Endocrine Practice最新文献

{"title":"Expanding Access to Continuous Glucose Monitoring in Medicare Patients Receiving Specialty Diabetes Care: A Quality Improvement Project","authors":"Kristen L. Flint MD,&nbsp;Tiffany Ting NP,&nbsp;Kyianna Rivera MA,&nbsp;Prakriti Tamang AS,&nbsp;Caitlin A. Colling MD,&nbsp;Josephine H. Li MD,&nbsp;Melissa S. Putman MD, MMSc","doi":"10.1016/j.eprac.2025.04.001","DOIUrl":"10.1016/j.eprac.2025.04.001","url":null,"abstract":"<div><h3>Objective</h3><div>Despite recent revisions of Medicare coverage guidelines for continuous glucose monitoring (CGM) in 2023, the policy change has been slow to disseminate to providers and patients. This quality improvement project aimed to increase CGM prescriptions and utilization amongst qualifying Medicare patients with diabetes on insulin.</div></div><div><h3>Methods</h3><div>An interprofessional study team used process mapping to define the baseline state of CGM ordering and opportunities for improvement at a single diabetes specialty clinic. Several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles, including general and targeted provider education, provider-facing technology support documents, a formulary guide, and patient-facing education about the new coverage requirements. The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started monthly. Demographic and socioeconomic factors in patients using and not using CGM were measured to assess for differences in prescribing practices.</div></div><div><h3>Results</h3><div>Over 8 months of intervention, the percentage of eligible Medicare patients using CGM increased from 49.6% to 62.6%. The median number of CGM orders started monthly increased from 34 to 60. Both pre- and postintervention, compared to patients not using CGM, patients using CGM were younger, had lower A1c, and were more often enrolled in the electronic health record patient portal. There were no differences in other demographic factors between the groups.</div></div><div><h3>Conclusion</h3><div>Quality improvement interventions targeting providers and patients can help translate policy changes into clinical practice. Creating interventions with all patients in mind can prevent new differences in care as innovations are adopted.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 8","pages":"Pages 1018-1024"},"PeriodicalIF":3.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474286","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":"The Effect of Growth Hormone-Secreting Pituitary Adenoma Disease Activity on Thyroid Nodules.","authors":"Caiyan Mo, Tao Tong, Yao Wang, Hongyu Liu, Dan Liang, Ying Guo, Jian Xu, Liyong Zhong","doi":"10.1016/j.eprac.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.eprac.2025.06.013","url":null,"abstract":"<p><strong>Objective: </strong>Previous studies on thyroid nodules in patients with growth hormone-secreting pituitary adenoma (GHPA) had small sample sizes and inconsistent findings. This study aims to summarize the clinical characteristics of thyroid nodules in patients with GHPA, investigate the relationship between thyroid nodule volume and disease activity, and analyze risk factors associated with thyroid nodule development.</p><p><strong>Methods: </strong>There were 150 patients with GHPA included from a retrospective review of medical records from January 2009 to December 2024. At baseline, correlations were investigated between growth hormone (GH), insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH) with maximum thyroid nodule diameter (TND) and total thyroid nodule volume (TTNV). A binary logistic regression analysis was used to explore the risk factors for the development of thyroid nodules in patients with GHPA. Data from 54 patients were available for longitudinal follow-up measures of thyroid nodule characteristics between baseline and last follow-up.</p><p><strong>Results: </strong>The prevalence of thyroid nodules in patients with GHPA was 74%. Baseline TND and TTNV were positively correlated with age and IGF-1 levels and negatively correlated with TSH levels. Patients with thyroid nodules exhibited higher GH levels. During prospective follow-up, TND significantly decreased following a marked reduction in GH/IGF-1 levels. Logistic regression analysis identified baseline GH level as an independent risk factor for thyroid nodule occurrence.</p><p><strong>Conclusion: </strong>Chronic elevation of GH/IGF-1 levels in patients with GHPA is associated with the development and progression of thyroid nodules. Following treatment of GHPA, a reduction in GH/IGF-1 levels correlates with a decrease in thyroid nodule volume. Close monitoring of nodule growth and regular thyroid ultrasonography are recommended, particularly for nodules with malignant features.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495232","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-Guided Insulin Infusion in Critically Ill Patients Promotes Safety, Improves Time Efficiency, and Enhances Provider Satisfaction.","authors":"Erin R Giovannetti, Rachael O Lee, Robert L Thomas, Tamar Wolinsky, Adrianne V Talbot, Rabia S Ali, Tricia Santos Cavaiola, Kristen Kulasa, Schafer C Boeder","doi":"10.1016/j.eprac.2025.05.751","DOIUrl":"10.1016/j.eprac.2025.05.751","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the integration of real-time CGM (rtCGM) into an insulin infusion computer calculator (IICC) to improve glycemic control, time efficiency, safety, and clinician workflow in the intensive care unit (ICU).