Comprehensive Health , Naples, FL 34102 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8453-9311","authenticated-orcid":false,"given":"Mustafa","family":"Sadek","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Naples Comprehensive Health , Naples, FL 34102 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9552-4759","authenticated-orcid":false,"given":"Edward","family":"Ruby","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Naples Comprehensive Health , Naples, FL 34102 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"2026091603531342600_luag266-B1","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2020.593780","article-title":"Glucose intolerance on phaeochromocytoma and paraganglioma\u2014the current understanding and clinical perspectives","volume":"11","author":"Abe","year":"2020","journal-title":"Front Endocrinol"},{"issue":"1","key":"2026091603531342600_luag266-B2","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s12022-022-09704-6","article-title":"Overview of the 2022 WHO classification of paragangliomas and pheochromocytomas","volume":"33","author":"Mete","year":"2022","journal-title":"Endocr Pathol"},{"issue":"12","key":"2026091603531342600_luag266-B3","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1530\/ERC-22-0218","article-title":"Glycemic disorders in patients with pheochromocytomas and sympathetic paragangliomas","volume":"29","author":"Araujo-Castro","year":"2022","journal-title":"Endocr Relat Cancer"},{"issue":"6","key":"2026091603531342600_luag266-B4","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s11739-015-1217-5","article-title":"Pheochromocytoma presenting as hyperglycemic hyperosmolar syndrome and unusual fever","volume":"10","author":"Lee","year":"2015","journal-title":"Intern Emerg Med"},{"issue":"8","key":"2026091603531342600_luag266-B5","doi-asserted-by":"crossref","first-page":"4671","DOI":"10.1007\/s10072-022-06088-7","article-title":"Acute stroke-like deficits associated with nonketotic hyperglycemic hyperosmolar state: an illustrative case and systematic review of literature","volume":"43","author":"Rossi","year":"2022","journal-title":"Neurol Sci"},{"issue":"8","key":"2026091603531342600_luag266-B6","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.2337\/dci24-0032","article-title":"Hyperglycemic crises in adults with diabetes: a consensus report","volume":"47","author":"Umpierrez","year":"2024","journal-title":"Diabetes Care"},{"issue":"8","key":"2026091603531342600_luag266-B7","doi-asserted-by":"crossref","first-page":"999","DOI":"10.4158\/EP171914.RA","article-title":"The physiology behind diabetes mellitus in patients with pheochromocytoma: a review of the literature","volume":"23","author":"Mesmar","year":"2017","journal-title":"Endocr Pract"},{"issue":"12","key":"2026091603531342600_luag266-B8","doi-asserted-by":"crossref","first-page":"e4661","DOI":"10.1210\/clinem\/dgaa608","article-title":"Predicting metastatic potential in pheochromocytoma and paraganglioma: a comparison of PASS and GAPP scoring systems","volume":"105","author":"Wachtel","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2026091603531342600_luag266-B9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ccell.2017.01.001","article-title":"Comprehensive molecular characterization of pheochromocytoma and paraganglioma","volume":"31","author":"Fishbein","year":"2017","journal-title":"Cancer Cell"},{"issue":"6","key":"2026091603531342600_luag266-B10","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1210\/jc.2014-1498","article-title":"Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline","volume":"99","author":"Lenders","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2026091603531342600_luag266-B11","doi-asserted-by":"crossref","first-page":"e2393","DOI":"10.1210\/clinem\/dgab130","article-title":"The role for metyrosine in the treatment of patients with pheochromocytoma and paraganglioma","volume":"106","author":"Gruber","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2026091603531342600_luag266-B12","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0033","article-title":"European Society of Endocrinology clinical practice guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paraganglioma","volume":"174","author":"Plouin","year":"2016","journal-title":"Eur J Endocrinol"}],"container-title":["JCEM Case 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