Endocrine Practice最新文献

{"title":"Impulse Control Disorders in Patients With Hyperprolactinemia on Dopamine Agonist Therapy—How Concerned Should We Be?","authors":"Ghazal Daftari MD ,&nbsp;Nicholas A. Tritos MD, DSc","doi":"10.1016/j.eprac.2025.04.018","DOIUrl":"10.1016/j.eprac.2025.04.018","url":null,"abstract":"<div><h3>Objective</h3><div>Dopamine agonists (DAs), including cabergoline and bromocriptine, are the mainstay of treatment for prolactinomas. An underappreciated adverse effect associated with DAs is impulse control disorders (ICDs), characterized by the development of compulsive behaviors, including hypersexuality, pathological gambling, binge eating, and compulsive shopping, among others, which can negatively impact patients' and families’ lives. This article reviews the prevalence, risk factors, presumed pathophysiology, and diagnostic and management strategies for ICDs in hyperprolactinemic patients treated with DAs.</div></div><div><h3>Methods</h3><div>Electronic literature searches were conducted to retrieve pertinent articles for inclusion in this article.</div></div><div><h3>Results</h3><div>The reported prevalence of ICDs in patients with prolactinomas or hyperprolactinemia on DAs ranges from 7.5% to 46% across studies, with cabergoline being more commonly implicated than bromocriptine. Younger age, male sex, and specific genetic polymorphisms appear to increase the risk of ICDs. Diagnostic tools, such as the Minnesota Impulse Disorders Interview, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease, the Barratt Impulsivity Scale-11, and computer-based tests, are instrumental in identifying ICDs. Patient education and periodic screening are advisable for early detection. Management strategies for patients who develop ICDs may include a decrease in DA dose or medication discontinuation, and psychiatric evaluation.</div></div><div><h3>Conclusion</h3><div>ICDs may occur in patients with hyperprolactinemia on DAs and negatively influence their lives if undetected. Further studies are needed to fully elucidate the risk factors and underlying mechanisms and to identify effective therapies for managing ICDs in patients with hyperprolactinemia on DAs.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 938-945"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992751","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":"Patients With Persistent Hashimoto-Related Symptoms. Dilemmas in Advice-Giving and Self-Selection for Thyroidectomy. An Observational Study","authors":"Geir Hoff MB, ChB, PhD ,&nbsp;Tomm Bernklev PhD ,&nbsp;Jan Terje Kvaløy MSc, PhD ,&nbsp;Charlotte Gibbs MD, PhD ,&nbsp;Laurens Cornelus Reitsma MD","doi":"10.1016/j.eprac.2025.04.007","DOIUrl":"10.1016/j.eprac.2025.04.007","url":null,"abstract":"<div><h3>Objective</h3><div>Some Hashimoto-related symptoms, persistent despite medically obtained euthyroidism, are believed to be related to autoimmunity. Total thyroidectomy has proved beneficial for patient-reported outcome measures (PROMs), but with a certain risk of complications. Selection criteria for surgery have not been defined. Molecular evidence supporting an autoimmune cause is lacking, and a placebo effect of surgery cannot be excluded. Short of selection criteria for thyroidectomy and no pathophysiologic model to adequately explain persistent symptoms, we wanted to look into factors that may be related to patients’ decision for surgery, thus aiming to facilitate patient-physician communication on treatment for persistent Hashimoto-related symptoms.</div></div><div><h3>Methods</h3><div>A total of 177 patients with persistent Hashimoto disease-related symptoms and highly motivated for thyroidectomy completed an 18-month watchful waiting period with biannual consultations before being offered thyroidectomy. PROMs were monitored before and after surgery.</div></div><div><h3>Results</h3><div>After 18 months of watchful waiting, 131 (74%) of 177 patients proceeded to thyroidectomy whereas 46 declined surgery. There was no difference between the surgery and no-surgery groups regarding sex, age, and thyroid peroxidase antibody levels at 18 months watchful waiting. Compared with the no-surgery group, PROM scores were consistently poorer in the surgery group for all domains in the PROM questionnaires used.</div></div><div><h3>Conclusions</h3><div>A grace period of 18 months with biannual follow-up before thyroidectomy may be useful to modify exposure to surgery carrying a certain risk of complications. At 18 months, the fatigue score stands out as the most important factor influencing the odds for maintaining a choice to have surgery.