Endocrine Practice最新文献

{"title":"American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults with Dyslipidemia - 2025 Update.","authors":"Shailendra B Patel, L Maria Belalcazar, Samina Afreen, Ramiro Balderas, Robert A Hegele, Fredrik Karpe, Carlos I Ponte-Negretti, Aman Rajpal","doi":"10.1016/j.eprac.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.07.014","url":null,"abstract":"<p><strong>Objective: </strong>To provide visual guidance in concise algorithms and tables to assist with clinical decision making in the management of adults with dyslipidemia to reduce risk of ASCVD and triglyceride-induced pancreatitis.</p><p><strong>Methods: </strong>An international multidisciplinary task force of clinical experts was convened to update the 2020 AACE algorithm for dyslipidemia. Literature searches informed the creation of visual guidance graphics and supporting narratives that reflect consensus of the task force.</p><p><strong>Results: </strong>The 2025 algorithm for the management of adults with dyslipidemia includes the following sections: (1) guiding principles for patient-centered management of dyslipidemia; (2) risk assessment and testing for dyslipidemia; (3) identifying genetic dyslipidemias; (4) specific lifestyle recommendations for adults with dyslipidemia; (5) targeting LDL-cholesterol with pharmacologic therapy for ASCVD prevention in adults; (6) approach to statin-associated muscle symptoms in adults; (7) management of adults with hypertriglyceridemia; (8) management of special populations with dyslipidemia (older adults, adults receiving transgender care or HIV control, adults with autoimmune disorders, survivors of childhood cancers, adults with organ transplantation); (9) management of hypercholesterolemia in pregnant and lactating individuals; (10) management of hypertriglyceridemia in pregnant and lactating individuals; and (11) FDA-approved medications for dyslipidemia.</p><p><strong>Conclusions: </strong>This 2025 dyslipidemia algorithm update aligns with the 2025 AACE Clinical Practice Guideline for Pharmacologic Management of Adults with Dyslipidemia and other recent AACE guidance. The algorithm is also in agreement with guidance provided by the other international bodies represented within this task force. This update emphasizes ASCVD risk assessment, addresses pancreatitis risk, and highlights individualized pharmacotherapy. The algorithm includes considerations on health equity, cost effectiveness, and the benefits and harms of different management options.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039354","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":"Choice of hormone assay to monitor feminizing gender-affirming hormone therapy.","authors":"Daniel J Slack, Nithya Krishnamurthy, Meghan Garrity, Derek Chen, Moira Kyweluk, Eli Trakhtenberg, Jerrica Kirkley, Joshua D Safer","doi":"10.1016/j.eprac.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.08.010","url":null,"abstract":"<p><strong>Context: </strong>Studies have shown variability in the correlation among testosterone (T) concentrations, estradiol (E2) concentrations, and other clinical parameters to monitor response to feminizing gender-affirming hormone therapy (GAHT). We aimed to determine the degree to which data support the use of serum T, serum E2, luteinizing hormone (LH), or follicle stimulating hormone (FSH) to monitor feminizing GAHT with the goal of decreasing the effect of endogenous androgens.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of T and E2 concentrations in 9,916 transfeminine individuals prescribed estradiol to examine the association between individuals' most recent serum T, E2, LH and FSH concentrations in the context of feminizing GAHT treatment.</p><p><strong>Results: </strong>Changes in T concentrations were inversely correlated with changes in E2 concentrations (p<.001). However, orchiectomy, age, and the use of spironolactone were associated with changes in T, but not E2 concentrations (p<.001). Changes in T concentrations were also correlated with changes in LH (p<.05). Such correlations were not demonstrated with E2 concentrations.</p><p><strong>Conclusions: </strong>To monitor feminizing GAHT, it may be reasonable to favor target T concentrations over E2 concentrations in patients with testes and to consider LH concentrations in patients without testes who are not taking GnRH agonists.