Endocrine Practice最新文献

Thyroid dysfunction produces characteristic changes in weight and body composition, but treatment often results in progressive weight gain. This review examines underlying mechanisms, predictors, and implications for patient management. 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 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. Understanding these patterns 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.

Currently, the total 25-hydroxyvitamin D (25(OH)D) is recognized as the indicator of vitamin D status that is used to define vitamin D sufficiency. Vitamin D binding protein (DBP) is the major carrier for circulating vitamin D and plays an important role in regulating circulating total and free vitamin D metabolites. Since the concentration of DBP and its affinity to vitamin D varies by different physiological and clinical conditions, measuring total 25(OH)D may not accurately reflect functional vitamin D status. In addition, DBP is a potential prognostic indicator of clinical outcomes since it has other important functions beyond that as vitamin D carrier, including its role in actin scavenging after tissue injury and inflammation and immune modulation. It has been proposed that circulating DBP is altered in some clinical conditions, which affects the levels of total and free vitamin D metabolites and can explain clinical outcomes. Furthermore, in some clinical situations, total 25(OH)D levels are altered and knowing whether DBP is also changed may have diagnostic and therapeutic implications. The goal of this review is to assess clinical conditions altering DBP concentrations and then total 25(OH)D levels and their effects on prognosis. We suggest using the free 25(OH)D level as a better marker for vitamin D status in certain clinical conditions.

Objective: Primary hyperparathyroidism significantly impacts bone health leading to decreased bone mineral density (BMD). We assessed changes in BMD following parathyroidectomy in patients with biochemically mild primary hyperparathyroidism.

Methods: A retrospective chart review of 93 patients with primary hyperparathyroidism who underwent parathyroidectomy between 2000 and 2022 was conducted. Dual-energy X-ray absorptiometry (DXA) scans were done at the same site pre- and post-parathyroidectomy at varying time points. Statistical analyses were performed using ANOVA as the homogeneity of variance was > 0.05. A p-value of <0.05 was considered statistically significant.

Results: No statistically significant differences in DXA measurements were observed based on age, timing of DXA after parathyroidectomy, number and total weight of removed parathyroid glands, pre-operative vitamin D levels, or pre-operative 24-hour urinary calcium levels. In site-specific analysis based on T-scores at individual skeletal regions, only the femoral neck showed a significant post-operative bone mineral density (BMD) improvement in osteoporotic patients compared to those with osteopenia (p = 0.018) and normal bone density (p = 0.019), while the lumbar spine and total hip did not. When patients were grouped by overall osteoporosis status-defined as having osteoporosis at any site-significant BMD improvements were observed at the femoral neck and total hip compared to those with osteopenia (p = 0.031 and p = 0.015, respectively).

Conclusion: These findings underscore the potential for tailored interventions in managing bone health in patients with mild primary hyperparathyroidism, emphasizing the need for personalized approaches to optimize outcomes.

This systematic review and meta-analysis investigated the prognostic value of the BRAF V600E mutation in papillary thyroid carcinoma (PTC). 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 PRISMA guidelines and QUADAS-2 quality assessment. Random-effects models were applied to evaluate associations between BRAF status and major oncological outcomes. BRAF V600E mutation was significantly associated with lymph node metastasis (OR = 1.38; 95% 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. 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.

Objectives: Diabetic Ketoacidosis (DKA)-related hospitalizations significantly burden the healthcare system. Recurrent DKA prolongs hospitalization and worsens outcome. In this study, we compared patient characteristics, clinical outcomes, and healthcare cost between patients with DKA who successfully transitioned from intravenous to subcutaneous insulin and those who did not.

Methods: This retrospective cohort study included 493 patients, aged ≥18 years, admitted with DKA. Divided into two groups: successful transition (ST) and failed transition (FT) from intravenous to subcutaneous insulin. Clinical characteristics, length of ICU stay, in-hospital mortality, and healthcare costs were compared. Independent-sample t-tests and chi-square tests were used to analyze the data.

Results: Of 493 participants, 84.6% successfully transitioned, while 15.4% failed transition. Compared with the ST Group, the FT Group had higher mean BMI, more comorbidities, longer ICU stay (6.9 ± 7.7 vs 2.3 ± 4.5 days; p<0.001), and higher in-hospital mortality (9.2% vs 1.0%; p<0.001). The FT Group incurred greater healthcare costs, with mean hospital charge of $224,362 ± 317,628 compared to $75,226 ± 128,042 in the ST Group (p<0.001). Multivariable logistic regression identified higher BMI (OR 1.05; p=0.029), presence of comorbidities (OR 2.53; p=0.034), lower bicarbonate during transition (OR 0.88; p=0.004), and higher anion gap (OR 1.11; p=0.049) as significant predictors of transition failure.

Conclusions: The FT Group had worse clinical outcomes and utilized more healthcare resources than the ST Group. Key factors such as higher BMI, more comorbidities, higher post-transition glucose and lower bicarbonate levels are associated with transition failure.

Objectives: A clinically nonfunctioning pituitary adenoma (CNFPA) is the likely diagnosis in a patient presenting with a sellar mass consistent with an adenoma on imaging and no clinical or lab evidence of hormone excess. A better understanding of the outcome of observation alone for CNFPAs not requiring surgery at diagnosis is needed.

Methods: We conducted a prospective, observational study of apparent CNFPAs ≥ 6mm in diameter following ES guidelines for clinical, endocrine and imaging follow-up.

