Endocrine journal最新文献

{"title":"Early diagnosis of capivasertib-associated severe hyperglycemia with diabetic ketosis diagnosed in routine clinical practice: a case report with review of literature.","authors":"Masashi Yoshikawa, Keiichiro Takahashi, Satoshi Yoshino, Yutaka Watanuki, Aya Osaki, Hiroki Ito, Masaya Uehara, Keiko Tanabe, Sasagu Kurozumi, Shunichi Matsumoto, Kazuhiko Horiguchi, Eijiro Yamada","doi":"10.1507/endocrj.EJ26-0035","DOIUrl":"https://doi.org/10.1507/endocrj.EJ26-0035","url":null,"abstract":"<p><p>Capivasertib, an oral pan-AKT inhibitor, is a therapeutic option for hormone receptor-positive advanced breast cancer. While hyperglycemia is a recognized adverse effect of AKT inhibition, its diagnosis is often delayed in routine clinical practice. We report a case of acute-onset severe hyperglycemia with diabetic ketosis identified within 4 days of initiating capivasertib in a patient without pre-existing glucose intolerance. A 61-year-old woman developed marked hyperglycemia (random plasma glucose, 482 mg/dL) with ketosis, despite being asymptomatic. Laboratory evaluation showed markedly elevated serum insulin (591.9 μU/mL), indicating preserved pancreatic β-cell function and severe insulin resistance. Blood glucose levels improved rapidly within 2 days of admission using minimal insulin therapy and fluid replacement. Unlike previously reported cases identified after symptomatic presentation, including emergency department visits, or under intensive inpatient monitoring, this case was detected through a proactively scheduled outpatient visit on day 4-strategically timed to coincide with the end of the first dosing cycle based on the drug's pharmacological profile. This observation highlights that severe hyperglycemia can develop very early and remain asymptomatic, underscoring the importance of proactive detection. Therefore, even in patients without pre-existing glucose intolerance or with preserved insulin secretion, proactive glucose monitoring during the first week of therapy, specifically near the end of the initial dosing cycle, is essential to prevent severe metabolic complications. Appropriate patient education and early consultation with diabetes specialists are also crucial for timely management.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging human cell-based in vitro models for studying pituitary development and disorders.","authors":"Ryusaku Matsumoto, Ayaka Nishio, Yutaka Takahashi, Takuya Yamamoto","doi":"10.1507/endocrj.EJ25-0601","DOIUrl":"10.1507/endocrj.EJ25-0601","url":null,"abstract":"<p><p>The pituitary gland plays a central role in maintaining physiological homeostasis by secreting multiple hormones that regulate diverse body functions. Dysregulation of pituitary hormones can arise from various conditions, such as pituitary tumors and autoimmune diseases, leading to a broad spectrum of symptoms. During embryonic organogenesis, the pituitary gland originates from the oral ectoderm in close contact with the adjacent hypothalamus. This tissue interaction is essential for proper development. Although the molecular mechanisms underlying pituitary development and related disorders have been extensively studied using animal models, such as rodents and zebrafish, species-specific differences limit the translatability of these findings to humans. Moreover, the scarcity of established human pituitary cell lines has hindered the investigation of human-specific mechanisms. Recent biotechnological advances have addressed these limitations by enabling the long-term culture of human pituitary tumor tissues and in vitro generation of pituitary hormone-producing cells from human pluripotent stem cells. These emerging platforms provide powerful tools for deepening our understanding of pituitary biology and diseases. In this review, we summarize current in vitro experimental models derived from pituitary tissues and pluripotent stem cells and discussed their applications in the study of pituitary development, physiology, and related disorders.