The Journal of clinical endocrinology and metabolism最新文献

{"title":"Iopanoic Acid in Severe Thyrotoxicosis: Rediscovering an Effective Therapy.","authors":"Peter Taylor, Nadia Schoenmakers, Leonidas Duntas, Anna Scholz, Fizzah Iqbal, Lynette James, Colin Dayan, Carla Moran, Kristien Boelaert","doi":"10.1210/clinem/dgag421","DOIUrl":"https://doi.org/10.1210/clinem/dgag421","url":null,"abstract":"<p><strong>Background: </strong>Severe thyrotoxicosis remains a high-risk endocrine emergency, particularly in thyroid storm and amiodarone-induced thyrotoxicosis (AIT), where morbidity and mortality remain substantial despite modern intensive care. Rapid reduction of circulating triiodothyronine (T3) is central to stabilization, yet conventional therapies are often slow, unpredictable, or ineffective, particularly in iodine-replete states such as AIT.</p><p><strong>Summary: </strong>We reviewed mechanistic, pharmacokinetic and clinical evidence for iopanoic acid, a potent inhibitor of type I and type II 5'-deiodinase that produces rapid, reversible suppression of peripheral thyroxine (T4) to T3 conversion, alongside comparative rescue strategies including Lugol's iodine, perchlorate, lithium, cholestyramine and therapeutic plasma exchange. Across early clinical studies and a contemporary tertiary-center case series, short-course iopanoic acid consistently produced large, rapid reductions in serum T3, typically within 24-48 hours, with parallel clinical improvement. In a recent series of 12 patients with treatment-resistant thyrotoxicosis, mean free T3 fell by approximately 55%, normalizing within a median of 2 days and enabling progression to definitive surgery in most cases. Reported use extends beyond thyroid storm to urgent pre-operative preparation of uncontrolled hyperthyroidism, amiodarone-induced thyrotoxicosis and destructive thyroiditis. Adverse effects are uncommon and generally mild, and withdrawal from routine clinical use reflects the obsolescence of oral cholecystography rather than safety concerns.</p><p><strong>Conclusions: </strong>Iopanoic acid offers safe, rapid and predictable T3 reduction as short-course rescue or bridging therapy in thyroid storm and refractory, iodine-unresponsive AIT, where it can be lifesaving. It is not recommended for straightforward thyrotoxicosis. We synthesize the evidence into a pragmatic, protocol-based framework and argue that reliable, appropriately governed sourcing is now the principal barrier to its use.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-Stratified Outcomes Using the 2025 ATA Thyroglobulin Cutoff After Total Thyroidectomy in Differentiated Thyroid Cancer.","authors":"Mayumi Endo, Kulsum Madani, Danielle Tran, Christophe Courtine, Riya Yerramilli, Irina Azaryan, Andrew Hoofnagle, Mara Y Roth","doi":"10.1210/clinem/dgag425","DOIUrl":"https://doi.org/10.1210/clinem/dgag425","url":null,"abstract":"<p><strong>Background: </strong>Differentiated thyroid cancer (DTC) is increasingly managed with total thyroidectomy (TT) without radioactive iodine (RAI). An unstimulated thyroglobulin (Tg) ≤ 0.2 ng/mL has traditionally defined remission. The 2025 American Thyroid Association (ATA) guideline raised the threshold to 2.5 ng/mL to reduce overtreatment. We evaluated the performance of this cutoff in clinical practice.</p><p><strong>Methods: </strong>We performed a retrospective study of patients with DTC treated with TT without RAI between 2001 and 2023. Eligible patients had more than 3 years of follow-up, undetectable anti-thyroglobulin antibody, and negative initial imaging.</p><p><strong>Results: </strong>Of 2,781 screened patients, 205 met inclusion criteria: 118 were ATA low-, 42 low-intermediate, and 45 intermediate-high risk disease. Mean follow-up was 85 months. Using the revised Tg threshold (<2.5 ng/mL) increased the excellent response group from 76% to 98%. Among ATA low-risk patients, no structural recurrences were missed. However, 3.5% of patients with low-intermediate or higher-risk disease developed structural recurrence despite meeting excellent response criteria. The median time to recurrence was 22 months. In these patients, a postoperative Tg cutoff of 0.3 ng/mL demonstrated 100% sensitivity for structural recurrence. No thyroid cancer-related deaths occurred.