Clinical Endocrinology最新文献

{"title":"Clinical Profile, Biochemical Characteristics, and Surgical Outcomes in Cushing Disease: An Age-Stratified Analysis of a Large Tertiary-Care Cohort.","authors":"Rakhi Pooja, Vivek Jha, Kavyanjali Kundu, Jashanpreet Kaur, Bhawna Sharma, Rajesh Chhabra, Apinderpreet Singh, Sivashanmugam Dhandapani, Sushanta Kumar Sahoo, Sanjay Kumar Bhadada, Rama Walia","doi":"10.1111/cen.70200","DOIUrl":"https://doi.org/10.1111/cen.70200","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the clinical, biochemical, radiological, and surgical profile of Cushing disease in a large tertiary-care cohort, with emphasis on age-stratified differences.</p><p><strong>Methods: </strong>This retrospective observational audit included 277 patients with confirmed Cushing disease managed at a high-volume tertiary-care center between 2006 and 2025. Baseline clinical, biochemical, metabolic, radiological, and outcome data were extracted from the time of initial evaluation at our center, generally during diagnostic confirmation and before definitive therapy. Hormonal parameters were assessed using electrochemiluminescence immunoassay, and bone mineral density was evaluated using dual-energy X-ray absorptiometry only in a clinically selected subset. Surgical outcomes were assessed based on early postoperative cortisol levels, with remission defined as morning cortisol < 138 nmol/L.</p><p><strong>Results: </strong>The cohort demonstrated a marked female predominance (71.8%), with most patients presenting in the third and fourth decades. Classical cushingoid features were highly prevalent, including weight gain (79.4%), centripetal obesity (62.5%), hyperpigmentation (61.0%), and proximal myopathy (60.6%). Exploratory age-stratified patterns were observed in selected clinical and biochemical variables. Younger patients showed a relatively higher recorded frequency of dermatological and reproductive manifestations, including striae, acne, and menstrual irregularities, whereas the recorded burden of cardiometabolic comorbidities at tertiary-care assessment, including hypertension (70.8%) and diabetes mellitus (48.0%), was higher in older age groups. Body mass index and blood pressure also varied across age groups, although these findings should be interpreted cautiously because of the retrospective design, unequal age-stratum sizes, and absence of adjustment for multiple comparisons. Biochemically, median cortisol levels were elevated across the cohort, with exploratory variation across age groups. Higher cortisol concentrations were observed in younger patients, while adrenocorticotropic hormone levels remained comparable across age decades. Bone mineral density was available in a clinically selected subset of 78 patients. Within this DXA subset, reduced bone density was frequent; however, these findings were not extrapolated to the entire cohort. Transsphenoidal surgery was the primary treatment modality. Numerically similar early remission proportions were observed in microadenomas (72.7%) and macroadenomas (72.2%) in this cohort, with no clear descriptive age-related pattern in early postoperative outcomes. Early biochemical remission was observed in 166/233 surgically treated patients (71.2%), while 67/233 patients (28.8%) had persistent disease. Relapse was assessed only after documented initial remission and occurred in 22/166 patients (13.3%).</p><p><strong>Conclusion: </strong>This large single-cen","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700958","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":"Self-Reported Health Burden and Quality-of-Life-Related Concerns in Patients With Achondroplasia: A Survey From Türkiye.","authors":"Zehra Aycan, Murat Berge, Sukran Darcan, Saadet Olcay Evliyaoglu, Fatih Suheyl Ezgu, Ercan Mihci, Feristah Ferda Ozkinay","doi":"10.1111/cen.70190","DOIUrl":"https://doi.org/10.1111/cen.70190","url":null,"abstract":"<p><strong>Objective: </strong>Achondroplasia is an autosomal dominant genetic disorder, characterised by distinctive growth patterns and recognisable skeletal features. This study aimed to determine the demographic and clinical characteristics, quality of life (QoL) losses, and expectations of individuals with achondroplasia in Türkiye.</p><p><strong>Design: </strong>In this survey-based study, Computer-Assisted Telephone Interviewing (CATI) system was used and questions were directed to patients or their parents via phone calls.