{"title":"Ketone supplementation acutely lowers androgen and glucose levels in women with polycystic ovary syndrome: a randomized clinical trial.","authors":"Dilara Tekin Uzman, Gizem Dağcı","doi":"10.1093/ejendo/lvaf163","DOIUrl":"10.1093/ejendo/lvaf163","url":null,"abstract":"","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"L10-L11"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834543","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}
Kristina Isand, Riccardo Pofi, Oliver Haermson, Melissa Vergis, Harishanthi Mahendran, John Ayuk, John Wass, Parag Yajnik, Karin Bradley, Niki Karavitaki, Aparna Pal
{"title":"Venous thromboembolism in patients with pituitary adenoma: UK multicentre cohort study.","authors":"Kristina Isand, Riccardo Pofi, Oliver Haermson, Melissa Vergis, Harishanthi Mahendran, John Ayuk, John Wass, Parag Yajnik, Karin Bradley, Niki Karavitaki, Aparna Pal","doi":"10.1093/ejendo/lvaf139","DOIUrl":"10.1093/ejendo/lvaf139","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess risk of venous thromboembolism (VTE) in patients with Cushing's disease (CD) compared to acromegaly and non-functioning pituitary adenomas (NFPAs) and to investigate the timing and risk factors for VTE.</p><p><strong>Design: </strong>This is a retrospective, observational cohort study.</p><p><strong>Methods: </strong>Patients diagnosed with acromegaly, NFPA, or CD across 3 UK centres between 2010 and 2021 were included. χ² and Cox regression were performed to compare VTE cumulative incidence and examine associations with clinical factors.</p><p><strong>Results: </strong>Among 827 patients (107 CD, 502 NFPA, 218 acromegaly), the cumulative incidence of VTE was 11.2% in CD, 0.4% in NFPA, and 2.7% in acromegaly. Follow-up time was similar across diagnostic groups (median ∼13.3-13.5 years, P = .41), allowing valid comparison of VTE incidence and Cox regression modelling. Patients with CD had significantly higher VTE risk compared to those with NFPA (odds ratio [OR] 21.05, P < .001) and acromegaly (OR 4.48, P = .002). Cox regression showed that CD diagnosis (hazard ratio [HR] 46.87, P < .001) and history of diabetes or impaired glucose tolerance (HR 3.48, P = .008) were significantly associated with VTE. In patients with CD, there were 12 VTEs recorded, with most (8/12) occurring within 1 year of CD diagnosis. Notably, 4 VTEs occurred within 45 days post-transsphenoidal surgery.</p><p><strong>Conclusion: </strong>Patients with CD exhibit a significantly elevated risk of VTE compared to those with acromegaly or NFPA, with diabetes mellitus independently associated with this risk. In CD, VTEs were more frequently diagnosed around the time of diagnosis and during the peri-operative period.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"270-277"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559547","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}
Sara Öster, Tim Spelman, Sophie Bensing, Jakob Skov
{"title":"Psychotropic drug use in patients with autoimmune Addison's disease: a Swedish population-based cohort study.","authors":"Sara Öster, Tim Spelman, Sophie Bensing, Jakob Skov","doi":"10.1093/ejendo/lvaf155","DOIUrl":"10.1093/ejendo/lvaf155","url":null,"abstract":"<p><strong>Objective: </strong>The effect of autoimmune Addison's disease (AAD) on mental health is not well known. The aim of this study was to examine the use of psychotropic drugs around diagnosis and after long-term follow-up in Swedish individuals with AAD.</p><p><strong>Design and methods: </strong>In this population-based cohort study, national health and population registers and the Swedish Addison Registry were used to identify individuals diagnosed with AAD between July 2006 and December 2019 and matched population controls. The Swedish Prescribed Drug Register was used to retrieve information on annual dispensations (yes/no) of anti-psychotics [Anatomical Therapeutic Chemical (ATC) N05A], anxiolytics (ATC N05B), hypnotics/sedatives (ATC N05C), and anti-depressants (ATC N06A), from 3 years before to 3 years after diagnosis. A cross-sectional analysis of the year 2019 was also performed.