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 35 critically ill adult patients requiring insulin infusion in the surgical and medical ICUs. Dexcom G7 rtCGM values were integrated into an institution-developed IICC using an ongoing validation protocol, allowing for nonadjunctive CGM use. The accuracy of rtCGM was assessed by comparing matched CGM and point-of-care (POC) glucose values using mean absolute relative difference (MARD), surveillance error grid, and Parkes Error Grid analyses. CGM time-in-range metrics, clinician turnaround time for glucose monitoring, and nurse satisfaction were also evaluated.</p><p><strong>Results: </strong>A total of 1291 matched glucose pairs were analyzed. The rtCGM system demonstrated a MARD of 12.5%, with 99.6% of the values falling within clinically acceptable error zones (A+B) on the Parkes Error Grid. Patients in the rtCGM-IICC protocol had mean glucose 141.9 mg/dL, with mean time in range (70-180 mg/dL) 82.8%, time above range (> 180 mg/dL) 14.5%, and time below range (< 70 mg/dL) 0.5%. Clinician time efficiency improved significantly, with POC testing requiring a mean turnaround time of nearly 5 minutes compared to 3-second CGM retrieval. All surveyed nurses (n = 20) reported rtCGM increased efficiency and improved safety and preferred rtCGM with POC over POC testing alone.</p><p><strong>Conclusion: </strong>Integrating rtCGM with an IICC protocol in the ICU enhances glycemic control, improves workflow efficiency, and reduces clinician workload while maintaining high accuracy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495230","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":"Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?","authors":"Molly L. Tanenbaum PhD ,&nbsp;Mabelle B. Pasmooij BS ,&nbsp;Rachel Tam BS ,&nbsp;Marina Basina MD ,&nbsp;Michael S. Hughes MD ,&nbsp;Franziska K. Bishop MS, CPHS, CDCES ,&nbsp;David M. Maahs MD, PhD","doi":"10.1016/j.eprac.2025.03.006","DOIUrl":"10.1016/j.eprac.2025.03.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.</div></div><div><h3>Methods</h3><div>Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.</div></div><div><h3>Results</h3><div>Participants were 33 adults (age 42.7 ± 16.7 years, 55% female, 91% non-Hispanic White, 23 ± 16 years living with diabetes, HbA1c 6.5 ± 0.6% (48 ± 6 mmol/mol)). Most (88%) used automated insulin delivery. Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.</div></div><div><h3>Conclusions</h3><div>Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using automated insulin delivery and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 8","pages":"Pages 1011-1017"},"PeriodicalIF":3.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495231","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":"Trajectories of Antidiabetic Medication Adherence in Older Adults and the Effect of Depression and Anxiety Symptoms.","authors":"Giraud Ekanmian, Carlotta Lunghi, Helen-Maria Vasiliadis, Line Guénette","doi":"10.1016/j.eprac.2025.06.012","DOIUrl":"10.1016/j.eprac.2025.06.012","url":null,"abstract":"<p><strong>Objectives: </strong>Common mental health disorders, such as anxiety and depression, significantly impact medication adherence in various chronic conditions. However, few studies have captured the evolving nature of adherence behavior, indicating a need for further investigation. The objectives were to describe adherence trajectories to antidiabetic medications among older patients and to explore the potential association between these trajectories and the presence of anxiety and depression.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Enquête sur la santé des aînés et l'utilisation des services de santé study, involving 282 elderly participants who were prevalent users of antidiabetic medications. Medication adherence was measured using claims data over 12 months. Group-based trajectory modeling was employed to identify distinct adherence trajectories. The association between the presence of common mental health disorders, assessed using self-reported symptoms and diagnostic codes from medico-administrative data, and adherence trajectories was estimated through multinomial logistic regressions.</p><p><strong>Results: </strong>Four distinct adherence trajectories were identified and defined as low adherence (6.7%), fair adherence (18.1%), high adherence (37.9%), and nearly perfect adherence (37.2%). These patterns were also stable during the 12-month follow-up period. No significant association was found between common mental health disorders and medication adherence trajectories in this cohort, even after adjusting for potential confounders.</p><p><strong>Conclusion: </strong>Older patients with diabetes mostly depicted high adherence. Depression or anxiety did not impact adherence trajectories. However, our study was underpowered to detect small-to-moderate effects of these common mental health disorders.