Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"Circulating Proteomic Profiles Are Associated With Incident Type 2 Diabetes in Asian Populations.","authors":"Yujian Liang, Charlie G Y Lim, Scott C Ritchie, Nicolas Bertin, Jin-Fang Chai, Jiali Yao, Yun Li, E Shyong Tai, Rob M van Dam, Xueling Sim","doi":"10.1210/clinem/dgaf045","DOIUrl":"10.1210/clinem/dgaf045","url":null,"abstract":"<p><strong>Context: </strong>Type 2 diabetes (T2D) is a major global concern, with Asia at its epicenter in recent years. Proteins, products of gene transcription, serve as dynamic biomarkers for pinpointing perturbed pathways in disease development. Previous T2D proteomic association studies primarily focused on European populations.</p><p><strong>Objective: </strong>The aim of this study was to investigate the relationship between plasma proteins and the incidence of T2D in Asian individuals.</p><p><strong>Methods: </strong>We examined the association of 4775 plasma proteins with incident T2D in a Singapore multi-ethnic cohort of 1659 Asian individuals (539 cases and 1120 controls) using logistic regression. We used 2-sample mendelian randomization and colocalization analysis to evaluate the causal relationship between proteins and T2D.</p><p><strong>Results: </strong>Our analysis revealed 522 proteins that were associated with incident T2D after adjusting for age, sex, and ethnicity, and 17 proteins that remained statistically significantly associated after adjusting for other T2D risk factors such as fasting glucose, waist circumference, and triglycerides. Among the 522 proteins associated with incident T2D, the change in 205 plasma proteins, observed in parallel with the development of T2D at baseline and 6-year follow-up, were further associated with incident T2D. The associated proteins showed enrichment in neuron generation, glycosaminoglycan binding, and insulin-like growth factor binding. Two-sample mendelian randomization analysis suggested 3 plasma proteins, GSTA1, INHBC, and FGL1, play causal roles in the development of T2D, with colocalization evidence supporting GSTA1 and INHBC.</p><p><strong>Conclusion: </strong>Our findings reveal plasma protein profiles linked to the onset of T2D in Asian populations, offering insights into the biological mechanisms of T2D development.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e3391-e3400"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025715","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":"Potential Mechanism Associated with Post-Heart Transplantation Diabetes Mellitus in Chinese Patients.","authors":"Xiao Huang, Qiling Xu, Linhua Chen, Li Liu, Ying Zhou, Hong Zhou, Yu Zhang","doi":"10.1210/clinem/dgaf071","DOIUrl":"10.1210/clinem/dgaf071","url":null,"abstract":"<p><strong>Context: </strong>Posttransplantation diabetes mellitus (PTDM) is a common metabolic complication following heart transplantation (HT), which not only leads to elevated microvascular morbidity, but also seriously affects graft function and recipient survival. However, the specific metabolites and underlying mechanisms are not yet fully understood.</p><p><strong>Objective: </strong>This study aimed to preliminarily screen out differentially expressed metabolites that are associated with PTDM in HT recipients and elucidate its potential pathophysiological mechanisms by using a global metabolomics approach, and provide a basis for the management of PTDM.</p><p><strong>Methods: </strong>A total of 106 adult HT recipients (56 PTDM and 50 non-PTDM) who were followed for more than 1 year were enrolled in the study. Untargeted metabolomics was performed by ultra-high-performance liquid chromatography-tandem mass spectrometry. Demographics, clinical data, and drug information were collected at the time of sample collection.</p><p><strong>Results: </strong>PTDM patients were older (P = .003), with higher body mass index scores (P = .010), higher triglyceride levels (P = .007), and a higher prevalence of hypertension (P = .001) than non-PTDM patients. A total of 1174 metabolites were detected, of which 99 metabolites showed significantly differentially abundant (VIP > 1; P < .05; FC > 1.5 or <0.67). KEGG functional enrichment analysis showed these differently expressed metabolites could be further enriched in ABC transporter, carbon metabolism, retrograde endocannabinoid signaling, and phospholipase D signaling pathway. Compared with the non-PTDM group, glutamate, diacylglycerol, and D-sorbitol were significantly changed in PTDM through metabolomics.