Journal of the Endocrine Society最新文献

{"title":"Diagnostic utility of basal luteinizing hormone in evaluating central precocious puberty.","authors":"Vittorio Ferrari, Daniela Elleri, Jennifer Roach, Mike Crane, Rod Thomas Mitchell","doi":"10.1210/jendso/bvag131","DOIUrl":"10.1210/jendso/bvag131","url":null,"abstract":"<p><strong>Background: </strong>Basal luteinizing hormone (bLH) is increasingly proposed as a surrogate marker of hypothalamic-pituitary-gonadal activation, potentially reducing the need for gonadotropin-releasing hormone (GnRH) testing in children with suspected central precocious puberty (CPP). However, diagnostic thresholds remain assay-dependent, and values below the detection limit complicate interpretation.</p><p><strong>Objective: </strong>This study aims to assess the diagnostic performance of bLH in predicting GnRH test response in patients evaluated for suspected CPP, using a censoring-aware approach for values below the assay limit of detection (LOD).</p><p><strong>Methods: </strong>We retrospectively analyzed 258 first-time GnRH stimulation tests performed for suspected CPP between 2011 and 2025 at the Royal Hospital for Children and Young People, Edinburgh. Basal luteinizing hormone was measured in fasting early-morning samples collected between 08:00 and 10:00 Am immediately before GnRH administration, with Abbott Architect (LOD 0.5 U/L) or Roche Cobas (LOD 0.3 U/L). Values below the assay-specific LOD were treated as left-censored observations and handled with parametric regression on order statistics. Receiver operating characteristic analyses were performed separately by sex.</p><p><strong>Results: </strong>Basal luteinizing hormone showed good accuracy for predicting a pubertal GnRH response, with an AUC of 0.80. The optimal threshold was 0.5 U/L (sensitivity 0.61, specificity 0.97), while a bLH ≥ 1.0 U/L achieved 100% specificity and positive predictive value. Sex-stratified analyses showed similar performance in girls and boys, although discrimination was higher in boys. Combined models including bLH and sex steroids did not materially improve discrimination in girls, whereas the model combining bLH and testosterone showed strong performance in boys (AUC 0.88).</p><p><strong>Conclusion: </strong>Early-morning bLH provides clinically useful information for the assessment of suspected CPP. Higher values can reliably predict a positive GnRH response, supporting its use as a first-line test and a more selective use of GnRH stimulation testing, whereas low or indeterminate values still require careful clinical interpretation.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag131"},"PeriodicalIF":4.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437097","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":"Achondroplasia management in the era of targeted therapies: a meta-analysis of C-type natriuretic peptide analogs.","authors":"Abul Bashar Mohammad Kamrul-Hasan, Suma Uday, Lakshmi Nagendra, Deep Dutta, Saptarshi Bhattacharya, Joseph M Pappachan, Ambika P Ashraf","doi":"10.1210/jendso/bvag121","DOIUrl":"10.1210/jendso/bvag121","url":null,"abstract":"<p><strong>Context: </strong>No prior meta-analysis has systematically assessed efficacy and safety of C-type natriuretic peptide (CNP) analogs within the context of evolving understanding of FGFR3 biology and achondroplasia natural history.</p><p><strong>Objective: </strong>To evaluate the safety and efficacy of CNP analogs in children with achondroplasia and contextualize clinical outcomes and natural history.</p><p><strong>Methods: </strong>Systematic review of randomized control trials and real-world studies evaluating the safety and efficacy of CNP analogs (vosoritide and navepegritide) in children aged <18 years with genetically confirmed achondroplasia was performed. Coprimary outcomes of interest were adverse events (AEs) and changes from baseline in annualized growth velocity (AGV) at the end of the trials. Secondary outcomes included changes from baseline in height <i>Z</i>-score, standing height, and upper-to-lower body segment (ULS) ratio.