Pub Date : 2025-01-01DOI: 10.1016/j.eprac.2024.10.007
Huda Al-Bahadili MD , Jennifer Powers Carson PhD , Alexander Markov MD , Sina Jasim MD, MPH
Objective
Thyroid disorders are common. Serum thyroid stimulating hormone 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-thyrotropin 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 MD , Jennifer Powers Carson PhD , Alexander Markov MD , Sina Jasim MD, MPH","doi":"10.1016/j.eprac.2024.10.007","DOIUrl":"10.1016/j.eprac.2024.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid disorders are common. Serum thyroid stimulating hormone 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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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-thyrotropin or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.</div></div><div><h3>Conclusion</h3><div>For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 92-101"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.004
Areeba Fareed MBBS , Laura Ghanem MBBS , Rayyan Vaid MBBS , Zoha Iftikhar MBBS , Adeel Ur Rehman MBBS , Ayesha Sarwar MBBS , Muhammad Iqbal Asif MBBS
Background
Obesity, a pervasive global health challenge affecting more than 2 billion people, requires comprehensive interventions. Traditional approaches, including lifestyle modification, and diverse drugs targeting a gastrointestinal hormone, including glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (Liraglutide, Semaglutide, Exenatide, Albiglutide, Dulaglutide, Lixisenatide, Orlistat, Phentermine/Topiramate, Lorcaserin, Sibutramine, and Rimonabant) offer tailored strategies; yet their effectiveness is limited and some drugs were taken off the market. Moreover, various surgical modalities, such as Roux-en-Y Bypass surgery, sleeve gastrectomy, intragastric balloons, biliopancreatic diversion with duodenal switch, laparoscopic adjustable gastric band, and vagal nerve blockade can be considered but are associated with numerous side effects and require careful monitoring. Consequently, there is a pressing need for novel anti-obesity treatments.
Methods
This comprehensive review was based on the available data to discuss the traditional pharmaceutical and surgical therapeutical strategies for obesity, going further to discuss tirzepatide's mode of action, its outcomes for obesity, and the associated side effects.
Results
In this landscape, tirzepatide, initially designed for type 2 diabetes management, emerges as a potential game-changer. Functioning as a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, it not only addresses control but also introduces a fresh perspective on weight reduction. This review intricately explores tirzepatide's mechanism, dissecting insights from clinical studies and positioning it as a major force in obesity treatment.
Conclusions
In the middle of significant shifts in obesity management, tirzepatide presents itself as a promising and cost-effective intervention. Its Food and Drug Administration approval marks a milestone in the realm of obesity therapeutics. Going beyond a recapitulation of findings, the conclusion emphasizes the imperative for ongoing exploration and vigilant safety monitoring in tirzepatide's application.
{"title":"Charting New Territories in Obesity Management- Traditional Techniques to Tirzepatide","authors":"Areeba Fareed MBBS , Laura Ghanem MBBS , Rayyan Vaid MBBS , Zoha Iftikhar MBBS , Adeel Ur Rehman MBBS , Ayesha Sarwar MBBS , Muhammad Iqbal Asif MBBS","doi":"10.1016/j.eprac.2024.09.004","DOIUrl":"10.1016/j.eprac.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Obesity, a pervasive global health challenge affecting more than 2 billion people, requires comprehensive interventions. Traditional approaches, including lifestyle modification, and diverse drugs targeting a gastrointestinal hormone, including glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (Liraglutide, Semaglutide, Exenatide, Albiglutide, Dulaglutide, Lixisenatide, Orlistat, Phentermine/Topiramate, Lorcaserin, Sibutramine, and Rimonabant) offer tailored strategies; yet their effectiveness is limited and some drugs were taken off the market. Moreover, various surgical modalities, such as Roux-en-Y Bypass surgery, sleeve gastrectomy, intragastric balloons, biliopancreatic diversion with duodenal switch, laparoscopic adjustable gastric band, and vagal nerve blockade can be considered but are associated with numerous side effects and require careful monitoring. Consequently, there is a pressing need for novel anti-obesity treatments.</div></div><div><h3>Methods</h3><div>This comprehensive review was based on the available data to discuss the traditional pharmaceutical and surgical therapeutical strategies for obesity, going further to discuss tirzepatide's mode of action, its outcomes for obesity, and the associated side effects.</div></div><div><h3>Results</h3><div>In this landscape, tirzepatide, initially designed for type 2 diabetes management, emerges as a potential game-changer. Functioning as a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, it not only addresses control but also introduces a fresh perspective on weight reduction. This review intricately explores tirzepatide's mechanism, dissecting insights from clinical studies and positioning it as a major force in obesity treatment.</div></div><div><h3>Conclusions</h3><div>In the middle of significant shifts in obesity management, tirzepatide presents itself as a promising and cost-effective intervention. Its Food and Drug Administration approval marks a milestone in the realm of obesity therapeutics. Going beyond a recapitulation of findings, the conclusion emphasizes the imperative for ongoing exploration and vigilant safety monitoring in tirzepatide's application.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 102-113"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282249","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.015