</p><p><strong>Conclusion: </strong>These findings may provide a novel understanding of the pathological mechanism of PTDM and could be used to predict the development and progression of PTDM.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2800-2809"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076194","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":"Glucose Metabolic Abnormalities and Their Interaction With Defective Phosphate Homeostasis in Tumor-induced Osteomalacia.","authors":"RuoTong Zhou, Ruizhi Jiajue, Xiaolin Ni, Qianqian Pang, Yue Chi, Yan Jiang, Ou Wang, Mei Li, Xiaoping Xing, Lijia Cui, Xiang Li, Yong Liu, Huanwen Wu, Jin Jin, Wei Lv, Yu Xia, Li Huo, Lian Zhou, Wei Yu, XunWu Meng, Weibo Xia","doi":"10.1210/clinem/dgae886","DOIUrl":"10.1210/clinem/dgae886","url":null,"abstract":"<p><strong>Context: </strong>Phosphate homeostasis was compromised in tumor-induced osteomalacia (TIO) due to increased fibroblast growth factor 23 (FGF23) secretion. Nevertheless, the glucose metabolic profile in TIO patients has not been investigated.</p><p><strong>Objectives: </strong>This work aimed to clarify the glucose metabolic profiles in TIO patients and explore their interaction with impaired phosphate homeostasis.</p><p><strong>Methods: </strong>20 TIO patients, 20 individuals with normal glucose tolerance, and 20 patients with type 2 diabetes mellitus (DM) were enrolled and underwent an oral glucose tolerance test (OGTT). Serum phosphate and FGF23 concentration were monitored during OGTT.</p><p><strong>Results: </strong>In patients with TIO, 60% (12/20) exhibited impaired glucose tolerance (IGT) and 5% (1/20) had type 2 DM. Those with IGT or type 2 DM experienced more ambulatory difficulties (69.2% vs 42.9%), lower phosphate concentrations (0.43 ± 0.10 vs 0.53 ± 0.10, P = .042), and lower calcium concentrations (2.20 ± 0.08 vs 2.30 ± 0.40, P = .001) compared to TIO patients without these conditions. According to correlation analysis, serum phosphate levels were negatively correlated with plasma glucose levels at 60 minutes (P < .001), fasting plasma insulin levels (P < .05), and homeostasis model assessment for insulin resistance (P < .05). Those with high FGF23 levels had a higher glucose level at 60 minutes (10.5 [9.3, 12.3] vs 7.3 [6.4, 10.1], P = .048) than that of low group. After glucose loading, both FGF23 and phosphate levels exhibited a decreasing trend.</p><p><strong>Conclusion: </strong>The development of diabetes in TIO patients may be predisposed by ambulatory issues, low phosphate, and elevated FGF23 levels. Dysglycemia might further aggravate hypophosphatemia.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2869-2878"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053830","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":"Using a Composite Summary of Daily Sex Hormones to Gauge Time Until Menopause: A Focus on Pregnanediol Glucuronide (PDG).","authors":"J F Winkles, Alicia Colvin, Samar R El Khoudary, Nanette Santoro, Mary Sammel, Sybil Crawford","doi":"10.1210/clinem/dgae895","DOIUrl":"10.1210/clinem/dgae895","url":null,"abstract":"<p><strong>Context: </strong>The timing of a woman's final menstrual period (FMP) in relation to her age is considered a valuable indicator of overall health, being associated with cardiovascular, bone health, reproductive, and general mortality outcomes.</p><p><strong>Objective: </strong>This work aimed to evaluate the relationship between hormones and the \"time to FMP\" when daily hormone trajectories are characterized by their 1) entropy, and 2) deviation from premenopausal/stable cycle patterns (representing a textbook \"gold standard\"; GS).</p><p><strong>Methods: </strong>As part of the Study of Women's Health Across the Nation, urinary luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen conjugates (E1C), and pregnanediol glucuronide (PDG) were measured daily from a multiracial sample of 549 mid-life women for the duration of one menstrual cycle. Hormone trajectories were mapped onto a plane with axes representing Fuzzy entropy (FuzzEn) and the normalized dynamic time warping distance (DTW) from the GS.