</p><p><strong>Conclusions: </strong>The 2025 ATA Tg threshold increased excellent response classification without missing recurrence in low-risk patients. However, structural recurrences occurred in patients with higher-risk disease below the revised cutoff, suggesting that Tg thresholds may require risk-adapted interpretation. Continued imaging surveillance remains important for patients with low-intermediate or higher recurrence risk, even when Tg criteria for excellent response are met under the 2025 ATA guidelines.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of tirzepatide (GIP/GLP-1 dual receptor agonist) on cardiorenal biomarkers and functional capacity in heart failure: a systematic review and meta-analysis.","authors":"Naseem Eisa, Mira Khoury","doi":"10.1210/clinem/dgag284","DOIUrl":"https://doi.org/10.1210/clinem/dgag284","url":null,"abstract":"<p><strong>Background: </strong>Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated clinical benefits in heart failure with preserved ejection fraction (HFpEF) and obesity. However, its effects on cardiorenal biomarkers and functional capacity have not been comprehensively synthesized. We hypothesized that tirzepatide produces significant reductions in cardiorenal biomarkers and improvements in functional capacity compared to placebo or standard of care.</p><p><strong>Methods: </strong>This systematic review and meta-analysis (PROSPERO: CRD42026137255) searched PubMed, Embase, CENTRAL, Web of Science, and Scopus from inception to April 17, 2026, without restrictions. Randomized controlled trials and prospective observational studies reporting NT-proBNP, high-sensitivity C-reactive protein (hsCRP), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), 6-minute walk test (6 MWT), or renal outcomes with tirzepatide vs placebo or standard of care were included. Data were pooled using random-effects models with Hartung-Knapp-Sidik-Jonkman adjustment.</p><p><strong>Results: </strong>Seven studies (5 RCTs, 2 observational; 5406 participants) were included. Tirzepatide significantly reduced hsCRP by 34.3% (95% CI: -38.4% to -30.1%; P < .0001; I2 = 0.0%; 6 studies) and NT-proBNP by 17.6% (95% CI: -26.7% to -8.5%; P = .0001; I2 = 58.1%; 3 studies). In the SUMMIT trial, KCCQ-CSS improved by 5.1 points (P < .001) and 6 MWT by 15.8 m (P = .004). Single-trial data demonstrated estimated glomerular filtration rate (eGFR) preservation (+2.90 mL/min/1.73 m2/year; 95% CI: 0.94 to 4.86) and urine albumin-to-creatinine ratio reduction (-25.0%; 95% CI: -36.0% to -13.0%).</p><p><strong>Conclusion: </strong>Tirzepatide produces consistent anti-inflammatory effects and significant natriuretic peptide reductions, supported by moderate Grading of Recommendations Assessment, Development and Evaluation certainty. Evidence for functional and renal outcomes remains limited to single-trial analyses and should be considered hypothesis-generating pending larger dedicated heart failure trials.</p><p><strong>Prospero registration: </strong>CRD42026137255.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to a patient with MEN1 syndrome.","authors":"Anna L Mitchell, Márta Korbonits","doi":"10.1210/clinem/dgag414","DOIUrl":"https://doi.org/10.1210/clinem/dgag414","url":null,"abstract":"<p><p>MEN1 (multiple endocrine neoplasia type 1) is an uncommon, autosomal dominant inherited endocrine tumour predisposition syndrome. The most common manifestations of MEN1 are primary hyperparathyroidism, pancreatic neuroendocrine tumours and pituitary adenomas. Individuals with MEN1 benefit from lifelong surveillance, with the aim of detecting MEN1 manifestations early. The ideal timepoint for interventions needs to be carefully selected in the context of the syndrome. Published guidelines help clinicians to navigate the management and follow up of individuals with MEN1. This article aims to explore some of the nuance in the investigation and management of this often complex condition from an endocrinologist's point of view, through exploration of 4 clinical case vignettes.