Clinical Endocrinology最新文献

{"title":"Endoscopic Ultrasound-Guided Ethanol Ablation for Benign Insulinoma: A Single-Centre Experience and Literature Review.","authors":"Yuchao Wu, Haitao Shi, Xiaokang Wu, Ying Kong, Xueqian Li, Lijing Yan, Juanjuan Wu, Shimei Ding, Jing Zhang, Ruo Zhang, Chunhong Zhang, Jing Xu, Aiyu Jing, Xuan Xie, Shiyang Ma, Yang Jiao","doi":"10.1111/cen.70219","DOIUrl":"https://doi.org/10.1111/cen.70219","url":null,"abstract":"<p><strong>Objectives: </strong>Insulinoma is a predominantly benign pancreatic neuroendocrine tumour that is traditionally managed surgically. However, surgical invasiveness and anaesthesia-related risks limit its applicability in selected patients. Endoscopic ultrasound (EUS)-guided ethanol ablation has emerged as a minimally invasive alternative. This study aimed to evaluate the efficacy, safety, and feasibility of EUS-guided ethanol ablation for benign insulinoma.</p><p><strong>Methods: </strong>We retrospectively analysed 17 patients with insulinoma who underwent EUS-guided ethanol ablation, predominantly as a primary treatment. All procedures were performed by experienced gastroenterologists using 95% absolute ethanol.</p><p><strong>Results: </strong>The study cohort had a mean age of 58.47 ± 12.29 years and a mean disease duration of 34.43 months (range, 0.36-84.0). Clinical success was achieved in 16 patients (94.1%). One patient with an initial suboptimal response successfully underwent a repeat ablation after 8 months. Over a median follow-up period of 46.1 months (range, 6.6-97.8), one patient was lost to follow-up. Disease recurrence was observed in four patients, resulting in a recurrence rate of 25% (4/16) among those with available follow-up data. Three recurrent cases underwent repeat ablation, all achieving symptomatic resolution. A total of 22 ablation procedures were performed. Adverse events were documented in 36.4% (8/22) of procedures, with the majority being mild (31.8%, 7/22) and one severe adverse event (4.5%, 1/22).</p><p><strong>Conclusions: </strong>EUS-guided ethanol ablation is an effective and well-tolerated treatment for benign insulinoma. It represents a viable minimally invasive alternative to surgery and remains effective for managing recurrence or initial treatment failure without compromising subsequent surgical options.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LGALS3 Drives Dopamine Agonist Resistance in Prolactinoma by Activating the MAPK/ERK Pathway: A Multi-Omics Study.","authors":"Changjun Rao, Xiaoyan Liu, Yangyu Luo, Chuzhong Li, Zerui Wu","doi":"10.1111/cen.70220","DOIUrl":"https://doi.org/10.1111/cen.70220","url":null,"abstract":"<p><strong>Background: </strong>Dopamine agonist resistance is observed in 10%-30% of patients with prolactinomas, resulting in therapeutic failure and tumour progression. The molecular mechanisms underlying this resistance are not yet fully understood, highlighting the need for the identification of novel biomarkers and therapeutic targets.</p><p><strong>Methods: </strong>We performed a comprehensive integrative analysis of bulk RNA sequencing and single-cell RNA sequencing datasets obtained from dopamine agonist-resistant and dopamine agonist-sensitive prolactinomas. To substantiate the primary findings, we utilised a multifaceted methodological framework that integrated Weighted Gene Co-expression Network Analysis with machine learning techniques, including Random Forest, Support Vector Machine, and Least Absolute Shrinkage and Selection Operator. This was complemented by functional assays, which encompassed in vitro experiments involving gene overexpression and knockdown in GH3 cell models, alongside in vivo investigations using nude mouse xenograft models.</p><p><strong>Results: </strong>LGALS3 has been identified as a pivotal factor in mediating resistance. Through single-cell RNA sequencing analysis, a resistance-specific subpopulation, termed Cluster 15, was discovered. This cluster is characterised by heightened genomic instability and stemness, as evidenced by increased expression of SOX2 and SOX9, with predominant expression of LGALS3. Mechanistically, LGALS3 activates the MAPK/ERK signalling pathway, which in turn enhances cell viability, prolactin secretion, and migration, while simultaneously inhibiting apoptosis by modulating the Bax/Bcl-2/Caspase cascade. Functional validation studies demonstrated that silencing LGALS3 significantly reduced tumour growth both in vitro, as shown by decreased Ki67 proliferation and impaired migration, and in vivo, as indicated by reduced tumour weight and volume.