</p><p><strong>Results: </strong>A total of 963 persons with AAD and 9366 matched controls were identified. Use of hypnotics/sedatives, anxiolytics, and anti-depressants was significantly higher in patients with AAD the year preceding diagnosis [ORs 1.72 (1.40-2.11), 1.38 (1.07-1.78), and 1.29 (1.05-1.59), respectively]. After diagnosis, use of hypnotics/sedatives remained significantly higher [ORs 1.42 (1.13-1.78) to 1.78 (1.45-2.19)]. We found no difference in dispensation of other psychotropic drugs after diagnosis. In the cross-sectional analysis of 2019, the increased dispensation of hypnotics/sedatives remained elevated [odds ratio (OR) 1.31 (1.01-1.70)].</p><p><strong>Conclusions: </strong>Prescription patterns suggest that early symptoms of AAD are associated with or mistaken for mental health disorders. Furthermore, insomnia is common in patients with AAD.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"262-269"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764786","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}
Jessica Goi, Miguel Paja Fano, Alicia Rizo Gellida, Marga González-Boillos, Patricia Martín Rojas-Marcos, Laura Caja Guayerbas, Ana María García Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente, Emilia Gómez-Hoyos, Mònica Recasens, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M Perdomo, Laura Manjón-Miguélez, Ángel Rebollo Román, Cristina Robles Lázaro, José María Recio, María Calatayud, Noemi Jiménez López, Miguel Sampedro Nuñez, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, Joaquín Serrano, Theodora Michalopoulou, Susana Tenes Rodrigo, Eider Pascual-Corrales, Fernando Jaén Aguila, Nuria Muñoz Rivas, Eva María Moya Mateo, Sonsoles Gutiérrez-Medina, Felicia Alexandra Hanzu, Paola Parra Ramírez, Marta Araujo-Castro
{"title":"Efficacy and safety of medical treatment of primary aldosteronism: a real-world data study in Spain.","authors":"Jessica Goi, Miguel Paja Fano, Alicia Rizo Gellida, Marga González-Boillos, Patricia Martín Rojas-Marcos, Laura Caja Guayerbas, Ana María García Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente, Emilia Gómez-Hoyos, Mònica Recasens, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M Perdomo, Laura Manjón-Miguélez, Ángel Rebollo Román, Cristina Robles Lázaro, José María Recio, María Calatayud, Noemi Jiménez López, Miguel Sampedro Nuñez, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, Joaquín Serrano, Theodora Michalopoulou, Susana Tenes Rodrigo, Eider Pascual-Corrales, Fernando Jaén Aguila, Nuria Muñoz Rivas, Eva María Moya Mateo, Sonsoles Gutiérrez-Medina, Felicia Alexandra Hanzu, Paola Parra Ramírez, Marta Araujo-Castro","doi":"10.1093/ejendo/lvaf158","DOIUrl":"10.1093/ejendo/lvaf158","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to analyze current medical management of primary aldosteronism (PA) in Spain, including doses, adverse events (AEs), and efficacy.</p><p><strong>Methods: </strong>SPAIN-ALDO is a national, multicenter, retrospective registry of patients with PA in Spain. For this study, information about medical treatment with mineralocorticoid receptor antagonist (MRA) as first-line or postsurgical therapy and about antihypertensive medications used before PA targeted treatment (MRA or adrenalectomy) was included. We reported surgically and medically treated patients at baseline and at last available follow-up and evaluated clinical and biochemical responses according to Primary Aldosteronism Surgical Outcome (PASO) and Primary Aldosteronism Medical treatment Outcome (PAMO) criteria.