Clinical Endocrinology最新文献

{"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}

{"title":"Congenital Adrenal Hyperplasia due to Proximal Steroidogenic Defects: A Single-Centre Experience From New Delhi.","authors":"Sukanya Priyadarshini, Priyanka Gupta, Avadhesh Verma, Rajni Sharma, Vandana Jain","doi":"10.1111/cen.70212","DOIUrl":"https://doi.org/10.1111/cen.70212","url":null,"abstract":"<p><strong>Background: </strong>Variants in STAR, encoding Steroidogenic Acute Regulatory (StAR) protein, and CYP11A1, encoding the cholesterol Side-Chain Cleavage (SCC) enzyme, result in proximal steroidogenic defects. These are classically described as presenting with neonatal-onset primary adrenal insufficiency, with the additional finding of sex reversal in 46,XY newborns. However, the phenotypic spectrum is much wider. The present study aimed at describing the phenotypic heterogeneity and genotypes of patients with STAR and CYP11A1 variants followed up at a tertiary care centre in India.</p><p><strong>Methods: </strong>Hospital records of all patients with variants in STAR and CYP11A1 who were followed up at the Paediatric Endocrinology division of a tertiary care hospital between January 2018 and January 2026 were reviewed for clinical details and genotypes.</p><p><strong>Results: </strong>Variants in STAR and CYP11A1 were identified in four patients each. Among patients with variants in STAR, two had homozygous pathogenic/likely pathogenic variants, while two had two heterozygous variants; phase undetermined [of which one was a variant of uncertain significance (VUS)]. The presenting features were salt-wasting crisis (n = 3, at ages 2 years, 5 years and Day 15, respectively) and atypical genitalia (n = 1). Among patients with variants in CYP11A1, one had two heterozygous variants; phase undetermined (of which one was a VUS), while three had homozygous VUSs. The presentation ranged from adrenal crisis (n = 1, at 3.8 years) and salt-wasting crisis (n = 1, at 10 months) to progressive hyperpigmentation (n = 2, at ages 6.5 years and 21.9 years, respectively). None of the patients had genital ambiguity, while one patient presented with 46,XY sex reversal.</p><p><strong>Conclusion: </strong>The present study highlights the wide phenotypic spectrum associated with STAR and CYP11A1 variants, ranging from classical neonatal salt-wasting crisis with 46,XY sex reversal, to isolated primary adrenal insufficiency, or isolated undervirilisation, with later emergence of gluco- and mineralocorticoid deficiency.</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":"149105001","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":"Testosterone Replacement Therapy in Adolescents and Young Adults With Prader-Willi Syndrome: Efficacy and Effects on Behaviour.","authors":"Wiebe R Flamman, Demi J Trueba-Timmermans, Lionne N Grootjen, Laura C G de Graaff, Joyce M Geelen, Janielle A E M van der Velden, Edmond H H M Rings, Anita C S Hokken-Koelega, Gerthe F Kerkhof","doi":"10.1111/cen.70213","DOIUrl":"https://doi.org/10.1111/cen.70213","url":null,"abstract":"<p><strong>Context: </strong>Hypogonadism in Prader-Willi syndrome (PWS) is associated with decreased bone mineral density (BMD) in male adolescents and adults. Testosterone Replacement Therapy (TRT) improves BMD and sexual maturation, but TRT could aggravate pre-existing challenging behaviour in male patients with PWS.</p><p><strong>Objective: </strong>To investigate the effect of TRT on behaviour, BMD and body composition in adolescents and young adults with PWS.</p><p><strong>Design: </strong>Longitudinal observational study in a Dutch PWS cohort.</p><p><strong>Participants: </strong>Fifty-nine male patients with PWS on growth hormone treatment, aged > 14 years.</p><p><strong>Methods: </strong>Behaviour was assessed by the Developmental Behaviour Checklist-Parents(DBC-P). Dual energy X-ray absorptiometry scans were performed, measuring BMD of the lumbar spine (BMD_LS) and total body (BMD_TB), lean body mass (LBM) and fat mass percentage (FM%).</p><p><strong>Results: </strong>59 patients with a median (IQR) age of 22.57 (18.46-26.35) years, of which 44 used TRT. Median age at TRT initiation was 16.6 years. Three patients (6.8%) discontinued TRT permanently due to challenging behaviour. In 30 patients (68.2%), there was no behaviour necessitating a dose change or discontinuation. DBC-P total score did not significantly change during TRT. BMD SDS stabilised following TRT initiation, with a mean (95% CI) BMD SDS difference from baseline of 0.24 (-0.06 to 0.54; p = 0.107) BMD_LS and -0.28 (-0.50 to -0.06; p = 0.014) BMD_TB after 5 years. LBM SDS improved and FM% SDS remained similar.</p><p><strong>Conclusion: </strong>Under close surveillance, TRT is an efficacious method to maintain BMD and improve body composition in hypogonadal male patients with PWS, with minor effects on behaviour in most cases.