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 906-912"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994026","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":"Low-Dose Tolvaptan for the Treatment of Syndrome of Inappropriate Antidiuretic Hormone–Associated Hyponatremia: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Clinical Effectiveness and Safety","authors":"David Lewellyn MBChB, MRCP, BSc ,&nbsp;Thitikorn Nuamek MD ,&nbsp;Eduard Ostarijas MD ,&nbsp;Hugh Logan Ellis MBBChir, MRCP, MA (cantab) ,&nbsp;Eftychia E. Drakou MD, MSc ,&nbsp;Simon J.B. Aylwin MA, MBBChir, PhD, FRCP ,&nbsp;Georgios K. Dimitriadis MD, MSc, FRCP, FAcadTM, SCOPE/EASO(UK National Fellow), PhD","doi":"10.1016/j.eprac.2025.04.012","DOIUrl":"10.1016/j.eprac.2025.04.012","url":null,"abstract":"<div><h3>Objective</h3><div>Tolvaptan at the licensed dose of 15 mg effectively treats syndrome of inappropriate antidiuresis (SIAD)–associated hyponatremia. However, concerns about overcorrection and osmotic demyelination syndrome have limited its adoption. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of lower tolvaptan doses (&lt;15 mg) for treating SIAD-associated hyponatremia.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, Cochrane CENTRAL, <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, and Scopus from inception to February 2024. The primary outcomes were change in serum sodium and overcorrection rates. The secondary outcomes included adverse effects, hospital length of stay, and quality-of-life measures. We conducted meta-analyses using mean differences for efficacy and proportions for safety outcomes, with dose-based subgroup analyses and meta-regression.</div></div><div><h3>Results</h3><div>From 968 identified studies, 18 met inclusion criteria, comprising 495 patients. Initial doses below 15 mg increased the serum sodium level by 7.2 mmol/L (95% CI, 6.0-8.4) within 24 hours. In the 7.5-mg subgroup (n = 286), the mean increase was 7.8 mmol/L (95% CI, 6.2-9.4). The overcorrection rates were 31% (95% CI, 15%-53%) for an increase of ≥10 mmol/L and 10% (95% CI, 3%-20%) for an increase of ≥12 mmol/L in 24 hours. In the 3.75-mg subgroup, the mean increase was 7.1 mmol/L (95% CI, 4.7-9.6). There were insufficient data to review overcorrection rates. No cases of osmotic demyelination syndrome were reported. The secondary outcome data were insufficient for meta-analysis.</div></div><div><h3>Conclusion</h3><div>Low-dose tolvaptan (3.75-7.5 mg) effectively increases the serum sodium level in SIAD-associated hyponatremia. We recommend initiating tolvaptan at 7.5 mg, or 3.75 mg in high-risk patients, with close monitoring of sodium levels. These findings support a lower starting dose than currently licensed, although randomized controlled trials are needed to confirm optimal dosing strategies.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 956-964"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956398","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":"Info for Readers/Subscription page","authors":"","doi":"10.1016/S1530-891X(25)00909-7","DOIUrl":"10.1016/S1530-891X(25)00909-7","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages A1-A2"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580540","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":"Reassessing the Risk-Benefit Profile of Thiazolidinediones: Cardiovascular Risks and Stroke Prevention Through Real-World Data","authors":"Lu Fei PhD ,&nbsp;Yingjie Zhao MD","doi":"10.1016/j.eprac.2025.04.004","DOIUrl":"10.1016/j.eprac.2025.04.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Research has increasingly explored the benefits of thiazolidinediones (TZDs) beyond diabetes management, particularly in reducing stroke and dementia risks. However, concerns about cardiovascular adverse events, especially heart failure (HF), necessitate a re-evaluation of TZD-associated cardiovascular risks using real-world data.</div></div><div><h3>Methods</h3><div>This study re-evaluates the cardiovascular risks of TZDs and their efficacy in stroke prevention. We conducted a real-world pharmacovigilance study using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (January 2004 to December 2023) to assess cardiovascular risks associated with TZDs, including myocardial infarction, HF, and stroke. Multivariable logistic regression adjusted the reporting odds ratio from the disproportional analysis. Additionally, a network meta-analysis of clinical studies (January 2000 to March 2024) examined the efficacy of TZDs in stroke prevention.