Endocrine Practice最新文献

{"title":"Autoimmune Primary Adrenal Insufficiency: Understanding the Past, Present, and Future","authors":"Asif Surani MD,&nbsp;Ty B. Carroll MD","doi":"10.1016/j.eprac.2025.04.008","DOIUrl":"10.1016/j.eprac.2025.04.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary adrenal insufficiency (PAI), or Addison's disease, results from adrenal gland dysgenesis or destruction, leading to impaired production of glucocorticoids, mineralocorticoids, and adrenal androgens. Our understanding of the etiology, pathophysiology, and clinical manifestations of PAI has significantly evolved since this condition was originally described.</div></div><div><h3>Results</h3><div>Over the past 3 decades, the epidemiology and demographics of PAI has shifted, with autoimmune PAI now recognized as the most common cause. This shift has been influenced by increasing awareness of autoimmunity and the widespread use of immune modulating medications, such as immune checkpoint inhibitors. The diagnosis of PAI is often delayed, likely due to its nonspecific clinical presentation. This delay may result in increased morbidity and mortality from adrenal crisis. While treatment involves lifelong hormone replacement therapy, optimizing glucocorticoid dosing remains a challenge. Emerging therapeutic approaches focus on preserving residual adrenal function and preventing disease progression, offering hope for improved long-term outcomes.</div></div><div><h3>Conclusion</h3><div>This review provides an updated overview of the epidemiology, pathophysiology, and future directions in the care of autoimmune PAI. It examines key pathophysiologic and autoimmune features of PAI and explores future directions aimed at identifying genetic and molecular markers that may change the diagnosis, treatment, and outcome of this important endocrinopathy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 813-820"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964532","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)00886-9","DOIUrl":"10.1016/S1530-891X(25)00886-9","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages A1-A2"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254310","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":"Triglyceride to High-Density Lipoprotein Cholesterol Ratio as a Marker of Subclinical Coronary Atherosclerosis and Hepatic Steatosis in Familial Hypercholesterolemia","authors":"Gavin Huangfu MD ,&nbsp;Dick C. Chan PhD ,&nbsp;Jing Pang PhD ,&nbsp;Biyanka Jaltotage MD ,&nbsp;Gerald F. Watts PhD ,&nbsp;Nick S.R. Lan MBBS ,&nbsp;Damon A. Bell PhD ,&nbsp;Abdul R. Ihdayhid PhD ,&nbsp;Oyekoya T. Ayonrinde PhD ,&nbsp;Girish Dwivedi PhD","doi":"10.1016/j.eprac.2025.02.013","DOIUrl":"10.1016/j.eprac.2025.02.013","url":null,"abstract":"<div><h3>Objective</h3><div>Features of the cardiometabolic syndrome are prevalent in patients with familial hypercholesterolemia (FH). Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, a surrogate marker of insulin resistance, may be a robust predictor of cardiac events in the general population. We explored the association between TG/HDL-C ratio and high-risk coronary artery plaque (HRP) and hepatic steatosis (HS) in asymptomatic patients with FH.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of 290 patients (mean age = 49 years, 44% male) who underwent computed tomography coronary angiography for cardiovascular risk assessment. HRP and HS were assessed from computed tomography coronary angiography, and TG/HDL-C ratio was derived from the fasting lipid panel collected around time of scanning. Associations were assessed using binary logistic and Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>TG/HDL-C ratio was significantly associated with HRP (odds ratio, 1.27; 95% CI, 1.04-1.56; <em>P</em> = .020) and HS (odds ratio, 1.71; 95% CI, 1.17-2.51; <em>P</em> = .005) after adjusting for age, body mass index, smoking, and coronary calcium score. TG/HDL-C ratio was associated with