</p><p><strong>Results: </strong>A total of 997 patients with PA were included. Before PA diagnosis, the classes of antihypertensive drugs most used were calcium-channel blockers (66%) and angiotensin II receptor blockers (48.4%). Of the initial cohort, 880 patients had at least 1 visit available after initiation of MRA (N = 511 as first-line therapy, N = 47 postsurgery) or adrenalectomy (N = 322). The median defined daily dose of MRA therapy was 1.33. Spironolactone was more prescribed than eplerenone (58% vs 42%). Eplerenone was better tolerated than spironolactone (AEs in 4% vs 18%), particularly among males. After a median follow-up of 35 and 17 months for medically and surgically managed patients, the latter achieved a complete biochemical (68.1%) or clinical (33.6%) response more frequently than people under MRA as first-line therapy (48.6% and 15.7%; P < .001).</p><p><strong>Conclusion: </strong>This study underscores the need to optimize PA medical management in Spain to improve patient clinical and biochemical outcomes, since currently the proportion of patients achieving complete clinical and biochemical response with MRA is quite low.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"297-309"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759526","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}
Tero Varimo, Päivi J Miettinen, Hanna Huopio, Toni Rikkonen, Raimo Voutilainen, Sirpa Tenhola, Taneli Raivio, Matti Hero
{"title":"Impact of aromatase inhibition on bone mineral density and structure: a randomized controlled trial in boys with delayed puberty.","authors":"Tero Varimo, Päivi J Miettinen, Hanna Huopio, Toni Rikkonen, Raimo Voutilainen, Sirpa Tenhola, Taneli Raivio, Matti Hero","doi":"10.1093/ejendo/lvaf160","DOIUrl":"10.1093/ejendo/lvaf160","url":null,"abstract":"<p><strong>Objective: </strong>Treatment of boys with delayed puberty (DP) with aromatase inhibitor or low-dose testosterone (T) induces different hormonal milieus allowing assessment of the relative roles of sex steroids in bone metabolism.</p><p><strong>Design: </strong>A prospective randomized controlled trial (NCT01797718).</p><p><strong>Methods: </strong>Peripheral quantitative computed tomography (pQCT) of the non-dominant arm and left leg was performed in 27 boys with DP. Fifteen boys were treated with letrozole (Lz) (2.5 mg/day) and 12 boys with T (1 mg/kg every 4 weeks) for 6 months. pQCT scans were performed at 0, 6, and 12 months. Circulating bone status indices were measured at 0, 3, 6, and 12 months.</p><p><strong>Results: </strong>Between 0 and 3 months, levels of bone formation markers (P1NP, BAP) increased more in the T group than in the Lz group (P = .001-.014). Accordingly, T-treated boys exhibited greater gain in bone mineral content (BMC) between 0 and 6 months at distal site of tibia than the boys in the Lz group (mean 18.1 mg/mm [25.4] vs. -1.8 mg/mm [SD 1.0], respectively P = .043). No significant between-group differences were observed in cortical or endosteal parameters. In both groups, the changes in testosterone levels during the treatment correlated positively with changes in BMC at distal radius (both P = .041).</p><p><strong>Conclusions: </strong>Testosterone treatment increased bone formation markers and predicted greater BMC accrual than Lz at metabolically active skeletal sites. These findings reinforce the anabolic role of androgens, partly mediated by estrogens, in early pubertal bone development. A short, 6-month treatment with Lz did not appear detrimental to bone accrual based on pQCT parameters. However, these findings do not allow conclusions regarding skeletal safety of longer Lz use.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"289-296"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834542","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}
Amica Corda Müller-Nedebock, Eric Wenzel, Roland Pfäffle
