Pub Date : 2024-11-01DOI: 10.1016/j.eprac.2024.09.001
Objective
Cure after adrenalectomy for primary aldosteronism has been reported in only 15% to 40% of patients, with no disease severity score available to measure response objectively. Furthermore, the criteria used to define cure are outdated. This study aims to determine the rate of cure based on the current definition of normal blood pressure and develop a disease severity score to measure clinical improvement after adrenalectomy for primary aldosteronism.
Methods
This was a retrospective single-center study that included patients who underwent adrenalectomy for primary aldosteronism between 2000 and 2023. Blood pressure, a defined daily dose of antihypertensives, and potassium supplementation were incorporated into a new Primary Aldosteronism Disease Severity Score (PADSS), which was calculated with preoperative and 6-month postoperative parameters.
Results
The study included 201 patients. Adrenalectomy was guided by adrenal venous sampling in 86.1% of patients. The cure rate per the new definition of normal blood pressure was 7.5% (n = 15). The median PADSS was 16.3 (13.6-19.9) preoperatively and decreased to 10 (4.5-13.3) postoperatively. An improvement of the PADSS was observed in 90% (n = 180) of patients at 6 months of adrenalectomy. The median rate of improvement in PADSS was 33.3% (13.8% to 56.6%).
Conclusions
Although complete cure rates are low after adrenalectomy in primary aldosteronism, especially based on the new definition of normal blood pressure, a clinical improvement is seen in the vast majority of patients postoperatively. The newly introduced PADSS can be used to assess the clinical benefit achieved with adrenalectomy.
{"title":"A New Disease Severity Score for Measuring Treatment Response to Adrenalectomy in Patients With Primary Aldosteronism","authors":"","doi":"10.1016/j.eprac.2024.09.001","DOIUrl":"10.1016/j.eprac.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>Cure after adrenalectomy for primary aldosteronism has been reported in only 15% to 40% of patients, with no disease severity score available to measure response objectively. Furthermore, the criteria used to define cure are outdated. This study aims to determine the rate of cure based on the current definition of normal blood pressure and develop a disease severity score to measure clinical improvement after adrenalectomy for primary aldosteronism.</div></div><div><h3>Methods</h3><div>This was a retrospective single-center study that included patients who underwent adrenalectomy for primary aldosteronism between 2000 and 2023. Blood pressure, a defined daily dose of antihypertensives, and potassium supplementation were incorporated into a new Primary Aldosteronism Disease Severity Score (PADSS), which was calculated with preoperative and 6-month postoperative parameters.</div></div><div><h3>Results</h3><div>The study included 201 patients. Adrenalectomy was guided by adrenal venous sampling in 86.1% of patients. The cure rate per the new definition of normal blood pressure was 7.5% (<em>n</em> = 15). The median PADSS was 16.3 (13.6-19.9) preoperatively and decreased to 10 (4.5-13.3) postoperatively. An improvement of the PADSS was observed in 90% (<em>n</em> = 180) of patients at 6 months of adrenalectomy. The median rate of improvement in PADSS was 33.3% (13.8% to 56.6%).</div></div><div><h3>Conclusions</h3><div>Although complete cure rates are low after adrenalectomy in primary aldosteronism, especially based on the new definition of normal blood pressure, a clinical improvement is seen in the vast majority of patients postoperatively. The newly introduced PADSS can be used to assess the clinical benefit achieved with adrenalectomy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264365","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}
Pub Date : 2024-11-01DOI: 10.1016/j.eprac.2024.08.005
Objective
To evaluate the effects of teprotumumab on ophthalmologic and biochemical findings and assess potential genetic markers for response to treatment.
Methods
This is a retrospective study. Participants were 18-76 year old. All subjects were treated with teprotumumab. The primary outcome was the change in proptosis before and after teprotumumab treatment. Secondary outcomes include change in other ophthalmic measures and thyroid laboratory tests. Human leukocyte antigens (HLA) markers were analyzed for response to teprotumumab.
