Endocrine Practice最新文献

{"title":"Long-Term Antithyroid Drug Therapy in the Management of Graves’ Hyperthyroidism: An Updated Narrative Review","authors":"Fereidoun Azizi MD","doi":"10.1016/j.eprac.2026.05.005","DOIUrl":"10.1016/j.eprac.2026.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>To review recent developments in the management of Graves’ hyperthyroidism, emphasizing long-term antithyroid drug (ATD) therapy and its comparison with radioactive iodine and thyroidectomy.</div></div><div><h3>Methods</h3><div>A search was applied using MEDLINE and manual reference searches for studies published from January 2010 to July 2025. Eligible articles addressed long-term ATD, thyroidectomy, radioiodine therapy, cardiovascular risks in hyperthyroidism or relapse prediction, and thyrotropin-receptor antibody changes.</div></div><div><h3>Results</h3><div>Long-term treatment with continuous methimazole (≥60 months) resulted in substantially higher sustained remission (&lt;20% relapse) compared with conventional ATD courses (approximately 50% relapse). It produced faster normalization of thyrotropin, greater time spent in euthyroidism, fewer orbitopathy exacerbations, and minimal late adverse events. Both radioiodine therapy and thyroidectomy resulted in high rates of permanent hypothyroidism, while cardiovascular studies underscored the importance of early and sustained correction of hyperthyroidism. Thyrotropin-receptor antibody trajectory patterns, composed of smooth, fluctuating, and smoldering, were strong predictors of relapse and supported individualized extension of ATD therapy.</div></div><div><h3>Conclusions</h3><div>Continuous ATD treatment for ≥60 months is more effective in inducing sustained long-term euthyroidism and is associated with fewer adverse events and lower relapse risk than conventional 12-18-month courses and ablative treatment, supporting its inclusion as a therapeutic option in future guidelines for Graves' disease management.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1512-1521"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Once-Weekly Insulin Icodec: Safety Profile in Type 2 and Type 1 Diabetes Based on a Pooled Analysis of ONWARDS 1-6","authors":"Harpreet S. Bajaj MD,&nbsp;Sofie Bech Andersen PhD,&nbsp;Boryana Hristova MD,&nbsp;Satish Hulkund MSc,&nbsp;Monika Kellerer MD PhD,&nbsp;Yiming Mu MD,&nbsp;Siri Vinther PhD,&nbsp;Ildiko Lingvay MD","doi":"10.1016/j.eprac.2026.05.003","DOIUrl":"10.1016/j.eprac.2026.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the safety profile of once-weekly insulin icodec (icodec), focusing on aspects beyond hypoglycemia, in a pooled population from the ONWARDS phase 3a trials.</div></div><div><h3>Methods</h3><div>ONWARDS 1-6 investigated the efficacy and safety of icodec versus once-daily basal insulin comparators in insulin-naive and insulin-experienced adults with type 2 diabetes, and insulin-experienced adults with type 1 diabetes. Adverse event (AE) data from all trial periods were pooled. Hypersensitivity, injection-site reactions, and medication errors, as well as microvascular and macrovascular (including time to first major adverse cardiovascular event [MACE]) complications, were among the safety areas evaluated.</div></div><div><h3>Results</h3><div>Total treatment exposure was 2118.70 and 2127.76 patient-years of exposure (PYE) in the icodec (<em>n</em> = 2170) and comparator groups (<em>n</em> = 2170), respectively. Adjusted rates (events/100 PYE) were similar for icodec and comparators for all AEs (248.49 vs 242.53), serious AEs (14.51 vs 14.03), and severe AEs (7.92 vs 7.50), respectively. Adjusted rates of hypersensitivity were 5.88 and 6.74 events/100 PYE in the icodec and comparator groups, respectively. Most injection-site reactions were mild; adjusted rates: 5.86 and 3.66 events/100 PYE, respectively. Medication error rates were 2.47 and 2.53 events/100 PYE, respectively. Time to first MACE was similar between groups (hazard ratio [95% confidence interval]: 0.93 [0.56-1.56]). Adjusted rates for other AEs were broadly similar between groups.