Therapeutic Advances in Endocrinology and Metabolism最新文献

{"title":"Update on the medical management of fibrous dysplasia of the bone.","authors":"Kelly L Wentworth, Jeayoung Park, Xiaobing Yu, Edward C Hsiao","doi":"10.1177/20420188251347350","DOIUrl":"https://doi.org/10.1177/20420188251347350","url":null,"abstract":"<p><p>Fibrous dysplasia (FD) is a rare, benign skeletal disorder characterized by expansile, fibrotic bone lesions that replace normal bone, resulting in decreased bone strength, pain, and fractures. The clinical presentation of FD can vary widely, complicating the diagnosis. FD can manifest as monostotic (single bone) or polyostotic (multiple bones) disease and can occur independently or as part of McCune-Albright Syndrome (MAS), a genetic condition that includes café-au-lait skin hyperpigmentation and endocrine abnormalities. FD/MAS arises from activating mutations in the <i>GNAS</i> gene, leading to constitutive activation of the G_sα protein and elevated cAMP levels. Despite understanding the genetic cause of FD, effective treatments remain limited. Current management strategies focus primarily on symptom control following the most recent comprehensive guidelines published in 2019. This review highlights emerging pharmacologic treatments, including denosumab, a monoclonal antibody that has shown promise in reducing lesion size and pain in FD patients, and burosumab, a monoclonal antibody targeting FGF23, which reduces renal phosphate wasting and osteomalacia in FD patients. In addition, we review updates in advanced genetic testing techniques, such as cell-free DNA and direct lesion sampling for next-generation sequencing, which are promising methods for improving the diagnostic accuracy of FD. Finally, multimodal approaches for pain management in FD, including nonsteroidal anti-inflammatory drugs, bisphosphonates, and novel agents like cannabinoids, are being used alongside the traditional approaches with physical therapy and psychological support. Ongoing research aims to enhance our understanding of FD pathogenesis and develop targeted therapies that could potentially reverse disease progression. This review underscores the importance of implementing a multidisciplinary approach in the management of FD/MAS and finding new therapeutic approaches that will help address the diverse manifestations and improve the quality of life for patients.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251347350"},"PeriodicalIF":3.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of osteoporosis in the solid organ transplant recipient: an organ-based approach.","authors":"Soumya Kurnool, Nandi Shah, Preethika Ekanayake","doi":"10.1177/20420188251347351","DOIUrl":"10.1177/20420188251347351","url":null,"abstract":"<p><p>Bone and mineral disorders are highly prevalent in solid organ transplant recipients. These patients are at high risk for osteoporosis and fragility fractures due to several pre- and post-transplant factors, including end-stage organ disease leading to chronic malnutrition and osteomalacia, as well as chronic immunosuppressive therapy that has direct adverse effects on bone remodeling. Low pre-transplant bone mineral density is associated with an increased risk for fragility fracture post-transplant. Furthermore, there is a precipitous loss of bone density within 6-12 months post-transplant due to a myriad of causal factors. In this review, we will elaborate on the treatment options and challenges in management of osteoporosis in solid organ recipients using vitamin D, calcium, bisphosphonates, denosumab, and osteoanabolic agents. The greatest body of evidence discusses the use of bisphosphonates, with most patients benefiting from early treatment.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251347351"},"PeriodicalIF":3.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of technology on impaired awareness of hypoglycaemia in type 1 diabetes.","authors":"Simon A Berry, Iona Goodman, Simon Heller, Ahmed Iqbal","doi":"10.1177/20420188251346260","DOIUrl":"10.1177/20420188251346260","url":null,"abstract":"<p><p>Iatrogenic hypoglycaemia remains a major barrier to optimal glycaemic control required to prevent long-term complications in people with type 1 diabetes (pwT1D). Hypoglycaemia is the consequence of the interaction between absolute or relative insulin excess from treatment and compromised physiological defences against falling plasma glucose. With a longer duration of diabetes and repeated exposure to hypoglycaemia, pwT1D can develop impaired awareness of hypoglycaemia (IAH). IAH increases the risk of severe hypoglycaemia six-fold, causing significant morbidity, and, if left untreated, death. Over the last few decades, a stepwise change in diabetes management has been the introduction and widespread uptake of novel technologies, including continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems. These technologies aim to improve glycaemic control whilst minimising hypoglycaemia. Alarms and safety functions, such as suspension of insulin delivery, can help to reduce the hypoglycaemia burden. This review examines the role of continuous glucose monitors and AID systems in managing IAH, exploring evidence for their impact on symptomatic awareness and identifying areas for future research. In conclusion, there is strong evidence that CGM and AID systems improve glycaemic control and reduce the hypoglycaemia burden. However, despite the use of these technologies, severe hypoglycaemic episodes are not entirely eliminated, and it remains unclear whether their implementation restores the physiological symptoms and counter-regulatory response to hypoglycaemia.