Clinical Endocrinology最新文献

{"title":"Andrological Outcomes in Boys Undergoing Testicular Tissue Extraction Prior to Gonadotoxic Treatment: Evolution During Peripuberty and Young Adulthood.","authors":"Eulalie Martin, Hamza Benderradji, Laura Keller, Iva Gueorguieva, Christine Lefevre, Arthur Lauriot Dit Prevost, Berengère Ducrocq, François Marcelli, Anne-Sophie Defachelles, Pascal Pigny, Benedicte Bruno, Clara Leroy","doi":"10.1111/cen.70073","DOIUrl":"10.1111/cen.70073","url":null,"abstract":"<p><strong>Objective: </strong>Advances in oncological and haematological treatments have markedly improved childhood survival, yet gonadotoxic therapies often compromise testicular function. Testicular tissue extraction (TTE) with cryopreservation is increasingly offered to prepubertal boys at high risk of infertility; however, data on long-term endocrine and fertility outcomes remain limited. This study evaluated the long-term endocrine and exocrine testicular function of males who underwent TTE prior to gonadotoxic therapy.</p><p><strong>Design and patients: </strong>This was a retrospective, observational, single-centre study including 50 males treated between 2009 and 2022 at Lille University Hospital (median age at TTE: 5.6 years; median age at last follow-up: 14.6 years). Underlying conditions comprised malignant haematological disorders (52%), non-malignant diseases (34%), and solid tumours (14%); 80% underwent allogeneic haematopoietic stem cell transplantation.</p><p><strong>Measurements: </strong>Serial clinical assessments and biochemical markers of Leydig and Sertoli cell function (LH, FSH, testosterone, inhibin B, AMH) were recorded from puberty onset to young adulthood. Data were stratified by treatment intensity, pubertal timing, and disease type. Post-pubertal semen analysis was performed in consenting individuals.</p><p><strong>Results: </strong>All participants experienced spontaneous pubertal onset. Sertoli cell dysfunction, evidenced by elevated FSH and persistently low inhibin B, was detectable early in puberty and persisted into adulthood. At Tanner stage 5, 18% had elevated LH, 75% elevated FSH, and 89% low inhibin B; comparable rates were observed in adulthood. Radiotherapy was associated with higher gonadotropin levels at equivalent chemotherapy doses, and Sertoli cell impairment was more pronounced in malignant disease and peri-pubertal treatment. Among 12 semen analyses, spermatozoa were detected in 42%, all in non-malignant cases without radiotherapy.</p><p><strong>Conclusions: </strong>Males undergoing TTE prior to gonadotoxic therapy frequently develop persistent Sertoli cell dysfunction, with limited fertility potential in many cases. These findings underscore the importance of systematic, long-term andrological surveillance and personalised fertility counselling in this high-risk population.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"590-602"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964944","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":"Crooke Cell Adenoma: Is Its Aggressiveness Overestimated? Evidence From a Single-Centre Experience.","authors":"Ilkin Muradov, Serdar Sahin, Sumeyye Akpinar, Ali Tunc, Banu Betul Kocaman, Lala Soltanova, Cansu Turker Saricoban, Nil Comunoglu, Necmettin Tanriover, Nurperi Gazioglu, Hande Mefkure Ozkaya, Pinar Kadioglu","doi":"10.1111/cen.70121","DOIUrl":"10.1111/cen.70121","url":null,"abstract":"<p><strong>Objective: </strong>Crooke cell adenomas (CCAs) are considered rare and potentially aggressive variants of corticotroph adenomas. However, data on their clinical behaviour remain limited. This study aimed to compare the clinical, biochemical, radiological, and surgical outcomes of patients with CCAs and non-CCA Cushing's disease (CD).</p><p><strong>Material and methods: </strong>We retrospectively analyzed patients diagnosed with CD at our tertiary Pituitary Centre. Clinical presentation, baseline biochemical characteristics, tumour size, Ki-67 index, remission rates, recurrence, and presence of residual tumour on follow-up MRI were compared between CCA and non-CCA groups.</p><p><strong>Results: </strong>At baseline, patients with CCAs (n = 21) and non-CCAs (n = 60) demonstrated comparable biochemical profiles, except for ACTH levels, which were higher in the CCA group compared with the non-CCA group (p = 0.007). Remission and recurrence rates at 3, 6, and 12 months did not differ significantly between the two groups (p > 0.05 for all). However, CCAs tended to present with larger tumour sizes and higher Ki-67 proliferation indices than non-CCAs (p = 0.055 and p = 0.05, respectively). Moreover, residual pituitary lesions were more frequently detected on follow-up MRI among patients with CCA (p = 0.005).