</div></div><div><h3>Conclusion</h3><div>Based on a detailed evaluation of safety focus areas across the ONWARDS 1-6 trials, the safety profile of once-weekly icodec was generally similar to that of once-daily basal insulin comparators in individuals with type 2 diabetes or type 1 diabetes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1475-1482"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Causes of Pediatric Primary Adrenal Insufficiency: An Observational Cohort Study","authors":"Mathilde Schermesser-Sicard MD,&nbsp;Dinane Samara-Boustani MD,&nbsp;Florence Roucher-Boulez PharmD, PhD,&nbsp;Graziella Pinto MD,&nbsp;Jean-Claude Carel MD, PhD,&nbsp;Adrien Nguyen-Quoc MD,&nbsp;Gaëlle Vermillac MD,&nbsp;Sibylle Rovani MD,&nbsp;Caroline Thalassinos MD,&nbsp;Sabrina Da Costa MD,&nbsp;Maria Beatriz Arrom Branas MD,&nbsp;Isabelle Flechtner MD,&nbsp;Laura Gonzalez-Briceno MD,&nbsp;Magali Viaud MSc,&nbsp;Alix Besançon MD, PhD,&nbsp;Athanasia Stoupa MD, PhD,&nbsp;Michel Polak MD, PhD,&nbsp;Dulanjalee Kariyawasam MD, PhD","doi":"10.1016/j.eprac.2026.05.011","DOIUrl":"10.1016/j.eprac.2026.05.011","url":null,"abstract":"<div><h3>Objective</h3><div>Primary adrenal insufficiency (PAI) is a rare, chronic condition responsible for life-threatening complications and is usually due to 21-hydroxylase deficiency. Identifying other rare causes is crucial to ensure optimal management. The objective of this study was to describe rare causes of pediatric PAI.</div></div><div><h3>Methods</h3><div>An observational, retrospective, single-center, cohort study.</div></div><div><h3>Results</h3><div>Of 172 patients under 18 years diagnosed with PAI in 1980-2023: 113 with 21-hydroxylase deficiency and 59 (34%) with rare causes of PAI including monogenic diseases (<em>n</em> = 38, 64%), auto-immune disorders (<em>n</em> = 15, 25%), and bilateral adrenal hemorrhage (<em>n</em> = 3). Median follow-up was 7.6 years. The mortality was 6 of 59 (10%), with myelodysplasia, infections, restriction of growth, adrenal hypoplasia, genital phenotypes and enteropathy syndrome as the most common cause. Acute adrenal crisis occurred in 26 (45%) patients, usually due to poor treatment adherence. Excess weight was common (16/59, 27%). Among 37 available data, puberty was normal in 26 (72%), early in 6 (17%), and delayed in 5 (14%). Growth outcomes were satisfactory of 28 (48%) patients who attained their adult height, median final height was −1.1 standard deviation score (SDS) in males and −0.4 SDS in females and median height in the 27 patients still growing was −0.4 SDS.</div></div><div><h3>Conclusion</h3><div>The wide range of rare causes of PAI raises diagnostic challenges. In most cases, however, the cause can be determined, allowing optimal therapy. Phenotypic characteristics—including age at PAI onset, growth patterns, pubertal development, and body mass index—vary according to the underlying genotype (i.e., myelodysplasia, infections, restriction of growth, adrenal hypoplasia, genital phenotypes and enteropathy syndrome Triple A syndrome, and NNT deficiency). Targeted monitoring of these features is therefore essential.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1464-1474"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prepregnancy Dopamine Agonist Treatment Duration as a Predictor of Postpartum Prolactinoma Remission","authors":"Seung Shin Park MD, MS,&nbsp;Min-Jung Park BS,&nbsp;Yong Hwy Kim MD, PhD,&nbsp;Jung Hee Kim MD, PhD","doi":"10.1016/j.eprac.2026.04.010","DOIUrl":"10.1016/j.eprac.2026.04.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Prolactinoma is a major cause of infertility in women of reproductive age. Although pregnancy has been proposed to induce prolactinoma remission, evidence remains inconsistent because of the lack of well-matched control groups. This study evaluated the impact of pregnancy on prolactinoma outcomes and identified predictors of sustained postpartum remission.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 225 women with prolactinoma treated between 2003 and 2024. Seventy-five patients who became pregnant during dopamine agonist (DA) therapy were matched 1:2 with 150 nonpregnant controls using propensity score matching based on age, baseline prolactin levels, and tumor size. Logistic regression and Kaplan–Meier analyses were performed to assess remission outcomes and identify independent predictors.</div></div><div><h3>Results</h3><div>Baseline characteristics were well balanced between groups. At the last follow-up (median 110.0 months for the pregnancy group), the final remission rates were comparable between groups (20.0% vs 14.7%, <em>P</em> = .342). Pregnancy was not associated with prolactinoma remission in the overall cohort (<em>P</em> = .576). Among women who became pregnant, a prepregnancy DA treatment duration &gt;48 months was the only significant independent predictor of remission (odds ratio 4.48, 95% confidence interval 1.31-15.36; <em>P</em> = .017). Kaplan–Meier analysis demonstrated significantly higher recurrence-free probability in patients treated for &gt;48 months before conception (<em>P</em> = .020), whereas the 36-month threshold was not significant (<em>P</em> = .103).