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"811-826"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A predictive nomogram for progression-free survival in radioiodine-refractory papillary thyroid carcinoma after reoperation: a longitudinal study in Vietnam.","authors":"Nguyen Thi Nhung, Le Ngoc Ha, Van Dong Hoang, Zhanna Mussazhanova, Hirokazu Kurohama, Katsuya Matsuda, Yuki Matsuoka, Le Thi Khanh Tam, Ngo Thi Minh Hanh, Van Phu Thang Nguyen, Thi Ngoc Anh Nguyen, Katsiaryna Tratsiakova, Michiko Matsuse, Norisato Mitsutake, Masahiro Nakashima","doi":"10.1507/endocrj.EJ25-0565","DOIUrl":"10.1507/endocrj.EJ25-0565","url":null,"abstract":"<p><p>Radioiodine-refractory (RAI-R) papillary thyroid carcinoma (PTC) with disease progression is associated with poor prognosis. This study aimed to develop a predictive nomogram for progression-free survival (PFS) in RAI-R PTC by integrating clinical, pathological, and mutational features. In this longitudinal study, 145 patients with RAI-R PTC who underwent reoperation for locoregional recurrence were followed for disease progression. A Bayesian model averaging (BMA) approach was employed to identify the optimal model for predicting PFS. Model performance was assessed using time-dependent area under the receiver operating characteristic curve (AUC), Brier scores, and calibration plots. A nomogram for PFS prediction was then developed based on parameters from the optimal model. During a median follow-up of 29.7 months, 38 patients (26.2%) experienced disease progression after reoperation. Among eight candidate variables, BMA identified an optimal model that included four key predictors: treatment response, extrathyroidal/extranodal extension, mitotic count, and coexisting BRAF^V600E and TERT promoter mutations (Dmut). The hazard ratios (95% confidence intervals) were 3.86 (1.54-9.72) for biochemical incomplete response, 9.39 (3.35-26.3) for structural incomplete response, 3.40 (1.69-6.85) for extrathyroidal/extranodal extension, 1.34 (1.13-1.58) for mitotic count, and 6.08 (2.79-13.2) for Dmut. The optimal model demonstrated strong discriminative performance and stability across time points, with AUCs (95% confidence intervals) of 0.905 (0.801-1.000), 0.919 (0.857-0.981), and 0.921 (0.861-0.981) at 12, 24, and 36 months, respectively, and showed good calibration. This study demonstrates that integrating treatment response, extrathyroidal/extranodal extension, mitotic count, and Dmut into a predictive nomogram offers a clinically relevant tool for stratifying progression risk in patients with RAI-R PTC.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"867-881"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of iodine-131-metaiodobenzylguanidine therapy for multiple endocrine neoplasia type 2A-associated metastatic pheochromocytoma: case report and literature review.","authors":"Kentaro Suda, Noriko Kimura, Toshihiro Maeda, Shiro Watanabe, Sachiyo Nishida, Hiroaki Shima, Taro Sugawara, Shinya Uchino, Aki Ishikawa, Toshiaki Tanaka, Masato Furuhashi, Naoya Masumori, Akihiro Sakurai","doi":"10.1507/endocrj.EJ25-0486","DOIUrl":"10.1507/endocrj.EJ25-0486","url":null,"abstract":"<p><p>Malignant transformation in multiple endocrine neoplasia type 2 (MEN2)-associated pheochromocytoma is rare, and there have been few reports of treatment with ¹³¹I-metaiodobenzylguanidine (MIBG) therapy. Here, we describe a 47-year-old woman diagnosed as having bilateral pheochromocytoma with medullary thyroid carcinoma. Genetic testing confirmed the MEN2A subtype with the pathogenic variant p.C634Y in the RET oncogene. She underwent total thyroidectomy due to medullary thyroid carcinoma with elevated calcitonin levels as high as 1,380 pg/mL, classified as pT2N0M0, stage I. Plasma noradrenaline levels were significantly elevated, and abdominal computed tomography showed bilateral tumors of up to 6 and 2 cm in the right and left adrenal glands, respectively. She underwent right adrenalectomy and left partial adrenalectomy. Pathological examination confirmed bilateral pheochromocytoma, with Ki-67 indices of 2% and 12% in the left and right adrenal tumors, respectively. Calcitonin and catecholamine levels decreased after surgery. Seven years later, elevated plasma-free normetanephrine levels along with multiple metastases in the liver, spine, and pelvis on MIBG scintigraphy were indicative of metastatic pheochromocytoma. She underwent ¹³¹I-MIBG therapy with a dose of 7.6 GBq. Despite no significant change in metastatic or left adrenal tumor size, normetanephrine levels decreased from 1,210 to 437 pg/mL, and the patient has remained stable for more than 2 years after treatment without tumor growth. The malignant potential of MEN2A-associated pheochromocytoma emphasizes the need for accurate informed consent, especially when performing partial adrenalectomy. While ¹³¹I-MIBG therapy appears promising, its efficacy requires further assessment due to the limited number of reported cases of MEN2A-associated metastatic pheochromocytoma.