</p><p><strong>Conclusion: </strong>LGALS3 functions as a candidate diagnostic biomarker and represents a promising therapeutic target. Targeting the LGALS3-MAPK axis presents a viable strategy to restore therapeutic sensitivity in patients with refractory prolactinoma.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival in Patients With Pituitary Carcinoma.","authors":"Oksana Hamidi, Dana Erickson, Jorge Trejo-Lopez, Candace Dalpiaz-Sietz, Wlliam F Young, Mabel Ryder, John Atkinson, Jamie J Van Gompel, Diane Donegan","doi":"10.1111/cen.70221","DOIUrl":"https://doi.org/10.1111/cen.70221","url":null,"abstract":"<p><strong>Objective: </strong>Pituitary carcinoma (PC) is defined by the presence of metastasis from a pituitary tumour. PC is rare, therefore information regarding survival and factors influencing survival are limited. We sought to assess overall survival following the diagnosis of PC and to determine factors associated with outcome.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Patients: </strong>Patients with PC who attended the Mayo clinic between 1997 and 2025.</p><p><strong>Measurements: </strong>Information regarding patient demographics, tumour characteristics, management and outcomes were extracted.</p><p><strong>Results: </strong>In total 25 patients (11 women, 44%) were diagnosed with PC (median age 56 years, range, 44-78). The most common cell type was a corticotroph tumour (n = 15, 60%). All but one patient had pituitary directed surgery and all received pituitary adenoma (PA) directed radiation therapy. Metastases were identified a median 6 years (range, 1-32) after initial PA diagnosis. At last follow-up, 10 (40%) patients were alive, 12 (48%) died of PC, and 3 (12%) died from other causes. The median survival time of patients from PC diagnosis was 3 years. The 1-, 5- and 10-year survival rates were 59%, 37% and 15%, respectively. Increased survival probability was associated with temozolomide treatment (n = 9) at some point in treatment plan (p = 0.026), the use of systemic therapy vs locoregional treatment (p = 0.045), female sex (p = 0.011), and in nonfunctional tumours (p = 0.023).</p><p><strong>Conclusion: </strong>PC carries a poor prognosis, with a median survival of only 3 years. Improved survival was associated with temozolomide exposure, female sex, and nonfunctional tumour subtype and underscores the prognostic relevance of tumour biology and treatment approach.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nailfold Capillaroscopy in Primary Hyperparathyroidism: Cautions Regarding Biomarker Claims and Methodology.","authors":"Guihua Zhao","doi":"10.1111/cen.70224","DOIUrl":"https://doi.org/10.1111/cen.70224","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortisol Cutoffs for Adrenal Insufficiency Using Elecsys II: A Systematic Review.","authors":"Sarah Haunton, Nicola Leppinen, Heather MacDonald, Rebecca A Tobin, Raoul Rooman, Leanne M Ward, Alexandra Ahmet, Utkarsh J Dang","doi":"10.1111/cen.70218","DOIUrl":"https://doi.org/10.1111/cen.70218","url":null,"abstract":"<p><strong>Objective: </strong>Adrenal insufficiency (AI) is associated with increased risk of morbidity and mortality if improperly managed. Adrenocorticotrophin (ACTH) stimulation testing is the most widely used AI diagnostic test. Historically, a serum cortisol threshold of 500 nmol/L (18.1 µg/dL), derived using polyclonal assays, was widely used. Improved monoclonal immunoassays show reduced cross-reactivity and lower cortisol values, but no universally accepted ACTH-stimulated cortisol threshold exists. Suggestions ranging between 348 and 485 nmol/L [12.6-17.6 µg/dL] reflect methodology and cohort differences. Our objective was to systematically review the literature and recommend a revised cortisol threshold.</p><p><strong>Design and methods: </strong>We searched MEDLINE, Web of Science, and Google Scholar for English language studies published between January 2016 and 19 September 2023 (PROSPERO CRD42023479405). Eligible studies reported original data, used the Roche Elecsys II assay, and recommended a cortisol threshold. Quality of evidence was assessed using the GRADE framework, and risk of bias with the ArRoWS questionnaire. Multiple suggested thresholds based on ROC, sensitivity/specificity, or regression analysis were identified.