Clinical Endocrinology最新文献

{"title":"Incidental Pituitary FDG Uptake on PET-CT: A Retrospective Review of Current Practice and Outcomes at a UK Tertiary Centre.","authors":"Trevor Tam, Thin Kyi Phyu Naing, Lee Elzubeir, Francesca Swords, Ketan Dhatariya, Ramona-Rita Barbara, Rupa Ahluwalia","doi":"10.1111/cen.70060","DOIUrl":"https://doi.org/10.1111/cen.70060","url":null,"abstract":"<p><strong>Context: </strong>Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is widely used in malignancy diagnosis and surveillance. However, benign conditions also increase avidity. Distinguishing between benign and pathological uptake is critical. Rising PET-CT utilisation has led to increased detection of incidental pituitary FDG uptake. Referral pathways and secondary imaging remain inconsistent, and no UK guidelines exist. This study aims to review our current practice and assess the potential role of SUVmax to differentiate physiological from pathological uptake in the pituitary gland.</p><p><strong>Design: </strong>A retrospective single-centre cohort study was conducted at a UK tertiary hospital.</p><p><strong>Patients: </strong>Among 15824 PET-CT scans between 01/01/2017-30/06/2024, 70 patients (mean age 72.1 ± 1.3 years, 25.7% female) were included.</p><p><strong>Measurements: </strong>Demographics, primary pathology, oncological treatment, SUVmax on initial PET-CT, secondary imaging findings, endocrine referral, and pituitary biochemistry were collected.</p><p><strong>Results: </strong>48 patients (68.6%) underwent secondary imaging; 70.8% (n = 34) were normal. Pathological findings included macroadenomas (n = 6), microadenomas (n = 3), and other lesions (n = 5). Mean SUVmax was significantly higher in patients with pituitary pathology (pituitary adenomas- 20.62 ± 4.82; all pathology- 16.74 ± 3.80) versus normal imaging- 4.66 ± 0.26 (p < 0.001). A SUVmax threshold of 4.75 yielded 100% sensitivity and 53.9% specificity for detecting pituitary pathology (ROC curve; 95% CI: 69%-100%).</p><p><strong>Conclusions: </strong>Our review highlights significant variation in referral patterns for secondary imaging and to the Endocrine department. We suggest potential use of SUVmax threshold to distinguish physiological from pathological pituitary FDG uptake. Further validation in larger cohorts is warranted before routine clinical application.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586180","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}

{"title":"Endocrine Functions of Bone Are Suppressed by Orally Administered Glucose Regardless of Bodyweight","authors":"Niki Jalava,&nbsp;Terhi J. Heino,&nbsp;Pirjo Nuutila,&nbsp;Kirsi A. Virtanen,&nbsp;Kaisa K. Ivaska","doi":"10.1111/cen.70059","DOIUrl":"10.1111/cen.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Bone is a target for diabetic complications, but the impact of metabolic changes on bone metabolism is less understood. Bones participate in energy metabolism by via secreted osteokines. Glucose ingestion reduces bone resorption, but the effects on osteokines remain unknown. Further, it is not known whether the response is altered in obesity. The objective of the study was to compare responses in circulating levels of osteokines to glucose ingestion between participants with normal weight (BMI &lt; 26 kg/m², <i>n</i> = 22) and obesity (BMI &gt; 28 kg/m², <i>n</i> = 27) (age = 21–54 yr).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>C-terminal telopeptide of collagen I (b-CTX-I), total osteocalcin (OC), sclerostin, fibroblast growth-factor 23 (cFGF23), uncarboxylated OC, and lipocalin 2 (LCN2) at baseline and after 2 h oral glucose tolerance test (OGTT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>OGTT resulted in a significant decrease in bone resorption, median decrease in b-CTX-I was 42% (<i>p</i> &lt; 0.0001) in both groups. Osteokine levels were modestly but statistically significantly decreased, OC decreased by 11% (<i>p</i> &lt; 0.0001) and FGF23 by 14% (<i>p</i> = 0.007) in both groups, while uncarboxylated OC decreased by 1.2% (<i>p</i> &lt; 0.0001) and sclerostin by 7.8% (<i>p</i> = 0.032) only in participants with obesity. Although the differences in responses between the groups were not statistically significant, we observed a tendency for less pronounced effect on b-CTX-I (<i>p</i> = 0.052) and a greater effect on OC (<i>p</i> = 0.051) in participants with obesity compared to normal weight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Osteokines respond rapidly to oral glucose regardless of body weight. Orally-administered glucose affects not only bone turnover but can also suppress bone endocrine functions. Furthermore, obesity may influence the effect of oral glucose on circulating levels of bone turnover markers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 2","pages":"130-138"},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596256","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}

