Journal of Endocrinological Investigation最新文献

{"title":"Serum uric acid to creatinine ratio as marker of early vascular damage and renal tubular injury in non-albuminuric diabetic kidney disease.","authors":"Maurizio Di Marco, Sabrina Scilletta, Nicoletta Miano, Nicola Marrano, Annalisa Natalicchio, Francesco Giorgino, Giosiana Bosco, Francesco Di Giacomo Barbagallo, Roberto Scicali, Andrea Tumminia, Agostino Milluzzo, Lucia Frittitta, Salvatore Piro, Antonino Di Pino","doi":"10.1007/s40618-026-02972-7","DOIUrl":"10.1007/s40618-026-02972-7","url":null,"abstract":"<p><strong>Purpose: </strong>Serum uric acid to creatinine ratio (SUA/sCr) has emerged as potential biomarker for non-albuminuric diabetic kidney disease (NA-DKD), a recently recognized high-prevalence DKD phenotype. However, the relationship between SUA/sCr and cardiovascular and renal injury profile in this population is not well established. This study aimed to evaluate SUA/sCr across the spectrum of DKD, particularly focusing on NA-DKD, and to test its association with subclinical vascular damage, urinary biomarkers and ultrasound features of kidney damage.</p><p><strong>Methods: </strong>Presence of carotid plaques, pulse wave velocity (PWV), renal resistive index (RRI), and urinary biomarkers of tubular injury were assessed in 207 individuals with type 2 diabetes. Participants were split based on estimated-glomerular-filtration-rate (eGFR) and urinary-albumin-to-creatinine-ratio (UACR) into four groups: controls (UACR < 30 mg/g, eGFR ≥ 60 ml/min/1.73m²), A-DKD (Albuminuric-DKD; UACR ≥ 30 mg/g, eGFR ≥ 60 ml/min/1.73m²), NA-DKD (Non-albuminuric-DKD; UACR < 30 mg/g, eGFR < 60 ml/min/1.73m²), A&L-DKD (Albuminuric-and-Low-eGFR-DKD; UACR ≥ 30 mg/g, eGFR < 60 ml/min/1.73m²).</p><p><strong>Results: </strong>Participants with NA-DKD showed a lower SUA/sCr than those with A-DKD and controls (4.71 ± 1.52 vs 6.06 ± 1.70 vs 6.67 ± 1.87, both P < 0.0001). A lower SUA/sCr was independently correlated with NA-DKD (β = -1.63, P < 0.0001) and A&L-DKD (β = -2.01, P < 0.0001). SUA/sCr was inversely and independently associated with urinary β2-microglobulin (β = -0.21, P = 0.0082). Moreover, lower SUA/sCr was associated with PWV > 10 m/s (OR 0.77, 95%CI 0.63-0.95, P = 0.014), the presence of carotid plaques (OR 0.78, 95%CI 0.63-0.96, P = 0.020), and higher RRI (β = -0.18, P = 0.0082).</p><p><strong>Conclusion: </strong>In T2D, lower SUA/sCr correlated with NA-DKD, but not with A-DKD. Lower SUA/sCr was associated with subclinical vascular and tubular damage. Future studies are needed to test SUA/sCr as candidate biomarker to improve DKD risk stratification.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2975-2984"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"lncRNA PANDAR predicts adverse pregnancy outcomes and reflects hyperglycemia-associated cellular stress in gestational diabetes mellitus.","authors":"Longding Chen, Danping Peng, Yunzhi Xu","doi":"10.1007/s40618-026-02956-7","DOIUrl":"10.1007/s40618-026-02956-7","url":null,"abstract":"<p><strong>Purpose: </strong>Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with placental dysfunction and adverse maternal-fetal outcomes. LncRNAs have emerged as important regulators in metabolic diseases. The clinical significance and molecular mechanisms of lncRNA PANDAR in GDM remain unclear.</p><p><strong>Methods: </strong>117 GDM patients and 110 healthy pregnant women were enrolled. Relative expression of genes was measured by qRT-PCR. The diagnostic value of PANDAR was assessed using ROC analysis, and its association with adverse pregnancy outcomes was evaluated by logistic regression. High-glucose model was established in HTR-8/Svneo trophoblast cells to investigate the function of PANDAR. Cell apoptosis, viability, and invasion were assessed using flow cytometry, CCK-8, and Transwell assays. The regulatory relationships among molecules were validated by dual-luciferase reporter assays.</p><p><strong>Results: </strong>PANDAR expression was upregulated in GDM patients and exhibited good diagnostic performance. PANDAR levels were higher in GDM patients with adverse pregnancy outcomes. Elevated PANDAR was independently associated factor for adverse pregnancy outcomes. High glucose induced PANDAR expression and promoted trophoblast apoptosis while inhibiting cell viability and invasion, effects that were alleviated by PANDAR silencing. PANDAR functioned as a ceRNA for miR-192-5p, thereby upregulating the pro-apoptotic target BCL2L11. Rescue experiments confirmed that a PANDAR/miR-192-5p/BCL2L11 axis mediated trophoblast dysfunction under hyperglycemic conditions.