Endocrine Practice最新文献

{"title":"The Childhood Estrobolome: A Missing Link in Early Puberty Onset.","authors":"Md Zeyaullah, Md Faruque Ahmad","doi":"10.1016/j.eprac.2026.10.008","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.008","url":null,"abstract":"<p><p>Precocious puberty, defined as the onset of secondary sexual characteristics before age 8 in girls, is rising globally with most cases lacking a clearly identifiable cause. The biome is increasingly recognized as a regulator of hormonal homeostasis, yet its role in childhood hormonal programming remains largely unexplored. The estrobolome - the collection of gut bacteria encoding β-glucuronidase (β-GUS) enzymes - controls enterohepatic estrogen recycling in adult women but has never been systematically characterized in prepubertal girls. This narrative review proposes and synthesizes evidence supporting the hypothesis that early-life dysregulation of the childhood estrobolome may prime the hypothalamic-pituitary-gonadal (HPG) axis for premature activation, contributing to early puberty onset in girls. Elevated fecal β-GUS activity has been documented in girls with central precocious puberty (CPP), consistent with altered estrobolome activity during pubertal development. Early-life exposures - including antibiotics, high-fat diet, cesarean delivery, formula feeding, and endocrine-disrupting chemicals - modulate the childhood microbiome in ways that enrich β-GUS-producing taxa. The resulting increase in enterohepatic estrogen reabsorption may provide a chronic low-level estrogenic signal sufficient to sensitize kisspeptin neurons and initiate premature GnRH pulsatility. Overall, the childhood estrobolome represents a compelling but entirely uncharacterized mechanistic bridge between gut dysbiosis and early puberty. Direct characterization of β-GUS activity in healthy prepubertal girls and longitudinal cohort studies are urgently needed. Microbiome-targeted interventions including probiotics, dietary modification, and antibiotic stewardship may hold promise as preventive strategies.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223487","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":"Feasibility of an Activity Control System in Patients with Type 2 Diabetes: Results from a Non-Randomised Controlled Pilot Study.","authors":"David Pérez Cruzado, Macarena Espinilla-Estévez, Pablo de Blas Zamorano, Matilde Romero López, Pedro Montagut Martínez, Nicomedes Rodríguez Rodríguez, David Díaz-Jiménez, Jesús González Lama","doi":"10.1016/j.eprac.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.007","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes mellitus (DM) is a disease that requires continuous, active management by the patient, encompassing lifestyle and activities of daily living (ADL). There is limited evidence and a scarcity of devices that monitor ADL in patients with DM using artificial intelligence-based technology. This study evaluates the feasibility of the AI2EPD home activity monitoring system, focusing on therapeutic adherence in the treatment of people with DM2.</p><p><strong>Methods: </strong>A pilot-controlled study was conducted. Vibration and motion sensors were placed in the home, and physical activity bracelets were worn, together with an Artificial Intelligence web system. The following scales were used for evaluation: System Usability Scale (SUS), Morisky-Green Test, Charlson Comorbidity Index (CCI), Spanish version of the Summary of Diabetes Self-Care Activities Measure (SDSCA-Sp), Diabetes Knowledge Questionnaire (DKQ-24), International Physical Activity Questionnaire (IPAQ), and EuroQol 5D.</p><p><strong>Results: </strong>Twenty-one participants were included (10 in the intervention group and 11 in the control group). The clinical results were similar for both groups. The intervention group found the system easy to use and safe, indicating high acceptance. No clinical benefit attributable to the intervention was demonstrated. The only statistically significant within-group improvement in HbA1c was observed in the control group; however, given the pilot nature of the study and the multiple exploratory comparisons, this finding should be interpreted with caution.</p><p><strong>Conclusions: </strong>The use of the AI2EPD intelligent remote monitoring system in the home was feasible and well accepted by participants. Exploratory findings regarding therapeutic adherence and clinical outcomes warrant further evaluation in adequately powered studies.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223490","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":"Transition from pediatric to adult care for patients with type 1 diabetes mellitus: more than just a handover.","authors":"Panagiota Georgia Maltezou, Ioannis-Anargyros Vasilakis, Eleni Angelopoulou, Christina Kanaka-Gantenbein","doi":"10.1016/j.eprac.