Endocrine Practice最新文献

{"title":"Consensus Thyroid Nodule Radiofrequency Ablation Reporting Guidelines Established Using a Delphi Approach.","authors":"Kendyl Carlisle, Rebecca Kowalski, Qing Lina Hu-Bianco, Sophie Y Dream, Jonathon O Russell, Steven P Hodak, Jennifer H Kuo, Yinin Hu","doi":"10.1016/j.eprac.2025.06.006","DOIUrl":"10.1016/j.eprac.2025.06.006","url":null,"abstract":"<p><strong>Objectives: </strong>Radiofrequency ablation (RFA) has become increasingly utilized for thyroid nodules. However, best practice recommendations on data collection and outcomes reporting are lacking. The objective of this study was to generate consensus guidelines for thyroid RFA data collection for purposes of quality assurance and collaborative research.</p><p><strong>Methods: </strong>We recruited a multidisciplinary panel of experienced RFA practitioners through the North American Society for Interventional Thyroidology. Using a modified Delphi process, experts created and iteratively revised a data collection form encompassing items from the pre-, intra-, and postprocedural phases. Emphasis was placed on parameters that are readily available to both community and academic-based practitioners. Items with > 70% (strongly-agree) or 100% (agree) consensus for inclusion were retained. The Delphi process and the final reporting instrument were built on REDCap.</p><p><strong>Results: </strong>Ten panelists from 9 institutions performing a median of 22.5 cases/year completed 5 Delphi rounds. All panelists voted strongly-agree for retention on 63% (n = 37) of included items. The final instrument was divided into 3 forms: 1. Preprocedure (n = 18 items), 2. Immediate postprocedure (n = 9 items), and 3. Follow-up (n = 10 items).</p><p><strong>Conclusions: </strong>Adoption of these 3 new thyroid RFA data collection forms by new and established interventionalists may facilitate collaboration, standardized outcomes reporting, and clinical trial design.</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":"144324816","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 Future of Automated Insulin Delivery Systems.","authors":"Michael S Hughes, Carol J Levy","doi":"10.1016/j.eprac.2025.05.752","DOIUrl":"10.1016/j.eprac.2025.05.752","url":null,"abstract":"<p><p>Automated insulin delivery (AID) systems have revolutionized diabetes care by integrating continuous glucose monitoring, insulin pumps, and advanced algorithms to improve glycemic outcomes and reduce user burden. Early commercial AID systems were developed with a conservative approach, prioritizing safety and regulatory approval over full automation or extensive customization. While these systems significantly improved diabetes management, they still face limitations, including incomplete automation, accessibility barriers, and the need for better adaptation to diverse user needs and lifestyles. These challenges are now catalyzing development of next-generation AID technologies with a focus on achieving full automation, greater personalization, and broader accessibility. This review examines key limitations of current AID systems and explores future directions, including fully closed-loop control, novel insulin formulations, multi-hormonal systems, advanced sensor technologies, and integration of wearable and artificial intelligence tools. By addressing these challenges, future AID systems have the potential to deliver better effectiveness and equity in diabetes care for all individuals requiring insulin therapy.</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":"144324818","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":"Dental Implant Failure and Medication-Related Osteonecrosis of the Jaw Related to Dental Implants in Patients Taking Antiresorptive Therapy for Osteoporosis: A Systematic Review and Meta-Analysis.","authors":"Reza Mirza, Mohamed El Rabbany, Dalal S Ali, Sotirios Tetradis, Archibald Morrison, Salvatore Ruggiero, Rasha Alnajimi, Aliya A Khan, Gordon Guyatt","doi":"10.1016/j.eprac.2025.06.003","DOIUrl":"10.1016/j.eprac.2025.06.003","url":null,"abstract":"<p><strong>Objectives: </strong>To inform the 2024 International Task Force on Osteonecrosis of the Jaw update, we conducted a systematic review and meta-analysis evaluating dental implant failure and medication-related osteonecrosis of the jaw (MRONJ) related to antiresorptive therapy for osteoporosis.