Endocrine Practice最新文献

Objective: This consensus statement provides evidence-based visual guidance in graphic algorithms and a summary of evidence and considerations to assist health care professionals with the diagnosis and management of adults with prediabetes and diabetes mellitus in shared decision making to improve care.

Methods: The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts to update the 2023 AACE Comprehensive Type 2 Diabetes Management Algorithm and align this algorithm update with related AACE clinical guidance.

Results: This algorithm for management of adults with type 2 diabetes (T2D) includes 11 sections: (1) Principles for the Management of Adults With T2D; (2) Prediabetes Algorithm (3) Diabetes Classification Algorithm (new); (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Comorbidities- and Complications-Centric Glycemic Control Algorithm; (7) Glucose-Centric Glycemic Control Algorithm; (8) Initiating and Titrating Insulin Algorithm; (9) Profiles of Pharmacotherapy for T2D; (10) Profiles of Pharmacotherapy for Obesity; and (11) Vaccine Recommendations for Adults With T2D.

Conclusions: This 2026 update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and T2D. It also provides guidance on the management of atherosclerotic risk factors of dyslipidemia and hypertension. A new algorithm was added to ensure that other causes and classes of diabetes are considered beyond T2D. There continues to be an emphasis on a complications- and comorbidities-centric approach, beyond glucose levels, to frame decisions regarding first-line and subsequent pharmacological choices for treating adults with T2D.

The melanocortin system, derived from pro-opiomelanocortin processing, represents a crucial neuroendocrine-immune interface that regulates inflammatory and metabolic pathways. Through its five melanocortin receptors, MCR1 to MCR5, this system exerts widespread endocrine, paracrine, and autocrine functions across the central nervous system, skin, adipose tissue, bone, and immune cells. Activation of melanocortin signaling produces potent anti-inflammatory effects by modulating cytokine release, leukocyte trafficking, and transcriptional control of pro-inflammatory mediators. Adrenocorticotropic hormone (ACTH), via the hypothalamic-pituitary-adrenal axis and direct interaction with MCR2, stimulates both cortisol synthesis and mediates steroid-independent immunomodulation in extra-adrenal tissues. It should be taken into account that ACTH is the only ligand for MCR2 inducing steroidogenesis, cell proliferation and anti-inflammatory effects. Synthetic and natural ACTH formulations, such as repository corticotropin injection (Acthar® Gel) and Purified Cortrophin™ Gel, have demonstrated clinical benefit in refractory inflammatory diseases, as their efficacy may extend beyond classic glucocorticoid pathways. Recent preclinical studies of selective MCR agonists, including MCR1-targeted compounds like dersimelagon, highlight novel therapeutic possibilities for autoimmune and fibrotic disorders. Understanding the dual steroidogenic and non-steroidogenic actions of melanocortins provides a framework for developing targeted therapies with improved safety profiles compared with conventional glucocorticoids.

Recurrent papillary thyroid carcinoma (PTC) represents a complex clinical scenario that requires individualized, evidence-based management. The 2025 American Thyroid Association (ATA) guidelines introduce a new four-tier recurrence risk model and the DATA framework (Diagnosis, Assessment, Treatment, and Assessment of response) for decision-making. This review integrates recent advances in risk stratification and discusses therapeutic options including active surveillance, locoregional ablation, and systemic targeted therapies. Through a representative hypothetical clinical case, we illustrate how multidisciplinary collaboration can guide treatment selection and improve outcomes in recurrent and metastatic PTC.

Objectives: To examine the association between circulating insulin-like growth factor-1 (IGF-1) levels and liver fibrosis burden in adults with metabolic dysfunction-associated fatty liver disease (MAFLD).

