Endocrine Practice最新文献

{"title":"Combining Image Similarity and Predictive Artificial Intelligence Models to Decrease Subjectivity in Thyroid Nodule Diagnosis and Improve Malignancy Prediction","authors":"Govind Nair ,&nbsp;Aishwarya Vedula ,&nbsp;Ethan Thomas Johnson ,&nbsp;Johnson Thomas MD ,&nbsp;Rajshree Patel MD ,&nbsp;Jennifer Cheng DO ,&nbsp;Ramya Vedula DO, MPH","doi":"10.1016/j.eprac.2024.08.001","DOIUrl":"10.1016/j.eprac.2024.08.001","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the efficacy of combining predictive artificial intelligence (AI) and image similarity model to risk stratify thyroid nodules, using retrospective external validation study.</div></div><div><h3>Methods</h3><div>Two datasets were used to determine efficacy of the AI application. One was Stanford dataset ultrasound images of 192 nodules between April 2017 and May 2018 and the second was private practice consisting of 118 thyroid nodule images between January 2018 and December 2023. The nodules had definitive diagnosis by cytology or surgical pathology. The AI application was used to predict the diagnosis and American College of Radiology Thyroid Imaging and Data System (ACR TI-RADS) score.</div></div><div><h3>Results</h3><div>In the Stanford dataset, the AI application predicted malignancies with sensitivity of 1.0 and specificity of 0.55. Positive predictive value (PPV) was 0.18 and negative predictive value (NPV) was 1.0. The Area Under the Curve - Receiver Operating Characteristic was 0.78. ACR TI-RADS based clinical recommendation had a polychoric correlation of 0.67. In the private dataset, the AI application predicted malignancies with sensitivity of 0.91 and specificity of 0.95. PPV was 0.8 and NPV was 0.98. The area under the curve - receiver operating characteristic was 0.93 and accuracy was 0.94. ACR TI-RADS based score had a polychoric correlation of 0.94.</div></div><div><h3>Conclusion</h3><div>The AI application showed good performance for sensitivity and NPV between the two datasets and demonstrated potential for 61.5% reduction in the need for fine needle aspiration and strong correlation to ACR TI-RADS. However, PPV was variable between the datasets possibly from variability in image selection and prevalence of malignancy. If implemented widely and consistently among various clinical settings, this could lead to decreased patient burden associated with an invasive procedure and possibly to decreased health care spending.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1031-1037"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912243","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":"Improved Clinical Outcomes Associated With Hungry Bone Syndrome Following Parathyroidectomy in Dialysis Patients","authors":"Panida Silarat MD ,&nbsp;Sarunya Saeseow MD ,&nbsp;Adisorn Pathumarak MD ,&nbsp;Praopilad Srisuwarn MD ,&nbsp;Ronnarat Suvikapakornkul MD ,&nbsp;Sinee Disthabanchong MD","doi":"10.1016/j.eprac.2024.08.004","DOIUrl":"10.1016/j.eprac.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>Hungry bone syndrome (HBS) is a common complication after parathyroidectomy in dialysis patients with severe secondary hyperparathyroidism. The rapid decline in parathyroid hormone (PTH) levels diminishes bone resorption and accelerates bone formation. This causes a significant influx of calcium and phosphate into the bone, resulting in severe and prolonged hypocalcemia. While previous studies have established risk factors for HBS, the outcomes beyond the reduced recurrence rate of hyperparathyroidism have been largely unexplored.</div></div><div><h3>Methods</h3><div>This single-center retrospective study analyzed 322 cases in 314 dialysis patients who underwent parathyroidectomy between 2012 and 2022. The study examined baseline factors associated with HBS, adverse events, and clinical outcomes, including changes in blood pressure and hematologic and nutritional parameters over 3-12 months of follow-up, stratified by HBS status.</div></div><div><h3>Results</h3><div>Total parathyroidectomy was performed in 28 cases (8.7%), total parathyroidectomy with implantation in 98 cases (30.4%), and subtotal parathyroidectomy in 196 cases (60.9%). HBS occurred in 207 cases (64%). Independent predictors of HBS included male sex, lower serum calcium levels, higher PTH levels, and lack of active vitamin D treatment at baseline. Patients with HBS had longer hospital stays but did not experience an increase in other adverse events. Following parathyroidectomy, the HBS group showed a greater reduction in blood pressure and more significant increases in hemoglobin, total lymphocyte count, and serum creatinine. This group also saw a more substantial decrease in the proportions of patients with hemoglobin &lt;11 g/dL and serum creatinine/body surface area &lt;380 μmol/L/m². Although the HBS group showed a more significant decline in PTH levels from baseline, similar proportions achieved the target PTH level by the end of the study. Serum calcium levels remained substantially lower in the HBS group throughout the follow-up, while serum phosphate and PTH levels were comparable.