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104943","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 Following Parathyroidectomy for Primary Hyperparathyroidism: Symptom Resolution Kinetics.","authors":"Jacquelyn Elise Fitzgerald Speer, Muhammad Osama Khan, Rongzhi Wang, Rachael Caretti, Niranjna Swaminathan, Andrea Gillis, Brenessa Lindeman, Sophie Dream, Herbert Chen","doi":"10.1111/cen.70208","DOIUrl":"https://doi.org/10.1111/cen.70208","url":null,"abstract":"<p><strong>Objective: </strong>Primary hyperparathyroidism has been associated with significant symptom burden and impaired quality of life (QoL), yet the trajectory of recovery, especially in reoperative patients is incompletely characterised. This study evaluated longitudinal QoL changes following parathyroidectomy, characterising symptom resolution kinetics and comparing outcomes between cohorts. A prospective longitudinal cohort study was conducted between July 2021 and September 2023 at a single high volume tertiary centre. Patients with biochemically confirmed primary hyperparathyroidism who underwent parathyroidectomy were selected to complete the Primary Hyperparathyroidism Quality of Life questionnaire preoperatively, at 2 weeks postoperatively and then monthly through 12 months postoperative.</p><p><strong>Results: </strong>There were 124 patients who completed at least one survey. Mean QoL scores improved significantly from baseline (31) to Month 1 (42; Cohen's d = 0.92). Symptom resolution generally occurred in over half of patients, with fatigue and bone pain resolving in 88% and 85% of patients by Month 12 respectively. Neuropsychiatric symptoms had a more variable postoperative resolution. Lower baseline QoL was the only predictor in postoperative QoL score improvement (β = -0.51, p < 0.01). Reoperative parathyroidectomy was associated with similar QoL improvements but higher rates of persistent neurocognitive symptoms.</p><p><strong>Conclusion: </strong>Parathyroidectomy results in both rapid and persistent improvement in QoL in patients with primary hyperparathyroidism. Symptom resolution was variable based on number of operations and symptom domain. Baseline QoL was the strongest predictor of benefit supporting the use of QoL as a preoperative metric to be considered in patients with primary hyperparathyroidism.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104979","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":"International Survey of Growth Hormone and Sleep Evaluation Practices in Infants With Prader-Willi Syndrome.","authors":"Emily Paprocki, David Ingram, Janelle Noel-MacDonnell, Sani M Roy, Keisha Shaheed, David Viskochil, Parisa Salehi, Maida Chen, Kelsee Halpin","doi":"10.1111/cen.70216","DOIUrl":"https://doi.org/10.1111/cen.70216","url":null,"abstract":"<p><strong>Objective: </strong>Guidelines encourage polysomnogram (PSG) prior to starting growth hormone (GH) in individuals with Prader-Willi Syndrome (PWS) to avoid adverse effects; however, this presents a challenge in infancy due to barriers regarding access and lack of normative data to guide recommendations. This international survey study assessed clinician practices regarding GH initiation and sleep evaluation in infants with PWS. The primary objective was to determine the prevalence of clinicians reporting they do not always perform a baseline PSG prior to GH Initiation and whether responses were associated with volume of PWS patients seen annually.</p><p><strong>Design: </strong>A survey was distributed through 10 medical societies involved in PWS care. Respondents were grouped by volume of patients with PWS seen annually (<5 (low volume, LV), 5-20 (medium volume, MV), and >/= 21 (high volume, HV) and practice region (United States (US) vs. outside of the US). The primary outcome was evaluated using bivariate analysis, a test for trend, and multivariable logistic regression. All other outcome analyses were considered exploratory.</p><p><strong>Results: </strong>We analysed 141 surveys from 18 countries (primarily US respondents; 79%). There were 58 (41%) LV, 42 (30%) MV, and 41 (29%) HV respondents. With respect to our primary outcome, HV respondents were more likely to answer \"not always\" when asked whether they perform baseline PSG prior to GH initiation with a decreasing trend to the LV group (HV: 56%, MV: 31%, LV: 26%, p = 0.003). Concurrently, the most common reason to forgo the baseline PSG in the US is to avoid delaying GH start (56%) and less concerns about side effects (apnea, sudden death) in this age group (54%). Outside of the US, the top reason was lack of availability of sleep lab (78%). In multivariable logistic regression, the odds of \"not always\" obtaining a baseline PSG prior to starting GH in infants was 3.66 times (95% CI: 1.48, 9.04) higher in individuals seeing more than 21 PWS patients (HV) compared to less than 5 (LV) when controlling for respondent's geographic location and years treating patients with PWS (p = 0.004).