Results
Twenty-six patients were included in the final analysis. There was a significant decrease in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and significant increases in glycated hemoglobin A1c, fasting glucose, and total T3 levels. There was also significant reduction in proptosis, clinical activity score, retinal nerve fiber layer thickness, ganglion cell analysis, and intraocular pressure. HLA haplotypes were distinct between responders and nonresponders, with HLA-DRB3 02:02:01G, HLA-DRB4 neg, and HLA-DQB1 02:01:01G demonstrating better response to teprotumumab and HLA-A 23:01:01G strongly correlating to nonresponse.
Conclusions
Patients with both acute and chronic thyroid eye disease treated with teprotumumab had a significant reduction in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and improvement in proptosis, clinical activity score, retinal nerve fiber layer and ganglion cell analysis thickness, and intraocular pressure. HLA may predict responders vs nonresponders. Further studies with longer duration and larger population comparing teprotumumab with steroids or other immunomodulatory agents (tocilizumab, rituximab, etc) may be helpful.
{"title":"Effects of Teprotumumab and Role of Human Leukocyte Antigens Markers in Patients With Thyroid Eye Disease","authors":"","doi":"10.1016/j.eprac.2024.08.005","DOIUrl":"10.1016/j.eprac.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of teprotumumab on ophthalmologic and biochemical findings and assess potential genetic markers for response to treatment.</div></div><div><h3>Methods</h3><div>This is a retrospective study. Participants were 18-76 year old. All subjects were treated with teprotumumab. The primary outcome was the change in proptosis before and after teprotumumab treatment. Secondary outcomes include change in other ophthalmic measures and thyroid laboratory tests. Human leukocyte antigens (HLA) markers were analyzed for response to teprotumumab.</div></div><div><h3>Results</h3><div>Twenty-six patients were included in the final analysis. There was a significant decrease in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and significant increases in glycated hemoglobin A1c, fasting glucose, and total T3 levels. There was also significant reduction in proptosis, clinical activity score, retinal nerve fiber layer thickness, ganglion cell analysis, and intraocular pressure. HLA haplotypes were distinct between responders and nonresponders, with HLA-DRB3 02:02:01G, HLA-DRB4 neg, and HLA-DQB1 02:01:01G demonstrating better response to teprotumumab and HLA-A 23:01:01G strongly correlating to nonresponse.</div></div><div><h3>Conclusions</h3><div>Patients with both acute and chronic thyroid eye disease treated with teprotumumab had a significant reduction in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and improvement in proptosis, clinical activity score, retinal nerve fiber layer and ganglion cell analysis thickness, and intraocular pressure. HLA may predict responders vs nonresponders. Further studies with longer duration and larger population comparing teprotumumab with steroids or other immunomodulatory agents (tocilizumab, rituximab, etc) may be helpful.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072253","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}
Pub Date : 2024-11-01DOI: 10.1016/j.eprac.2024.07.014
Objective
Metformin is clinically effective in treating polycystic ovary syndrome (PCOS) with insulin resistance (IR), while its efficacy varies among individuals. This study aims to develop a machine learning model to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR.
Methods
This is a retrospective analysis of a multicenter, randomized controlled trial involving 114 women diagnosed with PCOS and IR. All women received metformin treatment for 4 months. We incorporated 27 baseline clinical variables of the women into the construction of our machine learning model. We firstly compared 4 commonly used feature selection methods to screen valuable clinical variables. Then we used the valuable variables as inputs to evaluate the performance of 5 machine learning models, including k-Nearest Neighbors, Support Vector Machine, Logistic Regression, Random Forest, and Extreme Gradient Boosting, in predicting the efficacy of metformin.
Results
Among the 5 machine learning models, Support Vector Machine performed the best with an area under the receiver operating characteristic curve of 0.781 (95% confidence interval [CI]: 0.772-0.791). The key predictive variables identified were homeostasis model assessment of insulin resistance, body mass index, and low-density lipoprotein cholesterol.
Conclusion
The developed machine learning model could be applied to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR. The result could help doctors evaluate the efficacy of metformin in advance, optimize treatment plans, and thereby enhance overall clinical outcomes.