</p><p><strong>Patients: </strong>A total of 140 patients with achondroplasia, of whom 50.7% were male (age range, 0-20 years) were included.</p><p><strong>Measurements: </strong>The questionnaire forms were prepared by a committee including clinicians and the president of the Achondroplasia and Families Association. The forms included questions on sociodemographic characteristics, diagnosis and treatment, expectations from the patient association, and quality of life.</p><p><strong>Results: </strong>Achondroplasia was commonly diagnosed by obstetricians (76.5%) and the patients were followed by multiple specialties. Of the patients, 10% received growth hormone treatment, and 55.7% underwent at least one surgical procedure, with 23.6% undergoing limb lengthening surgery. The main symptoms frequently/very frequently observed in the patients were: sleep-disordered breathing (40%), recurrent ear infections (32%), and frequent respiratory tract infections (28%). The primary concerns involved experiences of social exclusion due to physical appearance and together with related psychological challenges. The main expectations of the participants and parents from the association were to receive education on achondroplasia management and new treatment options, and to promote public awareness.</p><p><strong>Conclusions: </strong>Patients with achondroplasia face significant challenges in daily life, they require medical treatment and some supportive services to improve their quality of life.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677290","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 Patient With Combined Pituitary Hormone Deficiency Due to a Novel Homozygous LHX3 Variant.","authors":"Sirmen Kızılcan Çetin, İbrahim Dikmen, Elif Özsu, Zehra Aycan, Merih Berberoğlu, Zeynep Şıklar","doi":"10.1111/cen.70198","DOIUrl":"https://doi.org/10.1111/cen.70198","url":null,"abstract":"<p><strong>Context: </strong>Variants in LHX3, encoding a LIM-homeodomain transcription factor essential for pituitary and neuronal development, are a rare cause of combined pituitary hormone deficiency (CPHD). Affected patients typically exhibit deficiencies of growth hormone (GH), thyrotropin (TSH), prolactin (PRL), and gonadotropins, often accompanied by cervical spine rigidity or sensorineural hearing loss.</p><p><strong>Case description: </strong>A 4.8-year-old boy presented with short stature and central hypothyroidism. Combined deficiencies of GH, TSH, and PRL were documented, while ACTH secretion remained intact. Cranial magnetic resonance imaging showed normal pituitary morphology. Neck mobility and audiological evaluation were unremarkable.</p><p><strong>Evaluation: </strong>A targeted next-generation sequencing panel for panhypopituitarism was non-diagnostic. Whole-exome sequencing (WES) was performed at 10.5 years of age.</p><p><strong>Results: </strong>WES identified a novel homozygous LHX3 c.575 G > A, p.(Arg192His) variant located within the homeodomain. Segregation analysis confirmed parental heterozygosity. A younger sister carrying the same homozygous variant exhibited a similar endocrine phenotype. Growth velocity normalized on recombinant human GH replacement.</p><p><strong>Conclusion: </strong>This case expands the phenotypic spectrum of LHX3-related CPHD by demonstrating that a homeodomain missense variant may produce isolated endocrine deficiencies without structural, auditory, or motor abnormalities, and underscores the value of serial genetic re-evaluation in unexplained CPHD.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677262","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":"Clinical, Biochemical, and Molecular Spectrum of Pseudohypoaldosteronism Type 1B in Indian Children: A Multicentric Case Series.","authors":"Melkunte Shanthaiah Dhananjaya, Leenatha Jakkadi, Parvathy Lalitha, L Prasadh Rao, Hebbal Nagarajappa Vani, Avani Hegde, Rajneesh Reddy, Hitesh Reddy, Sandhya Nair, Vijaya Sarathi","doi":"10.1111/cen.70196","DOIUrl":"https://doi.org/10.1111/cen.70196","url":null,"abstract":"<p><strong>Background: </strong>Pseudohypoaldosteronism type 1 (PHA1) is a rare hereditary disorder characterised by aldosterone resistance leading to salt wasting, hyperkalaemia, and metabolic acidosis. Two forms are recognised: a milder renal form (PHA1A) due to NR3C2 mutations and a severe systemic form (PHA1B) caused by biallelic mutations in epithelial sodium channel (ENaC) subunit genes. Data on Indian patients are scarce. This study describes the clinical, biochemical, and molecular characteristics and treatment outcomes of children with PHA1 from South India.