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251346260"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel therapeutic targets for metabolism-related diseases: proteomic Mendelian randomization and colocalization analyses.","authors":"Yue-Yang Zhang, Bin-Lu Wang, Bing-Xue Chen, Qin Wan","doi":"10.1177/20420188251343140","DOIUrl":"10.1177/20420188251343140","url":null,"abstract":"<p><strong>Background: </strong>In recent years, driven by the rapid advancement of proteomics research, numerous scholars have investigated the intricate associations between plasma proteins and various diseases. Thus, this study aimed to identify novel therapeutic targets for preventing and treating metabolic-related diseases through Mendelian randomization (MR).</p><p><strong>Methods: </strong>This study primarily utilized the MR method, leveraging genetic data from multiple large-scale publicly available genome-wide association studies. We employed two-sample MR within this framework to assess the associations between 1001 plasma proteins and 5 metabolism-related diseases. Finally, we strengthen the robustness and reliability of the MR results by conducting a series of sensitivity analyses, including bidirectional MR, colocalization analysis, Cochran's <i>Q</i> test, and the MR-Egger intercept test.</p><p><strong>Results: </strong>The results from the inverse variance weighted method revealed that, following false discovery rate correction, many plasma proteins are significantly associated with metabolic-related diseases. Genetically predicted risks vary across diseases: for coronary artery disease, from 0.82 FGR proto-oncogene, Src family tyrosine kinase (FGR) to 1.13 (interleukin-6); for obesity, from 0.992 (POLR2F) to 1.005 (PRKAB1); for osteoporosis, from 0.998 (AIF1) to 1.001 (CLC); for stroke, from 0.71 (TNFRSF1A) to 1.47 (TGM2); and for type 2 diabetes, from 0.79 (KRT18) to 1.47 (RAB37).</p><p><strong>Conclusion: </strong>Our findings reveal numerous plasma proteins linked to metabolic-related diseases. These findings offer fresh insights into the etiology, diagnostics, and treatment of these conditions.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251343140"},"PeriodicalIF":3.9,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip axis length and non-hip cortical fragility fractures in young postmenopausal nonobese Caucasian women.","authors":"Irina Manuela Nistor, Simona Fica, Sorina Carmen Martin, Marius Lucian Mitrache, Theodor Eugen Oprea, Anca Elena Sirbu, Carmen Gabriela Barbu","doi":"10.1177/20420188251332082","DOIUrl":"10.1177/20420188251332082","url":null,"abstract":"<p><strong>Introduction: </strong>Although measuring bone mineral density (BMD) with dual X-ray absorptiometry (DXA) represents the standard of diagnosis and management of osteoporosis, there is a significant number of fragility fractures occurring in young patients without low BMD. Recently, clinical risk tools included hip axis length (HAL), a geometric parameter derived from the hip DXA scan, as a predictor of hip fractures in older postmenopausal women. This study aims to evaluate the relationship between HAL and other cortical bone fractures in young postmenopausal, clinically healthy women.</p><p><strong>Materials and methods: </strong>This study is a retrospective analysis of Lunar DXA scans of 206 normal or overweight Caucasian women aged 40-60, who had less than 10 years of menopause without secondary causes of osteoporosis, no prior osteoporosis diagnosis or medication, and no history of hip or vertebral fractures.</p><p><strong>Results: </strong>The 15 fractured women displayed statistically greater HAL values compared to the 191 non-fractured subjects (109.43 ± 6.44 vs 104.81 ± 5.32 mm, <i>p</i> = 0.002), even though there were no significant differences in age, body mass index, or BMD. The difference in HAL remained significant after adjusting for lumbar spine (LS) BMD and height (108.49 ± 1.23 vs 104.88 ± 0.34 mm, <i>p</i> = 0.005). HAL proved to be a fair indicator of non-hip, non-vertebral cortical fractures (area under curve = 0.720, <i>p</i> = 0.003), with a sensitivity of 86.7% and a specificity of 55.5%.</p><p><strong>Conclusion: </strong>HAL was positively associated with non-hip, non-vertebral cortical bone fragility fractures in young postmenopausal, clinically healthy women and had significantly greater values in the fractured subgroup even after adjusting for LS BMD and height.