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Case Report | DOI: https://doi.org/10.31579/2690-4861/901
1 Division of Endocrinology, Diabetes and Metabolism, Ohio State University Wexner Medical Center, USA.
2 Department of Internal Medicine, University of Central Florida College of Medicine, USA.
# Present address: National Institute of Environmental Health Sciences, USA.
*Corresponding Author: Melanie Natasha Rayan, MD. MPH. Division of Endocrinology, Diabetes and Metabolism the Ohio State University 5th Floor McCampbell Hall 1581 Dodd Drive Columbus, OH 43210.
Citation: Melanie N. Rayan, Samantha Sircar, Jessica Chippior, Lawrence S. Kirschner, Steven W. Ing, (2025), Case Report: Atypical Endocrine Interactions in Carney Complex: Remission of Cushing’s Syndrome Unveiling Calcitriol-Mediated Hypercalcemia, International Journal of Clinical Case Reports and Reviews, 31(5); DOI: 10.31579/2690-4861/901
Copyright: © 2025, Melanie Natasha Rayan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 19 November 2025 | Accepted: 03 December 2025 | Published: 12 December 2025
Keywords: carney complex; carney; PPNAD; hypercalcemia; atrial myxoma; cushing syndrome
Carney Complex (CNC) is a rare, multisystem disorder with diverse endocrine and non-endocrine manifestations. We describe a 31-year-old woman with genetically confirmed CNC who developed severe calcitriol-mediated hypercalcemia during suspected remission of Cushing's syndrome due to primary pigmented nodular adrenocortical disease. The patient had recently experienced multifocal ischemic strokes attributed to emboli from an atrial myxoma, followed by persistent nausea and vomiting. Laboratory evaluation revealed severe hypercalcemia (15.4 mg/dL) with suppressed parathyroid hormone (8.6 pg/mL; normal 14.0-72.0 pg/mL), normal PTHrP (1.3 pmol/L; normal ≤4.2 pmol/L), normal 25-hydroxyvitamin D (68 ng/mL; normal 30-100 ng/mL), and markedly elevated 1,25-dihydroxyvitamin D (107 pg/mL; normal 20-79 pg/mL). Imaging showed bilateral pulmonary ground-glass opacities raising suspicion for a granulomatous process suggesting extra-renal calcitriol production; however, infectious and autoimmune workups were negative. Twenty-four-hour urinary cortisol levels, previously elevated at 60 mcg/24h, declined to 6.2 mcg/24h, suggesting temporary remission of Cushing's syndrome. Her hypercalcemia resolved with hydrocortisone and zoledronic acid, and she maintained eucalcemia on continued glucocorticoid therapy after atrial myxoma excision. This case illustrates a novel endocrine interaction in CNC, where suppression of cortisol may unmask calcitriol-driven hypercalcemia, a phenomenon typically associated with granulomatous disease. Recognition of this pattern may inform surveillance strategies in patients with fluctuating cortisol states.
Carney Complex (CNC) is a rare autosomal dominant multiple neoplasia syndrome characterized by a constellation of dermatologic, cardiac, endocrine, and neural manifestations.[1] Fewer than 750 cases have been reported worldwide.[2] Inactivating variants of PRKAR1A, which encodes the type 1A regulatory subunit of protein kinase A,[3,4] are responsible for more than 70% of familial cases and 30% of sporadic cases.[1]
The clinical manifestations of CNC are diverse and typically include spotty skin pigmentation such as lentigines and blue nevi, which often present early in life; cardiac myxomas and benign mucocutaneous myxomas are common, typically developing at a young age and potentially causing embolic events or cardiac dysfunction.[5] Endocrine overactivity is a key component of CNC, most notably primary pigmented nodular adrenocortical disease (PPNAD), which leads to Cushing’s syndrome in approximately 25% of patients.[1,6] PPNAD demonstrates significant variability in cortisol secretion patterns, with individuals experiencing persistent overproduction, cyclical or fluctuating cortisol levels, subclinical hypercortisolism or silent PPNAD with normal laboratory values and absent clinical symptoms.[7] Inactivating mutations in the PRKAR1A gene lead to unregulated activation of the cAMP/PKA signaling pathway which drives adrenocortical cell proliferation and excess cortisol synthesis.[8]
Additional endocrine manifestations include pituitary adenomas producing growth hormone, thyroid nodules in up to 75% of patients, and large cell calcifying Sertoli cell tumors in males. Schwannomas, specifically psammomatous melanotic variants, occur in around 10% of cases.[1]
Our purpose is to present a case of calcitriol-mediated hypercalcemia in a patient with CNC, that became evident during suspected remission of Cushing’s syndrome.
