Endocrine Practice最新文献

{"title":"Association of Thyroid-stimulating Immunoglobulin in Early Pregnancy with Adverse Obstetric Outcomes: A Retrospective Cohort Study.","authors":"Peiheng Zhang, Yu Wang, Weijie Sun, Yang Zhang, Lili Zhang, Youyuan Huang, Huixia Yang, Ying Gao","doi":"10.1016/j.eprac.2026.08.029","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.029","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of TSI positivity in pregnant women and its association with pregnancy complications remain unclear.</p><p><strong>Methods: </strong>This study evaluated 3090 pregnant women with stored serum samples during early pregnancy at Peking University First Hospital from October 2017 to August 2018. The risks of maternal and fetal adverse outcomes were compared across three groups: group A (TSI < 0.1 IU/L), group B (0.1≤ TSI < 0.55 IU/L), and group C (TSI ≥ 0.55 IU/L), using logistic regression models.</p><p><strong>Results: </strong>The positivity rate of TSI (≥0.55 IU/L) was 1.33%, whereas 96.31% of women had TSI levels below the lower detection limit (<0.1 IU/L) in general pregnant women. 0.36% of women had TSI levels higher than three times the upper limit of the reference range. In the first trimester of pregnancy, thyrotoxicosis was most common in group C (12.20%), whereas the majority of women in group A were euthyroid (83.12%). Compared with group A, women in group B had an increased risk of fetal loss (OR 2.30, 95% CI: 1.17∼4.52), preterm birth (OR 2.29, 95% CI: 1.002∼5.22) and maternal composite outcomes (OR 1.62, 95% CI: 1.002∼2.63) . Women in group C had higher odds of neonatal hospitalization (OR 2.09, 95% CI 0.90∼4.88) than group A, but this increase did not each statistical significance. No significant differences were observed in other pregnancy outcomes across the three groups.</p><p><strong>Conclusion: </strong>TSI might be associated with thyroid autoimmunity and an increased risk of adverse obstetric outcomes. However, universal screening is not warranted during pregnancy.</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":"149148927","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":"Weight Management in Obesity-Associated Sleep-Disordered Breathing: Mechanisms, Clinical Management, and Emerging Therapies.","authors":"Ron T Varghese, Isabella Sharifi, Sneha Akurati","doi":"10.1016/j.eprac.2026.09.120","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.120","url":null,"abstract":"<p><strong>Objective: </strong>To review the mechanistic links between obesity and sleep-disordered breathing (SDB) and summarize practical approaches to weight-directed, sleep-directed, and phenotype-informed management.</p><p><strong>Methods: </strong>We conducted a focused narrative review of clinical trials, systematic reviews, meta-analyses, guidelines, and mechanistic studies identified through PubMed/MEDLINE, Embase, and Google Scholar. Search terms included obesity, obstructive sleep apnea, obesity hypoventilation syndrome, weight loss, positive airway pressure, bariatric surgery, incretin-based pharmacotherapy, endotypes, and circadian disruption.</p><p><strong>Results: </strong>Obesity promotes sleep-disordered breathing through upper airway mechanical loading, reduced lung volumes, inflammation, altered ventilatory control, and sleep behavior pathways. Positive airway pressure remains a core therapy for many patients with obstructive sleep apnea and obesity hypoventilation syndrome. Sustained weight loss provides complementary disease modification. Lifestyle intervention, metabolic and bariatric surgery, and incretin based pharmacotherapy can improve obstructive sleep apnea, although residual disease is common. Tirzepatide has shown clinically meaningful reductions in apnea-hypopnea index in adults with obesity and moderate to severe obstructive sleep apnea, largely in association with weight reduction. In obesity hypoventilation syndrome, stable ambulatory patients generally require positive airway pressure. Durable weight loss of approximately 25% to 30% may be needed to resolve hypoventilation. Therapies targeting endotypes and device based options may help selected patients, but they remain adjunctive, investigational, or directed by specialists.