Thaer Idrees MD , Ammar A. Rashied MS , Brian Kim MD
Objective
Fine needle aspiration (FNA) of thyroid nodules is the gold standard screening test for thyroid malignancy. Unfortunately, FNA may produce insufficient material for diagnosis. If nodules requiring FNA with a higher risk for nondiagnostic (ND) cytology could be identified pre-procedure, this might allow better patient guidance and potentially facilitate an altered approach to FNA.
Methods
The literature investigating risk factors for ND cytology was reviewed, including studies of patient factors, sonographic or nodule factors, and procedural factors. Twenty-five studies that included assessment of at least two potential factors in ND outcomes for initial FNA were identified. Individual factors were evaluated in terms of the general consensus of studies reporting either a positive significant association with ND cytology or no association.
Results
Most patient and nodule factors lack consensus as far as their association with ND cytology across these studies. Factors where there are some consensuses include practitioner experience, depth of nodule, and cystic content; however, hypervascularity of the nodule does not appear to have a consensus.
Conclusion
A number of study design improvements suggested by this review could realistically be incorporated into higher powered future studies. Novel factors such as tissue composition anterior to the nodule or the age of the patient could also be investigated in future work. Operator experience is the most convincing procedural factor, and approaches to future studies of the FNA technique itself are proposed. That said, the factors with consensus among studies can be seen leading candidates for this future research, and the published studies illuminate a number of as yet unexplored factors that could in many cases be studied retrospectively.
{"title":"Nondiagnostic Fine Needle Aspiration of Thyroid Nodules: Review of Predisposing Factors","authors":"Thaer Idrees MD , Ammar A. Rashied MS , Brian Kim MD","doi":"10.1016/j.eprac.2024.09.015","DOIUrl":"10.1016/j.eprac.2024.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>Fine needle aspiration (FNA) of thyroid nodules is the gold standard screening test for thyroid malignancy. Unfortunately, FNA may produce insufficient material for diagnosis. If nodules requiring FNA with a higher risk for nondiagnostic (ND) cytology could be identified pre-procedure, this might allow better patient guidance and potentially facilitate an altered approach to FNA.</div></div><div><h3>Methods</h3><div>The literature investigating risk factors for ND cytology was reviewed, including studies of patient factors, sonographic or nodule factors, and procedural factors. Twenty-five studies that included assessment of at least two potential factors in ND outcomes for initial FNA were identified. Individual factors were evaluated in terms of the general consensus of studies reporting either a positive significant association with ND cytology or no association.</div></div><div><h3>Results</h3><div>Most patient and nodule factors lack consensus as far as their association with ND cytology across these studies. Factors where there are some consensuses include practitioner experience, depth of nodule, and cystic content; however, hypervascularity of the nodule does not appear to have a consensus.</div></div><div><h3>Conclusion</h3><div>A number of study design improvements suggested by this review could realistically be incorporated into higher powered future studies. Novel factors such as tissue composition anterior to the nodule or the age of the patient could also be investigated in future work. Operator experience is the most convincing procedural factor, and approaches to future studies of the FNA technique itself are proposed. That said, the factors with consensus among studies can be seen leading candidates for this future research, and the published studies illuminate a number of as yet unexplored factors that could in many cases be studied retrospectively.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 85-91"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343892","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.004
Nikolaos Angelopoulos MD, PhD , Dimitrios G. Goulis MD, PhD , Ioannis Chrisogonidis MD, PhD , Sarantis Livadas MD, PhD , Rodis Paparodis MD , Ioannis Androulakis MD, PhD , Ioannis Iakovou MD, PhD
Objective
The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.