</p><p><strong>Conclusion: </strong>Our findings suggest that CCAs may not be as aggressive as previously assumed with respect to biochemical remission and recurrence rates. Nonetheless, their larger tumour size, higher proliferative index, and increased likelihood of residual disease underscore the importance of careful long-term follow-up. Further multicenter studies are warranted to better characterize the clinical course of CCAs.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"647-656"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376274","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":"Quality of Life in Children With Congenital Adrenal Hyperplasia: A Tertiary-Center Case-Control Study.","authors":"Özlem Nalbantoğlu, Özge Köprülü, Fatma Yavuzyılmaz Şimşek, İbrahim Mert Erbaş, Gülşen Özer, Nagihan Cevher Binici, Behzat Özkan","doi":"10.1111/cen.70101","DOIUrl":"10.1111/cen.70101","url":null,"abstract":"<p><strong>Background: </strong>Congenital adrenal hyperplasia (CAH) is a chronic endocrine disorder affecting adrenal steroidogenesis, often requiring lifelong glucocorticoid therapy. Its impact on health-related quality of life (HRQoL) in pediatric patients is inconsistent in the literature, with limited data from specific populations.</p><p><strong>Objective: </strong>To compare HRQoL in children and adolescents with CAH to healthy peers, and to evaluate the influence of age, sex, ambiguous genitalia, and glucocorticoid dose.</p><p><strong>Methods: </strong>This cross-sectional case-control study included 25 children and adolescents with CAH (aged 5-18 years) and 25 healthy controls frequency-matched for age and sex. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL™ 4.0) via child self-reports and parent proxy reports. Participants were grouped by age: 5-6, 7-12, and 13-18 years. Clinical data, including, presence of ambiguous genitalia, and glucocorticoid dose, were recorded.</p><p><strong>Results: </strong>Overall, HRQoL scores were similar between CAH patients and controls. Age-stratified analysis showed that children aged 7-12 years with CAH reported higher physical functioning (p = 0.037) and total HRQoL (p = 0.04) compared to controls. Adolescents with CAH reported significantly lower school functioning (p = 0.03), while other domains were comparable. No significant differences in HRQoL were observed by sex, ambiguous genitalia, or glucocorticoid dose.</p><p><strong>Conclusion: </strong>Children and adolescents with CAH generally achieve HRQoL comparable to healthy peers under adequate treatment. Age-specific differences suggest younger children may experience preserved or enhanced physical well-being, while adolescents are vulnerable to reduced school functioning. These findings highlight the need for multidisciplinary, age-sensitive management strategies that include psychological and academic support, especially during adolescence.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"574-583"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218864","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":"Pediatric and Adult Craniopharyngioma: A 37-Year Experience at a National Referral Center.","authors":"María Isabel Hernández, Consuelo Ibeas, José Pablo Fernández, Danisa Ivanovic-Zuvic, Marisol Gómez, Dina Gutiérrez, Samuel Valenzuela, Cecilia Okuma","doi":"10.1111/cen.70103","DOIUrl":"10.1111/cen.70103","url":null,"abstract":"<p><strong>Introduction: </strong>Craniopharyngioma (CP) is a rare, recurrent central nervous system tumor with significant hormonal, visual, and metabolic sequelae.</p><p><strong>Methodology: </strong>This retrospective cohort study analyzes 37 years of experience managing pediatric and adult CP patients at a specialized referral center in Chile, stratified by age at onset. Clinical, biochemical, imaging, and neurosurgical data from 1986 to 2023 were reviewed.</p><p><strong>Results: </strong>A total of 87 patients (1-68 years) were included, with 65 (75%) presenting in childhood (≤ 18 years) and 22 (25%) in adulthood. Mean follow-up was 9.3 years (IQR 3.7-14.1). Histology was adamantinomatous in 84%, papillary in 3%, and unspecified in 13%. The most common symptoms at presentation were headache (77%), visual disturbances (60%), and nausea (45%). At diagnosis, 54% had at least one pituitary dysfunction, most frequently thyrotropic (28.2%) and somatotropic (27.9%). Following initial treatment, pituitary dysfunction increased to 71%, with thyrotropic (59%) and corticotropic (48%) being the most affected axes. Anterior panhypopituitarism occurred in 25%, and permanent AVP deficiency in 32%. Tumor recurrence or progression was observed in 63%.</p><p><strong>Conclusions: </strong>CP carries a high risk of recurrence and neuroendocrine complications. This study, based on 37 years of experience in a reference center, is the first national report on CP patients, with findings consistent with previous literature. The management of these patients is complex and demands a highly experienced multidisciplinary team to achieve optimal long-term outcomes.