<div> <section> <h3> Background</h3> <p>Hypopituitarism, characterized by the deficiency of one or more pituitary hormones, can lead to diverse gastrointestinal (GI) manifestations that are often under-recognized, particularly in elderly patients. These symptoms, ranging from nausea and constipation to severe complications like malabsorption and hepatic dysfunction, can significantly impact patient outcomes if not addressed promptly.</p> </section> <section> <h3> Objective</h3> <p>This review aims to elucidate the GI implications of hypopituitarism, focusing on the clinical features, underlying mechanisms and therapeutic approaches, with an emphasis on hormone replacement therapy (HRT) and its potential benefits and risks.</p> </section> <section> <h3> Methods</h3> <p>A comprehensive literature review was conducted to explore the relationship between pituitary hormone deficiencies and GI function. The study synthesizes findings on how deficiencies in growth hormone (GH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), gonadotropins, prolactin and arginine vasopressin affect gut motility, nutrient absorption and overall GI health. Relevant studies were identified through database searches, and clinical evidence was evaluated to highlight diagnostic and therapeutic strategies.</p> </section> <section> <h3> Results</h3> <p>GI manifestations in hypopituitarism include nausea, vomiting, constipation, malabsorption, intestinal pseudo-obstruction and hepatic dysfunction, driven by specific hormonal deficiencies. GH deficiency impairs gut motility and mucosal integrity, ACTH deficiency leads to nausea and nutrient malabsorption, TSH deficiency causes slowed GI transit and arginine vasopressin deficiency contributes to dehydration-related constipation. HRT, including hydrocortisone, levothyroxine and GH, can alleviate these symptoms, but overtreatment may result in adverse effects such as gastric ulcers, diarrhoea or hyperglycaemia. Multidisciplinary management, including nutritional support and symptomatic treatment, is crucial for optimizing outcomes.</p> </section> <section> <h3> Conclusion</h3> <p>Hypopituitarism significantly impacts GI function, necessitating increased clinical awareness for timely diagnosis and management. Tailored HRT, combined with vigilant monitoring for overtreatment and lifestyle interventions, can effectively address GI symptoms and improve quality of life. Further research is needed to clarify the mechan
{"title":"Unveiling Gastrointestinal Involvement in Hypopituitarism: Clinical Features and Treatment Approaches","authors":"Mengmei Li, Ling Song, Jing Wang, Chengsen Zhang","doi":"10.1111/cen.70021","DOIUrl":"10.1111/cen.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypopituitarism, characterized by the deficiency of one or more pituitary hormones, can lead to diverse gastrointestinal (GI) manifestations that are often under-recognized, particularly in elderly patients. These symptoms, ranging from nausea and constipation to severe complications like malabsorption and hepatic dysfunction, can significantly impact patient outcomes if not addressed promptly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This review aims to elucidate the GI implications of hypopituitarism, focusing on the clinical features, underlying mechanisms and therapeutic approaches, with an emphasis on hormone replacement therapy (HRT) and its potential benefits and risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature review was conducted to explore the relationship between pituitary hormone deficiencies and GI function. The study synthesizes findings on how deficiencies in growth hormone (GH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), gonadotropins, prolactin and arginine vasopressin affect gut motility, nutrient absorption and overall GI health. Relevant studies were identified through database searches, and clinical evidence was evaluated to highlight diagnostic and therapeutic strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GI manifestations in hypopituitarism include nausea, vomiting, constipation, malabsorption, intestinal pseudo-obstruction and hepatic dysfunction, driven by specific hormonal deficiencies. GH deficiency impairs gut motility and mucosal integrity, ACTH deficiency leads to nausea and nutrient malabsorption, TSH deficiency causes slowed GI transit and arginine vasopressin deficiency contributes to dehydration-related constipation. HRT, including hydrocortisone, levothyroxine and GH, can alleviate these symptoms, but overtreatment may result in adverse effects such as gastric ulcers, diarrhoea or hyperglycaemia. Multidisciplinary management, including nutritional support and symptomatic treatment, is crucial for optimizing outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypopituitarism significantly impacts GI function, necessitating increased clinical awareness for timely diagnosis and management. Tailored HRT, combined with vigilant monitoring for overtreatment and lifestyle interventions, can effectively address GI symptoms and improve quality of life. Further research is needed to clarify the mechan","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"641-650"},"PeriodicalIF":2.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura S. Aagaard, Jesper Krogh, Signe Perlman, Marianne Klose, Mikkel Andreassen
Objective
Oral estrogens increase the levels of cortisol binding globulin (CBG) potentially affecting test results for adrenal insufficiency. The objective was to evaluate the influence of oral and transdermal estradiol on total plasma (p) and salivary cortisol in hypogonadal women with secondary adrenal insufficiency or at risk of developing adrenal insufficiency. Furthermore, to determine if estradiol treatment can lead to a change in the diagnosis of adrenal insufficiency based on a Synacthen-test.
Methods
Crossover study. Intervention: 12 weeks oral estradiol (2 mg), 12 weeks transdermal estradiol (100 µg/day), and 12 weeks without estradiol. After each intervention plasma total cortisol (pTC), salivary cortisol and CBG were measured before and after a 250 ug Synacthen-test (30 min) (normal response pTC > 420 nmol/L, overt adrenal insufficiency pTC < 250 nmol/L).
