European Journal of Endocrinology最新文献

{"title":"BMI as a partitioning factor for estradiol and estrone reference intervals in middle-aged men and postmenopausal women.","authors":"M Kruijt, R de Mutsert, A van Hylckama Vlieg, F R Rosendaal, J J Hillebrand, M den Heijer, A C Heijboer","doi":"10.1093/ejendo/lvag194","DOIUrl":"https://doi.org/10.1093/ejendo/lvag194","url":null,"abstract":"<p><strong>Introduction: </strong>Estrogens play a large role in female and male physiology and are routinely determined in the clinical setting. For interpretation, distinct reference intervals are applied for men, pre---, and postmenopausal women. Adipose tissue is a potent producer of estrogens and influences the circulating estrogen concentrations, although its impact on estrogen reference intervals is currently unknown.</p><p><strong>Method: </strong>We determined estradiol and estrone concentrations in 6,671 middle-aged participants of a large cohort oversampled for persons with BMI >27 kg/m2. We investigated partitioning based on sex, age, menopausal status, and BMI by assessing the proportion of subgroups outside each limit of a shared 95% reference interval (ideally 2.5%) and calculating reference intervals for justified subgroups according to CLSI EP28-A3c.</p><p><strong>Results: </strong>As expected, the strongest partitioning factor was sex, followed by menopausal status for women. When using a shared reference interval for all BMI categories, 4.9% and 5.2% of values in men with obesity and 11.4% and 7.7% of values in postmenopausal women with obesity fell above the reference interval for estradiol and estrone, respectively. Within postmenopausal women differences in the upper reference limit were found, being 138, 157, and 210 pmol/L for estradiol and 32, 41, and 74 pmol/L for estrone for normal weight, overweight, and obesity, respectively.</p><p><strong>Discussion: </strong>Laboratory professionals and clinicians should be aware that BMI affects estrogen concentrations to such extent that it may influence clinical interpretation. Ideally their reference intervals should be stratified by BMI category to reflect the increased estrogen concentrations associated with higher BMI.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Quantifies Within-Subject Facial Change in Acromegaly.","authors":"Ali Ammar, Hana Hadley, Saif Rjaibi, Adam Levitan, Chris Brogly, Alireza Sadeghian, Michael D Cusimano","doi":"10.1093/ejendo/lvag189","DOIUrl":"https://doi.org/10.1093/ejendo/lvag189","url":null,"abstract":"<p><strong>Objective: </strong>Machine-learning models can distinguish acromegaly from controls in single photographs, but whether gradual facial change can be measured within the same person from ordinary photographs is unknown. We tested whether a person's face shifts measurably toward an acromegaly-associated pattern over time.</p><p><strong>Design: </strong>Multicenter, international, cross-sectional cohort study with within-subject longitudinal analysis.</p><p><strong>Methods: </strong>People with acromegaly and other pituitary tumors contributed retrospective photographs. Two timepoints per person were paired by self-reported disease stage when available, with chronological pairing otherwise. A face-recognition model and a general-image model described each image, and leave-one-patient-out scoring quantified within-person movement toward the acromegaly-associated pattern.</p><p><strong>Results: </strong>Of 582 participants, 110 contributed usable frontal photographs and 69 had two timepoints (50 acromegaly, 19 tumor controls). The facial score separated held-out advanced-disease from control faces (AUC 0.858). In acromegaly, the median within-person shift was 0.59 and 76.0% moved in the predicted direction (p=0.0003); 81.5% of clean untreated pairs moved as predicted (p=0.0008). The three contrast strata ordered directionally, although the trend was not significant (p=0.15). The 15 non-Cushing aging controls showed no significant shift (p=0.72), and the between-group difference remained after adjustment for photograph interval (p=0.029). Pre-diagnosis untreated baselines showed modest separation from all control baselines (AUC 0.65, one-sided p=0.033). The general-image model showed no within-person change (p=0.32).</p><p><strong>Conclusions: </strong>Acromegaly-associated facial change is measurable within individuals from ordinary photographs, supporting further evaluation of longitudinal photograph-based monitoring and earlier recognition.