Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"Adult Height Following Prepubertal Treatment With Antiandrogen, Aromatase Inhibitor, and Reduced Hydrocortisone in CAH.","authors":"Deborah P Merke, Ashwini Mallappa, Megan Parker, Charles Sukin, Sarah E Kulkarni, Margaret F Keil, Carol Van Ryzin, Suvimol Chirathivat Hill, James C Reynolds, Gordon B Cutler, Ninet Sinaii","doi":"10.1210/clinem/dgae824","DOIUrl":"10.1210/clinem/dgae824","url":null,"abstract":"<p><strong>Context: </strong>Height outcome in patients with classic congenital adrenal hyperplasia (CAH) is suboptimal due to glucocorticoid and androgen excess.</p><p><strong>Methods: </strong>In an open, randomized, controlled trial, children with classic CAH were randomized to receive a combination regimen of antiandrogen, aromatase inhibitor, reduced hydrocortisone, and fludrocortisone prior to puberty or standard therapy (hydrocortisone, fludrocortisone). Females continued on antiandrogen during puberty. The primary endpoint was adult height.</p><p><strong>Results: </strong>Of 62 children randomized, 45 completed the study. Adult height SDS did not differ between the investigational and control groups (-0.34 [0.93] vs -0.60 [0.89], respectively), mean difference 0.26 [95% CI -0.29, 0.82], P = .35), irrespective of midparental height, but was greater than the predicted adult height pretreatment in both groups (P < .001). Growth rate and rate of bone maturation were reduced in the investigational group prior to puberty, despite lower hydrocortisone dose (7.6 [1.5] vs 15.0 [3.6] mg/m2/day, P < .001), and improvement in predicted adult height appeared greater at pubertal onset (P = .049) compared to standard therapy. Antiandrogen treatment during puberty in girls allowed for lower-dose glucocorticoid, and improved height outcome (adult minus midparental height: -0.7 [4.6] vs -5.6 [5.2] cm, mean difference 4.9 [95% CI 0.09, 9.7], P = .046). Those who received GnRHa had lower growth rate (P = .023) and longer years of unchanged bone age (P = .017), regardless of treatment.</p><p><strong>Conclusion: </strong>Prepubertal antiandrogen, aromatase inhibitor combination with reduced hydrocortisone improves short-term predicted height for children with CAH but does not result in taller adult stature than those treated with standard therapy, and is not recommended. Females may benefit from antiandrogen treatment during puberty.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2171-e2182"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822842","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":"Approach to the Patient: Diagnostic Challenges in the Workup for Polycystic Ovary Syndrome.","authors":"Anju E Joham, Chau Thien Tay, Joop Laven, Yvonne V Louwers, Ricardo Azziz","doi":"10.1210/clinem/dgae910","DOIUrl":"10.1210/clinem/dgae910","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) affects 10% to 13% of women globally. It is a condition with metabolic, reproductive, and psychological features, with health impacts across the lifespan. The etiology of PCOS is complex, with an interplay of several factors, including genetic and epigenetic susceptibility, androgen exposure in early life and adiposity-related dysfunction leading to hypothalamic-ovarian disturbance. Diagnosis is recommended based on the International PCOS Guideline criteria, with diagnosis confirmed in adults when 2 of out the following 3 criteria are met: (i) hyperandrogenism (clinical or biochemical); (ii) irregular cycles; and (iii) polycystic ovary morphology or elevated anti-Müllerian hormone (AMH) levels. With its clinical heterogeneity, distinct phenotypes, variation across the lifespan and ethnic variation, PCOS diagnosis can present significant diagnostic challenges to clinicians.