Endocrine Practice最新文献

Objectives: Testosterone replacement therapy (TRT) in prostate cancer survivors with hypogonadism remains controversial due to concerns that restoring testosterone may increase the risk of disease recurrence. We performed a cohort study of men with localized prostate cancer treated with radiotherapy with or without androgen deprivation therapy (ADT), who received TRT, and a narrative review of published studies evaluating TRT after radiotherapy.

Methods: Biochemical and clinical recurrence, patient-reported symptoms, PSA, testosterone, and hemoglobin were analyzed in this cohort and published studies.

Results: Among 33 men with pathology-confirmed prostate cancer treated with radiation without or with ADT, who received TRT (median age at TRT initiation, 75 [IQR 69.0-77.0] years), median testosterone increased from 66.0 (IQR 16.0-140.0) to 299.3 (IQR 152.5-569.0, p<0.001) ng/dL. PSA rose from 0.04 (IQR 0.02-0.17) to 0.17 ng/mL (IQR 0.04-0.44) (p=0.018). TRT was associated with improvements in fatigue, mood, and sexual symptoms; anemia was corrected in 9 of 21 (42.9%) patients with anemia. One patient (3%) developed metastatic disease 3 years after starting TRT. In narrative review of published case-reports, weighted mean biochemical recurrence rate was 3.3% during mean 42.6 months of follow-up.

Conclusions: Our cohort study and narrative review found a low incidence of biochemical recurrence in prostate cancer survivors treated with radiation therapy with or without ADT. TRT was associated with correction of anemia and improvements in fatigue, energy, and sexual symptoms. These findings provide the ethical and scientific rationale for a randomized controlled trial to evaluate the safety and efficacy of TRT in this population.

Objectives: To compare two levothyroxine (LT4) dosing regimens during Ramadan; pre-Iftar and pre-Dawn, with respect to thyroid biochemical control and patient satisfaction.

Methods: This multicenter, open-label randomized controlled trial recruited adults with primary hypothyroidism from three Saudi cities (Jeddah, Riyadh, Al-Ahsa). Patients with thyroid cancer were excluded. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured 2 weeks before and 4-6 weeks after Ramadan. Participants were randomized to take LT4 either before breaking the fast (pre-Iftar) or just before fasting began (pre-Dawn).

Results: A total of 303 participants completed the study (156 pre-Iftar, 147 pre-Dawn). Groups were comparable in demographics and comorbidities. Mean age was 49 ± 12 years; 87% were female; mean disease duration was 9.7 ± 8.3 years. Weekly LT4 dose was 753 ± 349 μg (pre-Iftar) vs. 733 ± 266 μg (pre-Dawn; p=0.001). Pre-Ramadan TSH was 2.56 ± 2.16 mIU/L vs. 2.46 ± 1.72 mIU/L (p=0.3), and FT4 was 13.45 ± 2.1 vs. 13.08 ± 2.4 pmol/L (p=0.16). Post-Ramadan TSH was 3.64 ± 4.1 vs. 4.07 ± 4.2 mIU/L (p=0.78), and FT4 was 12.96 ± 0.1 vs. 12.64 ± 0.2 pmol/L (p=0.003). Within-group post-Ramadan changes were non-significant. Repeated-measures ANOVA showed no significant differences in TSH or FT4 over time or between groups (p=0.47 and p=0.81). Compliance and satisfaction were comparable.