{"title":"Short-Term, Low-Dose Spironolactone for Treatment of Hyperandrogenic Symptoms of Polycystic Ovary Syndrome—A Systematic Review","authors":"Telma Martins Viveiros,&nbsp;Neha Deshpande,&nbsp;Irene Karderinis,&nbsp;Yangxinrui Ma,&nbsp;Sophie Clarke,&nbsp;Vikram Talaulikar,&nbsp;Bassel Wattar","doi":"10.1111/cen.70062","DOIUrl":"10.1111/cen.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Polycystic ovary syndrome (PCOS) is a common condition, that manifests as menstrual irregularities, subfertility, or symptoms of hyperandrogenism – including hirsutism, adult acne, and alopecia. Current pharmacological treatment of the hyperandrogenic symptoms includes the combined oral contraceptive pill. However, there are multiple contraindications and side-effects, which limit their use. Anti-androgens, such as spironolactone, are commonly prescribed off-label but its efficacy in PCOS is uncertain. This review aims to evaluate the efficacy and safety of spironolactone, when compared to other nonhormonal medications in the management of PCOS hyperandrogenic symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Comprehensive literature searches were conducted across MEDLINE, EMBASES, PUBMED and SCOPUS. RCTs published in English assessing the use of spironolactone for hyperandrogenism in PCOS were included. The quality of papers was assessed using Cochrane RoB 2.0 tool. Meta-analysis was conducted using a random-effects model, reporting as standardised mean differences and 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3378 studies identified, five open-label RCTs met the inclusion criteria, three of which were included in the meta-analysis. Spironolactone, monotherapy or combination with metformin, showed no statistically significant difference in reducing Ferriman-Gallwey scores, total testosterone levels or BMI compared to metformin monotherapy. Side effects of spironolactone included menstrual irregularities, polyuria, and gastrointestinal symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current evidence does not show any significant difference in the use of spironolactone when compared to metformin. Given its widespread use and limited safety concerns, spironolactone remains an off-label option, especially for those unable to take hormonal contraceptives. However, larger, better quality studies are needed to establish its efficacy in PCOS management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 3","pages":"179-187"},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145586190","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}

{"title":"The Use of Routine Laboratory 17-Hydroxyprogesterone for Identification of Cases of 21-Hydroxylase Deficiency Congenital Adrenal Hyperplasia","authors":"Joseph McElvaney,&nbsp;Salma R. Ali,&nbsp;Amy R. Frank,&nbsp;Sophie Longmuir,&nbsp;Jane McNeilly,&nbsp;Malika Alimussina,&nbsp;Ruth McGowan,&nbsp;Syed Faisal Ahmed","doi":"10.1111/cen.70058","DOIUrl":"10.1111/cen.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical outcome studies of 21-hydroxylase deficiency congenital adrenal hyperplasia (21OHD CAH) may be subject to selection bias due to incomplete case ascertainment. This study aimed to develop a methodology for identifying existing CAH cases and explore its utility to study clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>17-hydroxyprogesterone assays (17OHP) processed in NHS Greater Glasgow and Clyde between 2014 and 2022 were analysed based on 17OHP result (≥ 6 or &lt; 6nmol/L), location, test frequency and clinical details. Identified cases were cross-referenced against local clinical data logs. For confirmed cases, current age, sex, age at diagnosis, mortality status, most recent blood pressure (BP) and anthropometry were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Assay results from 57,011 cases were extracted and, of these, 116 (F:M, 81:35) had confirmed CAH but 66 (57%) were not reported by any local clinical data logs. The median age at the time of the study was 33 years (range, 2, 75) and 95 (82%) were over 16 years (F:M, 69:26). In these adults, 52 (55%) were diagnosed in childhood (i.e. ≤ 16 years) and only 1 male was diagnosed in adulthood. The median body mass index (BMI) standard deviation score of children was 0.70 (−2.43, 3.15). Median BMI of adults was 28 (15, 56) and median adult and paediatric systolic BP was 120 mmHg (95, 153) and 106 mmHg (83, 130), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 17OHP-based algorithm that was used in this study represents a useful method for identifying existing cases of CAH and can allow improved understanding of routinely collected markers of clinical outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 2","pages":"123-129"},"PeriodicalIF":2.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563037","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}