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"889-897"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from maturity-onset diabetes of the young into impaired insulin secretion in type 2 diabetes.","authors":"Yukio Horikawa, Yoshihiro Takahashi, Kazuyoshi Hosomichi","doi":"10.1507/endocrj.EJ26-0092","DOIUrl":"10.1507/endocrj.EJ26-0092","url":null,"abstract":"<p><p>Monogenic diabetes arises from pathogenic variants in a single gene that are sufficient to cause disease predisposition. In general, a greater functional impact of genetic abnormalities is associated with an earlier age of onset. Accordingly, monogenic diabetes encompasses a wide clinical spectrum, including neonatal diabetes mellitus presenting within the first six months of life, and maturity-onset diabetes of the young (MODY) typically manifesting from childhood to early adulthood; both diabetic types exhibit impaired insulin secretory capacity. Although MODY is currently classified as diabetes of monogenic defect with impaired insulin secretion, it has become evident that mutations in rare MODY subtypes exhibit reduced pathogenic effects and low penetrance. In addition, observed differences in the clinical phenotypes caused by the same mutation, even in the same family, might be caused by other phenotypic modifying factors. Furthermore, their clinical expression is influenced, at least in part, by environmental factors, such as the intrauterine environment. Nevertheless, identification of the causative genes underlying monogenic diabetes has elucidated previously unrecognized molecular mechanisms responsible for the impaired insulin secretion. These findings have not only revealed novel therapeutic targets but have also provided important insights into the pathophysiology of common type 2 diabetes mellitus in the Japanese population, a multifactorial disease in which defective insulin secretion plays a central role.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"667-675"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital aldosterone deficiency and its resistance.","authors":"Toshihiro Tajima, Naoko Amano, Tomohiro Ishii, Michio Otuski, Takuyuki Katabami, Kenichi Kashimada, Tomonobu Hasegawa, Tokuo Mukai, Yuichi Yoshida, Hirotaka Shibata","doi":"10.1507/endocrj.EJ25-0630","DOIUrl":"10.1507/endocrj.EJ25-0630","url":null,"abstract":"<p><p>Aldosterone synthase deficiency (ASD), which is caused by a genetic defect in CYP11B2, involves a deficiency in aldosterone alone. Newborn and early childhood ASD patients can present with salt-wasting symptoms. In severe cases, this can lead to shock and be life-threatening. ASD must also be differentiated from another disease, pseudohypoaldosteronism type 1 (PHA1), which involves resistance to aldosterone. PHA1 can be classified into PHA1a, PHA1b, and secondary PHA1. PHA1a is caused by a heterozygous defect in NR3C2, which encodes the mineralocorticoid receptor. PHA1b is an autosomal recessive disorder caused by defects in the 3 epithelial sodium channel subunits α, β, and γ, encoded by SCNN1A, SCNN1B, and SCNN1G. Since ASD is a very rare disorder, the \"The Intractable Adrenal Disorders Research by the Ministry of Health, Labour, and Welfare\" developed the \"Diagnostic criteria and severity classification for aldosterone synthase deficiency\" to better understand the disorder. The criteria are as follows: Clinical symptoms: patient meets criteria 1 and 2. 1) Presents with salt-wasting symptoms (poor feeding, vomiting, dehydration, poor weight gain). 2) No skin pigmentation. Laboratory findings: patient meets criteria 1 through 3. 1) Low serum sodium and high serum potassium. 2) Low to normal plasma aldosterone and high plasma renin activity or high plasma active renin concentration. 3) No low blood cortisol level. Diagnoses of exclusion include PHA1, 21-hydroxylase deficiency, congenital lipoid adrenal hyperplasia, and congenital adrenal hypoplasia. We believe that the diagnostic criteria of ASD will enable clinicians and researchers to better understand congenital aldosterone deficiency.