{"title":"Predicting Metformin Efficacy in Improving Insulin Sensitivity Among Women With Polycystic Ovary Syndrome and Insulin Resistance: A Machine Learning Study","authors":"","doi":"10.1016/j.eprac.2024.07.014","DOIUrl":"10.1016/j.eprac.2024.07.014","url":null,"abstract":"<div><h3>Objective</h3><div>Metformin is clinically effective in treating polycystic ovary syndrome (PCOS) with insulin resistance (IR), while its efficacy varies among individuals. This study aims to develop a machine learning model to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of a multicenter, randomized controlled trial involving 114 women diagnosed with PCOS and IR. All women received metformin treatment for 4 months. We incorporated 27 baseline clinical variables of the women into the construction of our machine learning model. We firstly compared 4 commonly used feature selection methods to screen valuable clinical variables. Then we used the valuable variables as inputs to evaluate the performance of 5 machine learning models, including k-Nearest Neighbors, Support Vector Machine, Logistic Regression, Random Forest, and Extreme Gradient Boosting, in predicting the efficacy of metformin.</div></div><div><h3>Results</h3><div>Among the 5 machine learning models, Support Vector Machine performed the best with an area under the receiver operating characteristic curve of 0.781 (95% confidence interval [CI]: 0.772-0.791). The key predictive variables identified were homeostasis model assessment of insulin resistance, body mass index, and low-density lipoprotein cholesterol.</div></div><div><h3>Conclusion</h3><div>The developed machine learning model could be applied to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR. The result could help doctors evaluate the efficacy of metformin in advance, optimize treatment plans, and thereby enhance overall clinical outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901334","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}
Pub Date : 2024-11-01DOI: 10.1016/j.eprac.2024.08.007
Background
Detectable, and especially rising postthyroidectomy serum calcitonin and carcinoembryonic antigen levels, as per American Thyroid Association guidelines, indicate potential disease presence, requiring frequent calcitonin measurement or imaging for early detection of persistent or recurrent medullary thyroid carcinoma. Thus, defining the clinical cutoff value of detection of calcitonin assays relative to imaging and clinical status is crucial for patient care. This study aimed to evaluate postoperative calcitonin levels using the new Siemens Atellica assay system to determine the most appropriate levels for clinical decision-making.
Methods
A retrospective analysis was conducted using Siemens Atellica for calcitonin testing on 56 samples from 40 patients between September 27, 2022 and August 11, 2023. Only calcitonin results performed at least 3 months post-total thyroidectomy were included. Imaging studies, within 6 months of the calcitonin report, were assessed. Carcinoembryonic antigen results were also reviewed.
Results
Precision analysis at 2.94 and 5.24 pg/mL revealed coefficients of variation at 16.49% and 8.87%, respectively. For the evidence of post-total thyroidectomy persistent or recurrent medullary thyroid carcinoma confirmed by imaging, using a 1.89 pg/mL cutoff for calcitonin yielded 43% sensitivity and 67% specificity. Using a 5.00 pg/mL cutoff resulted in 0% sensitivity and 100% specificity.
Conclusions
Our findings indicate the potential suitability of a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform for evaluating tumor persistence or recurrence in post-thyroidectomy patients in our institution. However, individual laboratories should establish their own clinical cutoff value when evaluating calcitonin levels for monitoring tumor recurrence post-thyroidectomy.
