Medicine (Abingdon, England : UK ed.)最新文献

{"title":"Polycystic ovary syndrome","authors":"Hassan Kahal","doi":"10.1016/j.mpmed.2025.07.008","DOIUrl":"10.1016/j.mpmed.2025.07.008","url":null,"abstract":"<div><div>Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. In this review we summarize and reflect on the 2023 international evidence-based guidelines for the assessment and management of PCOS in adults.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 635-637"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236335","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":"Male hypogonadism and testosterone replacement therapy","authors":"Leighton J Seal","doi":"10.1016/j.mpmed.2025.07.004","DOIUrl":"10.1016/j.mpmed.2025.07.004","url":null,"abstract":"<div><div>The causes of male hypogonadism can be classified into primary (testicular) and secondary (central). This review discusses the indications for testosterone replacement therapy, provides a practical clinical guide to managing this therapy and reviews its use in non-gonadal illness such as HIV. It summarizes the preparations available for testosterone replacement, with an emphasis on newer delivery systems, and discusses the adverse effects of testosterone treatment, including prostate cancer and polycythaemia. Recent studies on the safety of testosterone with regard to cardiovascular safety and thromboembolism are discussed.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 638-643"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236336","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":"Adrenal adenomas: an overview","authors":"Mohammed Abdel-Magid,&nbsp;Faisal Hasan","doi":"10.1016/j.mpmed.2025.07.003","DOIUrl":"10.1016/j.mpmed.2025.07.003","url":null,"abstract":"<div><div>Adrenal adenomas are benign tumours of the adrenal cortex. Their incidence increases with age, reaching 10% in elderly individuals. They can be either functional (hormonally active) or non-functional. Non-functioning adenomas may not produce clinical symptoms or signs and can remain asymptomatic until discovered during imaging. Functional adrenal adenomas can produce excess glucocorticoids (resulting in Cushing's syndrome or mild autonomous cortisol secretion (MACS)), mineralocorticoids (resulting in hypertension and/or hypokalaemia) or androgens (usually symptomatic in female patients), although the latter is rare in isolation. Evaluation of an adrenal adenoma requires both imaging (non-contrast computed tomography is usually recommended, except in certain circumstances where magnetic resonance imaging might be more suitable) and hormonal work-up. Hormonal tests include a 1 mg overnight dexamethasone suppression test, plasma or urinary metanephrines and measurement of renin and aldosterone levels. If adrenocortical carcinoma is suspected, additional tests are needed which include measurement of sex hormones as well as steroid precursors. Adrenal adenomas are rare in childhood, and their incidence increases with age. The finding of adrenal adenoma in a child or young adult should raise the suspicion of malignancy. Small adenomas that are hormonally inactive can be followed up without immediate intervention. Adrenalectomy is the preferred treatment for hormonally active adenomas. This article reviews the evaluation and management of adrenal adenomas, including lesions found on routine imaging undertaken for other purposes (sometimes called adrenal ‘incidentalomas’).</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 709-713"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236331","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":"Endocrine manifestations of adult malignancy","authors":"Maria Michaelidou,&nbsp;Adhithya Sankar,&nbsp;Shaishav Dhage","doi":"10.1016/j.mpmed.2025.07.013","DOIUrl":"10.1016/j.mpmed.2025.07.013","url":null,"abstract":"<div><div>Endocrine manifestations of adult malignancy are well documented in various forms including ectopic production of hormones from non-endocrine organs (paraneoplastic syndromes), direct involvement of endocrine organs causing hormone imbalance, chronic long-term endocrine effects in cancer survivors and, more commonly, endocrine organ dysfunction secondary to newer and systemic anti-cancer therapies. Interestingly, some of these manifestations can pre-date the onset of cancer or be a presenting symptom of more advanced cancers, detected incidentally. Although most of these manifestations are not serious, they are occasionally life-threatening and can cause significant delays and complications for continuing cancer therapies. Awareness of these endocrine manifestations and early treatment is a very important part of supportive treatment in cancer patients. This review provides a brief overview of common endocrine conditions associated with adult malignancies and newer systemic anti-cancer therapies, including immune checkpoint inhibitor-related endocrinopathies.