Current Opinion in Endocrinology & Diabetes and Obesity最新文献

Purpose of review: To summarize the epidemiology and clinical implications of adrenal incidentalomas, as well as the recommended hormonal and radiological evaluation, treatment and follow-up that should be carried out in patients with adrenal incidentalomas.

Recent findings: The prevalence of adrenal incidentalomas has increased in the last decades due to advanced and more sensitive imaging modalities, their increased utilization, and the aging population. The evaluation of patients with adrenal incidentalomas should be focused on addressing two questions: Is the tumor functional, and is the tumor malignant? In relation to functionality, although most adrenal incidentalomas are clinically nonfunctioning, a significant proportion of patients have mild autonomous cortisol secretion and a lower proportion over functional adrenal syndromes. The differentiation between malignant and benign lesions is usually based on the radiological appearance of the lesion in CT and/or MRI. Adrenalectomy is considered the first-line treatment for malignant and functioning tumors. Radiological follow-up is not necessary for lesions classified as benign, but for indeterminate lesions, CT/MRI should be repeated in 6-12 months.

Summary: Adrenal incidentalomas are a common clinical problem, and their assessment should be focused on ruling out hormonal hypersecretion and malignancy. In general, adrenalectomy is considered the treatment of choice for malignant and functioning adrenal tumors.

Purpose of review: To review the current medical evidence in the diagnosis and management of thyroid nodules.

Recent findings: The widespread use of imaging modalities in recent years has led to frequent discovery of incidental thyroid nodules. These nodules are mostly benign (over 90%), hence precise insight in evaluating nodules of concern and following up other nodules is important to avoid unnecessary surgeries and its complications.

Summary: Certain nodules, which are symptomatic or suspicious on clinical evaluation, need further evaluation with ultrasonography and cytopathology before embarking on definitive treatment. Indeterminate nodules can further be analysed by newer advances like molecular tests, liquid biopsy to guide further management. Active surveillance is an option for select malignant nodules that fit the defined criteria. Small benign nodules which are symptomatic or of cosmetic concern can also be treated with minimally invasive options of ethanol injection or thermal ablative techniques. Hemithyroidectomy is diagnostic for follicular neoplasm or definitive treatment for solitary, symptomatic or hypersecreting benign nodules or even for small solitary thyroid carcinoma. Total thyroidectomy is option of choice for symptomatic or hypersecreting or malignant multiple nodules.

Purpose of review: Subclinical hyperthyroidism is a clinical condition where thyroid-stimulating hormone (TSH) is below the normal range along with normal levels of circulating thyroid hormones. It is associated with cardiovascular complications such as atrial fibrillation, but the effects on other organ systems is less certain. There are areas of uncertainty in the management of this condition, which this review seeks to address by reviewing relevant literature from the last 18 months.

Recent findings: Data on prevalence from recent meta-analyses are in line with previous studies. Individual TSH reference ranges are influenced by genetic factors, which suggests that current reference ranges may be leading to misdiagnosis. Further research has increased the strength of evidence for the association with atrial fibrillation. A meta-analysis has shown increased risk of osteoporosis and fractures. Data support an association between subclinical hyperthyroidism and dementia. A randomised controlled trial has recently been conducted to investigate the effect of treatment on atrial fibrillation incidence, in which post hoc-analysis showed normalisation of TSH decreased risk of atrial fibrillation.

Summary: Degree of TSH suppression is an important element of clinical assessment. Subclinical hyperthyroidism is associated with atrial fibrillation, osteoporosis and dementia. Further research in this field is warranted.

Purpose of review: Whilst the prognosis of thyroid carcinoma remains excellent, patients with advanced thyroid carcinoma have a considerable burden of disease. Clinicians continue to face and manage challenging scenarios in the setting of thyroid cancer, particularly in those with recurrent disease, metastatic disease or special scenarios such as thyroid cancer in pregnancy. The purpose of this article is to provide an overview of thyroid cancer management and an update in emerging areas of management, particularly in the setting of locally advanced disease.

Recent findings: Systemic treatment of thyroid malignancy, particularly in the setting of locally advanced thyroid cancer, is rapidly evolving. Advances in targeted therapy have allowed for previously unresectable thyroid malignancies to undergo surgery, with significant increases to disease-free survival. Genomic profiling of tumours allows for specific mutations to be targeted with promising results for this cohort of patients.

Summary: This overview of the current management of thyroid carcinoma pays close attention to differentiated thyroid malignancy, with summaries of assessment, work-up and surgical management. Focus is made to the scenarios that continue to challenge clinicians, with up-to-date summaries of recent advances in this field.

Purpose of review: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with limited therapeutic options and poor prognosis. This review highlights recent advances in risk stratification, systemic therapies, surgical approaches and personalized treatment strategies to improve outcomes in ACC.

Recent findings: Significant progress has been made in molecular characterization of ACC, enabling more precise risk stratification and prognostication. Novel biomarkers and integrated scoring systems now complement traditional staging methods. Therapeutic advances include refinements in surgical approaches for both localized and metastatic disease, while systemic treatment options are expanding beyond traditional mitotane-based regimens. Immunotherapy and targeted agents show emerging promise, particularly in molecularly selected patients. The role of adjuvant therapy continues to evolve, with recent evidence supporting more selective application based on individual risk assessment. Multimodal strategies combining locoregional and systemic therapies are demonstrating improved outcomes in advanced disease.