</div></div><div><h3>Conclusion</h3><div>HBS was associated with more pronounced improvements in blood pressure, anemia, and nutritional parameters. The presence of HBS could indicate greater achievement in controlling hyperparathyroidism following parathyroidectomy.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1079-1088"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105429","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":"Life’s Essential 8 and Mortality in US Adults With Obesity: A Cohort Study","authors":"Xiaoqiang Liu MD ,&nbsp;Yingxuan Huang MD ,&nbsp;Chanchan Lin MD ,&nbsp;Xinqi Chen MD ,&nbsp;Yisen Huang MD ,&nbsp;Xinda Wang MD ,&nbsp;Yingyi Li MD ,&nbsp;Yubin Wang MD","doi":"10.1016/j.eprac.2024.08.015","DOIUrl":"10.1016/j.eprac.2024.08.015","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the relationship between the Life’s Essential 8 (LE8) scoring system and all-cause and cause-specific mortality among obese individuals using National Health and Nutrition Examination Survey data.</div></div><div><h3>Methods</h3><div>Data from 9143 obese participants (BMI ≥30 kg/m²) collected between 2005 and 2018 were analyzed. Participants were categorized based on their LE8 scores: low cardiovascular health (Low CVH, <em>n</em> = 2264), moderate cardiovascular health (Moderate CVH, <em>n</em> = 6541), and high cardiovascular health (High CVH, <em>n</em> = 338). Associations between LE8 scores and mortality were assessed using Kaplan-Meier survival analysis and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Over a median follow-up of 7.3 years, there were 867 all-cause deaths (9.5%), including 246 cardiovascular disease (CVD) deaths (2.7%) and 621 non-CVD deaths (6.8%). In multivariable Cox regression analysis, compared to the Low CVH group, the Moderate CVH group had an adjusted hazard ratio (HR) for all-cause mortality of 0.63 (95% CI: 0.55-0.72), and the High CVH group had an HR of 0.25 (95% CI: 0.10-0.60). For CVD mortality, the HRs were 0.61 (95% CI: 0.47-0.78) for Moderate CVH and 0.19 (95% CI: 0.03-1.38) for High CVH. For non-CVD mortality, the HRs were 0.64 (95% CI: 0.54-0.75) for Moderate CVH and 0.27 (95% CI: 0.10-0.72) for High CVH. Each 10-point increase in LE8 score was associated with a 20% reduction in all-cause mortality (<em>P</em> &lt; .001), 21% reduction in CVD mortality (<em>P</em> &lt; .001), and 20% reduction in non-CVD mortality (<em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Higher LE8 scores are significantly associated with lower rates of all-cause, CVD, and non-CVD mortality among obese individuals. These findings support the LE8 scoring system as an effective predictor of health status and mortality risk.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1089-1096"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145404","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":"Thyroid Function and Cognitive Decline: A Narrative Review","authors":"Sophia Hemmrich Sinha MD ,&nbsp;Kahli Zietlow MD ,&nbsp;Maria Papaleontiou MD","doi":"10.1016/j.eprac.2024.07.013","DOIUrl":"10.1016/j.eprac.2024.07.013","url":null,"abstract":"<div><h3>Objective</h3><div>As the population of older adults in the United States continues to rise, understanding modifiable risk factors that contribute to cognitive decline and dementia becomes increasingly important. This narrative review summarizes existing literature on the association between thyroid function in the euthyroid range, hypothyroidism and hyperthyroidism, and cognitive outcomes in older adults.</div></div><div><h3>Methods</h3><div>A comprehensive literature search of the PubMed and Ovid/Medline databases was conducted. Randomized controlled trials, systematic reviews, meta-analyses, and observational studies published in English between January 2000 and December 2023 were included.