Endocrine Practice最新文献

Objective: To review the pathophysiology, risk factors, clinical implications, monitoring strategies, and therapeutic approaches for glucocorticoid-induced hyperglycemia (GCIH), with a focus on patients with cancer.

Methods: This narrative review integrates findings from clinical studies, expert guidelines, and recent advances in glucose monitoring and pharmacologic therapy, particularly in oncologic settings where glucocorticoid use is common.

Results: GCIH is a frequent and often underrecognized complication, even in individuals without preexisting diabetes. In patients with cancer, GCIH is associated with increased risk of infections, chemotherapy delays, longer hospital stays, and higher mortality. Key mechanisms include enhanced insulin resistance, increased hepatic gluconeogenesis, and β-cell dysfunction. Afternoon and postprandial hyperglycemia are typical due to the pharmacodynamics of once-daily morning glucocorticoids. Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are essential tools. HbA1c may assist in baseline assessment, but fructosamine better reflects short-term glycemic changes. Insulin is the treatment of choice for moderate to severe GCIH, with basal-bolus regimens, especially using NPH insulin aligned with glucocorticoid timing, providing effective control. Selected non-insulin agents may be considered in stable outpatients with mild hyperglycemia. However, standardized definitions, evidence-based algorithms, and randomized trials remain limited.

Conclusion: Optimal GCIH management requires proactive monitoring and individualized treatment strategies tailored to glucocorticoid type, dose, and clinical setting. Further research should aim to refine diagnostic criteria, validate therapeutic protocols, and assess emerging technologies such as automated insulin delivery systems and selective glucocorticoid receptor modulators.

Objectives: The optimal blood pressure (BP) target for stroke prevention in patients with primary aldosteronism (PA) remains to be determined. This cohort study examined the association between mean BP levels during follow-up and stroke incidence in this population.

Methods: The study retrospectively enrolled patients with PA aged ≥30 years who were hospitalized at our hypertension center between January 2008 and December 2019. The exposure variable was the mean BP from ≥3 follow-up visits per patient. The primary outcome was incident stroke during follow-up. The association of mean follow-up BP with risk of stroke was assessed using Cox proportional hazard models and restricted cubic splines.

Results: The cohort comprised 3138 patients with PA (median age 49 years, 55% male). During a median follow-up of 6 years, 101 patients experienced incident stroke (ischemic, n=79; hemorrhagic, n=22). After adjusting for age, sex,pretreatment BP, and other relevant confounders, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) during follow-up showed significant positive associations with the risk of incident stroke (HR 1.04, 95% CI 1.02-1.06, P<0.001 and HR 1.05, 95% CI 1.01-1.08, P=0.005, respectively). In multivariable survival analysis, compared with the SBP ≥140 mmHg group, the risk of stroke was decreased by 54% in the SBP <130 mmHg group (HR 0.46, 95% CI 0.26-0.80, P=0.006) and by 47% in the SBP 130-139 mmHg group (HR 0.53, 95% CI 0.33-0.84, P=0.007). No association was observed when DBP was analyzed categorically. When variables were modeled using restricted cubic splines, the risk of stroke increased linearly with SBP and DBP. The risk of stroke began to increase rapidly at a BP of around 133/83 mmHg. In subgroup and sensitivity analyses, the association between mean follow-up SBP and stroke incidence remained consistent.

Conclusions: A target BP of <130/80 mmHg might be associated with a reduced risk of stroke in patients with primary aldosteronism. Nevertheless, additional validation remains necessary through prospective, randomized controlled trials.

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: 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.

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 to evaluate the overall influence of KD on lipid profile parameters in adults.

Methods: A comprehensive search of 5 major electronic databases was carried out using predefined keywords to identify randomized controlled trials 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 levels (weighted mean difference [WMD]: -19.96 mg/dl, 95% CI: -26.10 to -13.81) and the triglyceride/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 (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.

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.