</p><p><strong>Results: </strong>Six studies involving 1799 samples from 430 adult and paediatric patients were included. A serum cortisol cutoff of 405 nmol/L (14.7 µg/dL) was defined based on synthesis, sensitivity analysis, and a conservative approach to reduce false‑negatives.</p><p><strong>Conclusions: </strong>We affirm recommendations to lower the cortisol threshold for AI when using monoclonal assays. A peak threshold of 405 nmol/L (14.7 µg/dL) is suggested for a standard-dose ACTH test on the Elecsys II assay for diagnosis of AI, acknowledging limitations related to the small number and GRADE quality of included studies.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Risk of Thyrotoxicosis After COVID-19 in Adolescents and Young Adults During the Omicron-Predominant Period: A Nationwide Matched Study.","authors":"Koichi Miyashita, Kenji Ohba, Hironao Hozumi, Kazuki Furuhashi, Tomoyuki Fujisawa, Naoki Inui, Toshiyuki Ojima, Takafumi Suda","doi":"10.1111/cen.70217","DOIUrl":"https://doi.org/10.1111/cen.70217","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid dysfunction has been increasingly reported after the coronavirus disease 2019 (COVID-19) pandemic. To date, no population-based study has examined this association using more than 10 million matched pairs. We compared the risk of documented thyroid outcomes after COVID-19 with that after influenza during the Omicron-predominant period.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective cohort study using the Japanese National Database of Health Insurance Claims, including patients with COVID-19 between January 2022 and March 2023, and those with influenza between September 2017 and March 2023. Individuals with pre-existing thyroid disease were excluded. After 1:1 propensity score matching, 24,173,646 pairs were analysed. Database-recorded outcomes assessed within 90 days of documented COVID-19 infection included diagnoses of thyrotoxicosis, hypothyroidism and subacute thyroiditis, as well as initiation of antithyroid drugs (ATDs) and thyroid hormone replacement therapy (THRT).</p><p><strong>Results: </strong>Among database-recorded outcomes, COVID-19 was associated with higher risks of thyrotoxicosis diagnosis (risk ratio [RR], 1.08), hypothyroidism diagnosis (RR, 1.12), ATD initiation (RR, 1.06) and THRT initiation (RR, 1.22) than influenza, but not subacute thyroiditis diagnosis. Age-stratified analyses showed markedly higher risks in individuals aged 0-19 years for thyrotoxicosis diagnosis (RR, 1.38) and ATD initiation (RR, 1.77).</p><p><strong>Conclusions: </strong>In this nationwide cohort, COVID-19 was associated with higher risks of database-recorded diagnoses of thyrotoxicosis and hypothyroidism than influenza during the Omicron-predominant period. The strongest association was observed for thyrotoxicosis diagnosis and ATD initiation in younger individuals, underscoring the importance of post-COVID-19 thyroid monitoring in adolescents and young adults.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Infections: An Underrecognized Cause of Primary Adrenal Insufficiency.","authors":"Taweesak Wannachalee, Suranut Charoensri, Rongpong Plongla, Thiti Snabboon, Sarat Sunthornyothin, Wasita Warachit Parksook","doi":"10.1111/cen.70222","DOIUrl":"https://doi.org/10.1111/cen.70222","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenal infections are an underrecognized but clinically significant cause of primary adrenal insufficiency (PAI).</p><p><strong>Objectives: </strong>This review proposes a diagnostic algorithm for the evaluation of suspected cases.