{"title":"Defining the Functional Sensitivity for the Siemens Atellica Calcitonin Assay: Insight From a Single-Center Study","authors":"","doi":"10.1016/j.eprac.2024.08.007","DOIUrl":"10.1016/j.eprac.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Detectable, and especially rising postthyroidectomy serum calcitonin and carcinoembryonic antigen levels, as per American Thyroid Association guidelines, indicate potential disease presence, requiring frequent calcitonin measurement or imaging for early detection of persistent or recurrent medullary thyroid carcinoma. Thus, defining the clinical cutoff value of detection of calcitonin assays relative to imaging and clinical status is crucial for patient care. This study aimed to evaluate postoperative calcitonin levels using the new Siemens Atellica assay system to determine the most appropriate levels for clinical decision-making.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using Siemens Atellica for calcitonin testing on 56 samples from 40 patients between September 27, 2022 and August 11, 2023. Only calcitonin results performed at least 3 months post-total thyroidectomy were included. Imaging studies, within 6 months of the calcitonin report, were assessed. Carcinoembryonic antigen results were also reviewed.</div></div><div><h3>Results</h3><div>Precision analysis at 2.94 and 5.24 pg/mL revealed coefficients of variation at 16.49% and 8.87%, respectively. For the evidence of post-total thyroidectomy persistent or recurrent medullary thyroid carcinoma confirmed by imaging, using a 1.89 pg/mL cutoff for calcitonin yielded 43% sensitivity and 67% specificity. Using a 5.00 pg/mL cutoff resulted in 0% sensitivity and 100% specificity.</div></div><div><h3>Conclusions</h3><div>Our findings indicate the potential suitability of a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform for evaluating tumor persistence or recurrence in post-thyroidectomy patients in our institution. However, individual laboratories should establish their own clinical cutoff value when evaluating calcitonin levels for monitoring tumor recurrence post-thyroidectomy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092534","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}
Pub Date : 2024-11-01DOI: 10.1016/j.eprac.2024.08.014
Objective
The risk of venous thromboembolism (VTE) with feminizing gender-affirming hormone therapy is an area of concern. This analysis aimed to assess whether gender-affirming hormone therapy and other potential risk factors are associated with VTE in transfeminine and gender diverse individuals.
Methods
We conducted a chart review of 2126 transfeminine and gender diverse adults receiving care within a large urban health system. The primary outcomes were the prevalence of VTE and odds ratios for the association of VTE with insurer, use of estrogen, and select comorbidities.
Results
A history of VTE was documented in 0.8% of the cohort. Those with a history of VTE were older (P < .001), more often self-identified as Hispanic or Black compared to White or Asian (P < .05) and were more likely to have Medicaid or Medicare (P < .01) when compared to those without a history of VTE. The prevalence of hyperlipidemia (P < .001), diabetes mellitus (P < .05), and hypercoagulable conditions (P < .001) were all greater in the positive VTE group. Hyperlipidemia (P < .001), diabetes mellitus (P < .05), and insurer (P < .05) were associated with increased odds of VTE in univariate analyses. None of the exposure variables analyzed were associated with VTE when controlling for age, race, and the number of comorbidities.
Conclusions
The prevalence of VTE in our cohort was lower than previously observed. VTE was not associated with any one risk factor, including estrogen use, when controlling for age, race, and the number of comorbidities. Those of advanced age and those with multiple cardiometabolic comorbidities may benefit from increased surveillance and mitigation of modifiable risk factors.