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 660-667"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236340","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":"Endocrine effects of immunotherapy for cancer","authors":"Mark Quinn,&nbsp;Mamta Joshi,&nbsp;Paul V Carroll","doi":"10.1016/j.mpmed.2025.07.009","DOIUrl":"10.1016/j.mpmed.2025.07.009","url":null,"abstract":"<div><div>Modern cancer immunotherapies have changed the way many cancers are treated. Their use is now first line in many advanced malignancies. These therapies, including immune checkpoint inhibitors (iCPIs), involve directing T cell activity against cancer cells. Adverse effects or immune-related adverse events (irAEs) are common and can affect any system. Endocrine organs are particularly vulnerable to dysfunction because of the underlying mechanism of action. Given their increasing use and rapid advances in the field it is imperative that specialists in both oncology and endocrinology keep up to date on the latest guidelines and protocols for recognizing and treating endocrine irAEs. It is essential to implement strategies that ensure minimal disruption to the anti-cancer therapy during the investigation and diagnosis of irAEs. Here we discuss the various endocrine irAEs described in the literature, focusing on those related to iCPI use. Using up-to-date data, we describe the natural history expected in these conditions. Importantly, as newer iCPI agents are introduced the rates of endocrine irAEs appear consistent.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 668-672"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236341","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":"Prevention and management of osteoporosis","authors":"Sarah Khan,&nbsp;Hamad Y Almatar,&nbsp;Aliya A Khan","doi":"10.1016/j.mpmed.2025.07.012","DOIUrl":"10.1016/j.mpmed.2025.07.012","url":null,"abstract":"<div><div>Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing individuals to an increased fracture risk. The diagnosis of osteoporosis in postmenopausal women and men over the age of 50 is confirmed in the presence of low bone density on a bone mineral density (BMD) dual energy xray absorptiometry (DXA) study. BMD is evaluated in g/cm² and expressed as standard deviation (T-score) above or below the mean BMD in the young adult female Caucasian population. A <em>T</em>-score of −2.5 or lower at the lumbar spine, femoral neck, total hip or one-third radius site confirm the diagnosis of osteoporosis by DXA technology. In postmenopausal women of any age and men over age 50, osteoporosis can also be diagnosed clinically in the presence of a low trauma fracture. Fracture risk assessment, incorporating the Fracture Risk Assessment Tool (FRAX), is crucial in guiding treatment decisions. Clinical evaluation should include a detailed history, physical examination and investigations to exclude secondary causes of osteoporosis, including endocrinopathies, gastrointestinal disorders, inflammatory conditions, malignancies as well as medication-related bone loss. Management strategies include ensuring adequate calcium, phosphate and vitamin supplementation. Pharmacological interventions are offered in the presence of an increased fracture risk.</div><div>Antiresorptive therapies include bisphosphonates, denosumab and selective oestrogen receptor modulators. They reduce bone turnover and fracture risk. Anabolic agents, include teriparatide, abaloparatide and romosozumab. These molecules promote bone formation and improve bone microstructure and dramatically improve bone density while significantly reducing fracture risk. The selection of individualized treatment is based on fracture risk as well as contraindications to therapy. In those at a moderate fracture risk with a major osteoporotic fracture (MOF) risk of 10–20% over the next 10 years a bisphosphonate can be offered for 5 years followed by a possible drug holiday. If the MOF is high (≥20%) or hip fracture risk is ≥3% then denosumab can be offered. If the MOF is very high (MOF&gt;30% or hip fracture risk &gt;4.5%) or in the presence of fragility fracture then an anabolic agent can be considered as first line therapy).