</div></div><div><h3>Conclusion</h3><div>Pregnancy itself did not influence the long-term prolactinoma remission. Instead, sustained postpartum remission was associated with at least 48 months of DA therapy before conception, highlighting the importance of adequate treatment duration prior to pregnancy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1456-1463"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728754","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":"North American Society for Interventional Thyroidology Statement on Directed Ablative Therapy for the Management of Benign Non-functional Thyroid Nodules","authors":"Vaninder Kaur Dhillon MD,&nbsp;John Woody Sistrunk MD,&nbsp;David T. Hughes MD,&nbsp;Toni Beninato MD,&nbsp;Sumedha Chablani MD,&nbsp;Ralph P. Tufano MD, MBA,&nbsp;Chelsey K. Baldwin MD","doi":"10.1016/j.eprac.2026.05.002","DOIUrl":"10.1016/j.eprac.2026.05.002","url":null,"abstract":"<div><div>Directed ablative therapy (DAT) for benign non-functional thyroid nodules (BNFTNs) is a first line management strategy for providing effective relief of compressive and cosmetic symptoms as an alternative to surgical excision or observation. The success of ablation procedures relies on careful patient selection and the technical expertise of the treating physician. These procedures have demonstrated significant nodule volume reduction and improvements in quality of life, with safety profiles and costs comparable to thyroid surgery while reducing the risk of postprocedural thyroid hormone deficiency. This statement supports the application of DAT for benign symptomatic thyroid nodules, as well as for appropriately selected nodules that are growing with impending symptoms, or indeterminate cytology with negative molecular markers. Robust data support DAT as an effective, cost-neutral, and safe alternative to surgery, expanding options for individualized care of symptomatic BNFTN.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1522-1530"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composite Pheochromocytomas: More Common Than Expected and Associated With Distinct Clinical Profile","authors":"Karolina Zawadzka MD,&nbsp;Ewelina Rzepka MD,&nbsp;Jan Calissendorff MD, PhD (Associate Professor),&nbsp;Magdalena Ulatowska-Białas MD, PhD,&nbsp;C. Christofer Juhlin MD, PhD (Professor),&nbsp;Alicja Hubalewska-Dydejczyk MD, PhD (Professor),&nbsp;Henrik Falhammar MD, PhD (Associate Professor)","doi":"10.1016/j.eprac.2026.05.008","DOIUrl":"10.1016/j.eprac.2026.05.008","url":null,"abstract":"<div><h3>Objective</h3><div>Composite pheochromocytomas, defined by the coexistence of pheochromocytoma and neural crest–derived elements and their clinical course remain poorly defined. The aim of this study was to assess the clinical characteristics and outcomes of composite pheochromocytomas compared with typical pheochromocytomas.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 190 patients with pheochromocytoma. Clinical outcomes were compared between composite and typical pheochromocytomas.</div></div><div><h3>Results</h3><div>The study included 190 patients: 28 (14.9%) had composite tumors and 160 had typical pheochromocytoma; 2 additional patients with mixed corticomedullary tumors (MCMTs) were analyzed separately. Patients with composite tumors were older (median 67 vs 56 years, <em>P</em> = .015) compared with patients with typical pheochromocytoma. In multivariable analysis, the composite phenotype was associated with preoperative systolic hypertension (odds ratio (OR)-2.47, 95% confidence interval [CI] 1.00-6.06, <em>P</em> = .049) and postoperative elevation of blood pressure, both systolic (OR-3.24, 95%CI 1.30-8.11, <em>P</em> = .012) and diastolic (OR-4.66, 95%CI 1.79-12.11, <em>P</em> = .002). On unenhanced computed tomography, attenuation of composite pheochromocytomas was lower (median 30 vs 35 Hounsfield units, <em>P</em> = .01), and these were less often detected as adrenal incidentalomas. Laparoscopic adrenalectomy was performed less frequently in composite pheochromocytomas (67.9% vs 87.5%, <em>P</em> = .02). Composite pheochromocytomas had a higher risk of Ki-67 expression in the 3% to 5% range (OR-28.68, 95%CI 1.49-552.79, <em>P</em> = .026). Tumor size, recurrence and metastasis rates, and mortality were comparable to typical pheochromocytoma.</div></div><div><h3>Conclusions</h3><div>Composite pheochromocytomas were associated with older age, lower computed tomography attenuation, distinct perioperative features, and a higher burden of hypertension. These findings suggest that this subgroup may require closer postoperative monitoring. Although Ki-67 was higher in composite pheochromocytomas, its prognostic significance remains uncertain.