</div></div><div><h3>Results</h3><div>Overall, existing studies yielded conflicting results, failing to delineate a concrete relationship between thyroid function and cognitive outcomes and/or dementia in older adults. There may be a possible association between higher thyroid stimulating hormone in the reference range and lower risk of incident dementia, which may be more pronounced in women. Majority of studies elucidated a possible association between low thyroid stimulating hormone and incident dementia, with suggestion that duration of hyperthyroidism may contribute to increasing dementia risk. Even though evidence on the association of hypothyroidism and cognitive decline are disparate, current data do not support treatment of subclinical hypothyroidism to improve cognitive outcomes in older adults.</div></div><div><h3>Conclusion</h3><div>Despite numerous studies, there is no conclusive evidence that supports a direct relationship between hyperthyroidism or hypothyroidism and cognitive decline. Study limitations include heterogeneity in study designs, measurement methodologies, and cognitive assessment tools. Future research is needed to better delineate whether an association exists and whether treatment of thyroid dysfunction ameliorates cognitive impairment.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1113-1118"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901335","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":"Thyroid Cancer Survivorship: Challenges and Opportunities","authors":"Anupam Kotwal MD, MSc, FACE ,&nbsp;Abbey Fingeret MD, MHPTT, FACS ,&nbsp;Anne Knape APRN-NP ,&nbsp;Anery Patel MD ,&nbsp;Elizabeth Bradford Bell MD ,&nbsp;Whitney Goldner MD","doi":"10.1016/j.eprac.2024.08.003","DOIUrl":"10.1016/j.eprac.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To provide a narrative review of challenges and opportunities in the care of thyroid cancer survivors.</div></div><div><h3>Methods</h3><div>A literature search for full-text articles pertaining to quality of life and survivorship in thyroid cancer was performed and supplemented with personal experience of the authors.</div></div><div><h3>Results</h3><div>Despite usually favorable prognosis for most thyroid cancer survivors, health-related quality of life (HRQOL) can be as poor or even worse than that in more aggressive cancers. Worry of cancer recurrence and long-term effects from cancer treatment adversely affects HRQOL in addition to other factors. Disparities and financial hardships among thyroid cancer survivors further affect HRQOL. In addition to monitoring for cancer recurrence and managing hypothyroidism, long-term effects from cancer treatment, including surgical complications, effects from radioactive iodine therapy, a small but increased risk of second primary malignancies, and aging-related health conditions (bone, cardiac, and fertility), need to be monitored for and addressed during survivorship care.</div></div><div><h3>Conclusion</h3><div>Survivorship care models can vary depending on the specifics of the population served; however, a team-based survivor-centered approach provides the best care to thyroid cancer survivors.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1097-1102"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105430","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":"Safety and Efficacy of the Novel RNA Interference Therapies for Hypertriglyceridemia and Mixed Hyperlipidemia Management: A Systematic Review and Meta-analysis","authors":"A.B.M. Kamrul-Hasan MBBS, MD ,&nbsp;Deep Dutta MBBS, MD, DM, DNB, FRCP ,&nbsp;Lakshmi Nagendra MBBS, MRCP, MD, DM, DrNB ,&nbsp;Sunetra Mondal MBBS, MRCP, MD, DM ,&nbsp;Saptarshi Bhattacharya MBBS, MD, DM ,&nbsp;Sanjay Kalra MBBS, MD, DM","doi":"10.1016/j.eprac.2024.08.013","DOIUrl":"10.1016/j.eprac.2024.08.013","url":null,"abstract":"<div><h3>Background</h3><div>No meta-analysis has holistically analyzed and summarized the safety and therapeutic efficacy of the newer RNA interference (RNAi) therapies, olezarsen, plozasiran, and zodasiran, in managing conditions associated with hypertriglyceridemia (HTG).</div></div><div><h3>Methods</h3><div>Randomized controlled trials (RCTs) involving patients with HTG or mixed hyperlipidemia (MHL) receiving either olezarsen, plozasiran, or zodasiran in the intervention arm and a placebo in the control arm were searched through electronic databases. The primary outcome was the safety profile of the drugs studied; secondary outcomes included the percent change from baseline (CFB) in the lipid levels, including triglyceride (TG).