Journal of the Endocrine Society最新文献

{"title":"Geographical Variation in Adrenocortical Carcinoma Incidence Across Colorado.","authors":"Tessa B Holmstoen, Lucy K Volino, Elizabeth Molina Kuna, Tapahsama Banerjee, Lauren Fishbein, Margaret E Wierman, Katja Kiseljak-Vassiliades","doi":"10.1210/jendso/bvaf057","DOIUrl":"https://doi.org/10.1210/jendso/bvaf057","url":null,"abstract":"<p><p>Adrenocortical carcinoma (ACC) is an aggressive endocrine malignancy with an annual incidence of approximately 1 case per million, with the underlying etiology poorly understood. We retrospectively investigated the geographic distribution of 62 ACC cases diagnosed between 2010 and 2023 and of 115 pheochromocytoma/paraganglioma (PPGL) diagnosed between 2016 and 2023 at the University of Colorado Hospital, as well as 115 ACC cases diagnosed between 2012 and 2020 from the Colorado Central Cancer Registry (CCCR). Data on patient age, sex, zip code of residence, and tumor characteristics were collected and, for ACC cases, compared with CCCR data. Our University of Colorado cohort showed an average ACC annual incidence of 0.81 cases per million, with 61.2% of cases occurring in women. The CCCR cohort showed an average ACC annual incidence of 1.1 cases per million, with 48.7% of cases in women. For PPGL, the average annual incidence was 2.26 cases per million, with 60% of cases occurring in females. Our ACC cohort had an average annual incidence of 1.36 cases per million in Western Colorado and 0.68 cases per million in Eastern Colorado. Similarly, the state registry showed 1.49 cases per million in Western Colorado and 1 case per million in Eastern Colorado. In contrast, PPGL data showed 1.35 cases per million in Western Colorado and 2.36 cases per million in Eastern Colorado. These data suggest a higher incidence of ACC in Western Colorado, highlighting the need for investigation into environmental factors as potential pathogenic factors in ACC.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf057"},"PeriodicalIF":3.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbiota Metabolite TMAO and Adolescent Cardiometabolic Health: A Cross-sectional Analysis.","authors":"Fernando de Quadros Iorra, Paula Godinho Rodrigues, Patrícia Martins Bock, Marina Petrasi Guahnon, Sarah Eller, Tiago Franco de Oliveira, Leticia Birk, Patricia de Souza Schwarz, Michele Drehmer, Katia V Bloch, Felipe Vogt Cureau, Beatriz D Schaan","doi":"10.1210/jendso/bvaf055","DOIUrl":"https://doi.org/10.1210/jendso/bvaf055","url":null,"abstract":"<p><strong>Background: </strong>Trimethylamine N-oxide (TMAO) is a metabolite derived from gut microbiota that has been associated with cardiovascular and metabolic disease risk in adults. However, its role in assessing cardiometabolic risk in adolescents is unclear.</p><p><strong>Objective: </strong>This study investigates the association between serum TMAO levels and cardiometabolic health indicators in Brazilian adolescents.</p><p><strong>Materials and methods: </strong>This is a multicenter, cross-sectional analysis involving 4446 participants aged 12 to 17 years from four Brazilian cities. Serum TMAO levels were quantified using liquid chromatography-tandem mass spectrometry, and associations with clinical, metabolic, and inflammatory variables were evaluated through multivariate linear regression analyses.</p><p><strong>Results: </strong>After adjusting for potential confounders, being in the highest tertile of serum TMAO was positively associated with waist circumference [β 1.45; 95% confidence interval (CI) 0.77, 2.14; <i>P</i> < .001], body mass index Z-score (β .19; 95% CI 0.10, 0.27; <i>P</i> < .001), and C-reactive protein (β .24; 95% CI 0.13, 0.34; <i>P</i> < .001). A negative association between the highest tertile of TMAO and fasting plasma glucose was also observed (β -1.22; 95% CI -1.77, -0.66; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>TMAO may serve as an emerging biomarker for cardiometabolic risk assessment in adolescents.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf055"},"PeriodicalIF":3.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radioactive Iodine in Differentiated Thyroid Cancer: Effect on Detection of Distant Metastases Comparing 4 Guidelines.","authors":"Merel T Stegenga, W Edward Visser, Robin P Peeters, Folkert J van Kemenade, Marco Medici, Tessa M van Ginhoven, Frederik A Verburg, Evert F S van Velsen","doi":"10.1210/jendso/bvaf051","DOIUrl":"10.1210/jendso/bvaf051","url":null,"abstract":"<p><strong>Context: </strong>Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases.