Clinical Endocrinology最新文献

{"title":"Cardiovascular Health in Women-Across the Lifespan.","authors":"Jaya Chandrasekhar, Jessica Yao, Simone Gong, Madhuka Wijayarathne, Monique Watts, Swati Mukherjee","doi":"10.1111/cen.70027","DOIUrl":"10.1111/cen.70027","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) remains the leading cause of mortality and morbidity among women worldwide. However, CVD continues to be perceived as a predominantly male issue. CVD in women therefore remains understudied, underrecognized and undertreated. Starting in adolescence and extending into older age, lifestyle factors, psychosocial stressors, hormonal changes and pregnancy, significantly influence the cardiovascular health of women. This review provides a comprehensive overview of CVD in women, focusing on sex-specific risk factors, presentation, diagnosis, and treatment across the lifespan. The article seeks to raise awareness and provide insights into sex-specific prevention, diagnosis and management strategies. We highlight gaps in knowledge to underscore the importance of sex-based research that is crucial to improving outcomes for women with CVD.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"539-555"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Growth Hormone Adherence and Growth Outcomes in Paediatric Patients: Results From a Clinical Registry.","authors":"Tilman Robert Rohrer, Klaus Hartmann, Peter Herbert Kann, Tobias Vogelmann, Dorna Hogeabri, Tino Schubert","doi":"10.1111/cen.70105","DOIUrl":"10.1111/cen.70105","url":null,"abstract":"<p><strong>Objective: </strong>Daily growth hormone (GH) therapy for growth disorders requires long-term adherence. The aim of this study was to investigate the association of adherence with 2-year growth outcomes in paediatric patients receiving daily GH therapy in a clinical registry.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Patients: </strong>Patients with growth disorder were categorized after 2 years of treatment into low adherence (< 85%), high adherence (85%-110%) and adherence > 110% groups. Only patients with consistent adherence classification across both years were included in the 2-year outcome analysis.</p><p><strong>Measurements: </strong>Growth outcomes were compared the change in height standard deviation score (ΔHSDS) over 2 years. Statistical tests were performed using the nonparametric Spearman's rank correlation coefficient and a general linear regression model.</p><p><strong>Results: </strong>Seventy-four patients were analysed after 2 years of treatment. Mean ΔHSDS was 0.87 in the high adherence group and 0.33 in the low adherence group (absolute difference 0.54). Using the Spearman's correlation coefficient, ΔHSDS was statistically significantly positively correlated with high adherence compared to low adherence (rs = 0.33; p < 0.01). The linear regression results support these findings and estimate an improved ΔHSDS of 0.44 for patients in the high adherence group compared to the low adherence group (p = 0.03). Mean ΔHSDS in the adherence > 110% group was 0.79.</p><p><strong>Conclusion: </strong>Sustained high adherence (≥ 85%) to daily GH therapy was associated with clinically meaningful improvement in growth over 2 years.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"603-611"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characterization and Molecular Profiling by Targeted Next-Generation Sequencing in a Large Indian Cohort With 46,XY Differences in Sex Development.","authors":"Vandana Jain, Sukanya Priyadarshini, Rajni Sharma, Anil Kumar, Shilpa Sharma, Palany Raghupathy, Ralf Werner, Olaf Hiort, Mohammed Faruq","doi":"10.1111/cen.70122","DOIUrl":"10.1111/cen.70122","url":null,"abstract":"<p><strong>Background: </strong>46,XY differences in sex development (DSD) comprise a heterogeneous group of conditions. Molecular diagnosis guides management by giving insights into the pathophysiology of sex development, reproduction, tumour formation and extragenital issues.</p><p><strong>Methods: </strong>Children with 46,XY DSD from a tertiary hospital in India underwent comprehensive assessment and stepwise genetic testing. Targeted testing for SRD5A2 and AR was performed in cases with suspected 5α-reductase type 2 (5αR2) deficiency/androgen insensitivity syndrome (AIS). For all other patients, and those without variants in SRD5A2 or AR on Sanger sequencing, NGS using a targeted 155-gene panel was performed. Longitudinal clinical data was also collated.