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"751-763"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine disorders in pediatric medulloblastoma survivors treated with X-ray or proton beam therapy: a single-institution retrospective study.","authors":"Naoya Kaneko, Shuntaro Morikawa, Megumi Endo, Nozomi Hishimura, Liu Zhitong, Takeshi Yamaguchi, Hisato Segoe, Jutaro Abe, Kazumi Oura, Saori Sawai, Minako Sugiyama, Yukayo Terashita, Shinsuke Hirabayashi, Yuko Cho, Akie Nakamura, Yukitomo Ishi, Seishin Takao, Yuto Matsuo, Shigeru Yamaguchi, Takayuki Hashimoto, Atsushi Manabe","doi":"10.1507/endocrj.EJ25-0442","DOIUrl":"10.1507/endocrj.EJ25-0442","url":null,"abstract":"<p><p>Medulloblastoma, a common pediatric central nervous system disease, is managed with surgery, chemotherapy, and craniospinal irradiation (CSI) delivered with either X-rays or protons. Proton-beam CSI, introduced to protect the surrounding tissues, may reduce endocrine toxicity. In this single-institution retrospective observational study, we evaluated adverse endocrine events in 14 patients diagnosed with medulloblastoma before 13 years of age: 9 and 5 received X-ray and proton beam CSI, respectively. In the X-ray therapy group, the median age at diagnosis was 4.2 (range: 1.4-12.5) years, the median post-radiation follow-up was 19.5 (9.7-34.7) years, and the median CSI dose was 25.2 (23.4-36.0) Gy. The proton beam therapy group showed corresponding medians of 9.4 (5.3-11.7) years, 6.9 (5.4-8.1) years, and 23.4 (23.4-36.0) Gy. Five years after radiation therapy completion, the incidence of growth hormone deficiency was 44% (4/9) and 60% (3/5) in the X-ray and proton beam therapy groups, respectively. However, primary hypothyroidism and central hypothyroidism were exclusively observed in the X-ray therapy group, in 33% (3/9) and 11% (1/9) of patients. Given the short follow-up period for the proton beam therapy group, the difference in the occurrence rates of gonadal dysfunction and adrenal insufficiency is currently unknown. Our findings suggest that, at ≤5 years after the completion of radiation therapy, radiation-induced hypothyroidism was observed only in patients treated with X-ray therapy and not in those treated with proton beam therapy. Further studies with larger cohorts and longer follow-up periods are required to clarify this possible advantage and to refine radiation therapy protocols.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"729-740"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between stress hyperglycemia ratio and cognitive function in older patients with diabetes or prediabetes: a cross-sectional study from the NHANES.","authors":"Luwen Zou, Weiguang Ye, Chao Li, Shuai Yang","doi":"10.1507/endocrj.EJ25-0437","DOIUrl":"10.1507/endocrj.EJ25-0437","url":null,"abstract":"<p><p>To explore the association between stress hyperglycemia ratio (SHR) levels and cognitive function in older patients with diabetes or prediabetes. Cognitive function was assessed through a composite Z-score, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) subtest, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). SHR was calculated as the fasting blood glucose divided by the estimated average glucose from glycated hemoglobin. In subsequent analyses, SHR was divided into quartiles (quartiles 1 to 4), with the second quartile serving as the reference group. A weighted linear regression model was used to assess the association between SHR and cognitive function. After adjusting the corresponding covariates, the analysis revealed that compared to the second quartile, the first [β: -0.26; 95% confidence interval (CI): -0.39- -0.12], third (β: -0.13, 95% CI: -0.25- -0.02), and fourth (β: -0.21, 95% CI: -0.36- -0.06) quartiles were all associated with a decrease in Z-score. The first quartile was associated with a decline in AFT (β: -1.46, 95% CI: -2.57- -0.36). The first (β: -3.72, 95% CI: -6.06- -1.38) and fourth (β: -2.58, 95% CI: -4.98- -0.17) quartiles were associated with a decline in DSST. No statistically significant associations were observed between any of the quartile groups and CERAD (all p > 0.05). Both higher and lower SHR were associated with poorer overall cognitive function, with higher and lower SHR being related to worse memory dimensions, while lower SHR was associated with impaired executive function.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"691-707"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of the use of chemiluminescent enzyme immunoassay-measured plasma aldosterone concentration in the diagnostic process of unilateral primary aldosteronism: a real-world multicenter study in Japan.","authors":"Shoichiro Izawa, Kazuhisa Matsumoto, Kanako Kadowaki, Toshifumi Nakamura, Norio Wada, Takuyuki Katabami, Yoichi Nozato, Ryuji Okamoto, Takamasa Ichijo, Daisuke Taura, Masanori Murakami, Miki Kakutani, Takashi Yoneda, Minemori Watanabe, Yutaka Takahashi, Shintaro Okamura, Katsutoshi Takahashi, Hiroki Kobayashi, Mitsuhide Naruse, Kenichi Yokota, Masakatsu Sone","doi":"10.1507/endocrj.EJ25-0538","DOIUrl":"10.1507/endocrj.EJ25-0538","url":null,"abstract":"<p><p>Unilateral primary aldosteronism (UPA) is characterized by a