</p><p><strong>Methods: </strong>This multicentric retrospective series included nine children diagnosed with PHA1 across six tertiary care centres between 2022 and 2025. Clinical and biochemical data were extracted from hospital records. Plasma renin, aldosterone, cortisol, and 17-hydroxyprogesterone were measured at presentation. Genetic testing was performed using clinical exome sequencing, and variants were classified according to American College of Medical Genetics and Genomics (ACMG) guidelines.</p><p><strong>Results: </strong>All nine patients had the systemic form (PHA1B). The median age at presentation was 14 days (interquartile range 5.5-42.5), and parental consanguinity was present in seven (78%). All presented with hyponatraemia and hyperkalaemia (median serum sodium 124 mEq/L; potassium 8.0 mEq/L). Eight (pathogenic/likely-pathogenic: 4, supporting: 4) homozygous variants were identified in SCNN1A (n = 2), SCNN1B (n = 3), and SCNN1G (n = 3); all were novel. Six patients (67%) died, mainly due to sepsis (n = 2) or treatment discontinuation (n = 4), while three remain stable on oral sodium supplementation.</p><p><strong>Conclusions: </strong>This first multicentric South Indian series highlights exclusive reporting of PHA1B, high early mortality, and major treatment challenges. Eight novel ENaC variants expand the genetic spectrum of PHA1B in India.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668543","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":"Immune Checkpoint Inhibitor Therapy Induced Hypophysitis; A Tertiary Care Centre Experience; Highlighting Detection, Treatment Outcomes and Long Term Endocrinopathies and Recovery","authors":"Shani A. D. Mathara Diddhenipothage,&nbsp;Jacqui Warden,&nbsp;Katie Herbert,&nbsp;Riccardo Pofi,&nbsp;Robin Joseph,&nbsp;Nicholas Coupe,&nbsp;Miranda Payne,&nbsp;Jeremy W. Tomlinson,&nbsp;Helen E. Turner","doi":"10.1111/cen.70137","DOIUrl":"10.1111/cen.70137","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction and Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The number of patients receiving immune checkpoint inhibitor (ICI) therapy for cancer is expected to increase further; hence, heightened awareness of immune-related adverse effects (irAEs) such as hypophysitis (ICI-Hp) is essential. Acute ICI-Hp is a common endocrine irAE of ICI therapy, and our aim was to describe its diagnostic pattern, treatment outcomes, endocrinopathies, and recovery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Records and imaging of all patients with ICI-Hp (&lt;i&gt;n&lt;/i&gt; = 22), referred to a dedicated endocrine-ICI clinic, were retrospectively reviewed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The median time for onset of ICI-Hp was 13 weeks (IQR 9, 17), after the 3rd (IQR 3, 4) cycle of therapy. 55% of patients were female, with a median age of 67 years (IQR 53, 74), and 77% had metastatic melanoma. A combination of ipilimumab and nivolumab was used in 68% of those developing ICI-Hp. Headache (64%), fatigue (77%), nausea (64%), and hyponatraemia (41%) were the most common symptoms at presentation. Secondary adrenal insufficiency (SAI) was seen in 100%, secondary hypothyroidism (SH) in 41%, and secondary hypogonadism (SHG) in 27%. An enlarged pituitary gland (64%), thickened stalk (50%), mild optic chiasm compression (&lt;i&gt;n&lt;/i&gt; = 3), and asymptomatic pituitary enlargement (&lt;i&gt;n&lt;/i&gt; = 1) were noted on pituitary imaging. Glucocorticoid (GC) treatment regimens included intravenous methylprednisolone (IV MPP) (&lt;i&gt;n&lt;/i&gt; = 4), prednisolone (&lt;i&gt;n&lt;/i&gt; = 8), dexamethasone (&lt;i&gt;n&lt;/i&gt; = 1), and oral hydrocortisone stress dosing for 48 h (&lt;i&gt;n&lt;/i&gt; = 6). Complete resolution of symptoms and significant resolution of imaging findings were noted in all, independent of regimen. Acute psychosis was noted with IV MPP (&lt;i&gt;n&lt;/i&gt; = 1). None recovered SAI during follow-up, whilst recovery of SH and SHG was noted in 33% and 67%, respectively. Additionally, new-onset type 1 diabetes developed in 18%, with DKA in 3 patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;ICI-Hp is common and potentially associated with serious complications in the absence of prompt recognition and treatment. Assessment of recovery of the HP-thyroid and HP-gonadal axes is important; however, ACTH deficiency is more likely to be permanent, hence requiring long-term GC replacement and appropriate patient education. Occurrence of ICI-Hp is most commonly seen after the 3rd cycle of combination ICI therapy, and in the future it may be appropriate to warn treating physicians (and perhaps patients) of the symptoms to flag after the third cycle of combination immunotherapy.