</div></div><div><h3>Results</h3><div>Six RCTs with 334 participants were evaluated. Olezarsen, plozasiran, and zodasiran were well-tolerated with no higher risk of serious adverse events or injection-site reactions. After 24 weeks, plozasiran increased alanine aminotransferase and HbA1c more than placebo, although the difference was insignificant at 48 weeks. Plozasiran and zodasiran had little effect on hyperglycemia worsening. Olezarsen increased the likelihood of mild platelet count decreases without clinical harm. At their longest clinical trial follow-up, the highest doses of olezarsen, plozasiran, and zodasiran lowered TG by 55.2%, 50.57%, and 51.2% of baseline levels. All three drugs decreased non-HDL-C and remnant cholesterol. Olezarsen and plozasiran lowered ApoC-III and increased HDL-C, whereas zodasiran reduced HDL-C. Zodasiran decreased LDL-C, whereas olezarsen and plozasiran had no effects on LDL-C. Plozasiran and zodasiran lowered apolipoprotein B, but not olezarsen.</div></div><div><h3>Conclusion</h3><div>The newer RNA interference (RNAi) therapies appear safe and have excellent TG-lowering efficacy in patients with HTG and MHL.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1103-1112"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145405","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":"Oral Levodopa Stimulates Copeptin Secretion in Children and Adolescents with Intact Posterior Pituitary Function","authors":"Shirui Wang MD ,&nbsp;Xinke Zhou BSc ,&nbsp;Yuelun Zhang PhD ,&nbsp;Qi Zhang MMSc ,&nbsp;Bochuan Huang BM ,&nbsp;Yutong Wang BM ,&nbsp;Siyu Liang MD ,&nbsp;Xiang Zhou MD ,&nbsp;Xinqi Cheng MD ,&nbsp;Hui Pan MD ,&nbsp;Shi Chen MD ,&nbsp;Huijuan Zhu MD","doi":"10.1016/j.eprac.2024.08.006","DOIUrl":"10.1016/j.eprac.2024.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Copeptin stimulation tests can be used in the differential diagnosis of polyuria-polydipsia syndrome. Current stimulation methods rely on intravenous or subcutaneous administration. Oral stimulus can further simplify the diagnostic approach. The levodopa stimulation test is widely used in the evaluation of growth hormone deficiency, and the dopamine pathway was reported to be associated with arginine vasopressin secretion. This study aims to investigate the effect of oral levodopa on copeptin secretion.</div></div><div><h3>Methods</h3><div>This study was a prospective observational single-center cohort study. Patients &lt;18 years old with short stature and no symptoms of polyuria or polydipsia undergoing the levodopa stimulation test for suspected growth hormone deficiency were recruited from May 2023 to Nov 2023. Copeptin and growth hormone were measured at 0, 30, 60, 90, and 120 min during the levodopa test. The insulin tolerance test with copeptin and growth hormone measured at the same time points was conducted in part of patients.</div></div><div><h3>Results</h3><div>Forty-four participants were included in the final analysis. In the levodopa stimulation test, the median (interquartile range) copeptin concentration increased from 5.20 (3.51, 8.25) pmol/L to a maximum of 19.36 (8.97, 108.08) pmol/L (<em>P</em> &lt; .001), 3.94 (1.41, 13.88) times that of the baseline (<em>P</em> &lt; .001). Compared with the insulin tolerance test, peak copeptin in the levodopa test was significantly higher (34.61 [13.67, 98.96] vs 8.88 [7.14, 15.42] pmol/L, <em>P</em> = .009). Higher copeptin was associated with a larger dose of levodopa.</div></div><div><h3>Conclusions</h3><div>Oral levodopa could be used to stimulate copeptin.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1059-1065"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072254","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":"Use of Natural Language Processing to Extract and Classify Papillary Thyroid Cancer Features From Surgical Pathology Reports","authors":"Ricardo Loor-Torres MD ,&nbsp;Yuqi Wu PhD ,&nbsp;Esteban Cabezas MD ,&nbsp;Mariana Borras-Osorio MD ,&nbsp;David Toro-Tobon MD ,&nbsp;Mayra Duran MD ,&nbsp;Misk Al Zahidy MS ,&nbsp;Maria Mateo Chavez MD ,&nbsp;Cristian Soto Jacome MD ,&nbsp;Jungwei W. Fan PhD ,&nbsp;Naykky M. Singh Ospina MD ,&nbsp;Yonghui Wu PhD ,&nbsp;Juan P. Brito MD","doi":"10.1016/j.eprac.2024.08.008","DOIUrl":"10.1016/j.eprac.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>We aim to use Natural Language Processing to automate the extraction and classification of thyroid cancer risk factors from pathology reports.