</p><p><strong>Objective: </strong>This study compares 4 guidelines on RAI indications and potentially missed metastases.</p><p><strong>Methods: </strong>DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines.</p><p><strong>Results: </strong>In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%).</p><p><strong>Conclusion: </strong>Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf051"},"PeriodicalIF":3.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D Deficiency and Clinical Outcomes in Critically Ill Pediatric Patients: A Systematic Review and Meta-Analysis.","authors":"Chai-Hoon Nowel Tan, Bernita Yeo, Rashida Farhad Vasanwala, Rehena Sultana, Jan Hau Lee, Daniel Chan","doi":"10.1210/jendso/bvaf053","DOIUrl":"https://doi.org/10.1210/jendso/bvaf053","url":null,"abstract":"<p><strong>Context: </strong>Vitamin D deficiency (VDD) is common in paediatric populations, and its relationship with critical care outcomes warrants further investigation.</p><p><strong>Objective: </strong>The aim is to examine the association between VDD and clinical outcomes in children admitted to the Pediatric Intensive Care Unit (PICU).</p><p><strong>Methods: </strong>This systematic review and meta-analysis investigated the impact of VDD on clinical outcomes in PICU patients. A comprehensive search of Embase, Web of Science, PubMed, and Cochrane databases was conducted. Our primary outcomes were mortality and sepsis incidence, while secondary outcomes included length of stay (LOS), need for inotropic support, and need for and duration of mechanical ventilation. Eligible studies included infants and children aged 1 month to 18 years admitted to the PICU, with baseline 25-hydroxyvitamin D levels measured on admission. Two independent reviewers screened studies, extracted data, and assessed quality. Pooled estimates were obtained using a random-effects model.</p><p><strong>Results: </strong>Out of 2298 screened studies, 27 met the inclusion criteria, comprising 4682 patients. VDD was defined as 25-hydroxyvitamin D levels <20 ng/mL and <30 ng/mL in 22 and 5 studies, respectively. VDD was associated with increased mortality (odds ratio [OR] 2.05, 95% CI 1.21-3.48) and a greater need for inotropic support (OR 2.02, 95% CI 1.43-2.85) than children with vitamin D sufficiency (VDS). No differences were observed between VDD and VDS groups in terms of sepsis incidence postadmission, LOS, or the need for and duration of mechanical ventilation.</p><p><strong>Conclusion: </strong>VDD in critically ill pediatric patients was associated with increased mortality and higher need for inotropic support. Further research is warranted to evaluate the potential benefits of vitamin D supplementation in this high-risk population.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf053"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Glucose Uptake During Euglycemic Hyperinsulinemia Associates With Glycemia During Oral Glucose Tolerance Test.","authors":"Miikka-Juhani Honka, Eleni Rebelos, Laura Pekkarinen, Nelli Tuomola, Aino Latva-Rasku, Leena Koukkari, Heidi Immonen, Andrea Mari, Kari K Kalliokoski, Jarna C Hannukainen, Pirjo Nuutila","doi":"10.1210/jendso/bvaf054","DOIUrl":"10.1210/jendso/bvaf054","url":null,"abstract":"<p><strong>Context: </strong>Postprandial hepatic glycogen synthesis and glycolysis are reduced in hepatic insulin resistance. However, the physiologic interpretation of the reduction in hepatic glucose uptake (GU) during the gold-standard measurement of insulin sensitivity, hyperinsulinemic euglycemic clamp, in insulin resistance is unclear. This is because the peripheral route of glucose and insulin delivery during a clamp study differs greatly from the physiological route.</p><p><strong>Objective: </strong>We hypothesized that hepatic GU during hyperinsulinemic euglycemic clamp would predict glycemia during oral glucose tolerance test (OGTT).</p><p><strong>Design: </strong>We analyzed cross-sectional data of 120 individuals (70 men and 50 women) who did not have diabetes from the CMgene study cohort. Hepatic GU was measured with [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) and positron emission tomography.