</p><p><strong>Results: </strong>Eleven studies (<i>N</i> = 542) were included, of which 4 RCTs (<i>n</i> = 326) with low overall risk of bias were meta-analyzed. Overall and serious AE rates were comparable between CNP analogs and placebo, except for higher relative risks of injection site reactions (1.65), urticaria (4.04), and swelling (3.57). C-type natriuretic peptide analogs significantly increased mean differences in AGV (1.36 cm/year; 95% CI: 1.05-1.68; <i>P</i> < .00001) and standing height (1.24 cm; 95% CI: 0.47-2.01; <i>P</i> = .002), without short-term effect on ULS ratio. Real-world studies demonstrated sustained growth benefits with infrequent serious AEs or treatment discontinuations.</p><p><strong>Conclusion: </strong>C-type natriuretic peptide analogs provide slight but statistically meaningful improvements in linear growth in children with achondroplasia with acceptable short-term safety profile. Long-term studies are needed to define optimal timing of therapy on adult height, functional outcomes, and achondroplasia-related complications.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag121"},"PeriodicalIF":4.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265138","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":"Disparities in liver-related care among transgender adults with steatotic liver disease: a retrospective cohort study.","authors":"Maria Ortega Abad, Leandro Sierra, Nikki Duong, Ricardo Correa","doi":"10.1210/jendso/bvag129","DOIUrl":"10.1210/jendso/bvag129","url":null,"abstract":"<p><strong>Background: </strong>Transgender (TGD) adults experience healthcare disparities across multiple domains, yet care for steatotic liver disease (SLD) remains uninvestigated.</p><p><strong>Aims: </strong>Evaluate whether TGD adults with SLD receive equitable liver-related care compared with cisgender (CGD) adults.</p><p><strong>Methods: </strong>Retrospective cohort study conducted at a tertiary medical center (2015-2025). Adults with SLD were identified by a 2-step process (ICD-10 codes, manual chart review). Patients with other causes of liver disease and missing data were excluded. TGD status was defined by ICD-10 codes for gender dysphoria, documented gender incongruence or use of gender affirming hormone therapy. Controls and cases were selected from the same cohort with a 2:1 sampling ratio. Primary outcomes, gastroenterology consultation, hepatology assessment (FIB-4, elastography, or biopsy), and advanced workup, were analyzed using logistic regression adjusting for age and cardiometabolic covariates. An age restricted (30-60) sensitivity analysis was performed. Secondary outcomes included viral hepatitis screening/vaccination, SLD-directed therapies, and 5-year BMI trajectories.</p><p><strong>Results: </strong>Among 254 adults (85 TGD, 169 CGD), TGD individuals were younger (36.0 vs 57.0 years, <i>P</i> < .001) with higher MASLD prevalence (91.8% vs 77.5%, <i>P</i> = .05). TGD status was associated with lower odds of gastroenterology consultation (aOR 0.41; 95% CI .18-.93), any hepatology assessment (aOR 0.35; 95% CI .18-.70), advanced hepatology workup (aOR 0.34; 95% CI .17-.69), with robust findings in sensitivity analysis. GLP-1 agonist prescriptions were lower (9.4% vs 19.5%, <i>P</i> = .03), and BMI increased vs controls (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>TGD adults with SLD experience substantial disparities in care, requiring integrated, inclusive pathways to advance health equity.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag129"},"PeriodicalIF":4.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265167","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":"Prevalence of diabetes mellitus in long-term cancer survivors treated with craniospinal irradiation.","authors":"Franziska Richter, Cassandra Runow, Denise Obrecht-Sturm, Lea L Kronziel, Stefan Rutkowski, Desiree Grabow, Christian Denzer, Thorsten Langer, Judith Gebauer","doi":"10.1210/jendso/bvag116","DOIUrl":"10.1210/jendso/bvag116","url":null,"abstract":"<p><strong>Background: </strong>Childhood, adolescent, and young adult cancer survivors (CAYA) are at an increased risk for metabolic disorders such as diabetes mellitus. Although this risk has been well-documented for leukemia survivors and those exposed to abdominal radiotherapy, the metabolic risk profile for brain tumor survivors remains largely unexplored.