</p><p><strong>Conclusion: </strong>Obesity associated sleep-disordered breathing is best managed as a heterogeneous cardiometabolic and sleep breathing condition. Treatment should integrate positive airway pressure or other sleep specific therapy with individualized weight management. Ongoing reassessment is needed for residual disease, obesity hypoventilation syndrome, and atypical phenotypes.</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":"149147642","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":"Neurocognitive Outcomes in Patients with Pituitary Adenomas.","authors":"Amrik Singh, Pratibha Natesh","doi":"10.1016/j.eprac.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.030","url":null,"abstract":"<p><strong>Objective: </strong>To perform a systematic review to explore the impact of surgical interventions for pituitary adenomas on cognitive function. We assessed diverse cognitive domains, including memory and learning and complex attention and executive function.</p><p><strong>Methods: </strong>We conducted a systematic literature search across six databases. We identified studies published during a 20-year period (2004-2024) that included adult patients diagnosed with NFPA (Non functioning Pituitary adenoma), acromegaly or Cushing's Disease (CD) who had undergone standardised neurocognitive tests pre- and post-surgical interventions. Data synthesis included descriptive statistics and bias assessments using the 'NHLBI' (National Heart, Lung and Blood Institute) and 'GRADE' (Grading of Recommendations Assessment, Development and Evaluation) tools.</p><p><strong>Results: </strong>We included six eligible studies in our review. Post-operatively, there were significant improvements in memory in patients with diagnosed NFPAs and CD. There was promising recovery of attention, processing speed and working memory following surgical management, particularly for those patients with diagnosed NFPAs. Those patients with diagnosed CD demonstrated post-operative recovery of verbal fluency and general cognition. Conversely, those patients diagnosed with acromegaly had limited improvements in their cognition post-operatively, likely reflecting irreversible neurological changes caused by prolonged exposure to excessive serum levels of growth hormone.</p><p><strong>Conclusions: </strong>Surgical interventions for pituitary adenomas offer promising cognitive recovery for those patients diagnosed with NFPAs and CD, although cognitive deficits may persist post-operatively, particularly for those diagnosed with acromegaly. The variability in post-operative cognitive outcomes identified in this review highlights a need for standardised cognitive assessments and longitudinal studies to examine cognitive recovery following surgical management of pituitary adenomas. Clinically, routine cognitive assessment and integration of these measures into multidisciplinary management approaches are important to optimise patient outcomes.</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":"149147440","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":"Long-term Safety and Efficacy of Once-Weekly Lonapegsomatropin in Adults With Growth Hormone Deficiency: Results From a 52-Week Open-Label Extension Trial.","authors":"Beverly M K Biller, Aleksandra Gilis-Januszewska, Mirjana Doknic, Antonio Miguel Picó, Maria Fleseriu, Gerald Raverot, Andrea M Isidori, Jose M Garcia, Julie M Silverstein, Irina Bancos, Katharina Schilbach, Jennifer M Iklé, Allison S Komirenko, Wei Zhong, Yetao Hu, Laurie Domrzalski, Aimee D Shu, Kevin C J Yuen","doi":"10.1016/j.eprac.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.028","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate long-term safety and efficacy of once-weekly lonapegsomatropin in adults with growth hormone (GH) deficiency.</p><p><strong>Methods: </strong>This 52-week, multicenter, open-label extension trial enrolled adults with GH deficiency who completed the 38-week phase 3 foresiGHt trial, in which participants received lonapegsomatropin, placebo, or somatropin.¹ In the extension, all participants received lonapegsomatropin. Safety assessment included adverse events (AEs), laboratory values, vital signs, immunogenicity, 12-lead electrocardiograms, and fundoscopy. Body composition (trunk percent fat, trunk fat mass, visceral adipose tissue, total body lean mass, trunk lean mass, and appendicular lean mass) was measured by dual-energy X-ray absorptiometry, and patient-reported outcomes were evaluated.