Results
Seventeen hypopituitary patients, mean age 42 ± 6 years were included. 30-min pTC did not change significantly according to intervention (no estradiol 401 (interquartile range: 55–495), oral estradiol 440 (74–600), and transdermal estradiol 304 (48–492) nmol/L). Based on pTC no patients with overt adrenal insufficiency crossed the cut-off for adrenal insufficiency between interventions whereas three patients with borderline adrenal insufficiency (pTC 390–559 nmol/L) crossed the cut-off. CBG was higher on oral estradiol compared to no estradiol (p < 0.001) and transdermal estradiol (p = 0.017) whereas 30-min salivary cortisol was lower on oral estradiol compared to no estradiol (6.6 (1.6–23.0) vs. 10.4 (3.6–25.5 nmol/L) p = 0.04) and transdermal estradiol (p = 0.07).
Conclusion
In patients with overt adrenal insufficiency pTC was not influenced by estradiol supplementation. However, salivary cortisol decreased on oral estradiol concomitant with an increase in CBG levels. Our data may support the use of transdermal estradiol and the use of salivary cortisol when evaluating the adrenal axis.
{"title":"Significance of Exogenous Estradiol on Plasma Cortisol and Salivary Cortisol During Adrenocorticotropic Hormone Stimulation in Women With Pituitary Insufficiency","authors":"Laura S. Aagaard, Jesper Krogh, Signe Perlman, Marianne Klose, Mikkel Andreassen","doi":"10.1111/cen.70020","DOIUrl":"10.1111/cen.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Oral estrogens increase the levels of cortisol binding globulin (CBG) potentially affecting test results for adrenal insufficiency. The objective was to evaluate the influence of oral and transdermal estradiol on total plasma (p) and salivary cortisol in hypogonadal women with secondary adrenal insufficiency or at risk of developing adrenal insufficiency. Furthermore, to determine if estradiol treatment can lead to a change in the diagnosis of adrenal insufficiency based on a Synacthen-test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Crossover study. Intervention: 12 weeks oral estradiol (2 mg), 12 weeks transdermal estradiol (100 µg/day), and 12 weeks without estradiol. After each intervention plasma total cortisol (pTC), salivary cortisol and CBG were measured before and after a 250 ug Synacthen-test (30 min) (normal response pTC > 420 nmol/L, overt adrenal insufficiency pTC < 250 nmol/L).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen hypopituitary patients, mean age 42 ± 6 years were included. 30-min pTC did not change significantly according to intervention (no estradiol 401 (interquartile range: 55–495), oral estradiol 440 (74–600), and transdermal estradiol 304 (48–492) nmol/L). Based on pTC no patients with overt adrenal insufficiency crossed the cut-off for adrenal insufficiency between interventions whereas three patients with borderline adrenal insufficiency (pTC 390–559 nmol/L) crossed the cut-off. CBG was higher on oral estradiol compared to no estradiol (<i>p</i> < 0.001) and transdermal estradiol (<i>p</i> = 0.017) whereas 30-min salivary cortisol was lower on oral estradiol compared to no estradiol (6.6 (1.6–23.0) vs. 10.4 (3.6–25.5 nmol/L) <i>p</i> = 0.04) and transdermal estradiol (<i>p</i> = 0.07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with overt adrenal insufficiency pTC was not influenced by estradiol supplementation. However, salivary cortisol decreased on oral estradiol concomitant with an increase in CBG levels. Our data may support the use of transdermal estradiol and the use of salivary cortisol when evaluating the adrenal axis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 6","pages":"852-862"},"PeriodicalIF":2.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dorte Glintborg, Jens-Jakob Kjer Møller, Katrine Hass Rubin, Louise Lehmann Christensen, Marianne Skovsager Andersen
<div> <section> <h3> Objective</h3> <p>Autoimmunity can be part of the pathogenesis of polycystic ovary syndrome (PCOS), but prospective studies on autoimmune disease in population based cohorts are lacking. This study aimed to investigate incidence rates of autoimmune disease in Danish women with PCOS before and after PCOS diagnosis compared to controls.</p> </section> <section> <h3> Design</h3> <p>National register-based study.</p> </section> <section> <h3> Patients</h3> <p>Danish women diagnosed with PCOS (<i>N</i> = 30,340) and age-matched controls (<i>N</i> = 151,520).</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Autoimmune disease was study outcome (defined by ICD10 diagnosis for autoimmune diseases and/or medical treatment for type 1 diabetes (T1D) or thyroid disease).</p> </section> <section> <h3> Results</h3> <p>The median age at PCOS diagnosis was 29 years (interquartile range (IQR), 23; 36).</p> </section> <section> <h3> Before PCOS Diagnosis</h3> <p>(Mean risk time 11.3 years until PCOS diagnosis), the incidence rate ratio (IRR) for all autoimmune diseases was 1.52 (1.45; 1.59) in women with PCOS compared to controls, for T1D 2.31 (2.06; 2.59) and for thyroid disease 1.72 (1.61; 1.84), <i>p</i> < 0.001.</p> </section> <section> <h3> During Follow up</h3> <p>(After PCOS diagnosis, mean follow up duration 9.8 years), women with PCOS compared to controls had IRR for autoimmune disease of 1.50 (1.44; 1.57), T1D of 3.49 (3.16; 3.87) and thyroid disease of 1.48 (1.40; 1.57), all <i>p</i> < 0.001. In women with PCOS, higher incidence of autoimmune disease before and after PCOS diagnosis was related to foreign ethnicity, low family income, comorbidity, infertility, and higher BMI.</p> </section> <section> <h3> Conclusion</h3> <p>The incidence rate of autoimmune disease was higher in women with PCOS compared to controls, before and after PCOS diagnosis, and this higher incidence was associated with lower socioeconomic status, comorbidity and higher BMI.</p> </section> <section> <h3> Trial Registration</h3> <p>Not applicable.