A 31-year-old woman with a known diagnosis of CNC was transferred to our institution for evaluation of recurrent, worsening hypercalcemia. Her medical history was notable for a pathogenic PRKAR1A gene mutation consistent with Carney complex. Clinical manifestations included lentigines, dermal myxomas identified in early childhood, spinal schwannomas, atrial myxomas, and Cushing's syndrome. Approximately three months prior to this presentation, she experienced multifocal ischemic strokes attributed to emboli from an atrial myxoma, resulting in residual partial aphasia. Around the same time, she developed persistent intractable nausea and vomiting, contributing to poor oral intake and progressive volume depletion.
About four weeks prior to her most recent admission, she was hospitalized at our center for an initial episode of documented hypercalcemia. Calcium levels documented in the six years preceding this hospitalization were consistently within normal limits, with the highest value recorded as 10.1 mg/dL (Reference range [RR], 8.6 - 10.5 mg/dL). Laboratory testing revealed a corrected serum calcium of 12.6 mg/dL and an ionized calcium of 6.3 mg/dL (RR, 4.60 - 5.30 mg/dL). Her intact parathyroid hormone (iPTH) level was suppressed at <6>
Despite treatment, nausea and poor oral intake persisted. She represented to an outside emergency department with recurrent emesis and was transferred to our hospital. On arrival, she appeared volume-depleted and fatigued. Her blood pressure was 143/91 mmHg and heart rate 93 bpm. Laboratory testing revealed a markedly elevated corrected calcium of 15.4 mg/dL and ionized calcium of 7.8 mg/dL. Electrolyte abnormalities included hypokalemia (2.7 mmol/L, RR, 3.5 - 5.0 mmol/L), hypomagnesemia (1.4 mg/dL, RR, 1.6 - 2.6 mg/dL), and acute kidney injury with a creatinine of 2.62 mg/dL (baseline 0.6 mg/dL, RR, 0.50 - 1.20 mg/dL). Phosphorus was normal at 2.4 mg/dL (RR, 2.2 - 4.6 mg/dL). Endocrinology was consulted to evaluate and treat this patient’s severe hypercalcemia. Endocrine evaluation showed persistent iPTH suppression (8.6 pg/mL) and a normal PTHrP (1.3 pmol/L, RR, < or>Lab Value Reference Range Corrected calcium 15.4 mg/dL 8.6-10.5 mg/dL Ionized calcium 7.8 mg/dL 4.6-5.3 mg/dL 24-hour Urine calcium 1,549.5 mg/24 hours 100.0-300.0 mg/24 hours 1,25OHD 107.0 pg/ml 20.0-79.0 pg/ml 25-OHD 68.2 pg/ml 30.0-100.0 pg/ml iPTH 8.6 pg/ml 14.0-72.0 pg/ml PTHrP 1.3 pmol/L <4> CTX 4,273 pg/ml 150-635 pg/ml P1NP 222 mcg/L 19-83 mcg/L ACE 50 U/L 16-85 U/L 24-hour urine cortisol 6.2 mcg/24 hours 3.5-45 mcg/24 hours IL-6 11 pg/ml <6>
Table 1: Key laboratory Findings: 25-OHD = 25-hydroxyvitamin D, the major circulating form of vitamin D; 1,25OHD = 1,25-dihydroxyvitamin D; iPTH = intact parathyroid hormone; PTHrP = parathyroid hormone-related peptide; CTX = C-terminal telopeptide; P1NP = procollagen type 1 N-terminal propeptide; ACE = angiotensin-converting enzyme; IL-6 = interleukin-6.
