Clinical Endocrinology最新文献

{"title":"\"Risk of Dementia in Non-Overtly Functional Adrenal Tumour (NOFAT)\".","authors":"Elena Notarianni","doi":"10.1111/cen.15244","DOIUrl":"https://doi.org/10.1111/cen.15244","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691368","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":"Approach to the Management of Gastrointestinal Manifestations in Patients With Phaeochromocytoma and Paraganglioma.","authors":"Monica Majumder, Cherie Chiang, Grace Kong, Michael Michael, Nirupa Sachithanandan, Emma Boehm","doi":"10.1111/cen.15235","DOIUrl":"https://doi.org/10.1111/cen.15235","url":null,"abstract":"<p><strong>Objective: </strong>Managing gastrointestinal symptoms in patients with phaeochromocytoma and paraganglioma (PPGL) is challenging due to the risk of catecholaminergic crisis with many commonly prescribed medications, especially in functional tumours. We reviewed gastrointestinal symptom management and outcomes in PPGL patients at our centre and developed recommendations based on a literature review and our experience.</p><p><strong>Design, patients, measurement: </strong>A single-centre retrospective analysis of the management of gastrointestinal symptoms in patients with PPGL between 2019 and 2024 was completed. A literature review of gastrointestinal manifestations in PPGL was undertaken.</p><p><strong>Results: </strong>Twenty-four individuals with PPGL admitted for radionuclide therapy, chemotherapy, surgery or other medical illness were included. Eighteen (75%) had metastatic disease. Fifty administration events of antiemetics for nausea or vomiting occurred. Two patients had acute colonic pseudo-obstruction. Dopamine antagonists (metoclopramide) and corticosteroids (dexamethasone) were administered to 10 and 9 patients, respectively, the majority of whom were alpha-blocked (n = 7) or had a dopaminergic/biochemically silent phenotype (n = 10). A patient with noradrenergic PPGL experienced a hypertensive episode following high-dose dexamethasone. No patients with biochemically negative/dopaminergic phenotypes or on alpha blockade experienced an antiemetic-related adverse event. Published evidence of dopamine antagonists and corticosteroids precipitating catecholaminergic crisis was mostly limited to case reports. While low-risk antiemetics (serotonin, histamine or neurokinin antagonists) are preferable, we found higher-risk antiemetics (dexamethasone and metoclopramide) can be cautiously administered in patients with a biochemically negative/dopaminergic phenotype or in those on adequate alpha blockade. Limited case reports demonstrated anti-cholinergic agents were beneficial for the management of acute colonic pseudo-obstruction.</p><p><strong>Conclusions: </strong>Optimal management of gastrointestinal symptoms in PPGL should consider disease characteristics such as primary location, secretory profile, alpha blockade and medication profile.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691369","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":"Morning Salivary Cortisone Versus Serum Cortisol in the Overnight Dexamethasone Suppression Test (ODNST): Evaluation in a Clinical Setting.","authors":"Mathilde Mordaunt, Adrian Heald, Waseem Majeed, Rupinder Kochhar, Akheel Syed, Rajshekhar N Mudaliar, Ramadan Alshames, Fahmy Hanna, David Marshall, Brian Keevil, Anthony A Fryer","doi":"10.1111/cen.15233","DOIUrl":"https://doi.org/10.1111/cen.15233","url":null,"abstract":"<p><strong>Introduction: </strong>Saliva hormone measurement is increasingly being applied in everyday clinical practice. In relation to salivary cortisone measurement, there is a particular advantage, with minimal chance of cross-reaction with prescribed glucocorticoids and greater convenience. We evaluated the utility of salivary cortisone measurement in patients undergoing an overnight dexamethasone suppression test (ONDST).</p><p><strong>Methods: </strong>Individuals undergoing an ONDST had parallel measurement of serum cortisol and salivary cortisone at 0900 following midnight dexamethasone (1 mg). Salivary cortisone was measured by electrospray positive liquid chromatography tandem mass spectrometry. The threshold for adequate suppression of salivary cortisone was< 2.7nmol/L; serum cortisol was< 50nmol/L.