Conclusion: Both pre-Iftar and pre-Dawn LT4 regimens maintained thyroid stability during Ramadan. Either can be safely adopted according to patient preference.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver condition worldwide, closely linked to obesity, type 2 diabetes, and cardiometabolic risk factors. Despite lifestyle interventions and pharmacological advances, therapeutic options remain limited. Bariatric surgery, particularly sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), has demonstrated sustained weight loss and durable improvements in metabolic health. Beyond weight reduction, these procedures induce profound physiological, hormonal, and molecular changes that improve hepatic steatosis, reduce inflammation, and may partially reverse fibrosis. Evidence indicates that bariatric surgery decreases the risk of cirrhosis, hepatocellular carcinoma, and cardiovascular events, while enhancing overall survival and quality of life. This review summarizes the mechanisms by which SG and RYGB influence liver metabolism and highlights their role as disease-modifying interventions for MASLD. Bariatric surgery should thus be considered an integral component in the multidisciplinary management of MASLD, especially in patients with obesity and advanced metabolic risk profiles.

Radiofrequency ablation (RFA) has emerged as a promising minimally invasive treatment for low-risk papillary thyroid carcinoma (PTC), particularly for low-risk papillary thyroid microcarcinomas (PTMC). This review summarizes the current evidence on the indications, efficacy and safety of RFA in the management of PTC. Recent studies demonstrate a significant volume reduction with most tumors having a complete or near-complete response, low progression and recurrence rates and a favorable safety profile. RFA has the advantage of preserving thyroid function, avoiding visible scarring, and reduced recovery time. Emerging guidelines and international consensus statements now acknowledge RFA as a viable option in carefully selected cases, particularly for tumors less than 1 cm in maximum diameter without extrathyroidal extension or nodal involvement. Existing data support RFA as an effective, safe, and well-tolerated alternative to surgery and active surveillance for managing low-risk PTC, though more long-term data are needed to confirm durability. Since outcomes are operator dependent, the growing demand for this procedure necessitates the development of centers of excellence with experienced operators.

Objectives: The impact of the ketogenic diet (KD) on lipid metabolism remains inconclusive. To address this gap, we conducted a meta-regression analysis of randomized controlled trials (RCTs) to evaluate the overall influence of KD on lipid profile parameters in adults.

Methods: A comprehensive search of five major electronic databases was carried out using predefined keywords to identify RCTs assessing the effects of KD on lipid outcomes. Pooled weighted mean differences with 95% confidence intervals were calculated employing a random-effects model.

Results: Sixty-two studies were analyzed. The meta-analysis results from the included randomized controlled trials indicated a significant decrease in triglyceride (TG) levels (WMD: -19.96 mg/dl, 95% CI: -26.10 to -13.81) and the TG/high-density lipoprotein-cholesterol (HDL-C) ratio (WMD: -0.31, 95% CI: -0.49 to -0.12), despite a notable increase in HDL-C (WMD: 3.61 mg/dl, 95% CI: 1.44 to 5.57), low-density lipoprotein-cholesterol (LDL-C) (WMD: 8.49 mg/dl, 95% CI: 5.45 to 11.52), and total cholesterol (TC) (WMD: 8.14 mg/dl, 95% CI: 3.41 to 12.88) concentrations following KD compared to the control group. However, LDL-C levels increased by 8.49 mg/dL, which may carry potential adverse implications.Furthermore, the findings indicated a linear correlation between alterations in HDL-C and the duration of KD intervention.

Conclusions: The ketogenic diet significantly improves triglycerides and HDL-C but also leads to modest increases in LDL-C. Given the lack of long-term cardiovascular outcome data, these findings should be interpreted with caution.

Objectives: This study aimed to compare the anti-osteoporotic efficacy of zoledronic acid (ZOL) with denosumab (DEN) in osteoporosis patients with type 2 diabetes mellitus (T2DM).

Methods: This was a prospective, open-label, non-randomized clinical study. Osteoporotic women with T2DM aged 50 to 80 years were enrolled and assigned to either the ZOL group (n = 45) or the DEN group (n = 75) based on patient preference. The efficacy endpoint included the percent change from baseline in bone mineral density (BMD), bone turnover markers (BTMs) and the fracture risk evaluated by the fracture risk assessment tool (FRAX®) after 1 year. The propensity score-matched analysis was performed to confirm the robustness.