</p><p><strong>Results: </strong>Viewing FSH, E1C, PDG, and LH through this lens reveals that, contrary to existing wisdom, PDG stands out as a powerful predictor/descriptor of \"time to FMP.\" Using cluster analyses to discretize PDG on the DTW/FuzzEn plane yields statistically different survival curves, and Cox proportional hazards analyses confirm that this separation persists in the presence of known covariates of FSH, antimüllerian hormone, age, body mass index, financial hardship, smoking status, and cycle length.</p><p><strong>Conclusion: </strong>Since PDG is generally not considered a predictor/descriptor of ovarian aging, this work validates the DTW/FuzzEn analytical framework and introduces another metric/hormone to be used in FMP-related preventive care.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2832-2844"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025720","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":"Changes in 90-Day Time in Range Among Youth With Type 1 Diabetes Initiating Different Automated Insulin Delivery Systems.","authors":"Sonia Gera, Andrew Rearson, Greyson Baker, Julia L Douvas, Nicole Alicea-Trelles, Robert J Gallop, Seema Meighan, Brynn E Marks","doi":"10.1210/clinem/dgaf006","DOIUrl":"10.1210/clinem/dgaf006","url":null,"abstract":"<p><strong>Context: </strong>Glycemic outcomes in youth with type 1 diabetes (T1D) in the United States using the 2 most common automated insulin delivery (AID) systems, Insulet Omnipod 5 (OP5) and Tandem Control IQ (CIQ), have not been compared.</p><p><strong>Objective: </strong>We performed the first head-to-head analysis of changes in glycemic metrics among youth initiating AID.</p><p><strong>Methods: </strong>This single-center, retrospective study included youth < 21 years with T1D, who started OP5 or CIQ between January 2020 and December 2023, and had ≥ 70% continuous glucose monitoring (CGM) active time. We obtained 14-day baseline and 90-day CGM and AID data. A multiple linear regression model assessed for changes in 90-day time in range (TIR) according to AID system, adjusting for covariates. Subanalyses were conducted according to baseline TIR categories.</p><p><strong>Results: </strong>Among the 428 included youth, there were 214 (50%) in each AID group. OP5 users had a shorter T1D duration (1.6 vs 5.5 years, P < .001) and were more likely to have transitioned from multiple daily injections (76.1% vs 20.1%, P < .001). Baseline TIR was similar between groups (OP5 51.6% vs CIQ 53.1%, P = .70). 90-day TIR increased in both groups (P < .001), rising by 11.8 percentage points (95% CI [10.4, 13.3]) in OP5 users and 9.8 percentage points (95% CI [8.3, 11.2]) in CIQ users, without any significant between-group differences (P = .08). There were no between-group differences in 90-day TIR according to categorical baseline TIR.</p><p><strong>Conclusion: </strong>There are no clinically significant differences in 90-day TIR among youth with T1D initiating the 2 most commonly used AID systems. Patient preference and shared decision making should continue to guide the selection of AID systems.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e3472-e3481"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015390","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":"Searching for Monogenic Autoimmune Etiology in Patients With Type 1 Diabetes Onset Before 30 Months of Age.","authors":"Laura Saso-Jiménez, Inés Urrutia, Begona Calvo, José Ramón Bilbao, Ana Lucía Gómez-Gila, Isabel Leiva-Gea, Andrea Jiménez-Sanchis, Itxaso Rica, Luis Castano, Rosa Martínez","doi":"10.1210/clinem/dgaf049","DOIUrl":"10.1210/clinem/dgaf049","url":null,"abstract":"<p><strong>Introduction: </strong>The most frequent form of diabetes in pediatric patients is polygenic autoimmune diabetes (type 1 diabetes [T1D]), but single-gene variants responsible for autoimmune diabetes have also been described. Both disorders share clinical features, which can lead to monogenic forms being misdiagnosed as T1D. However, correct diagnosis is crucial for therapeutic choice, prognosis, and genetic counseling. The aim of this study was to search for monogenic autoimmune diabetes in Spanish pediatric patients with early-onset T1D.