Results: 118 patients aged 56 (range 24.7-81) yr., of which 62% were female and 72% macroadenomas, were followed for a median of 3.9 yr. (range 0.42-16 yr.). On follow-up, 49% increased (56% of macro- and 31% of microadenomas), 12% decreased and 39% were unchanged in size. The median time to increase in size was 2.2 (0.43-12.8) yr. for macro- and 3.44 (0.41-7.4) yr. for microadenomas (P =0.16). Twenty-nine (24.6%) patients (26 that were macro- and 3 that were microadenomas at diagnosis) underwent pituitary surgery after 2.58 (0.4-7.6) yr. of follow-up. Multivariable analysis found male sex to be a significant predictor of tumor growth and macroadenoma that of surgery. Most surgically removed CNFPAs were typical, hormone immuno-negative or gonadotropin staining tumors.

Conclusions: In this prospective study of 6-9 mm micro-CNFPAs and macro-CNFPAs followed conservatively, growth and surgery can occur within the first year or after many years of observation. Risks of enlargement and surgery are increased for some patient groups. These factors should be considered in designing a plan for follow-up.

Objective: The aim of this study is to investigate the natural growth and post-unilateral total adrenalectomy changes of bilateral macronodular adrenocortical disease (BMAD).

Methods: Retrospective analysis included BMAD patients with ≥2 CT scans: 52 in the natural course cohort (median follow-up 31 months, range 7-150) and 23 in the post-unilateral adrenalectomy cohort (median follow-up 36 months, range 2-98), with their adrenal volumes measured precisely. A linear mixed-effects model ‌was applied to‌ longitudinal data from patients with ‌≥3 CT scans to analyze adrenal growth patterns.

Results: In BMAD patients with natural course, total adrenal volume ranged from 5.5 to 92.8 mL. The‌ left adrenal volume was significantly larger than the right, and males had greater volumes than females (‌P‌<0.001). The exponential growth model best fitted volume changes, with a median volume doubling time (VDT) of 11.82 years (range: 1.72-102.70) and a median specific growth rate (SGR) of 5.87%/year (range: 0.67-40.41%). In post-unilateral adrenalectomy patients, contralateral adrenal volume showed a significant postoperative increase (P<0.05), with exponential growth (median VDT: 9.08 years, range: 2.56-61.86; median SGR: 7.63%/year, range: 0.17-29.96%). ROC analysis ‌demonstrated that‌ postoperative contralateral adrenal volume ‌had‌ superior diagnostic performance (AUC=0.913, 95% CI: 0.813-1.000) for diagnosing autonomous cortisol secretion.

Conclusions: BMAD exhibits exponential growth despite variability in size and growth speed, which supports using VDT and SGR for the individualized growth assessment and imaging follow-up. Postoperative adrenal volume may help assess autonomous cortisol secretion status after unilateral adrenalectomy.

Objective: Age-related variability in the response to testosterone-based gender-affirming hormone therapy (GAHT) among transgender and gender-diverse individuals assigned female at birth (TGD AFAB) remains poorly understood. We investigated 1-year changes in muscle strength and mass after GAHT initiation and examined whether outcomes differ by age at treatment onset.

Methods: In this prospective longitudinal observational study, a total of 107 TGD AFAB adults naïve to GAHT and gender-affirming surgeries were enrolled and stratified into four baseline age groups (20-24, 25-29, 30-34, and ≥35 years). Handgrip strength and body composition (dual-energy X-ray absorptiometry) were assessed at baseline and after 12 months of testosterone therapy. Within-group changes and age-related trends were evaluated using linear mixed models and quantile regression.

Results: Handgrip strength increased after one year across all age groups, with a clear age-related gradient in magnitude. Gains were largest and significant in younger participants: +4.35 kg in the 25-29 group (p=0.001) and +2.14 kg in the 20-24 group (p=0.025). In the 30-34 and ≥35 groups, mean increases were smaller and not significant. Appendicular skeletal muscle mass index (ASMMI) showed modest, non-significant increases in younger participants and plateaued or declined from age 30 onward, with the 30-34 group displaying a decline most evident at the 25th percentile.

Conclusions: Age at GAHT initiation markedly influences the anabolic response to testosterone therapy. Strength gains are more pronounced in early adulthood and decline with age, information that may assist clinicians in providing age-appropriate counseling for individuals beginning testosterone therapy.

Objectives: Coronary artery calcium (CAC) scoring measures calcific plaque burden to assess cardiovascular risk. The relationship between CAC and primary hyperparathyroidism (PHPT), a disease linked to increased cardiovascular risk, is yet to be defined. We thus evaluated the relationship between PHPT and CAC scores.

Methods: Patients who underwent CAC scoring from January 1, 2015, to December 31, 2024, were retrospectively identified via electronic records. Patients with concurrent serum calcium and parathyroid hormone levels within one year of CAC testing were included. Cardiovascular risk was stratified by CAC scores (Low-Intermediate: 0-99, High: ≥100) and compared between PHPT and non-PHPT groups. CAC scores were then sub-analyzed in the PHPT cohort stratified by cardiovascular risk and PHPT subtype.

Results: 415 patients (75 PHPT, 340 non-PHPT) were included. The PHPT group was more likely to have greater coronary calcific burden (67 vs 50% with CAC scores ≥100, p=.04). PHPT also independently predicted CAC scores ≥100 [OR 1.5 (95% CI: 1.1-2.7), p=.03]. Subgroup analysis revealed higher CAC scores in male versus female patients with PHPT [495 (IQR: 51-634) vs 6 (IQR: 0-190), p<.01]. Longer periods of untreated PHPT disease were associated with moderate-to-severe coronary calcific burden [OR 1.2 (95% CI: 1.1-1.3), p<.01].

Conclusions: Patients with PHPT had higher proportions of CAC scores ≥100, suggesting greater cardiovascular event risk. Men with PHPT had significantly higher CAC scores compared to women, and untreated parathyroid disease was associated with moderate-to-severe coronary calcific burden. Therefore, routine screening may be considered in PHPT populations to evaluate for cardiovascular risk.