{"title":"Uniparental disomy leads to a novel cause of MC2R-related familial glucocorticoid deficiency type 1.","authors":"Amica Corda Müller-Nedebock, Eric Wenzel, Roland Pfäffle","doi":"10.1093/ejendo/lvaf152","DOIUrl":"10.1093/ejendo/lvaf152","url":null,"abstract":"<p><p>Familial glucocorticoid deficiency type 1 (FGD1) is a rare autosomal recessive disease caused by pathogenic variants in the MC2R gene. This case report presents the first documented instance of FGD1 caused by a homozygous 1.421-kb deletion affecting the non-coding promoter region of MC2R. The patient, a 9-year-old girl, presented with severe cortisol insufficiency and hyperpigmentation starting at birth. Genetic testing initially missed the deletion, as standard whole-exome sequencing in 2016 did not include a copy number variation analysis. However, a whole-genome sequencing analysis in 2024 identified the deletion. The variant was inherited through paternal uniparental disomy (UPD), a rare genetic mechanism that caused the homozygous state. This case underscores the value of utilizing current genetic testing approaches, especially in cases where clinical features strongly suggest a genetic etiology despite inconclusive initial genetic testing results. Additionally, it highlights the need to consider non-coding regions and UPD in genetic diagnostics.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"K5-K10"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741707","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}
Felicia A Hanzu, Josep Puig, Paloma Puyalto, Manel Puig-Domingo
{"title":"Multimodal advanced imaging for precision medicine in pituitary tumors.","authors":"Felicia A Hanzu, Josep Puig, Paloma Puyalto, Manel Puig-Domingo","doi":"10.1093/ejendo/lvaf144","DOIUrl":"10.1093/ejendo/lvaf144","url":null,"abstract":"<p><p>Advances in imaging technologies are revolutionizing the understanding and management of pituitary diseases including pituitary adenomas, hypopituitarism, and neuroendocrine disorders. This review highlights state-of-the-art bioimaging tools, including magnetic resonance imaging, spectroscopy, functional positron emission tomography, and radiomics, and emphasizes their roles in diagnosis, characterization, treatment planning, and prognostication in precision medicine of pituitary tumors. We discuss technological advancements, integration with omics data, and future research directions for enhancing diagnostic accuracy and therapeutic outcomes. This comprehensive review underscores the pivotal role of advanced bioimaging tools in enhancing diagnostic accuracy, individualized treatment planning, and prognostic assessment, ultimately paving the way for a more personalized approach to managing pituitary tumors.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"R1-R14"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616887","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":"Comment on musculoskeletal disease in acromegaly: a population-based registry study.","authors":"Wenjian Wang, Zhiwei Han, Guoying Wang","doi":"10.1093/ejendo/lvaf161","DOIUrl":"10.1093/ejendo/lvaf161","url":null,"abstract":"","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"L7-L8"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834539","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}
Karolina Solhusløkk Höse, Adam Stenman, Henrik Falhammar, Cristina Volpe, Catharina Larsson, Jan Zedenius, C Christofer Juhlin
{"title":"Improving diagnosis in primary aldosteronism using HISTALDO and nodule size metrics.","authors":"Karolina Solhusløkk Höse, Adam Stenman, Henrik Falhammar, Cristina Volpe, Catharina Larsson, Jan Zedenius, C Christofer Juhlin","doi":"10.1093/ejendo/lvaf157","DOIUrl":"10.1093/ejendo/lvaf157","url":null,"abstract":"<p><strong>Background: </strong>Primary aldosteronism (PA) is the leading cause of secondary hypertension. The 2022 WHO classification introduced the HISTALDO system, separating solitary aldosterone-producing adenomas/nodules (APA/APN; classical histology) from multiple nodules/micronodules (MAPN/MAPM; non-classical histology). Surgery often cures classical cases, while non-classical cases frequently recur. HISTALDO uses CYP11B2 immunohistochemistry, but interpretation is challenged by background nodules. A \"B2 ratio\" (size ratio of the largest to second-largest CYP11B2-positive nodule) has been proposed to aid diagnosis.