</p><p><strong>Results: </strong>In a multiple regression analysis, hepatic GU, endogenous glucose production, insulin secretion capacity, and serum triglycerides predicted OGTT glucose area under the curve (<i>P</i> for all <.05), whereas skeletal muscle GU, the antilipolytic insulin index, and insulin clearance were not statistically significant predictors (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Hepatic GU measured during hyperinsulinemic euglycemic clamp is an independent predictor of OGTT glucose area under the curves even when accounting for well-known other factors affecting glycemic control. This finding supports the idea that insulin-mediated hepatic GU, and more broadly, first-pass glucose extraction, have a meaningful contribution to glycemic control. Thus, this measurement provides useful information about hepatic insulin sensitivity in the more physiologic conditions of the OGTT which may be useful when studying the pathophysiology of impaired glucose tolerance and when evaluating potential treatments for impaired glycemic control.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf054"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>SLC25A11</i>, a Novel Gene Associated With Carney-Stratakis Syndrome.","authors":"Felipe Freitas-Castro, Lucas S Santana, Gustavo F C Fagundes, Eduardo C Lobato, Ana Caroline F Afonso, Izabel T Nakamura, Felipe L Ledesma, Ibere C Soares, Berenice B Mendonca, Ana Claudia Latronico, Constantine A Stratakis, Madson Q Almeida","doi":"10.1210/jendso/bvaf052","DOIUrl":"https://doi.org/10.1210/jendso/bvaf052","url":null,"abstract":"<p><strong>Background: </strong>Carney-Stratakis syndrome (CSS), a rare condition characterized by paragangliomas and/or pheochromocytomas and gastrointestinal stromal tumors (GIST), is caused by germline heterozygous pathogenic variants in the succinate dehydrogenase subunit genes (<i>SDHB, SDHC, SDHD</i>).</p><p><strong>Methods: </strong>Histological, genetic, and functional analyses were conducted in a 59-year-old female with CSS (9 cm left pheochromocytoma, 4.8 cm paraganglioma, and 9.3 cm GIST). Whole-exome sequencing (WES) of germline DNA paired with tumor DNA was performed.</p><p><strong>Results: </strong>WES identified a rare heterozygous germline variant (c.293G>A/p.Arg98His) in the mitochondrial 2-oxoglutarate/malate carrier gene (<i>SLC25A11</i>). This variant, located in a highly conserved residue of the <i>SLC25A11</i> mitochondrial carrier domain, is predicted to be deleterious in silico (REVEL score = 0.81). WES of pheochromocytoma, paraganglioma, and GIST did not reveal somatic pathogenic variants in genes previously associated with these tumors. A significant reduction in <i>SLC25A11</i> expression was observed in the tumors of this patient with the <i>SLC25A11</i> c.293G>A variant (0.69 ± 0.003) compared to tumors from cluster 1 (1.39 ± 0.45; <i>P</i> = 0.0229) and cluster 2 (1.79 ± 0.71; <i>P</i> = .0154). Consistent with the mRNA findings, <i>SLC25A11</i> protein levels were markedly reduced in the pheochromocytoma and paraganglioma compared to other tumors. Negative staining for 5-hydroxymethylcytosine in all 3 tumors suggests a DNA hypermethylation profile characteristic of cluster 1A, despite normal SDHB expression levels. However, genome-wide copy number variation analysis did not reveal any loss of heterozygosity at the <i>SLC25A11</i> locus.</p><p><strong>Conclusion: </strong>The loss of SLC25A11 expression in tumors, the absence of somatic drivers, and the hypermethylation status strongly support the role of <i>SLC25A11</i> in CSS pathogenesis.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf052"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Tumors in Children and Adolescents in Sweden: A Register-Based Study Covering 15 Years.","authors":"Eleni Terezaki, Jan Calissendorff, Buster Mannheimer, Jonatan D Lindh, Henrik Falhammar","doi":"10.1210/jendso/bvaf058","DOIUrl":"https://doi.org/10.1210/jendso/bvaf058","url":null,"abstract":"<p><strong>Context: </strong>Adrenal tumors (ATs) are highly uncommon in children and adolescents, and more information on these tumors is needed.</p><p><strong>Objective: </strong>The aim of this study was to describe the tumor incidence, patient and tumor characteristics, treatment, and mortality in pediatric patients with ATs.