{"title":"Exploring Brain Parenchymal Changes in Acromegaly: Focus on White Matter Hyperintensities","authors":"Denise Costa,&nbsp;Giada Giuliani,&nbsp;Valentina Martines,&nbsp;Chiara Pellicano,&nbsp;Valeria Mercuri,&nbsp;Vittorio Di Piero,&nbsp;Patrizia Gargiulo,&nbsp;Camilla Virili","doi":"10.1111/cen.70057","DOIUrl":"10.1111/cen.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acromegaly is a rare chronic disease caused by excessive secretion of growth hormone. Even with biochemical control, hormonal imbalance may lead to cerebral changes. This study aimed to evaluate the presence of white matter hyperintensities (WMHs) in patients with acromegaly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively enrolled 37 acromegaly patients who underwent gadolinium-enhanced brain MRI to detect WMHs and their distribution. We analysed potential contributing factors such as cardiovascular comorbidities, migraine, inflammatory markers (plasma interleukin-33), and hand skin perfusion using laser speckle contrast analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>WMHs were found in 24 patients (64.9%), with nine showing a higher lesion burden. Patients with WMHs were older [63 years (IQR 47.5–67.5) versus 48 years (IQR 44–53), <i>p</i> = 0.023] and had a longer disease duration [19 years (IQR 11.5–26.5) versus 13 years (IQR 12–15), <i>p</i> = 0.028] than those without WMHs. Hypertension (22/37) and migraine (18/37) were the most common comorbidities. A higher WMH burden was significantly associated with hypertension (<i>p</i> = 0.05), while no significant link was found between WMHs and migraine (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several factors in acromegaly may affect brain structure, promoting WMH development, such as aging, disease duration, and hypertension. Therefore, in patients with acromegaly, we suggested the early management of cardiovascular comorbidities and regular radiological follow-up, not limited to the study of the pituitary gland. Future prospective studies are necessary to confirm our preliminary observations and to clarify the potential role of disease activity and treatment in WMH development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 3","pages":"238-244"},"PeriodicalIF":2.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562927","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}

{"title":"Mixed Gonadal Dysgenesis: A Comprehensive Review of Clinical Spectrum, Diagnostic Strategies, and Management Approaches","authors":"Dinesh Giri,&nbsp;Sushil Yewale,&nbsp;Hannah Hickingbotham,&nbsp;Cara Williams,&nbsp;Mohamed Shalaby,&nbsp;Julie Alderson,&nbsp;Julie Park","doi":"10.1111/cen.70053","DOIUrl":"10.1111/cen.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mixed gonadal dysgenesis (MGD) is a rare form of differences in sex development (DSD) typically associated with 45,X/46,XY mosaicism. The phenotypic presentation of MGD varies from atypical genitalia to typical male or female appearances often associated with Turner stigmata. Some of the challenges in the clinical management of patients with MGD include gonadal malignancy risk, decisions on gonadectomy, fertility and sex of rearing. The management is predominantly multidisciplinary with a focus on patient and family centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This article was prepared as a narrative review based on a comprehensive search of the literature. A systematic search of the PubMed, Embase, Scopus, and Google Scholar databases was performed using the key terms <i>“mixed gonadal dysgenesis,” “45,X/46,XY mosaicism,” “differences in sex development,” and “gonadal tumour risk”</i> to identify relevant articles published between 2000 and 2024. References from the identified papers were further screened to capture additional relevant literature. We gathered the findings to provide an updated overview of MGD, focusing on epidemiology, clinical manifestations, diagnostic evaluation, malignancy risk, approaches to management, psychosocial considerations, and evolving strategies in the long-term care of patients with MGD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MGD accounts for 5%–15% of cases of atypical genitalia and carries a 15%–25% risk of gonadal tumour, with the highest malignancy rates in intra-abdominal gonads. Approximately 12%–15% of patients with MGD may experience gender incongruence later in life. Management has shifted from early surgical intervention to a multidisciplinary, patient-centred, and shared decision making approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The future care of patients with MGD is likely to include biomarker-driven surveillance, along with advanced fertility preservation techniques. Long-term outcome data for patients with MGD along with patient-reported outcomes, are limited in the literature, underscoring the need for further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 2","pages":"92-102"},"PeriodicalIF":2.4,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480780","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}