</p><p><strong>Methods: </strong>Among 500 Spanish pediatric patients with T1D, those with disease onset between 9 and 30 months of age were selected for screening for monogenic autoimmune diabetes (n = 44). Genetic testing was performed by next-generation sequencing with a customized panel that included the major causative genes for monogenic autoimmune syndromes, including early-onset diabetes: AIRE, CTLA4, FOXP3, IL2RA, ITCH, LRBA, STAT1, STAT3, STAT5B. RT-PCR and cDNA sequencing of the RNA isolated from whole blood were used to analyze splicing variants.</p><p><strong>Results: </strong>Genetic screening identified, in 2 patients with diabetes onset before 1 year of age, 2 likely pathogenic novel variants affecting canonical splicing sites: c.286-12_290del in STAT5B and c.-22-2delA in FOXP3. RNA analyses demonstrated that both variants modify mRNA splicing. The variant in STAT5B induced exon 4 skipping and the variant in FOXP3 caused a deletion of 16 nucleotides before the transcription start site.</p><p><strong>Conclusion: </strong>T1D onset in the first year of life may indicate monogenic autoimmune diabetes and molecular testing may be recommended.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2853-2860"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054039","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":"Machine Learning: A Multicenter Study on Predicting Lateral Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma.","authors":"Jing Zhou, Daxue Li, Jiahui Ren, Chun Huang, Shiying Yang, Mingyao Chen, Zhaoyu Wan, Jinhang He, Yuchen Zhuang, Song Xue, Lin Chun, Xinliang Su","doi":"10.1210/clinem/dgaf070","DOIUrl":"10.1210/clinem/dgaf070","url":null,"abstract":"<p><strong>Background: </strong>The necessity of prophylactic lateral neck dissection for cN0 papillary thyroid carcinoma (PTC) remains debated. This study aimed to compare traditional nomograms with machine learning (ML) models for predicting ipsilateral lateral and level II, III, and IV lymph node metastasis (LNM).</p><p><strong>Methods: </strong>Data from 1616 PTC patients diagnosed via fine-needle aspiration biopsy from hospital A were split into training and testing sets (7:3). Two hundred forty-three patients from hospital B served as a validation set. Four dependent variables-ipsilateral lateral and level II, III, and IV LNM-were analyzed. Eight ML models [logistic regression, decision tree, random forest (RF), gradient boosting, support vector machine, K-nearest neighbor, Gaussian naive Bayes, neural networks] were developed and validated using 10-fold cross-validation and grid search hyperparameter tuning. Models were assessed using 11 metrics including accuracy, area under the curve (AUC), specificity, and sensitivity. The best was compared with nomograms using the probability-based ranking model approach (PMRA).</p><p><strong>Results: </strong>RF outperformed other approaches achieving accuracy, AUC, specificity, and sensitivity of 0.773/0.728, 0.858/0.799, 0.984/0.935, 0.757/0.807 in the testing/validation sets, respectively, for ipsilateral LLNM. A streamlined model based on the top 10 contributing features that includes ipsilateral central lymph node metastasis rate, extrathyroidal extension, and ipsilateral central lymph node metastasis number retained strong performance and clearly surpassed a traditional nomogram approach based on multiple metrics and PMRA analysis. Similar results were obtained for the other dependent variables, with the RF models relying on distinct but overlapping sets of features. Clinical tool implementation is facilitated via a web-based calculator for each of the 4 dependent variables.</p><p><strong>Conclusion: </strong>ML, especially RF, reliably predicts lateral LNM in cN0 PTC patients, outperforming traditional nomograms.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2762-2776"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374811","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":"Dysbetalipoproteinemia: Focus on a Neglected Lipid Disorder.","authors":"Amanda J Berberich, Robert A Hegele","doi":"10.1210/clinem/dgae804","DOIUrl":"10.1210/clinem/dgae804","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e3528-e3529"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631747","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":"Sex Differences in the Association Between Thyroid Hormone Sensitivity and Cardiovascular-Kidney-Metabolic Syndrome.","authors":"Lanxuan Jiang, Liyuan Zhou, Jia Liu, Ying Wang, Guang Wang","doi":"10.1210/clinem/dgaf059","DOIUrl":"10.1210/clinem/dgaf059","url":null,"abstract":"<p><strong>Background: </strong>The relationship between thyroid hormone sensitivity and cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. This study aims to investigate the association between thyroid hormone sensitivity and the early-stage of CKM syndrome, with a specific focus on the moderating effects of sex and age.