Methods: We conducted a cross-sectional analysis of 1,473 U.S. adults with MAFLD from the NHANES III (1988-1994) to examine the association between serum IGF-1 levels and liver fibrosis severity, assessed by the fibrosis-4 (FIB-4) index. Nonlinear associations between serum IGF-1 levels and the log-transformed FIB-4 index were explored using generalized additive models with smoothing splines. A segmented linear regression model was subsequently applied to identify potential threshold effects, and likelihood ratio tests were used to compare linear and segmented models.Stratified analyses and multiplicative interaction tests were performed to assess potential effect modification by sex, age, diabetes status, obesity and hypertension.

Results: Higher serum IGF-1 levels were independently associated with lower log-transformed FIB-4 scores after adjustment for demographic, metabolic, and lifestyle factors (β = -0.0013; 95% CI: -0.0016 to -0.0010). A nonlinear threshold effect was observed, with the inverse association being more pronounced at lower IGF-1 concentrations (threshold: 283.4 ng/mL); below this threshold, IGF-1 was more strongly inversely associated with log-transformed FIB-4 (β = -0.0024; P < 0.001). Similar inverse associations were observed across clinically relevant subgroups, with a significant interaction for diabetes status (P for interaction =0.004).

Conclusions: Circulating IGF-1 levels are inversely associated with liver fibrosis risk in adults with MAFLD, exhibiting a nonlinear relationship characterized by a threshold effect. IGF-1 may serve as a biomarker for fibrosis risk stratification and warrants further investigation regarding its potential biological relevance in metabolic liver disease.

Objectives: Bilateral adrenal venous sampling (AVS) is critical for accurate primary aldosteronism (PA) subtype differentiation and treatment planning; however, its complexity and invasiveness limit its widespread adoption. We tested a less invasive simultaneous bilateral AVS via right cubital vein using 2 4F MPA1 catheters to improve practicality/safety.

Methods: Single-center feasibility study of 85 PA patients was enrolled from August 2024 to June 2025. Procedures were guided primarily by computed tomography (88.23%) and ultrasound (41.18%), with careful documentation of procedural specifics, including patient demographics, anatomical variations of the right adrenal central vein, and outcomes such as success rates and complications.

Results: The 85 enrolled patients had a uniform age and gender distribution. 88.23% of patients with PA underwent computed tomography assessment of adrenal vein anatomy prior to AVS, while 41.18% of patients with PA underwent ultrasound examination of the elbow vein during AVS. Right adrenal central vein anatomical variants were categorized, with Type I being most common (60.81%). The novel AVS method achieved a remarkable success rate of 97.53% (79/81). In these cases, 59.49% (47/79) exhibited dominant aldosterone secretion, informing further treatment strategies. A single instance (1.18%) of post-procedural adrenal vein hematoma was noted.

Conclusions: The implementation of simultaneous bilateral AVS through the right cubital vein using specialized catheters significantly simplifies the procedure, increases surgical success, and reduces patient trauma. The high success rate, coupled with a low complication incidence, underscores the technique's safety, feasibility, and substantial clinical implications, suggesting broad applicability for improved PA management.

Objective: Thyroid dysfunction produces characteristic changes in weight and body composition, but treatment often results in progressive weight gain.

Methods: This review examines underlying mechanisms, predictors, and implications for patient management.

Results: There are significant changes in weight, appetite, and body composition associated with underproduction and overproduction of thyroid hormone. The disease states of hypothyroidism and hyperthyroidism can be studied in order to document and understand the significant changes in body weight that ensue with these conditions. In addition, treatment of these conditions is associated with further alterations in body weight. As will be discussed, hypothyroidism is associated with mild to modest increases in body weight and accompanying changes in body composition, with partial reversal of these alterations with its treatment with thyroid hormone. Ongoing treatment of hypothyroidism tends to be associated with ongoing weight gains. In contrast, hyperthyroidism can be accompanied by profound weight loss, with a decrease in fat mass, muscle mass, and bone mass, with reversal of the weight loss with restoration of euthyroidism. Specifically, the transition to euthyroidism with treatment of hyperthyroidism is accompanied by an increase in fat mass, muscle mass, and bone mass. However, resolution of hyperthyroidism typically is associated over time with a net increase in body weight that significantly exceeds the nadir seen during hyperthyroidism.

