Introduction: Prediabetes or intermediate hyperglycemia (IH) represents a critical phase in the trajectory toward type 2 diabetes mellitus (T2DM). Recent evidence from the International Diabetes Federation (IDF) suggests that 1-hour OGTT (1HOGTT) ≥8.6 mmol/L is a more sensitive biomarker for early beta-cell dysfunction, with enhanced detection of IH and future T2DM risk. Conventional screening using hemoglobin A1c (HbA1c) or 2-Hour OGTT (2HOGTT) may delay identification of prediabetes, narrowing the window for early intervention. This study evaluates 1HOGTT as a screening tool for prediabetes among Malaysians. Methodology: This cross-sectional study enrolled adults without prior T2DM or prediabetes. Participants underwent 1HOGTT, 2HOGTT, and HbA1c, classified as per the Malaysian Clinical Practice Guideline for T2DM (6th Edition) and IDF 2024 criteria. Agreement between tests was assessed using McNemar’s test and Cohen’s kappa. Diagnostic accuracy was evaluated via receiver operating characteristic (ROC) curve analysis. Cost-effectiveness was determined using reagent cost only. Results: The majority of the 310 participants were female (71.6%), Malay (87.1%), with average age of 40. The 1HOGTT identified prediabetes in 21.6% (n = 67) compared to 17.1% (n = 53) by HbA1c and 2.6% (n = 8) by 2HOGTT. McNemar’s test confirmed statistically significant discordance between 1HOGTT and 2HOGTT (chi-square = 53.397, p <0.001): 61 participants were prediabetic by 1HOGTT but normal by 2HOGTT, versus only 2 in the reverse direction. No significant discordance was found between 1HOGTT and HbA1c (chi-square = 2.817, p = 0.093). 1HOGTT demonstrated excellent discriminatory ability against 2HOGTT (AUC = 0.908; 95% CI: 0.837–0.978), significantly outperforming HbA1c (AUC = 0.664; CI: 0.462– 0.867; DeLong p = 0.012). In a population-level cost analysis, 1HOGTT achieved lowest cost per prediabetes case detected (RM 5.79) – approximately 8.3 times and 8.1 times more cost-effective than 2HOGTT (RM 48.08) and HbA1c (RM 46.78) respectively. Conclusion 1HOGTT identifies a significant proportion of individuals with prediabetes missed by 2HOGTT and HbA1c. Incorporating 1HOGTT enhances the detection of prediabetes, is cost-effective, and enables timely preventive measures in our population with high diabetes burden.
Glucose Tolerance Test ; Glycated Hemoglobin ; Prediabetic State

Introduction: Type 2 diabetes mellitus is a major healthcare problem worldwide, yet high percentage of patients are undiagnosed. There is a dire need for effective screening strategies. We examine the use of modified Asian FINDRISC (M-FINDRISC) and POCT random capillary blood glucose (rCBG) for the detection of dysglycemia Methodology: This cross-sectional, observational study included 151 adults aged ≥30 years without a prior history of diabetes in healthcare and community settings. Hemoglobin A1c of ≥6.3% was used for the diagnosis of diabetes, and 5.7– 6.2% for prediabetes. Areas under the receiver operating curve (ROC-AUC) for M-FINDRISC were analyzed. The sensitivity and specificity of the combined use of M-FINDRISC and rCBG for the detection of dysglycemia were evaluated. Results: The mean age of the participants was 44.6 ± 11.0 years. They had high body mass index (27.8 ± 4.9 kg/m²). Most were sedentary (only 25.2% reported physical activities of ≥30 min/day). A total of 52.3% had first-degree relatives with diabetes, but less than 12% were taking antihypertensive medication. Out of 151 participants, 3.3% (n = 5) were diagnosed with diabetes mellitus and 37.7% (n = 57) with prediabetes, giving an overall prevalence of 41.1% for dysglycemia. The mean age of participants with dysglycemia was significantly older (47.9 vs. 42.3 years, p-value 0.002). Other parameters were not statistically different for the two groups. Mean M-FINDRISC score was 9.7 ± 3.9 in the normal and 10.8 ± 4.0 in the dysglycemic group, while rCBG was 6.4 ± 1.1 mmol/L and 7.1 ± 3.1 mmol/L, respectively. ROC-AUC of M-FINDRISC for dysglycemia was 0.561. A combined screening strategy (M-FINDRISC score ≥7.5 and CBG ≥7.8 mmol/L) yielded high specificity (89.9%) but low sensitivity (17.7%) for dysglycemia. Conclusion While the combined screening strategy utilizing M-FINDRISC and POCT random CBG improves specificity, M-FINDRISC showed limited predictive value for dysglycemia in this specific cohort, making it a less ideal tool for screening.