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"628-636"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084556","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 Capillary Changes in Primary Hyperparathyroidism.","authors":"Ahmet Ozcan, Hakan Korkmaz, Rahime Cankat Gurel, Ahmet Faruk Ay, Selma Korkmaz","doi":"10.1111/cen.70115","DOIUrl":"10.1111/cen.70115","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate morphological changes in nailfold capillaries in patients with primary hyperparathyroidism (PHPT) and to investigate their association with serum parathormone (PTH) and calcium levels.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Patients: </strong>The study included 62 patients with PHPT and 34 matched healthy controls.</p><p><strong>Measurements: </strong>Serum levels of creatinine, calcium, phosphorus, magnesium, albumin, PTH, and 25-hydroxy vitamin D were measured in both PHPT patients and healthy controls. Nail fold capillary morphology was assessed using digital dermatoscopy.</p><p><strong>Results: </strong>Minor morphological changes (MiMC) in nailfold capillaries were significantly more prevalent in the PHPT group compared with healthy controls (p = 0.001). The semiquantitative MiMC score was also significantly higher in the PHPT group (p < 0.001). Avascular area scores (AAS) showed positive correlations with plasma PTH, serum calcium levels, and age (r = 0.498, p < 0.001; r = 0.552, p < 0.001; and r = 0.346, p = 0.001, respectively). Serum calcium levels were independently associated with MiMC scores (p = 0.036), whereas both plasma PTH levels and age independently influenced AAS (p = 0.032 and p = 0.002, respectively).</p><p><strong>Conclusion: </strong>Microvascular alterations in nailfold capillaries were observed in patients with PHPT. These findings suggest that, in addition to the previously reported cardiovascular involvement, PHPT may also affect peripheral microcirculation at the capillary level.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"584-589"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324784","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":"Endocrinopathies and Their Recovery in a 20-Year Cohort Study of People With Heroin Dependence.","authors":"Chris Tremonti, Stephen M Twigg, Katherine L Mills, Christina Marel, Maree Teesson, Paul S Haber","doi":"10.1111/cen.70109","DOIUrl":"10.1111/cen.70109","url":null,"abstract":"<p><strong>Objective: </strong>Chronic opioid use suppresses hypothalamic-pituitary signalling, leading to hypogonadism and adrenal insufficiency. Whether these abnormalities persist following long-term opioid cessation remains unclear. In particular, data on the female gonadal axis are limited, while other endocrine outcomes are predominantly reported in male cohorts. This study examined endocrine function in a long-term prospective cohort of people with opioid use disorder, comparing those in sustained remission with those continuing opioid use, exploring associations with opioid exposure, sex and depression.</p><p><strong>Design: </strong>Prospective cohort study using data from the Australian Treatment Outcome Study 18-20 year follow-up.</p><p><strong>Patients and measurements: </strong>Participants underwent a structured interview and fasting endocrine assessment, including gonadal, adrenal, thyroid, and prolactin measurements. Endocrinopathies were defined using prespecified biochemical and clinical criteria. Prevalence was compared between opioid-free and opioid-using participants. Associations with opioid exposure, sex and depression were examined using Firth logistic regression.</p><p><strong>Results: </strong>Among 123 participants with complete endocrine data, 71 (57.7%) had at least one endocrinopathy. Thirty-five participants (28.4%) were opioid-free. Hypogonadism was markedly less common in opioid-free participants (3.3% vs. 26.7%), and no opioid-free participant had hypocortisolism, compared with 14.8% of those with continuing opioid use. Methadone dose, male sex, and depression were independently associated with hypogonadism. Men prescribed methadone had significantly lower testosterone and luteinising hormone levels. No participant with hypogonadism or hypocortisolism had been previously diagnosed or treated.</p><p><strong>Conclusions: </strong>Opioid-induced endocrine suppression appears reversible with sustained opioid abstinence. Higher methadone dose, male sex, and depression were associated with hypogonadism. Despite frequent healthcare contact, patients remained undiagnosed, highlighting a gap in clinical awareness of opioid-associated endocrinopathies and the need for routine screening in opioid agonist treatment settings.