</p><p><strong>Conclusion: </strong>High volume PWS clinicians were more likely to report not always obtaining baseline PSG prior to starting GH in infants, primarily to prevent delayed therapy. These findings highlight a gap between guidelines and practice and support the need for prospective outcome data.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105007","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":"Effectiveness of Recombinant Human Growth Hormone Therapy in Small-for-Gestational-Age Children With Short Stature: A Stratified Analysis Based on Genetic Variant Status","authors":"Sanghee Park,&nbsp;Yena Lee,&nbsp;Hwal Rim Jeong,&nbsp;Eun Young Kim,&nbsp;Eu-seon Noh,&nbsp;Hye young Jin,&nbsp;Eun Byul Kwon,&nbsp;Hye Jin Lee,&nbsp;Young-Jun Seo,&nbsp;Young Suk Shim,&nbsp;Su Jin Kim,&nbsp;Ji-Eun Lee,&nbsp;Nan Young Kim,&nbsp;Sangkyoon Hong,&nbsp;Min Jae Kang,&nbsp;Il Tae Hwang","doi":"10.1111/cen.70186","DOIUrl":"10.1111/cen.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the impact of pathogenic genetic variants on growth outcomes following 3 years of recombinant human growth hormone (rhGH) therapy in children born small for gestational age with persistent short stature (SGA-SS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>One hundred and seventy-nine SGA-SS children who underwent clinical and genetic evaluation were classified into variant-positive (<i>n</i> = 30) and variant-negative groups (<i>n</i> = 149).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Clinical characteristics and growth outcomes were assessed over 3 years of rhGH therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, the variant-positive group had significantly lower height standard deviation score (SDS) (−2.83 vs. −2.28, <i>p</i> &lt; 0.001) and higher rates of intellectual disability (36.7% vs. 7.4%, <i>p</i> &lt; 0.001) and congenital anomalies (30.0% vs. 6.7%, <i>p</i> &lt; 0.001). rhGH therapy promoted longitudinal growth in both groups (evaluated <i>n</i> = 142); after 3 years, the estimated marginal mean (EMM) of height SDS reached −1.30 ± 0.10 in the variant-positive group and −0.93 ± 0.04 in the variant-negative group. However, linear mixed model analysis revealed a progressive attenuation of incremental height SDS gain in the variant-positive group as the treatment progressed, with significant interaction estimates observed at Year 1 (Estimate −0.18), Year 2 (Estimate −0.31) and Year 3 (Estimate −0.36; all <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>As one of the first longitudinal analyses utilizing repeated-measures modelling in a genetically characterized patient population, this study demonstrates that while rhGH therapy effectively promoted linear growth in SGA-SS children, patients with a molecular diagnosis presented with lower baseline stature and an attenuated incremental growth response over time, highlighting the importance of genetic evaluation for personalized treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 5","pages":"556-564"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663560","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":"Comment on: ACTH Stimulation Testing Is Often Unnecessary After Appropriate Patient Preparation Prior to Screening Cortisol Measurement","authors":"Maajid Mohi Ud Din Malik","doi":"10.1111/cen.70176","DOIUrl":"10.1111/cen.70176","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 5","pages":"531-532"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469157","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":"Correction to “Growth Hormone Treatment Response and Machine Learning-Based Prediction in Idiopathic Ghd and Iss: Analysis of the Korean Lg Growth Study”","authors":"","doi":"10.1111/cen.70204","DOIUrl":"10.1111/cen.70204","url":null,"abstract":"<p>Park J, Joo EY, Kim SJ, Yoo MJ, Lee JE. Growth Hormone Treatment Response and Machine Learning-Based Prediction in Idiopathic GHD and ISS: Analysis of the Korean LG Growth Study. Clinical Endocrinology. 2026;105(3):322–330. https://doi.org/10.1111/cen.70163</p><p>The Acknowledgements section should have included the following Funding statement: “This study was supported by the Young Faculty Research Grant funded by Inha University (2025).”</p><p>We apologize for this error.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900154","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":"Seminal Plasma Kisspeptin-1 and Kisspeptin-54 Levels Are Associated With Semen Parameters and Oxidative Stress in Male Infertility","authors":"Oya Korkmaz,&nbsp;Seda Karabulut,&nbsp;Pelin Macit","doi":"10.1111/cen.70199","DOIUrl":"10.1111/cen.