Endocrine Practice最新文献

{"title":"Glucagon-like Peptide-1 Receptor Agonists Are Associated With Improved Survival and Reduced Liver-Related Events in Patients With Type 2 Diabetes and Metabolic Dysfunction-Associated Liver Disease: A Large Real-World Retrospective Study.","authors":"Benjamin D Liu, Mohammed Aly, Cindy Hsin-Ti Lin, Noordeep Panesar, Hannah Hill, Kamran Qureshi","doi":"10.1016/j.eprac.2025.04.017","DOIUrl":"10.1016/j.eprac.2025.04.017","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or pioglitazone (PGZ) are associated with improved survival, reduced liver-related outcomes (LROs), and better metabolic outcomes in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated liver disease (MASLD) or steatohepatitis (MASH).</p><p><strong>Methods: </strong>We used the TriNetX platform to identify adults with T2DM and MASLD/MASH from 2006 onward (n = 558 075) using Internation Classification of Diseases codes. Patients with confounding liver diseases, overlapping study medications, or bariatric surgery were excluded. Three exclusive cohorts-GLP-1 RA, PGZ, and other antidiabetic agents (controls)-were formed. After 1:1 propensity score matching, time-to-event analyses were performed using Cox proportional hazards models and Kaplan-Meier methods.</p><p><strong>Results: </strong>Among matched groups, GLP-1 RAs (n = 17 465) were associated with a 40.9% reduction in all-cause mortality versus controls (hazard ratio [HR] 0.59; P < .0001) and significantly lower rates of LRO (HR 0.77) and liver transplantation (HR 0.33). In contrast, PGZ (n = 1803) showed reduced LRO rates (HR 0.68) but not mortality. In cirrhotic patients, GLP-1 RA was linked to fewer transplant events but did not significantly reduce mortality. GLP-1 RA therapy noted greater reductions in body mass index and hemoglobin A1c relative to controls.</p><p><strong>Conclusions: </strong>In this large real-world cohort, GLP-1 RA use was associated with improved survival and hepatic outcomes in T2DM patients with MASLD/MASH, particularly among those without established cirrhosis. PGZ exhibited hepatic benefits. These findings highlight the potential importance of further prospective studies to evaluate early GLP-1 RA therapy in this high-risk diabetic population with MASLD/MASH.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996614","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":"Menopause in Cystic Fibrosis: Special Considerations for Bone Health, Menopausal Symptoms, and Treatment.","authors":"Sarah Haroon, Crystal Cobb, Sandy Sufian, Raksha Jain, Naim M Maalouf, Melissa S Putman","doi":"10.1016/j.eprac.2025.04.011","DOIUrl":"10.1016/j.eprac.2025.04.011","url":null,"abstract":"<p><p>Cystic fibrosis (CF) is a multisystem autosomal recessive disease arising from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Dysfunction of the CFTR protein leads to progressive pulmonary disease, pancreatic exocrine insufficiency, and nutritional deficiencies. Survival has significantly increased over the last several decades due to improved pulmonary and nutritional management, including CFTR modulator therapy. The adult CF population now faces new challenges of aging, such as menopause-related symptoms and age-related osteoporosis superimposed on underlying CF-related bone disease. The menopausal transition and early postmenopause are characterized by rapid bone loss and represent a window of opportunity to preserve bone mass. Menopausal hormone therapy may alleviate vasomotor symptoms and improve bone density in appropriately selected people. This review will discuss the current knowledge of menopause and bone health in females with CF, address CF-specific considerations on osteoporosis and menopause treatment options, and explore opportunities for future areas of research.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989542","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":"Autoimmune Primary Adrenal Insufficiency: Understanding the Past, Present, and Future.","authors":"Asif Surani, Ty B Carroll","doi":"10.1016/j.eprac.