</p><p><strong>Conclusion: </strong>PANDAR is associated with adverse pregnancy outcomes and may reflect hyperglycemia-induced cellular responses by promoting trophoblast dysfunction via a miR-192-5p/BCL2L11 axis.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2985-2994"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium in diabetic ketoacidosis: a multicenter observational study of occurrence, associated factors and outcomes from 578,204 hospitalizations.","authors":"Songlin Xie, Jincong Liu, Weifeng Zeng, Junfen Cheng, Chengzhao Huang, Ping Lin, Xiongtian Liang, Zhangaixi Liu, Junde Mo, Liping Chen, Binbin Tian, Kangjie Chen","doi":"10.1007/s40618-026-02975-4","DOIUrl":"10.1007/s40618-026-02975-4","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a neuropsychiatric syndrome in hospitalized diabetic ketoacidosis (DKA) patients and is associated with poor clinical outcomes. However, multicenter national data on its prevalence and associated factors in this population are lacking.</p><p><strong>Methods: </strong>Adult patients with DKA were identified from the National Inpatient Sample (2013-2022) and stratified by delirium occurrence. Multivariable logistic regression identified delirium associated factors, including demographics, institutional characteristics, comorbidities, and complications.</p><p><strong>Results: </strong>In 578,204 DKA-related hospitalizations, delirium was documented in 6,161 hospitalizations (1.1%), increasing from 0.5% in 2013 to 1.4% in 2022. Multivariable analysis demonstrated that patients aged ≥ 45 years, ≥ 2 comorbidities, large hospital and teaching hospital were associated with higher odds of delirium. Comorbidities including alcohol use, congestive heart failure, coagulopathy, depression, liver disease, other neurological disorders, psychoses, weight loss, and dementia correlated with higher delirium odds. Complications such as pulmonary embolism, sepsis, stroke, urinary tract infection, pneumonia, acute myocardial infarction, and acute kidney injury were also associated with delirium. Patients with delirium had prolonged median hospitalization duration (8 vs. 3 days), higher healthcare costs ($82,196 vs. $29,417), and higher mortality (6.4% vs.3.2%) (P < 0.001).</p><p><strong>Conclusion: </strong>Although delirium occurrence is modest in DKA patients, it is associated with adverse clinical outcome. Healthcare providers should identify high-risk populations and enhance surveillance protocols. Further prospective studies are needed to clarify these associations and develop preventive strategies.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"3053-3062"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of subcutaneous GLP-1 receptor agonists versus SGLT2 inhibitors on metabolic and hepatic outcomes in T2DM with MASLD: a propensity score-matched study.","authors":"Barbara Toffoli, Matteo Sirignano, Valeria Bonato, Giulia Fusaro, Erica Russo, Valerio Velardi, Lory Saveria Crocè, Bruno Fabris, Riccardo Candido, Stella Bernardi","doi":"10.1007/s40618-026-02976-3","DOIUrl":"10.1007/s40618-026-02976-3","url":null,"abstract":"<p><strong>Aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexists with type 2 diabetes mellitus (T2DM), complicating its management. In this population, we aimed to compare the effectiveness of subcutaneous GLP-1 receptor agonists (scGLP-1RA) to SGLT2 inhibitors (SGLT2i) on metabolic and hepatic parameters, while investigating the influence of GLP1R and PNPLA3 genetic variants on treatment response.</p><p><strong>Methods: </strong>This retrospective study included patients with T2DM starting scGLP-1RA or SGLT2i, balanced through Propensity Score Matching (PSM) to account for baseline clinical differences. Clinical and biochemical data were compared at baseline and after one year of treatment. Genotyping was performed for PNPLA3 (rs738409) and GLP1R (rs761387, rs6923761) polymorphisms. Multivariable linear regression was used to identify independent predictors of HbA1c, BMI, and transaminase reduction.</p><p><strong>Results: </strong>Both drug classes significantly improved glycemic control and BMI. However, scGLP-1RA demonstrated superior efficacy in HbA1c and BMI reduction compared to SGLT2i (β = -0.349, p = 0.001; β = -0.711, p = 0.045). In MASLD subgroups (baseline ALT > 35 U/L or hepatic steatosis), only scGLP-1RA led to a significant reduction in ALT levels (p = 0.02). Multivariable analysis identified the GLP1R rs761387 G allele as an independent predictor of a blunted glycemic response (β = -0.277, p = 0.018).