Methods
From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).
Results
Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (P > .05). Two malignancies were missed.
Conclusion
EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.
{"title":"Diagnostic Performance of European and American College of Radiology Thyroid Imaging Reporting and Data System Classification Systems in Thyroid Nodules Over 20 mm in Diameter","authors":"Nikolaos Angelopoulos MD, PhD , Dimitrios G. Goulis MD, PhD , Ioannis Chrisogonidis MD, PhD , Sarantis Livadas MD, PhD , Rodis Paparodis MD , Ioannis Androulakis MD, PhD , Ioannis Iakovou MD, PhD","doi":"10.1016/j.eprac.2024.10.004","DOIUrl":"10.1016/j.eprac.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.</div></div><div><h3>Methods</h3><div>From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).</div></div><div><h3>Results</h3><div>Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (<em>P</em> > .05). Two malignancies were missed.</div></div><div><h3>Conclusion</h3><div>EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 72-79"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497251","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.09.018
James R. Howe MD , Yusuf Menda MD , Chandrikha Chandrasekharan MBBS , Andrew M. Bellizzi MD , Dawn E. Quelle PhD , M. Sue O’Dorisio MD, PhD , Joseph S. Dillon MB, BCh
The Iowa Neuroendocrine Tumor (NET) Clinic was founded and developed by two remarkable physicians, Thomas and Sue O’Dorisio. Tom was an Endocrinologist and close friend and colleague of Aaron Vinik. Both men were pioneers in studies of gastrointestinal hormones and the management of patients with NETs. Sue was a Pediatric Oncologist and research scientist with great expertise in new drug development and clinical trials. She and Tom were leaders in bringing somatostatin analogs and somatostatin-conjugated radioligands to the clinic for the therapy and diagnosis of NETs. All three physicians received lifetime achievement awards for their contributions to the field of NETs. This is the story of how the Iowa NET Clinic developed over the years to become a model for the multidisciplinary mantagement of patients with NETs, culminating in its designation as a European Neuroendocrine Tumor Society NET Center of Excellence, and the receipt of a Specialized Project of Research Excellence (SPORE) grant for the study of NETs from the National Institutes of Health.
爱荷华州神经内分泌肿瘤（NET）诊所是由两位杰出的医生托马斯-奥多里西奥和苏-奥多里西奥创建和发展起来的。汤姆是内分泌科医生，也是亚伦-维尼克的好友和同事。两人都是研究胃肠激素和治疗 NET 患者的先驱。苏是一名儿科肿瘤学家和研究科学家，在新药开发和临床试验方面拥有丰富的专业知识。她和汤姆是将体生长激素类似物和体生长激素结合放射配体应用于临床治疗和诊断 NET 的领军人物。这三位医生都因其在 NET 领域的贡献获得了终身成就奖。这就是爱荷华州NET诊所多年来如何发展成为多学科治疗NET患者典范的故事，该诊所最终被指定为欧洲神经内分泌肿瘤协会NET卓越中心，并获得了美国国立卫生研究院的NET研究专项卓越研究项目（SPORE）资助。
{"title":"The University of Iowa Neuroendocrine Tumor Clinic","authors":"James R. Howe MD , Yusuf Menda MD , Chandrikha Chandrasekharan MBBS , Andrew M. Bellizzi MD , Dawn E. Quelle PhD , M. Sue O’Dorisio MD, PhD , Joseph S. Dillon MB, BCh","doi":"10.1016/j.eprac.2024.09.018","DOIUrl":"10.1016/j.eprac.2024.09.018","url":null,"abstract":"<div><div>The Iowa Neuroendocrine Tumor (NET) Clinic was founded and developed by two remarkable physicians, Thomas and Sue O’Dorisio. Tom was an Endocrinologist and close friend and colleague of Aaron Vinik. Both men were pioneers in studies of gastrointestinal hormones and the management of patients with NETs. Sue was a Pediatric Oncologist and research scientist with great expertise in new drug development and clinical trials. She and Tom were leaders in bringing somatostatin analogs and somatostatin-conjugated radioligands to the clinic for the therapy and diagnosis of NETs. All three physicians received lifetime achievement awards for their contributions to the field of NETs. This is the story of how the Iowa NET Clinic developed over the years to become a model for the multidisciplinary mantagement of patients with NETs, culminating in its designation as a European Neuroendocrine Tumor Society NET Center of Excellence, and the receipt of a Specialized Project of Research Excellence (SPORE) grant for the study of NETs from the National Institutes of Health.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 4-18"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343894","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.003