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.04.008","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-26","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":"Impact of the Addition of Beta-Hydroxybutyrate in the 72-Hour Fast Protocol on Hospitalization Duration: A Quality Improvement Report.","authors":"Michelle D Lundholm, Dianna Jo Copley, Vinni Makin, Pratibha P R Rao","doi":"10.1016/j.eprac.2025.04.015","DOIUrl":"10.1016/j.eprac.2025.04.015","url":null,"abstract":"<p><strong>Objective: </strong>The 72-hour fast is the \"gold standard\" test for detecting insulinoma but imposes significant burdens on patients and expends hospital resources. Balancing diagnostic accuracy with patient comfort and cost remains challenging. We aimed to leverage the metabolic indicator beta-hydroxybutyrate (BHB), indicative of insulin suppression, to curtail inpatient fasting time without missing insulinoma cases.</p><p><strong>Methods: </strong>Our institution implemented an inpatient 72-hour fast protocol in 2018, and updated the protocol in 2020 to include a BHB >2.7 mmol/L stopping criterion. In this quality improvement and patient safety project, we retrospectively reviewed all patients who completed a 72-hour fast at our institution by the original (January 2018 to June 2020) and updated (June 2020 to December 2022) protocols.</p><p><strong>Results: </strong>Sixty-four patients (78% female, mean age 48 ± 17 years) underwent fasting: 34 patients by the original protocol and 30 patients by the revised protocol. The original protocol had an average fast duration of 57.6 hours (median 72 hours, IQR [49,72]). After the update, 50% (N = 15) ended for BHB >2.7 mmol/L, with an average fast duration of 49.7 hours (median 53 hours, IQR [39.1, 71.8], P = .03). This reduced cumulative inpatient fasting by 376.5 hours and reduced medical costs. All insulinoma cases (N = 7) developed hypoglycemia within 43 hours with BHB ≤1.2 mmol/L; no cases were missed.</p><p><strong>Conclusion: </strong>Adding a BHB >2.7 mmol/L stopping criterion reduced inpatient hospitalization time, medical costs, and patient burden without compromising insulinoma detection. This evidence-based intervention improves patient adherence and more effectively uses hospital resources.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970509","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, Thitikorn Nuamek, Eduard Ostarijas, Hugh Logan Ellis, Eftychia E Drakou, Simon J B Aylwin, Georgios K Dimitriadis","doi":"10.1016/j.eprac.2025.04.012","DOIUrl":"10.1016/j.eprac.2025.04.012","url":null,"abstract":"<p><strong>Objective: </strong>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 (<15 mg) for treating SIAD-associated hyponatremia.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-25","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":"Assessing Clinician Engagement With a Passive Clinical Decision Support System for Liver Fibrosis Risk Stratification in a Weight Management Clinic.","authors":"Arpan Mohanty, Kirsten Austad, Nicholas A Bosch, Michelle T Long, Eric Nolen-Doerr, Allan J Walkey, Mari-Lynn Drainoni, Ivania Rizo, Kathryn L Fantasia","doi":"10.1016/j.eprac.2025.04.014","DOIUrl":"10.1016/j.eprac.2025.04.014","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 P 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-25","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}

{"title":"Trends and Risk Factors of Oral Health and Preventive Dental Care in Adults With Diabetes and Prediabetes: National Health and Nutrition Examination Survey 1999-2000 to 2017-2020.","authors":"You Lu, Yilin Yoshida","doi":"10.1016/j.eprac.2025.04.010","DOIUrl":"10.1016/j.eprac.2025.04.010","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence, trends, and risk factors of major oral health indicators across diabetes mellitus (DM) subgroups.</p><p><strong>Methods: </strong>A total of 22 082 adults of diagnosed DM, undiagnosed DM (UnDxDM), prediabetes mellitus (PreDM), and normal glucose groups were selected from the National Health and Nutrition Examination Survey (1999 to March 2020). We examined age, sex, and race-adjusted prevalence of preventive dental service (preventive dental service and self-dental cleaning) and oral health outcomes (≥10 missing teeth, self-rated oral health, and periodontitis). We used logistic regression to identify risk factors associated with each outcome DM population.