Clinical Endocrinology最新文献

{"title":"Macroprolactin over time: Is there any point in rechecking it in people with a persistently elevated serum prolactin?","authors":"Mark Livingston,&nbsp;Syeda F. Hashmi,&nbsp;Sudarshan Ramachandran,&nbsp;Ian Laing,&nbsp;Adrian Heald","doi":"10.1111/cen.15051","DOIUrl":"10.1111/cen.15051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective and Design</h3>\u0000 \u0000 <p>Macroprolactinemia may influence the interpretation of serum prolactin levels—a recognised phenomenon since 1981. The degree of macroprolactinaemia over time is less well described. We determined how macroprolactin status (based on polyethylene glycol (PEG) precipitation) varied by analysing serial measurements in hyperprolactinaemic individuals over a period of 9 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Measurements</h3>\u0000 \u0000 <p>Results from 1810 individuals were included. All serum total prolactin results (measured using Roche Cobas 8000 analyser) were extracted from the laboratory information system for the period 1 January 2012 to 1 April 2021, along with relevant patient demographic/test data. Samples with a macroprolactin screening test performed (on samples with prolactin &gt; 700 miu/L) were included in the main analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 2782 macroprolactin checks were performed (12.5% of all prolactin tests) in 1810 individuals (599 males/2183 females, median-age: 35, interquartile range: 25–47, range: 16–93 years). Multiple macroprolactin checks were carried out on 465 patients (1437 measurements) with 94 patients (141 measurements) screening positive (&lt;60% recovery). Only 19 patients (18 female) had at least one result above and one below the 60% screening cut-off, with 10 of these patients having results close to the 60% cut-off; in 9 patients, results were clearly different between repeat samples. In seven cases, the adjusted monomeric prolactin showed a potentially clinically significant difference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study, only 19/465 patients appeared to change macroprolactin status based on a 60% PEG recovery cut-off. The majority of these 19 patients were on antipsychotic/antidepressant medication(s) or had a prolactinoma; in only 7 did monomeric prolactin change significantly. This suggests that once macroprolactin status has been determined, clinical decision making is rarely affected by repeating it.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"450-458"},"PeriodicalIF":3.2,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140293006","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":"Value of cannulated prolactin testing in identifying true hyperprolactinaemia in females of reproductive age","authors":"Su Ann Tee,&nbsp;Hady Gad,&nbsp;Christopher Boot,&nbsp;Andy James,&nbsp;Yaasir Mamoojee,&nbsp;the RVI Endocrine Group","doi":"10.1111/cen.15048","DOIUrl":"10.1111/cen.15048","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"447-449"},"PeriodicalIF":3.2,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173914","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":"Service evaluation suggests variation in clinical care provision in adults with congenital adrenal hyperplasia in the UK and Ireland","authors":"Lauren Madden Doyle,&nbsp;S. Faisal Ahmed,&nbsp;Jessica Davis,&nbsp;Sue Elford,&nbsp;Yasir S. Elhassan,&nbsp;Lynette James,&nbsp;Neil Lawrence,&nbsp;Sofia Llahana,&nbsp;Grace Okoro,&nbsp;D. Aled Rees,&nbsp;Jeremy W. Tomlinson,&nbsp;Michael W. O'Reilly,&nbsp;Nils P. Krone","doi":"10.1111/cen.15043","DOIUrl":"10.1111/cen.15043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Congenital adrenal hyperplasia (CAH) encompasses a rare group of autosomal recessive disorders, characterised by enzymatic defects in steroidogenesis. Heterogeneity in management practices has been observed internationally. The International Congenital Adrenal Hyperplasia registry (I-CAH, https://sdmregistries.org/) was established to enable insights into CAH management and outcomes, yet its global adoption by endocrine centres remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We sought (1) to assess current practices amongst clinicians managing patients with CAH in the United Kingdom and Ireland, with a focus on choice of glucocorticoid, monitoring practices and screening for associated co-morbidities, and (2) to assess use of the I-CAH registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>We designed and distributed an anonymised online survey disseminated to members of the Society for Endocrinology and Irish Endocrine Society to capture management practices in the care of patients with CAH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Marked variability was found in CAH management, with differences between general endocrinology and subspecialist settings, particularly in glucocorticoid use, biochemical monitoring and comorbidity screening, with significant disparities in reproductive health monitoring, notably in testicular adrenal rest tumours (TARTs) screening (<i>p</i> = .002), sperm banking (<i>p</i> = .0004) and partner testing for CAH (<i>p</i> &lt; .0001). Adoption of the I-CAH registry was universally