</p><p><strong>Methods: </strong>We searched 5 databases (1946-2024) for interventional and noninterventional studies reporting rates of dental implant failure or osteonecrosis in those with osteoporosis or osteopenia. Two reviewers independently screened all titles, abstracts, and full texts. Risk of bias was assessed using the modified Ottawa-Newcastle scale, and the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>We found 793 unique citations. Nine studies (n = 655) were included in the implant failure analysis. Random-effects meta-analysis revealed wide confidence intervals (CIs) for implant failure among those exposed to antiresorptives (relative risk, 0.82; 95% CI, 0.52-1.28; P = .38, very low certainty). Sensitivity analysis at the level of implant suggested that antiresorptives reduce implant failure (relative risk, 0.53; 95% CI, 0.34-0.81; P = .003, very low certainty). We identified 186 cases of MRONJ in implant recipients. The pooled rate of MRONJ following implantation in those exposed to antiresorptive therapy was 0.5% pooled from 21 cohorts. A single report of risk-adjusted MRONJ found that bisphosphonates increased MRONJ by 3 cases per 1000 patients (adjusted hazard ratio, 4.09; 95% CI, 2.75-6.09; P < .001, moderate certainty).</p><p><strong>Conclusions: </strong>The low-certainty evidence suggests that antiresorptive therapy for osteoporosis reduces dental implant failure. Bisphosphonates are associated with MRONJ in patients with osteoporosis receiving dental implants with moderate certainty.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283020","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 Evolution of Our Understanding of the Nuances of Pathologic Cortisol Secretion.","authors":"Lewis S Blevins","doi":"10.1016/j.eprac.2025.06.002","DOIUrl":"10.1016/j.eprac.2025.06.002","url":null,"abstract":"<p><p>Over a century has passed since Harvey Cushing reported and described the findings in his patient that led to his name being ascribed to the clinical syndrome we call Cushing syndrome. Decades of study have led to a greater understanding of the nuances of cortisol secretion associated with the various conditions that result in either relative or overt hypercortisolism. Referencing \"Cushing syndrome,\" and failing to recognize the subtle presentations of disordered cortisol secretion, leads to delays in diagnosis and treatment and excess morbidity in affected patients.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283021","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 Review of Real-World Evidence About the Use of Automated Insulin Delivery Systems in People With Type 1 Diabetes.","authors":"Sonia Gera, Jaisree Iyer, Seema Meighan, Christine A March, Brynn E Marks","doi":"10.1016/j.eprac.2025.06.004","DOIUrl":"10.1016/j.eprac.2025.06.004","url":null,"abstract":"<p><strong>Introduction: </strong>Automated insulin delivery systems (AID) have revolutionized type 1 diabetes (T1D) management. Guidelines support offering AID to all people with T1D and engaging in shared decision making when choosing among the available AID systems.</p><p><strong>Results: </strong>In clinical trials, AID has been shown to improve glycemic control and reduce hypoglycemia while also improving quality of life. However, participants in clinical trials do not accurately reflect the entire T1D population and outcomes from these controlled may not generalize to clinical care. A growing body of real-world evidence seeks to understand the effect of AID systems on glycemia and person-reported outcome measures in real-world populations. These real-world studies highlight the effect of differences in engagement with AID, including time in automated mode and boluses per day, considerations about AID system selection, and approaches to educate people with T1D.</p><p><strong>Conclusion: </strong>In this review, we compare glycemic and person reported outcomes in clinical trials and the real-world studies, with consideration of the effects of different systems according to user characteristics. We also review the current state of device selection and education for people with diabetes, their caregivers, and clinicians. Lastly, we summarize key findings across AID systems and opportunities for further research.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283019","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":"Undetectable Serum Thyroglobulin in Patients With Differentiated Thyroid Cancer: Antithyroglobulin Antibodies, Assay Limitation, or Other?","authors":"Benjamin Andress, Sandra A Miller, Anthony D Maus, Jennifer V Kemp, Joshua A Bornhorst, Stefan K Grebe, Alicia Algeciras-Schimnich","doi":"10.1016/j.eprac.2025.06.001","DOIUrl":"10.1016/j.eprac.2025.06.001","url":null,"abstract":"<p><strong>Objective: </strong>To determine why some patients with differentiated thyroid cancer (DTC) lymph node (LN) metastases do not have detectable serum thyroglobulin (Tg).