Conclusion: Understanding these patterns of weight changes described above is critical for clinicians to appreciate so that prior to treatment patients can be counseled about what to expect, and then after treatment strategies can be developed to prevent or minimize long-term weight gain after restoration of euthyroidism.

Objective: To investigate the prognostic value of the B-type Raf kinase (BRAF) V600E mutation in papillary thyroid carcinoma.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science up to August 31, 2025 identified 46 eligible studies including 20,570 patients, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies version 2 quality assessment. Random-effects models were applied to evaluate associations between BRAF status and major oncological outcomes.

Results: BRAF V600E mutation was significantly associated with lymph node metastasis (odds ratios [OR] = 1.38; 95% confidence interval [CI], 1.17-1.61) and showed a borderline association with recurrence risk (OR = 1.56; 95% CI, 1.00-2.41). In contrast, no significant associations were observed for distant metastases (OR = 0.75; 95% CI, 0.48-1.17) or cancer-related mortality (OR = 0.97; 95% CI, 0.64-1.49). Sensitivity analyses confirmed the robustness of all pooled estimates. Meta-regressions revealed an inverse relationship between BRAF mutation prevalence and its prognostic impact, suggesting that the higher the mutation prevalence in a population, the lower its discriminative prognostic power. Funnel plot inspection and Egger's tests indicated no major publication bias.

Conclusion: Overall, these findings confirm that BRAF V600E mutation is associated with an increased risk of nodal metastasis and recurrence in papillary thyroid carcinoma. However, its lack of impact on distant metastases and disease-specific mortality limits its role as an independent prognostic marker in clinical decision-making.

Thyroid-stimulating hormone (TSH) suppression therapy is a widely used strategy in the management of differentiated thyroid carcinoma to reduce the risk of recurrence and disease progression. However, the benefit of the TSH suppression in terms of clinical outcomes in patients with differentiated thyroid cancer has been questioned in recent studies. The TSH suppression could be associated with potential adverse effects, including cardiovascular risks, bone loss, and poor quality of life. While considering TSH suppression in patients with differentiated thyroid cancer, a careful assessment of risks and benefits should be made based on the patient's risk of recurrence, response to therapy, and comorbidities. Aggressive TSH suppression should be avoided if possible in patients with osteoporosis, atrial fibrillation, coronary artery disease, and older patients, since the risk might be more than the benefit in these patients. This review explores the benefits and harms of TSH suppression therapy.

Objective: To examine how weight status influences insulin-like growth factor-1 (IGF-1) levels and growth outcomes in short statured children treated with growth hormone (GH) for GH deficiency or idiopathic short stature.

Methods: This retrospective cohort study analyzed 293 children (95 GH deficiency, 197 idiopathic short stature) treated with GH in an endocrine clinic at a tertiary pediatric referral center (2016-2021). Data were collected at baseline and years 1-3, including auxological parameters, pubertal staging, GH dose, and IGF-1 levels. Mixed-model analyses examined the effects of weight on height standard deviation score (Ht-SDS), IGF-1-SDS, and GH dosing over a 3-year period.

Results: Body mass index-SDS positively correlated with IGF-1-SDS (B = 0.150, P < .001). Overweight/obese children consistently demonstrated higher IGF-1 SD scores than normal-weight children (P < .001), despite receiving lower GH doses (P = .034). Both weight groups showed comparable height-SDS improvements over time (P < .001), with no significant difference in growth response (P = .685). Body surface area was positively associated with IGF-1-SDS at all-time points. Pubertal status significantly influenced IGF-1 levels.

Conclusions: Weight status has a significant influence on IGF-1 levels in children treated with GH, with overweight/obese children exhibiting elevated IGF-1 levels despite receiving lower GH doses. These elevations likely represent a normal physiological response rather than overtreatment. Our findings underscore the importance of considering weight when monitoring IGF-1 levels and adjusting GH doses in clinical practice.