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.006","url":null,"abstract":"<p><p>Type 1 diabetes (T1D) is a chronic autoimmune disease that commonly presents during childhood or adolescence and requires lifelong multidisciplinary care. The transition from pediatric to adult diabetes services is a pivotal stage often accompanied by poorer glycemic control, reduced clinic attendance, and increased risk of disengagement from healthcare. This review summarizes current evidence on the principles, challenges, and effective strategies for transitioning adolescents and young adults with T1D from pediatric to adult care. A review of the literature was conducted, focusing on transition models, clinical and psychosocial outcomes, and recommendations from the International Society for Pediatric and Adolescent Diabetes (ISPAD) and other relevant studies. Evidence supports transition as a structured, individualized, and developmentally appropriate process rather than a single transfer of care. Successful transition programs incorporate early preparation, multidisciplinary collaboration, joint pediatric-adult care, transition coordinators, psychosocial support, and progressive patient autonomy. These approaches improve continuity of care, self-management, clinic attendance, and glycemic outcomes while reducing loss to follow-up. Although transition care is increasingly recognized as a key component of T1D management, its implementation remains inconsistent. Wider adoption of standardized, evidence-based transition pathways is needed to optimize long-term health outcomes for young adults with T1D.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215185","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 Real-World Beta-Cell Preservation Framework in Type 1 Diabetes: Consensus from the T1D Exchange (T1DX-QI).","authors":"Carla Demeterco-Berggren, David T Broome, G Todd Alonso, Jennifer L Sherr, Daniel J DeSalvo, Kimber Simmons, Lauren Culbreth, Ava K Rapp, Brent Gelick, Jacqueline Lonier, Naomi R Fogel, Laura Levin, Mary McCauley, Alexander R Tuttle, Vandana Raman, Abha Choudhary, Jeniece Ilkowitz, Mary Pat Gallagher, Shideh Majidi, Sarah L Holly, Claire Rainey, Nicole Rioles, Trevon Wright, Laura M Jacobsen","doi":"10.1016/j.eprac.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.003","url":null,"abstract":"<p><strong>Objective: </strong>Type 1 diabetes (T1D) follows a trajectory defined by four stages. Autoantibody screening and disease-modifying therapy (DMT) strategies to preserve beta-cell function are rapidly emerging. Clinical implementation guidance is limited.</p><p><strong>Methods: </strong>A national group of pediatric and adult endocrinology experts was formed through invitation by a nonprofit network of over 60 centers. Experts were invited based on their expertise in autoantibody (AAB) screening for T1D and treating children and adults at risk for T1D. The group comprised 22 experts from 13 academic medical centers across the U.S. Group meetings were held from November 2025 to February 2026 to agree on topics for inclusion, form writing groups, and develop evidence-based statements using a targeted literature search.</p><p><strong>Results: </strong>Topics covered include current guidelines, AAB screening framework, early stage and stage 3 T1D, clinical protocol for T1D screening, treatment and Quality Improvement framework, education, social and behavioral considerations, and the implementation gap. Early identification of T1D through screening allows additional time for families to receive comprehensive diabetes education and appropriate psychological support. This provides a smoother transition to stage 3 disease while reducing hospitalizations, length of stay, and allowing consideration of DMT in early stage or stage 3 T1D. Guidance on real-world clinical implementation of T1D AAB screening and DMT remains limited.</p><p><strong>Conclusion: </strong>This article provides a national consensus from T1DX-QI on the clinical implementation of T1D AAB screening in those at risk and DMT for beta-cell preservation for individuals in stage 2 and new onset stage 3 T1D.