Journal of the Endocrine Society最新文献

{"title":"Comparison of BoneXpert and IB-Lab-PANDA automated Bone Age Evaluation in Children With Growth and Puberty Disorders.","authors":"Inge-Lore Ruiz-Arana, Victor Lechanteur, Kanetee Busiah, Thérèse Bouthors, Maria-Christina Antoniou, Sophie Stoppa-Vaucher, Martina Ruspa, Leonor Alamo, Michael Hauschild","doi":"10.1210/jendso/bvaf122","DOIUrl":"10.1210/jendso/bvaf122","url":null,"abstract":"<p><strong>Context: </strong>Bone age (BA) evaluation in children presenting growth problems is time-consuming. Artificial intelligence (AI) BA assessment programs are increasingly used. However, agreement between different commercially available methods in the same population, or possible age-, puberty- or sex-related differences have not been sufficiently evaluated.</p><p><strong>Methods: </strong>BA assessment of 521 left hand radiographs of patients aged 2-19 years with IB-lab-PANDA® and BoneXpert® were compared. Of the 521 radiographs, 213 were compared to the Greulich-Pyle (GP) reference. We analyzed gender, age, diagnosis, body mass index (BMI) and puberty categories. Accuracy was calculated as mean-absolute-deviation (MAD) and root-mean-square-error (RMSE).</p><p><strong>Results: </strong>MAD was 0.61 years and the RMSE 0.83 years between BoneXpert and IB-lab-PANDA, with poor agreement in girls over 14 years (MAD 1.18 years).Compared to the manual rating, both methods showed a positive bias in boys (0.28 years BoneXpert vs 0.51 years IB-lab-PANDA) and in children with pathologies associated with BA delay (BoneXpert 0.18 years vs IB-lab-PANDA 0.35 years). IB-lab-PANDA underestimated BA in girls after 14 years (-0.67 years). IB-lab-PANDA had a MAD of 0.64 years and RMSE of 0.85 years compared to manual assessment, whereas BoneXpert had a MAD of 0.63 years and RMSE of 0.82 years.BoneXpert was significantly more accurate than IB-lab-PANDA in prepubertal children (MAD 0.7 vs 0.83 years; <i>P</i> = .027).</p><p><strong>Conclusion: </strong>The direct agreement between IB-lab-PANDA® and BoneXpert® falls within human inter-rater variability. Their agreement on manual BA determination is equivalent except in prepubertal children, where BoneXpert seems more accurate. Both are fast, valuable tools for determining BA accurately and efficiently.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf122"},"PeriodicalIF":3.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958963","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":"Efficacy and Hepatotoxicity During Rapid Titration of Ketoconazole and/or Metyrapone in Patients With Cushing Syndrome.","authors":"Henrik Elenius, Raven McGlotten, Lynnette K Nieman","doi":"10.1210/jendso/bvaf118","DOIUrl":"10.1210/jendso/bvaf118","url":null,"abstract":"<p><strong>Context: </strong>Ketoconazole (KTZ) and metyrapone (MET) are used to normalize cortisol in Cushing syndrome (CS). Available recommendations can delay time to control.</p><p><strong>Objective: </strong>This work aimed to identify predictors of treatment success and hepatotoxicity during rapid titration of KTZ and MET and to assess differences in blood pressure or potassium.</p><p><strong>Methods: </strong>A retrospective evaluation was conducted at a tertiary referral center. Participants included 52 patients receiving treatment for adrenocorticotropin (ACTH)-dependent CS from 2004 to 2023. Interventions included KTZ or MET. The main outcome measures included the number of patients achieving target morning serum cortisol (AM F), defined as 12 mcg/dL or less (≤331 nmol/L), or increased liver function tests (LFTs) suggesting drug-induced liver injury (alanine/aspartate transaminase and alkaline phosphatase ≥3-fold upper limit of normal [≥3ULN], total bilirubin [Bili] ≥2ULN).</p><p><strong>Results: </strong>KTZ achieved target AM F in 39% (95% CI 24%-56%) of patients, compared to 74% (95% CI 49%-90%) on MET. Lower baseline AM F predicted success only with MET. Among KTZ responders, maximal effect occurred by 2 days after a dose increase. LFTs worsened with KTZ and improved with MET. A similar proportion of patients had an LFT reach or exceed 3ULN with KTZ (22%; 95% CI 10%-39%) and MET (25%; 95% CI 4%-64%). Higher doses of KTZ, but not MET, predicted this. Bili reached or exceeded 2ULN in 3% (95% CI 0%-15%) of patients receiving KTZ and none receiving MET. Blood pressure and hypokalemia improved with KTZ but did not change with MET.</p><p><strong>Conclusion: </strong>Hypercortisolism can likely be controlled faster with rapid titration of KTZ or MET. LFT abnormalities increased with KTZ but were common with MET treatment, likely reflecting underlying liver pathology in CS.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf118"},"PeriodicalIF":3.