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2298-e2308"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015387","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":"Diurnal Cortisol Profiles Across Pregnancy: Challenges in the Current State of Knowledge.","authors":"Rosario Pivonello, Renata S Auriemma, Chiara Simeoli, Claudia Pivonello, Annamaria Colao","doi":"10.1210/clinem/dgae644","DOIUrl":"10.1210/clinem/dgae644","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2399-e2400"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299903","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":"Clinical and Radiological Features of Atypical Adrenal Masses-A Multicenter Retrospective Study.","authors":"Vania Balderrama-Brondani, Ruaa Al-Ward, Katja Kiseljak-Vassiliades, Lauren Fishbein, Danielle Dawes, Oksana Hamidi, Reza Pishdad, Juan Pablo Perdomo Rodriguez, Mohamad Anas Sukkari, Joseph R Grajo, Hans Kumar Ghayee, Sara Bedrose, Roland L Bassett, Amir H Hamrahian, Mouhammed Amir Habra","doi":"10.1210/clinem/dgae781","DOIUrl":"10.1210/clinem/dgae781","url":null,"abstract":"<p><strong>Context: </strong>The natural history and malignant potential of cases classified as atypical adrenal masses (AAMs) are unknown.</p><p><strong>Objective: </strong>To describe the radiological characteristics and clinical outcomes of AAMs.</p><p><strong>Design and participants: </strong>A multicenter retrospective study. Patients ≥18 years old with AAMs [diameter of 10-39 mm on first imaging study and pre-contrast attenuation of >10 Hounsfield units (HU) on computed tomography] were studied. We excluded adrenal metastasis, pheochromocytoma, sarcoma, lymphoma, infiltrative lesions, and adrenal hemorrhage, as well as patients with genetic predisposition to adrenal neoplasms. Data are presented as percentages and median values with interquartile ranges (IQRs).</p><p><strong>Results: </strong>We included 217 patients with 224 adrenal masses (61.3% women); the median age was 58 years (IQR 49-65 years). The median size was 20.5 mm (IQR 15-27 mm), with a median precontrast attenuation of 23.5 HU (IQR 17-30 HU). The median AAM growth rate was 0.3 mm/year (IQR 0-1.8 mm/year). Seventy-one masses (31.7%) underwent pathological evaluation. Adrenal adenoma (n = 38; 17%) and adrenocortical carcinoma (ACC) (n = 25; 11.2%) were the 2 most common diagnoses. For the adenomas, the growth rate was 0.3 mm/year (IQR 0-2.3 mm/year) and for ACCs, the growth rate was 12.9 mm/year (IQR 3.5-22 mm/year). The absolute contrast washout was >60% in 5 out of 7 (71.4%) ACC cases. The best growth rate cutoff for predicting malignancy was 2.68 mm/year (area under the curve 0.939; sensitivity 87.5%, specificity 88.8%).</p><p><strong>Conclusion: </strong>AAMs carry significant malignant potential, and long-term follow-up is warranted when surgery is not pursued. Contrast washout is not reliable in predicting malignant potential of AAMs.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2183-e2190"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584876","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":"X-Linked Hypophosphatemia Management in Children: An International Working Group Clinical Practice Guideline.","authors":"Dalal S Ali, Thomas O Carpenter, Erik A Imel, Leanne M Ward, Natasha M Appelman-Dijkstra, Catherine Chaussain, Suzanne M Jan de Beur, Pablo Florenzano, Hajar Abu Alrob, Rana Aldabagh, R Todd Alexander, Farah Alsarraf, Signe Sparre Beck-Nielsen, Martin Biosse-Duplan, Rachel K Crowley, Karel Dandurand, Guido Filler, Lisa Friedlander, Seiji Fukumoto, Claudia Gagnon, Paul Goodyer, Corinna Grasemann, Chelsey Grimbly, Salma Hussein, Muhammad K Javaid, Sarah Khan, Aneal Khan, Anna Lehman, Willem F Lems, E Michael Lewiecki, Ciara McDonnell, Reza D Mirza, Emmett Morgante, Archibald Morrison, Anthony A Portale, Christina Rao, Yumie Rhee, Eric T Rush, Heide Siggelkow, Sotirios Tetradis, Laura Tosi, Gordon Guyatt, Maria Luisa Brandi, Aliya A Khan","doi":"10.1210/clinem/dgaf093","DOIUrl":"10.1210/clinem/dgaf093","url":null,"abstract":"<p><strong>Context: </strong>An International Working Group (IWG) developed new guidelines on the diagnosis, evaluation, management, and monitoring of X-linked hypophosphatemia (XLH) in children. Over the past 5 years, important advances have occurred in our understanding of the presentation, complications, and treatment of XLH.</p><p><strong>Methods: </strong>A group of 50 international experts in XLH from Canada, the United States, Europe, Asia, and South America, along with methodology experts and a patient partner, held 18 teleconference meetings in 2023-2024. These meetings addressed key issues regarding diagnosing, evaluating, managing, and monitoring XLH in children. Two systematic reviews were conducted to examine the impact of burosumab compared to conventional therapy (phosphate salts and active vitamin D) or no therapy, and to assess the impact of conventional therapy vs no therapy on patient-important outcomes. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Additionally, narrative reviews were completed on XLH diagnosis and the role of genetic testing, and an expert clinical practice survey informed the monitoring recommendations.</p><p><strong>Outcomes: </strong>An approach to establishing the diagnosis of XLH is presented. GRADEd recommendations were developed on treatment strategies for XLH in children. Monitoring recommendations, GRADEd as weak with very low certainty, were based on clinical practice survey of the IWG experts. The guidelines also addressed dental complications and proposed potential strategies to mitigate them.</p><p><strong>Conclusion: </strong>These clinical practice guidelines provide an update of the current evidence on the diagnosis and management of XLH and provide a comprehensive guidance for multidisciplinary healthcare professionals involved in the care of children with XLH.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2055-2070"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442638","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 Using Diabetes Technology in Pregnancy.","authors":"Laura T Dickens, Maritza G Gonzalez","doi":"10.1210/clinem/dgae914","DOIUrl":"10.1210/clinem/dgae914","url":null,"abstract":"<p><p>Diabetes in pregnancy increases risk for complications for the pregnant patient and neonate. Tight glycemic control to maintain glucose levels as close to nondiabetic ranges as possible can lower risk for these complications. Achieving strict glycemic targets can be challenging, and technologies including continuous glucose monitors (CGMs) and hybrid closed-loop (HCL) insulin pumps have the potential to improve diabetes control and pregnancy outcomes. The aim of this review is to present and appraise the current data about use of these technologies in pregnancy. In pregnancies with type 1 diabetes (T1D), CGM can improve glycemic control and reduce risk for neonatal complications. International consensus guidelines recommend more than 70% time in pregnancy target range (TIR) of 63 to 140 mg/dL (3.5-7.8 mmol/L), and there are data to suggest higher TIR in pregnancies with T1D can reduce risk for neonatal complications including fetal overgrowth and pregnancy complications like preeclampsia. Recent randomized controlled trials have demonstrated improved glycemic outcomes with use of HCL insulin pumps in pregnancy with T1D, though the results vary depending on the system used and available glycemic targets. In pregnancies with type 2 diabetes (T2D) and gestational diabetes mellitus (GDM), retrospective data suggest CGM can improve glycemia but there are limited data about outcomes or optimal CGM targets. Studies have reported glycemic measures for pregnancies without diabetes, which may serve as a guide for further outcomes studies of T2D and GDM. Access to diabetes technology and the necessary health care systems to support use of these devices may be barriers that contribute to health care disparities.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2317-e2326"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958232","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":"Basal and Stimulated Inhibin B in Pubertal Disorders.","authors":"Shakun Chaudhary, Richard Quinton, Rama Walia","doi":"10.1210/clinem/dgaf005","DOIUrl":"10.1210/clinem/dgaf005","url":null,"abstract":"<p><p>Pubertal disorders in the form of delayed puberty (DP) or precocious puberty (PP) can cause considerable anxiety to both children and parents. Since the clinical and biochemical signatures of self-limiting and permanent conditions overlap considerably, it can be hard to determine whether to offer reassurance or intervention. Researchers have thus long been searching for a robust test to indicate whether the process of endogenous puberty is underway and is likely to proceed to completion. Although existing tests are available, such as basal gonadotropins, gonadotropin-releasing hormone (GnRH)-stimulated luteinizing hormone, and basal and human chorionic gonadotropin-stimulated testosterone, their diagnostic specificity is inadequate. Inhibin B, a glycoprotein hormone, is secreted by Sertoli cells