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474302","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 and Phenotypes of Idiopathic Diabetes: A Systematic Review.","authors":"Rana El Nahas, Ghalia Missous, Mohannad Al-Tarakji, Mohamed Said-Ghali, Khalid Hussain, Nicholas van Panhuys, Laura Herrero, Meritxell Espino-Guarch","doi":"10.1016/j.eprac.2025.06.009","DOIUrl":"10.1016/j.eprac.2025.06.009","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes classification includes various forms, primarily type 1 and type 2, along with atypical types like type-1b diabetes (T1bD), which lack classic autoimmune markers or high-risk human leukocyte antigen (HLA) alleles, presenting diagnostic challenges and suggesting alternative pathogenic mechanisms. This review explores the potential genetic basis of these cases and the need for comprehensive testing.</p><p><strong>Methods: </strong>Seventeen studies, including case reports, cross-sectional, and cohort studies, were analyzed from PubMed, Web of Science, and Scopus databases up to March 14, 2024, covering 290 T1bD cases.</p><p><strong>Results: </strong>The cases were reclassified using the American Diabetes Association's criteria (autoantibody-negative, onset <35 years old, nonobese, and not HLA-associated). Genetic testing results were reviewed, focusing on identified mutations. Reclassification identified 201 T1bD cases, of which 30% of autoantibody-negative T1bD cases had pathogenic variants linked to monogenic diabetes, such as maturity-onset diabetes of the young, and mutations in INS, KCNJ11, and KLF1 genes linked to neonatal diabetes. Only 60 T1bD cases underwent exome sequencing, and none had whole genome sequencing, indicating limited genetic exploration.</p><p><strong>Conclusion: </strong>A significant proportion of T1bD cases may have an undetermined genetic basis, emphasizing the need for more comprehensive diagnostic assessments. Increased use of advanced genetic screening, such as whole genome sequencing, and data sharing are vital for improving diagnosis and management, potentially enabling personalized treatment for idiopathic diabetes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483667","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 Effectiveness of Glucagon-like Peptide-1- Receptor Agonists in Patients With Heart Failure With Preserved or Minimally Reduced Ejection Fraction: A Comprehensive Bayesian Network Meta-Analysis and Network Meta-Regression.","authors":"Ibrahim Khalil, M Rafiqul Islam, A B M Kamrul-Hasan, Lakshmi Nagendra, Sunjida Amin Promi, Md Abu Sayed, Mohd Turzo Rahman, Nowrin Sultana, Noshin Anjum Tasmi, Manisha Das, Salsabil Tarannum, Rajendronath Dey, Deep Dutta","doi":"10.1016/j.eprac.2025.06.005","DOIUrl":"10.1016/j.eprac.2025.06.005","url":null,"abstract":"<p><strong>Objectives: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown beneficial effects on clinical outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or minimally reduced ejection fraction (HFmrEF). This network meta-analysis (NMA) aimed to consolidate evidence from RCTs assessing the effects of GLP-1 RAs in HFpEF and HF with reduced ejection fraction.</p><p><strong>Methods: </strong>Several databases were searched comprehensively for relevant RCTs. A Bayesian NMA was conducted using R, and meta-regression was employed to investigate potential sources of heterogeneity. Statistical significance was evaluated using 95% credible intervals (CrIs) and surface under the cumulative ranking curve to rank treatment effectiveness. The primary outcome was hospitalization for HF (HHF).</p><p><strong>Results: </strong>Eight reports from 6 Phase 3 RCTs (N = 24 099), mostly with low risks of bias, were included. Compared to placebo, semaglutide reduced the risk of HHF (HR 0.52, 95% CrI [0.25, 0.87]), while tirzepatide (HR 0.51, 95% CrI [0.16, 1.24]) and exenatide (HR 0.82, 95% CrI [0.33, 1.73]) demonstrated no effect. Semaglutide and exenatide, but not tirzepatide, reduced the risk of all-cause mortality. None affected cardiovascular mortality. Semaglutide decreased the risk of worsening of HF events; tirzepatide did not. Tirzepatide and semaglutide enabled weight loss; however, only semaglutide notably enhanced the 6-minute walk distance. According to the surface under the cumulative ranking curve values, tirzepatide ranked highest for reducing HHF and body weight, semaglutide for decreasing cardiovascular mortality and worsening of HF events and improving the 6-minute walk distance, and exenatide for reducing all-cause mortality.</p><p><strong>Conclusion: </strong>GLP-1 RAs provide significant benefits for patients with HFpEF or HFmrEF, with semaglutide offering more advantages than tirzepatide and exenatide.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483666","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":"Thyroid Emergencies: A Narrative Review.","authors":"Margaret L Kruithoff, Benjamin J Gigliotti","doi":"10.1016/j.eprac.2025.06.010","DOIUrl":"10.1016/j.eprac.2025.06.010","url":null,"abstract":"<p><strong>Introduction: </strong>Myxedema coma and thyroid storm are rare thyroid emergencies associated with considerable mortality and morbidity.