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 3","pages":"331-338"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510056","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":"Obesity in Classic Congenital Adrenal Hyperplasia: Mechanisms, Complications and Management","authors":"Jialin Mu,&nbsp;Yue Li,&nbsp;Meng Sun,&nbsp;Yulin Li,&nbsp;Panpan Li,&nbsp;Hui Zou","doi":"10.1111/cen.70155","DOIUrl":"10.1111/cen.70155","url":null,"abstract":"<p>Classic congenital adrenal hyperplasia (CCAH) is an autosomal recessive genetic disorder primarily caused by 21-hydroxylase deficiency. Although the survival rate of patients has significantly improved with glucocorticoid replacement therapy, long-term use of supraphysiological doses and multiple factors inherent to the disease itself have led to obesity becoming a common metabolic complication in CCAH patients. The mechanism of obesity in CCAH patients is complex and involves multiple factors related to both treatment and the disease itself. This article provides a narrative review of the incidence, influencing factors, related complications and treatment management strategies of obesity in CCAH patients, with the aim of offering comprehensive management recommendations for clinical practice.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 3","pages":"271-284"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866936","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":"Metabolic Effects of Modified-Release Hydrocortisone Versus Short Acting Conventional Oral Glucocorticoids in Adrenal Insufficiency: A Systematic Review and Meta-Analysis","authors":"Mohammad Ehab Abdelsattar,&nbsp;Mai Abdallah,&nbsp;Ola Khaled,&nbsp;Heba Aboeldahab,&nbsp;Nour Mohyeldin Ahmed,&nbsp;Yusuf Abdeen,&nbsp;Nada Altayeb,&nbsp;Yousef Mousa,&nbsp;Ahmed Gaballa Ali,&nbsp;Mohammed Tarek Hasan","doi":"10.1111/cen.70149","DOIUrl":"10.1111/cen.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Adrenal insufficiency's (AI) lifelong replacement therapy by conventional glucocorticoid (GC) regimens poorly mimics physiological cortisol, leading to poor adherence and metabolic abnormalities. Modified-release hydrocortisone (MR-HC) provides a more physiological cortisol replacement with potentially enhanced outcomes. This study assessed comparative evidence of MR-HC versus GC in patients with AI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Comparative articles published until July 2025 were searched in PubMed, Scopus and Web of Science. Glucose metabolism, anthropometrics, lipid profile and blood pressure were the primary outcomes; bone health parameters and safety and tolerability measures were secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across six included studies (<i>n</i> = 400), MR-HC was associated with significant reductions in BMI (mean difference −1.1, 95% CI −2.11 to −0.1) and waist circumference (−5.03, 95% CI−8.54 to −1.51), without significant changes in body weight. MR-HC lowered total cholesterol (−10.64, 95% CI −19.86 to −1.42), systolic blood pressure (−6.03, 95% CI −10.95 to −1.1) and diastolic blood pressure (−4.35, 95% CI −7.37 to −1.34). Glucose metabolic outcomes (fasting glucose and HbA1c) did not differ significantly between the groups, but sensitivity analysis suggested a potential HbA1c benefit with MR-HC. Bone health results favoured MR-HC for lumbar spine <i>T</i>-score (0.69, 95% CI 0.16 to 1.22), and femoral neck <i>T</i>-score (0.64, 95% CI 0.16 to 1.12). Safety measures favoured MR-HC for Infection score (−1.7, 95% CI −2.6 to −0.8), and flu-like events (−1.0, 95% CI −1.6 to −0.4), but not vertebral fractures (0.20, 95% CI 0.03 to 1.55), or AddiQol score (4.00, 95% CI −0.68 to 8.68).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MR-HC demonstrated improved effects on anthropometric measures, lipid profile, blood pressure, bone mineral density, and safety and tolerability compared to conventional GC with no apparent differences in glucose metabolism. These findings validate MR-HC as a better regimen, but await larger long-term trials for confirmation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>This study was prospectively registered on PROSPERO (CRD420251074980). Available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251074980.