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058348","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":"Young Adult Diabetes Technology Use in Pediatric as compared to Adult Practices.","authors":"Sean DeLacey, Saketh Rompicherla, Jody Grundman, Naomi R Fogel, Sarah Corathers, Shivani Agarwal, Roberto Izquierdo, Lauren Golden, Jill Weissberg-Benchell, Osagie Ebekozien","doi":"10.1016/j.eprac.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.09.001","url":null,"abstract":"<p><strong>Objectives: </strong>People with Type 1 Diabetes (T1D) are more likely to have high hemoglobin A1c (HbA1c) levels in emerging adulthood. The transition to adult practices is often difficult and the ideal age for transfer is unclear. We aimed to characterize differences in disease outcomes and care between pediatric and adult institutions for young adults (YAs) with T1D.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients 18-23 years old, using data from the T1D Exchange (1/1/2022-12/31/2023) and categorized patients according to location of care (n=8,538 from pediatric institutions, n=839 from adult institutions). We compared group characteristics in an unadjusted manner and then used logistic regression, to compare rates of optimal (HgbA1C<7.0%) and poor (HgbA1C>9%) diabetes control, acute complications, and technology use between groups.</p><p><strong>Results: </strong>Those at adult institutions were older at time of analysis (mean: 21.4 vs 20 years) and more likely to have undocumented insurance (21% vs 2%). Technology use was high in both populations. However, adjusting for covariates, those in adult institutions were more likely to have poor control (OR 1.23, p=0.03) and less likely to use a continuous glucose monitor (CGM) (OR 0.64, p<0.001) or an insulin pump (OR 0.62, p<0.001).</p><p><strong>Conclusions: </strong>YAs receiving care in adult vs pediatric centers appear more likely to have poor diabetes control and less likely to use diabetes technology. The findings are limited by unequal regional representation and smaller adult center population. Research is needed to identify barriers to technology use for YAs particularly in adult practices.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058486","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":"Risk of Pituitary Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis","authors":"Zhe Li MD ,&nbsp;Ziang Liu MD ,&nbsp;Hongxia Wei MD ,&nbsp;Shuqing Jin MD ,&nbsp;Yuchen Sun MD ,&nbsp;Yi Zhang PhD ,&nbsp;Yunfeng Liu PhD","doi":"10.1016/j.eprac.2025.06.008","DOIUrl":"10.1016/j.eprac.2025.06.008","url":null,"abstract":"<div><h3>Objectives</h3><div><span><span>Immune checkpoint inhibitor (ICI)-induced </span>hypophysitis is one of the common endocrine immune-related </span>adverse events (irAEs). Our goal is to evaluate the risk of pituitary irAEs caused by ICIs.</div></div><div><h3>Methods</h3><div>The relevant literatures were retrieved from PubMed, Embase, and Cochrane Library from inception to October 31, 2024. References were screened according to inclusion and exclusion criteria, and study data were extracted. Meta-analysis was performed using Revman 5.3 and Stata 18.0 software.</div></div><div><h3>Results</h3><div><span>A total of 21 prospective single-arm trials and 17 randomized controlled trials<span><span> (RCTs) were included. In single-arm trials, the incidence of hypophysitis (4.00%) and </span>hypopituitarism<span> (3.84%) caused by cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors was the highest in monotherapy, and the incidence of hypophysitis caused by </span></span></span>programmed cell death<span><span> 1 (PD-1) inhibitors plus CTLA-4 inhibitors was the highest in ICI combination therapy (9.36%). In RCTs, the risk of pituitary irAEs caused by ICIs was higher than that of the control group (relative risk = 10.09, 95% CI: 6.90-14.75). Compared with monotherapy, ICI combination therapy has a higher risk of pituitary irAEs (relative risk = 5.42, 95% CI: 3.36-8.73). In monotherapy, CTLA-4 inhibitors caused the highest incidence of hypophysitis and </span>hypopituitarism, reaching 16.17% and 1.75%, respectively. Furthermore, the severity of adverse pituitary irAEs caused by CTLA-4 inhibitors was also the highest (5.12% in single-arm trials, 16.35% in RCTs).