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251332082"},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab for a rare pediatric case of concurrent thyroid eye disease and myasthenia gravis.","authors":"Haiyang Zhang, Ting Lu, Yinwei Li, Haixia Guan, Rebecca S Bahn, Huifang Zhou","doi":"10.1177/20420188251340137","DOIUrl":"10.1177/20420188251340137","url":null,"abstract":"<p><p>Rituximab (RTX) is a humanized chimeric anti-CD20 monoclonal antibody that leads to immunosuppression through rapid depletion of B lymphocytes. It has been demonstrated to be useful in treating both thyroid eye disease (TED) and myasthenia gravis (MG), respectively. However, the effectiveness of RTX in concurrent TED and MG cases is unclear and not previously reported in the literature. In this study, we describe a 13-year-old girl who presented with a 10-year history of general MG and a 1-year history of Graves' disease, bilateral proptosis, eye motility restriction, and lagophthalmos. A comprehensive evaluation confirmed the diagnosis of concurrent TED and MG. Satisfactory effectiveness was observed after RTX treatment without side effects. Based on the described observations, we suggest that RTX should be further explored as a treatment option for patients with concurrent TED and MG.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251340137"},"PeriodicalIF":3.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic therapies for medullary thyroid carcinoma: state of the art.","authors":"Alejandro Román-González, Ines Califano, Marcio Concepción-Zavaleta, Fabian Pitoia, Sarimar Agosto Salgado","doi":"10.1177/20420188251336091","DOIUrl":"https://doi.org/10.1177/20420188251336091","url":null,"abstract":"<p><p>Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor accounting for less than 5% of all thyroid cancers. An estimated 25% of cases are familial secondary to a germline mutation on the rearranged during transfection proto-oncogene (<i>RET</i>); this gene can be present as a somatic mutation in approximately 40%-60% of sporadic MTC tumors. There is an existing genotype-phenotype correlation in the clinical behavior of MTC, with the RET M918T variant associated with aggressive disease. The current systemic treatment profile for progressive metastatic MTC involves antiangiogenics multikinase inhibitors (MKI), specifically cabozantinib and vandetanib, and high-specific RET inhibitor therapy. Decisions on the timing of systemic therapy initiation in this population should involve multidisciplinary care and individualization on a case-by-case scenario; a comprehensive evaluation of performance status, tumor burden, progression rate, medical comorbidities, possible medication interactions, and goals of care must be considered in a patient-centered approach. This review summarizes the evidence on the safety, efficacy, and limitations of systemic therapies for MTC; the aim is to empower clinicians with the knowledge to optimally manage patients with advanced, progressive, or metastatic MTC.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251336091"},"PeriodicalIF":3.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal patterns of inpatient hypoglycaemia are treatment-dependent.","authors":"Wharton O Y Chan, Paik Shia Lim, Alcey Li Chang Ang, Su-Yen Goh, Yong Mong Bee, Ming Ming Teh","doi":"10.1177/20420188251338749","DOIUrl":"https://doi.org/10.1177/20420188251338749","url":null,"abstract":"<p><strong>Background: </strong>Inpatient hypoglycaemia has been well studied around the world, and more tools are being developed to understand and predict hypoglycaemic episodes. Most published data, however, focuses on patient characteristics and predictions of whether a patient would have a hypoglycaemic episode during inpatient stay. There is a paucity of data concerning the timing, as well as types of diabetic medications used, surrounding a hypoglycaemia episode.</p><p><strong>Objectives: </strong>To characterise inpatient hypoglycaemia episodes by time and associated diabetes medications, on top of baseline patient characteristics.</p><p><strong>Design: </strong>Retrospective observational study of 425 hypoglycaemia episodes, over a 2 month period from two general internal medicine wards, in a tertiary medical hospital.</p><p><strong>Methods: </strong>A discrete hypoglycaemic episode is defined as a capillary blood glucose (CBG) reading of <4 mmol/L. Hypoglycaemic episodes were further sub-analysed by dividing them into three time frames - day (0801-1600), evening (1601-2359) and night (0000-0800).</p><p><strong>Results: </strong>In total, 425 hypoglycaemia episodes from 207 patients were analysed. Sulphonylurea (SU), premixed, basal and basal-bolus insulin regimens were associated with 31.8%, 30.4%, 15.1% and 5.9% of the hypoglycaemia episodes, respectively. All agents revealed significant intra-day differences (<i>p</i> < 0.05) except for the basal-bolus insulin regimen (<i>p</i> = 0.76). Basal insulin and sulphonylurea-associated hypoglycaemia occurred mostly in the midnight timeframe (0000-0800) at 65.6% and 47.4%, respectively, whereas premixed insulin-associated hypoglycaemia occurred mostly in the evening timeframe (1601-2359) at 51.2%. In total, there were significant differences in the distribution of hypoglycaemia across the three time frames associated with different diabetes medications (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>There are marked differences in the medications associated with inpatient hypoglycaemia at differing time points. These time points offer insight into appropriate CBG testing timings for different diabetes medications. Hence, stratified monitoring and strategic 3 a.m. testing of CBG for patients on sulphonylurea and basal insulin should be considered in tackling inpatient hypoglycaemia.