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206594","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":"Using Homeostatic Model Assessment of Insulin Resistance to Improve Metabolic Dysfunction-Associated Steatotic Liver Disease Risk Stratification in Individuals with Type 2 Diabetes from Primary Care and Endocrinology Settings.","authors":"Nathaly Cuervo-Pardo, Srilaxmi Kalavalapalli, Eddison Godinez Leiva, Andrea Ortiz Rocha, Diana Barb, Anu Sharma, Jens Rosenberg, Fernando Bril, Margery A Connelly, Joseph R Grajo, Juan Pablo Perdomo, Juan Manuel Muñoz Peña, Enrique Valdez Saenz, Romina Lomonaco, Thao A Nguyen, Pierre Bedossa, Kenneth Cusi","doi":"10.1016/j.eprac.2026.08.031","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.031","url":null,"abstract":"<p><strong>Objectives: </strong>Current metabolic dysfunction-associated steatotic liver disease (MASLD) guidelines recommend fibrosis screening in individuals with type 2 diabetes (T2D) because of their increased risk of clinically significant fibrosis (≥F2). However, fibrosis risk is variable, and clinical tools to identify individuals at lower risk are lacking. We evaluated whether assessment of insulin resistance by homeostatic model assessment of insulin resistance (HOMA-IR) could improve risk stratification for clinically significant fibrosis.</p><p><strong>Methods: </strong>We prospectively recruited 501 adults with T2D from primary care and endocrinology clinics. Participants were classified as insulin-resistant (HOMA-IR ≥2.5; n=350) or insulin-sensitive (HOMA-IR <2.5; n=151). Liver steatosis was assessed using VCTE, MRI/MRE, or liver biopsy according to the most accurate test, and the prevalence of clinically significant fibrosis (≥F2) was compared between groups.</p><p><strong>Results: </strong>Insulin-resistant participants had higher prevalence of clinically significant fibrosis than insulin-sensitive participants (≥F2: 10% vs. <1%; p<0.001). They also had greater hepatic steatosis, higher ALT, AST, CK-18, HbA1c, and adipose tissue insulin resistance (Adipo-IR) levels, and lower adiponectin concentrations (all p<0.001). Fibrosis was infrequent among insulin-sensitive participants and almost exclusively limited to mild fibrosis (stage F1). Among participants with steatosis, ≥F2 fibrosis was present in 1% of insulin-sensitive participants compared with 13% of insulin-resistant participants (p<0.001).</p><p><strong>Conclusions: </strong>Clinically significant fibrosis (≥F2) was uncommon among insulin-sensitive individuals with T2D and largely limited to mild fibrosis (F1). HOMA-IR <2.5 identified a subgroup at very low risk for fibrosis, supporting its potential use as a simple, clinically accessible tool for MASLD risk stratification in primary care and endocrinology settings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192015","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":"Locally Advanced Disease and Clinical Outcomes of Pheochromocytomas and Paragangliomas: Insights from a Multicenter Study.","authors":"Buket Busra Icin, Ozden Uzun, Bekir Cakir, Belma Ozlem Tural Balsak, Narin Nasiroglu İmga, Lala Soltanova, Pinar Kadioglu, Ozge Sahin Kimyon, Sema Ciftci, Ozlem Kandemir Alibakan, Mutlu Niyazioglu, Filiz Mercan Sarıdas, Ozen Oz Gul, Rumeysa Selvinaz Erol, Filiz Eksi Haydardedeoglu, Zafer Pekkolay, Esma Merve Arda Ozkan, Mazhar Muslum Tuna, Elif Yivli, Taner Bayraktaroglu, Guzin Fidan Yaylali, Bahri Evren, Nese Cınar, Gulhan Akbaba, Merve Catak, Buse Ekici, Mehmet Celik, Umit Nur Ozbay, Dilek Tuzun, Ziynet Alphan Uc, Faruk Kilinc, Gulsah Elbuken, Sayid Shafi Zuhur","doi":"10.1016/j.eprac.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.005","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prognostic significance of locally advanced disease (LAD) in patients with pheochromocytomas and paragangliomas (PPGLs).</p><p><strong>Methods: </strong>We retrospectively analyzed 389 patients with histopathologically confirmed PPGLs from 19 tertiary centers. LAD was defined as capsular, periadrenal fat, adjacent-organ, or vascular invasion. Persistent/recurrent disease was the composite primary endpoint. The prognostic value of LAD was further assessed after excluding patients with distant metastatic disease at diagnosis, in patients with stage I-II disease, and in combination with Ki-67 labeling index (LI) ≥3%.</p><p><strong>Results: </strong>LAD was identified in 111 patients (28.5%). Persistent/recurrent disease occurred in 17.1% and 6.1% of patients with and without LAD, respectively (p<0.001), with corresponding 5-year disease-free survival (DFS) rates of 81.8% and 93.4% (log-rank p<0.001). LAD remained independently associated with persistent/recurrent disease in multivariable analysis (HR, 3.64; 95% CI, 1.55-8.52; p=0.003). Its prognostic association persisted after excluding patients with distant metastatic disease at diagnosis. Among patients with stage I-II disease, 5-year DFS was 84.8% and 95.5% with and without LAD, respectively (log-rank p=0.014), and adding LAD to the TNM-only model significantly improved model fit (likelihood-ratio p=0.025). Patients with both LAD and Ki-67 LI ≥3% had a 5-year DFS of 68.5%.