HRP in patients treated with lipid-lowering medications (<em>P</em> = .042) and inclusion in a predictive model outperformed the FH-Risk-Score (area under receiver operating characteristic 0.74 vs 0.63; <em>P</em> = .004). An elevated TG/HDL-C ratio predicted myocardial infarction or coronary revascularization over a median follow-up of 91 months with 10 cardiac events recorded (<em>P</em> = .043). TG/HDL-C ratio was strongly positively correlated (<em>P</em> &lt; .001 for all) with markers of cardiometabolic dysfunction: lipid accumulation product (r = 0.81), visceral adiposity index (r = 0.96), and triglyceride-glucose index (r = 0.91).</div></div><div><h3>Conclusion</h3><div>TG/HDL-C ratio was strongly associated with HRP, HS, and cardiac events in patients with FH treated with long-term cholesterol-lowering therapy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 776-783"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531271","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":"Benefits of Glucagon-like Peptide-1 Receptor Agonists After Kidney Transplantation","authors":"Sukhdeep S. Sahi MBBS ,&nbsp;Oscar Garcia Valencia MD ,&nbsp;Jie Na MS ,&nbsp;Adley Lemke PharmD ,&nbsp;Dustin Duffy MS ,&nbsp;Byron Smith MS ,&nbsp;Pavel Navratil MD ,&nbsp;Pooja Budhiraja MBBS ,&nbsp;Tayyab S. Diwan MD ,&nbsp;Naim Issa MD ,&nbsp;Mark D. Stegall MD ,&nbsp;Aleksandar Denic MD, PhD ,&nbsp;Ahmed A. Abdelrheem MB, ChB ,&nbsp;Hani M. Wadei MD ,&nbsp;Walter D. Park ,&nbsp;Pankaj Shah MD ,&nbsp;Yogish C. Kudva MD ,&nbsp;Aleksandra Kukla MD","doi":"10.1016/j.eprac.2025.02.020","DOIUrl":"10.1016/j.eprac.2025.02.020","url":null,"abstract":"<div><h3>Objective</h3><div>Benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in kidney transplant (KT) recipients have not been adequately studied.</div></div><div><h3>Methods</h3><div>We retrospectively examined the effects of GLP-1 RA on mortality, kidney outcomes and metabolic parameters in KT recipients with type 2 diabetes mellitus (T2DM) treated versus not treated with GLP-1 RA. A reference group of KT recipients not treated with GLP-1 RA was used for comparison. Data were analyzed using analysis of variance, χ2 tests, and generalized estimating equation models. GLP-1 RA was used as a time-dependent model in Cox regression modeling. For survival analysis, the final model fitting was stratified by race-ethnicity.</div></div><div><h3>Results</h3><div>Seventy-seven KT recipients with T2DM were treated with GLP-1 RA for at least 12 months. Reference group included 2094 patients not on GLP-1 RA. The mean (SD) age at transplant was 57.9 (9.5) and 60.8 (9.5) years for the treatment and reference groups, respectively. Median follow-up time from the index date for mortality was 1.5 (IQR 0.99, 2.4) in the treatment and 5.8 (IQR 3.4, 9.1) years in the reference group. GLP-1 RA use was associated with improved survival (<em>P</em> = .049), decreased urine albumin to creatinine ratio (net reduction of 10.62 mg/g per year, <em>P</em> = .003), slower estimated glomerular filtration rate decline (1.04 vs 1.56 mL/min/1.73 m² per year, <em>P</em> = .04), and lower troponin levels.</div></div><div><h3>Conclusions</h3><div>GLP-1 RA in KT recipients with T2DM was associated with reduced mortality, and improved kidney function compared to the reference group. Larger, prospective studies are needed to fully evaluate the risks and benefits of GLP-1 RA therapy in KT recipients.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 6","pages":"Pages 798-804"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585064","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, Michelle D Lundholm, Huijun Xiao, Keren Zhou, Kevin M Pantalone","doi":"10.1016/j.eprac.2025.05.748","DOIUrl":"10.1016/j.eprac.2025.05.748","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-31","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":"Imaging of Adrenal Masses.","authors":"Francis T Delaney, Ryan Chung, Michael A Blake, Ann T Sweeney","doi":"10.1016/j.eprac.2025.05.743","DOIUrl":"10.1016/j.eprac.2025.05.743","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 <40 years, and those with a history of an extra-adrenal malignancy.