</p><p><strong>Methods: </strong>Fine needle aspiration biopsy (FNAB) washout fluid from patients with DTC LN metastases and undetectable serum Tg measurement by immunoassay (Tg-IA) were evaluated for the presence of Tg and anti-Tg antibodies (TgAbs). Spike-recovery experiments in serum were performed to assess the reason for undetectable Tg.</p><p><strong>Results: </strong>Of the 42 patients, 87% had detectable Tg in the FNAB washout fluid by Tg-IA, and 83% by Tg mass spectrometry (Tg-MS) measurement. Seventy-six percent of these patients had detectable serum TgAb, while 26% did not. Tg spike-recovery experiments performed on the TgAb+ (positive) serum samples showed decreased Tg recovery by Tg-IA but not by Tg-MS (Tg-IA mean, range: 50%, 12%-84%; Tg-MS 96%, 70%-117%). In TgAb- (negative) serum samples no interference was observed (>94% recoveries). No difference in FNAB washout fluid Tg recovery between TgAb- and TgAb+ patients was observed.</p><p><strong>Conclusion: </strong>Tg was detected by both Tg-IA and Tg-MS methods in the majority of FNAB washout fluid from patients with DTC LN metastases who exhibited undetectable serum Tg by Tg-IA and Tg-MS. The absence of serum Tg could not be completely explained by the presence of TgAb. These results suggest that, for a subset of patients with DTC LN metastases, the absence of detectable Tg in serum does not appear to be due to analytical limitations of current Tg assays or the presence of TgAb interference.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274461","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 Beyond Glycated Hemoglobin to Glucose Patterns: Newer Indications for Continuous Glucose Monitor Use","authors":"Shubham Agarwal MD ,&nbsp;Ron T. Varghese MD ,&nbsp;Renato Savian MD ,&nbsp;Cecilia C. Low Wang MD, FACE, FACP ,&nbsp;Rodolfo J. Galindo MD, FACE","doi":"10.1016/j.eprac.2025.05.749","DOIUrl":"10.1016/j.eprac.2025.05.749","url":null,"abstract":"<div><div>Glucose homeostasis is a constant process involving several physiological mechanisms. Estimation of glucose via continuous glucose monitor (CGM) sensors provides a 24-hour comprehensive evaluation of glycemic excursions, enabling a closer understanding of the underlying defective mechanisms beyond current biomarkers of glycemia, focusing on the impact of glucose exposure, and not on the constant changes. CGM use in type 2 diabetes has shown to have a beneficial effect in improving glycated hemoglobin and time spent in range of 70-180 mg/dL. Some studies have also shown a legacy effect of CGM use after its discontinuation. Use of CGM in various other conditions such as end stage kidney disease, obstructive sleep apnea, gastroparesis, postbariatric hypoglycemia, and insulinoma has been shown to fill the diagnostic and therapeutic void. The advent of new glycemic metrics with the coming of CGM also improves our pathophysiological understanding of such diseases in the context of more readily available glycemic data. As future studies continue to emerge demonstrating the benefits of CGM in conditions other than diabetes; a frameshift focus on the value of constant glucose assessment and not on point-in-time metrics is necessary. Understanding and changing our approach to glycemic excursion will be pivotal for use of CGM beyond traditional indications and improve patient outcomes and quality of life metrics.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 8","pages":"Pages 1046-1053"},"PeriodicalIF":3.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247024","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":"Transient vs Permanent Congenital Hypothyroidism: Does Thyroid Volume Tell the Tale?","authors":"Sarah A Ackah, Erica A Eugster, Todd D Nebesio, Rebeca Santos, S Gregory Jennings, George J Eckert, Boaz Karmazyn","doi":"10.1016/j.eprac.2025.05.745","DOIUrl":"10.1016/j.eprac.2025.05.745","url":null,"abstract":"<p><strong>Objectives: </strong>Congenital hypothyroidism (CH) can be transient or permanent. We evaluated if thyroid volume measured by ultrasound can be distinguish between the 2 forms.</p><p><strong>Methods: </strong>Retrospective study (1/2005-12/2019) on patients with CH with eutopic thyroids. Permanent CH was defined as the inability to discontinue levothyroxine therapy after age 3, while transient CH included a successful trial off levothyroxine. Demographic and clinical characteristics were retrieved from the electronic medical records. Fisher's Exact tests and t-tests were used to compare categorial and continuous variables between children with transient and permanent CH. Receiver-operating characteristic curve analysis evaluated thyroid volume and thyroid-stimulating hormone (TSH) as individual predictors of transient/permanent CH. A classification tree analysis was used to combine thyroid volume and TSH for prediction.