</p><p><strong>Methods: </strong>This study assessed the prevalence of diabetes and dysglycemia in 2 CAYA survivor cohorts. The first included medulloblastoma and ependymoma survivors (HIT-MED), with data collected via self-reported online questionnaires. The second (CLI) was a retrospective analysis of an unselected cohort from our late effects clinic. In this cohort, dysglycemia was defined using hemoglobin A1c measurements alone, without additional glucose-based diagnostic criteria.</p><p><strong>Results: </strong>In the HIT-MED group, 37% (197/527) participated in an online-based questionnaire, revealing a diabetes mellitus prevalence of 3.05%. A total of 122 were male and 75 female, mean age was 27.1 ± 4.5 years (range 19-41). In comparison to an age-matched general population, there was no significant difference (<i>P</i> = .468). Among survivors in the CLI group who received craniospinal irradiation (mean age 38 years at assessment), 34.6% (9/26) exhibited dysglycemia, including 7.7% (2/26) with diabetes mellitus and 26.9% (7/26) with prediabetic glucose levels. This represented the second highest prevalence of impaired glucose regulation among all irradiation subgroups.</p><p><strong>Conclusion: </strong>CAYA brain tumor survivors exposed to craniospinal radiotherapy have an elevated risk of dysglycemia compared to other survivor cohorts. These findings support the need for structured, risk-adapted long-term metabolic monitoring to enable early intervention and reduce long-term morbidity.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag116"},"PeriodicalIF":4.4,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308812","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":"The role of hormonal markers in predicting reproductive lifespan in girls with Turner syndrome-a retrospective study.","authors":"Sanne van der Coelen, Theo Sas, Annette Richter-Unruh, Didi Braat, Kathrin Fleischer, Sapthami Nadesapillai, Joanna IntHout, Janielle van der Velden","doi":"10.1210/jendso/bvag122","DOIUrl":"10.1210/jendso/bvag122","url":null,"abstract":"<p><strong>Context: </strong>Early prediction of ovarian reserve is essential to improve fertility counseling in girls with Turner syndrome (TS).</p><p><strong>Objective: </strong>This work aimed to examine the occurrence of puberty and longitudinal hormone patterns in girls with TS, and to take an initial step toward developing a prediction model for ovarian function. Main outcome measures included thelarche, menarche, and age of premature ovarian insufficiency (POI).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of girls with TS. Levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), antimüllerian hormone (AMH), inhibin B, and information on karyotype and puberty were extracted from the medical records. A joint model combining a Cox survival model and 2 linear mixed-effects models for FSH and AMH was used to model the association between POI and longitudinal hormone values.</p><p><strong>Results: </strong>A total of 365 girls were included, of whom 287 had available data on pubertal development. In this patient cohort, 43% had monosomy 45,X, 17% had mosaic 45,X/46,XX, 18% had an isochromosome X, and 22% had an \"other\" karyotype in lymphocytes. Girls with spontaneous puberty had lower FSH and higher AMH before age 8 years compared to girls without spontaneous puberty. The joint model showed that lower AMH is significantly related to POI, while FSH was not significantly related to POI. The individual predicted risks on POI come with large uncertainty.</p><p><strong>Conclusion: </strong>AMH and FSH patterns contribute to understanding ovarian reserve at an early age in girls with TS. Creating a prediction model remained challenging and more data are needed.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag122"},"PeriodicalIF":4.