</p><p><strong>Methods: </strong>This is a Swedish nationwide, register-based, retrospective study. All patients up to 21 years old diagnosed between 2005 and 2019 with an AT were identified through national registers and then manually reviewed. Age-, sex-, and municipality-matched controls in a ratio 4:1 were selected from the total population register.</p><p><strong>Results: </strong>In total, 230 patients were included (and 920 controls), with an annual incidence of 6.20 new ATs per million for individuals up to 21 years old. The median age was 6.0 years (interquartile range, 1.0-17.70), with 120 (52.2%) being boys. Regarding tumor biology, 132 (57.4%) were malignant, 77 (33.5%) benign, and 21 (9.1%) were undetermined. There were at least 39 (16.9%) hormonally active ATs recognized as either pheochromocytomas, adrenocortical carcinomas, or benign functional adenomas. Patients with malignant tumors were younger than patients with benign tumors (mean age 2 vs 18, <i>P</i> < .001). Among patients with malignant ATs, the mortality reached 33.3% during a follow-up period of up to 15 years. Patients who were younger and received less aggressive treatments had better overall survival. Mortality was increased in all patients with malignant ATs compared to controls (<i>P</i> < .0001). Mortality was similar between patients with benign ATs and controls (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>Although rare, most identified tumors were malignant and associated with high mortality.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf058"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacodynamic Modeling of Cinacalcet in Secondary Hyperparathyroidism: Efficacy and Influencing Factors Analysis.","authors":"Zhizhou Wang, Yexuan Wang, Shun Han, Peixian Chen, Ruo Wu, Chuyao Fang, Junjie Cheng, Yujiao Wu, Tingting Guo, Xin Wen, Lujin Li","doi":"10.1210/jendso/bvaf021","DOIUrl":"10.1210/jendso/bvaf021","url":null,"abstract":"<p><strong>Context: </strong>Cinacalcet, the first FDA-approved calcimimetic agent for treating secondary hyperparathyroidism (SHPT), has unclear factors influencing its therapeutic efficacy in clinical practice.</p><p><strong>Objective: </strong>To establish a pharmacodynamic model for cinacalcet use in SHPT, analyze drug effect distribution and influencing factors, and determine optimal treatment strategy.</p><p><strong>Methods: </strong>We searched public databases for randomized trials on cinacalcet for SHPT, modeling changes in serum parathyroid hormone (PTH), calcium, and phosphorus postintervention. Key pharmacodynamic parameters and influencing factors were identified, with subgroup analysis for factors not in the covariate model. We also compared cinacalcet efficacy between United States/European Union (30-180 mg) and Asia (25-100 mg) dosage ranges.</p><p><strong>Results: </strong>Twenty-six studies (4242 subjects) were analyzed. Covariate analysis showed increasing PTH baseline and vitamin D use proportionally affected PTH and calcium decrease. Postintervention, maximum effects were observed with onset times of 0.46, 0.15, and 0.29 months. Subgroup analysis showed factors such as dialysis time, baseline calcium and phosphorus, phosphate binder use, gender proportion, patient ethnicity, blinding, and age influenced PTH, calcium, and phosphorus decrease. The efficacy of cinacalcet at a dosage of 25 to 100 mg in Asian populations was comparable to that observed at a dose range of 30 to 180 mg in Western populations, suggesting that reducing the therapeutic dose of cinacalcet may potentially yield a better benefit-risk ratio.</p><p><strong>Conclusion: </strong>We established a pharmacokinetic model for cinacalcet in SHPT treatment, providing crucial data for identifying effective patient populations and optimizing treatment strategies.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf021"},"PeriodicalIF":3.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etomidate in Severe Cushing Syndrome: A Systematic Review.","authors":"Dimuthu Tharanga Muthukuda, Kamani Dhanushka Liyanaarachchi, Kushalee Poornima Jayawickreme, Pasyodun Koralage Buddhika Mahesh, Vidana Gamage Dinithi Ruwanga, Sinduja Kumar, Chandrika Subasinghe, John Newell-Price","doi":"10.1210/jendso/bvaf039","DOIUrl":"10.1210/jendso/bvaf039","url":null,"abstract":"<p><strong>Background: </strong>Severe Cushing syndrome is a medical emergency. Etomidate is the only IV option available for treating hypercortisolism, especially in critically ill patients obviating oral medications.