Aditi Kumar MBBS , Mona Vahidi Rad MD , Alyssa K. McGary MS , Janna C. Castro BS , Curtiss B. Cook MD
Purpose
Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.
Methods
Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N = 174).
Results
In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, P = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, P = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, P = .016), with the Southeast site being comparable to the Southwest.
Conclusion
Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.
{"title":"Factors Associated With 30-Day Readmissions After Transsphenoidal Pituitary Surgery","authors":"Aditi Kumar MBBS , Mona Vahidi Rad MD , Alyssa K. McGary MS , Janna C. Castro BS , Curtiss B. Cook MD","doi":"10.1016/j.eprac.2024.10.003","DOIUrl":"10.1016/j.eprac.2024.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.</div></div><div><h3>Methods</h3><div>Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (<em>N</em> = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (<em>N</em> = 174).</div></div><div><h3>Results</h3><div>In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, <em>P</em> = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, <em>P</em> = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, <em>P</em> = .016), with the Southeast site being comparable to the Southwest.</div></div><div><h3>Conclusion</h3><div>Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 28-33"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460845","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.002
Daniel J. Slack MD , Anaïs Di Via Ioschpe MD , Michael Saturno BA , Sky Kihuwa-Mani BS , Uchechukwu O. Amakiri BS , Daniel Guerra BS , Subha Karim BS , Joshua D. Safer MD, FACP, FACE
Introduction
Individuals may seek gender-affirming hormone therapy (GAHT) to align their physical appearance with their gender identity. Feminizing GAHT typically involves the use of estrogen. This study investigates the effect of route of administration (ROA) and dose of estradiol on estradiol (E2) and testosterone (T) levels in transfeminine individuals.
Methods
We conducted a chart review of 573 patients with an active prescription for estradiol for feminizing GAHT and serum hormone levels available. Multiple linear regression and analysis of variance were used to analyze the effect of dose and ROA of estradiol on serum E2 and T.
Results
Oral estradiol was the only ROA demonstrating a linear dose-response, with each 1 mg/d increase associated with a reduction in T of 19.03 ng/dL (P = .005). Lower T levels were seen with higher doses of transdermal estradiol but a significant dose-response was not demonstrated. Intramuscular estradiol was associated with lower T and higher E2 compared to oral and transdermal ROAs (P < .001), with many achieving target hormone levels even at low doses. Higher doses of oral estradiol were associated with lower mean serum leutenizing hormone and follicle stimulating hormone levels (P < .05).
Conclusion
Oral estradiol can be titrated to achieve a stepwise decrease in serum T. The intramuscular ROA appears to be the most potent delivery of estradiol with impact on serum hormone levels with doses on the low end of guideline-suggested ranges. Serum leutenizing hormone and follicle stimulating hormone may also help with the management of feminizing GAHT.