</p><p><strong>Results: </strong>One hundred and forty-seven children with 46,XY DSD with a median (interquartile range) age of 3.8 (1.4, 10.6) years were enrolled. Provisional clinical diagnoses were 5αR2 deficiency/AIS (n = 83, 56.5%), gonadal dysgenesis (n = 31, 21%), testosterone biosynthetic defect (n = 11, 7.5%) and others (n = 22, 15%) based on clinical, biochemical and radiological assessment. Sequential single gene testing for SRD5A2 and AR performed in 75 patients with a clinical diagnosis of 5αR2 deficiency/AIS identified pathogenic/likely pathogenic variants in 44 subjects. NGS in the remaining 103 children revealed pathogenic/likely pathogenic variants in 20 subjects across 12 genes, with NR5A1 being the most frequent (7/103). Four subjects had variants of uncertain significance (VUS) deemed possibly pathogenic due to good genotype-phenotype correlation. Overall, 68/147 (46%) achieved a molecular diagnosis in this cohort.</p><p><strong>Conclusion: </strong>Sanger sequencing followed by NGS could provide molecular diagnosis in 46% of this Indian cohort with 46,XY DSD. SRD5A2, AR and NR5A1 were the most frequently implicated genes.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"612-627"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376292","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":"Cholestasis With ACTH/Cortisol Deficiencies and Hypopituitarism.","authors":"Aaron Hanukoglu, Shirli Abiri","doi":"10.1111/cen.70128","DOIUrl":"10.1111/cen.70128","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"702-703"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431235","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":"Is Caruncular Oedema a Reliable Indicator in the Clinical Activity Score for Thyroid Eye Disease? An Analysis of Bias and Observer Variability.","authors":"Marie Callet, Laura Licini, Océanne Haelewyn, Clara Bouche, Pauline Launay, Lucas Robelin, Sophie Azria, Edgard Farah, Marie Laure Herdan, Pierre Vincent Jacomet, Mathieu Zmuda, Olivier Galatoire","doi":"10.1111/cen.70112","DOIUrl":"10.1111/cen.70112","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the inter-observer reliability of the caruncular oedema criterion within the Clinical Activity Score (CAS) for thyroid eye disease (TED), and to investigate potential biases affecting its grading, including the influence of image review order and confounding from conjunctival hyperaemia and caruncular erythema.</p><p><strong>Design and patients: </strong>We retrospectively reviewed 773 standardised photographs from 261 TED patients.</p><p><strong>Measurements: </strong>Three independent ophthalmologists graded each image for caruncular oedema, caruncular erythema, and conjunctival hyperaemia. To assess the effect of repetition bias, a subset of images was evaluated in both random and sequential (chronological) order. Inter-observer agreement was quantified using Cohen's kappa, systematic differences were tested with McNemar's test, and agreement strength was interpreted according to Landis and Koch's classification.</p><p><strong>Results: </strong>Inter-rater agreement for caruncular oedema was slight (κ = 0.10, 95% CI: 0.06-0.15), and substantially lower than for conjunctival hyperaemia (κ = 0.30, 95% CI: 0.26-0.35). When comparing sequential with random readings, agreement was poor for two graders, both demonstrating significant order-related bias (p = 0.022 and < 0.001), and only moderate but non-significant for the third (κ = 0.49, p = 0.147). Across graders, oedema was more often identified in sequential order, consistent with a repetition (\"yes-set\") bias. Furthermore, caruncular erythema and conjunctival hyperaemia were strongly associated with oedema scoring: a red or congested caruncle markedly increased the likelihood of false-positive oedema calls. These confounders likely explain the limited reproducibility of this CAS item.</p><p><strong>Conclusions: </strong>Caruncular oedema scoring within the CAS shows poor inter-observer reliability and vulnerability to cognitive and visual biases. Conjunctival and caruncular hyperaemia act as significant confounders, inflating disease activity scores and potentially shifting patients across the CAS threshold (> 3) that guides immunosuppressive treatment. Given these limitations, refinement or replacement of this criterion, through either objective imaging tools or alternative markers such as ocular hypertension, should be considered to improve the reproducibility and diagnostic value of the CAS in both ophthalmology and endocrinology practice.