low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Differences in current management of CAH continue to exist. It appears crucial to objectify if different approaches result in different long-term outcomes. New studies such as CaHASE2, incorporating standardised minimum datasets including replacement therapies and monitoring strategies as well as longitudinal data collection, are now needed to define best-practice and standardise care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 4","pages":"386-396"},"PeriodicalIF":3.0,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142914","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":"A nationwide registry-based observational study of thyroid disease incidence in the Faroe Islands","authors":"Herborg Líggjasardóttir Johannesen,&nbsp;Anna Sofía Veyhe,&nbsp;Jens Andreassen,&nbsp;Pál Weihe,&nbsp;Marin Strøm,&nbsp;Guðrið Andorsdóttir,&nbsp;Aase Krogh Rasmussen,&nbsp;Ulla Feldt-Rasmussen,&nbsp;Allan Carlé,&nbsp;Stig Andersen","doi":"10.1111/cen.15050","DOIUrl":"10.1111/cen.15050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The occurrence of thyroid disease varies among populations. While the iodine nutrition level of the Faroese seems to have been decreasing over the past decades, there is no systematic evaluation of the thyroid disease pattern in the Faroe Islands. Such knowledge of thyroid disease occurrence in the North Atlantic region may support healthcare planning and prevention. To investigate incidence rates, including subtypes of thyroid diseases, and demographic characteristics of thyroid disease patients in the Faroe Islands, to improve understanding of the patterns and trends of these disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Method</h3>\u0000 \u0000 <p>A registry-based observational study was conducted over 10 years, encompassing all adult Faroese individuals. <b>Patients and Measurements</b>: Health records from general practitioners and hospitals were used to identify incident cases of thyroid diseases. Validation was performed using multiple data sources. The incidence rates were standardised using population data from the middle of the study period 2006–2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 1152 individuals diagnosed with thyroid disease, the standardised incidence rates per 100,000 person-years were 55 for hyperthyroidism and 112 for hypothyroidism, and around four times higher in women than in men. Hashimoto's thyroiditis was the dominant cause of hypothyroidism, while Graves' disease was the leading cause of hyperthyroidism. The incidence of hypothyroidism increases with age. A decreasing trend was observed over time for both hypothyroidism and hyperthyroidism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Considering the decrease in iodine nutrition levels over the past decades, we were surprised by the high incidence of autoimmune thyroid disease. The findings highlight the need for continuous monitoring of thyroid disease occurrence in coastal areas of the North Atlantic Ocean.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 6","pages":"575-584"},"PeriodicalIF":3.2,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118944","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":"Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review","authors":"Oded Cohen,&nbsp;Sharon Tzelnick,&nbsp;Gregory Randolph,&nbsp;Alessandra Rinaldo,&nbsp;Fernando Álvarez,&nbsp;Juan P. Rodrigo,&nbsp;Nabil F. Saba,&nbsp;Sandra Nuyts,&nbsp;June Corry,&nbsp;Antti A. Mäkitie,&nbsp;Vincent Vander Poorten,&nbsp;Cherie-Ann Nathan,&nbsp;Cesare Piazza,&nbsp;Alfio Ferlito","doi":"10.1111/cen.15041","DOIUrl":"10.1111/cen.15041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor from parafollicular cells that produce calcitonin (Ct). Despite several existing guidelines for the surgical management of sporadic MTC (sMTC), optimal initial surgical management of the thyroid, the central and the lateral neck remains a matter of debate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"468-476"},"PeriodicalIF":3.2,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109531","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":"Response to letter to the editor: ‘Gonadal tumour screening in XY gonadal dysgenesis’","authors":"Sabine E. Hannema,&nbsp;Katja P. Wolffenbuttel,&nbsp;Yolande van Bever,&nbsp;Hennie T. Bruggenwirth,&nbsp;Remko Hersmus,&nbsp;J. Wolter Oosterhuis,&nbsp;Leendert H. J. Looijenga","doi":"10.1111/cen.15039","DOIUrl":"10.1111/cen.15039","url":null,"abstract":"&lt;p&gt;To the Editor, We read with interest the letter by Barbar et al. We recognise the clinical scenario described by Barbar et al. of patients with XY gonadal dysgenesis or other types of differences/disorders of sex development (DSD) with a significant risk of germ cell cancer who are hesitant to undergo a prophylactic gonadectomy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Whereas in children the situation is more complex, with parents having to make medical decisions on behalf of their child, adults with DSD can of course decide for themselves to undergo such surgery or not. However, careful counselling and accurate information are essential for patients to