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Utility of Diurnal Salivary Cortisol Profiles in Neoplastic and Non-Neoplastic Hypercortisolism.","authors":"Fidéline Bonnet-Serrano, Jonathan Poirier, Ralph El Khoury, Louis Thomeret, Nesrine Benanteur, Anne Jouinot, Marie-Clémence Leguy, Anna Vaczlavik, Lucas Bouys, Laurence Guignat, Lionel Groussin, Guillaume Assié, Jean Guibourdenche, Jérôme Bertherat","doi":"10.1093/ejendo/lvag192","DOIUrl":"https://doi.org/10.1093/ejendo/lvag192","url":null,"abstract":"<p><strong>Objective: </strong>Salivary cortisol has the advantages of being non-invasive, readily accessible in ambulatory patients and reflecting the free bioactive fraction of cortisol. The cortisol diurnal cycle, based on six samples collected every 4 hours over a 24-hour period, allows a detailed characterization of cortisol variations throughout the day. The objective of this study was to assess the value of the salivary cortisol diurnal cycle for the diagnosis of Cushing's syndrome (CS) and the differential diagnosis of non-neoplastic hypercortisolism.</p><p><strong>Design: </strong>This retrospective cohort study included all the patients hospitalized in Endocrinology department of Cochin Hospital between 2012 and 2018 who had complete serum and salivary diurnal cycle assessments.</p><p><strong>Methods: </strong>Serum and salivary cortisol levels were measured using an automated and a radio immunoassay, respectively.</p><p><strong>Results: </strong>A total of 227 subjects without CS, 46 patients with non-neoplastic CS, 72 patients with ACTH-dependent CS and 67 with adrenal CS were included. For the diagnosis of CS, the cortisol nadir throughout the day showed better diagnostic performance than midnight cortisol, both in serum and saliva with, ROC AUCs of 0.98 and of 0.96, respectively. For the differential diagnosis between non-neoplastic hypercortisolism and ACTH-dependent CS, salivary cortisol showed better diagnostic performance than midnight serum cortisol (ROC AUC 0.97; optimal cut-off 5.3 nM; sensitivity 90%; specificity 87% for the salivary cortisol nadir).</p><p><strong>Conclusion: </strong>The salivary cortisol diurnal cycle appears to be a powerful tool for the diagnosis of CS and for the challenging differential diagnosis of non-neoplastic hypercortisolism, with the major advantage of being accessible in ambulatory patients.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbonyl Reductase 1 regulates prednisolone clearance and modifies its adverse effect profile.","authors":"Riccardo Pofi, Tom Potter, Sergi Coll, Nantia Othonos, Hamish Miller, Sarah White, Michelle Haylock, Núria Monfort, Rosa Ventura, Jeremy W Tomlinson","doi":"10.1093/ejendo/lvag193","DOIUrl":"https://doi.org/10.1093/ejendo/lvag193","url":null,"abstract":"<p><strong>Objective: </strong>Prednisolone is widely prescribed but associated with marked interindividual variability in adverse effects. While 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes regulate glucocorticoid activation, the contribution of alternative clearance pathways remains unclear. We aimed to characterize prednisolone metabolism beyond 11β-HSD enzymes, define the roles of carbonyl reductase 1 (CBR-1) and AKR1C1, and assess the clinical relevance of specific metabolites.</p><p><strong>Design: </strong>Post-hoc targeted metabolomic analysis of a randomized, double-blind, placebo-controlled trial combined with mechanistic in vitro overexpression studies.</p><p><strong>Methods: </strong>Thirty healthy male volunteers from the TICSI trial (NCT03111810) and HEK293 cells overexpressing CBR-1 or AKR1C1 were studied. Participants received prednisolone (20 mg daily for one week) with placebo or the selective 11β-HSD1 inhibitor AZD4017. In vitro, transfected HEK293 cells were treated with prednisolone or prednisone. Steroid metabolites were quantified by targeted LC-MS/MS, and associations with glucose disposal and osteocalcin were assessed.</p><p><strong>Results: </strong>20β-reduced metabolites were major contributors to prednisolone clearance. In vitro, CBR-1 preferentially reduced prednisone, with 20β-dihydro-prednisone accounting for up to 78% of its clearance, whereas AKR1C1 had minimal impact. In vivo, 11β-HSD1 inhibition reduced prednisolone exposure without a compensatory rise in prednisone, with a relative increase in CBR-1-mediated 20β-reduction. Higher circulating 20β-dihydro-prednisone at 4 hours independently predicted improved glucose disposal and higher osteocalcin levels.