</div></div><div><h3>Results</h3><div>Our analysis of the FAERS database revealed significantly higher cardiovascular risks associated with TZDs. However, clear differences exist in cardiovascular risks between pioglitazone and rosiglitazone. Rosiglitazone was linked to a markedly increased incidence of myocardial infarction, HF, and stroke. In contrast, we didn’t observe strong cardiovascular risks associated with pioglitazone. Instead, pioglitazone was shown to slightly heighten the risk of HF. Further, the network meta-analysis, based on SUCRA rankings and ranking probabilities also disclosed similar findings: when compared to placebo, rosiglitazone increased stroke risk, while pioglitazone reduced stroke incidence in individuals with diabetes and prediabetes.</div></div><div><h3>Conclusions</h3><div>Our analysis shows that pioglitazone has potential therapeutic effects on stroke prevention and fewer cardiovascular adverse events compared to rosiglitazone, underscoring the importance of reassessing TZD safety for optimal patient outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 875-883"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995165","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":"One-hour vs Two-hour Postprandial Glucose Targets and Fetomaternal Outcomes in Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis","authors":"Deep Dutta MD, DM ,&nbsp;Saptarshi Bhattacharya MD, DM ,&nbsp;Lakshmi Nagendra MD, DM ,&nbsp;ABM Kamrul-Hasan MD","doi":"10.1016/j.eprac.2025.05.741","DOIUrl":"10.1016/j.eprac.2025.05.741","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal time and target for postprandial glucose (PPG) measurement in gestational diabetes mellitus (GDM) remain unclear. This systematic review and meta-analysis evaluated whether targeting 1-hour PPG (1 hPG) vs 2-hour PPG (2 hPG) altered fetomaternal outcomes in GDM.</div></div><div><h3>Methods</h3><div>Studies that compared pregnancy outcomes in women undergoing 1 hPG vs 2 hPG monitoring in GDM were identified through comprehensive search of electronic databases. Primary outcomes analyzed were large-for-gestational age (LGA) and macrosomia. Secondary outcomes included low birthweight (LBW), neonatal intensive-care unit admission, neonatal hypoglycemia, cesarean section (CS), pre-eclampsia, gestational age at delivery, and preterm delivery.</div></div><div><h3>Results</h3><div>Six articles that compared 1 hPG&lt;140 mg/dL (7.8 mmol/L) vs 2 hPG &lt;120 mg/dL (7.2 mmol/L) were analyzed. Additionally, 3 articles that assessed 1 hPG&lt;120 mg/dL vs1 hPG&lt;140 mg/dL were also examined. Targeting 1 hPG&lt;140 mg/dL vs 2 hPG&lt;120 mg/dL significantly lowered the risk of LGA [odds ratio (OR) 0.54; 95% confidence interval (CI): 0.32-0.93; <em>P</em> = .03] but not macrosomia [OR 0.45; 95%CI:0.19-1.06; <em>P</em> = .07]. There was no difference in other parameters such as birthweight [mean difference -61.77g; 95%CI:−152.16-28.62; <em>P</em> = .018], LBW [OR 0.90; 95%CI:0.30-2.68;<em>P</em> = .85], neonatal hypoglycemia [OR 0.60; 95%CI:0.28-1.26; <em>P</em> = .18], gestational age at delivery [mean difference 0.20 weeks; 95%CI:−0.29-0.68; <em>P</em> = .43], CS [OR 0.99; 95%CI:0.46-2.12;<em>P</em> = .97], pre-eclampsia [OR 0.66;95% CI:.22-1.96; <em>P</em> = .46], or need for insulin therapy [OR 1.39; 95%CI:.79-2.43; <em>P</em> = .25]. More intensive 1 hPG target &lt;120 mg/dL vs &lt;140 mg/dl increased the risk of preterm delivery [OR 1.62; 95% CI:1.00-2.62; <em>P</em> = .05], without affecting birthweight, LGA, macrosomia, LBW, and CS.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that targeting 1 hPG &lt;140 mg/dL vs 2 hPG&lt;120 mg/dL lowers the risk of LGA, but does not affect other parameters. A stricter target of 1 hPG&lt;120 mg/dL can increase the risk of preterm delivery. Further studies to corroborate these findings are necessary.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 890-898"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132232","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":"Imaging of Adrenal Masses","authors":"Francis T. Delaney MD ,&nbsp;Ryan Chung MD ,&nbsp;Michael A. Blake MB, BAO, BSc, MRCPI FRCR FFR(RCSI) ,&nbsp;Ann T. Sweeney MD","doi":"10.1016/j.eprac.2025.05.743","DOIUrl":"10.1016/j.eprac.2025.05.743","url":null,"abstract":"<div><h3>Objective</h3><div>Adrenal lesions are common and require appropriate management when clinically relevant. The approach to the evaluation of an adrenal lesion is to exclude malignancy and hormone excess as these are associated with significant morbidity and mortality.