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"664-669"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269723","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":"ACTH Stimulation Testing Is Often Unnecessary After Appropriate Patient Preparation Prior to Screening Cortisol Measurement.","authors":"Christopher J Symonds, Alexander A Leung, Gregory A Kline","doi":"10.1111/cen.70102","DOIUrl":"10.1111/cen.70102","url":null,"abstract":"<p><strong>Context: </strong>Screening morning serum cortisol is used to select patients for ACTH stimulation testing to diagnose adrenal insufficiency (AI) but may be affected by pre-analytical factors. Careful consideration to discontinue confounding medications beforehand may preclude the need for subsequent stimulation testing.</p><p><strong>Objective: </strong>To determine whether serum cortisol collected after discontinuation of confounding medications is more predictive of AI compared to screening morning cortisol without mandatory medication adjustment.</p><p><strong>Methods: </strong>Retrospective chart review of 835 patients with ACTH stimulation testing (Short Synacthen Test [SST]). Linear regression to compare Roche Cortisol II immunoassay screening cortisol versus optimally collected cortisol measurements after removal of confounding medications. Receiver operating characteristic (ROC) curve analyses to identify 100% sensitivity threshold for AI.</p><p><strong>Results: </strong>The majority of patients passed the SST (n = 756; 90.5%). There was a poor correlation between screening morning cortisol and optimally collected cortisol measurements, r = 0.34 (95% CI, 0.25-0.42). Real-world screening morning cortisol measurements had moderate discrimination for the diagnosis of AI (AUC 0.80; 95% CI, 0.77-0.82; p < 0.001) with a 100% sensitivity threshold for AI of 262 nmol/L. Applying this threshold would save 112 SSTs (13.4% of all tests). In contrast, an optimally collected serum cortisol had strong discrimination for AI (AUC 0.89; 95% CI, 0.87-0.91; p < 0.0001) and the threshold with 100% sensitivity for the diagnosis was 246 nmol/L which would save another 4.8% of all tests.</p><p><strong>Conclusion: </strong>Careful attention to pre-test patient preparation and implementation of a lower cortisol threshold may significantly reduce the number of stimulation tests needed to screen for AI.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"567-573"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Management of Thyroid Nodules: A Joint Consensus Statement From the British Thyroid Association (BTA), British Association of Endocrine and Thyroid Surgeons (BAETS) and Collaborating Bodies.","authors":"Ram Moorthy, Saba P Balasubramanian, Kate Farnell, Mairead Kelly, Gitta Madani, Mufaddal Moonim, Carla Moran, Julia Priestley, Michael Stechman, Emma Watts, Kristien Boelaert","doi":"10.1111/cen.70116","DOIUrl":"10.1111/cen.70116","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"682-692"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-RAI Monocyte-to-Lymphocyte Ratio Predicts Early and Higher Recurrence Risk in Intermediate-Risk DTC, While PNI and NRI Show No Prognostic Value.","authors":"Tommaso Piticchio, Francesco Galeano, Salvatore Volpe, Antonio Prinzi, Ignazio Barca, Andrea Scuto, Rosario Le Moli, Giulio Geraci, Andrea Tumminia, Sium Wolde Sellasie, Francesco Pallotti, Francesco Frasca","doi":"10.1111/cen.70113","DOIUrl":"10.1111/cen.70113","url":null,"abstract":"<p><strong>Objective: </strong>Differentiated thyroid carcinoma (DTC) has an excellent prognosis, but recurrence remains a clinical concern, especially in intermediate-risk patients. Current stratification systems focus primarily on tumor characteristics, overlooking the host's biological capacity to counteract tumor progression. To investigate this aspect, we assessed systemic inflammatory and nutritional status using hematological indices. The study aimed to evaluate the prognostic value of these markers in predicting recurrence risk in patients with intermediate-risk DTC.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients with intermediate-risk DTC who met the following criteria: (1) were classified as intermediate risk according to ATA guidelines; (2) showed an excellent or indeterminate response 12 months after initial treatment; and (3) had at least three consecutive years of follow-up at our center after thyroidectomy. Nine hematological indices were calculated from blood samples collected on the day of RAI administration. Statistical analyses included ROC curve analysis, logistic regression, and Kaplan-Meier analysis.