Clinical Pearls: Q&A with William F. Young, Jr., MD, Editor-in-Chief of JCEM Case Reports           

Bill Young

In anticipation of the Endocrine Society’s new open access journal, JCEM Case Reports, its editor-in-chief, William F. Young, Jr., MD, talks to Endocrine News about how this new journal will have a place for both master clinicians and early-career physicians to present their cases, why it’s important to hear the patient’s perspective, as well as his own very first particularly challenging case.

In March, the Endocrine Society announced that it will launch a new open-access, online-only journal called JCEM Case Reports that will feature reports on clinical cases and detail how to approach and solve complex clinical problems in endocrinology. JCEM Case Reports will be fully peer-reviewed and begin publishing issues in late 2022.

And the Society is pleased to further announce that past president William F. Young, Jr., MD, will serve as three-year term as the journal’s inaugural editor-in-chief. Young is the Tyson Family Endocrinology Clinical Professor and professor of medicine in the Mayo Clinic College of Medicine and Science at the Mayo Clinic in Rochester, Minn.

“Case reports are a foundation of medicine, giving clinicians an opportunity to learn about novel situations and apply that knowledge to their own practices,” Young says. “It is truly an honor to be the first to lead JCEM Case Reports. The journal will help disseminate clinical pearls to busy clinicians worldwide.”

The journal will welcome educational or rare clinical cases that are well described, with clear learning points, and of special interest to early-career endocrinologists and members of endocrinology care teams. The journal is particularly interested in exploring ways to effectively diagnose and treat endocrine conditions in regions with limited clinical resources. These cases may have important implications for a wider audience.

“Case reports can impart valuable insights and clinical nuances that cannot be found in large case series, clinical trials, or clinical practice guidelines. Many of my best teaching and learning opportunities have been based on the care of single patients with challenging clinical scenarios.”

William F. Young, Jr., MD, Tyson Family Endocrinology Clinical Professor, professor of medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minn.; editor-in-chief, JCEM Case Reports

Young says that the editors are looking for cases reports on common endocrine disorders with unique — diagnostic, ethical, management — challenges; on rare endocrine disorders that present in a different way; recognition of a new association with an endocrine tumor; or other endocrine diagnosis. “Sometimes the unique findings in a case report are the nidus for broader prospective studies,” he says. “For example, a case report may show a potential link between two unusual findings. That observation may lead to a broader study to investigate a potential association. Sometimes there are unexpected findings or responses to treatment that were not expected or anticipated. That would also be good substrate for a case report.”

Endocrine News caught up with Young to talk about his passion for patient care and medical education, his first publication that furthered his interest in endocrinology, and his vision for this new venture.

Endocrine News: How does it feel to be appointed editor-in-chief of JCEM Case Reports?

William F. Young, Jr. MD: It is a tremendous honor to be the inaugural editor-in-chief of JCEM Case Reports. I am a clinician who enjoys medical editing, challenges, and building things from the ground up. So, how do I feel? I am thrilled and looking forward to taking on this role and charge!

EN: Can you tell me a little about your path to endocrinology, and some of your favorite moments or highlights from your career?

WFY: My interest in endocrinology started before entering medical school. My research project in graduate school was studying the effects of prostaglandins on the microvasculature. During my internal medicine residency, evaluating patients for potential endocrine disorders was an exercise in problem solving — something I enjoyed so much that I decided to pursue a career in clinical endocrinology. I was fortunate to be selected for the clinical endocrinology training program at Mayo Clinic in Rochester, Minnesota. Some of my career highlights have included joining the Mayo Clinic staff (1984), chairing our Division of Endocrinology at Mayo Clinic (2012-2019), and serving as president of the Endocrine Society (2012-2013). I have had the privilege of delivering more than 650 presentations at national and international meetings, and I have been invited as a visiting professor to more than 150 medical institutions.

EN: What attracted you to the role of EIC of JCEM Case Reports?

WFY: The EIC role at JCEM Case Reports is the perfect marriage between two of my passions — patient care and medical education. Case reports can impart valuable insights and clinical nuances that cannot be found in large case series, clinical trials, or clinical practice guidelines. Many of my best teaching and learning opportunities have been based on the care of single patients with challenging clinical scenarios. I have had a career-spanning interest in medical writing and editing. I have authored and co-authored six books. My most recent effort is the co-authored book, Adrenal Disorders: 100 Cases from the Adrenal Clinic, which is a perfect example of the value I place in clinical case reports. My interest and dedication to the peer-review process are evidenced by my associate editor roles at four different journals and as an author of 350 peer-reviewed publications. I am a board-certified editor (Board of Editors in the Life Sciences [ELS]) and a member of the Council of Science Editors.