{"title":"Incidence of Autoimmune Diseases in 30,340 Danish Women With Polycystic Ovary Syndrome (PCOS) Compared to 151,520 Controls. A National Cohort Study","authors":"Dorte Glintborg, Jens-Jakob Kjer Møller, Katrine Hass Rubin, Louise Lehmann Christensen, Marianne Skovsager Andersen","doi":"10.1111/cen.70019","DOIUrl":"10.1111/cen.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Autoimmunity can be part of the pathogenesis of polycystic ovary syndrome (PCOS), but prospective studies on autoimmune disease in population based cohorts are lacking. This study aimed to investigate incidence rates of autoimmune disease in Danish women with PCOS before and after PCOS diagnosis compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>National register-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>Danish women diagnosed with PCOS (<i>N</i> = 30,340) and age-matched controls (<i>N</i> = 151,520).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Autoimmune disease was study outcome (defined by ICD10 diagnosis for autoimmune diseases and/or medical treatment for type 1 diabetes (T1D) or thyroid disease).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age at PCOS diagnosis was 29 years (interquartile range (IQR), 23; 36).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Before PCOS Diagnosis</h3>\u0000 \u0000 <p>(Mean risk time 11.3 years until PCOS diagnosis), the incidence rate ratio (IRR) for all autoimmune diseases was 1.52 (1.45; 1.59) in women with PCOS compared to controls, for T1D 2.31 (2.06; 2.59) and for thyroid disease 1.72 (1.61; 1.84), <i>p</i> < 0.001.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> During Follow up</h3>\u0000 \u0000 <p>(After PCOS diagnosis, mean follow up duration 9.8 years), women with PCOS compared to controls had IRR for autoimmune disease of 1.50 (1.44; 1.57), T1D of 3.49 (3.16; 3.87) and thyroid disease of 1.48 (1.40; 1.57), all <i>p</i> < 0.001. In women with PCOS, higher incidence of autoimmune disease before and after PCOS diagnosis was related to foreign ethnicity, low family income, comorbidity, infertility, and higher BMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence rate of autoimmune disease was higher in women with PCOS compared to controls, before and after PCOS diagnosis, and this higher incidence was associated with lower socioeconomic status, comorbidity and higher BMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Not applicable.","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 6","pages":"863-872"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rohit Barnabas, Anurag Ranjan Lila, Saba Samad Memon, Manjiri Karlekar, Sneha Arya, Kunal Thakkar, Hemangini Thakkar, Virendra Patil, Vijaya Sarathi, Nalini S. Shah, Tushar R. Bandgar
Introduction
Biochemical evaluation of 46, XY disorders of sex development(DSD) remains challenging due to overlapping profiles and limited validation in genetically proven cases. We studied the diagnostic accuracy of serum hormonal parameters in a well-characterized cohort.
Methods
Post-hoc hormonal analysis of a prospective study on genetics of 46, XY DSD(n = 165) was performed. Etiological diagnosis was primarily based on genotypic data. Patients without pathogenic genetic variants but with mullerian structures were classified as having gonadal dysgenesis(GD). Serum hormone levels during mini-pubertal, prepubertal, and pubertal stages were analyzed for diagnostic accuracy across etiological subgroups.
Results
In GD, high serum FSH effectively distinguished others across all stages:mini puberty(AUC 0.896; sensitivity 75%, specificity 94.4% at 5.95 IU/L), prepuberty (AUC 0.860; sensitivity 60%, specificity 92.1% at 3.72 IU/L), and puberty (AUC 0.925; sensitivity 89.3%, specificity 90.6% at 38.15 IU/L). In17βHSD3D,(a gonadal steroidogenesis defect), prepubertal hCG-stimulated androstenedione(AUC = 0.929, cutoff 0.53 ng/ml, sensitivity 80%, specificity 80%) and Testosterone/Androstenedione(T/A) ratio(AUC = 0.898, cutoff 1.66, sensitivity 80%, specificity 94.5%) were diagnostic, while T/A cutoff 0.8 had 20% sensitivity. For SRD5A2,(testosterone metabolism defect), low pubertal LH(AUC = 0.908, cutoff 7.11 IU/L, sensitivity 75%, specificity 87.5%) was discriminatory, while prepubertal T/DHT cutoff 10 had 20% specificity. Androgen sensitivity index(ASI)(AUC = 0.972, cutoff 95.27, sensitivity 93.8%, specificity 93.3%) had highest diagnostic accuracy for androgen insensitivity syndrome(an androgen inaction) in pubertal stage.
Conclusion
This study identifies FSH, stimulated T/A (> 1.6), ASI, and LH as key discriminatory markers for etiological diagnosis in 46, XY DSD, while suggesting that traditional cutoffs like stimulated T/DHT > 10 and T/A < 0.8 may have limited utility emphasizing the need for rapid genetic analysis.