be able to make an informed decision. The multidisciplinary DSD team should make sure the individual understands the risk of developing germ cell cancer as well as the chance of remaining function of the gonad with regard to hormone production and fertility. In the patient described by Barbar et al. gonads were afunctional but in prepubertal children there may be some uncertainty about this, and in patients with partial gonadal dysgenesis residual function may vary and needs to be taken into consideration. The consequences of gonadectomy should be explained, that is, the need for and impact of hormone replacement therapy. In addition, the scenario where gonads are left in situ needs to be discussed. In case of afunctional gonads hormone replacement therapy will also be necessary. Periodic monitoring of gonads is recommended but is should be clear that this is aimed at early detection of germ cell cancer rather than preventing germ cell cancer, as premalignant lesions cannot currently be reliably detected through blood tests or imaging. Sertoli cell markers unfortunately are of little help as our recent study showed that germ cell cancer was present in three out of eleven (27%) of those with undetectable serum AMH and inhibin B, which is similar to the 15−40% risk described for gonadal dysgenesis in general.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although those with very low or undetectable AMH and inhibin B have a lower chance of having any germ cells, the risk of any remaining germ cells to develop into germ cell cancer may be higher because of the severe dysgenesis of the gonads. Lastly, social and cultural factors can also play a role and it is important to identify possible barriers, such as fear of anaesthesia or surgery, or worries about the costs of surgery or need to take leave from work, that may prevent some individuals from undergoing gonadectomy even when they are convinced of the need for the procedure. Peer support as well as psychological counselling may help individuals to weigh all the pros and cons when deciding on a prophylactic gonadectomy.&lt;/p&gt;&lt;p&gt;Currently there is an ongoing international study investigating the practice of gonadectomy in individuals with DSD through the I-DSD registry (https://sdmregistries.org/). We agree with Barbar et al. that to increase knowledge in this field it would be highly ","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"466-467"},"PeriodicalIF":3.2,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101173","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":"Beyond the bias! Sex distribution in paediatric growth hormone deficiency reexamined","authors":"Rohan K. Henry,&nbsp;Leena Mamilly,&nbsp;Monika Chaudhari,&nbsp;Brett G. Klamer,&nbsp;Melica Nikahd,&nbsp;Amy L. Pyle-Eilola","doi":"10.1111/cen.15047","DOIUrl":"10.1111/cen.15047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Various biases pertaining to stature account for a male sex predominance in growth hormone deficiency (GHD) cases diagnosed by endocrinology clinics. This manuscript will assess the sex distribution when biases are minimised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective chart review was conducted on patients diagnosed with GHD between 3 and 16 years of age. The sex distribution of cases was ascertained according to: (1) peak GH (pGH) by groups; based on growth hormone provocative testing, (2) pituitary gland imaging results, and (3) isolated GHD (IGHD) versus multiple pituitary hormone deficiencies (MPHD). The relative frequency of each sex was compared according to these subgroups with significance evaluated at <i>α</i> = .05 level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 5880 clinic referrals for short stature, there were 3709 boys (63%) and 2171 girls (37%). Of these, 20% of boys (<i>n</i> = 745) and 15.3% of girls (<i>n</i> = 332) underwent provocative testing for GHD. Of those tested, 39.2% of boys (<i>n</i> = 292) and 32.2% of girls (<i>n</i> = 107) were diagnosed with GHD, all <i>p</i> &lt; .001. There was a male predominance in GHD cases based on pGH or GHD severity. Though not significant, girls were more likely than boys to have MPHD (<i>p</i> = .056), even across pGH groups (<i>p</i> = .06). Both boys and girls had a similar distribution of imaging abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stratifying by sex, we found similar percentages of pituitary imaging abnormalities (including tumours) and the number of pituitary hormone deficiencies in boys and girls as the cause of GHD. For these classifications, we did not find the historically reported male sex predominance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"441-446"},"PeriodicalIF":3.