</p><p><strong>Results: </strong>Significant differences were found between the 2 groups in terms of TSH levels and thyroid volume. Thyroid volume in patients with transient CH was significantly smaller (1.0 ± 0.5 mL) compared to those with permanent CH (2.3 ± 2.6 mL). No transient CH patient had thyroid volume below 0.3 mL or above 2.5 mL. Combining TSH level at diagnosis of ≥200 mIU/L and thyroid volume ≤0.6 mL or ≥2.5 mL provided sensitivity of 78.4% and specificity of 85.7% in differentiating between transient and permanent CH.</p><p><strong>Conclusion: </strong>Thyroid volume ≥2.5 mL or ≤0.36 mL was seen only in permanent CH, potentially avoiding the need for a trial off levothyroxine. Using both TSH level and thyroid volume provides increased sensitivity and specificity for differentiating between permanent and transient CH.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233524","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":"Perineural Invasion Is Not an Independent Risk Factor for Recurrence and Lateral Neck Metastasis in Thyroid Cancer: A Propensity Score Matching Analysis.","authors":"Joonseon Park, Sue Youn Kim, Chan Kwon Jung, Solji An, Ja Seong Bae, Kwangsoon Kim","doi":"10.1016/j.eprac.2025.05.747","DOIUrl":"10.1016/j.eprac.2025.05.747","url":null,"abstract":"<p><strong>Objectives: </strong>Perineural invasion (PNI) in thyroid cancer is a relatively rare but significant pathologic feature with crucial implications for prognosis and management. This study investigates the impact of PNI on recurrence and lateral neck lymph node metastasis (N1b) in patients with thyroid cancer.</p><p><strong>Methods: </strong>This retrospective analysis included 8572 patients with thyroid cancer who underwent surgery from January 2000 to December 2020 at Seoul St. Mary's Hospital. Clinicopathologic characteristics and outcomes were compared between the patients with and without PNI before and after propensity score matching (PSM). The logistic regression analysis identified the risk factors for N1b, whereas the Cox regression analysis determined the risk factors for recurrence.</p><p><strong>Results: </strong>Of the 8572 patients, 144 (1.7%) presented with PNI. The PNI group had higher rates of gross extrathyroidal extension, vascular and lymphatic invasion, and advanced TNM stage. The recurrence rates were higher in the PNI group both before (11.1% vs 5.6%) and after PSM (11.3% vs 5.6%). PNI was a significant risk factor for N1b in the univariate logistic regression analysis but not in the multivariate analysis before and after PSM. The Cox regression analysis revealed that PNI is a significant risk factor for recurrence before PSM but not after PSM.</p><p><strong>Conclusions: </strong>The PNI in thyroid cancer was associated with higher recurrence rates and increased N1b. However, it was not considered a significant independent risk factor for recurrence or N1b. Further research is needed to refine the management strategies for patients with PNI to improve prognosis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233522","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":"Pituitary Stalk Lesions: Causes and Diagnostic Challenges.","authors":"Roberto Salvatori","doi":"10.1016/j.eprac.2025.05.750","DOIUrl":"10.1016/j.eprac.2025.05.750","url":null,"abstract":"<p><p>The pituitary stalk (PS) is a funnel-shaped structure that connects the hypothalamus to the pituitary gland. It contains some anterior pituitary cells, the hypophyseal vessels, and the axons of neurons whose bodies are located in the hypothalamus and terminate in the posterior pituitary gland, where they store and release arginine vasopressin and oxytocin. The PS is best visualized by magnetic resonance imaging. PS thickening (PST) is often associated with arginine vasopressin deficiency, but it can also present with anterior pituitary hormones deficits or normal pituitary function. PST can be an isolated finding, or be expression of a multisystem infectious, inflammatory, or neoplastic process. Accordingly, these cases are best managed with the input of pituitary specialists from different disciplines. Although PS biopsy can provide a pathologic diagnosis, this is an invasive procedure that requires an experienced neurosurgeon and carries significant risks. This review discusses the causes and symptoms of PST, and addresses the demographic, history, physical examination, biochemical and radiological features that can help the endocrinologist in identifying the most likely cause of PST in any given patient, and to decide when biopsy is needed.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233523","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}