</p><p><strong>Results: </strong>Following foresiGHt completion, 220 (88.7%) participants enrolled in the extension. Across foresiGHt and the extension, common lonapegsomatropin-associated AEs were nasopharyngitis, upper respiratory infection, and headache. Injection site reactions were infrequent (5.1%) and mild or moderate. After up to 90 weeks of treatment, body composition was maintained in participants continuing lonapegsomatropin, and improved relative to foresiGHt baseline in those initiating or switching to lonapegsomatropin. Clinically meaningful improvements in patient-reported outcomes from foresiGHt baseline were observed; 43.5%, 40.6%, and 35.8% of participants achieving a ≥10-point improvement in Treatment Related Impact Measure-Adult GH Deficiency (TRIM-AGHD) total score among those continuing, initiating, or switching to lonapegsomatropin, respectively.</p><p><strong>Conclusions: </strong>Once-weekly lonapegsomatropin was generally well tolerated and was associated with sustained improvements in body composition and patient-reported outcomes for up to 90 weeks. These findings extend prior evidence and support the long-term benefits of lonapegsomatropin in adults with GH deficiency, including those switching from somatropin.</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":"149149132","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":"Beyond Postprandial Symptoms: Fasting Hypoglycemia in Post-Bariatric Hypoglycemia.","authors":"Joanne Lin, Abtin Shams, Helen M Lawler","doi":"10.1016/j.eprac.2026.09.119","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.119","url":null,"abstract":"<p><strong>Background: </strong>Post-bariatric hypoglycemia (PBH) is characterized by postprandial neuroglycopenia resulting from an exaggerated hyperinsulinemic response to nutrient intake in patients who have undergone Roux-en-Y gastric bypass, sleeve gastrectomy, or other upper gastrointestinal surgical procedures for weight loss. Fasting hypoglycemia is atypical.</p><p><strong>Objective: </strong>We present a cohort of patients who developed symptomatic fasting hypoglycemia in the setting of established PBH and discuss the possible pathophysiological mechanisms. We also examine the role of β-cell hyperfunction in PBH.</p><p><strong>Methods: </strong>A retrospective chart review was performed on 135 patients with PBH to identify patients with PBH undergoing a supervised 72-hour fast between 2013 and 2026. Inclusion criteria included a PBH diagnosis and an abnormal 72-hour fast. Exclusion criteria included asymptomatic fasting hypoglycemia, adrenal insufficiency, end-organ failure, hepatomegaly, alcohol or illicit drug use, or medications causing hypoglycemia.</p><p><strong>Results: </strong>13 patients underwent a 72-hour fast and 5 patients experienced symptomatic non-insulin mediated hypoglycemia with mean glucose of 49.2mg/dL occurring at 8-22 hours. Two patients underwent selective arterial calcium stimulation testing (SACST), one with a normal response and the other with β-cell hyperfunction.</p><p><strong>Conclusion: </strong>PBH is known to cause post-prandial hyperinsulinemic hypoglycemia, yet this PBH cohort also demonstrates atypical symptomatic fasting non-insulin-mediated hypoglycemia. This suggests a therapeutic paradox; carbohydrate restriction used to treat PBH may contribute to fasting hypoglycemia. In addition, discordant SACST results raise the question of whether β-cell hyperfunction is pre-existing, develops de novo as a consequence of altered gut anatomy, or reflects a combination of both.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135516","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":"Improving Inpatient Continuous Glucose Monitoring Documentation Through Targeted Nursing Education.","authors":"Leticia De Mattei, Mary Kashat, Berk Celik, Daniel Shelden, Michael Brennan","doi":"10.1016/j.eprac.2026.09.114","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.114","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a targeted nursing education intervention improved adoption of a standardized electronic medical record (EMR) documentation workflow for patient-reported continuous glucose monitoring (CGM) values among hospitalized adults with diabetes.