severe clinical phenotype and can be cured by adrenalectomy. Establishing accurate cutoff values that indicate the need for adrenal venous sampling (AVS) is crucial. Therefore, we aimed to identify appropriate cutoff values for screening and confirmatory testing to predict UPA by LC-MS/MS-equivalent plasma aldosterone concentration (PAC) using chemiluminescent enzyme immunoassay (CLEIA). A retrospective cohort analysis was conducted as part of the JPAS-II study of 443 patients diagnosed with PA using CLEIA-measured PAC, of whom 179 were confirmed by AVS as having UPA. The screening aldosterone-to-renin ratio (sARR), screening PAC, post-captopril challenge test (CCT) aldosterone-to-renin ratio (ARR), post-CCT PAC, and post-saline infusion test (SIT) PAC were significantly higher in patients with UPA than in those with bilateral PA (p < 0.05). Receiver operator characteristic curve analysis yielded an sARR cutoff value of >183 pg/mL/ng/mL/h (sensitivity of 0.95). The post-CCT ARR (AUC: 0.824 ± 0.022) and post-CCT PAC (AUC: 0.845 ± 0.021) were superior predictors of UPA to post-SIT PAC (AUC: 0.782 ± 0.037). When the cutoff values were designed to maximize sensitivity without a significant reduction in specificity, cutoff values for post-CCT ARR of >153 pg/mL/ng/mL/h (sensitivity: 0.85, specificity: 0.55) and for post-SIT PAC of >48 pg/mL (sensitivity: 0.80, specificity: 0.61) were obtained. Importantly, these cutoff values contributed to a diagnosis of UPA when the presence of hypokalemia or adrenal tumor was also considered. In conclusion, LC-MS/MS-equivalent CLEIA-measured cutoff values for post-CCT ARR of >153 pg/mL/ng/mL/h and for post-SIT PAC of >48 pg/mL are considered to indicate AVS. Study registration number: UMIN ID: 000046631.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"709-719"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[¹⁸F]FB(ePEG12)12-Exendin-4 positron emission tomography/magnetic resonance imaging for precise preoperative localization of a pancreatic-head insulinoma: a case report with review of literature.","authors":"Hayao Yoshida, Takaaki Murakami, Kentaro Sakaki, Kanae Kawai Miyake, Yoichi Shimizu, Daisuke Otani, Mari Matsushiro, Koji Itagaki, Kazuyuki Nagai, Tsuyoshi Ohno, Hiroaki Ito, Shinya Otsuki, Hidefumi Inaba, Shizuka Kaneko, Hiroyuki Fujimoto, Daisuke Yabe, Yuji Nakamoto, Nobuya Inagaki","doi":"10.1507/endocrj.EJ25-0591","DOIUrl":"10.1507/endocrj.EJ25-0591","url":null,"abstract":"<p><p>Insulinomas are rare functional pancreatic neuroendocrine tumors that cause hypoglycemia from inappropriate insulin secretion. Surgical resection is curative but hinges on accurate preoperative localization. Conventional imaging with computed tomography and magnetic resonance imaging may miss small lesions, and invasive tests such as endoscopic ultrasound tissue acquisition and the selective arterial calcium stimulation test, while informative, are operator-dependent and not invariably conclusive. Glucagon-like peptide-1 receptor-targeted positron emission tomography has emerged as a sensitive, noninvasive localization tool. A 53-year-old man presented with endogenous hyperinsulinemic hypoglycemia, including a witnessed nocturnal seizure (glucose 27 mg/dL; immunoreactive insulin 40.5 μU/mL). Cross-sectional imaging showed a 10-12 mm hypervascular tumor in the pancreatic head. Glucagon-like peptide-1 receptor imaging with [¹⁸F]FB(ePEG12)12-exendin-4 positron emission tomography/magnetic resonance imaging (PET/MRI) acquired at end-expiration demonstrated intense focal uptake confined to the lesion, with high lesion-to-pancreas contrast and no additional tumor. Consistently, the selective arterial calcium stimulation test localized secretion to the superior mesenteric artery territory. Subsequently, pancreaticoduodenectomy achieved cure and pathology confirmed a well-differentiated insulinoma (grade 1; Ki-67 <1%). He remains asymptomatic without recurrence at 24 months. [¹⁸F]FB(ePEG12)12-exendin-4 PET combined with high-contrast, motion-managed magnetic resonance imaging enabled precise, confident localization in the motion-prone subdiaphragmatic region when cytology was nondiagnostic, directly informing the operative plan. [¹⁸F]FB(ePEG12)12-exendin-4 PET/MRI is feasible and clinically informative for preoperative localization of pancreatic-head insulinoma, facilitating curative surgery. Larger series are needed to define indications relative to other imaging strategies.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":" ","pages":"741-749"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}