The Lancet Diabetes & Endocrinology最新文献

{"title":"Surgery for the treatment of arterial hypertension in patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (CHIRACIC): a multicentre, open-label, superiority randomised controlled trial","authors":"Antoine Tabarin, Stéphanie Espiard, Timo Deutschbein, Laurence Amar, Delphine Vezzossi, Guido Di Dalmazi, Yves Reznik, Jacques Young, Rachel Desailloud, Bernard Goichot, Delphine Drui, Guillaume Assié, Hervé Lefebvre, Knut Mai, Frédéric Castinetti, Sandrine Laboureau, Massimo Terzolo, Amandine Ferriere, Aurore Georget, Eric Frison, Kathrin Zopf","doi":"10.1016/s2213-8587(25)00062-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00062-2","url":null,"abstract":"<h3>Background</h3>Adrenal incidentalomas are found in 3–10% of adults undergoing abdominal imaging. Of these, 30–50% are responsible for mild autonomous cortisol secretion (MACS), which is frequently associated with hypertension. The impact of adrenalectomy on hypertension in patients with unilateral incidentalomas and MACS remains uncertain. The aim of the CHIRACIC study was to prospectively assess the impact of surgical excision of the incidentaloma on blood pressure with a randomised trial combining accurate blood pressure measurement and standardisation of antihypertensive treatment.<h3>Methods</h3>CHIRACIC was a multicentre, superiority, open-label, parallel, randomised controlled trial performed at 17 university hospitals in France, Italy, and Germany. Adults with hypertension with MACS entered a run-in phase to confirm hypertension with multiple home blood pressure measurements (HBPM) before blood pressure was normalised with standardised stepped-care antihypertensive treatment. Eligible participants were then randomly assigned (1:1) to adrenalectomy or conservative management. Randomisation was blocked (random block size of 4 and 6) and stratified by intensity of antihypertensive treatment. Participants were followed up for 13 months and systematic attempts were made to gradually reduce antihypertensive treatment. The primary endpoint was the proportion of normotensive participants using HBPM who reduced their antihypertensive treatment in the intention-to-treat population at study completion. Key secondary endpoints included 24 h ambulatory blood pressure measurement (ABPM), mean change in antihypertensive treatment, and the proportion of participants with antihypertensive treatment at study completion. This study was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT02364089</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is completed.<h3>Findings</h3>Between April 9, 2015 and Nov 23, 2022, 78 patients were enrolled, and 52 eligible participants were randomly assigned to adrenalectomy (n=26, 23 underwent adrenalectomy and completed the study) or conservative management (n=26, 25 completed the study). The median age of participants was 63·3 years (IQR 57·4–68·2) and 36 (69%) were female. At study completion, a reduction in antihypertensive treatment with normal HBPM was observed in 12 (46%) of 26 participants treated with adrenalectomy and in four (15%) of 26 treated conservatively (adjusted risk difference [RD] 0·34 [95% CI 0·11 to 0·58]; p=0·0038). Similar results of smaller magnitude were observed for systolic blood pressure during 24 h ABPM. Ther","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"35 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143940266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenalectomy for mild autonomous cortisol secretion?","authors":"Andrea V Haas, Naomi D L Fisher, Gail K Adler","doi":"10.1016/s2213-8587(25)00117-2","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00117-2","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"17 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143940267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-processed foods: yet another wake-up call","authors":"","doi":"10.1016/s2213-8587(25)00139-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00139-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"1 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management","authors":"Wilmar M Wiersinga, Anja K Eckstein, Miloš Žarković","doi":"10.1016/s2213-8587(25)00066-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00066-x","url":null,"abstract":"Thyroid eye disease (TED; also known as Graves' orbitopathy), causes swollen extraocular muscles and orbital fat. Mechanistically, TED involves lid retraction, oedema and redness of the eyelids and conjunctiva, proptosis, diplopia, and optic neuropathy. Investigation of TED involves assessment of disease activity (inflammation) and disease severity. TED is predominantly mild in 77% of cases, moderate-to-severe in 22%, and rarely sight-threatening in 1% of patients. While most patients with TED have Graves' hyperthyroidism, up to 5% are euthyroid or even hypothyroid. Risk factors include male sex, older age, smoking, diabetes, hypercholesterolaemia, duration of hyperthyroidism, radioactive iodine therapy, and the presence of thyrotropin receptor (TSHR) antibodies (detectable in more than 95% of patients and directly related to TED activity and severity). Genetic immunisation of mice with TSHR, but not with insulin-like growth factor-1 receptor (IGF-1R), provides a reliable animal model of TED, demonstrating that TSHR is the primary autoantigen in the disease. Crosstalk between TSHR and IGF-1R occurs via a β-arrestin scaffold. Teprotumumab, a human monoclonal antibody that blocks IGF-1R without binding to TSHR, has been shown to significantly improve outcomes in moderate-to-severe TED, including greater proptosis reduction compared with intravenous methylprednisolone. However, its disadvantages include side effects (eg, hearing loss in 30% of patients), a high cost, and a high relapse rate. Therefore, intravenous steroids remain the treatment of choice in many parts of the world. Tocilizumab, which blocks the interleukin-6 receptor, is an effective treatment option for patients with TED who are steroid-resistant. This Review further discusses alternative medications, surgical treatments, local measures, and the importance of quality-of-life assessments and multidisciplinary care.