</p><p><strong>Conclusion: </strong>This review outlines the role of imaging for adrenal lesions, describes the various imaging options and investigation strategies, and highlights relevant imaging findings.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-24","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":"Diagnosis Frequency and Associated Factors of Nonalcoholic Fatty Liver Disease Among United States Hospitalized Adults in Urban vs Rural Populations From 2007 to 2019: An Emerging Public Health Crisis.","authors":"Judy Huynh, Asef Raiyan Hoque, S Sethu K Reddy","doi":"10.1016/j.eprac.2025.05.740","DOIUrl":"10.1016/j.eprac.2025.05.740","url":null,"abstract":"<p><strong>Objective: </strong>To describe and understand differences between United States rural and urban populations with respect to outcomes of hospitalization and related epidemiology of nonalcoholic fatty liver disease (NAFLD).</p><p><strong>Methods: </strong>We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample from 2007 to 2019, identifying 847 165 NAFLD cases, of which 370 131 met inclusion criteria. Statistical analyses included Pearson's chi-square, independent samples t-tests, Mann-Whitney U tests, and multivariate logistic regression models to examine factors associated with NAFLD.</p><p><strong>Results: </strong>Hospitalizations due to NAFLD significantly increased over time from 2007 to 2019 with urban cases constituting 84.9% while rural cases represented 15.1%. Differences in demographics, hospital characteristics, insurance, income, and outcomes were significant between the 2 groups. Multivariate analysis showed higher odds of NAFLD diagnosis in fringe metro areas (adjusted odds ratio [aOR] = 1.074, 95% CI = 1.044-1.105), medium metro counties (aOR. = 1.146, 95% CI = 1.114-1.179), small metro counties (aOR = 1.182, 95% CI = 1.140-1.226), and rural regions (aO R = 1.279, 95% CI = 1.233-1.327) compared to central metro areas. NAFLD was more prevalent in females, those aged 35-49 or 50-64 years, and White patients, particularly among those with diabetes, metabolic syndrome, and obesity.</p><p><strong>Conclusion: </strong>The increasing prevalence of NAFLD suggests a strong association with metabolic and cardiovascular diseases. With increasing closure of rural hospitals, we may see more rural patients with NAFLD admitted to urban centers. Early detection and diagnosis should help prevent long-term complications of NAFLD.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132197","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":"Continuous Glucose Monitoring for Prediabetes: Roles, Evidence, and Gaps.","authors":"Salwa J Zahalka, Halis K Akturk, Rodolfo J Galindo, Viral N Shah, Cecilia C Low Wang","doi":"10.1016/j.eprac.2025.05.742","DOIUrl":"10.1016/j.eprac.2025.05.742","url":null,"abstract":"<p><p>Continuous glucose monitoring (CGM) has transformed the care of patients with diabetes, and there is great potential to extend these benefits to prediabetes. The recent US Food and Drug Administration approval of over-the-counter CGMs has increased interest for use in individuals with prediabetes. It is of particular interest to use CGM to guide early individualized lifestyle interventions to prevent the progression of prediabetes to diabetes and support reversion to normoglycemia. In this review, we discuss published evidence regarding CGM metrics in normoglycemia, briefly review the use of CGM to diagnose prediabetes, and review available evidence for CGM use during lifestyle interventions in individuals with prediabetes. Future studies are needed to validate CGM metrics for prediabetes and evaluate effects of early intervention with CGM in this population.