{"title":"Efficacy and Tolerability of Metyrapone in Mild Autonomous Cortisol Secretion: Real-World Findings From Clinical Practice","authors":"Simon Berry,&nbsp;Ahmed Iqbal,&nbsp;John Newell-Price,&nbsp;Miguel Debono","doi":"10.1111/cen.70056","DOIUrl":"10.1111/cen.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Mild autonomous cortisol secretion (MACS) is associated with increased cardiometabolic risk factors including hypertension, type 2 diabetes and dyslipidaemia. By using evening doses of metyrapone, a short-acting 11-β hydroxylase inhibitor, it has been shown that it is possible to reset the abnormal circadian cortisol rhythm in MACS. This study aimed to evaluate the tolerability and impact of this approach on cardiometabolic outcomes in patients with MACS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We conducted a single-centre retrospective, longitudinal review of patients with MACS who received evening metyrapone (250–500 mg at 6 PM and 250 mg at 10 PM) to evaluate adverse events, tolerability, and cardiometabolic outcomes (systolic and diastolic blood pressure, HbA1c, weight and non-HDL cholesterol) at 6 months, compared to controls. Age and sex-matched controls were identified from patients with adrenal incidentalomas and non-suppressed serum cortisol following 1 mg overnight dexamethasone suppression testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients and 15 matched controls were identified. Over 6 months there were no adrenal crises. Metyrapone was stopped in 2/15 patients in view of side effects. In the metyrapone group compared to controls, there were significant decreases in systolic blood pressure (−17.7 (SE 5.8) vs. +8.7 (5.7)mmHg, <i>p</i> = 0.008, <i>n</i> = 9) and diastolic blood pressure (−9.9 (4.2) vs. +3.0 (3.6)mmHg, <i>p</i> = 0.024). The differences between groups for HbA1c, weight and non-HDL cholesterol were not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Evening metyrapone was associated with significant reductions in systolic and diastolic blood pressure in patients with MACS, without causing adrenal insufficiency, indicating its potential safe clinical utility. A well-powered, controlled, prospective study is needed to validate these findings and comprehensively investigate the broader metabolic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 3","pages":"215-221"},"PeriodicalIF":2.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457827","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}

{"title":"Benign Adrenal Adenomas Are Associated With Reduced Prevalence of Hospitalised Patients With COVID-19","authors":"Alan Kelsall,&nbsp;Chris Johns,&nbsp;Eleanor Hills,&nbsp;Jenny Zhao,&nbsp;John Newell-Price","doi":"10.1111/cen.70055","DOIUrl":"10.1111/cen.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adrenal incidentalomas (AI) are commonly found on imaging done for indications other than to assess the adrenal glands. Prevalence increases with age and is around 10% in people over 80 years. The majority of AIs are benign adenomas, with 20%−50% exhibiting mild autonomous cortisol secretion (MACS). Clinical guidelines recommend the use of dexamethasone to improve outcomes in patients with COVID-19 requiring oxygen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Benign adrenal adenomas protect against severe COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Reports for all computed tomography pulmonary angiogram (CTPA) scans at Sheffield Teaching Hospitals between 11 March 2020 and 10 November 2021 were assessed for details of AI. Scan requests mandated recording COVID-19 status. Patients with a positive COVID-19 test within 2 weeks before the CTPA were classed as COVID-19 positive for the analyses. Duplicate scans were removed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 4307 CTPA scans were included. The median age was 65 (IQR 49−77) and the majority of patients were female (55.0%). Seventy-six (1.76%) patients had a benign adenoma. COVID-19 positivity was found in 897 (20.8%). The presence of a benign adenoma was associated with a 70% reduced odds of being COVID-19 positive (aOR 0.30, 95% CI 0.12−0.74, <i>p</i> = 0.01), adjusting for age and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Prevalence of adrenal adenoma was associated with significantly reduced odds of being SARS-CoV2 positive in an inpatient cohort. Secretion of mild excess cortisol (MACS) may be protective against developing severe COVID-19.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 3","pages":"207-214"},"PeriodicalIF":2.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145451252","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}