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218332","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":"Emery-Dreifuss muscular dystrophy and familial partial lipodystrophy, Dunnigan variety due to heterozygous <i>LMNA</i> variants.","authors":"Anum, Xilong Li, Rebecca J Brown, Abhimanyu Garg","doi":"10.1210/jendso/bvag128","DOIUrl":"10.1210/jendso/bvag128","url":null,"abstract":"<p><strong>Context: </strong>Specific heterozygous pathogenic variants in <i>LMNA</i> have been reported in patients with Dunnigan-type familial partial lipodystrophy (FPLD2), while other variants cause autosomal dominant Emery-Dreifuss muscular dystrophy (AD-EDMD). FPLD2 is characterized by variable loss of subcutaneous fat from the extremities and trunk, and AD-EDMD is characterized by early joint contractures, proximal muscle weakness, and cardiac conduction defects. Previously, only 2 families have been reported with combined features of FPLD2 and AD-EDMD.</p><p><strong>Objective: </strong>To report the overlapping phenotype of both FPLD2 and AD-EDMD in 5 families with heterozygous <i>LMNA</i> variants.</p><p><strong>Methods: </strong>Clinical, anthropometric, laboratory, and genotyping data of affected subjects from 5 families with female probands presenting with FPLD2 and AD-EDMD phenotypes were collected.</p><p><strong>Results: </strong>Affected individuals (8 females, ages 18-57 years; 3 males, ages 25-41 years) harbored heterozygous p.T528R, p.R527P, p.R541P, or p.R453W <i>LMNA</i> variants. Five females and 2 males had joint contractures and proximal muscle weakness, and 4 females and 1 male had pacemaker-defibrillator implantation for cardiac arrhythmias, confirming AD-EDMD. Subcutaneous fat loss from the extremities confirming FPLD2 was observed in all females but only in 2 males. Four females had diabetes mellitus and hypertriglyceridemia, and 1 male had hypertriglyceridemia. Two females, 50 and 58 years old, died due to aspiration pneumonia and cerebrovascular accident, respectively, and one 40-year-old male died of alcoholic liver disease.</p><p><strong>Conclusion: </strong>Our report brings attention to the frequent co-occurrence of FPLD2 and AD-EDMD. In the future, all patients with AD-EDMD should be carefully evaluated for clinical signs of lipodystrophy and metabolic complications.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag128"},"PeriodicalIF":4.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13338774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679088","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":"Integrated mapping resolves pathogenicity of 11 <i>CYP21A2</i> variants in congenital adrenal hyperplasia.","authors":"Yingtong Xu, Anna Matveeva, Flemming Steen Jørgensen, Amit V Pandey","doi":"10.1210/jendso/bvag127","DOIUrl":"10.1210/jendso/bvag127","url":null,"abstract":"<p><strong>Context: </strong>Genotype-phenotype correlations in congenital adrenal hyperplasia (CAH) are often complicated by rare <i>CYP21A2</i> missense variants classified as variants of uncertain significance.</p><p><strong>Objective: </strong>To resolve the pathogenicity and structural mechanisms of 11 <i>CYP21A2</i> variants (p.L10del, p.R76K, p.E162G, p.S274Y, p.L308V, p.S373N, p.P387L, p.H393Q, p.R401G, p.R436C, and p.S494N).</p><p><strong>Methods: </strong>We integrated population allele frequency analysis (gnomAD, 1000G, and 38KJPN) with in silico structural modeling (ConSurf, FoldX, and DUET) and molecular dynamics simulations. In vitro functional assays were performed in HEK293T cells using radiolabeled progesterone and 17-hydroxyprogesterone, with results normalized to CYP21A2 protein expression.</p><p><strong>Results: </strong>The variants p.L10del and p.S494N were identified as common polymorphisms (allele frequencies >5% in specific cohorts) retaining near-wild-type activity (∼67-99%), supporting a benign classification. Variants p.R76K and p.S373N showed higher activities (∼72-92%), supporting a likely benign classification. Conversely, p.L308V, p.P387L, and p.R436C exhibited severe loss of function (<20% activity for 17-hydroxyprogesterone) and were reclassified as pathogenic (simple virilizing CAH). Structural modeling revealed that p.L308V causes steric clashes in the conserved I-helix, while p.R436C disrupts the surface hydrogen-bond network essential for redox partner docking. Variants p.E162G, p.H393Q, and p.R401G showed moderate impairment (∼40-45% activity), consistent with likely pathogenic status and nonclassic CAH.