</p><p><strong>Conclusions: </strong>CBR-1 is a key determinant of prednisolone and prednisone clearance in humans and is associated with clinically relevant metabolic and skeletal outcomes. Circulating 20β-dihydro-prednisone may serve as an informative biomarker of glucocorticoid exposure and adverse effect risk, supporting metabolite-guided approaches to glucocorticoid therapy.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When to stop monitoring pituitary stalk thickening?","authors":"Prashant Yadav, Roberto Salvatori","doi":"10.1093/ejendo/lvag195","DOIUrl":"https://doi.org/10.1093/ejendo/lvag195","url":null,"abstract":"<p><p>Pituitary stalk thickening (PST) in adults may arise from neoplastic, inflammatory, infectious, or congenital disease, yet the underlying cause frequently remains undetermined after initial evaluation. For patients without an established diagnosis, no adult-specific data defines how long magnetic resonance imaging (MRI) surveillance should be maintained. Current expert reviews recommend early reassessment at 3-6 months, followed by longitudinal imaging for approximately 3-5 years. Among initially indeterminate lesions, spontaneous regression is more likely than the progression, although late diagnosis of histiocytic disease can nevertheless occur. We suggest reducing MRI frequency after sustained stability and considering discontinuation only in carefully selected low-risk adults, while maintaining longer surveillance whenever endocrine, radiological, or systemic risk features persist.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Genetic Risk Approach to Differential Diagnosis of Type 1 Diabetes and Risk Stratification in the Spanish Population.","authors":"Laura Saso-Jiménez, Inés Urrutia, Maitane González-Arceo, Hector Diez, Josu Aurrekoetxea-Oribe, Begona Calvo, Jose Ramón Bilbao, Itxaso Rica, Nuria Valdés, Alicia Huerta-Chagoya, Silvia Bonàs-Guarch, Josep María Mercader, Jorge Ferrer, Luis Castano, Rosa Martínez","doi":"10.1093/ejendo/lvag188","DOIUrl":"https://doi.org/10.1093/ejendo/lvag188","url":null,"abstract":"<p><strong>Context: </strong>Accurate type 1 diabetes (T1D) risk assessment can improve diagnosis and preventive care, reducing misdiagnosis and enabling preclinical interventions. Genetic Risk Scores (GRS) offer a promising tool, but population-specific validation is required.Objective. To assess the performance of established vs. a novel Spanish-specific GRS for T1D differential diagnosis and risk stratification.</p><p><strong>Methods: </strong>From 2,338 genotyped individuals, 2,215 Spanish participants of European ancestry passed quality control: 816 T1D, 469 type 2 diabetes (T2D), 457 monogenic diabetes (MD), and 473 controls. A novel Spanish-specific GRS (T1D-SP-GRS) was developed and compared with HLA-DRB1 and two European-derived models (T1D-GRS and T1D-GRS2). The best-performing score was evaluated for T1D discrimination vs. T2D and MD, and for association with T1D-onset age.</p><p><strong>Results: </strong>T1D-GRS2 outperformed T1D-SP-GRS for T1D vs. controls (AUC-ROC: 0.888 [95% CI: 0.867-0.908] vs. 0.837 [0.797-0.877], p=0.001), retaining high discrimination vs. T2D and MD (0.886 [0.865-0.907]). In the combined pediatric-onset T1D and control cohort, the P50 cutoff yielded a sensitivity of 0.80 (95% CI: 0.76-0.84) and specificity of 0.81 (0.77-0.84); P25 prioritized sensitivity (0.97 [0.95-0.99]) while P75 specificity (0.96 [0.93-0.97]). A P90 threshold conferred 26-fold higher T1D odds vs. controls, and 18- and 17-fold vs. T2D and MD (p <0.001). Higher T1D-GRS2 in childhood- vs. adulthood-onset T1D revealed an age-dependent risk profile primarily driven by HLA.</p><p><strong>Conclusions: </strong>T1D-GRS2 discriminates T1D from other diabetes etiologies, providing a complementary tool to support diagnostic accuracy. The higher genetic risk associated with a younger age at onset provides key insights for early-stage T1D screening and intervention strategies.