{"title":"Evaluating the Risk of Venous Thromboembolism in Transfeminine and Gender Diverse People: A Retrospective Analysis","authors":"","doi":"10.1016/j.eprac.2024.08.014","DOIUrl":"10.1016/j.eprac.2024.08.014","url":null,"abstract":"<div><h3>Objective</h3><div>The risk of venous thromboembolism (VTE) with feminizing gender-affirming hormone therapy is an area of concern. This analysis aimed to assess whether gender-affirming hormone therapy and other potential risk factors are associated with VTE in transfeminine and gender diverse individuals.</div></div><div><h3>Methods</h3><div>We conducted a chart review of 2126 transfeminine and gender diverse adults receiving care within a large urban health system. The primary outcomes were the prevalence of VTE and odds ratios for the association of VTE with insurer, use of estrogen, and select comorbidities.</div></div><div><h3>Results</h3><div>A history of VTE was documented in 0.8% of the cohort. Those with a history of VTE were older (<em>P</em> < .001), more often self-identified as Hispanic or Black compared to White or Asian (<em>P</em> < .05) and were more likely to have Medicaid or Medicare (<em>P</em> < .01) when compared to those without a history of VTE. The prevalence of hyperlipidemia (<em>P</em> < .001), diabetes mellitus (<em>P</em> < .05), and hypercoagulable conditions (<em>P</em> < .001) were all greater in the positive VTE group. Hyperlipidemia (<em>P</em> < .001), diabetes mellitus (<em>P</em> < .05), and insurer (<em>P</em> < .05) were associated with increased odds of VTE in univariate analyses. None of the exposure variables analyzed were associated with VTE when controlling for age, race, and the number of comorbidities.</div></div><div><h3>Conclusions</h3><div>The prevalence of VTE in our cohort was lower than previously observed. VTE was not associated with any one risk factor, including estrogen use, when controlling for age, race, and the number of comorbidities. Those of advanced age and those with multiple cardiometabolic comorbidities may benefit from increased surveillance and mitigation of modifiable risk factors.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132115","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}
Pub Date : 2024-10-30DOI: 10.1016/j.eprac.2024.10.011
Michael F Holick
The goal of this Review is to compare the 2024 and 2011 Endocrine Society's Clinical Guidelines on Vitamin D. The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence. The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extraskeletal health the benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy related outcomes, prediabetic patients to reduce risk of diabetes and to improve mortality in those over 75 years. These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75 they recommend the Dietary Reference Intakes of 600 IUs, and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, preeclampsia, low birth weight, neonatal dental caries and deadly cancers that circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.
2024 年指南为普通健康人群提供了维生素 D 对骨骼和骨骼外健康益处的建议。这与 2011 年指南形成了鲜明对比，后者为临床医生提供了如何评估和治疗维生素 D 缺乏症患者并预防复发的指导。2024 年指南》重点关注随机对照试验、被忽视的关联研究以及其他支持维生素 D 对骨骼和骨骼外健康益处的研究。《2024 年指南》建议对 1 至 18 岁的儿童和青少年、孕妇、糖尿病前期患者和 75 岁以上老人进行经验性维生素 D 治疗，以降低上呼吸道感染风险，改善妊娠相关结果，降低糖尿病风险，并改善死亡率。这些指导原则不适用于钙、磷酸盐、维生素 D 和骨代谢异常的人群，2011 年的指导原则已对此做出规定。对于 75 岁以下的非怀孕成年人，《指南》建议其膳食维生素 D 参考摄入量为 600 IUs 和医学研究所建议的 800 IUs。相关研究表明，要从维生素 D 中获得最大的骨骼外益处，包括降低儿童和成人上呼吸道感染、自身免疫性疾病、先兆子痫、低出生体重、新生儿龋齿和致命癌症的风险，25-羟基维生素 D 的循环浓度应至少为 30 纳克/毫升，《2011 年指南》建议的首选范围为 40-60 纳克/毫升。
{"title":"Revisiting Vitamin D Guidelines: A Critical Appraisal of The Literature.","authors":"Michael F Holick","doi":"10.1016/j.eprac.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.10.011","url":null,"abstract":"<p><p>The goal of this Review is to compare the 2024 and 2011 Endocrine Society's Clinical Guidelines on Vitamin D. The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance for how to evaluate and treat patients with vitamin D deficiency and prevent recurrence. The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extraskeletal health the benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy related outcomes, prediabetic patients to reduce risk of diabetes and to improve mortality in those over 75 years. These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75 they recommend the Dietary Reference Intakes of 600 IUs, and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, preeclampsia, low birth weight, neonatal dental caries and deadly cancers that circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563996","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}
Pub Date : 2024-10-28DOI: 10.1016/j.eprac.2024.10.007
Huda Al-Bahadili, Jennifer Powers Carson, Alexander Markov, Sina Jasim
Objective: Thyroid disorders are common. Serum TSH is frequently measured and is the single best initial biomarker to diagnose thyroid disease. Automated immunoassays used to evaluate thyroid function are susceptible to interferences that can affect test results and therefore clinical decisions. In this comprehensive review, our aim is to discuss common assay and drug interferences leading to abnormal thyroid function tests.