</p><p><strong>Conclusions: </strong>In a real-world setting, scGLP-1RA showed higher potency than SGLT2i on metabolic and hepatic parameters. These findings support the preferential use of scGLP-1RA in patients with T2DM and MASLD and are consistent with current international recommendations. The association between GLP1R rs761387 variant and HbA1c reduction sheds light on the impact of this variant on treatment response. Further studies are needed to validate this genetic predictor in broader populations.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"3017-3025"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffusion-weighted magnetic resonance imaging as a promising technique for detection and follow-up of liver metastases from neuroendocrine tumors: a retrospective and prospective study from the NETTARE task force.","authors":"Tiziana Feola, Franz Sesti, Alessia Filice, Alexandra Nistor, Alessandra Valenti, Giulia Puliani, Roberta Centello, Carla Pandozzi, Arianna Gagliardi, Riccardo Pirisino, Oreste Bagni, Mauro Salducci, Marialuisa Appetecchia, Carlo Catalano, Andrea M Isidori, Francesca Maccioni, Elisa Giannetta","doi":"10.1007/s40618-026-02974-5","DOIUrl":"10.1007/s40618-026-02974-5","url":null,"abstract":"<p><strong>Background: </strong>A combination of morphological and functional imaging plays a crucial role for neuroendocrine tumors (NETs) management. Diffusion-weighted magnetic resonance imaging (DWI-MRI) is an emerging key imaging technique in the NET field.</p><p><strong>Aim: </strong>to evaluate the diagnostic and prognostic role of DWI-MRI in liver metastases (LMs) from NETs compared with multiparametric MRI and functional imaging with ⁶⁸Ga-DOTA peptides positron emission tomography (PET)-computed tomography (CT).</p><p><strong>Methods: </strong>This is a monocentric, observational, both retrospective and prospective study including patients with histologically proven diagnosis of gastroenteropancreatic (GEP) NET with LM evaluated with MRI and ⁶⁸Ga-DOTA peptides PET-CT, performed within 6 months apart at diagnosis or follow-up. We collected clinical, pathological, imaging data including lesions number detected on (a)MRI-gold standard, (b)DWI images, (c)⁶⁸Ga-DOTA peptides PET-CT. Apparent diffusion coefficient (ADC) was calculated on target lesions.</p><p><strong>Results: </strong>426 LMs were analyzed from 17 patients (11 males, mean age 57.2 ± 12.6 years) meeting the inclusion criteria (11.8% G1, 64.7% G2, and 23.5% G3); MRI detected a median of 15 (IQR 2.5-40) lesions per patient, DWI 15 (IQR 2.5-36.5) lesions, while PET-CT 6 (IQR 2.5-20) lesions. Non-parametric analyses suggested that DWI had a detection rate comparable to MRI (p = 0.068) and superior to 68Ga-DOTA peptides PET-CT (p = 0.004), whereas mixed-effects modelling accounting for within-patient clustering showed no statistically significant pairwise differences between imaging modalities after multiple-comparison correction. Moderate-to-good consistency in lesion burden estimation across imaging modalities supported the reproducibility of lesion quantification. Correlation analyses suggested MRI lesion load may reflect the aggressiveness of disease.</p><p><strong>Conclusions: </strong>DWI-MRI can be a useful time-saving imaging technique in the diagnosis and follow-up of LMs from NETs, with a potentially favorable cost-effectiveness ratio.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2759-2768"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered serum amylin and preptin levels in women with polycystic ovary syndrome: a comparative analysis based on obesity status.","authors":"Lanya Mohammed Nasralddin, Shwan Majid Ahmad","doi":"10.1007/s40618-026-02941-0","DOIUrl":"10.1007/s40618-026-02941-0","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder frequently associated with insulin resistance. Amylin and preptin, peptides secreted by pancreatic β cells, are major contributors to insulin secretion and glucose homeostasis. This study assessed serum amylin and preptin concentrations in women with PCOS and evaluated their associations with anthropometric, metabolic, and reproductive parameters.