</p><p><strong>Results: </strong>The most common causative pathogens are Mycobacterium tuberculosis and Histoplasma capsulatum; however, bacterial infections and viral pathogens such as cytomegalovirus (CMV) and SARS-CoV-2 (COVID-19) have also been reported. These infections, particularly in tuberculosis and histoplasmosis, can induce granulomatous inflammation, tissue necrosis, and destruction of the adrenal glands, leading to systemic symptoms and hormonal deficiency. The prevalence of adrenal insufficiency varies widely, ranging from 14% to 100%, depending on the study population and diagnostic criteria. Affected patients may present across a broad clinical spectrum, from chronic adrenal insufficiency to adrenal crisis, and some patients may be identified incidentally through imaging performed for unrelated indications. Computed tomography is the primary imaging modality for diagnosing adrenal infection, typically demonstrating bilateral adrenal lesions characterized by hypodensity with central necrosis, peripheral rim enhancement, and calcification. In contrast, during the late phase, the adrenal glands progressively decrease in size and may become atrophic, particularly in tuberculosis, and often with persistent calcifications. Tissue biopsy with histopathological examination and culture remains the definitive diagnostic tool to confirm the infectious etiology.</p><p><strong>Conclusions: </strong>Early recognition is essential, as management requires two complementary approaches: 1. antimicrobial therapy directed at the causative pathogen, and 2. hormonal replacement in patients with established adrenal insufficiency and longitudinal hormonal surveillance in those with preserved adrenal reserve at initial presentation.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Care Model for Differences in Sex Development: An Implementation Research Study.","authors":"Sukanya Priyadarshini, Ankesh Singh, Kaushal Kulkarni, Devendra Kumar Yadav, Rajesh Sagar, Rajni Sharma, Minu Bajpai, Vandana Jain","doi":"10.1111/cen.70211","DOIUrl":"https://doi.org/10.1111/cen.70211","url":null,"abstract":"<p><strong>Objective: </strong>To initiate a multidisciplinary care model for patients with differences in sex development (MD-DSD), assess its implementation, and evaluate changes in perceived quality of care following implementation among parents and health-care providers (HCPs).</p><p><strong>Design: </strong>Implementation research.</p><p><strong>Setting: </strong>Tertiary care Institute at New Delhi.</p><p><strong>Patients: </strong>Patients aged 0-22 years with DSD, receiving care in single-specialty clinics at the Institute.</p><p><strong>Interventions: </strong>A core MD-DSD team comprising specialists from Paediatric Endocrinology, Paediatric Surgery and Psychiatry was formed. Multidisciplinary clinics were conducted monthly, and board meetings for difficult cases were held bi-monthly, with participation from all core and requisite allied specialties.</p><p><strong>Main outcome measures: </strong>The primary outcome was successful implementation of MD-DSD clinics and board meetings, defined by representation from all three core specialties. Secondary outcomes included changes in the Perceived Quality-of-Care Questionnaire (PQCQ) scores (administered to parents at baseline and after attending two clinics, score range: 9-45), and perceptions of participating HCPs at study completion.</p><p><strong>Results: </strong>Over 28 months, 28 clinics and 13 meetings were held. A total of 188 patients (46,XX DSD, 69; 46,XY DSD, 104; and sex chromosome DSD, 15) attended the MD-DSD clinics; and 44 of these were also reviewed in MD-DSD meetings, predominantly for concerns relating to gender of rearing and decision on surgical intervention. Participation from all core specialties was present in 26 (93%) clinics and 12 (92%) meetings. The PQCQ scores (N = 79) improved from 32.2 ± 5.7 to 36.4 ± 4.5 (p < 0.001), contributed chiefly by improved parent knowledge and attention to psychosocial needs. The participating HCPs (N = 12/15) believed that the model was sustainable.</p><p><strong>Conclusions: </strong>The MD-DSD care model was feasible and demonstrated favourable perceived sustainability, with improvement in the perceived quality of care reported by both parents and HCPs.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic Protein Profile Changes During Gender-Affirming Hormone Therapy: A Prospective Clinical Study.","authors":"Emilie Bukh Madsen, Louise Lehmann Christensen, Sara Ravn Bach, Louise Skøttrup Christiansen, Mathilde Kamp Nørlund, Tine Taulbjerg Kristensen, Guy T'Sjoen, Anne Pernille Hermann, Camilla Viola Buskbjerg Palm, Jan Frystyk, Marianne Skovsager Andersen, Martin Overgaard, Dorte Glintborg","doi":"10.1111/cen.70209","DOIUrl":"https://doi.org/10.1111/cen.70209","url":null,"abstract":"<p><strong>Objective: </strong>Cardiovascular disease (CVD) risk is elevated in transgender individuals during gender-affirming hormone therapy (GAHT) with expected different mechanisms between T- and E2-based GAHT. We investigated prospective changes in cardiometabolic proteins relating to complement, inflammation, and transport during GAHT.