</div></div><div><h3>Methods</h3><div>We analyzed 1410 surgical pathology reports from adult papillary thyroid cancer patients from 2010 to 2019. Structured and nonstructured reports were used to create a consensus-based ground truth dictionary and categorized them into modified recurrence risk levels. Nonstructured reports were narrative, while structured reports followed standardized formats. We developed ThyroPath, a rule-based Natural Language Processing pipeline, to extract and classify thyroid cancer features into risk categories. Training involved 225 reports (150 structured, 75 unstructured), with testing on 170 reports (120 structured, 50 unstructured) for evaluation. The pipeline's performance was assessed using both strict and lenient criteria for accuracy, precision, recall, and F1-score; a metric that combines precision and recall evaluation.</div></div><div><h3>Results</h3><div>In extraction tasks, ThyroPath achieved overall strict F-1 scores of 93% for structured reports and 90% for unstructured reports, covering 18 thyroid cancer pathology features. In classification tasks, ThyroPath-extracted information demonstrated an overall accuracy of 93% in categorizing reports based on their corresponding guideline-based risk of recurrence: 76.9% for high-risk, 86.8% for intermediate risk, and 100% for both low and very low-risk cases. However, ThyroPath achieved 100% accuracy across all risk categories with human extracted pathology information.</div></div><div><h3>Conclusions</h3><div>ThyroPath shows promise in automating the extraction and risk recurrence classification of thyroid pathology reports at large scale. It offers a solution to laborious manual reviews and advancing virtual registries. However, it requires further validation before implementation.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1051-1058"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092535","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":"Objective Measures of Cardiometabolic Risk and Advanced Fibrosis Risk Progression in Primary Care Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease","authors":"Andrew D. Schreiner MD, MSCR ,&nbsp;Jingwen Zhang MS ,&nbsp;William P. Moran MD, MS ,&nbsp;David G. Koch MD, MSCR ,&nbsp;Justin Marsden MBA ,&nbsp;Chloe Bays MPH ,&nbsp;Patrick D. Mauldin PhD ,&nbsp;Mulugeta Gebregziabher PhD","doi":"10.1016/j.eprac.2024.08.002","DOIUrl":"10.1016/j.eprac.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>We examined the association of objective measures of cardiometabolic risk with progression to a high-risk for advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) at initially low- and indeterminate-risk for advanced fibrosis.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of primary care patients with MASLD between 2012 and 2021. We evaluated patients with MASLD and low- or indeterminate-risk Fibrosis-4 Index (FIB-4) scores and followed them until the outcome of a high-risk FIB-4 (≥2.67), or the end of the study period. Exposures of interest were body mass index, systolic blood pressure, hemoglobin A1c, cholesterol, estimated glomerular filtration rate, and smoking status. Variables were categorized by the threshold for primary care therapy intensification. Unadjusted and adjusted Cox regression models were developed for the outcome of time to a high-risk FIB-4 value.</div></div><div><h3>Results</h3><div>The cohort included 1347 patients with a mean follow-up of 3.6 years (SD 2.7). Of the cohort, 258 (19%) had a subsequent FIB-4 &gt; 2.67. In the fully adjusted Cox regression models, mean systolic blood pressure ≥ 150 mm Hg (1.57; 95% confidence interval (CI) 1.02-2.41) and glomerular filtration rate ≤ 59 ml/min (hazard ratio 2.78; 95%CI 2.17-3.58) were associated with an increased hazard of a high-risk FIB-4, while receiving a statin prescription (hazard ratio 0.51; 95%CI 0.39-0.66) was associated with a lower risk.</div></div><div><h3>Conclusions</h3><div>Nearly 1 in 5 primary care patients with MASLD transitioned to a high-risk FIB-4 score during 3.6 years of follow-up, and uncontrolled blood pressure and reduced kidney function were associated with an increased hazard of a FIB-4 at high-risk for advanced fibrosis.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 11","pages":"Pages 1015-1022"},"PeriodicalIF":3.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912244","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":"A New Disease Severity Score for Measuring Treatment Response to Adrenalectomy in Patients With Primary Aldosteronism","authors":"Ege Akgun MD ,&nbsp;Edip Memisoglu MD ,&nbsp;Arturan Ibrahimli MD ,&nbsp;Gizem Isiktas MD ,&nbsp;Ram K. Gurajala MD ,&nbsp;Erick Remer MD ,&nbsp;Dingfeng Li MD ,&nbsp;Pratibha Rao MD ,&nbsp;Ricardo Correa Marquez MD ,&nbsp;Eren Berber MD, MBA","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":"30 11","pages":"Pages 1073-1078"},"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}