</span></div></div><div><h3>Conclusions</h3><div>The results showed that ICIs are associated with a significantly higher risk of pituitary irAEs, and ICI combination may further increase the risk. In monotherapy, CTLA-4 inhibitors caused the highest incidence and severity of pituitary irAEs, while PD-L1 inhibitors caused the lowest. In combination therapy, PD-1 inhibitors combined with CTLA-4 inhibitors resulted in a higher incidence of hypophysitis.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1177-1184"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324817","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":"Transient vs Permanent Congenital Hypothyroidism: Does Thyroid Volume Tell the Tale?","authors":"Sarah A. Ackah MD ,&nbsp;Erica A. Eugster MD ,&nbsp;Todd D. Nebesio MD ,&nbsp;Rebeca Santos MD ,&nbsp;S. Gregory Jennings MD ,&nbsp;George J. Eckert MAS ,&nbsp;Boaz Karmazyn MD","doi":"10.1016/j.eprac.2025.05.745","DOIUrl":"10.1016/j.eprac.2025.05.745","url":null,"abstract":"<div><h3>Objectives</h3><div>Congenital hypothyroidism<span> (CH) can be transient or permanent. We evaluated if thyroid volume measured by ultrasound can be distinguish between the 2 forms.</span></div></div><div><h3>Methods</h3><div>Retrospective study (1/2005-12/2019) on patients with CH with eutopic thyroids. Permanent CH was defined as the inability to discontinue levothyroxine<span> therapy after age 3, while transient CH included a successful trial off levothyroxine. Demographic and clinical characteristics were retrieved from the electronic medical records. Fisher’s Exact tests and t-tests were used to compare categorial and continuous variables between children with transient and permanent CH. Receiver-operating characteristic curve analysis evaluated thyroid volume and thyroid-stimulating hormone (TSH) as individual predictors of transient/permanent CH. A classification tree analysis was used to combine thyroid volume and TSH for prediction.</span></div></div><div><h3>Results</h3><div>Significant differences were found between the 2 groups in terms of TSH levels and thyroid volume. Thyroid volume in patients with transient CH was significantly smaller (1.0 ± 0.5 mL) compared to those with permanent CH (2.3 ± 2.6 mL). No transient CH patient had thyroid volume below 0.3 mL or above 2.5 mL. Combining TSH level at diagnosis of ≥200 mIU/L and thyroid volume ≤0.6 mL or ≥2.5 mL provided sensitivity of 78.4% and specificity of 85.7% in differentiating between transient and permanent CH.</div></div><div><h3>Conclusion</h3><div>Thyroid volume ≥2.5 mL or ≤0.36 mL was seen only in permanent CH, potentially avoiding the need for a trial off levothyroxine. Using both TSH level and thyroid volume provides increased sensitivity and specificity for differentiating between permanent and transient CH.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1089-1094"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233524","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 Diabetes-related Autoantibodies Among Individuals With Type 2 Diabetes From Primary Care and Endocrinology Community Practice Settings","authors":"Laura D. Lomeli BA ,&nbsp;Michelle D. Lundholm MD ,&nbsp;Huijun Xiao MS ,&nbsp;Keren Zhou MD ,&nbsp;Kevin M. Pantalone DO, FACE","doi":"10.1016/j.eprac.2025.05.748","DOIUrl":"10.1016/j.eprac.2025.05.748","url":null,"abstract":"<div><h3>Objective</h3><div>The full implications of diabetes-related autoantibodies for classification and management of type 2 diabetes remain undetermined. To date, there are limited data on autoantibody positivity in community-based samples in the United States. This study assessed and compared the prevalence of diabetes-related autoantibodies in a community-based population of individuals with type 2 diabetes managed by endocrinology or primary care providers (PCPs).</div></div><div><h3>Methods</h3><div>This single-center cross-sectional study enrolled 202 adults (102 in endocrinology and 100 in PCPs) with type 2 diabetes without a history of latent autoimmune diabetes of adulthood. Glutamic acid decarboyxlase-65, anti-islet cell, insulinoma-associated-2, zinc transporter 8, and anti-insulin antibodies were determined.