</p><p><strong>Conclusion: </strong>This study provides a potential diagnostic map for 11 <i>CYP21A2</i> variants, distinguishing severe pathogenic mutations from benign polymorphisms. Our findings refine the molecular diagnosis of CAH.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag127"},"PeriodicalIF":4.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318010","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":"Model-based somapacitan dosing and IGF-I response in children born SGA or with ISS, Noonan or Turner syndromes.","authors":"Julie Desrochers, Philippe Backeljauw, Michael Højby, Rasmus Juul Kildemoes, Agnès Linglart, Jun Mori, Rory Forseth Leisegang","doi":"10.1210/jendso/bvag124","DOIUrl":"10.1210/jendso/bvag124","url":null,"abstract":"<p><strong>Context: </strong>The weekly insulin-like growth factor I (IGF-I) profile for children and adolescents treated with long-acting growth hormone differs from that of daily growth hormone (GH).</p><p><strong>Objective: </strong>The objective of this study is to provide guidance on the use of once-weekly somapacitan and IGF-I monitoring in prepubertal short children and adolescents born small for gestational age (SGA) or with idiopathic short stature (ISS), Noonan syndrome (NS), or Turner syndrome (TS).</p><p><strong>Methods: </strong>Modeling, including population pharmacokinetic/pharmacodynamic (PK/PD) modeling, were utilized, analyzing IGF-I data from 4 clinical studies, including 2 phase 3 trials (REAL8: NCT05330325; REAL9: NCT05723835) involving children and adolescents born SGA (<i>N</i> = 80), ISS (<i>N</i> = 69), NS (<i>N</i> = 62), and TS (<i>N</i> = 79), along with additional data from phase 2 (REAL5: NCT03878446, <i>N</i> = 59) and phase 1 trials (NCT01973244, <i>N</i> = 24).</p><p><strong>Results: </strong>Relationships between somapacitan dose, exposure, baseline IGF-I SD score (SDS), and height velocity (HV) were established in children born SGA, with similar responses anticipated for those with ISS, NS, or TS. A linear model enabled the estimation of average weekly IGF-I exposure from a single sample collected during the somapacitan dosing interval. IGF-I SDS simulations support flexible dosing changes while maintaining a minimum of 4 days between doses.</p><p><strong>Conclusion: </strong>Somapacitan 0.24 mg/kg/week produced similar IGF-I SDS changes and height velocity increases as daily GH in prepubertal short children and adolescents born SGA or with ISS, NS, or TS. The results support that the guidance already established for GHD regarding somapacitan initiation, dosing flexibility, and IGF-I monitoring remain appropriate for prepubertal short children and adolescents born SGA or with ISS, NS, or TS.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag124"},"PeriodicalIF":4.4,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13306058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345796","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":"Urinary iodine-to-creatinine ratio and outcomes after radioactive iodine ablation in thyroid cancer.","authors":"Maria Vamvini, Ashna Grover, Josephine H Li, Zhiheng H He, James V Hennessey","doi":"10.1210/jendso/bvag125","DOIUrl":"10.1210/jendso/bvag125","url":null,"abstract":"<p><strong>Context: </strong>Radioactive iodine ablation (RAIA) in differentiated thyroid cancer (DTC) requires elevated thyroid-stimulating hormone (TSH) levels, achieved through thyroid hormone withdrawal (THW) or recombinant human TSH (rhTSH). A low-iodine diet (LID) is recommended to enhance RAIA efficacy, but its impact on long-term outcomes remains uncertain.</p><p><strong>Objective: </strong>To determine whether pre-ablation urinary iodine concentrations predict disease outcomes after RAIA.