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1447-1455"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927656","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":"North American Society for Interventional Thyroidology Statement on Directed Ablative Therapy for the Management of Low Risk Papillary Thyroid Carcinoma","authors":"Chelsey K. Baldwin MD,&nbsp;Kaitlyn M. Frazier MD,&nbsp;Jennifer H. Kuo MD,&nbsp;Julia E. Noel MD,&nbsp;Jonathon O. Russell MD,&nbsp;Victoria E. Banuchi MD","doi":"10.1016/j.eprac.2026.05.037","DOIUrl":"10.1016/j.eprac.2026.05.037","url":null,"abstract":"<div><div>Thermal ablation (TA) has emerged as a minimally invasive and therapeutic management strategy for low-risk thyroid cancers (LRTCs). Procedural success and safety are highly contingent upon meticulous patient selection and the expertise of the treating physician. The recommended technique for TA of LRTC includes the use of small active ablation zones and low power settings employed via the transisthmic approach. Robust data have demonstrated that TA is cost effective and provides excellent oncological outcomes with a low incidence of complications, such as nerve injury and hypothyroidism. The procedure's efficacy is comparable to that of surgical resection in select patient populations, with recurrence rates remaining low over extended follow-up periods. Long-term success and widespread adoption of TA for LRTC is dependent on skilled follow-up care to monitor and report rates of disease eradication, complications, and recurrence. As advancements in technology and technique continue to evolve, TA is poised to play an increasingly prominent role in the comprehensive management of LRTC, offering patients a balance of efficacy and quality of life.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"32 10","pages":"Pages 1531-1538"},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease Burden, Surveillance, and Treatment Gaps in Chronic Hypoparathyroidism: Insights From a Multicenter Registry.","authors":"Rodis D Paparodis, Ioannis Androulakis, Nikolaos G Angelopoulos, Andreas Rizoulis, Anastasios Boniakos, Panagiotis Mylonas, Petros Varnavas, Dimos Florakis, Stylianos Fountoulakis, Dimitrios P Askitis, Maria Tsaroucha, Athanasios Tsekouras, Christianna Stylianidou, Emmanouil Choustoulakis, Christos Andronis, Valentina Petkova, Eleni Xanthakou, Liana Tzifa, Dimitra Zianni, Ermioni Tseniklidi, George Simeakis, Areti Korakovouni, Sofia Tsirona, Ploutarchos Tzoulis, Christina Pamporaki, Gioxaris Vasileios, Ilias Perogamvros, Dimitrios Papadogias, Panagiotis Spyropoulos, Elena Laspa, Maria Karaflou, Danae A Delivanis, Sarantis Livadas, Nikolaos Valvis, Angeliki Laina, Antonios Xydakis, Konstantinos Manolopoulos, Paraskevi Mentzelopoulos, Dimitrios T Papadimitriou, Panagiota Patrianakou, Juan Carlos Jaume, Evanthia Kassi","doi":"10.1016/j.eprac.2026.08.026","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.08.026","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate disease and treatment burden, renal surveillance gaps, multidimensional biochemical control, hypercalciuria management, and parathyroid hormone (PTH) replacement therapy use in adults with chronic hypoparathyroidism.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cross-sectional registry study across 41 endocrinology clinics. Adults with chronic hypoparathyroidism (>12 months) were identified using ICD-10 codes, medication records, and manual chart verification. Multidimensional control required simultaneous achievement of albumin-corrected serum calcium, serum phosphate, and 24-hour urinary calcium targets. Secondary multivariable logistic regression analyses evaluated factors associated with suboptimal control, at least one applicable guideline-based care gap, and renal impairment.</p><p><strong>Results: </strong>Among 522 patients (83.1% women; median disease duration, 8 years), 496/522 (95.0%) had postsurgical disease. High-dose elemental calcium and alfacalcidol were required in 45/522 (8.6%) and 8/522 (1.5%), respectively. Among patients with at least 5 years of disease, 119/400 (29.8%) had never undergone 24-hour urinary calcium assessment and 101/400 (25.3%) had not undergone renal imaging. Multidimensional biochemical control was achieved in 126/230 patients (54.8%). Hypercalciuria was present in 72/282 patients (25.5%) at the latest assessment; 50/72 (69.4%) were not receiving calcium-sparing diuretic therapy. Among 239 patients eligible for PTH replacement therapy, 196/239 (82.0%) had not initiated treatment. Lower current age was associated with suboptimal control, longer disease duration and postsurgical etiology with at least one care gap, and older age with renal impairment.