{"title":"Diagnostic Accuracy of Serum Steroids and Peptides in the Evaluation of 46, XY Disorders of Sex Development (DSD)","authors":"Rohit Barnabas, Anurag Ranjan Lila, Saba Samad Memon, Manjiri Karlekar, Sneha Arya, Kunal Thakkar, Hemangini Thakkar, Virendra Patil, Vijaya Sarathi, Nalini S. Shah, Tushar R. Bandgar","doi":"10.1111/cen.70017","DOIUrl":"10.1111/cen.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Biochemical evaluation of 46, XY disorders of sex development(DSD) remains challenging due to overlapping profiles and limited validation in genetically proven cases. We studied the diagnostic accuracy of serum hormonal parameters in a well-characterized cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Post-hoc hormonal analysis of a prospective study on genetics of 46, XY DSD(<i>n</i> = 165) was performed. Etiological diagnosis was primarily based on genotypic data. Patients without pathogenic genetic variants but with mullerian structures were classified as having gonadal dysgenesis(GD). Serum hormone levels during mini-pubertal, prepubertal, and pubertal stages were analyzed for diagnostic accuracy across etiological subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In GD, high serum FSH effectively distinguished others across all stages:mini puberty(AUC 0.896; sensitivity 75%, specificity 94.4% at 5.95 IU/L), prepuberty (AUC 0.860; sensitivity 60%, specificity 92.1% at 3.72 IU/L), and puberty (AUC 0.925; sensitivity 89.3%, specificity 90.6% at 38.15 IU/L). In17βHSD3D,(a gonadal steroidogenesis defect), prepubertal hCG-stimulated androstenedione(AUC = 0.929, cutoff 0.53 ng/ml, sensitivity 80%, specificity 80%) and Testosterone/Androstenedione(T/A) ratio(AUC = 0.898, cutoff 1.66, sensitivity 80%, specificity 94.5%) were diagnostic, while T/A cutoff 0.8 had 20% sensitivity. For SRD5A2,(testosterone metabolism defect), low pubertal LH(AUC = 0.908, cutoff 7.11 IU/L, sensitivity 75%, specificity 87.5%) was discriminatory, while prepubertal T/DHT cutoff 10 had 20% specificity. Androgen sensitivity index(ASI)(AUC = 0.972, cutoff 95.27, sensitivity 93.8%, specificity 93.3%) had highest diagnostic accuracy for androgen insensitivity syndrome(an androgen inaction) in pubertal stage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identifies FSH, stimulated T/A (> 1.6), ASI, and LH as key discriminatory markers for etiological diagnosis in 46, XY DSD, while suggesting that traditional cutoffs like stimulated T/DHT > 10 and T/A < 0.8 may have limited utility emphasizing the need for rapid genetic analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 6","pages":"823-832"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan C. Galofré, Juan J. Díez, Roberto Attanasio, Endre V. Nagy, Tomasz Bednarczuk, Enrico Papini, Miloš Žarković, Roberto Negro, Petros Perros, Ersin Akarsu, Maria Alevizaki, Göksun Ayvaz, Eszter Berta, Biljana Nedeljković Beleslin, Miklos Bodor, Anna Maria Borissova, Mihail Boyanov, Maria-Cristina Burlacu, Jasmina Ćirić, Valentin Fadeyev, Benjamin C. T. Field, Dagmar Führer, Jiskra Jan, Peter Kopp, Michael Krebs, Michal Kršek, Ivica Lazúrová, Vitaliy Luchytskiy, Francisca Marques Puga, Anne McGowan, Miguel Melo, Saara Metso, Carla Moran, Tatyana Morgunova, Dan Alexandru Niculescu, Božidar Perić, Tereza Planck, Eyal Robenshtok, Patrick Olivier Rosselet, Marek Ruchala, Alla Shepelkevich, Mykola Tronko, David Unuane, Irfan Vardarli, W Edward Visser, Andromachi Vryonidou, Younes R. Younes, Laszlo Hegedüs
Objective
A relationship among hypothyroidism and lipid disorders is well established. However, current evidence and guidelines do not support the use of thyroid hormones (TH) in euthyroid patients with hyperlipidaemia as potential harms are considerable. This European survey investigated the use of TH in euthyroid patients with severe hypercholesterolemia as a complementary treatment.
Design
Data were derived from the THESIS (Treatment of Hypothyroidism in Europe by Specialists) project that surveyed TH use. Univariable and multivariable analyses were used to explore associations.
Results
Out of 17,232 invitations, 5695 (33.0%) valid responses were received, and of these, 328 (5.8%) stated that TH are indicated in euthyroid patients with severe hypercholesterolemia. Univariable analyses disclosed significant differences and associations: (a) more non-endocrinologists (8.9%) than endocrinologist (5.4%) used TH (p < 0.001), (b) the number of hypothyroid patients treated per year was inversely related to use of TH (p = 0.024), (c) members of international endocrine/thyroid societies were more likely to use TH than non-members (p < 0.001), (d) significant variations by country and geographical region (p < 0.001), and (e) inverse relationship between gross national income per capita (GNIPC) and TH use (p < 0.001). Multivariable analyses yielded significant associations between use of TH, and male gender, specialty and GNIPC (p < 0.001).
Conclusions
This study suggests that a small but noteworthy minority of European thyroid specialists may be using TH to treat of severe hypercholesterolemia in euthyroid patients. If confirmed, this finding highlights the importance of raising awareness among thyroid specialists, professional societies, and healthcare providers to ensure adherence to evidence-based practices.