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary adenomas in older patients: approaches, challenges, and future directions.","authors":"Sandrine A Urwyler, Daniela Esposito, Athanasios Fountas, Georgia Ntali, Elena Valassi, Niki Karavitaki","doi":"10.1093/ejendo/lvag183","DOIUrl":"10.1093/ejendo/lvag183","url":null,"abstract":"<p><p>Several pituitary adenomas are diagnosed at an old age. Over the decades, the increase in life expectancy has led to fundamental changes in the age structure of the society. As a result of this, the number of elderly patients newly diagnosed or living with a pituitary adenoma is increasing. Clinical phenotypes in this group often differ from that encountered in younger patients, and ageing can have a negative impact on pituitary adenoma-related comorbidities. Timely diagnosis may be influenced by factors including confusion with physical changes occurring during normal ageing, presence of visual abnormalities mimicking those caused by pituitary adenomas, and age-related alterations in pituitary function. In this review, we present data on various types of pituitary adenomas diagnosed in the elderly from the published literature of the last 20 years, discuss differences with younger patients, and highlight diagnostic and therapeutic challenges in this field. Overall, essential priority is to offer a patient-tailored management strategy, which will be effective, safe, pragmatic, enhancing optimal age-adjusted quality of life and considering patient wishes and frailty. Directing the management to centres of excellence with proven and established surgical/endocrine expertise combined with wider multi-disciplinary input will serve this priority.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"R1-R10"},"PeriodicalIF":6.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow responses to GLP-1 and GIP infusion under hyperglycaemic conditions.","authors":"Nina Wærling Hansen, Morten Svarer Hansen, Jesper Havelund, Nils Færgeman, Bolette Hartmann, Kurt Højlund, Morten Frost","doi":"10.1093/ejendo/lvag181","DOIUrl":"10.1093/ejendo/lvag181","url":null,"abstract":"<p><strong>Objectives: </strong>Food intake stimulates secretion of incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which acutely suppress systemic markers of bone resorption in humans. Whether incretins exert parallel effects on bone turnover within the bone marrow (BM) microenvironment during hyperglycaemia is unknown. We investigated the acute effects of GLP-1, GIP, and their combination on bone turnover in BM under hyperglycaemic conditions, alongside BM metabolomics and stromal cell characteristics.</p><p><strong>Design: </strong>Crossover study in healthy men.</p><p><strong>Methods: </strong>Twelve men completed 3 study days with 2-hour intravenous infusions of GLP-1, GIP, or combined GLP-1 + GIP during a hyperglycaemic clamp targeting postprandial plasma glucose. Bone resorption (C-terminal telopeptide of type I collagen, CTX) and formation (procollagen type I N-terminal propeptide, P1NP) markers were measured in peripheral plasma during infusions and in BM plasma before and after infusions. Untargeted metabolomic profiling by liquid chromatography-mass spectrometry was performed on BM plasma, and BM stromal cells (BMSCs) were assessed ex vivo for clonogenic capacity and osteogenic and adipogenic differentiation.</p><p><strong>Results: </strong>All infusions suppressed BM plasma CTX to a similar extent. P1NP increased transiently in peripheral plasma during GIP and GLP-1 + GIP infusions and was elevated in BM plasma after GIP infusion. Metabolomics revealed changes consistent with altered glucose and insulin levels, without a bone-specific signature. BMSC differentiation was unchanged, although clonogenic capacity was reduced after GLP-1 + GIP infusion.</p><p><strong>Conclusions: </strong>Under hyperglycaemic conditions, both incretins acutely suppressed bone resorption in healthy men without detectable bone-specific metabolic signatures. GIP was additionally associated with increased BM P1NP at 2 hours, in contrast to only a short-lived rise in peripheral plasma, suggesting a possible transient uncoupling of bone turnover.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"549-561"},"PeriodicalIF":6.