</p><p><strong>Design: </strong>Prospective clinical study with assessment at baseline and after 1 year of GAHT.</p><p><strong>Patients: </strong>The main study population comprised 55 GAHT-naïve individuals (34 TM, 21 TF). An additional 35 GAHT-ongoing individuals (26 TM, 9 TF) were included as a cross-sectional comparison group at baseline.</p><p><strong>Measurements: </strong>19 cardiometabolic proteins relating to atherosclerotic and thrombotic processes were analysed using targeted proteomics. Body composition was assessed by dual-energy X-ray absorptiometry.</p><p><strong>Results: </strong>In GAHT-naïve TM individuals, the mean age at baseline was 27 years and median BMI was 26.5 (22.3-28.9) kg/m². Following T-based GAHT, complement factor H and B, 3, 4b, and transport proteins (sex hormone-binding globulin, ceruloplasmin, corticosteroid-binding globulin, vitamin D-binding protein, vitronectin, and afamin) decreased, and transthyretin increased. In GAHT-naïve TF individuals, the mean age at baseline was 27 years and median BMI was 21.5 (20.3-23.6) kg/m². Following E2-based GAHT, complement factor H and B, 3, 4b, 9, C-reactive protein, immunoglobulin heavy constant alpha 1 (IGHA1), and transport proteins increased. In cross-sectional analyses, complement factor H and B, 3, 4b, 9, C-reactive protein, IGHA1, and afamin were higher in GAHT-ongoing TF individuals at baseline compared to GAHT-naïve TF individuals at 1 year.</p><p><strong>Conclusion: </strong>T- and E2-based GAHT were associated with opposite directional changes in cardiometabolic protein profiles.</p><p><strong>Trial registration: </strong>ClinicalTrials. gov (Identifier: NCT04254354, NCT05169762).</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulinoma With Secondary Adrenal Dysfunction: Clinical Characteristics and High-Risk Factors.","authors":"Mengni Li, Yu Luo, Xi Chen, Xia Wang, Yao Chen, Junhui Xie","doi":"10.1111/cen.70210","DOIUrl":"https://doi.org/10.1111/cen.70210","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study is to investigate the clinical characteristics and high-risk factors of insulinoma combined with secondary adrenal cortical dysfunction.</p><p><strong>Methods: </strong>We conducted a retrospective study including 44 surgically confirmed insulinoma patients and 16 diabetes patients with hypoglycemia from 2010 to 2023. Serum cortisol was measured on non-hypoglycemic days at three time points (8 AM, 4 PM, and 0 AM), and ACTH was measured at 8 AM on non-hypoglycemic days. Tumour size was assessed by imaging and pathology. Significance for all analyses were determined at the p < 0.05. IBM SPSS Statistic 27 was used for statistical analysis.</p><p><strong>Results: </strong>Compared to type 2 diabetes patients with hypoglycemia, insulinoma patients had lower serum cortisol at three points (8 AM, 4 PM, 0 AM) and lower blood glucose levels during hypoglycemia. In insulinoma patient group, patients with insulin release index (IRI) > 1.2 and the insulin levels > 38.6 μIU/mL had larger tumour diameters compared to the patients with IRI < 0.3 and 18.8-38.6 μIU/mL, respectively. The tumour diameters ≥ 1 cm group had lower morning serum cortisol and ACTH compared to those with tumour diameters < 1 cm group. In insulinoma groups, the tumour diameter is negatively correlated with morning cortisol (r = -0.44, p = 0.013), positively correlated with insulin (r = 0.437, p = 0.014), and insulin release index (r = 0.506, p = 0.004).</p><p><strong>Conclusions: </strong>Insulinoma patients with secondary adrenal dysfunction have a higher risk of severe hypoglycemia. Our study suggest a potential correlation between tumour size and secondary adrenal dysfunction in insulinoma patients which may increase perioperative risks. Routine screening for adrenal cortical function is recommended to prevent the occurrence of more serious complications.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}