</div></div><div><h3>Methods</h3><div>Imaging of adrenal lesions primarily aims to identify features indicating benignity. Noncontrast computed tomography is recommended as first-line imaging for adrenal lesions. Indeterminate lesions that require further characterization may proceed to adrenal protocol computed tomography (with contrast) or magnetic resonance imaging, with a trend in recent years towards increasing use of magnetic resonance imaging. Positron emission tomography-computed tomography may also be used to assess adrenal lesions in certain clinical scenarios.</div></div><div><h3>Results</h3><div>Clinical guidelines recommend that all adrenal incidentalomas require further dedicated imaging unless they are clearly benign on imaging. The imaging strategy of adrenal lesions depends upon a number of factors including patient history, nature of detection, imaging characteristics (size, heterogeneity, presence of intracellular lipid), and the presence or absence of hormone excess. Special considerations are given to pregnant patients, young patients &lt;40 years, and those with a history of an extra-adrenal malignancy.</div></div><div><h3>Conclusion</h3><div>This review outlines the role of imaging for adrenal lesions, describes the various imaging options and investigation strategies, and highlights relevant imaging findings.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 965-974"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149437","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":"Emerging and Established Adverse Events of Pasireotide: A Twelve-Year Pharmacovigilance Study","authors":"Cong Zou MD ,&nbsp;Xing Wang MD ,&nbsp;Ruizhen Huang MD ,&nbsp;Honglin Hu MD","doi":"10.1016/j.eprac.2025.04.005","DOIUrl":"10.1016/j.eprac.2025.04.005","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to provide a comprehensive assessment of pasireotide's real-world safety profile by analyzing adverse events (AEs) reported in the FDA Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>FAERS data from Q4 2012 to Q3 2024 were retrospectively analyzed using disproportionality methods, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker. Descriptive analyses evaluated clinical characteristics such as age, sex, country of report, and time to AE onset, while subgroup analyses assessed variations in AE occurrence across demographic groups.</div></div><div><h3>Results</h3><div>A total of 7892 pasireotide-related AEs were identified across 27 system organ classes. Frequently reported AEs included hyperglycemia, cholelithiasis, and gastrointestinal disturbances, with hyperglycemia being the most common. Emerging safety signals were identified, including nephrolithiasis, sudden hearing loss, ptosis, and atrioventricular block. Subgroup analyses indicated that metabolic AEs were more prevalent in females, while males reported higher rates of gastrointestinal symptoms. Older patients were more susceptible to cardiovascular AEs.</div></div><div><h3>Conclusions</h3><div>This study underscores the need for ongoing pharmacovigilance to detect both established and emerging AEs associated with pasireotide. Implementing personalized monitoring strategies based on demographic factors such as age and sex can help mitigate risks and optimize treatment outcomes, enhancing patient safety in clinical practice.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 928-937"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970375","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":"Computed Tomography Cardiac Angiography Findings in Patients With Sheehan Syndrome","authors":"Aqib Mohammad MD ,&nbsp;Majid Jehangir MD ,&nbsp;Shahnaz Ahmad Mir DM ,&nbsp;Syeed Aalishan Fatima MD ,&nbsp;Mohammad Salem Baba DM ,&nbsp;Bashir Ahmad Laway DM ,&nbsp;Javaid Ahmad Bhat DM ,&nbsp;Nadia Shafi MD","doi":"10.1016/j.eprac.2025.04.006","DOIUrl":"10.1016/j.eprac.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>Sheehan Syndrome (SS), or postpartum pituitary necrosis, is associated with an elevated risk of atherosclerotic cardiovascular (CV) diseases, driven by factors such as dyslipidemia, chronic inflammation, and growth hormone deficiency. To better understand the prevalence and characteristics of atherosclerotic CV disease in this population, we conducted a noninvasive evaluation of the coronary arteries using computed tomography cardiac angiography.