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild Autonomous Cortisol Secretion and Psychiatric Morbidity in Patients With Adrenal Tumors: A Cohort Study.","authors":"Hadis Mirzaei, Jonatan D Lindh, Alexandra Falhammar, Merit Schaafsma, Buster Mannheimer, Henrik Falhammar","doi":"10.1210/clinem/dgag419","DOIUrl":"https://doi.org/10.1210/clinem/dgag419","url":null,"abstract":"<p><strong>Context: </strong>Mild autonomous cortisol secretion (MACS) in adrenal tumors (ATs) is associated with cardiometabolic disease, but its relationship with psychiatric morbidity is poorly defined.</p><p><strong>Objective: </strong>To investigate psychiatric outcomes in relation to cortisol autonomy in patients with ATs.</p><p><strong>Methods: </strong>Population-based retrospective cohort study of 3195 patients with a first benign AT diagnosis (2005-2018) and an available 1-mg dexamethasone suppression test (DST) result in the Stockholm Region, Sweden, identified via national registers and regional laboratories. Patients were classified as having MACS (DST >50 nmol/L) or non-functional AT (NFAT) (DST ≤50 nmol/L). Prevalent and incident psychiatric diagnoses and dispensed psychotropic medications were analyzed by logistic and Cox regression, adjusted for age, sex, and socioeconomic status.</p><p><strong>Results: </strong>Of 3195 patients (median age, 64 years; 58.9% women), 1979 had NFAT and 1216 had MACS. Psychiatric disorders were more common with MACS (adjusted odds ratio, 1.35 [95% CI, 1.11-1.64]). Over 4.7 years' median follow-up, MACS was associated with higher incidence of psychiatric disorders (adjusted hazard ratio [aHR], 1.79 [1.43-2.23]), including anxiety, mood, and substance use disorders (aHR range, 1.41-2.50), with the highest point estimate among men younger than 65 years (aHR, 3.11 [1.87-5.18]). However, after correction for multiple comparisons only psychiatric disorders and substance use disorders remained significant. Findings were consistent across categorical and continuous cortisol measures.</p><p><strong>Conclusions: </strong>Psychiatric disorders were more common among patients with MACS than NFAT. These findings suggest that mild cortisol autonomy may contribute to psychiatric vulnerability and support consideration of psychiatric history and symptoms when assessing patients with ATs.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconception incretin therapy reduces pregnancy and cardiometabolic outcomes in polycystic ovary syndrome.","authors":"Alex E Henney, Phoebe J Holmes, David Riley, Megan Heague, Dharani K Hapangama, Uazman Alam, Daniel J Cuthbertson","doi":"10.1210/clinem/dgag423","DOIUrl":"https://doi.org/10.1210/clinem/dgag423","url":null,"abstract":"<p><strong>Background: </strong>Polycystic ovary syndrome (PCOS), now polyendocrine metabolic ovarian syndrome (PMOS), is associated with reproductive and cardiometabolic complications. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptor agonists (RAs) improve obesity-related outcomes, but their impact on pregnancy outcomes in PMOS remains unclear.</p><p><strong>Methods: </strong>We conducted a target trial emulation using the TriNetX global federated health research network. Women ≥18 years with PCOS/PMOS receiving pre-conception GLP-1/dual GLP-1/GIP RA therapy (liraglutide, semaglutide or tirzepatide) were compared with metformin. Propensity score matching (1:1) accounted for demographics, anthropometrics, comorbidities and medications. The primary outcome was a composite of adverse pregnancy outcomes (hypertensive, glycaemic, placental, delivery, labour, foetal growth, preterm and early pregnancy complications) over two years. Individual pregnancy endpoints, major adverse cardiovascular events (MACE) and type 2 diabetes (T2D) were exploratory secondary outcomes. Cox regression generated hazard ratios (HRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>After matching, 48,126 patients were included per group. Pre-conception GLP-1/GIP RA use was associated with lower risk of the composite pregnancy outcome (HR 0.38; 95% CI 0.34-0.41). Exploratory analyses also demonstrated lower risks of individual pregnancy endpoints, MACE (HR 0.88; 95% CI 0.81-0.95) and T2D (HR 0.31; 95% CI 0.30-0.33). Associations varied across some sensitivity analyses.