Methods: Authors conducted a literature review of PubMed to include studies on drug related and laboratory assay interferences leading to primary and secondary thyroid dysfunction in addition to interferences with thyroid hormone replacement and thyroid function tests.
Results: Overall, there are several assay interferences as well as drug interferences leading to primary thyroid dysfunction including iodine-containing drugs such as amiodarone, lithium, immune checkpoint inhibitors and tyrosine kinase inhibitors, drug interferences leading to secondary thyroid dysfunction such as glucocorticoids, and drug interferences affecting thyroid hormone absorption, metabolism, and thyroid binding globulin levels. In addition, assay interferences from biotin, heterophile antibodies, Macro-TSH or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.
Conclusion: For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.
{"title":"The Complex Web of Interferences with Thyroid Function Tests.","authors":"Huda Al-Bahadili, Jennifer Powers Carson, Alexander Markov, Sina Jasim","doi":"10.1016/j.eprac.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.10.007","url":null,"abstract":"<p><strong>Objective: </strong>Thyroid disorders are common. Serum TSH is frequently measured and is the single best initial biomarker to diagnose thyroid disease. Automated immunoassays used to evaluate thyroid function are susceptible to interferences that can affect test results and therefore clinical decisions. In this comprehensive review, our aim is to discuss common assay and drug interferences leading to abnormal thyroid function tests.</p><p><strong>Methods: </strong>Authors conducted a literature review of PubMed to include studies on drug related and laboratory assay interferences leading to primary and secondary thyroid dysfunction in addition to interferences with thyroid hormone replacement and thyroid function tests.</p><p><strong>Results: </strong>Overall, there are several assay interferences as well as drug interferences leading to primary thyroid dysfunction including iodine-containing drugs such as amiodarone, lithium, immune checkpoint inhibitors and tyrosine kinase inhibitors, drug interferences leading to secondary thyroid dysfunction such as glucocorticoids, and drug interferences affecting thyroid hormone absorption, metabolism, and thyroid binding globulin levels. In addition, assay interferences from biotin, heterophile antibodies, Macro-TSH or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.</p><p><strong>Conclusion: </strong>For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544449","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}
Pub Date : 2024-10-25DOI: 10.1016/j.eprac.2024.10.012
Jayachidambaram Ambalavanan, Jill Rusticelli, Diana Isaacs, Huijun Xiao, James Bena, Christopher Babiuch, M Cecilia Lansang
Objective: Hypoglycemia can be life-threatening for patients with diabetes (DM). We aimed to 1) evaluate percentage of glucagon prescription in patients with hypoglycemia on CGM reports, and 2) determine incident glucagon prescription after an educational letter delivered to the providers.
Research design and methods: The study had two components - retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March-October 2023 on adult patients in a tertiary care health system with type 1 DM, or type 2 DM on insulin, sulfonylurea, or meglitinide. Percentages of pre-existing and incident glucagon prescription were evaluated. For the QI, we contacted providers whose patients had hypoglycemia defined as time below range (TBR) ≥4% on CGM reports without a glucagon prescription and shared the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription was collected 4 weeks later.
Results: Of the 1,543 patients included 170 had TBR ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p<0.001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild , 49% with moderate, and 63% with severe hypoglycemia (p<0.001 mild vs severe; moderate vs no hypoglycemia; severe vs no hypoglycemia). Among 70 patients whose providers received education, 27 (39%) prescribed glucagon. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were top choices.
Conclusion: Glucagon prescription remains suboptimal among patients with hypoglycemia on CGM reports. Provider engagement via QI can increase glucagon prescription.