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251338749"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into body composition in pediatric craniopharyngioma patients after surgical treatment.","authors":"Hussein Zaitoon, Ori Eyal, Michal Yackobovitch-Gavan, Ravit Regev, Yael Issan, Jonathan Roth, Shlomi Constantini, Yael Lebenthal, Avivit Brener","doi":"10.1177/20420188251336087","DOIUrl":"https://doi.org/10.1177/20420188251336087","url":null,"abstract":"<p><strong>Background: </strong>Craniopharyngioma, a benign suprasellar tumor, is typically treated surgically with radiotherapy when indicated. Due to its proximity to the pituitary-hypothalamic region, patients often experience endocrine deficiencies.</p><p><strong>Objective: </strong>To explore the body composition components and their interaction with metabolic syndrome (MetS) components in pediatric craniopharyngioma patients after surgery.</p><p><strong>Design: </strong>Longitudinal single-center real-life study of 33 pediatric patients who were diagnosed with craniopharyngioma for which they underwent surgery between 2012 and 2024.</p><p><strong>Methods: </strong>Electronic medical reports were reviewed for clinical data, and a bioimpedance analysis (BIA) database was searched for body composition. Fifty-four BIA reports of 21 patients with craniopharyngioma were analyzed. The latest reported values were compared to those of 63 sex- and age-matched healthy controls. Changes in anthropometric measurements and indices of muscle and adiposity were assessed by linear mixed models.</p><p><strong>Results: </strong>Patients with craniopharyngioma exhibited higher adiposity compared to controls, with significantly elevated total body fat percentage (FATP; <i>p</i> < 0.001), trunk-to-total body FATP ratio (<i>p</i> = 0.012), and lower muscle-to-fat ratio (MFR) <i>z</i>-scores (<i>p</i> < 0.001). The appendicular skeletal muscle mass (ASMM) <i>z</i>-scores were similar. A sex- and age-adjusted model revealed that the diagnosis of MetS components was positively associated with FATP [odds ratio = 1.13, confidence interval (1.04, 1.23), <i>p</i> = 0.006]. Patients with craniopharyngioma demonstrated an increase in ASMM <i>z</i>-score over time (β = 0.14, SE = 0.04, <i>p</i> = 0.002) together with a decline in sex- and age-adjusted FATP (β = -0.99, SE = 0.41, <i>p</i> = 0.018).</p><p><strong>Conclusion: </strong>Despite struggling with obesity and hormonal deficiencies, survivors of craniopharyngioma showed favorable changes in body composition with appropriate medical interventions. Strategies to prevent metabolic complications and tailored hormone replacement therapies are essential for managing metabolic decline.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251336087"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of morning basal serum cortisol for assessing adrenal reserve: a single-center experience from the United Arab Emirates.","authors":"Raya Almazrouei, Jawaher Alshamsi, Mohamed Abdelsalhen, Fatima Alkaabi, Adnan Agha","doi":"10.1177/20420188251335180","DOIUrl":"https://doi.org/10.1177/20420188251335180","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenal insufficiency can be life-threatening due to the lack of cortisol elevation in times of stress. The short Synacthen test (SST) is the most common diagnostic test for adrenal insufficiency. This study aimed to assess the diagnostic performance of morning basal serum cortisol during an SST to assess normal adrenal reserve in a local Emirati population.</p><p><strong>Methods: </strong>We retrospectively analyzed the electronic medical records of adult patients who underwent morning SST to assess adrenal reserve between August 2012 and August 2022.</p><p><strong>Results: </strong>This study included 344 patients (201 women) with a mean age of 49.1 ± 22.6 years. Based on the previously published cutoff data for SST peak values at 30 min (408 nmol/L for Beckman-Access used from 2012 to 2017 and 402 nmol/L for Roche-Cobas Generation-II used since 2018) as a gold standard to identify patients with adequate adrenal reserve, 106 patients (30.8%) were diagnosed with adrenal insufficiency and 238 (69.2%) with adequate adrenal reserve. Using the receiver-operator characteristics curve for morning cortisol, we identified a cutoff of 332 nmol/L, which corresponded to adequate Synacthen stimulation with 100% specificity and 73% sensitivity. Morning cortisol levels of <96 nmol/L corresponded to suboptimal adrenal response to SST, with 95% specificity and 55% sensitivity.</p><p><strong>Conclusion: </strong>We propose that a morning cortisol cutoff of >332 nmol/L can help identify patients with adequate adrenal reserve, thereby avoiding unnecessary SSTs.</p>","PeriodicalId":22998,"journal":{"name":"Therapeutic Advances in Endocrinology and Metabolism","volume":"16 ","pages":"20420188251335180"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}