</div></div><div><h3>Results</h3><div>Among 199 participants with full antibody panel testing results, 13.6% tested positive for at least one diabetes-related autoantibody; prevalence trended higher, but nonsignificantly, among individuals managed by endocrinologists (16.0%) vs PCPs (11.1%). GAD-65 positivity was 4.5%. No participants displayed anti-islet cell autoantibodies. After excluding an additional 12 individuals positive for only anti-insulin antibodies, 8.0% of the remaining participants were autoantibody-positive (median age, 71 years; median body mass index, 31.8 kg/m²).</div></div><div><h3>Conclusions</h3><div>The prevalence of diabetes-related autoantibodies in individuals with type 2 diabetes in a U.S. community-based care setting, most of whom did not display LADA phenotype characteristics, was notable and similar regardless of management by endocrinology or PCP practices. Although further studies are needed to assess the clinical implications of these findings, it is possible that proactive awareness of autoantibody status in individuals with type 2 diabetes could provide additional context to help guide treatment decisions.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1127-1132"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208016","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":"The Evolution of Our Understanding of the Nuances of Pathologic Cortisol Secretion","authors":"Lewis S. Blevins Jr. MD","doi":"10.1016/j.eprac.2025.06.002","DOIUrl":"10.1016/j.eprac.2025.06.002","url":null,"abstract":"<div><div>Over a century has passed since Harvey Cushing reported and described the findings in his patient that led to his name being ascribed to the clinical syndrome we call Cushing syndrome. Decades of study have led to a greater understanding of the nuances of cortisol secretion associated with the various conditions that result in either relative or overt hypercortisolism. Referencing “Cushing syndrome,” and failing to recognize the subtle presentations of disordered cortisol secretion, leads to delays in diagnosis and treatment and excess morbidity in affected patients.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1185-1188"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283021","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":"Effects of Continuous Glucose Monitoring Versus Blood Glucose Monitoring During a Carbohydrate-Restricted Nutrition Intervention in People With Type 2 Diabetes: 6-Month Follow-up Outcomes From a Randomized Clinical Trial","authors":"Holly J. Willis PhD, RDN, CDCES ,&nbsp;Stephen E. Asche MA ,&nbsp;Rebecca N. Adams PhD ,&nbsp;Caroline G.P. Roberts MD ,&nbsp;Amy L. McKenzie PhD ,&nbsp;Shannon Krizka MS, RDN ,&nbsp;Shaminie J. Athinarayanan PhD ,&nbsp;Alison R. Zoller MS, RDN ,&nbsp;Brittanie M. Volk PhD, RDN ,&nbsp;Richard M. Bergenstal MD","doi":"10.1016/j.eprac.2025.05.746","DOIUrl":"10.1016/j.eprac.2025.05.746","url":null,"abstract":"<div><h3>Objectives</h3><div>Low and very-low carbohydrate eating patterns can improve glycemia in people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) may also help improve glycemic outcomes, like time in range (TIR). This research evaluated differences in diabetes-related outcomes when people with T2D used CGM or blood glucose monitoring (BGM) to support dietary choices and medication management for 6 months during a virtual, medically supervised ketogenic diet program (MSKDP). Three-month primary outcomes are published, and here we report 6-month follow-up outcomes.</div></div><div><h3>Methods</h3><div>The IGNITE study (Impact of Glucose moNitoring and nutrItion on Time in rangE) randomized participants to use CGM (<em>N</em> = 81) or BGM (<em>N</em> = 82) to support care during 6 months in a MSKDP. Glycemia, diabetes medications, dietary intake, ketones, and weight were assessed at baseline (Base) and month 6 (M6); differences between and within arms were evaluated.</div></div><div><h3>Results</h3><div>Adults (<em>N</em> = 163) with mean (SD) T2D duration of 9.7 (7.7) years and HbA1c of 8.1% (1.2%) participated. From Base to M6, TIR improved from 61% to 87% for CGM and from 63% to 88% for BGM (<em>P</em> &lt; .001), with no difference in changes between arms (<em>P</em> = .99). HbA1c decreased at least 1.3% from Base to M6 in both arms (<em>P</em> &lt; .001). Diabetes medications were deintensified in both arms based on medication effect scores (<em>P</em> &lt; .01). Energy and carbohydrate intake decreased (<em>P</em> &lt; .001) and participants in both arms had clinically meaningful weight loss (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>The CGM and BGM arms achieved similar and significant improvements in glycemia and other diabetes-related outcomes after 6 months in this MSKDP.