</p><p><strong>Conclusion: </strong>Pre-conception GLP-1/GIP RA use in women with PCOS/PMOS was associated with lower risks of adverse pregnancy outcomes and cardiometabolic disease compared with metformin, consistent with potential benefits of pre-conception metabolic optimisation. This study cannot evaluate in-pregnancy safety or efficacy, and these findings do not support GLP-1/GIP RA use during gestation.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Molecular Genetic Testing Risk Stratification for Pediatric Papillary Thyroid Carcinoma Therapy.","authors":"Lingyi Yang, Kai Qian, Zirui Huang, Kai Guo, Mengjia Fei, Anqi Li, Yunjun Wang, Yuan Shi, Ming Qiu, Zixian Chen, Xi He, Zhuoying Wang","doi":"10.1210/clinem/dgag418","DOIUrl":"https://doi.org/10.1210/clinem/dgag418","url":null,"abstract":"<p><strong>Background: </strong>Children and young adolescents with papillary thyroid cancer (CAYA-PTC) have high recurrence rates. Current guidelines advocate intensive treatment, yet existing risk stratification systems lack integration of genomic characteristics and provide limited precision in guiding surgical extent and postoperative radioactive iodine (RAI).</p><p><strong>Patients and methods: </strong>This retrospective, multicenter study analyzed 435 CAYA-PTC patients (ages 2-18 years) treated between 2006 and 2024. A clinicogenomic nomogram for disease-free survival (DFS) was developed using clinical data, postoperative pathology, and molecular testing of surgical tissue. Patients were stratified according to the nomogram score. Model performance was internally compared with the American Thyroid Association (ATA) pediatric risk system. Treatment associations were assessed by surgical extent (total thyroidectomy vs lobectomy) and receipt of postoperative RAI therapy within each risk stratification.</p><p><strong>Results: </strong>Five variables were independent predictors of worse DFS: age ≤15 years, tumor size >4 cm, lateral neck node involvement (N1b), coexisting Hashimoto thyroiditis, and RET/NTRK fusions (all P <.05). The nomogram stratified patients into low-, intermediate-, and high-risk groups with 7-year DFS rates of 92.4%, 83.1%, and 56.4% (P <.001). In internal comparison, nomogram-based risk stratification had higher concordance index (0.721 vs 0.656) and 3-year AUC (0.748 vs 0.651) values than ATA stratification (both P <.05). Total thyroidectomy was associated with better DFS in intermediate- and high-risk patients but not low-risk patients. Higher DFS with postoperative RAI was observed in the high-risk group (P =.028).</p><p><strong>Conclusions: </strong>Using retrospective clinicogenomic features, our stratification suggests a risk-adapted framework for CAYA-PTC. However, non-significant differences, especially in small subgroups, do not establish treatment equivalence or confirm the safety of de-escalation. These findings represent associations that require future external validation.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and non-invasive assessment of metabolic dysfunction-associated steatotic liver disease and glycogenic hepatopathy in individuals with type 1 diabetes.","authors":"Sílvia Ballesta, Juan Pedro-Botet, Elisenda Climent, Sonia Fernández-Veledo, Rosa Gaja, Anna Garrido, Joan Vendrell, Juan Sánchez, Mercè Fernández, Juan J Chillarón, Gemma Llauradó","doi":"10.1210/clinem/dgag422","DOIUrl":"https://doi.org/10.1210/clinem/dgag422","url":null,"abstract":"<p><strong>Objective: </strong>To deepen understanding of metabolic dysfunction-associated steatotic liver disease (MASLD) and presumptive glycogenic hepatopathy (GH) in adults with type 1 diabetes (T1D), and to evaluate non-invasive indices and novel biomarkers for their differentiation.