</p><p><strong>Materials and methods: </strong>This prospective, case-control study included females of reproductive age with PCOS and age-matched healthy controls. Participants were classified as obese and non-obese. Serum amylin and preptin were measured using ELISA, whereas hormonal and biochemical parameters were assessed using standard automated laboratory assays.</p><p><strong>Results: </strong>Women with PCOS exhibited markedly reduced circulating concentrations of amylin and preptin compared with the control group. Amylin levels were consistently lower regardless of obesity status, whereas the reduction in preptin was more pronounced in non-obese individuals. A positive correlation between the two peptides was observed across all groups, with stronger associations in the control subjects. In women with PCOS, both peptides demonstrated only modest correlations with fasting glucose, insulin, HOMA-IR, and QUICKI. Despite these reductions, HOMA-β values were significantly elevated in PCOS, suggesting preserved or compensatory β-cell activity. In addition, women with PCOS showed adverse anthropometric and lipid profiles, along with increased luteinizing hormone, testosterone, and LH/FSH ratio.</p><p><strong>Conclusion: </strong>The combined assessment of amylin and preptin suggests alterations in β-cell-derived peptide secretion in PCOS that are not solely explained by adiposity. Notably, these changes occurred despite significantly elevated HOMA-β values, indicating preserved or compensatory β-cell activity. Together, these findings suggest differential regulation of β-cell peptides in PCOS, although the underlying mechanisms require further investigation.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2825-2843"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A goitrous woman in 17th-century Andalusia in a painting by Diego Velazquez.","authors":"F Trimarchi, E Martino, L Bartalena","doi":"10.1007/s40618-026-02905-4","DOIUrl":"10.1007/s40618-026-02905-4","url":null,"abstract":"","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"3109-3110"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and effectiveness of setmelanotide in young patients with severe obesity due to craniopharyngioma: a real world monocentric experience.","authors":"Oana Ruxandra Cotta, Cesare Morgante, Annalisa Giandalia, Flavio Angileri, Francesco Ferrau', Salvatore Cannavo'","doi":"10.1007/s40618-026-02950-z","DOIUrl":"10.1007/s40618-026-02950-z","url":null,"abstract":"<p><strong>Background: </strong>Hypothalamic obesity (HO) is a severe, often treatment-refractory complication after craniopharyngioma (CP) surgery. Setmelanotide, a melanocortin-4 receptor agonist (MC4R-A), offers a targeted therapeutic approach, but real-world data are limited.</p><p><strong>Methods: </strong>We performed a retrospective review of patients with post-CP HO treated with setmelanotide at our center, collecting clinical, metabolic, and treatment-related data.</p><p><strong>Results: </strong>Three young adults with HO after surgery for CP were included. Treatment responses were variable: one patient discontinued setmelanotide after continued weight gain, while two experienced reductions in weight, BMI, waist circumference, triglycerides and insulin levels over 6-9 months. Adverse effects were mild and non-limiting.</p><p><strong>Conclusion: </strong>Setmelanotide may provide meaningful benefit for selected patients with severe, treatment-refractory HO after CP. Despite small sample size, this series supports further investigation of MC4R agonism as a targeted therapy for acquired HO.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"3091-3094"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glymphatic dysfunction is associated with hyperglycemia-related cortical thinning in patients with type 2 diabetes mellitus.","authors":"Shuyue Fan, Yujie Zhang, Yong Luo, Rong Huang, Xin Wang, Yu-Chen Chen, Yong Xiao, Wenqing Xia","doi":"10.1007/s40618-026-02978-1","DOIUrl":"10.1007/s40618-026-02978-1","url":null,"abstract":"<p><strong>Purpose: </strong>Type 2 diabetes mellitus (T2DM) increases the risk of cognitive impairment through metabolic-neurodegenerative interactions, yet the underlying neural mechanisms remain unclear. This study investigates whether glycemic control modulates the relationships among glymphatic dysfunction, cortical thinning, and cognition in T2DM, with a focus on whether glymphatic impairment is associated with chronic hyperglycemia-related neurostructural decline.