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958933","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":"Glucagon-Like Peptide-1 Receptor Agonists and Peri-Procedural Aspiration Risk.","authors":"Cindy N Ho, Alessandra T Ayers, Michael A Kohn, Guillermo E Umpierrez, David C Klonoff","doi":"10.1210/jendso/bvaf088","DOIUrl":"10.1210/jendso/bvaf088","url":null,"abstract":"<p><strong>Context: </strong>Delayed gastric emptying caused by glucagon-like peptide-1 receptor agonists (GLP-1RAs) has raised concerns about increased aspiration risk during surgical and endoscopic procedures. In June 2023, the American Society of Anesthesiologists (ASA) recommended discontinuing GLP-1RAs one day (daily users) or one week (weekly users) before elective surgery or endoscopic esophagogastroduodenoscopy (EGD). In October 2024, the ASA reversed the initial recommendation and advised most patients to continue taking GLP-1RAs before elective surgery.</p><p><strong>Objective: </strong>We conducted a systematic review of the evidence for or against the original recommendation.</p><p><strong>Methods: </strong>We searched PubMed for retrospective cohort studies published between June 2023 and March 2025 investigating the association between GLP-1RA use and the risk of aspiration/pneumonia in patients undergoing elective surgery or endoscopic procedures. We calculated a summary risk ratio for studies that could be combined.</p><p><strong>Results: </strong>We identified 3 studies of elective surgery and 4 of EGD using large databases to identify an increased risk of aspiration/pneumonia associated with GLP-1RA use. The 3 elective surgery studies had a combined risk ratio of 1.00 [0.76, 1.30]. The 4 EGD studies had a combined risk ratio of 1.10 [0.95, 1.27]. In one study, a parallel analysis of the aspiration/pneumonia risk associated with opioid medications found a risk ratio of 2.68 [1.89, 3.81], indicating that the methodology could detect an increased risk of aspiration/pneumonia from a motility inhibitor.</p><p><strong>Conclusion: </strong>Although GLP-1RAs cause delayed gastric emptying, retrospective cohort studies using large real-world evidence databases have not consistently identified a GLP-1RA-associated risk of aspiration/pneumonia for elective surgical and endoscopic procedures.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf088"},"PeriodicalIF":3.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958952","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":"Management of Osilodrostat Therapy in Patients With Cushing's Syndrome: A Modified Delphi Consensus Panel.","authors":"Susan L Samson, Diane Donegan, Eliza B Geer, Murray B Gordon, Oksana Hamidi, Wenyu Huang, Adriana G Ioachimescu, Julie M Silverstein, Joanna L Spencer-Segal, Nicholas A Tritos, Kevin C J Yuen","doi":"10.1210/jendso/bvaf103","DOIUrl":"10.1210/jendso/bvaf103","url":null,"abstract":"<p><strong>Introduction: </strong>Endogenous Cushing's syndrome (CS) is a rare endocrine disorder that chronically exposes patients to supraphysiological cortisol levels. Primary therapy for CS consists of surgery. Medical therapies are also considered for many patients with CS, including those who are not surgical candidates or have persistent or recurrent hypercortisolism after surgery. Osilodrostat, an adrenal steroidogenesis inhibitor, demonstrated sustained efficacy and safety in phase 3 clinical trials and is currently approved to treat endogenous CS in Europe and the United States. Because of limited clinical experience, questions remain about how to individualize osilodrostat treatment for different clinical scenarios and special populations. Additional guidance from experts based on clinical study and real-world experiences with osilodrostat is needed.</p><p><strong>Methods: </strong>A modified Delphi consensus panel study was conducted consisting of 13 specialists from high-volume endocrinology centers with experience prescribing osilodrostat. Advisors participated in 3 consensus rounds (2 anonymous surveys, 1 virtual workshop) over approximately 10 months to provide guidance and recommendations on optimal osilodrostat use.</p><p><strong>Results: </strong>Over 2 surveys and a 2-hour virtual workshop, 26 statements related to osilodrostat achieved consensus among Delphi panelists and 5 were excluded. Topics included patient preparation before osilodrostat initiation, baseline testing, dosing at onset and during treatment, managing dose adjustments, monitoring during dose titration, and treatment alterations for planned and unexpected clinical events.</p><p><strong>Conclusion: </strong>Treatment guidance and recommendations for osilodrostat use were obtained using the Delphi method. These statements are intended to provide physicians with education and guidance on using osilodrostat to optimally treat patients with CS.