Results: After 1-year of treatment, DEN was more effective than ZOL at increasing femoral neck BMD (least-squares mean difference 4.59% [95% CI: 0.93% to 8.25%]; P=0.017), but not at BMD in the lumbar spine or total hip. Besides, compared with the ZOL group, the DEN group demonstrated greater suppression of osteocalcin (least-squares mean difference -20.58% [95% CI: -39.93 to -1.24]; P=0.041) and a greater reduction in major osteoporotic fracture risk (least-squares mean difference -11.20% [95% CI: -20.76 to -1.64]; P=0.025).

Conclusions: The results suggest that DEN should be considered as a potentially better option for T2DM patients who have low femoral neck BMD.

Objective: Previous studies have highlighted emerging deficiencies in the U.S. endocrinologist workforce. Yet, few studies have analyzed the training pathway for endocrinologists. The purpose of this study was to define the annual number of applicants and training positions for U.S. endocrinology training.

Methods: This was a cross-sectional study of applicants for endocrinology, diabetes, and metabolism fellowship training in the United States (2009 to 2025). Annual match outcomes were calculated, and trends were assessed with linear regression.

Results: From 2009 to 2025, there was growth in the annual number of endocrinology training positions (223 to 386, 73.1% increase, P < .001) and number of applicants (325 to 488, 50.2% increase, P < .001). The annual applicant-to-training position ratio decreased (1.46 to 1.26, P < .001), while the annual match rate increased (60.0% to 77.9%, P < .001). The annual rate of unfilled training positions decreased over the study period (12.6% to 1.6%, P < .001). The annual representation of U.S. allopathic medical school graduates decreased (50.8% to 30.0%, P < .001), while the annual representation of non-U.S. allopathic medical school graduates increased (49.2% to 70.0%, P < .001) among matched endocrinology fellows. Annual match rates for U.S. allopathic medical school graduates exceeded those for non-U.S. allopathic medical school graduates (90.7% vs 67.7%, P < .001).

Conclusions: Growth in endocrinology training positions has exceeded growth in the number of applicants. Surveillance of match outcomes is warranted as anticipated shortages of endocrinologists may trigger potential deleterious consequences for population health needs.

Objective: Mitochondrial diabetes (mtDB) is a rare form of diabetes with limited information regarding its clinical spectrum, and long-term outcomes. This study aimed to describe the glycemic control, treatment patterns, and associated comorbidities among patients with mtDB.

Methods: We identified 30 patients with diabetes and confirmed mitochondrial mutations, predominantly the MT-TL1 m.3243A>G variant (n=28). Monogenic diabetes genes, including MODY-associated variants, were not evaluated. Statistical analyses were performed using BlueSky Statistics (v10.3.4). Categorical variables were assessed using Fisher's exact and ANOVA tests, and continuous variables using univariate analysis.

Results: The cohort was 63.3% female, with a mean age at diabetes diagnosis of 38.0 (±13.0) years for females and 34.6 (±13.7) years for males. More than 70% were initially misdiagnosed with type 2 diabetes (T2D), resulting in an average diagnosis delay of 9.3 years from the date of their diabetes diagnosis. Mean BMI at diagnosis was 25 kg/m² (±11.3). The cohort demonstrated a high burden of comorbidities-including retinopathy, neurological disease, cardiac arrhythmias, nephropathy, and gastrointestinal disorders-many of which preceded diabetes onset. Glycemic control remained stable, with more than 90% maintaining HbA1c <8%. Treatment modality (insulin vs. non-insulin) did not significantly impact HbA1c levels (mean 6.85%) though the study's descriptive design and small sample size may limit interpretability. Mean survival after mtDB diagnosis was 8 years (±10.3), and four patients died from mitochondrial disorder-related complications.

Conclusion: mtDB is frequently misdiagnosed as T2D and is associated with multisystem comorbidities. Earlier recognition and individualized management strategies are essential to improve outcomes.