</p><p><strong>Methods: </strong>T2DM patients were stratified by glycemic control (Hemoglobin A1c < 7.5% vs. ≥ 7.5%). All participants underwent neuropsychological assessments and magnetic resonance imaging (MRI) to quantify cortical thickness, choroid plexus volume (CPV), perivascular space (PVS) volume, and the diffusion tensor image analysis along the perivascular space (DTI-ALPS) index. Group comparisons, Spearman correlations, and mediation analyses were used to examine the pathways linking glycemic control, glymphatic function, and cortical structure.</p><p><strong>Results: </strong>A total of 54 poorly controlled T2DM patients, 38 well-controlled T2DM patients, and 99 healthy controls were included. Poorly controlled T2DM patients exhibited worse cognitive performance compared with healthy controls. Both T2DM groups showed reduced cortical thickness in the insula, fusiform gyrus, and supramarginal gyrus relative to healthy controls, with insular atrophy significantly associated with enlarged CPV. Markers of glymphatic dysfunction, including enlarged CPV, increased PVS volume, and reduced DTI-ALPS index, were most pronounced in the poorly controlled T2DM group. Cortical thickness and glymphatic measures each correlated with cognitive performance. Mediation analysis indicated that CPV showed associations consistent with a mediating role in the relationship between HbA1c and left insular cortical thinning.</p><p><strong>Conclusion: </strong>Compared with other subgroups, in the poorly controlled T2DM group, glymphatic changes were more pronounced, and the glymphatic-cognitive associations were more evident. Furthermore, CPV showed associations consistent with a mediating role in the relationship between hyperglycemia and cortical thinning in T2DM patients. These findings suggest that the glymphatic system may serve as an associative link between systemic metabolic dysregulation and structural neurodegeneration, offering potential imaging biomarkers for early neurological risk assessment in T2DM.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"3039-3051"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of gynecomastia in adolescence and adults: the clinical practice guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS).","authors":"Carlotta Pozza, Riccardo Selice, Arcangelo Barbonetti, Valeria Hasenmajer, Francesco Lotti, Davide Menafra, Daniela Pasquali, Andrea Sansone, Andrea M Isidori, Vincenzo Rochira","doi":"10.1007/s40618-026-02915-2","DOIUrl":"10.1007/s40618-026-02915-2","url":null,"abstract":"<p><strong>Purpose: </strong>Gynecomastia, defined as the benign proliferation of male breast glandular tissue, is a common condition in both adolescence and adulthood, often associated with physical discomfort and psychological distress. Despite its high prevalence, clinical management is frequently inconsistent and lacks standardized, evidence-based recommendations.</p><p><strong>Methods: </strong>The Italian Society of Andrology and Sexual Medicine (SIAMS) convened a multidisciplinary expert panel to develop updated clinical practice guidelines for the evaluation and management of gynecomastia. Recommendations were formulated based on a systematic review of the available literature and developed through expert consensus according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. The document was critically reviewed and approved by the SIAMS Executive Committee.</p><p><strong>Results: </strong>The guidelines address physiological, pharmacological, pathological, congenital, and genetic forms of gynecomastia, providing a structured diagnostic and therapeutic approach. Clinical assessment, including detailed history and examination, is the cornerstone of diagnosis, and should be complemented by targeted hormonal and imaging investigations when appropriate. Observation is recommended for physiological or recent-onset cases. Pharmacological therapy may be considered in selected idiopathic or painful forms, whereas testosterone replacement should be restricted to men with proven hypogonadism. Surgery is indicated for long-standing fibrotic gynecomastia or significant psychological distress. Psychological support is also advised, especially for adolescents.</p><p><strong>Conclusions: </strong>These SIAMS Guidelines provide an evidence-based, standardized framework for the diagnosis and management of gynecomastia, promoting individualized, multidisciplinary care and identifying priorities for future research.</p>","PeriodicalId":48802,"journal":{"name":"Journal of Endocrinological Investigation","volume":" ","pages":"2583-2610"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}