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted on the use of etomidate in the treatment of severe Cushing syndrome. This was registered in PROSPERO, and data reporting was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-six published articles comprising 76 clinical cases of 78 clinical episodes of etomidate use were included in the analysis for this review.</p><p><strong>Results: </strong>Etomidate was administered safely to patients with ages ranging from 2 months to 82 years. It served as the first-line treatment in 53.2% of the cases, with 84.3% of patients treated in intensive care unit (ICU) settings. Infusion durations varied from 3 hours to 5.5 months, but 84.8% of treatments were completed in under 2 weeks. Faster cortisol reduction rates were observed in patients with higher baseline cortisol levels (<i>P</i> = .02), those receiving a prior bolus dose (<i>P</i> = .015), and those given higher initial infusion rates (<i>P</i> = .004). Etomidate as first-line therapy (<i>P</i> = .01) and in ICU settings (<i>P</i> < .01) were associated with more rapid cortisol reduction compared to its use as subsequent therapy or in non-ICU settings. Overall, 80.9% of patients survived to receive definitive treatment.</p><p><strong>Conclusion: </strong>Etomidate is effective and safe for reducing cortisol levels in Cushing syndrome. There is a need for standardized guidelines on etomidate use, including detailed recommendations for different clinical settings and patient conditions to ensure safety and effectiveness.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 4","pages":"bvaf039"},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Bone Ultrasonometry and Cardiovascular Morbimortality: A Systematic Review and Meta-analysis.","authors":"Clément Vachey, Aurélie Dufour, Pier-Alexandre Tardif, Aboubacar Sidibé, Lynne Moore, Fabrice Mac-Way","doi":"10.1210/jendso/bvaf049","DOIUrl":"10.1210/jendso/bvaf049","url":null,"abstract":"<p><strong>Context: </strong>Quantitative ultrasound (QUS) can estimate bone mineral density and predict fracture risk, but its association with cardiovascular outcomes remains unclear.</p><p><strong>Objective: </strong>We aimed to assess the associations between bone QUS parameters and cardiovascular event risk, cardiovascular mortality (CVM) and all-cause mortality (ACM).</p><p><strong>Data sources: </strong>Pubmed, Embase, Cochrane Library databases, and grey literature were searched.</p><p><strong>Study selection: </strong>We considered studies including people aged >40 years who reported associations between bone QUS parameters (any bone site) and our outcomes.</p><p><strong>Data extraction: </strong>Two reviewers selected eligible studies, extracted and analyzed data, and assessed risk of bias with the Risk of Bias in Non-randomized Studies of Exposure tool. Adjusted hazard ratios (HR) with 95% confidence intervals (CIs), estimated for 1 SD reduction of QUS parameters, were pooled using random effects meta-analyses.</p><p><strong>Data synthesis: </strong>We included 9 studies with 275 to 477 683 (median = 3244) participants (follow-up duration range 2.8-12.8 years). All studies presented associations based on calcaneal QUS parameters; only 2 reported associations with cardiovascular events with discordant results. Seven studies reported associations with CVM and 7 with ACM. Meta-analyses based on 3 studies showed that broadband ultrasound attenuation (BUA) was inversely associated with CVM (HR = 1.22, 95% CI: 1.11-1.34, <i>I</i> ² = 0%) and ACM (HR = 1.16, 95% CI: 1.10-1.23, <i>I</i> ² = 0%). Meta-analyses, based on 4 and 3 studies, respectively, showed that speed of sound (SOS) was also inversely associated with CVM (HR = 1.19, 95% CI: 1.11-1.27, <i>I</i> ² = 29%) and ACM (HR = 1.15, 95% CI: 1.07-1.23, <i>I</i> ² = 0%).</p><p><strong>Conclusion: </strong>In a cohort of middle-aged individuals, a decrease in calcaneal BUA and SOS were both independently associated with higher cardiovascular and ACM.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 5","pages":"bvaf049"},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}