{"title":"Thyroid Hormone Treatment for Hypercholesterolemia in Euthyroid Patients: Results From a European Survey of Thyroid Specialists","authors":"Juan C. Galofré, Juan J. Díez, Roberto Attanasio, Endre V. Nagy, Tomasz Bednarczuk, Enrico Papini, Miloš Žarković, Roberto Negro, Petros Perros, Ersin Akarsu, Maria Alevizaki, Göksun Ayvaz, Eszter Berta, Biljana Nedeljković Beleslin, Miklos Bodor, Anna Maria Borissova, Mihail Boyanov, Maria-Cristina Burlacu, Jasmina Ćirić, Valentin Fadeyev, Benjamin C. T. Field, Dagmar Führer, Jiskra Jan, Peter Kopp, Michael Krebs, Michal Kršek, Ivica Lazúrová, Vitaliy Luchytskiy, Francisca Marques Puga, Anne McGowan, Miguel Melo, Saara Metso, Carla Moran, Tatyana Morgunova, Dan Alexandru Niculescu, Božidar Perić, Tereza Planck, Eyal Robenshtok, Patrick Olivier Rosselet, Marek Ruchala, Alla Shepelkevich, Mykola Tronko, David Unuane, Irfan Vardarli, W Edward Visser, Andromachi Vryonidou, Younes R. Younes, Laszlo Hegedüs","doi":"10.1111/cen.70014","DOIUrl":"10.1111/cen.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A relationship among hypothyroidism and lipid disorders is well established. However, current evidence and guidelines do not support the use of thyroid hormones (TH) in euthyroid patients with hyperlipidaemia as potential harms are considerable. This European survey investigated the use of TH in euthyroid patients with severe hypercholesterolemia as a complementary treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Data were derived from the THESIS (Treatment of Hypothyroidism in Europe by Specialists) project that surveyed TH use. Univariable and multivariable analyses were used to explore associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 17,232 invitations, 5695 (33.0%) valid responses were received, and of these, 328 (5.8%) stated that TH are indicated in euthyroid patients with severe hypercholesterolemia. Univariable analyses disclosed significant differences and associations: (a) more non-endocrinologists (8.9%) than endocrinologist (5.4%) used TH (<i>p</i> < 0.001), (b) the number of hypothyroid patients treated per year was inversely related to use of TH (<i>p</i> = 0.024), (c) members of international endocrine/thyroid societies were more likely to use TH than non-members (<i>p</i> < 0.001), (d) significant variations by country and geographical region (<i>p</i> < 0.001), and (e) inverse relationship between gross national income per capita (GNIPC) and TH use (<i>p</i> < 0.001). Multivariable analyses yielded significant associations between use of TH, and male gender, specialty and GNIPC (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study suggests that a small but noteworthy minority of European thyroid specialists may be using TH to treat of severe hypercholesterolemia in euthyroid patients. If confirmed, this finding highlights the importance of raising awareness among thyroid specialists, professional societies, and healthcare providers to ensure adherence to evidence-based practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"749-756"},"PeriodicalIF":2.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin Nilsson, J. Gustav Smith, Mark Thier, Erik Nordenström, Anders Bergenfelz, Martin Almquist
Objective
Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT).
Design
The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls.
Methods
Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors.
Results
TIA was increased in patients pre-and postoperatively with a peak 1–4 years before PTX (IRR: 2.06, CI 95%: 1.31–3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51–6.85), and heart failure (IRR: 1.37, 1.11–1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively.
Conclusions
The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.
目的：虽然以前的研究表明甲状旁腺切除术（PTX）后心血管事件减少，但尚不清楚这是否适用于诊断和治疗的疾病较以前轻的当代患者。这项全国性研究的目的是确定PTX对心血管事件的影响，并综合评估原发性甲状旁腺功能亢进（pHPT）患者的心血管疾病表现。设计：该队列包括5009名接受PTX治疗的患者，这些患者来自斯堪的纳维亚甲状腺、甲状旁腺和肾上腺外科质量登记。患者与14983名对照人群相匹配。方法：数据与国家患者和死亡登记处相关联。评估PTX前后急性心肌梗死、卒中、短暂性脑缺血发作（TIA）复发事件的发生率比（IRRs），以及冠状动脉疾病、心力衰竭、主动脉瓣和二尖瓣狭窄、颈动脉狭窄、外周动脉疾病和主动脉瘤（AA）的首发诊断。分析血清钙和腺体重量作为预测因素。结果：TIA在术前和术后均有所增加，在PTX前1-4年达到高峰（IRR: 2.06, CI 95%: 1.31-3.25）。术前和术后急性心肌梗死和脑卒中的发生率均未升高。二尖瓣狭窄（IRR: 3.22, 1.51-6.85）和心力衰竭（IRR: 1.37, 1.11-1.67）术前升高，但术后无升高。术前和术后AA均升高。结论：pHPT患者二尖瓣狭窄和心力衰竭的发生率术前增高，术后恢复正常。相比之下，术后TIA和AA的发生率仍然升高。
{"title":"Cardiovascular Morbidity in Patients Undergoing Successful Surgery for Primary Hyperparathyroidism","authors":"Martin Nilsson, J. Gustav Smith, Mark Thier, Erik Nordenström, Anders Bergenfelz, Martin Almquist","doi":"10.1111/cen.70015","DOIUrl":"10.1111/cen.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Although previous studies have shown reduced cardiovascular events following parathyroidectomy (PTX), it is unclear whether this extends to contemporary patients diagnosed and treated with milder disease than previously. The aim of this nation-wide study was to determine the effect on cardiovascular events after PTX, and to comprehensively evaluate cardiovascular disease manifestations in patients with primary hyperparathyroidism, (pHPT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The cohort consisted of 5009 patients who underwent PTX and were identified from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery. Patients were matched with 14,983 population controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was linked with the National Patient and Death Registries. Incidence rate ratios (IRRs) were estimated before and after PTX for recurrent events of acute myocardial infarction, stroke, transient ischemic attack (TIA), and first-onset diagnoses of coronary artery disease, heart failure, aortic and mitral valve stenosis, carotid artery stenosis, peripheral artery disease, and aortic aneurysm (AA). Serum calcium and gland weight were analysed as predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TIA was increased in patients pre-and postoperatively with a peak 1–4 years before PTX (IRR: 2.06, CI 95%: 1.31–3.25). The incidence rates for acute myocardial infarction and stroke were not increased pre- and postoperatively. Mitral valve stenosis (IRR: 3.22, 1.51–6.85), and heart failure (IRR: 1.37, 1.11–1.67) were increased preoperatively, but not postoperatively. AA was increased pre- and postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence rates for mitral valve stenosis and heart failure were increased preoperatively in patients with pHPT, normalizing after surgery. In contrast, the incidence of TIA and AA remained elevated postoperatively.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"669-681"},"PeriodicalIF":2.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Liu, Deric Morrison, Laszlo Hegedüs, Endre V. Nagy, Enrico Papini, Petros Perros, Roberto Attanasio, Roberto Negro, Stan Van Uum, Birte Nygaard, Steen J. Bonnema, Kamilla R. Riis
Objective
The practice of treating hypothyroid and euthyroid patients with thyroid hormones varies between countries, as observed in the recent surveys of European thyroid experts, THESIS. As part of the THESIS initiative, we investigated Canadian endocrinologists′ perspectives on this topic, focusing on combination therapy with either liothyronine (LT3) plus levothyroxine (LT4) or desiccated thyroid extract (DTE).