She was treated with 2 litres of normal saline and calcitonin 300 International units every 12 hours for 4 doses, while further evaluation for the etiology of her hypercalcemia was pursued.[9] Bone turnover markers were elevated, including procollagen type 1 propeptide of 222 mcg/L (RR, 19-83 mcg/L), C-terminal telopeptide, 4273 pg/mL (RR, 150-635 pg/ml), and osteocalcin, 85 ng/mL (RR, 9-42 ng/mL). Dual-Energy X-ray Absorptiometry scan performed three months earlier demonstrated osteopenia with a T-score of -2.0 in the left femoral neck. Urinary calcium excretion was quite elevated, at 1550 mg per 24 hours (RR, 100.0-300.0 mg/24 hours) and a calcium-to-creatinine ratio above 0.155 (RR, <0>
Given the elevated calcitriol and suppressed iPTH, a granulomatous process was suspected. As part of outpatient follow-up for her recently diagnosed atrial myxoma, she had undergone cardiac computed tomography (CT) imaging, which incidentally revealed a filling defect in the inferior vena cava. This prompted further evaluation with a CT angiogram of the abdomen and pelvis, which unexpectedly revealed ground-glass opacities in the bilateral posterior lung fields, the largest nodule measuring 8 mm. Due to this finding, infectious workup was pursued during her hospitalization including serologies for tuberculosis (Quantiferon), histoplasmosis, coccidioidomycosis, and Bartonella, which returned negative.[10,11] Granulomatous diseases such as sarcoidosis were considered; however, her serum angiotensin-converting enzyme (ACE) was normal at 50 U/L (RR, 16-85 U/L). Due to concerns about radiation exposure, the patient and her family declined a dedicated chest CT, which would have evaluated for features of sarcoidosis such as hilar adenopathy and pulmonary nodules. Interleukin-6 (IL-6) was measured to assess for myxoma-associated hypercalcemia and was found to be modestly elevated at 11 pg/mL (RR, <6>
Further diagnostic considerations were complicated by her history of Cushing's syndrome. Prior testing for Cushing's syndrome consisted of a 24-hour urinary free cortisol of 60 mcg/24h 4 months prior to admission, and late-night salivary cortisol testing was elevated at 490 ng/dL and 709 ng/dL (reference range <100>
She was treated with 4 mg of intravenous zoledronic acid for hypercalcemia and monitored closely.[9] Her symptoms improved and serum calcium gradually normalized. She was discharged with weekly metabolic panel monitoring. At outpatient follow-up, her corrected calcium had decreased to 9.4 mg/dL. She completed excision of left atrial myxoma, and eucalcemia was maintained on glucocorticoid therapy.
Given concerns that prolonged hypercortisolism from PPNAD could lead to hypothalamic-pituitary-adrenal axis suppression, as observed in other forms of adrenal Cushing's syndrome, empiric glucocorticoid replacement therapy was continued.[13] Three months after initiating hydrocortisone, the patient experienced rapid weight gain of >40 pounds, concerning for recurrence of Cushing’s syndrome. Hydrocortisone was tapered and ultimately discontinued four months post-discharge. Follow-up laboratory evaluation after discontinuation revealed an elevated 24-hour urinary free cortisol of 128 mcg/24 h (RR, 3.5–45 mcg/24 h), a persistently suppressed ACTH level of <5>
An unusual and clinically significant feature in this case was the development of severe hypercalcemia, a finding not typically characteristic of CNC. Multiple etiologies were explored to determine the cause of her hypercalcemia. One known cause of hypercalcemia in patients with cardiac myxomas can be through the overexpression of IL-6 mRNA in myxoma cells.[14] IL-6 leads to hypercalcemia by stimulating osteoclast activity, increasing bone resorption and release of calcium into the bloodstream. The production of IL-6 by myxoma cells is regulated through the activation of STAT3 and Akt pathways that create an autocrine loop that perpetuates the cycle of IL-6 secretion. Removal of the myxoma typically leads to a reduction in IL-6 and resolution of hypercalcemia.[15,16] Additionally, this process is largely independent of calcitriol, making it a less likely explanation given the elevated calcitriol level of 107 pg/mL.