</p><p><strong>Objective: </strong>To assess whether standardized tissue sampling and the B2 ratio improve PA diagnosis and correlate with outcomes.</p><p><strong>Methods: </strong>A prospective study of 75 unilateral PA patients undergoing adrenalectomy (2017-2022) at Karolinska University Hospital. CYP11B2 immunohistochemistry was performed using a standardized protocol, and the B2 ratio was calculated in cases with multiple CYP11B2-positive nodules (HISTALDO B2R). Outcomes were assessed using Primary Aldosteronism Surgical Outcome criteria.</p><p><strong>Results: </strong>HISTALDO classified 20 cases as classical and 55 as non-classical (median B2 ratio 9). Using a B2 ratio cut-off ≥8.1, 29/55 non-classical cases were reclassified, yielding 49 classical and 26 non-classical cases under HISTALDO B2R. Higher B2 ratios correlated with complete clinical response (P = .0038) and fewer antihypertensive medications postoperatively (R = -0.4, P = .0022). A trend for B2 ratio as an independent predictor of complete response was observed (OR = 1.07, P = .058).</p><p><strong>Conclusions: </strong>HISTALDO may over-report non-classical histology. Adding the B2 ratio improves diagnostic accuracy, distinguishing APA with background zona glomerulosa activity from true multinodular disease, facilitating patient management and follow-up.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"278-288"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741705","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}
Matthias Hepprich, Christina Romberg, Jonathan Mudry, Julie Refardt, Damian Wild, Kwadwo Antwi, Emanuel Christ
{"title":"Exenatide for diagnosing endogenous hyperinsulinemic hypoglycemia: a randomized placebo-controlled, double-blind, cross-over proof-of-principle study.","authors":"Matthias Hepprich, Christina Romberg, Jonathan Mudry, Julie Refardt, Damian Wild, Kwadwo Antwi, Emanuel Christ","doi":"10.1093/ejendo/lvaf153","DOIUrl":"10.1093/ejendo/lvaf153","url":null,"abstract":"<p><strong>Objective: </strong>The 72 h fasting test, gold standard for diagnosing endogenous hyperinsulinemic hypoglycemia (EHH), is cumbersome and costly. We evaluated exenatide, a GLP-1 receptor agonist, as a faster, less burdensome alternative diagnostic tool.</p><p><strong>Design and methods: </strong>In this prospective, placebo-controlled, double-blind, randomized cross-over, proof-of-principle study, 10 μg intravenous exenatide was compared to placebo in 14 patients with confirmed EHH in a fasting test. Fourteen matched controls received 10 μg exenatide unblinded. Clinical monitoring and measurements of glucose, insulin, C-peptide, and proinsulin were performed for 4 h. Follow-up for EHH patients included imaging and histology.</p><p><strong>Results: </strong>Exenatide induced diagnostic hypoglycemia in 6 of 14 EHH patients (42%) compared to none with placebo (P = .005). In patients with EHH, glucose nadir occurred earlier after exenatide (67 min [95% CI 50-142] vs 210 min [95% CI 174-219], P < .0001) and at lower glucose levels (2.68 mmol/L [95% CI 2.26-3.02] vs 3.2 mmol/L [95% CI 2.92-3.77], P < .0001) compared to placebo. Proinsulin levels 120 min post-exenatide were higher in patients with EHH [69 pmol/L (95% CI 3.8-232)] compared to controls [9 pmol/L (95% CI 4.5-16.9), P = .0001]. Compared to the fasting test, exenatide significantly shortened time to hypoglycemia (1.38 h [95% CI .67-2.99] vs 12 h [95% CI 1.44-36.1], P = .032). Exenatide was well tolerated and preferred by patients over the fasting test.</p><p><strong>Conclusions: </strong>Exenatide is a promising, faster, less cumbersome, and less expensive diagnostic tool for EHH compared to the fasting test. Larger trials are warranted to confirm its diagnostic utility. Trial Registration ClinicalTrials.gov (NCT04909333).</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"247-254"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759527","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}