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"34 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Diabetes Endocrinol 2025; published online April 25. https://doi.org/10.1016/S2213-8587(25)00053-1","authors":"","doi":"10.1016/s2213-8587(25)00133-0","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00133-0","url":null,"abstract":"<em>Atila C, Chifu I, Drummond JB, et al. A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies.</em> Lancet Diabetes Endocrinol <em>2025; published online April 25. https://doi.org/10.1016/S2213-8587(25)00067-1</em>—The second appendix of this Article has been corrected as of May 2, 2025.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"73 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should diabetes diagnostic thresholds be lowered? Insights from the Middle East","authors":"Barrak Alahmad, Faisal H Al-Refaei, Fahd Al-Mulla, Hamad Ali","doi":"10.1016/s2213-8587(25)00125-1","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00125-1","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"56 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Diabetes Endocrinol 2025; published online April 28. https://doi.org/10.1016/S2213-8587(25)00022-1","authors":"","doi":"10.1016/s2213-8587(25)00132-9","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00132-9","url":null,"abstract":"<em>Knowler WC, Doherty L, Edelstein SL, et al. Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial.</em> Lancet Diabetes Endocrinol <em>2025; published online April 28. https://doi.org/10.1016/S2213-8587(25)00022-1</em>—In figure 1 in this Article, in the intensive lifestyle intervention arm, the number of individuals enrolled in the DPPOS should have been 916. Additionally, in the Introduction section, the final sentence of the first paragraph should have read, “…in participants treated with metformin, with an RD [rate difference] of –3·2 cases per 100 person-years”, and in the Results section, the second sentence of the third paragraph should have read, “The estimated cumulative incidence up to 21 years was 69·9%...”. Appendix 2 has also been corrected. These corrections have been made to the online versions as of May 1, 2025, and the printed version will be correct.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"13 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redifferentiation therapy in unresectable or metastatic radioactive iodine refractory thyroid cancer: an International Thyroid Oncology Group statement","authors":"Sophie Leboulleux, Laura Boucai, Naifa Busaidy, Cosimo Durante, James A Fagin, Sasan Fazeli, Andrew G Gianoukakis, Bryan R Haugen, Hyunseok Kang, Bhavana Konda, Theodore W Laetsch, Laura Locati, Mabel Ryder, Christine Spitzweg, Francis P Worden, Lori Wirth, Alan Ho","doi":"10.1016/s2213-8587(25)00064-6","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00064-6","url":null,"abstract":"In patients with follicular cell-derived thyroid cancer that have distant metastases and no iodine uptake, redifferentiation—ie, the restoration of tumoural ¹³¹I uptake with systemic therapy—is now possible. The use of mitogen-activated protein kinase (MAPK) inhibitors for a short period of time before the administration of high activity ¹³¹I shows promising results with iodine uptake restoration and tumour response. Redifferentiation has been used in patients with <em>BRAF</em>-mutated and <em>RAS</em>-mutated tumours in prospective trials and in the case of patients with <em>RET</em> or <em>NTRK</em> fusions. The iodine uptake restoration ranges from 33% to 95%, and tumour response rates from 11% to 80%. There is substantial variability between trials with regards to inclusion criteria, duration of redifferentiation drug therapy, activity of radioactive iodine, and use of dosimetry. Randomised studies are missing to clearly establish the effectiveness and applicability of redifferentiation. Thus, long-term studies are needed to establish the most effective redifferentiation protocols. The objectives of this Review are to: (1) provide a comprehensive review of the available results from prospective trials and case reports, including results regarding the restoration of radioiodine uptake and treatment efficacy (morphological and biological); (2) describe the differences in redifferentiation trial design between studies and discuss their potential impact on treatment efficacy; (3) describe the implications and limitations of dosimetry; and (4) outline the key questions to be addressed in future redifferentiation trials.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"47 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Diabetes Endocrinol 2025; published online April 25. https://doi.org/10.1016/S2213-8587(25)00053-1","authors":"","doi":"10.1016/s2213-8587(25)00130-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00130-5","url":null,"abstract":"<em>Atila C, Chifu I, Drummond JB, et al. A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies.</em> Lancet Diabetes Endocrinol <em>2025; published online April 25. https://doi.org/10.1016/S2213-8587(25)00053-1</em>—In this Article, the title should have been “A novel diagnostic score for diagnosing arginine vasopressin deficiency (central diabetes insipidus) or primary polydipsia with basal laboratory and clinical parameters: results from two international multicentre prospective diagnostic studies”. This correction has been made to the online version as of April 30, 2025, and the printed version will be correct.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"87 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does tirzepatide treatment improve skeletal muscle composition?","authors":"Norbert Stefan","doi":"10.1016/s2213-8587(25)00054-3","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00054-3","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"94 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}