Design
Members of the Canadian Society of Endocrinology and Metabolism (CSEM) were invited to participate in an anonymous online survey.
Results
Out of 348 eligible CSEM members, 68 (19.5%) respondents were included in the analysis. All respondents used LT4 as the first-line treatment for hypothyroid patients. Many respondents (64.7%) would consider LT4 + LT3 for patients on LT4 with persistent symptoms, whereas fewer would consider DTE (16.2%). Most respondents attributed persistent symptoms in LT4-treated patients to psychosocial factors, comorbidities, or unrealistic expectations. Approximately half of the respondents stated that thyroid hormone therapy is never indicated for euthyroid patients. The remaining respondents considered thyroid hormones for euthyroid women with infertility and high thyroid antibody levels (36.8%), depression (13.2%), and growing goiter (7.4%).
Conclusions
Following current guidelines, LT4 tablet is the preferred treatment for hypothyroidism. Most respondents would consider triiodothyronine-containing therapy for patients with persistent symptoms, preferring LT4 + LT3 over DTE. The number of endocrinologists considering combination therapy for hypothyroid patients in Canada was higher than in Europe. Finally, at variance with current guidelines, a fraction of the respondents would consider thyroid hormones in patients with non-thyroidal conditions.
{"title":"Canadian Endocrinologists′ Perspectives on Treatment With Thyroid Hormone Substitutions in Euthyroid and Hypothyroid Patients: A 2023 THESIS Questionnaire Survey","authors":"Anna Liu, Deric Morrison, Laszlo Hegedüs, Endre V. Nagy, Enrico Papini, Petros Perros, Roberto Attanasio, Roberto Negro, Stan Van Uum, Birte Nygaard, Steen J. Bonnema, Kamilla R. Riis","doi":"10.1111/cen.70009","DOIUrl":"10.1111/cen.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The practice of treating hypothyroid and euthyroid patients with thyroid hormones varies between countries, as observed in the recent surveys of European thyroid experts, THESIS. As part of the THESIS initiative, we investigated Canadian endocrinologists′ perspectives on this topic, focusing on combination therapy with either liothyronine (LT3) plus levothyroxine (LT4) or desiccated thyroid extract (DTE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Members of the Canadian Society of Endocrinology and Metabolism (CSEM) were invited to participate in an anonymous online survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 348 eligible CSEM members, 68 (19.5%) respondents were included in the analysis. All respondents used LT4 as the first-line treatment for hypothyroid patients. Many respondents (64.7%) would consider LT4 + LT3 for patients on LT4 with persistent symptoms, whereas fewer would consider DTE (16.2%). Most respondents attributed persistent symptoms in LT4-treated patients to psychosocial factors, comorbidities, or unrealistic expectations. Approximately half of the respondents stated that thyroid hormone therapy is never indicated for euthyroid patients. The remaining respondents considered thyroid hormones for euthyroid women with infertility and high thyroid antibody levels (36.8%), depression (13.2%), and growing goiter (7.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following current guidelines, LT4 tablet is the preferred treatment for hypothyroidism. Most respondents would consider triiodothyronine-containing therapy for patients with persistent symptoms, preferring LT4 + LT3 over DTE. The number of endocrinologists considering combination therapy for hypothyroid patients in Canada was higher than in Europe. Finally, at variance with current guidelines, a fraction of the respondents would consider thyroid hormones in patients with non-thyroidal conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"739-748"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is a rare, aggressive subtype with distinct clinicopathological features. This study aimed to characterize its molecular alterations and evaluate their clinical associations.
Methods
A retrospective analysis of 51 DSV-PTC cases was conducted. Clinicopathological data were reviewed, and molecular profiling was performed using fluorescent PCR to detect mutations and gene fusions across 12 thyroid cancer-related genes.
Results
This study included eight paediatric cases (15.7%) and 43 adult cases (84.3%) of DSV-PTC. The most common alteration was BRAF mutation (39.2%), followed by RET fusions (25.5%; including CCDC6-RET in 23.5% and NCOA4-RET in 2.0%), ETV6-NTRK3 fusion (5.9%) and TERT promoter mutations (2.0%). Compared with BRAF-mutated tumours, RET fusion-positive cases showed significantly larger primary tumours (p = 0.016), larger metastatic nodes (p = 0.009) and higher T stages (p = 0.046). Paediatric patients exhibited more aggressive features, such as higher rates of lateral neck metastasis and extrathyroidal extension, but had fewer BRAF mutations. The overall recurrence rate was 15.7%, with earlier recurrence in RET fusion cases. One patient with coexisting ETV6-NTRK3 fusion and TERT mutation progressed to anaplastic thyroid carcinoma and died of disease.
Conclusion
DSV-PTC demonstrates substantial molecular heterogeneity. RET fusions are linked to more aggressive behaviour, and paediatric cases often show extensive locoregional spread. Coexisting NTRK and TERT alterations may signal high-risk progression, highlighting the value of molecular stratification in management.