</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 10","pages":"Pages 689-693"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236345","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":"Pituitary hormone replacement","authors":"Maria Michaelidou,&nbsp;Shaishav S Dhage","doi":"10.1016/j.mpmed.2025.06.002","DOIUrl":"10.1016/j.mpmed.2025.06.002","url":null,"abstract":"<div><div>Hypopituitarism is associated with increased morbidity and mortality. Hormone replacement therapies are available for the effective treatment of anterior pituitary deficiencies of growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone and follicle-stimulating hormone secretion. The posterior pituitary antidiuretic hormone can also be replaced. The aim of replacement therapy is to mimic as far as possible the normal physiology of the hormone and to avoid over-treatment. Currently available hormone preparations and their advantages and disadvantages are discussed.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 574-578"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934262","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":"Diabetes insipidus (arginine vasopressin deficiency and resistance)","authors":"Merah Al Busaidy,&nbsp;Mark Sherlock","doi":"10.1016/j.mpmed.2025.06.010","DOIUrl":"10.1016/j.mpmed.2025.06.010","url":null,"abstract":"<div><div>Arginine vasopressin (AVP) is a critical hormone in the regulation of water balance and vascular tone. Synthesized in the hypothalamus and released from the posterior pituitary, AVP acts primarily on V2 receptors in the renal collecting ducts to promote water reabsorption via aquaporin-2 (AQP-2) channels, and on V1 receptors to mediate vasoconstriction. Disorders of AVP production or action manifest clinically as diabetes insipidus (DI), more recently termed AVP deficiency (AVP-D) and AVP resistance (AVP-R). These conditions are characterized by hypotonic polyuria and compensatory polydipsia.</div><div>Current diagnostic approaches include the water deprivation test (WDT) and hypertonic saline infusion with copeptin assessment, with increasing emphasis on the utility of copeptin as a stable and reliable biomarker for distinguishing between AVP deficiency (AVP-D), AVP resistance (AVP-R), and primary polydipsia (PP). Management of AVP-D relies on desmopressin (dDAVP), with careful titration to avoid hyponatraemia. AVP-R requires fluid management and pharmacologic interventions including thiazide diuretics and non-steroidal anti-inflammatory drugs. Additional subtypes of DI, such as gestational DI and adipsic hypernatraemia, present specific diagnostic and treatment complexities.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 593-596"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934264","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":"Addison's disease","authors":"Vincent Simpson,&nbsp;Antonia M Brooke","doi":"10.1016/j.mpmed.2025.06.011","DOIUrl":"10.1016/j.mpmed.2025.06.011","url":null,"abstract":"<div><div>Addison's disease, or primary adrenocortical failure, is rare, most commonly caused in the UK by autoimmune destruction of the adrenal glands. The insidious onset of symptoms over many months means there is often a delay in diagnosis and patients can first present in adrenal crisis, which is life-threatening if not appropriately treated. The diagnosis is made by finding a low serum cortisol at 09:00 hours in the presence of an elevated adrenocorticotropic hormone (ACTH) concentration, or by a suboptimal cortisol response to exogenous ACTH on provocation testing. Replacement with hydrocortisone and fludrocortisone should approximate physiological concentrations as closely as possible. Patients and families should have a good understanding of the condition and how to adjust the corticosteroid dosing in times of illness.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 597-601"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934265","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":"Endocrine hypertension","authors":"Mark Sherlock,&nbsp;Merah Al Busaidy","doi":"10.1016/j.mpmed.2025.06.001","DOIUrl":"10.1016/j.mpmed.2025.06.001","url":null,"abstract":"<div><div>Up to 10% of patients have a secondary cause for their hypertension. Endocrine conditions associated with hypertension include diseases associated with mineralocorticoid excess, glucocorticoid excess, phaeochromocytomas/paragangliomas, acromegaly and primary hyperparathyroidism. Primary aldosteronism is the most common endocrine cause of hypertension. If not appropriately managed, primary aldosteronism has an unfavourable cardiovascular morbidity and mortality profile. It is treatable by medical or surgical approaches. Phaeochromocytomas and paragangliomas are rare neuroendocrine tumours frequently associated with genetic abnormalities.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 9","pages":"Pages 602-606"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934266","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}