in males and small antral follicles in females. Entry into puberty is characterized by a rise in inhibin B levels in both genders. For the past 2 decades, researchers have been studying the role of inhibin B in the differential diagnosis of DP and PP. Initial studies showed promising results for using inhibin B to distinguish between constitutional (or self-limited) DP and congenital hypogonadotropic hypogonadism. However, diverse population studies have revealed varying cutoffs, limiting the use of basal inhibin B (basal-iB) in routine clinical practice. Recently, the concept of stimulated inhibin B has been introduced, using either follicle-stimulating hormone (FSH) or GnRH-analogs. Both FSH- and GnRH-analog-stimulated inhibin B concentrations were found to be more reliable than basal levels for investigation of pubertal disorders. This review examines the current status of basal-iB in the differential diagnosis of DP and PP, addressing its main advantages and limitations, and shedding light on the role of stimulated inhibin B concentrations.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2136-e2145"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958244","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":"The Influence of Study Quality, Age, and Geographic Factors on PCOS Prevalence-A Systematic Review and Meta-analysis.","authors":"Mina Amiri, Sana Hatoum, Richard P Buyalos, Ali Sheidaei, Ricardo Azziz","doi":"10.1210/clinem/dgae917","DOIUrl":"10.1210/clinem/dgae917","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS) is a highly prevalent disorder with substantial burden, yet global epidemiological data remains limited.</p><p><strong>Objectives: </strong>To estimate the PCOS prevalence globally.</p><p><strong>Materials and methods: </strong>We systematically searched PubMed and Embase for PCOS studies in unselected populations through February 2024.</p><p><strong>Results: </strong>Our study included 88 studies (n = 561 287 women) from 7144 records. The highest PCOS prevalence was identified by the Rotterdam criteria, followed by the Androgen Excess and PCOS Society (AE-PCOS) and the National Institutes of Health (NIH). High-quality studies, as assessed using our newly developed PCOS Epidemiology and Phenotype (PEP) tool, indicated prevalences of 10.89%, 10.61%, and 6.63% using Rotterdam, AE-PCOS, and NIH, respectively. Considering only high-quality studies revealed no significant regional disparities using either NIH [ranging from 5.72% in the Eastern Mediterranean Region (EMR) to 6.90% in the Western Pacific Region (WPR)] or Rotterdam (ranging from 11.15% in South-East Asia to 9.12% in EMR). For AE-PCOS, sufficient data was available only for the WPR region (6.9%). No studies were available in the African Region. A higher PCOS prevalence was observed in adults than adolescents using NIH (8.52% vs 4.44%; P = .01), although the difference diminished when considering only high-quality studies (7.25% vs 4.44%; P = .053). Limited data restricted age-group comparisons using Rotterdam and AE-PCOS.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis reveals a trend toward regional variations and age differences across diagnostic criteria. The study results suggest considering study quality using instruments tailored for epidemiological studies in PCOS, such as the PEP tool, when carrying out these types of meta-analyses.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2082-2103"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933431","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":"Association of Maternal Thyroglobulin With Gestational Thyroid Function and Offspring IQ and Brain Morphology.","authors":"Tessa A Mulder, Mònica Guxens, Maria Luisa Rebagliato, Mariana Dineva, Sarah C Bath, Sandra Hunziker, Jordi Sunyer, Juana Maria Delgado-Saborit, Amaia Irizar Loibide, Nerea Lertxundi, Ryan L Muetzel, Henning Tiemeier, Robin P Peeters, Tim I M Korevaar","doi":"10.1210/clinem/dgae679","DOIUrl":"10.1210/clinem/dgae679","url":null,"abstract":"<p><strong>Background: </strong>Low maternal urinary iodine concentration (UIC) during pregnancy is associated with adverse offspring neurodevelopment. Thyroglobulin (Tg) has been suggested as a more sensitive biomarker than UIC of long-term iodine status, but associations of Tg with neurodevelopment and the possible mediating role of thyroid function remain unknown.