EN: JCEM Case Reports is a brand-new journal. What’s your hope for the journal as it launches?

WFY: My hope is that JCEM Case Reports will not only be the number one choice of endocrinologists to read, but also their preferred forum to share challenging cases. I am especially keen to encourage article submissions from endocrine trainees and early-career aspiring endocrinologists. When I was an internal medicine resident, my very first clinical publication was a case report on a patient with a pituitary gland disorder that was a diagnostic conundrum; caring for that patient and writing up the report helped ignite my interest in pursuing a career in endocrinology.

EN: Can you share a little about that case? What made it particularly challenging?

WFY: This was in 1979, and we didn’t have MRI scans back then. Sellar polytomography was a commonly used x-ray technique to image the sella turcica. Our best imaging study of the pituitary was the newly invented head CT scan, which was pretty crude compared to today’s standards.

A 32-year-old woman presented with vision loss due to bitemporal hemianopsia. Sellar polytomography demonstrated thinning of the floor of the sella turcica. However, the CT scan showed fluid density in the sella turcica rather than a tumor. So, the suspicion was that she had a large pituitary cyst or a cystic pituitary tumor that was compressing the optic chiasm and causing the vision loss. The other possibility was a condition called “empty sella” where the suprasellar subarachnoid space extends into the sella turcica and the optic chiasm can prolapse into the sella and thus causing the vision loss. Back then the most common way to distinguish between those 2 possibilities was a painful procedure where air was injected into the cerebrospinal fluid (pneumoencephalography).

With our neuroradiologist, we adapted a technique to put a water-soluble contrast agent (metrizamide) into her spinal column and by rotating the patient we could see if metrizamide filled up the sella turcica on a coronal CT scan — a finding that would confirm an empty sella. She proved to have primary empty sella syndrome and a surgical procedure was avoided. Back then, we thought that was a pretty slick way of figuring things out.

“Case reports can impart valuable insights and clinical nuances that cannot be found in large case series, clinical trials, or clinical practice guidelines. Many of my best teaching and learning opportunities have been based on the care of single patients with challenging clinical scenarios.”

William F. Young, Jr., MD, Tyson Family Endocrinology Clinical Professor, professor of medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minn.; editor-in-chief, JCEM Case Reports

EN: Absolutely.

WFY: We published that case report  in JAMA, that was back in the days when Journal of the American Medical Association was taking case reports. That was my first clinical publication.

EN: What’s your vision for the future of this publication?

WFY: Recognizing that many article submissions will be from clinicians in training, our editorial team will work with authors to optimize their case reports for clarity and key learning points. I am also eager to encourage submission of case reports that highlight approaches to challenging clinical scenarios where resources are limited. We can learn a lot from clinicians who see patients where resources are limited. Sharing that experience provides some very practical perspectives on different ways to approach the diagnosis and treatment of endocrine disorders. 

There will be an optional section for each article to offer the patient’s perspective. What did the patient think about the diagnostic evaluation and treatment of their endocrine disorder? I suspect that in many cases the patient perspective comments will be enlightening and surprising. My hope would be a third to a half of the reported cases will have a patient perspective paragraph.

“JCEM Case Reports will need to distinguish itself in this field. The journal will have an excellent start with the gravitas provided by the Endocrine Society and JCEM — it simply does not get better than that! However, active innovation will be necessary to make JCEM Case Reports a leader in this field.”

William F. Young, Jr., MD, Tyson Family Endocrinology Clinical Professor, professor of medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minn.; editor-in-chief, JCEM Case Reports

We will recruit master clinicians to write commentaries based on two to three case reports of variations on the same clinical theme. The commentaries will provide context and guidance on how the case reports inform the clinician on unique aspects of the clinical presentation, diagnosis, and treatment. In addition to case reports, the journal will encourage submissions of educational “Images in Endocrinology.” Those are just some of the plans we have for JCEM Case Reports.

EN: What do you feel will set this journal apart from other peer-reviewed journals in this field?

WFY: JCEM Case Reports will need to distinguish itself in this field. The journal will have an excellent start with the gravitas provided by the Endocrine Society and JCEM — it simply does not get better than that! However, active innovation will be necessary to make JCEM Case Reports a leader in this field. Our plans include strategies to make JCEM Case Reports an engaging and educational resource for clinicians from around the world. We will start accepting articles for consideration of publication in late summer of 2022.

Bagley is the senior editor of Endocrine News. In the April issue, he wrote about the possibility of how stem cell technology could potentially lead to a cure for diabetes.

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