</p><p><strong>Methods: </strong>We conducted a cross-sectional study including 202 adults with T1D. Hepatic steatosis was assessed using a stepwise imaging approach: all participants underwent ultrasound (US); liver magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was performed when US was abnormal. Based on imaging, participants were categorized into three hepatic phenotypes: normal liver (NL), MASLD (steatosis on both US and MRI), and presumptive GH (hyperechogenicity on US but <5% fat on MRI). MRI-derived fat correlations and the performance of non-invasive indices and biomarkers were assessed.</p><p><strong>Results: </strong>Hepatic steatosis was identified by US in 39 participants, yielding a MASLD prevalence of 19.3%. Among the 32 participants with abnormal US who underwent MRI-PDFF, only 50% had liver fat ≥5%, indicating limited specificity of US and enabling identification of a presumptive GH phenotype (8.2%). MASLD was associated with a worse metabolic profile than presumptive GH or NL. The Fatty Liver Index (FLI) correlated strongly with MRI liver fat (ρ = 0.726, p < 0.0001) and showed promising exploratory performance (AUC = 0.842, 95% CI 0.687-0.998).</p><p><strong>Conclusions: </strong>US may overestimate hepatic steatosis in adults with T1D, partly due to presumptive GH. Among participants undergoing MRI-PDFF, FLI showed promising exploratory performance for identifying steatosis, but requires further validation in cohorts undergoing systematic MRI-PDFF assessment.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Denosumab Versus Bisphosphonates for Hypercalcemia of Malignancy: A Real-World Cohort Study.","authors":"Jovan Milosavljevic, Beatrice Y Wong, Brendon Fusco, Zoe Videlefsky, Rasim Gucalp, Vafa Tabatabaie","doi":"10.1210/clinem/dgag417","DOIUrl":"https://doi.org/10.1210/clinem/dgag417","url":null,"abstract":"<p><strong>Context: </strong>The 2023 Endocrine Society guideline conditionally favors denosumab over intravenous bisphosphonates for hypercalcemia of malignancy (HCM), but direct comparative evidence is scarce.</p><p><strong>Objective: </strong>To compare effectiveness of denosumab versus bisphosphonates for the treatment of HCM.</p><p><strong>Design and setting: </strong>Observational cohort study of adults hospitalized with HCM between January 2016 and January 2026 at a large academic safety-net hospital system in the Bronx, NY.</p><p><strong>Patients: </strong>Adults aged ≥18 years with serum calcium >10.5 mg/dL, active or prior malignancy, and treated with bisphosphonates or denosumab as inpatient. Patients with eGFR <15 mL/min/1.73 m2 or recent antiresorptive exposure were excluded.</p><p><strong>Interventions: </strong>Intravenous bisphosphonate (zoledronic acid or pamidronate) versus denosumab.</p><p><strong>Main outcome measures: </strong>Primary outcome was time to serum calcium normalization (≤10.5 mg/dL). Secondary outcomes included hypocalcemia, hypercalcemia recurrence, and 90-day all-cause mortality. Propensity score overlap weighting balanced baseline covariates.</p><p><strong>Results: </strong>Among 836 patients (mean age 67.0 years; 50.1% female; 44.9% non-Hispanic Black, 29.9% Hispanic) contributing 869 admissions, 814 (93.7%) received bisphosphonates and 55 (6.3%) denosumab. Time to normalization was similar (median 1.62 vs 1.58 days; HR 0.80; 95% CI, 0.57-1.12). Hypocalcemia (HR 0.86; 95% CI, 0.58-1.26) and 90-day recurrence (HR 0.97; 95% CI, 0.54-1.74) did not differ. Ninety-day mortality was lower with denosumab (HR 0.51; 95% CI, 0.30-0.88).</p><p><strong>Conclusions: </strong>Denosumab and bisphosphonates were associated with similar calcium normalization, hypocalcemia, and recurrence rates in this real-world observational cohort. The lower 90-day mortality observed with denosumab warrants prospective investigation given the limitations of observational research.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Aldosteronism Severity Grading: Missing the Mark for the Moderate Majority.","authors":"Elisabeth Ng, Adina F Turcu","doi":"10.1210/clinem/dgag409","DOIUrl":"https://doi.org/10.1210/clinem/dgag409","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}