</p><p><strong>Conclusion: </strong>LAD was associated with unfavorable outcomes in PPGLs and provided additional prognostic information beyond TNM stage in stage I-II disease. Combined assessment of local invasiveness and proliferative activity warrants further evaluation for risk stratification.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192055","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 Feasibility of a Low-Dose Tirzepatide Strategy in Older Adults with Type 2 Diabetes: Persistence, Metabolic Benefit, and Treatment Simplification in a Real-World Cohort.","authors":"Ken Kanazawa, Koji Hayashi, Cao Xinyi, Mai Hijikata, Koichiro Kuwabara","doi":"10.1016/j.eprac.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.004","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical feasibility of a low-dose tirzepatide strategy in older adults with type 2 diabetes mellitus in routine outpatient practice.</p><p><strong>Methods: </strong>This single-center retrospective cohort included Japanese adults who initiated tirzepatide between April 2024 and December 2025 and received a maximum observed dose of ≤5 mg/week through week 28. The primary endpoint in adults aged ≥65 years combined treatment persistence, absence of adverse event (AE)-related discontinuation, and either ≥3% weight loss or an HbA1c reduction ≥1.0 percentage point (≥11 mmol/mol). Younger adults were contextual comparators using overlap weighting.</p><p><strong>Results: </strong>Among 122 tirzepatide initiators, 107 were included in the low-dose strategy cohort, including 37 older adults. The primary endpoint was achieved by 23/37 (62.2%); 33/37 (89.2%) remained on treatment, and 2/37 (5.4%) discontinued because of AEs. Median body weight change was -3.07%, median HbA1c change was -1.0 percentage point (-11 mmol/mol), and 19/37 (51.4%) achieved HbA1c <7.0% (<53 mmol/mol). Renal, hydration, and nutritional laboratory markers remained generally stable. Overlap-weighted comparisons showed no clear age-related attenuation.</p><p><strong>Conclusion: </strong>In selected older adults, low-dose tirzepatide provided modest metabolic benefit with high persistence and infrequent AE-related discontinuation.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192066","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":"When Does Polyendocrine Metabolic Ovarian Syndrome (PMOS) Change Definition? A Lifespan Perspective on Menopause and Metabolic Health.","authors":"Angela D Mazza","doi":"10.1016/j.eprac.2026.09.113","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.113","url":null,"abstract":"<p><p>The evolving concept of Polyendocrine Metabolic Ovarian Syndrome (PMOS) reflects a growing recognition that this condition extends beyond reproductive dysfunction and ovarian morphology to encompass complex interactions among metabolic, endocrine, inflammatory, and cardiometabolic pathways. While PMOS is most commonly diagnosed during the reproductive years, increasing numbers of affected women are now entering perimenopause and menopause, highlighting important limitations of current diagnostic paradigms. Traditional reproductive markers-including ovulatory dysfunction and ovarian morphology-become progressively less informative with advancing age, raising questions about whether the diagnosis remains relevant after menopause. Despite the attenuation of ovarian manifestations, many women with a history of PMOS continue to exhibit persistent metabolic and endocrine abnormalities, including insulin resistance, visceral adiposity, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, chronic low-grade inflammation, and elevated cardiovascular risk. Emerging evidence suggests that these metabolic consequences may persist across the lifespan and contribute to trajectories of accelerated cardiometabolic aging. This review examines the challenges of applying reproductive-age diagnostic frameworks to midlife and older women and proposes a lifespan model in which PMOS evolves from a predominantly ovarian and reproductive syndrome into a broader metabolic-endocrine phenotype. We explore the clinical implications of this transition for risk assessment, long-term surveillance, and therapeutic decision-making during perimenopause and beyond. As understanding of PMOS continues to evolve, menopause may represent not the end of the syndrome, but rather a shift in its clinical expression. Reframing PMOS as a dynamic lifespan condition may provide a more comprehensive approach to the care of women across aging and support the development of age-appropriate diagnostic and management strategies.