</p><p><strong>Methods: </strong>A total of 8391 euthyroid participants were enrolled in this cross-sectional study. Data on metabolic parameters and thyroid hormone levels were collected. Thyroid hormone sensitivity indices-thyroid feedback quantile index (TFQI), thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI), and free T3 to free T4 ratio were calculated. Logistic regression models and restricted cubic spline regression (RCS) were used to analyze the association between thyroid hormone sensitivity and stage 2 of CKM syndrome stratified by sex and age.</p><p><strong>Results: </strong>In men, the higher TFQI, TSHI, and TT4RI values were significantly associated with increased risks of stage 2 of CKM syndrome. In women, these associations were weaker but still present, particularly for TSHI. RCS analysis also showed that the risk of CKM syndrome tended to increase with decreasing thyroid hormone sensitivity in men. However, these associations in women were not as significant as in men. Age-stratified analysis revealed that older men (>50 years) showed a stronger correlation between thyroid hormone sensitivity and CKM syndrome compared to women.</p><p><strong>Conclusion: </strong>This study demonstrated that impaired thyroid hormone sensitivity was significantly associated with the early-stage of CKM syndrome, particularly in older men. These findings provide the evidence of the importance of thyroid hormone sensitivity in CKM syndrome, especially in men over the age of 50.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e3303-e3312"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124076","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":"Approach to the Patient: Hirsutism.","authors":"Ricardo Azziz, Mina Amiri, Fernando Bril, Anju E Joham, Fahrettin Kelestimur, Sasha Ottey, Larisa Suturina, Chau Thien Tay, Helena Teede, Bulent O Yildiz, Xiaomiao Zhao","doi":"10.1210/clinem/dgaf226","DOIUrl":"10.1210/clinem/dgaf226","url":null,"abstract":"<p><p>Hirsutism affects approximately 10% of women globally, with substantial economic and quality of life effect. Facial and body terminal hair growth in a male-like pattern is determined by a number of factors, including circulating androgens, and tissue androgen receptor, 5α-reductase, 3α- and 17β-hydroxysteroid dehydrogenase, and ornithine decarboxylase content. The presence of hirsutism is usually determined by the modified Ferriman-Gallwey (mFG) visual scale, assessing the amount of terminal hair at 9 body sites (upper lip, chin, chest, upper and lower back, upper and lower abdomen, upper arms, and thighs). Specific diagnostic cutoffs vary somewhat by ethnicity, although hirsutism is usually defined by an mFG score greater than 4 to 6. Hirsutism is a sign of polycystic ovary syndrome in 80% to 90% of affected women, idiopathic hirsutism in 5% to 10%, and, depending on ethnicity, 21-hydroxylase-deficient nonclassic adrenal hyperplasia in 1% to 10%. Rarer causes include androgen-secreting neoplasms, iatrogenic/drug-induced, acromegaly, Cushing syndrome, syndromes of severe insulin resistance/lipodystrophy, ovarian hyperthecosis, and chronic skin irritation. The choice of treatment for hirsutism depends on the severity of symptoms, the patient's reproductive goals, and the underlying cause. Clinicians should not underestimate the degree of patient distress caused by hirsutism. Further, women who complain of excess unwanted hair growth should be evaluated for underlying causes, regardless of the degree to which hirsutism is observable on examination. Management options include medical therapies, such as combined oral contraceptive pills and antiandrogens, and mechanical methods of hair removal. The most effective therapeutic strategy will involve a combination of these modalities, with shared decision-making a key driver.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e3503-e3519"},"PeriodicalIF":5.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812825","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}