{"title":"Surgical Outcomes Following Neoadjuvant-Targeted Therapy for Advanced Differentiated Thyroid Cancer—Real-World Data","authors":"Alexandra Dorman,&nbsp;Genady Shendler,&nbsp;Anton Warshavsky,&nbsp;Nidal Muhanna,&nbsp;Gilad Horowitz,&nbsp;Liyona Kampel Furman,&nbsp;Shahaf Shilo,&nbsp;Ben-Zion Joshua,&nbsp;Eran Alon,&nbsp;Eric Remer,&nbsp;Galit Avior,&nbsp;Avi Khafif,&nbsp;Orit Gutfeld,&nbsp;Elena Izkhakov,&nbsp;Jobran Mansour,&nbsp;Inbar Finkel","doi":"10.1111/cen.70054","DOIUrl":"10.1111/cen.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Differentiated thyroid carcinoma (DTC) is typically managed surgically with favourable outcomes. However, surgery may have dire consequences when the tumour invades critical structures. Neoadjuvant therapy with tyrosine kinase inhibitors (TKIs) has emerged as a potential strategy to improve resectability and reduce morbidity in advanced DTC. We evaluated the efficacy and safety of neoadjuvant TKI therapy in patients with advanced or unresectable DTC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted on patients with advanced DTC treated with neoadjuvant TKIs (lenvatinib or dabrafenib/trametinib) followed by curative intent surgery between 2023 and 2025. Data on disease extent, genetic alterations, treatment regimens, and adverse effects were collected. Radiologic response was assessed by CT or PET-CT according to the RECIST 1.1 criteria. Surgical outcomes were evaluated by the degree of morbidity and by tumour involvement in the surgical margins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine patients were included, seven treated with lenvatinib, two treated with dabrafenib/trametinib on the basis of molecular alterations. The median duration of TKI therapy was 5 months, and no disease progression was observed throughout. Radiological assessment revealed a median reduction in tumour burden of 23.53%, contributing to improved tumour resectability. All patients underwent surgical resection with preservation of critical structures. Elevated TSH levels during neoadjuvant therapy was correlated with a positive treatment response (<i>p</i> = 0.028).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neoadjuvant TKIs may improve the surgical outcomes of patients with advanced DTC. Decision-guided radiological and blood-based surrogate biomarkers, such as TSH, can assist in evaluating treatment response and guide decisions regarding treatment duration and extent of surgical resection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 3","pages":"270-280"},"PeriodicalIF":2.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450462","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}

{"title":"A Retrospective Study on the Impact of Primary Aldosteronism in Pregnancy (H.A.P.P.I. Study Group)","authors":"Diana Oprea,&nbsp;Frédérique Lefrançois,&nbsp;Matthieu St-Jean,&nbsp;Anne-Marie Côté,&nbsp;Marie-Ève Roy-Lacroix,&nbsp;Mandy Malick,&nbsp;Pierre-Luc Mallet,&nbsp;Nadine Sauvé","doi":"10.1111/cen.70051","DOIUrl":"10.1111/cen.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Primary aldosteronism (PA) is a common cause of hypertension in young women. However, there is a paucity of data regarding its impact during pregnancy. The primary objective of this study was to describe the occurrence of hypertensive disorders of pregnancy (HDP) in PA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective cohort study compared outcomes in pregnancies according to PA status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>Pregnancies occurred between 2011 and 2022 at the Centre Hospitalier Universitaire de Sherbrooke. All selected pregnancies were screened for PA with an aldosterone-to-renin ratio (ARR) within a 5-year period. Pregnancies with more than two fetuses and with other endocrinopathies were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>To ascertain PA diagnosis, ARR measurements were conducted, followed by a confirmatory test if abnormal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 226 studied pregnancies, 15 (6.6%) were diagnosed with PA. In the PA group, pre-eclampsia was diagnosed in 46.7% of pregnancies (vs. 30.8%, <i>p</i> = 0.252), while gestational hypertension was diagnosed in 0.0% of pregnancies (vs. 16.6%, <i>p</i> = 0.136). Post-partum HDP occurred in 40.0% of pregnancies with PA (vs 19.4%, <i>p</i> = 0.093). Additionally, 40.0% and 13.3% of pregnancies with PA respectively required intravenous antihypertensive treatment (vs. 24.2%, <i>p</i> = 0.216) and intensive care admission (vs. 3.3%, <i>p</i> = 0.113).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A trend towards an increased incidence of postpartum and severe pre-eclampsia was noted in the PA group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"104 2","pages":"113-122"},"PeriodicalIF":2.4,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145372372","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}