</p><p><strong>Aim: </strong>To study whether maternal Tg is associated with (1) maternal and newborn thyroid function and (2) offspring IQ and brain morphology.</p><p><strong>Methods: </strong>Participants were selected from 2 population-based prospective cohorts: Generation R (the Netherlands, iodine-sufficient) and INfancia y Medio Ambiente (Spain, mildly iodine-deficient) with maternal Tg and thyroid function data in the first half of pregnancy or in cord blood, early childhood IQ (age 4.5 and 6 years), late childhood IQ (age 9 and 13), or brain morphology at 10 years. Associations of Tg with TSH, free T4 (FT4), IQ, and brain morphology were studied with multivariable linear regression.</p><p><strong>Results: </strong>(1) Tg was associated with lower TSH (-0.12 [-0.16; -0.08]) and higher FT4 (0.08 [0.05; 0.12]) in pregnancy (n = 4367) but not with cord blood TSH or FT4 (n = 2008). (2) Tg was associated with lower IQ in early childhood (β [95% confidence interval]: -0.06 [-0.10; -0.01], n = 2919) but not with IQ (n = 2503) or brain morphology (n = 1180) in later childhood. None of the associations of Tg with the studied outcomes differed by the iodine-to-creatinine ratio (ie, effect modification) or changed when adjusted for thyroid function.</p><p><strong>Conclusion: </strong>Higher Tg is associated with lower IQ in early childhood and higher thyroid function during pregnancy but not with IQ or brain morphology in later childhood. Further research should determine the value of Tg in addition to UIC for defining iodine status.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2007-2015"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331507","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":"Effectiveness of Dexamethasone for COVID-19 in Hospitalized Patients With Diabetes: A Retrospective Cohort Study.","authors":"Salman Zahoor Bhat, Jiajun Wu, Jamie Perin, Kunbo Wang, Matthew L Robinson, Brian T Garibaldi, Nestoras Mathioudakis","doi":"10.1210/clinem/dgae734","DOIUrl":"10.1210/clinem/dgae734","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes have higher mortality from COVID-19 compared to the general population. Dexamethasone, a potent glucocorticoid used for moderate to severe COVID-19, can worsen hyperglycemia in patients with diabetes, potentially leading to worse outcomes. The efficacy and safety of use of dexamethasone for COVID-19 in patients with diabetes needs further evaluation.</p><p><strong>Objective: </strong>The study aimed to assess the efficacy and safety of dexamethasone in patients with diabetes hospitalized for COVID-19 infection.</p><p><strong>Design: </strong>This retrospective study analyzed data from 5 hospitals in the Johns Hopkins Health System collected between March 3, 2020, and June 25, 2022. Propensity score matching was applied to a cohort of patients with diabetes who received dexamethasone and those who did not (controls), and outcomes were compared using Cox proportional hazards regression models.</p><p><strong>Outcomes: </strong>The primary outcome was time to death within 28 days. The secondary outcome was time to clinical improvement. Additional outcomes included the incidence of hyperglycemic emergencies and subgroup analysis of primary outcomes by clinical severity.</p><p><strong>Results: </strong>Out of 10,329 patients admitted for COVID-19, 3679 had diabetes, and 2361 met the inclusion criteria. After propensity score matching, 529 patients were analyzed in each group. Survival rates between the dexamethasone and control groups during the 0- to 6-day and 7- to 28-day periods and time to clinical improvement at 28 days did not differ significantly. There was no difference in the incidence of diabetic ketoacidosis or hyperosmolar hyperglycemic state between the groups.</p><p><strong>Conclusion: </strong>Dexamethasone treatment did not significantly improve survival or time to clinical improvement in patients with diabetes and COVID-19 infection. Further prospective studies are needed to confirm these findings and determine potential mechanisms.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1846-1853"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479562","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}