Our patient's hypercalcemia appeared to be mediated by elevated levels of calcitriol with suppressed iPTH consistent with calcitriol-driven PTH-independent hypercalcemia. This form of hypercalcemia is classically associated with granulomatous diseases such as sarcoidosis and tuberculosis, where extra-renal, activated macrophages overexpress 1α-hydroxylase, bypassing normal regulatory mechanisms and producing excess calcitriol.[17] Our patient's 1,25-dihydroxyvitamin D level of 107 pg/mL represents a moderate elevation above the normal range (20-79 pg/mL). In a systematic cohort study of 101 patients with calcitriol-mediated hypercalcemia, Donovan et al. found that while calcitriol levels were consistently elevated above normal, extreme elevations >120 pg/mL (>300 pmol/L) were more characteristic of non-sarcoid etiologies such as malignancy and infection, rather than sarcoidosis.[18] Our patient's level of 107 pg/mL falls within the range typically observed in granulomatous diseases like sarcoidosis, supporting our clinical suspicion of an occult granulomatous process. Although infectious and autoimmune workup was negative in our patient, imaging revealed multiple pulmonary nodules with ground-glass opacities, raising suspicion for an occult granulomatous or inflammatory process. Despite a normal serum ACE level, sarcoidosis remains a consideration, as ACE levels are highly specific but insensitive for sarcoidosis and may be normal in up to 40% of cases.[19,20]
Cushing’s syndrome in CNC occurs due to autonomous cortisol production from the adrenal glands in individuals with PPNAD.[6] Hypercortisolism in PPNAD can be overt, subclinical, cyclic, or atypical. In affected individuals, the adrenal glands show multiple small pigmented cortical micronodules measuring 1-4 mm, composed of eosinophilic cells, with some cells containing lipopigment. These nodules secrete cortisol independent of ACTH. Most patients with classic Cushing’s syndrome have inactivating mutations in the PRKAR1A gene, leading to unregulated activation of the cAMP/PKA signaling pathway which drives adrenocortical cell proliferation and excess cortisol synthesis.[8] A retrospective study at Mayo Clinic showed significant variability in cortisol secretion patterns, with individuals experiencing persistent overproduction, cyclical or fluctuating cortisol levels, subclinical hypercortisolism, silent PPNAD with no biochemical or clinical evidence, or spontaneous remission.[7] This variability in cortisol production was attributed to heterogeneity in the micronodules, with some being overactive while others were normoactive or low-activity. Due to the patchy distribution and intermittent function of adrenal nodules, cortisol levels can fluctuate significantly, and standard testing may be inconclusive.
Our patient demonstrated biochemical evidence of temporary remission of Cushing’s syndrome, with a significant decline in urinary cortisol to near adrenal insufficiency thresholds during her hospitalization compared to values obtained months prior. This shift in cortisol status appeared to coincide with the development of severe hypercalcemia. Cortisol deficiency itself is an uncommon cause of hypercalcemia.[21] Mechanisms include hypovolemia leading to decreased glomerular filtration rate, decreased filtration of calcium, increased proximal tubular reabsorption of calcium, and increased 1-alpha hydroxylase activity. However, this alone would not explain the markedly elevated calcitriol level seen in our patient. It is likely that the decline in endogenous cortisol allowed previously suppressed calcitriol-mediated hypercalcemia to emerge. Glucocorticoids have profound effects on calcium metabolism; while cortisol excess promotes hypercalciuria and can blunt hypercalcemia, cortisol deficiency may enhance calcium retention and increase 1α-hydroxylase activity.[22] Therefore, transient remission of Cushing’s syndrome in our patient could have facilitated unopposed calcitriol activity leading to hypercalcemia. This phenomenon has been observed in other clinical scenarios, such as calcitriol-mediated hypercalcemia being precipitated by reduction or discontinuation of glucocorticoids.[23,24] A similar pattern is observed in patients with renal sarcoidosis when their steroid dose is tapered too quickly or their steroid maintenance dose is not continued for a sufficient duration.[25] Glucocorticoids not only reduce the activity of extra-renal 1-alpha hydroxylase but also decrease gastrointestinal reabsorption of calcium.[22] Therefore, without sufficient steroids (either endogenously produced or exogenously administered), relapses of hypercalcemia can occur.[25]
To our knowledge, hypercalcemia as described in this case is not a recognized feature of Carney Complex.[6] This case is novel in demonstrating unmasked calcitriol-mediated hypercalcemia coinciding with altered cortisol production due to primary PPNAD. It highlights an unreported endocrine interaction within CNC and reinforces the atypical presentation patterns of PPNAD-related Cushing’s syndrome. These findings support the need for further investigation into the dynamic endocrine physiology of Carney Complex and its potential contribution to hypercalcemia
This case highlights a previously unreported manifestation in CNC: severe calcitriol-mediated hypercalcemia that emerged with the remission of Cushing’s syndrome. This presents an important clinical consideration for physicians managing patients with Carney Complex, particularly during periods of fluctuating cortisol levels. Recognition of this unique presentation broadens the spectrum of possible complications in Carney Complex and emphasizes the need for comprehensive and multidisciplinary surveillance and management.
None to disclose
M.N.R, S.S, J.C, L.K and S.I have no conflicts of interest to disclose
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My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
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Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