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 3","pages":"285-297"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764386","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":"Dual Metabolic Burden of Polyendocrine Metabolic Ovarian Syndrome (PMOS) and Gestational Diabetes in Pregnancy: Impact on Neonatal Anthropometry: Insights From the Born in Bradford Cohort","authors":"Harshal A. Deshmukh,&nbsp;Amal Rauf,&nbsp;Eunice Waife,&nbsp;Aatif Syed,&nbsp;Emmanuel Ssemmondo,&nbsp;Najeeb Shah,&nbsp;Thozhukat Sathyapalan","doi":"10.1111/cen.70168","DOIUrl":"10.1111/cen.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Polyendocrine metabolic ovarian syndrome (PMOS) and gestational diabetes mellitus (GDM) independently influence foetal growth, but their combined impact remains poorly characterised. This study examined the individual and joint associations of PMOS and GDM with neonatal anthropometry in a large, multi-ethnic population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a secondary analysis of 9454 singleton pregnancies from the Born in Bradford (BiB) cohort (UK, 2007–2011). Women were classified into four groups: (1) normoglycemic non-PMOS controls, (2) PMOS only, (3) GDM only and (4) PMOS + GDM. GDM was defined using NICE criteria. The primary outcome was birth weight; secondary outcomes included head circumference, mid-arm circumference and subscapular skinfold thickness. Multivariable linear regression models were used to assess associations, adjusting for maternal age, pre-pregnancy BMI and ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with PMOS were younger (25.5 ± 4.6 vs. 27.3 ± 5.6 years, <i>p</i> &lt; 0.001) and had higher BMI (27.9 vs. 25.9 kg/m², <i>p</i> &lt; 0.0001) than controls. Offspring of women with PMOS or GDM had lower mean birth weights than controls (3171 and 3162 g vs. 3242 g, <i>p</i> = 0.0005), with the greatest reduction among PMOS + GDM pregnancies (3118 g). In adjusted models, maternal BMI was strongly associated with birth weight (<i>β</i> = 19.3 g/kg/m², <i>p</i> &lt; 1 × 10⁻⁶²), whereas PMOS (<i>β</i> = −123.9 g, <i>p</i> = 0.007), GDM (<i>β</i> = −136.5 g, <i>p</i> = 1.8 × 10⁻⁹) and PMOS + GDM (<i>β</i> = −241.8 g, <i>p</i> = 0.046) were associated with lower birth weights. Infants of mothers with combined PMOS + GDM also had the lowest mid-arm circumference and subscapular skinfold thickness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both PMOS and GDM are independently and additively associated with lower foetal birth weight, with coexisting PMOS + GDM conferring the greatest reduction in neonatal size and adiposity. These findings highlight the compounded intrauterine metabolic stress in pregnancies in women with coexisting PMOS and GDM and underscore the importance of targeted antenatal care to mitigate intergenerational metabolic risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 3","pages":"307-313"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216709","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":"Supraphysiological Glucocorticoid Doses and Pitfalls of Annual Biomarker Monitoring in Adults With CAH","authors":"Jakob Bolinder,&nbsp;Oskar Ragnarsson,&nbsp;Gudmundur Johansson","doi":"10.1111/cen.70172","DOIUrl":"10.1111/cen.70172","url":null,"abstract":"&lt;p&gt;Management of congenital adrenal hyperplasia (CAH) remains a balancing act between androgen excess and glucocorticoid overexposure. We performed a retrospective review of 58 adults with 21-hydroxylase deficiency (21-OHD) followed at the Department of Endocrinology at the Sahlgrenska University Hospital during the period 2020–2024. While the limited study size and retrospective design warrant cautious interpretation, the findings nonetheless point to important challenges in current practice.&lt;/p&gt;&lt;p&gt;The cohort included all forms of confirmed 21-OHD (&lt;i&gt;n&lt;/i&gt; = 58), predominantly classic CAH (salt-wasting and simple virilizing; &lt;i&gt;n&lt;/i&gt; = 50). Half of the patients (&lt;i&gt;n&lt;/i&gt; = 29) used daily doses above 13 mg/m&lt;sup&gt;2&lt;/sup&gt;/day, approximating the midpoint of the recommended dosing range in pediatric care (10–15 mg/m&lt;sup&gt;2&lt;/sup&gt;/day). Furthermore, a total of 11 patients followed a reverse-circadian regimen, most commonly with prednisolone at bedtime (&lt;i&gt;n&lt;/i&gt; = 9) (Table 1). Treatment was individualized; the number of daily doses was influenced by glucocorticoid type, phenotype, and patient preferences, with long-standing stable regimens sometimes maintained in the absence of clear adverse effects or unsatisfactory response to treatment changes. Although sick day rules and emergency care are addressed with patients, parenteral hydrocortisone rescue treatment was prescribed in only 27.6% overall and 36.4% of patients with salt-wasting CAH, representing an important area for improvement.