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1116-1126"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224771","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":"A Review of Real-World Evidence About the Use of Automated Insulin Delivery Systems in People With Type 1 Diabetes","authors":"Sonia Gera MD ,&nbsp;Jaisree Iyer MD ,&nbsp;Seema Meighan DNP, CPNP-PC, MPH ,&nbsp;Christine A. March MD, MS ,&nbsp;Brynn E. Marks MD, MSHPEd","doi":"10.1016/j.eprac.2025.06.004","DOIUrl":"10.1016/j.eprac.2025.06.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Automated insulin delivery systems (AID) have revolutionized type 1 diabetes (T1D) management. Guidelines support offering AID to all people with T1D and engaging in shared decision making when choosing among the available AID systems.</div></div><div><h3>Results</h3><div><span>In clinical trials, AID has been shown to improve </span>glycemic control<span> and reduce hypoglycemia while also improving quality of life<span>. However, participants in clinical trials do not accurately reflect the entire T1D population and outcomes from these controlled may not generalize to clinical care. A growing body of real-world evidence seeks to understand the effect of AID systems on glycemia and person-reported outcome measures in real-world populations. These real-world studies highlight the effect of differences in engagement with AID, including time in automated mode and boluses per day, considerations about AID system selection, and approaches to educate people with T1D.</span></span></div></div><div><h3>Conclusion</h3><div>In this review, we compare glycemic and person reported outcomes in clinical trials and the real-world studies, with consideration of the effects of different systems according to user characteristics. We also review the current state of device selection and education for people with diabetes, their caregivers, and clinicians. Lastly, we summarize key findings across AID systems and opportunities for further research.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1150-1161"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283019","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":"Pituitary Stalk Lesions: Causes and Diagnostic Challenges","authors":"Roberto Salvatori MD","doi":"10.1016/j.eprac.2025.05.750","DOIUrl":"10.1016/j.eprac.2025.05.750","url":null,"abstract":"<div><div><span>The pituitary stalk<span> (PS) is a funnel-shaped structure that connects the hypothalamus to the </span></span>pituitary gland<span><span>. It contains some anterior pituitary cells, the hypophyseal vessels, and the axons of neurons whose bodies are located in the hypothalamus and terminate in the posterior pituitary<span> gland, where they store and release arginine vasopressin and oxytocin. The PS is best visualized by magnetic resonance imaging. PS thickening (PST) is often associated with arginine vasopressin deficiency, but it can also present with </span></span>anterior pituitary hormones<span><span><span> deficits or normal pituitary function. PST can be an isolated finding, or be expression of a multisystem infectious, inflammatory, or </span>neoplastic process. Accordingly, these cases are best managed with the input of pituitary specialists from different disciplines. Although PS biopsy can provide a pathologic diagnosis, this is an invasive procedure that requires an experienced neurosurgeon and carries significant risks. This review discusses the causes and symptoms of PST, and addresses the demographic, history, physical examination, biochemical and radiological features that can help the </span>endocrinologist in identifying the most likely cause of PST in any given patient, and to decide when biopsy is needed.</span></span></div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 9","pages":"Pages 1171-1176"},"PeriodicalIF":4.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233523","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}