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 8","pages":"bvaf103"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575761","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":"Continuous Glucose Monitoring in Patients With Postbariatric Hypoglycemia: Effect on Hypoglycemia and Quality of Life.","authors":"Nicole Turk, Suruchi Ramanujan, Termeh Shamloo, Colleen Craig, Tracey McLaughlin","doi":"10.1210/jendso/bvaf106","DOIUrl":"10.1210/jendso/bvaf106","url":null,"abstract":"<p><strong>Context: </strong>Postbariatric hypoglycemia (PBH), complicating up to one-third of bariatric surgeries, is characterized by repeated episodes of severe hypoglycemia and hypoglycemia unawareness that threaten patient safety and impair quality of life.</p><p><strong>Objective: </strong>We tested the hypothesis that use of a continuous glucose monitor (CGM) would reduce hypoglycemia and improve quality of life in patients with PBH.</p><p><strong>Design: </strong>In a crossover design, 14 patients with diagnosed PBH were assigned in random order to sequential treatment with unblinded CGM or blinded CGM/no alarms for 10 days each. Glucose and quality of life measures were compared between the 2 periods.</p><p><strong>Setting: </strong>Outpatient.</p><p><strong>Outcomes: </strong>Hypoglycemia measured by fingerstick blood glucose in response to symptoms or CGM alarm and CGM glucose values; quality of life measures included dietary liberalization and hypoglycemia-related worries/behaviors captured by the Hypoglycemia Fear Survey-II.</p><p><strong>Results: </strong>Baseline frequency of hypoglycemic events, disability, and hypoglycemia-related worries were high. Symptom-triggered hypoglycemic events confirmed by fingerstick glucose were reduced 6-fold (<i>P</i> = .008) and the glucose nadir measured by CGM was >8 mg/dL higher (<i>P</i> = .005) during unblinded use of CGM compared to the blinded comparison period. Hypoglycemia Fear Survey-II scores improved significantly in response to unblinded CGM use compared to the blinded control period (<i>P</i> = .026). The intake of carbohydrate-containing meals increased without increasing rate of postprandial hyper- or hypoglycemia.</p><p><strong>Conclusion: </strong>Use of unblinded CGM in patients with PBH reduces frequency and severity of hypoglycemia and improves quality of life by decreasing hypoglycemia-related worries and enabling a less restrictive diet. CGM should be considered a first-line treatment for patients with PBH.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 9","pages":"bvaf106"},"PeriodicalIF":3.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958889","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":"Long-Term Testosterone Shows Cardiovascular Safety in Men With Testosterone Deficiency in Electronic Health Records.","authors":"Yilu Lin, Shaveta Gupta, Lizheng Shi, Franck Mauvais-Jarvis, Vivian Fonseca","doi":"10.1210/jendso/bvaf074","DOIUrl":"10.1210/jendso/bvaf074","url":null,"abstract":"<p><strong>Objective: </strong>Our objective is to examine the association between cardiovascular (CV) safety and long-term testosterone therapy (TTh) in men with testosterone deficiency (TD) in real-world practice.</p><p><strong>Method: </strong>We extracted the electronic health records of 2683 adult men with TD from 3 healthcare systems from January 1, 2012, to June 30, 2023. We matched TTh and non-TTh groups in a 1:1 ratio based on age, race, Charlson Comorbidity Index, and serum testosterone level via propensity score. We used intent-to-treat analysis using Kaplan-Meier curves and Cox regressions to examine CV risk for major adverse cardiovascular events (MACE). We also explored the impact of TTh on diabetes and hyperlipidemia development and progression. We compared 928 TTh patients to 928 untreated patients with a median follow-up of 3 years for both groups.</p><p><strong>Results: </strong>After matching, body mass index, diastolic blood pressure, hyperlipidemia, hypertension, depression, and anxiety were statistically significant different between treatment and control cohorts. The log-rank test for the cumulative MACE incidence was comparable (<i>P</i> > .05). There were no statistically significant associations between TTh use and CV risk hazard ratios (HRs) in the univariate Cox regression (HR [95% CI]: 1.01 [0.75-1.36]) and Cox regressions adjusted by the preexisting MACE (HR [95% CI]: 0.98 [0.72-1.32]) and other baseline covariates (HR [95% CI]: 0.93 [0.68-1.26]). No statistically significant associations were found between TTh and diabetes. For hyperlipidemia, TTh group presented statistically significant improvement on low-density lipoprotein and total cholesterol.</p><p><strong>Conclusion: </strong>TTh use among men with TD was not associated with increased CV risk in real-world clinical practice.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"9 8","pages":"bvaf074"},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12146265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266541","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":"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}