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093519","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":"Development and validation of a risk prediction model for preterm birth in women with gestational diabetes mellitus","authors":"Hanbing Li,&nbsp;Lingling Gao,&nbsp;Xiao Yang,&nbsp;Lu Chen","doi":"10.1111/cen.15044","DOIUrl":"10.1111/cen.15044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to develop and validate a prediction model for preterm birth in women with gestational diabetes mellitus (GDM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We conducted a retrospective study on women with GDM who gave birth at the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, between November 2017 and July 2021. We divided 1879 patients into a development set (<i>n</i> = 1346) and a validation set (<i>n</i> = 533). The development set was used to construct the prediction model for preterm birth using the stepwise logistic regression model. A nomogram and a web calculator were established based on the model. Discrimination and calibration were assessed in both sets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Measurements</h3>\u0000 \u0000 <p>Patients were women with GDM. Data were collected from medical records. GDM was diagnosed with 75-g oral glucose tolerance test during 24-28 gestational weeks. Preterm birth was definied as gestational age at birth &lt;37 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of preterm birth was 9.4%. The predictive model included age, assisted reproductive technology, hypertensive disorders of pregnancy, reproductive system inflammation, intrahepatic cholestasis of pregnancy, high-density lipoprotein, homocysteine, and fasting blood glucose of 75-g oral glucose tolerance test. The area under the receiver operating characteristic curve for the development and validation sets was 0.722 and 0.632, respectively. The model has been adequately calibrated using a calibration curve and the Hosmer–Lemeshow test, demonstrating a correlation between the predicted and observed risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study presents a novel, validated risk model for preterm birth in pregnant women with GDM, providing an individualized risk estimation using clinical risk factors in the third trimester of pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 3","pages":"206-215"},"PeriodicalIF":3.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093520","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":"Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia","authors":"Nicole Lafontaine,&nbsp;Suzanne J. Brown,&nbsp;Petros Perros,&nbsp;Enrico Papini,&nbsp;Endre V. Nagy,&nbsp;Roberto Attanasio,&nbsp;Laszlo Hegedüs,&nbsp;John P. Walsh","doi":"10.1111/cen.15049","DOIUrl":"10.1111/cen.15049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Participants</h3>\u0000 \u0000 <p>Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>We analysed questionnaires that had complete demographic data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"100 5","pages":"477-485"},"PeriodicalIF":3.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093521","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":"Single and multi-dose pharmacology of recombinant and urinary human chorionic gonadotrophin in men","authors":"David J. Handelsman,&nbsp;Amanda Idan,&nbsp;Reena Desai,&nbsp;Janelle Grainger,&nbsp;Catrin Goebel,&nbsp;Sue Sleiman,&nbsp;Sasha Savkovic,&nbsp;Dorothy Kouzios,&nbsp;Venna Jayadev,&nbsp;Ann J. Conway","doi":"10.1111/cen.15040","DOIUrl":"10.1111/cen.15040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Human choriogonadotrophin (hCG) treatment of gonadotrophin-deficient infertile men uses hCG of urinary (uhCG) or recombinant (rhCG) origin, but these treatments have not been compared nor are there studies defining rhCG dosing in men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>hCG products were studied in randomized cross-over single-dose studies of standard (Study 1, 1500 IU and 62.5 µg, respectively) or high (Study 2, 5000 IU and 250 µg) dose and a multi-dose population pharmacology study of hCG use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Eight (Study 1) and seven (Study 2) volunteers in cross-over and 52 gonadotrophin-deficient men in the multi-dose study</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>In cross-over studies, serum testosterone (T), dihydrotestosterone (DHT) and estradiol by liquid chromatography-mass spectrometry (LCMS) and serum hCG, LH, FSH, SHBG and T (observational study) by immunoassays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After standard and high-dose injection, serum hCG and testosterone responses had similar timing and peak concentrations except for a mildly lower early (&lt;48 h) serum testosterone with uhCG. In the multi-dosing study, both hCGs had similar pharmacokinetics (pooled half-life 5.8 days, <i>p</i> &lt; .001), while serum testosterone concentrations were stable after injection and did not differ between hCG products. Bench testing verified that 20% of pens from 4/10 individuals were used inappropriately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although hCG pharmacokinetics are not formally bioequivalent, the similar pharmacodynamic effects on serum testosterone indicate that at the doses tested both hCGs provide comparable clinical effects. The starting dose of rhCG for treating gonadotrophin-deficient men should be 62.5 µg (6 clicks) of the rhCG pen.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 1","pages":"42-50"},"PeriodicalIF":3.2,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140038879","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}