</div></div><div><h3>Methods</h3><div>This observational cross-sectional study included women diagnosed with SS who were receiving standard replacement therapy including thyroxine and glucocorticoids. All participants underwent computed tomography cardiac angiography to identify the presence of coronary artery plaques.</div></div><div><h3>Results</h3><div>The study included 30 patients with SS, with a mean age of 54.20 ± 8.27 years and a mean duration of pituitary disease of 22.67 ± 6.27 years. Coronary artery calcium (CAC) scoring revealed the following risk stratification for coronary artery disease: minimal risk (CAC 1-10) in 6.7% (n = 2), mild risk (CAC 11-100) in 16.7% (n = 5), and moderate risk (CAC 101-400) in 3.3% (n = 1). Coronary artery plaques were identified in 23.3% (n = 7) of patients. Among these, 4 patients had noncalcified plaques, 2 had calcified plaques, and 1 patient had both calcified and noncalcified plaques. A strong positive correlation was observed between CAC scores and percentage stenosis (r = 0.96, <em>P</em> = .01).</div></div><div><h3>Conclusion</h3><div>Approximately one-fourth of patients with SS were found to have atherosclerotic plaques in their coronary arteries, highlighting their increased susceptibility to CV morbidity and mortality.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 913-917"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970410","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":"Assessing Clinician Engagement With a Passive Clinical Decision Support System for Liver Fibrosis Risk Stratification in a Weight Management Clinic","authors":"Arpan Mohanty MD, MSc ,&nbsp;Kirsten Austad MD, MPH ,&nbsp;Nicholas A. Bosch MD, MSc ,&nbsp;Michelle T. Long MD, MSc ,&nbsp;Eric Nolen-Doerr MD ,&nbsp;Allan J. Walkey MD, MSc ,&nbsp;Mari-Lynn Drainoni PhD, Med ,&nbsp;Ivania Rizo MD ,&nbsp;Kathryn L. Fantasia MD, MSc","doi":"10.1016/j.eprac.2025.04.014","DOIUrl":"10.1016/j.eprac.2025.04.014","url":null,"abstract":"<div><h3>Objective</h3><div>Metabolic dysfunction-associated steatotic liver disease is common in obesity. Guidelines recommend liver fibrosis risk stratification with tools such as Fibrosis-4 (FIB-4) index, liver stiffness measurement with vibration-controlled transient elastography (VCTE) and/or hepatology referral for elevated FIB-4. Despite recommendations, implementation remains limited. Using mixed methods, we evaluated a 3-strategy implementation bundle to improve fibrosis risk stratification—a FIB-4-based electronic health record embedded clinical decision support system (CDSS), educational outreach, and internal facilitation in a weight management clinic.</div></div><div><h3>Methods</h3><div>The primary outcome was penetration: the proportion of patients with elevated FIB-4 completing VCTE or hepatology referral. We compared rates, pre and postactivation of implementation bundle using Fischer’s exact test. Semi-structured provider interviews, guided by the i-PARIHS framework, assessed acceptability and feasibility 3 months postimplementation.</div></div><div><h3>Results</h3><div>In the preactivation phase, 880 out of 3933 (22.4%) weight management visits had the necessary labs to calculate automated FIB-4 scores with 128 elevated scores. In the postactivation phase, 2513 of 4634 weight management visits (54.2%) had automated FIB-4 scores; with 234 elevated score. Preactivation, there were no VCTE and 2 hepatology referrals. Postactivation, there were 3 VCTE referrals and 2 hepatology referrals (Fischer’s exact test <em>P</em> value = 1.00). Providers cited shared responsibility with primary care, low awareness and trust in risk-stratification tools, workflow challenges, and competing demands as barriers. Educational outreach and facilitation improved CDSS engagement, while technical issues reduced it.</div></div><div><h3>Conclusion</h3><div>This implementation strategy bundle did not achieve meaningful metabolic dysfunction-associated steatotic liver disease fibrosis risk stratification. Electronic health record-based CDSS shows promise but requires alignment with provider priorities, seamless workflow integration, and robust technical infrastructure.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 7","pages":"Pages 899-905"},"PeriodicalIF":3.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983848","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}