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic testing and reporting: what the endocrinologists should know and can expect (joint position paper of the ENDO-ERN).","authors":"Thomas Eggermann, Dorte L Lildballe, Martine Cools, Bernadette von Nesselrooij, Vassos Neocleous, Pavlos Fanis, Athanasia Stoupa, Maria Louisa Brandi, Federico Baronio, Anne Barlier, Corinna Grasemann, Marco Bonomi, Ronald de Krijger, Soara Menabò, Adrian F Daly, Sofia Asioli, Susan O'Connell, Pedro Marques, Gérald Raverot, Federico Gatto, Nienke Biermaz, Iris Pelsma, Danielle van der Kaay, Claus H Gravholt, Luca Persani, Leonidas Phylactou, Dirk Prawitt","doi":"10.1093/ejendo/lvag177","DOIUrl":"10.1093/ejendo/lvag177","url":null,"abstract":"<p><p>Over the last decade, next-generation sequencing (NGS) has become an essential tool for diagnostic DNA testing in human genetics. To improve the understanding of available genetic testing strategies and to facilitate the request of genetic testing in daily endocrine practice, clinical and laboratory experts in the field have summarized the major issues which should be known and considered. In this joint position paper of the ENDO-ERN, the roles and responsibilities of the healthcare professionals involved in the diagnostic workflow are described, and the major issues concerning genetic testing workflows are overviewed. These issues encompass all relevant steps, including test request and pre-analytical procedures, laboratory and data processing workflows, quality assurance, and reporting. As NGS procedures result in an increasing number of variants of unknown significance and incidental findings, these aspects are addressed as well. Accompanied by illustrations of the genetic diagnostic workflow and of concise reports for a fast orientation about the major aspects of genetic testing, this joint paper should support the healthcare professionals during a request for genetic testing.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"R109-R118"},"PeriodicalIF":6.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular morbidity in acromegaly during a long-term follow-up-a nationwide cohort study.","authors":"Antti Partanen, Elina Peltola, Heini Huhtala, Essi Ryödi, Heli Rantala, Jarmo Louhelainen, Khalil Sumrein, Saara Metso, Helene Markkanen, Milla Rosengård-Bärlund, Henna Cederberg-Tamminen, Elina Ritvonen, Satu Vehkavaara, Heidi Immonen, Pirjo Nuutila, Heikki Rajala, Leena Moilanen, Reeta Rintamäki, Minna Koivikko, Tapani Ebeling, Camilla Schalin-Jäntti, Pia Jaatinen","doi":"10.1093/ejendo/lvag180","DOIUrl":"10.1093/ejendo/lvag180","url":null,"abstract":"<p><strong>Objective: </strong>Acromegaly has been associated with increased cardiovascular morbidity, but it is unclear to what extent this holds true in contemporary acromegaly cohorts and when the cardiovascular diseases (CVDs) evolve in relation to the time of diagnosis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Cardiovascular morbidity was studied in the Finnish acromegaly cohort (n = 565) and 5629 controls using Kaplan-Meier analysis from 10 years before the diagnosis of acromegaly and continuing up to >30 years after the diagnosis. Hazard ratios for CVD-related hospital visits were calculated with Cox regression analyses in the post-diagnosis period. The effects of received treatments, hypopituitarism, and biochemical control of acromegaly were studied with multivariable analyses among the patients.</p><p><strong>Results: </strong>Cardiovascular morbidity increased years before the diagnosis of acromegaly and remained elevated compared to controls [hazard ratio (HR) 1.59 (95% CI 1.42-1.78)] throughout the follow-up (median 17.2 years, IQR 8.7-26.5 years). The highest increase was observed in diseases of pulmonary arteries [HR 2.74 (1.87-4.02)], valvular diseases and cardiomyopathies [HR 2.68 (2.09-3.44)], and hypertension [HR 2.11 (1.85-2.42)]. Radiotherapy, hypopituitarism, and post-treatment Insulin-Like Growth Factor-1 (IGF-1) above or below the reference range were associated with increased cardiovascular morbidity. Even patients who achieved biochemical remission and normal pituitary function after surgery suffered from increased morbidity compared to controls.</p><p><strong>Conclusions: </strong>Patients with acromegaly are still characterized by increased morbidity across a wide range of CVDs. Cardiovascular morbidity is already present before diagnosis and persists despite acromegaly-specific therapy. This underlines the importance of early diagnostics and CVD prevention for these patients.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"562-573"},"PeriodicalIF":6.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}