</p><p><strong>Results: </strong>Results for 34 individuals which included 21% men (mean age 49.4 years) and 79% women (mean age 56.7 years) were analysed. Serum cortisol did not suppress in 22/34 cases. Salivary cortisone did not suppress in two of the cases where cortisol did suppress. We found a strong correlation between 0900 salivary cortisone and serum cortisol after 1 mg ONDST (r² = 0.65, p = 0.009). When performance of post-dexamethasone salivary cortisone (< 2.7nmol/L) alone in relation to suppression of serum cortisol (< 50nmol/L) was analysed all but 2 individuals were correctly classified. They had values for post dexamethasone salivary cortisone/serum cortisol of respectively 5.9/23 nmol/L (presented with unexplained fatigue, case 25) and 7/32 nmol/L (investigated for cyclical Cushing's Syndrome that was excluded, case 29). Agreement was 94.1%, kappa 0.87, p < 0.0001. The sensitivity of salivary cortisone for potential Cushing's syndrome as indicated by the post-dexamethasone 0900 serum cortisol was 100% (all cases of potential cortisol excess (0900 cortisol > 50nmol/L) were picked up) and specificity of 84.6% with a positive predictive value of 90.5% of salivary cortisone (using serum cortisol as the standard) and negative predictive value of 100% in relation to ruling out cortisol excess.</p><p><strong>Conclusion: </strong>We have provided further evidence that ONDST salivary cortisone has potential to be the first-line test for suspected Cushing's syndrome, not requiring venepuncture or attendance at hospital, with 100% sensitivity and reasonable specificity. Application of the salivary cortisone test has the potential for significant savings of money and time in this and other contexts.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669476","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":"Tools to Predict Unilateral Primary Aldosteronism and Optimise Patient Selection for Adrenal Vein Sampling: A Systematic Review.","authors":"Elisabeth Ng, Stella May Gwini, Winston Zheng, Peter J Fuller, Jun Yang","doi":"10.1111/cen.15225","DOIUrl":"https://doi.org/10.1111/cen.15225","url":null,"abstract":"<p><strong>Objective: </strong>Primary aldosteronism (PA), the most common endocrine cause of hypertension, is evaluated using adrenal vein sampling (AVS), to determine if aldosterone excess is bilateral or unilateral. AVS is invasive and technically challenging; it would ideally be used only in those with unilateral PA who are candidates for surgical cure. Those with bilateral PA would benefit from a direct path to medical management before AVS. Strategic patient selection for AVS would enable judicious and cost-efficient use of this procedure. This review evaluates the diagnostic accuracy of published algorithms that aim to predict unilateral PA and therefore facilitate informed selection for AVS.</p><p><strong>Design: </strong>This systematic review was performed by searching Medline and EMBASE databases to identify published models that sought to subtype PA (PROSPERO registration CRD42021277841). Algorithms reported to predict unilateral PA and therefore select patients for AVS, using AVS and/or surgical outcomes as the gold standard, were systematically evaluated.</p><p><strong>Results: </strong>There were 28 studies evaluating 63 unique predictive algorithms, of which 14 were tested in multiple cohorts. These were grouped into 5 categories; those combining biochemical, radiological and demographic characteristics, those involving confirmatory testing those using biochemical results only, those involving dynamic testing, and anatomical imaging. The algorithm with the highest sensitivity for unilateral PA which has been validated in at least two cohorts, involved serum potassium, CT imaging, PAC, ARR and female sex (sensitivity 78-96%). In a hypothetical scenario of 1000 people with PA where 30% have unilateral PA, this top performing algorithm would appropriately select 234-289 people for AVS and allow 143-324 to correctly bypass AVS.