</p><p><strong>Methods: </strong>We conducted a retrospective pre-post quality improvement study at a 1,131-bed academic institution. Adults aged ≥18 years with type 1 or type 2 diabetes admitted with a functional CGM were included. Pre-intervention data (7/21/24-11/21/24) were compared with a 5-month post-intervention period (11/21/24-04/21/25) following implementation of a nursing practice alert and education initiative. The primary outcome was the proportion of patients with at least 1 CGM value documented in the designated \"Patient Performed Glucose\" flowsheet.</p><p><strong>Results: </strong>A total of 224 patients were included (34% type 1, 66% type 2 diabetes) in the primary analysis, and 222 patients were included in the pre-post comparison (94 pre-intervention and 128 post-intervention). Mean age was 63±15 years and median HbA1c 7.4% (IQR 6.4-8.4). Documentation rates increased from 54.3% pre-intervention to 68.8% post-intervention (χ² p=0.0389). Average documented CGM readings per day did not differ pre- and post-intervention. Among documented readings, level 2 hypoglycemia decreased from 0.47% to 0.19%, whereas hyperglycemic readings increased from 30.8% to 35.1%.</p><p><strong>Conclusion: </strong>A targeted, low-cost nursing education intervention was associated with improved adoption of a standardized inpatient CGM documentation workflow. Further studies are needed to establish optimal documentation practices and determine their clinical impact.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126679","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":"ADOPTION OF THE FIFTH WORKSHOP URINARY CALCIUM THRESHOLD IN ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM.","authors":"Elena Castellano, Alberto Boriano, Roberto Attanasio, Giorgio Borretta, Anna Pia","doi":"10.1016/j.eprac.2026.09.116","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.116","url":null,"abstract":"<p><strong>Objective: </strong>The clinical presentation of sporadic primary hyperparathyroidism (PHPT) has shifted over the last decades towards an asymptomatic disease (aPHPT). International workshops have refined surgical criteria, and urinary calcium excretion (24h-UCa) has been among the most controversial parameters. Notably, 24h-UCa was the only modified criterion between the Fourth and Fifth Workshops. The threshold was lowered from a single cut-off of 400 mg/24h (Fourth Workshop) to gender-specific cut-offs of 300 mg/24h for males and 250 mg/24h for females (Fifth Workshop).</p><p><strong>Methods: </strong>We retrospectively analyzed our series of 540 patients with PHPT, focusing on the 225 patients with aPHPT and applying the surgical criteria dictated by the Fourth and Fifth International Workshops.</p><p><strong>Results: </strong>Patients with aPHPT who met the criteria for surgery increased from 186/225 (82.7%) to 199/225 (88.4%) by applying the Fourth and Fifth workshop criteria, respectively. The percentage of patients who exceeded the threshold for surgery according to the 24h-UCa criterion increased from 18.3% (34/186) to 45.2% (90/199), respectively. The percentage of those met only the 24h-UCa criterion increased from 8/186 (4.3%) to 13/199 (6.5%). Notably of the 39 patients with aPHPT who had not met any Fourth Workshop surgical criteria, 13 (33.3%) exceeded the new Fifth Workshop 24h-UCa threshold, thus newly qualifying for surgery.</p><p><strong>Conclusions: </strong>Lowering the 24h-UCa threshold led to surgical reclassification in 13/39 patients (33.3%) with aPHPT who previously did not meet surgical indications. This revised criterion increased the overall proportion of patients meeting surgical criteria from 186/225 (82.7%) to 199/225 (88.4%), representing an absolute increase of 5.7% within the study cohort.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127029","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":"Resistance to Thyroid Hormone Alpha: Clinical Spectrum, Diagnostic Clues, and Therapeutic Strategies - A Narrative Review.","authors":"Bushra Amer, Albaraa Haidarah, Ahmad Alam, A B M Kamrul-Hasan","doi":"10.1016/j.eprac.2026.09.118","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.118","url":null,"abstract":"<p><p>Resistance to thyroid hormone alpha (RTHα) is a rare, inherited disorder of thyroid hormone action caused by pathogenic variants in the thyroid hormone receptor alpha gene. Unlike resistance to thyroid hormone beta, RTHα typically presents with near-normal thyroid function tests and a non-elevated thyroid-stimulating hormone (TSH), contributing to substantial underdiagnosis. The biochemical hallmark is a low or low-normal free