Summary: The ACC treatment landscape is undergoing significant transformation, moving toward personalized approaches guided by molecular profiling and risk-adapted strategies. While challenges remain in overcoming treatment resistance and validating new biomarkers, the integration of advanced diagnostics with innovative therapies offers hope for improved patient outcomes. Future progress will depend on collaborative research efforts and the development of robust clinical trials.

Purpose of review: This review outlines the indications for medical management of hypercortisolism and summarizes available and emerging pharmacologic agents.

Recent findings: Endogenous Cushing syndrome is a complex endocrine disorder resulting from chronic cortisol excess. The underlying etiology of Cushing syndrome is due to either adrenocorticotropic hormone (ACTH)-dependent causes, such as pituitary tumors (Cushing disease) or ectopic ACTH syndrome from nonpituitary neuroendocrine tumors, or ACTH-independent causes, such as autonomous cortisol production by adrenal adenomas, hyperplasia, or carcinomas. Cushing syndrome is associated with increased cardiometabolic morbidity and mortality, infections, thromboembolic events, cognitive and psychiatric disorders, and reduced quality of life. Successful treatment significantly reduces mortality and improves associated clinical and metabolic consequences of chronic hypercortisolism. Management of Cushing syndrome varies depending on the underlying etiology. While surgical resection of the causal lesion remains the first-line treatment for all etiologies of Cushing syndrome, second-line treatments, such as medical management, radiation therapy, and bilateral adrenalectomy, may be needed when surgery is not feasible or has failed.

Summary: We discuss the efficacy of medical therapies for hypercortisolism, combination therapy strategies, special considerations in unique populations, and monitoring protocols. Finally, we explore emerging treatments and potential future directions in the management of this complex condition.

Purpose of review: The skeletal system is one of the main targets of endocrine hormone dysregulation. After briefly summarizing the endocrinal regulation of the skeleton, this review focuses on the recent advances in our understanding of how endocrine dysregulations promote the development of heterotopic bones after trauma.

Recent findings: Endocrinal regulation of skeletal fetal development, and growth is well established. However, whether trauma such as central nervous system insults, hip arthroplasty and severe burns trigger heterotopic ossifications via hormonal dysregulation has just begun to be investigated. Recent findings in mouse models of trauma-induced and most particularly spinal cord injury-induced heterotopic ossifications suggest that spinal cord injury leads to stimulation of catecholamine and glucocorticoid secretion by adrenal glands early post-injury, which triggers pathological bone formation in injured muscles.

Summary: This review summarizes the recently identified roles of adrenal hormones in driving pathological heterotopic ossification development after spinal cord injury. Further research into how endocrine hormones regulate heterotopic bone formation after trauma is essential and likely to reveal new targetable pathways to prevent pathological heterotopic ossifications.

Purpose of review: As the prevalence of diabetes mellitus (DM) increases due to urbanization, aging populations, and lifestyle changes, it is crucial to understand the mechanisms, diagnosis, and treatment of diabetes-related bone disorders. This review highlights recent advancements in the field and explores their implications for clinical practice and research.

Recent findings: Recent studies have elucidated the complex interplay between diabetes and bone health, emphasizing the roles of advanced glycation end-products (AGEs), inflammation, oxidative stress, senescence, and molecular signaling pathways such as Wnt, mammalian target of rapamycin (mTOR), and exosome-mediated mechanisms. Key findings highlight the significance of bone marrow adipose tissue (BMAT) in bone metabolism and the impact of sarcopenia on fracture risk. Novel diagnostic tools, including miRNA biomarkers and emerging therapeutic strategies like exosome-based therapies and glycogen synthase kinase 3 beta (GSK3β) inhibitors, offer promising opportunities for improving bone health in diabetic patients.

Summary: The findings underscore the need for integrated strategies for managing diabetes-related bone complications. Clinicians should prioritize early screening, lifestyle interventions, and personalized pharmacological treatments to mitigate fracture risk and improve bone health in diabetic patients. Future research should focus on optimizing diagnostic tools and developing targeted therapies to address the unique challenges of bone disorders related to diabetes.

Purpose of review: This review explores the potential of circulating miRNAs as diagnostic biomarkers for osteoporosis and bone associated disease, highlighting challenges in translating miRNA findings into clinical practice, including variability in circulating miRNA levels, the need for robust assay methods, and the importance of preanalytical and postanalytical variables.

Recent finding: Recent finding in miRNA research have identified miRNAs involved in bone cells differentiation, function, and in the regulation of osteoblasts, osteocytes, and osteoclasts. Novel miRNAs associated with osteoporosis, fracture risk, and bone turnover, as well as their utility in distinguishing between primary and secondary forms of osteoporosis have been recently identified. On the other hand, clinical implementation of miRNAs is still limited due to the lack of standardized analytical procedures.

Summary: miRNAs are noncoding RNA molecules that regulate gene expression, making them key players in complex biological processes, such as bone metabolism. The altered expression of several miRNAs may contribute to bone disorders, including osteoporosis. While significant progress has been made in identifying circulating miRNAs associated with bone disorders, the clinical implementation of miRNA-based diagnostics requires further research and standardization of methods before becoming part of clinical practice.