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132198","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, Saptarshi Bhattacharya, Lakshmi Nagendra, Abm Kamrul-Hasan","doi":"10.1016/j.eprac.2025.05.741","DOIUrl":"10.1016/j.eprac.2025.05.741","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Six articles that compared 1 hPG<140 mg/dL (7.8 mmol/L) vs 2 hPG <120 mg/dL (7.2 mmol/L) were analyzed. Additionally, 3 articles that assessed 1 hPG<120 mg/dL vs1 hPG<140 mg/dL were also examined. Targeting 1 hPG<140 mg/dL vs 2 hPG<120 mg/dL significantly lowered the risk of LGA [odds ratio (OR) 0.54; 95% confidence interval (CI): 0.32-0.93; P = .03] but not macrosomia [OR 0.45; 95%CI:0.19-1.06; P = .07]. There was no difference in other parameters such as birthweight [mean difference -61.77g; 95%CI:-152.16-28.62; P = .018], LBW [OR 0.90; 95%CI:0.30-2.68;P = .85], neonatal hypoglycemia [OR 0.60; 95%CI:0.28-1.26; P = .18], gestational age at delivery [mean difference 0.20 weeks; 95%CI:-0.29-0.68; P = .43], CS [OR 0.99; 95%CI:0.46-2.12;P = .97], pre-eclampsia [OR 0.66;95% CI:.22-1.96; P = .46], or need for insulin therapy [OR 1.39; 95%CI:.79-2.43; P = .25]. More intensive 1 hPG target <120 mg/dL vs <140 mg/dl increased the risk of preterm delivery [OR 1.62; 95% CI:1.00-2.62; P = .05], without affecting birthweight, LGA, macrosomia, LBW, and CS.</p><p><strong>Conclusion: </strong>Our findings suggest that targeting 1 hPG <140 mg/dL vs 2 hPG<120 mg/dL lowers the risk of LGA, but does not affect other parameters. A stricter target of 1 hPG<120 mg/dL can increase the risk of preterm delivery. Further studies to corroborate these findings are necessary.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","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":"Continuous Subcutaneous Hydrocortisone Infusion in Adrenal Insufficiency: Practical Experience in 33 Subjects.","authors":"Jane Lee, Oksana Hamidi, Emily Simon, Sasan Mirfakhraee","doi":"10.1016/j.eprac.2025.05.004","DOIUrl":"10.1016/j.eprac.2025.05.004","url":null,"abstract":"<p><strong>Objectives: </strong>Diminished subjective health status and increased mortality have been reported in people with adrenal insufficiency (pwAI) receiving conventional glucocorticoid replacement therapy. Continuous subcutaneous hydrocortisone infusion (CSHI) permits individualized glucocorticoid delivery and mimics a more physiologic cortisol pattern compared with oral glucocorticoid therapy. However, data are limited regarding patient selection for CSHI, optimal dosing of CSHI, and CSHI impact on relevant clinical outcomes.</p><p><strong>Methods: </strong>We performed a single-center, retrospective longitudinal cohort study in 33 consecutive pwAI offered a therapeutic trial of CSHI due to persistent AI symptoms.</p><p><strong>Results: </strong>Our cohort comprised of 33 pwAI (82% women). Nine (27.3%) had primary adrenal insufficiency, 16 (48.5%) had secondary AI, and 8 (24.2%) had glucocorticoid-induced AI. The median total daily dose of glucocorticoid (in hydrocortisone equivalent) decreased from 30 mg/d (range, 15-180 mg) before CSHI to 26.7 mg/d (P = .013) at CSHI initiation and 26.6 mg/d (P = .023) at last encounter. The median number of ED visits/year due to adrenal crisis decreased from 0.5 (range, 0-3.4) to 0 (P = .002) and median number of hospitalization days/y decreased from 0.2 (range, 0-18) to 0 (P = .019) after switching to CSHI. There was a numerical increase in subjective health scores (SF-36 survey) following CSHI use. No significant differences were noted for change in weight, blood pressure, diabetes, cardiovascular/cerebrovascular events, total cholesterol, LDL, and/or triglyceride concentrations pre and post CSHI. At study conclusion, most patients (84.8%) remained on CSHI based on personal preference and tolerability.</p><p><strong>Conclusions: </strong>CSHI is a safe and effective means of delivering individualized glucocorticoid therapy to pwAI.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076725","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}