&lt;/p&gt;&lt;p&gt;In addition to controlling clinical hyperandrogenism in women and supporting fertility in both men and women, a central aim in the long-term follow-up of patients with CAH has been to reduce supraphysiological doses and to avoid non-physiological regimens such as reverse-circadian dosing. This is motivated by previous reports linking glucocorticoid overexposure in adults with CAH to obesity, hypertension, insulin resistance, and reduced bone mineral density [&lt;span&gt;2&lt;/span&gt;], and by studies suggesting that evening cortisol elevations exert more detrimental metabolic effects than morning elevations [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Blood samples were mostly collected in the morning before each out-patient visit without any instructions related to last glucocorticoid dose. Mean 17-hydroxyprogesterone (17-OHP) levels exceeded reference values in the majority of patients (&lt;i&gt;n&lt;/i&gt; = 49). Testosterone in women, particularly in the presence of hirsutism or fertility concerns, and androstenedione in men may offer greater clinical utility [&lt;span&gt;3&lt;/span&gt;]. These concentrations were frequently outside the reference intervals, as illustrated in Figure 1. Importantly, however, normalization of these biomarkers should not be the therapeutic goal in most patients, as they may instead lead to glucocorticoid excess and overtreatment [&lt;span&gt;3&lt;/span&gt;]. Nevertheless, the same patient frequently presented with values both above and below the reference range at different time points, often in ","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"105 3","pages":"360-362"},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270573","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":"Lupus‑Associated Hypophysitis: A Narrative Systematic Review of Clinical, Radiological and Endocrine Features.","authors":"Abdellatif Zhalka, Shadi Shinnawi, Rami Jabareen, Awad Karem, Muhammad Zahlaka","doi":"10.1111/cen.70197","DOIUrl":"https://doi.org/10.1111/cen.70197","url":null,"abstract":"<p><strong>Background: </strong>Lupus-associated hypophysitis is a rare but clinically important manifestation of systemic lupus erythematosus (SLE), characterised by heterogeneous pituitary dysfunction and inflammatory sellar changes that may mimic other pituitary disorders. Evidence is limited to isolated reports. We aimed to summarise clinical, radiological, endocrine features, management, and outcomes.</p><p><strong>Methods: </strong>A narrative systematic review of MEDLINE, Embase, Web of Science, and Google Scholar to 10 November 2025. Reports were included if accepted SLE criteria were met and hypophysitis or hypothalamic-pituitary inflammation was attributed to SLE after exclusion of alternative sellar pathology. Demographic, clinical, endocrine, imaging, treatment, and outcome data were synthesised descriptively.</p><p><strong>Results: </strong>Eleven cases (63% female; median age 23 years) were identified, most presenting at or near SLE diagnosis. Common symptoms included polyuria/polydipsia, fatigue, amenorrhoea, and headache. Arginine vasopressin deficiency (AVP-D) frequently coexisted with multi-axis anterior hypopituitarism. MRI typically demonstrated pituitary stalk thickening, gland enlargement, and loss of the posterior pituitary bright spot. High-dose glucocorticoids, with or without additional immunosuppression, led to improvement in most cases, although persistent adrenal and gonadal deficits were common; one patient died from severe hyponatraemia.</p><p><strong>Conclusions: </strong>Lupus-associated hypophysitis is a rare manifestation of SLE with heterogeneous endocrine and radiological presentations that may create diagnostic challenges. Early endocrine evaluation and pituitary imaging are important in patients with suspected hypothalamic-pituitary involvement.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668670","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}