</p><p><strong>Methods: </strong>This retrospective study evaluated DTC patients treated with post-surgical RAIA at BIDMC from 2007 to 2020. Of 463 patients reviewed, 304 met inclusion criteria (THW: 189; rhTSH: 115), all completing a 2-week LID; urinary iodine-to-creatinine ratio (UICR) was measured as iodine status marker. Disease recurrence at 12 months, defined by elevated thyroglobulin (Tg), abnormal neck ultrasound, or a positive whole-body scan, was the primary outcome, with associations between UICR and outcomes evaluated using univariable and multivariable logistic regression.</p><p><strong>Results: </strong>Positive pre-treatment Tg (odds ratio [OR] 6.13, 95% CI 1.90-19.83; <i>P</i> = .002) and AJCC stage IV disease (OR 8.45, 95% CI 1.39-51.36; <i>P</i> = .02) were independently associated with recurrence. Older age was associated with lower recurrence risk only in unadjusted models. UICR showed no association with outcomes. Although mean UICR was higher in the rhTSH group (<i>P</i> < .0001), recurrence rates were similar between THW and rhTSH (<i>P</i> = .3).</p><p><strong>Conclusion: </strong>Higher UICR in rhTSH-prepared patients did not translate into worse outcomes. Pre-treatment Tg and stage IV disease were the strongest predictors of recurrence, whereas iodine status was not. These findings suggest that strict iodine depletion at the level achieved here, reflected by UICR, may not determine RAIA efficacy in DTC.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 8","pages":"bvag125"},"PeriodicalIF":4.4,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578958","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":"Preoperative eGFR, age, and sex predict early postoperative renal changes in acromegaly.","authors":"Keiko Tomiyama, Izumi Fukuda, Mikiko Okazaki-Hada, Shunsuke Kobayashi, Mototsugu Nagao, Shigeyuki Tahara, Masato Iwabu","doi":"10.1210/jendso/bvag126","DOIUrl":"10.1210/jendso/bvag126","url":null,"abstract":"<p><strong>Objective: </strong>Acromegaly induces renal alterations. However, early postoperative renal changes following rapid hormonal correction remain unclear. We assessed early postoperative changes in estimated glomerular filtration rate (eGFR) and their associated factors, focusing on preoperative eGFR, age, and sex.</p><p><strong>Methods: </strong>We retrospectively analyzed 44 patients with acromegaly who underwent trans-sphenoidal surgery between 2012 and 2024. We analyzed renal function using preoperative eGFR and changes in eGFR at postoperative day 14 (POD14) relative to preoperative values (ΔeGFR). Patients were stratified by preoperative eGFR (≥ 90 vs <90 mL/min/1.73 m²), age (<65 vs ≥65 years), and sex. Multivariate regression analyses were performed to identify factors associated with preoperative eGFR and postoperative changes.</p><p><strong>Results: </strong>The eGFR had decreased significantly by POD14, especially among patients with higher preoperative eGFR (ΔeGFR: -27, <i>P</i> < .0001) and in females. Significant declines in eGFR occurred in both younger and older patients, with greater reductions in younger patients. Among older patients, 3 exhibited declines in eGFR to <60 mL/min/1.73 m² at POD14. Multivariate analysis revealed an association between female sex and greater reductions in IGF-1 standard deviation scores with larger ΔeGFR.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first study to demonstrate that rapid postoperative hormonal reductions in acromegaly are associated with early eGFR declines, particularly in patients with higher baseline eGFR, females, and younger patients. While eGFR declines are modest, patients with advanced age and metabolic comorbidities may be at risk of clinically relevant renal impairment and require careful monitoring.</p>","PeriodicalId":17334,"journal":{"name":"Journal of the Endocrine Society","volume":"10 7","pages":"bvag126"},"PeriodicalIF":4.4,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13265133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258454","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}