</p><p><strong>Results: </strong>A total of 282 patients were included, with a median follow-up of 91 months. Among the indices tested, the monocyte-to-lymphocyte ratio (MLR) predicted recurrence better than the others. A cut-off of 0.188 yielded 82.9% sensitivity and 54.7% specificity (AUC: 0.70). In multivariate analysis, high MLR (OR  =  4.94, p  <  0.001), tumor size, vascular invasion, and lymph node metastases were independently associated with recurrence. Cox regression confirmed MLR as an independent predictor of shorter recurrence-free survival (HR  =  3.01, p <  0.001). Nutritional indices showed no prognostic value.</p><p><strong>Conclusions: </strong>Pre-RAI MLR may serve as a simple marker to refine recurrence risk stratification and personalize follow-up in intermediate-risk DTC.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"670-681"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation and Maintenance of Low-Dose Transdermal Testosterone in Non-Binary Individuals: A Retrospective Audit.","authors":"Eli Ward-Smith, Ada S Cheung, Peter Locke, Sav Zwickl, Brendan J Nolan","doi":"10.1111/cen.70110","DOIUrl":"10.1111/cen.70110","url":null,"abstract":"<p><strong>Objective: </strong>An increasing number of trans individuals, particularly those who are non-binary, desire lower testosterone doses than those outlined in current guidelines for gender affirmation. These guidelines acknowledge the need for a tailored approach to treatment, especially for non-binary people. However, existing guidelines for initiation of testosterone assume that trans individuals desire rapid and complete masculinisation through standard dosing. We aimed to assess the initiation and maintenance of low-dose testosterone in non-binary individuals treated with transdermal testosterone for ≥ 6 months.</p><p><strong>Design: </strong>Retrospective audit.</p><p><strong>Patients: </strong>Non-binary individuals initiating low-dose transdermal testosterone with ≥ 6 months follow-up.</p><p><strong>Intervention: </strong>Testosterone 1% gel (< 50 mg daily) or testosterone 5% cream (< 100 mg daily).</p><p><strong>Measurements: </strong>Transdermal testosterone dose and serum total testosterone concentration.</p><p><strong>Results: </strong>Forty-six individuals were included. Median age was 27 years (24-30) and duration of testosterone was 14 months (9-24). For individuals treated with testosterone 1% gel, median dose at initiation was 12.5 mg (12.5-25) and 25 mg (20.4-37.5) at last follow-up (p < 0.01), and for those treated with testosterone 5% cream, the median dose at initiation was 50 mg (31.3-50) and 50 mg (50-68.8) at last follow-up (p = 0.02). Median serum total testosterone concentration was 11 nmol/L (5.2-15.7). By the last follow-up, 40 (87%) remained on low-dose testosterone and 6 (13%) had increased to full-dose testosterone. In a subgroup of 30 individuals with ≥ 12 months treatment, 26 (87%) remained on low-dose testosterone by last follow-up. Three (7%) individuals had polycythemia (haematocrit > 0.5).</p><p><strong>Conclusions: </strong>Most non-binary individuals initiating low-dose transdermal testosterone continue doses lower than those recommended in current guidelines after 6-12 months of treatment. These hypothesis-generating findings highlight the need for studies evaluating the influence of low-dose testosterone on clinical outcomes and safety end-points.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"657-663"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Neuroendocrine Role of Oxytocinergic Pathways in Obesity.","authors":"Xueqin Liu, Yunfeng Chen, Yanmei Huang, Xinhua Xiao, Xiaolin Zhong","doi":"10.1111/cen.70111","DOIUrl":"10.1111/cen.70111","url":null,"abstract":"<p><p>Oxytocin (OXT) and its neuronal system demonstrate significant therapeutic potential for obesity and related metabolic disorders. Preclinical studies indicate that OXT promotes weight loss by suppressing food intake, enhancing energy expenditure, and stimulating lipolysis. However, clinical trial results have been heterogeneous, and challenges such as long-term safety concerns and difficulties in dose control hinder its clinical translation. Further elucidation of the neuroendocrine interactions between oxytocinergic neurons and metabolic regulation, along with exploration of targeted neuronal activity modulation, may provide critical breakthroughs for developing effective and safe obesity treatments.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"556-566"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282437","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}