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"637-646"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282418","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":"Diagnostic Utility of Genetic Testing in Hyperthyroxinemia With Non-Suppressed TSH.","authors":"Hilal Sekizkardes, Mehmet Eltan, Senol Demir, Dilek Giray, Zehra Yavas Abali, Saygin Abali","doi":"10.1111/cen.70126","DOIUrl":"10.1111/cen.70126","url":null,"abstract":"<p><strong>Background: </strong>Hyperthyroxinemia with non-suppressed thyroid-stimulating hormone (TSH) is a complex clinical entity that presents significant diagnostic challenges. Inherited causes include resistance to thyroid hormone beta (RTHβ), characterised by highly variable clinical presentation, and familial dysalbuminemic hyperthyroxinemia (FDH), a form of assay interference caused by pathogenic variants in the ALB gene leading to pseudo elevation of free thyroxine (FT4). This study aimed to characterise the clinical, laboratory, and molecular features of a paediatric cohort presenting with hyperthyroxinemia and non-suppressed TSH, and to identify clinical parameters that may aid in differential diagnosis.</p><p><strong>Methods: </strong>In this retrospective observational study, 25 children from 19 unrelated families with elevated FT4 and non-suppressed TSH were evaluated. Clinical history, anthropometric data, physical examination findings, vital signs, laboratory results, radiological imaging, and sequencing data of the THRB and/or ALB genes were reviewed.</p><p><strong>Results: </strong>THRB gene sequencing was performed in 21 children from 18 families, identifying pathogenic or likely pathogenic variants in six patients from six unrelated families, including a novel variant c.997 G > C, p.(Glu333Gln), consistent with a diagnosis of RTHβ in 33.3% of those tested. Among these patients, tachycardia was observed in three cases (50%). ALB gene sequencing was completed in 16 children from 13 families, revealing the hotspot variant c.725 G > A, p.(Arg242His) in 12 patients from six unrelated families, corresponding to FDH in 46.2% of those tested. None of the FDH-confirmed patients exhibited tachycardia or other signs of thyroid dysfunction. FT4 and TSH levels were similar between RTHβ and FDH groups; however, FT3 levels tended to be lower in FDH, although FT3/FT4 ratio did not differ significantly.</p><p><strong>Conclusion: </strong>Our findings highlight the critical role of molecular testing in accurately diagnosing the underlying cause of elevated FT4 with non-suppressed TSH and in preventing unnecessary interventions. Hotspot analysis of the ALB gene is recommended as a first-line test, particularly in asymptomatic individuals.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":"693-701"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376289","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":"Perceptions and Psychological Adverse Effects of Central Precocious Puberty or Early Normal Puberty, and Its Treatment Among Affected Girls and Their Caregivers.","authors":"Kalyarat Wilaiwongsathien, Jariya Chuthapisith, Pat Mahachoklertwattana, Natee Sakornyutthadej, Preamrudee Poomthavorn","doi":"10.1111/cen.70156","DOIUrl":"https://doi.org/10.1111/cen.70156","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate psychological adverse effects of idiopathic central precocious puberty and early normal puberty (iCPP/ENP) on Thai girls and their caregivers, and to explore their perceptions of iCPP/ENP and the treatment.</p><p><strong>Design, patients and measurements: </strong>Questionnaires were used to assess the perceptions and psychological adverse effects of iCPP/ENP. Newly diagnosed patients were additionally evaluated for bullying, depression, anxiety and low self-esteem.</p><p><strong>Results: </strong>Nine hundred and fifty-four participants (340 iCPP, 140 ENP, and 474 caregivers) were included. Mean (SD) age at enrolment was 9.9 (1.1) years. Breast buds, body odour and acne were perceived by the girls as their signs of puberty in 234 (49%), 174 (36%), and 162 (34%) girls, respectively. Two hundred and sixteen (45%) girls believed that certain types of food were the cause of iCPP/ENP. Additionally, the greatest concerns of caregivers were the child's short final adult height and early menarche. On a 10-point anxiety scale, caregivers reported a score of 8.3 (1.7). Among the 38 newly diagnosed girls, 8 (21%) reported being bullied, with experiences of verbal harassment about their breasts and breast grabbing. Additionally, 4 (11%) girls had depression, 9 (24%) had anxiety, and 5 (13%) had low self-esteem. Depression and anxiety were more prevalent in the iCPP group.</p><p><strong>Conclusions: </strong>This study demonstrated that girls and their caregivers lacked adequate knowledge of iCPP/ENP. Given that psychological stress was associated with iCPP/ENP, screening for psychological stress should be considered as part of caring for these patients.