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170358","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":"Diagnostic Performance of Common Biochemical Screening Tests for Mild Autonomous Cortisol Secretion in Adrenal Incidentalomas: A Systematic Review and Hierarchical SROC Meta-analysis.","authors":"Zachary C Bueling, Dani R Douri, August H Berg, Charles E Garrity, Brian M Olson, Bailey R Riehl, Claire M Westby, Jakob T Swan, Sherief A Ghozy, Issa A Rabadi, Rodhan A Khthir","doi":"10.1016/j.eprac.2026.09.121","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.121","url":null,"abstract":"<p><strong>Objective: </strong>Mild autonomous cortisol secretion (MACS) is a biochemical phenotype in adrenal incidentalomas associated with cardiometabolic risk. Serum and salivary dexamethasone suppression testing (DST), late-night salivary cortisol (LNSC), and urinary free cortisol (UFC) are used, but interpretation is limited by nonuniform disease definitions and reference standards.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and Scopus were searched through November 19, 2025, in accordance with PRISMA-DTA. QUADAS-2 assessed risk of bias. Bivariate random-effects models generated HSROC estimates and likelihood ratios, and Fagan analyses modeled post-test probabilities. Sensitivity assessments examined reference-standard dependence, diagnostic era, and threshold selection.</p><p><strong>Results: </strong>Twelve studies comprising 1,420 patients were included. Serum DST had sensitivity of 97.9% (95% CI, 88.6-99.6), specificity of 76.8% (64.5-85.7), and a negative likelihood ratio of 0.03 (0.00-0.16). Salivary DST had sensitivity of 74.9% and specificity of 80.5%; LNSC sensitivity was 62.7%, and UFC estimates were highly imprecise. All three serum DST studies used reference definitions that incorporated DST or a related dexamethasone-suppression criterion, leaving no fully independent-reference serum DST pool. Threshold-specific data showed substantial sensitivity-specificity tradeoffs.</p><p><strong>Conclusion: </strong>Serum DST produced the lowest pooled negative likelihood ratio against study-defined biochemical reference standards, suggesting potential rule-out value. Incorporation bias, threshold heterogeneity, indirect comparisons, and sparse study counts preclude claims of diagnostic superiority. Positive results require clinical context and confirmatory evaluation when appropriate.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147266","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":"Oral or Enteral Levothyroxine for Myxedema Coma When Intravenous Therapy Is Unavailable: A Systematic Review and Descriptive Evidence Synthesis.","authors":"Vivek Jha, Mannuru Venkateswarlu, Tushar Bhadada, Amal Shaharyar, Dipika Bansal, Pinaki Dutta, Sanjay Kumar Bhadada","doi":"10.1016/j.eprac.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.10.002","url":null,"abstract":"<p><strong>Objectives: </strong>Intravenous levothyroxine is generally preferred for myxedema coma but may be unavailable in many healthcare settings. We summarized published treatment regimens and outcomes with oral or enteral levothyroxine when intravenous therapy was unavailable. Intravenous-only and mixed-route reports were included for clinical context.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception through March 2026. Studies reporting myxedema coma treated with oral, enteral, nasogastric, or intravenous levothyroxine and extractable clinical outcomes were included. Pooled proportions were calculated only as descriptive summaries of oral/enteral reports and were not interpreted as treatment-effect estimates. Intravenous-only and mixed-route studies were summarized narratively. Methodological quality was assessed using Joanna Briggs Institute tools, and certainty of evidence using GRADE.</p><p><strong>Results: </strong>Nine studies comprising 70 patients were included: six oral/enteral, two intravenous-only, and one mixed-route study. Oral/enteral loading doses ranged from 300 to 1000 μg. Descriptively pooled proportions were 0.20 for mortality, 0.76 for intensive care unit admission, 0.54 for mechanical ventilation, and 0.62 for vasopressor requirement. These estimates are descriptive summaries of selected published reports and should not be interpreted as population-level event rates, treatment-effect estimates, route-specific risks, or expected outcome probabilities in routine clinical practice.</p><p><strong>Conclusions: </strong>Published reports document oral or enteral levothyroxine as a rescue approach when intravenous treatment is unavailable. However, evidence is insufficient to establish comparative efficacy, safety, equivalence, or an optimal dosing regimen. Intravenous levothyroxine should remain preferred when available, particularly in patients with shock, ileus, or unreliable gastrointestinal absorption.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147790","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}