thyroxine (FT4) level with a disproportionately high free triiodothyronine (FT3) level, yielding a reduced FT4:FT3 ratio and often a low or low-normal reverse T3. Clinical features reflect the tissue distribution of TRα1 and include growth retardation, delayed skeletal maturation, constipation, normocytic anemia, neurodevelopmental delay, dyspraxia, and macrocephaly. These closely mimic primary hypothyroidism but occur without TSH elevation. Most pathogenic THRA variants are heterozygous and act through a dominant-negative mechanism, whereby mutant receptors interfere with co-expressed wild-type TRα activity. Frameshift and nonsense variants generally produce more severe phenotypes than missense variants, though considerable variability exists even among individuals carrying identical mutations. Levothyroxine remains the only therapeutic intervention reported, with evidence suggesting that earlier treatment initiation is associated with better neurodevelopmental and growth outcomes, while established skeletal abnormalities show limited reversibility. Standard newborn screening programs typically fail to detect RTHα, contributing to diagnostic delay. This narrative review consolidates current knowledge on the genetic basis, molecular pathophysiology, clinical spectrum, differential diagnosis, and treatment outcomes of RTHα. Its aim is to enhance clinician recognition and guide future research, including expanded screening strategies and genotype-informed treatments.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126672","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":"Implementing MASLD Screening in Primary Care for Adults with Type 2 Diabetes: A Quality Improvement Initiative.","authors":"Danielle Joyner Piekaar, Einat Kadar-Kricheli, Kathryn Evans Kreider, Blanca Iris Padilla","doi":"10.1016/j.eprac.2026.09.117","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.117","url":null,"abstract":"<p><strong>Objective: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over two-thirds of adults with type 2 diabetes (T2D), yet advanced fibrosis often remains undiagnosed. This quality improvement (QI) project implemented a standardized screening pathway to identify patients at risk for advanced fibrosis and guide appropriate follow-up.</p><p><strong>Methods: </strong>A pre-post QI initiative was conducted from February to April 2026 in a primary care practice within a southeastern United States integrated health system. Adults aged 18-75 years with T2D underwent FIB-4 index risk stratification via electronic health record (EHR) SmartPhrase (auto text). The intervention included clinician education, EHR-based decision support, workflow redesign, and certified medical assistant supported pre-visit preparation. Patients with indeterminate or high-risk FIB-4 index scores were referred for transient elastography. Primary outcomes were FIB-4 index documentation and referral rates.</p><p><strong>Results: </strong>All eligible clinicians (7/7) completed pre-implementation education sessions. FIB-4 index screening documentation increased from 0.9% (1/115 encounters) at baseline to 14.4% (67/464 encounters) during the 12 weeks post-implementation (P < .001). Seven screened patients (10.4%) met criteria for additional fibrosis evaluation; 3 of 7 (42.9%) were referred. Only 3 of 7 patients (42.9%) had abnormal liver enzymes, indicating that 4 patients (57.1%) would not have been identified for further evaluation based on liver enzyme abnormalities alone.</p><p><strong>Conclusion: </strong>A standardized MASLD screening pathway was associated with increased FIB-4 index screening among adults with T2D and identified fibrosis risk missed by liver enzymes alone. Additional implementation strategies are needed to optimize workflow integration and increase screening uptake in primary care.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Early Postoperative Intact Parathyroid Hormone Dynamics After Curative Parathyroidectomy for Sporadic Primary Hyperparathyroidism: Trajectories, Predictors of Eucalcemic PTH Elevation, and 18-Month Outcomes.","authors":"Vivek Jha, Sanjay Kumar Bhadada, Soham Mukherjee, Rimesh Pal, Amal Shaharyar, Divya Dahiya","doi":"10.1016/j.eprac.2026.09.115","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.09.115","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105590","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}