{"title":"Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior.","authors":"Jayachidambaram Ambalavanan, Jill Rusticelli, Diana Isaacs, Huijun Xiao, James Bena, Christopher Babiuch, M Cecilia Lansang","doi":"10.1016/j.eprac.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.10.012","url":null,"abstract":"<p><strong>Objective: </strong>Hypoglycemia can be life-threatening for patients with diabetes (DM). We aimed to 1) evaluate percentage of glucagon prescription in patients with hypoglycemia on CGM reports, and 2) determine incident glucagon prescription after an educational letter delivered to the providers.</p><p><strong>Research design and methods: </strong>The study had two components - retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March-October 2023 on adult patients in a tertiary care health system with type 1 DM, or type 2 DM on insulin, sulfonylurea, or meglitinide. Percentages of pre-existing and incident glucagon prescription were evaluated. For the QI, we contacted providers whose patients had hypoglycemia defined as time below range (TBR) ≥4% on CGM reports without a glucagon prescription and shared the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription was collected 4 weeks later.</p><p><strong>Results: </strong>Of the 1,543 patients included 170 had TBR ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p<0.001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild , 49% with moderate, and 63% with severe hypoglycemia (p<0.001 mild vs severe; moderate vs no hypoglycemia; severe vs no hypoglycemia). Among 70 patients whose providers received education, 27 (39%) prescribed glucagon. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were top choices.</p><p><strong>Conclusion: </strong>Glucagon prescription remains suboptimal among patients with hypoglycemia on CGM reports. Provider engagement via QI can increase glucagon prescription.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567019","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}
Pub Date : 2024-10-23DOI: 10.1016/j.eprac.2024.10.009
Ken Kanazawa, Mai Hijikata, Koichiro Kuwabara
Objective: To evaluate the association between nocturnal hypoglycemia (NH) and latent adrenal insufficiency (LAI) among elderly aged >65 years.
Methods: This propensity-matched, retrospective observational study was conducted in an outpatient setting, assessing 1238 elderly aged >65 years between November 2017 and February 2020. Of them, 430 patients with unassessed LAI were monitored for NH using continuous glucose monitoring (CGM) with Freestyle Libre Pro®. The primary outcome was the combined prevalence of newly diagnosed and suspected LAI in patients with NH.
Results: After propensity score matching, 192 patients were included (96 each in the NH and non-NH group). The overall incidence rate of NH was 28.8% (124/430). The association of NH with newly diagnosed and suspected LAI was significantly higher in the NH group (26.04%, 50/192) than in the non-NH (12.5%, 24/192) (odds ratio: 3.26; 95% confidence interval: 2.59-9.06; P < 0.001). In the NH, compared with patients without LAI, those with new-diagnosed LAI had a higher incidence of hypoglycemia CONCLUSIONS: Diagnosing and treating LAI in the elderly with NH may prevent complications, including fatal diseases, and extend their life expectancy.
{"title":"Evaluating Latent Adrenal Insufficiency in Elderly Patients with Nocturnal Hypoglycemia: A Retrospective Observational Study.","authors":"Ken Kanazawa, Mai Hijikata, Koichiro Kuwabara","doi":"10.1016/j.eprac.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.10.009","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between nocturnal hypoglycemia (NH) and latent adrenal insufficiency (LAI) among elderly aged >65 years.</p><p><strong>Methods: </strong>This propensity-matched, retrospective observational study was conducted in an outpatient setting, assessing 1238 elderly aged >65 years between November 2017 and February 2020. Of them, 430 patients with unassessed LAI were monitored for NH using continuous glucose monitoring (CGM) with Freestyle Libre Pro®. The primary outcome was the combined prevalence of newly diagnosed and suspected LAI in patients with NH.</p><p><strong>Results: </strong>After propensity score matching, 192 patients were included (96 each in the NH and non-NH group). The overall incidence rate of NH was 28.8% (124/430). The association of NH with newly diagnosed and suspected LAI was significantly higher in the NH group (26.04%, 50/192) than in the non-NH (12.5%, 24/192) (odds ratio: 3.26; 95% confidence interval: 2.59-9.06; P < 0.001). In the NH, compared with patients without LAI, those with new-diagnosed LAI had a higher incidence of hypoglycemia CONCLUSIONS: Diagnosing and treating LAI in the elderly with NH may prevent complications, including fatal diseases, and extend their life expectancy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497253","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}
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