Introduction: Parathyroid carcinoma is a rare endocrine malignancy found in 1–5% of patients with primary hyperparathyroidism. It commonly presents with severe hypercalcemia and markedly elevated parathyroid hormone (PTH) levels. We report a challenging case of parathyroid carcinoma presenting with refractory hypercalcemia with incidental papillary thyroid microcarcinoma. Case: A 63-year-old female with hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease had been followed for primary hyperparathyroidism since 2014 (PTH5.5 pmol/L, calcium range 2.3–4.7 mmol/L). Initial neck ultrasound was suggestive of parathyroid adenoma over left side, but parathyroid scintigraphy failed to localize a lesion. She refused surgical intervention initially until April 2025, then she later agreed. Re-evaluation prior to operation revealed PTH level 76 pmol/L, and repeated parathyroid scintigraphy showed mild sestamibi avid uptake on left thyroid nodule. While awaiting surgery, she was admitted with a hypercalcemic crisis (serum calcium 3.7–5.38 mmol/L), complicated with acute kidney injury. Repeated ultrasound neck revealed extrathyroidal lesion adjacent to inferior pole of left thyroid (1.6 × 1.7 × 1.2 cm). She required aggressive intravenous hydration, intravenous pamidronate, calcitonin, and Denosumab to optimize her calcium level peri-operatively. She underwent left neck exploration with en-bloc left inferior parathyroidectomy, left hemithyroidectomy, and central neck dissection in November 2025. Histopathological examination confirmed parathyroid carcinoma (pT3N1) with nodal metastasis (1/4 lymph nodes positive) and an incidental papillary thyroid microcarcinoma measuring 1 mm (pT1a). Conclusion This case highlights the challenges of perioperative hypercalcemia management in parathyroid carcinoma. Effective preoperative control often requires multiple treatment modalities. Severe refractory hypercalcemia and high PTH level should raise a high index of suspicion for malignancy. Early complete resection is the cornerstone of treatment and is associated with optimal outcomes.
Papillary Thyroid Microcarcinoma ; Calcium ; Parathyroid Neoplasms

Introduction: Mediastinal paragangliomas (PGLs) are extremely rare extra-adrenal neuroendocrine tumors, accounting for approximately 2% of all PGLs and commonly associated with pathogenic germline variants (PGVs), particularly those involving succinate dehydrogenase (SDH) mutations. Case: We report a 35-year-old female presenting with chronic cough and hemoptysis, accompanied by paroxysmal symptoms and new-onset hypertension. She had a history of pheochromocytoma treated 15 years earlier with right adrenalectomy and liver lobectomy due to intraoperative adrenal adherence to the liver. Histopathology confirmed adrenal pheochromocytoma, with no evidence of PGL in the liver. She remained in biochemical remission for 3 years but subsequently defaulted. Biochemical evaluation revealed markedly elevated 24-hour urinary normetanephrine (58,950 nmol/L; ~26-fold increase). Computed tomography of the thorax demonstrated a mediastinal mass compressing the right bronchus, resulting in luminal narrowing and segmental lung collapse. Endobronchial biopsy confirmed PGL (Ki-67 index 5%). Functional imaging with DOTATATE, FDG-PET, and MIBG demonstrated metastatic disease involving the lungs and lymph nodes. Genetic testing identified a heterozygous pathogenic SDHB mutation (c.79C>T; p.Arg27), consistent with autosomal dominant hereditary PGL-pheochromocytoma syndrome; family screening confirmed the same mutation in her father and two siblings. She underwent two sessions of bronchoscopic intervention, including cryoablation, balloon dilation, argon plasma coagulation, and intratumoral alcohol injection for airway control and hemoptysis. Multidisciplinary evaluation deemed complete surgical resection high risk and not feasible; therefore, peptide receptor radionuclide therapy was initiated. Conclusion This case demonstrates the aggressive and metastatic nature of SDHB-mutated PGLs. This group of patients require long term surveillance given the risk of developing new tumors even years or decades after primary tumor resection. It highlights the importance of genetic testing following pheochromocytoma surgery to guide targeted therapy, lifelong surveillance, and family screening within a multidisciplinary care approach.
Paraganglioma