</p><p><strong>Conclusions: </strong>Accurate algorithms to inform selection for AVS will ensure that AVS is only performed in patients with a high probability of unilateral PA without clear evidence of the side of lateralisation. This will lower the demand for this invasive procedure, avoid unnecessary procedural complications, and reduce associated health care costs. Further validation of the top-performing algorithms in larger and diverse cohorts will support their use in routine practice.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656253","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":"An Exploratory Cross-Sectional Study on Thyroid Hormone Reference Intervals in Children With Down syndrome.","authors":"Ayako Konishi, Kimiko Ueda, Nobuhiko Okamoto, Shinobu Ida, Yuri Etani, Masanobu Kawai","doi":"10.1111/cen.15236","DOIUrl":"https://doi.org/10.1111/cen.15236","url":null,"abstract":"<p><strong>Objective: </strong>Accurate evaluation of thyroid dysfunction in children with Down syndrome is challenging because of the lack of age-specific reference intervals in these individuals. This study aimed to establish age-specific reference intervals for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels in children with Down syndrome.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted on children with Down syndrome, aged 6 months to 15 years, who visited the Osaka Women's and Children's Hospital between April 2019 and March 2020. Subjects who had used medications that influenced thyroid function or who lacked thyroid hormone data were excluded from the study. The final analysis included 301 subjects. Serum TSH and FT4 levels were measured, and reference intervals were calculated using nonparametric methods.</p><p><strong>Results: </strong>The reference intervals for TSH in children with Down syndrome were 2.03-14.22, 1.79-12.98, 1.26-10.24, and 0.58-10.11 mIU/L in infants, toddlers, school children, and adolescents, respectively, which were higher than those observed in the general paediatric population. The reference intervals for FT4 were 13.57-26.42, 13.20-22.70, 13.15-22.36, and 11.97-24.77 pmol/L, respectively, which were comparable to those of the general paediatric population. Multivariate regression analyses revealed a significant inverse association between age and the levels of TSH and FT4 (p < 0.01).</p><p><strong>Conclusions: </strong>We provide evidence for age-specific reference intervals for TSH and FT4 levels in children with Down syndrome, which may help clinicians accurately evaluate thyroid hormone status.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656252","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":"Case Series of Patients With FGFR1-Related Pheochromocytoma and Paraganglioma With a Focus on Biochemical, Imaging Signatures and Treatment Options.","authors":"Sakshi Jhawar, Abhishek Jha, Sara Talvacchio, Junne Kamihara, Jaydira Del Rivero, Karel Pacak","doi":"10.1111/cen.15212","DOIUrl":"https://doi.org/10.1111/cen.15212","url":null,"abstract":"<p><p>Pheochromocytoma and paraganglioma (together PPGL) are tumours with a high degree of heritability. Genetic landscape is divided into three clusters, cluster 1 (Krebs/pseudohypoxia signalling pathway), cluster 2 (kinase signalling pathway) and cluster 3 (Wnt signalling pathway). With increasing knowledge in the field of genetics, cluster-specific tumour characteristics, biochemical phenotype and imaging signatures are established in commonly found genes. The association of FGFR1 pathogenic mutations with PPGL have been recently described although its features are not yet well established. Here, we present four patients with PPGL who were found to have somatic FGFR1 pathogenic mutations. We discuss their clinical presentations, biochemical phenotypes, imaging signatures and treatment options that will be relevant for practicing physicians in managing these patients effectively.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647287","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":"Boys Equal Girls.","authors":"Tim Cheetham","doi":"10.1111/cen.15234","DOIUrl":"https://doi.org/10.1111/cen.15234","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647284","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":"Prevalence of Metabolic-Associated Steatotic Liver Disease in Patients With Primary Aldosteronism.","authors":"Irene Tizianel, Alberto Madinelli, Filippo Crimì, Mattia Barbot, Simona Censi, Chiara Sabbadin, Filippo Ceccato","doi":"10.1111/cen.15231","DOIUrl":"https://doi.org/10.1111/cen.15231","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of metabolic associated steatotic liver disease (MASLD) in patients with primary aldosteronism (PA) compared to benign adrenal adenomas, and to evaluate the impact of hormonal excess in inducing MASLD.