{"title":"Exploring the Molecular Features and Clinicopathological Correlations of Diffuse Sclerosing Papillary Thyroid Carcinoma","authors":"Yanhui Zhang, Tingting Ding, Runfen Cheng, Ying Wang, Jianghua Wu","doi":"10.1111/cen.70013","DOIUrl":"10.1111/cen.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is a rare, aggressive subtype with distinct clinicopathological features. This study aimed to characterize its molecular alterations and evaluate their clinical associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 51 DSV-PTC cases was conducted. Clinicopathological data were reviewed, and molecular profiling was performed using fluorescent PCR to detect mutations and gene fusions across 12 thyroid cancer-related genes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included eight paediatric cases (15.7%) and 43 adult cases (84.3%) of DSV-PTC. The most common alteration was <i>BRAF</i> mutation (39.2%), followed by <i>RET</i> fusions (25.5%; including <i>CCDC6-RET</i> in 23.5% and <i>NCOA4-RET</i> in 2.0%), <i>ETV6-NTRK3</i> fusion (5.9%) and <i>TERT</i> promoter mutations (2.0%). Compared with <i>BRAF</i>-mutated tumours, <i>RET</i> fusion-positive cases showed significantly larger primary tumours (<i>p</i> = 0.016), larger metastatic nodes (<i>p</i> = 0.009) and higher T stages (<i>p</i> = 0.046). Paediatric patients exhibited more aggressive features, such as higher rates of lateral neck metastasis and extrathyroidal extension, but had fewer <i>BRAF</i> mutations. The overall recurrence rate was 15.7%, with earlier recurrence in <i>RET</i> fusion cases. One patient with coexisting <i>ETV6-NTRK3</i> fusion and <i>TERT</i> mutation progressed to anaplastic thyroid carcinoma and died of disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DSV-PTC demonstrates substantial molecular heterogeneity. <i>RET</i> fusions are linked to more aggressive behaviour, and paediatric cases often show extensive locoregional spread. Coexisting <i>NTRK</i> and <i>TERT</i> alterations may signal high-risk progression, highlighting the value of molecular stratification in management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"729-738"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christian Rosendal, Annika Vestergaard Kvist, Rogério Pessoto Hirata, Peter Vestergaard, Jakob Dal
Objective
Balance impairment is an underrecognized complication of acromegaly with potentially serious consequences for affected patients. In this study, we aimed to assess the balance in patients with long-term acromegaly compared to non-acromegalic controls.
Design
Cross-sectional study.
Patients and Measurements
Seventeen patients with acromegaly and 17 age- and sex-matched controls were examined using a force platform measuring the Centre of Pressure area (CoParea) and velocity (CoPvelocity), the timed up-and-go (TUG) test, hand grip and knee extension dynamometry, nerve conduction measurements, visual acuity tests, and questionnaires concerning fear of falling and joint pain (Falls Efficacy Scale [FES-I] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Descriptive statistics and linear regression analyses were used to compare groups.
Results
Compared to controls, participants with acromegaly (mean acromegaly duration 13 [±8.8] years, latest mean IGF-I standard deviation score 1.2 [±1.59]) had significantly increased CoParea adjusted for neural and visual function. When performing a difficult executive task, the CoParea was impaired, both with (β: 2.24 [1.29; 3.92], p = 0.01) and without (β: 2.09 [1.02; 4.26], p = 0.04) a cushion under their feet, as compared to controls. Mean TUG time was significantly higher in patients with acromegaly than controls (β: 1.24 [0.07; 2.42], p = 0.04), and correlated with self-reported joint pain (β: 0.04 [0.0004; 0.08], p = 0.05).
Conclusions
Both static and dynamic balance is impaired in patients with long-term controlled acromegaly, warranting clinical attention. Further studies are needed to address therapeutic options for this overlooked and potentially serious complication.
目的：平衡障碍是肢端肥大症的一种未被充分认识的并发症，对患者有潜在的严重后果。在这项研究中，我们旨在评估长期肢端肥大症患者与非肢端肥大症对照组的平衡。设计：横断面研究。患者及测量：17例肢端肥大症患者和17例年龄和性别匹配的对照组采用测量压力中心面积（CoParea）和速度（CoPvelocity）的力平台、时间起落（TUG）测试、手部握力和膝关节伸展力测量、神经传导测量、视力测试和关于害怕跌倒和关节疼痛的问卷（跌倒疗效量表[FES-I]和西安大略省和麦克马斯特大学骨关节炎指数[WOMAC]）进行检查。组间比较采用描述性统计和线性回归分析。结果：与对照组相比，肢端肥大症患者（肢端肥大症平均病程13[±8.8]年，最近平均IGF-I标准差评分1.2[±1.59]）的神经和视觉功能调整后的CoParea显著增加。当执行困难的执行任务时，CoParea受损，均为(β: 2.24 [1.29；3.92], p = 0.01)和无(β: 2.09 [1.02；4.26], p = 0.04)，与对照组相比，他们脚下有一个垫子。肢端肥大症患者的平均TUG时间显著高于对照组(β: 1.24 [0.07；2.42], p = 0.04)，且与自我报告的关节疼痛相关(β: 0.04 [0.0004；0.08], p = 0.05)。结论：长期控制肢端肥大症患者的静态和动态平衡均受损，值得临床注意。需要进一步的研究来解决这种被忽视的潜在严重并发症的治疗选择。
{"title":"Static and Dynamic Balance Is Impaired in Patients With Long-Term, Well-Controlled Acromegaly: A Cross-Sectional Study","authors":"Christian Rosendal, Annika Vestergaard Kvist, Rogério Pessoto Hirata, Peter Vestergaard, Jakob Dal","doi":"10.1111/cen.70010","DOIUrl":"10.1111/cen.