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833464","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":"Early Transient Hypothyroidism Is Associated With Long-Term Outcomes of 131I Treatment in Graves' Disease: A Retrospective Cohort Study.","authors":"Pei Yin, Jiangmeng Wu, Huayi Zhao, Lei Jiang, Yanchao Lu, Dan Liu, Yan Zhang, Yong Wang","doi":"10.1111/cen.70153","DOIUrl":"https://doi.org/10.1111/cen.70153","url":null,"abstract":"<p><strong>Background: </strong>Radioactive iodine (¹³¹I) is a cornerstone therapy for Graves' disease (GD), yet predicting long-term thyroid functional outcomes remains challenging. Early transient hypothyroidism (ETH) is a common phenomenon post-therapy, but its prognostic value for differentiating between permanent hypothyroidism and persistent hyperthyroidism is not fully elucidated.</p><p><strong>Methods: </strong>This retrospective cohort study included 222 GD patients treated with ¹³¹I. Patients were categorized based on thyroid function within the first 6 months: the ETH group (occurrence of transient hypothyroidism, n = 59) and the Non-ETH group (n = 163). ETH was defined as TSH > 4.2 mIU/L with or without low FT4 on at least one measurement, with temporary levothyroxine support provided if symptomatic. Detailed baseline characteristics, including calculated dose per gram of thyroid tissue (mCi/g), were analyzed. The primary endpoints were permanent hypothyroidism, euthyroidism, or persistent/recurrent hyperthyroidism. Kaplan-Meier survival analysis and multinomial logistic regression models were employed to identify independent predictors of long-term outcomes.</p><p><strong>Results: </strong>Baseline analysis revealed that the ETH group had significantly higher pretreatment TRAb levels (median 19.30 vs. 14.35 IU/L, p = 0.021) and a higher prevalence of palpitations (84.7% vs. 64.4%, p = 0.004) compared to the Non-ETH group. Importantly, the ETH group had a significantly higher rate of developing permanent hypothyroidism (52.5% vs. 20.9%, p < 0.001), whereas the Non-ETH group was prone to persistent hyperthyroidism (55.8% vs. 28.8%). In multinomial logistic regression adjusted for dose intensity (mCi/g), Non-ETH status was a strong independent predictor for persistent hyperthyroidism (OR = 3.888, 95% CI: 1.435-10.535, p = 0.008) relative to permanent hypothyroidism. Furthermore, higher dose intensity (mCi/g) was universally associated with permanent hypothyroidism, while older age favored euthyroidism outcomes (OR = 1.055, p = 0.002).</p><p><strong>Conclusion: </strong>Early transient hypothyroidism following ¹³¹I therapy serves as a clinical indicator associated with effective glandular destruction and a high trajectory toward permanent hypothyroidism. Conversely, the absence of ETH signals a high risk of treatment failure. These findings suggest that patients with ETH require careful long-term monitoring for hypothyroidism rather than aggressive anti-thyroid drug re-initiation, and the dose per gram of tissue is a definitive determinant of functional ablation.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834511","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":"Optimizing Parathyroid Localization in Real Life: The Role of Expert-Performed Ultrasonography.","authors":"Tzahi Yamin, Nir Battat, Annat Blank, Shmuel Meirsdorf, Bar Sara Zigdon, Oded Cohen, Avi Khafif","doi":"10.1111/cen.70154","DOIUrl":"https://doi.org/10.1111/cen.70154","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the accuracy of expert-performed ultrasonography (US) for preoperative localization in minimally invasive parathyroidectomy (MIP) compared with community US and other imaging modalities.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center for endocrine surgery.</p><p><strong>Methods: </strong>A retrospective, single-center diagnostic accuracy study of 227 patients with primary hyperparathyroidism who underwent surgery and pre-operative imaging by a dedicated neck radiologist (expert US). Sensitivity, specificity, and positive predictive value (PPV) were calculated, and were compared to other imaging modalities including community US, 99mTc-MIBI, SPECT-CT and 4DCT.</p><p><strong>Results: </strong>Expert US showed high sensitivity (89%), specificity (98%), and PPV (95%), correctly localizing adenomas in 89% of cases. It outperformed the sensitivity and specificity of community US (50%/95%), MIBI (75%/95%), SPECT-CT (82%/96%) and 4D-CT (52%/94%), respectively, particularly in atypical cases like ectopic adenomas (25% prevalence) and multiglandular disease (6% prevalence).</p><p><strong>Conclusions: </strong>Expert-performed US should be considered the primary imaging modality for guiding MIP. Surgeons should consider referring patients to an expert ultrasonographer in cases of suspected ectopic adenoma, presence of multiglandular disease, before referring to 4D-CT scans or when considering bilateral neck explorations.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834509","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}