</p><p><strong>Design: </strong>Single-centre retrospective study.</p><p><strong>Methods: </strong>Hepatic steatosis was assessed by liver/spleen (L/S) ratio from unenhanced abdomen computed tomography images (reference value < 1.1) in a cohort of 41 patients with PA without cortisol cosecretion, 20 unilateral (uPA) and 21 bilateral (BPA), 50 with nonfunctioning adrenal incidentalomas (NF-AI), 48 with mild autonomous cortisol secretion (MACS) and 10 with adrenal Cushing Syndrome (CS).</p><p><strong>Results: </strong>Hepatic steatosis was increased in patients with PA at diagnosis: L/S ratio was lower in PA than NF-AI (1.1 vs. 1.25, p < 0.001) and MACS (1.1 vs. 1.21, p 0.007), but was similar to adrenal CS (1.1 vs. 1.15, p = 0.147). A improvement in L/S ratio after medical or surgical treatment was observed in PA patients, resulting in reduced liver steatosis. MASLD prevalence was higher in PA compared to MACS (49% vs. 25%, p < 0.05) and NF-AI (49% vs. 14%, p < 0.001), but similar to CS (49% vs. 45%, p = 0.61). uPA patients had higher MASLD prevalence compared to BPA group 71% (53%-89%) versus 25% (7%-43%).</p><p><strong>Conclusions: </strong>Prevalence of MASLD was increased in PA (higher in uPA than BPA) compared to MACS and NFAI, and similar to adrenal CS.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623741","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":"Response to Letter to Editor From Dr. Wei.","authors":"Ashna Grover, Hamayle Saeed, Mary Elizabeth Patti","doi":"10.1111/cen.15230","DOIUrl":"https://doi.org/10.1111/cen.15230","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604115","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":"Shared Decisionmaking in the Treatment of Hypothyroidism.","authors":"Antonio C Bianco","doi":"10.1111/cen.15228","DOIUrl":"https://doi.org/10.1111/cen.15228","url":null,"abstract":"<p><strong>Background: </strong>Hypothyroidism, a condition characterized by an underactive thyroid gland, affects millions worldwide, leading to cognitive and metabolic slowdowns. It is most prevalent in women and older adults, with causes including autoimmune thyroiditis, surgical thyroidectomy, and certain medications.</p><p><strong>Standard of care and limitations: </strong>The standard treatment involves synthetic levothyroxine (LT4) monotherapy, which alleviates symptoms by converting to the active hormone, T3. However, some patients continue to experience symptoms such as fatigue, mood disturbances, and poor quality of life despite normalized TSH levels. This persistence of symptoms may stem from misdiagnosis, inadequate dosing, or incomplete normalization of thyroid hormone signaling.</p><p><strong>New findings: </strong>Research suggests that LT4 monotherapy may not fully restore T3 levels, leading to suboptimal symptom control. Consequently, combination therapy with LT4 and liothyronine (LT3) has been proposed as an alternative, aiming to balance T4 and T3 levels more effectively. Although randomized controlled trials have not identified significant differences in patient-reported outcomes between LT4 monotherapy and combination therapy, they indicate that patients may prefer the latter.</p><p><strong>Conclusion: </strong>Guidelines from leading endocrinology organizations now recommend considering combination therapy for patients with persistent symptoms despite adequate LT4 dosing. A patient-centered approach, emphasizing shared decision-making and individualized treatment plans, is essential for optimizing outcomes in hypothyroidism management. Further research is needed to refine dosing strategies and identify the patients who would benefit most from combination therapy.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613763","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}