</p><p><strong>Results: </strong>Myxedema coma is a state of decompensated hypothyroidism with widespread multi-organ dysfunction, including impaired consciousness, mixed respiratory failure, and hypothermia. Thyroid storm is the extreme state of thyrotoxicosis occurring when a patient's metabolic, thermoregulatory, and cardiovascular compensatory mechanisms are surpassed; clinical features include hyperthermia, neuropsychiatric symptoms, and tachyarrhythmias. Thyroid emergencies usually result from a precipitating event or trigger transforming a previously compensated hypothyroid or thyrotoxic state. Supportive care for the cardiovascular, respiratory, and thermoregulatory manifestations, as well as possible intercurrent illness or adrenal insufficiency, plays a lead role in the management. For myxedema coma, treatment typically includes high-dose levothyroxine with the addition of liothyronine for critically ill patients. Management of thyroid storm is multipronged and stepwise, consisting of first-line thionamide and beta-adrenergic receptor antagonist therapy, followed by inorganic iodine, cholestyramine, plasmapheresis, or emergent thyroidectomy in appropriate severely ill patients.</p><p><strong>Conclusions: </strong>This review provides an updated narrative overview of the diagnosis and management of myxedema coma and thyroid storm.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483668","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":"Thyroid Eye Disease: Management, Advances, and Future Opportunities.","authors":"Tamaryn Fox, Andrea Lora Kossler, Chrysoula Dosiou","doi":"10.1016/j.eprac.2025.06.011","DOIUrl":"10.1016/j.eprac.2025.06.011","url":null,"abstract":"<p><p>Thyroid eye disease (TED), the most common extrathyroidal manifestation of Graves disease, is a debilitating autoimmune condition that significantly impacts quality of life and can threaten vision. This review highlights advances in the understanding of TED, particularly in pathophysiology, emerging treatments, novel surgical techniques, and the use of imaging and artificial intelligence (AI). Teprotumumab, the first Food and Drug Administration-approved drug for TED, has shown effectiveness in reducing proptosis, improving diplopia, and enhancing quality of life. Other therapies in development include alternative insulin-like growth factor-1 receptor antagonists, FcRn inhibitors, interleukin pathway antagonists, and thyroid-stimulating hormone receptor inhibitors, all of which offer promising potential. Surgical approaches, such as orbital decompression and eyelid correction, have also evolved, with minimally invasive techniques gaining favor. Diagnostic advancements in biomarkers could further enhance early detection and disease monitoring. AI tools for assessing disease severity and predicting treatment outcomes are also emerging. Despite significant progress in molecular understanding and treatment options, TED remains complex and continued research is essential to improve diagnostic precision and therapeutic outcomes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483669","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":"Risk of Pituitary Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.","authors":"Zhe Li, Ziang Liu, Hongxia Wei, Shuqing Jin, Yuchen Sun, Yi Zhang, Yunfeng Liu","doi":"10.1016/j.eprac.2025.06.008","DOIUrl":"10.1016/j.eprac.2025.06.008","url":null,"abstract":"<p><strong>Objectives: </strong>Immune checkpoint inhibitor (ICI)-induced hypophysitis is one of the common endocrine immune-related adverse events (irAEs). Our goal is to evaluate the risk of pituitary irAEs caused by ICIs.</p><p><strong>Methods: </strong>The relevant literatures were retrieved from PubMed, Embase, and Cochrane Library from inception to October 31, 2024. References were screened according to inclusion and exclusion criteria, and study data were extracted. Meta-analysis was performed using Revman 5.3 and Stata 18.0 software.</p><p><strong>Results: </strong>A total of 21 prospective single-arm trials and 17 randomized controlled trials (RCTs) were included. In single-arm trials, the incidence of hypophysitis (4.00%) and hypopituitarism (3.84%) caused by cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors was the highest in monotherapy, and the incidence of hypophysitis caused by programmed cell death 1 (PD-1) inhibitors plus CTLA-4 inhibitors was the highest in ICI combination therapy (9.36%). In RCTs, the risk of pituitary irAEs caused by ICIs was higher than that of the control group (relative risk = 10.09, 95% CI: 6.90-14.75). Compared with monotherapy, ICI combination therapy has a higher risk of pituitary irAEs (relative risk = 5.42, 95% CI: 3.36-8.73). In monotherapy, CTLA-4 inhibitors caused the highest incidence of hypophysitis and hypopituitarism, reaching 16.17% and 1.75%, respectively. Furthermore, the severity of adverse pituitary irAEs caused by CTLA-4 inhibitors was also the highest (5.12% in single-arm trials, 16.35% in RCTs).</p><p><strong>Conclusions: </strong>The results showed that ICIs are associated with a significantly higher risk of pituitary irAEs, and ICI combination may further increase the risk. In monotherapy, CTLA-4 inhibitors caused the highest incidence and severity of pituitary irAEs, while PD-L1 inhibitors caused the lowest. In combination therapy, PD-1 inhibitors combined with CTLA-4 inhibitors resulted in a higher incidence of hypophysitis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324817","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}