</p><p><strong>Conclusion: </strong>Assessment based solely on serum calcium may underestimate incomplete disease control. Multidimensional biochemical abnormalities, surveillance deficiencies, and therapeutic care gaps remain common despite specialist endocrine follow-up.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106061","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":"Preoperative Zoledronic Acid for the Prevention of Hungry Bone Syndrome After Parathyroidectomy in Primary Hyperparathyroidism: A Randomized Placebo-Controlled Trial.","authors":"Akanksha Gautam, Vivek Jha, Prabhat Rijal, Rahul Gupta, Divya Dahiya, Tulika Singh, Uma Nahar Saikia, Ashwani Sood, Sanjay Kumar Bhadada","doi":"10.1016/j.eprac.2026.07.020","DOIUrl":"https://doi.org/10.1016/j.eprac.2026.07.020","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether preoperative zoledronic acid (ZA) reduces the incidence of hungry bone syndrome (HBS) after curative parathyroidectomy in patients with primary hyperparathyroidism (PHPT).</p><p><strong>Methods: </strong>In this single-blind, randomized, placebo-controlled trial, adults with PHPT and albumin-corrected serum calcium ≥11 mg/dL were randomized in a 1:1 ratio to receive either ZA 5 mg or placebo within 2 weeks before surgery. Following parathyroidectomy, participants underwent daily inpatient biochemical monitoring until discharge and were subsequently assessed during three prespecified outpatient windows over 12 months. HBS was identified using postoperative calcium, phosphorus, alkaline phosphatase, clinical findings, and postoperative parathyroid hormone where available.</p><p><strong>Results: </strong>HBS occurred in 6 of 22 patients in the ZA group and 6 of 23 patients in the placebo group. Preoperative ZA did not reduce the odds of HBS compared with placebo, OR 1.06, 95% CI 0.28-3.98; P=0.928. BMD increased after parathyroidectomy in both groups; however, ZA did not provide a statistically significant additional benefit in lumbar spine or femoral neck BMD gain. CTX suppression was more consistently pronounced in the ZA group, reflecting greater inhibition of bone resorption. Adverse events were more frequent in the ZA group, largely driven by a higher frequency of paresthesias.</p><p><strong>Conclusion: </strong>In patients with PHPT undergoing curative parathyroidectomy, a single preoperative infusion of ZA did not prevent HBS. These findings do not support routine use of ZA solely for prevention of HBS, although it may still be considered selectively for preoperative control of hypercalcemia or as a bridge to surgery.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106067","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":"Comparative Weight-Loss Outcomes Following Initiation of GLP-1 Receptor Agonists versus SGLT2 Inhibitors: A Real-World Active Comparator Study.","authors":"Valentin Milanov","doi":"10.1016/j.eprac.2026.09.013","DOIUrl":"10.1016/j.eprac.2026.09.013","url":null,"abstract":"<p><strong>Objective: </strong>To compare 12-month weight loss between GLP-1 receptor agonist (GLP-1RA) and SGLT2 inhibitor (SGLT2i) initiators and assess effect modification by diabetes status, sex, and race/ethnicity in a diverse US cohort.</p><p><strong>Methods: </strong>Retrospective active comparator new-user cohort study using the NIH All of Us Research Program (2018-2023). We identified 2,932 SGLT2i-naïve GLP-1RA initiators and 941 GLP-1RA-naïve SGLT2i initiators aged 18-80 with BMI ≥27 kg/m² and available weight measurements. Inverse probability of treatment weighting (IPTW) with a 17-covariate propensity score model - including heart failure and CKD - achieved balance on all 28 diagnostics (maximum SMD 0.077). The primary outcome was percent body weight change at 12 months; secondary outcomes included ≥10% weight loss, HbA1c, and blood pressure change.</p><p><strong>Results: </strong>After IPTW, GLP-1RA initiators lost more weight than SGLT2i initiators (difference -1.20 pp [95% CI, -1.91 to -0.48]; P = .001; OR 1.75 [95% CI, 1.40-2.19]; RR 1.61 [95% CI, 1.19-2.03]; NNT 14), concentrated in obesity-only patients (-1.96 pp; P <.001) but absent in type 2 diabetes (+0.08 pp; interaction P = .006). Sex modified the effect (P = .017): -1.71 pp in women vs +0.12 pp in men. HbA1c decreased more with GLP-1RA (-0.261%; P = .032); blood pressure did not differ significantly.</p><p><strong>Conclusion: </strong>GLP-1RA initiators achieved greater weight loss than SGLT2i initiators, concentrated in women and patients without type 2 diabetes, supporting individualized treatment selection. Interaction findings are hypothesis-generating and require prospective confirmation.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080158","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}