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Balance impairment is an underrecognized complication of acromegaly with potentially serious consequences for affected patients. In this study, we aimed to assess the balance in patients with long-term acromegaly compared to non-acromegalic controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Measurements</h3>\u0000 \u0000 <p>Seventeen patients with acromegaly and 17 age- and sex-matched controls were examined using a force platform measuring the Centre of Pressure area (CoP<sub>area</sub>) and velocity (CoP<sub>velocity</sub>), the timed up-and-go (TUG) test, hand grip and knee extension dynamometry, nerve conduction measurements, visual acuity tests, and questionnaires concerning fear of falling and joint pain (Falls Efficacy Scale [FES-I] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Descriptive statistics and linear regression analyses were used to compare groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to controls, participants with acromegaly (mean acromegaly duration 13 [±8.8] years, latest mean IGF-I standard deviation score 1.2 [±1.59]) had significantly increased CoP<sub>area</sub> adjusted for neural and visual function. When performing a difficult executive task, the CoP<sub>area</sub> was impaired, both with (<i>β</i>: 2.24 [1.29; 3.92], <i>p</i> = 0.01) and without (<i>β</i>: 2.09 [1.02; 4.26], <i>p</i> = 0.04) a cushion under their feet, as compared to controls. Mean TUG time was significantly higher in patients with acromegaly than controls (<i>β</i>: 1.24 [0.07; 2.42], <i>p</i> = 0.04), and correlated with self-reported joint pain (<i>β</i>: 0.04 [0.0004; 0.08], <i>p</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both static and dynamic balance is impaired in patients with long-term controlled acromegaly, warranting clinical attention. Further studies are needed to address therapeutic options for this overlooked and potentially serious complication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"703-710"},"PeriodicalIF":2.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In patients with hypercalcaemia, assessment of urinary calcium excretion helps differentiate primary hyperparathyroidism (PHPT) from familial hypocalciuric hypercalcaemia (FHH). For this, 24 h calcium to creatinine clearance ratio (CCCR) is recommended, but others tests like random CCCR, 24 h urine calcium excretion (UCE), and calcium to creatinine ratio (CR) are also frequently used.
Objective
The survey objective was to evaluate current practice among UK endocrinologists and surgeons.
Methods
A web-based anonymous cross-sectional survey, consisting of eight multiple-choice questions was developed using Survey Monkey. The survey was disseminated to members of British Association of Endocrine and Thyroid Surgeons (BAETS) and Society for Endocrinology (SfE) between November 20, 2025 and December 19, 2024.
Results
Two hundred and sixty-six responses from 210 endocrinologists and 56 surgeons were received (85% consultants). Respondents worked in both university (48.9%) and district hospitals (47.7%). The most commonly performed urine calcium test in hypercalcaemic patients was 24 h UCE (58.6%), but for PHPT versus FHH differentiation, the most preferred test was 24 h CCCR (43.6%), followed by random CCCR (24.8%), 24 h UCE (14.3%), and CR (16.5%). Of respondents who had experience with using CCCR (n = 235), most (55.6%) used a cut-off of > 0.01 to rule out FHH, while > 0.02 cut off was used by 26.7% respondents. Most clinicians (70.3%) used albumin-adjusted calcium for CCCR calculation, and 71.4% respondents considered vitamin D levels ≥ 50 nmol/L to be adequate for urinary calcium measurement.
Conclusion
The survey provides valuable insight into current UK practice. 24 h and random CCCR are the most commonly used tests to exclude FHH, but overall, practice varies widely.
{"title":"Urinary Calcium Measurement in Patients With Hypercalcaemia; Endocrine Physicians and Surgeons Survey Results From UK","authors":"Muhammad Fahad Arshad, Saba P. Balasubramanian","doi":"10.1111/cen.70008","DOIUrl":"10.1111/cen.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with hypercalcaemia, assessment of urinary calcium excretion helps differentiate primary hyperparathyroidism (PHPT) from familial hypocalciuric hypercalcaemia (FHH). For this, 24 h calcium to creatinine clearance ratio (CCCR) is recommended, but others tests like random CCCR, 24 h urine calcium excretion (UCE), and calcium to creatinine ratio (CR) are also frequently used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The survey objective was to evaluate current practice among UK endocrinologists and surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A web-based anonymous cross-sectional survey, consisting of eight multiple-choice questions was developed using Survey Monkey. The survey was disseminated to members of British Association of Endocrine and Thyroid Surgeons (BAETS) and Society for Endocrinology (SfE) between November 20, 2025 and December 19, 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and sixty-six responses from 210 endocrinologists and 56 surgeons were received (85% consultants). Respondents worked in both university (48.9%) and district hospitals (47.7%). The most commonly performed urine calcium test in hypercalcaemic patients was 24 h UCE (58.6%), but for PHPT versus FHH differentiation, the most preferred test was 24 h CCCR (43.6%), followed by random CCCR (24.8%), 24 h UCE (14.3%), and CR (16.5%). Of respondents who had experience with using CCCR (<i>n</i> = 235), most (55.6%) used a cut-off of > 0.01 to rule out FHH, while > 0.02 cut off was used by 26.7% respondents. Most clinicians (70.3%) used albumin-adjusted calcium for CCCR calculation, and 71.4% respondents considered vitamin D levels ≥ 50 nmol/L to be adequate for urinary calcium measurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The survey provides valuable insight into current UK practice. 24 h and random CCCR are the most commonly used tests to exclude FHH, but overall, practice varies widely.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"103 5","pages":"757-760"},"PeriodicalIF":2.4,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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