</p><p><strong>Results: </strong>The prevalence of lacking preventive dental service (DM, 52%; UnDxDM, 48%; PreDM, 44%; and normal, 42%, respectively), self-dental cleaning (38%, 37%, 30%, and 25%, respectively), missing teeth (39%, 31%, 19%, and 10%, respectively), poorly self-rated oral health (38%, 26%, 31%, and 27%, respectively), and periodontitis (50%, 51%, 42%, and 29%, respectively) remained consistently higher in those with DM than in normal glucose group. We observed a decline in the prevalence of lacking self-dental cleaning in the PreDM population and a decline in poorly self-rated oral health in all except the UnDxDM group. In the DM population, education, income, smoking, insurance, and glycemic control are risk factors for all outcomes.</p><p><strong>Conclusion: </strong>The trends of lacking preventive dental care and suboptimal oral health outcomes were consistently higher in people with DM or PreDM than in those people without diabetes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989544","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":"Harnessing the Power of Physician Word Choice in Thyroid Cancer Treatment Decision-Making.","authors":"Catherine B Jensen, Kathryn Flaharty, Hunter J Underwood, Michael A Rubyan, Brian J Zikmund-Fisher, Susan C Pitt","doi":"10.1016/j.eprac.2025.04.016","DOIUrl":"10.1016/j.eprac.2025.04.016","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974402","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 Pharmacovigilance Analysis of Lorlatinib-Associated Metabolic Effects Using the FDA Adverse Events Reporting System (FAERS) Database From 2013 to 2024.","authors":"Connor Frey","doi":"10.1016/j.eprac.2025.03.016","DOIUrl":"10.1016/j.eprac.2025.03.016","url":null,"abstract":"<p><strong>Objective: </strong>The advent of anaplastic lymphoma kinase (ALK) inhibitors, including lorlatinib, has transformed the treatment of ALK-rearranged malignancies. While lorlatinib effectively overcomes resistance mutations and penetrates the central nervous system, its use is associated with metabolic adverse events, including hypercholesterolemia, hypertriglyceridemia, and weight gain. These complications increase cardiovascular risks, disrupt metabolic homeostasis, and may affect therapy adherence.</p><p><strong>Methods: </strong>This study utilizes data from the FDA Adverse Event Reporting System and employs disproportionality analysis to investigate the prevalence and nature of lorlatinib-associated metabolic adverse events.</p><p><strong>Results: </strong>Significant associations were identified between lorlatinib and lipid-related adverse events, including hypercholesterolemia (reporting odds ratio [ROR] = 98.46; 95% CI: 79.28-122.29), hypertriglyceridemia (ROR = 66.10; 95% CI: 49.60-88.11), increased body mass index (ROR = 81.57; 95% CI: 48.87-136.14), and increased blood cholesterol (ROR = 23.42; 95% CI: 19.69-27.86). Additional associations were noted for increased blood triglycerides (ROR = 28.14; 95% CI: 22.15-35.75) and dyslipidemia (ROR = 53.60; 95% CI: 38.51-74.60).</p><p><strong>Conclusion: </strong>These findings highlight the need for proactive monitoring and management of metabolic side effects in patients receiving lorlatinib. A multidisciplinary approach-incorporating pharmacologic interventions, lifestyle modifications, and regular monitoring-is essential to mitigate metabolic risks. This study enhances the understanding of lorlatinib's safety profile and informs clinical strategies to balance efficacy and tolerability in ALK inhibitor therapy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973504","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":"Comment on Patel et al American Association of Clinical Endocrinology Clinical Practice Guideline on Pharmacologic Management of Adults With Dyslipidemia.","authors":"Aidar R Gosmanov, Niyaz R Gosmanov","doi":"10.1016/j.eprac.2025.03.015","DOIUrl":"10.1016/j.eprac.2025.03.015","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974394","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}