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Kisspeptin-1 and Kisspeptin-54 are key regulators of the hypothalamic–pituitary–gonadal axis and may play a role in male reproductive function. This study aimed to evaluate the association between seminal plasma kisspeptin levels and male infertility, and to examine their relationships with semen parameters and oxidative stress markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty men attending an in vitro fertilization centre were classified into normozoospermia (<i>n</i> = 20), oligoasthenoteratozoospermia (OAT) (<i>n</i> = 18) and azoospermia (<i>n</i> = 12) groups according to WHO 2021 criteria. Seminal plasma Kisspeptin-1 and Kisspeptin-54 levels were measured using ELISA. Oxidative stress parameters, including total antioxidant capacity (TAC), total oxidant capacity (TOC) and oxidative stress index (OSI), were assessed using spectrophotometric methods. Correlation and regression analyses were performed to evaluate associations between variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Kisspeptin-1 and Kisspeptin-54 levels showed a progressive decrease with increasing infertility severity (normozoospermia→OAT→azoospermia; <i>p</i> &lt; 0.05). Both kisspeptins were positively associated with sperm concentration and progressive motility, and negatively associated with TOC and OSI (<i>p</i> &lt; 0.01). TAC levels were higher in normozoospermic men, whereas oxidative load was increased in azoospermic individuals. Regression analyses indicated that seminal kisspeptin levels were significantly associated with sperm concentration and progressive motility. Parallel alterations in kisspeptin levels and oxidative stress markers suggest a relationship between these peptides and the seminal microenvironment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Seminal plasma kisspeptin levels are associated with semen quality and oxidative stress parameters in male infertility. These findings suggest that kisspeptin may represent a potential biomarker candidate for the evaluation of male infertility, although further validation is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 5","pages":"590-599"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688537","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":"Non-Glucocorticoid Immunosuppressive Therapy in Post-Glucocorticoid Persistent or Recurrent Primary Autoimmune Hypophysitis: A Systematic Review","authors":"Parag Agrawal,&nbsp;Chethan Yami Channaiah,&nbsp;Anurag Ranjan Lila,&nbsp;Vijaya Sarathi,&nbsp;Archana Rao,&nbsp;Saba Samad Memon,&nbsp;Rohit Barnabas,&nbsp;Manjiri Karlekar,&nbsp;Aditya Phadte,&nbsp;Anima Sharma,&nbsp;Tushar Bandgar","doi":"10.1111/cen.70174","DOIUrl":"10.1111/cen.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Persistent or recurrent primary autoimmune hypophysitis (PAH) is a rare disease, and the role of non-glucocorticoid (GC) immunosuppressive therapy (NGIT) such as azathioprine (AZA), mycophenolate mofetil (MMF), rituximab (RTX), methotrexate (MTX), infliximab (IFX), and tacrolimus (TAC) has not been systematically studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A systematic review of post-GC persistent or recurrent PAH managed with NGIT (<i>n</i> = 29, including two patients from our centre) was conducted to assess the effectiveness and safety of NGIT in this subset of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority of patients (62.1%) had recurrent disease after an initial response to GC therapy, and the remaining patients had persistent disease (37.9%). Most of the patients (75.8%) received a single NGIT agent (AZA: 14, MMF: 4, RTX: 3, MTX: 1), while the remaining seven patients received multiple NGITs in a sequential manner (AZA→RTX: 4, AZA→MMF→TAC: 1, MMF→IFX: 1, MTX→IFX→RTX: 1). In the majority (59.1%), NGIT was administered concomitantly with GC. The median (IQR) duration of NGIT use was 10.5 (4.0–24.2) months. Overall, clinical, hormonal, and radiological PAH remission was observed in ~91%, ~26%, and ~72%, respectively. Radiological response was best with RTX (100%, 8/8), followed by MMF (~66%, 4/6) and AZA (~37%, 7/19). Overall, adverse events (MMF: alopecia, hepatitis; IFX: pulmonary aspergillosis; AZA: hepatitis, leucopenia) were observed in ~20%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NGITs are effective treatment modalities for post-GC therapy persistent or recurrent PAH. Given the heterogeneity of treatment regimens and limited data, larger studies are needed to determine the optimal agent, timing, and duration of NGIT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 5","pages":"565-572"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444417","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}