导言：个人可能会寻求性别确认荷尔蒙疗法（GAHT），以使自己的外貌符合自己的性别认同。女性化激素疗法通常需要使用雌激素。本研究调查了给药途径（ROA）和雌二醇剂量对转女性患者体内雌二醇（E2）和睾酮（T）水平的影响：我们对 573 名开具雌二醇处方治疗女性化 GAHT 且血清激素水平可用的患者进行了病历审查。采用多元线性回归和方差分析来分析雌二醇的剂量和 ROA 对血清 E2 和 T 的影响：结果：口服雌二醇是唯一显示出线性剂量反应的 ROA，每增加 1 毫克/天，T 降低 19.03 纳克/分升（p=0.005）。经皮雌二醇剂量越大，T水平越低，但未显示出显著的剂量反应。与口服和透皮 ROA 相比，肌肉注射雌二醇与较低的 T 值和较高的 E2 值相关（p 结论：口服雌二醇可以滴定，而透皮雌二醇可以滴定：口服雌二醇可以通过滴定来实现血清 T 的逐步下降。肌肉注射 ROA 似乎是最有效的雌二醇给药方式，其对血清激素水平的影响剂量在指南建议范围的低端。在管理女性化 GAHT 方面，血清 T 可能是比 E2 更可靠的生物标志物。血清 LH 和 FSH 也有助于管理女性化 GAHT。
{"title":"Examining the Influence of the Route of Administration and Dose of Estradiol on Serum Estradiol and Testosterone Levels in Feminizing Gender-Affirming Hormone Therapy","authors":"Daniel J. Slack MD , Anaïs Di Via Ioschpe MD , Michael Saturno BA , Sky Kihuwa-Mani BS , Uchechukwu O. Amakiri BS , Daniel Guerra BS , Subha Karim BS , Joshua D. Safer MD, FACP, FACE","doi":"10.1016/j.eprac.2024.10.002","DOIUrl":"10.1016/j.eprac.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals may seek gender-affirming hormone therapy (GAHT) to align their physical appearance with their gender identity. Feminizing GAHT typically involves the use of estrogen. This study investigates the effect of route of administration (ROA) and dose of estradiol on estradiol (E2) and testosterone (T) levels in transfeminine individuals.</div></div><div><h3>Methods</h3><div>We conducted a chart review of 573 patients with an active prescription for estradiol for feminizing GAHT and serum hormone levels available. Multiple linear regression and analysis of variance were used to analyze the effect of dose and ROA of estradiol on serum E2 and T.</div></div><div><h3>Results</h3><div>Oral estradiol was the only ROA demonstrating a linear dose-response, with each 1 mg/d increase associated with a reduction in T of 19.03 ng/dL (<em>P</em> = .005). Lower T levels were seen with higher doses of transdermal estradiol but a significant dose-response was not demonstrated. Intramuscular estradiol was associated with lower T and higher E2 compared to oral and transdermal ROAs (<em>P</em> < .001), with many achieving target hormone levels even at low doses. Higher doses of oral estradiol were associated with lower mean serum leutenizing hormone and follicle stimulating hormone levels (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>Oral estradiol can be titrated to achieve a stepwise decrease in serum T. The intramuscular ROA appears to be the most potent delivery of estradiol with impact on serum hormone levels with doses on the low end of guideline-suggested ranges. Serum leutenizing hormone and follicle stimulating hormone may also help with the management of feminizing GAHT.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 19-27"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460844","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 : 2025-01-01DOI: 10.1016/j.eprac.2024.10.001
Cassandra Chua BS , Elizabeth N. Pearce MD, MSc , Sun Y. Lee MD, MSc
Objective
Thyrotoxicosis can adversely affect pregnancy. The quality of care (QoC) for thyrotoxicosis in pregnancy at a tertiary care safety net hospital was evaluated based on current guidelines.
Methods
Pregnant patients with thyrotoxicosis or a history of Graves disease who delivered in 2015-2021 were divided into 3 groups: low thyroid stimulating hormone (TSH), active Graves disease, and past Graves disease. The QoC was assessed using thyroid hormone and thyroid stimulating immunoglobulin (TSI) levels, fetal ultrasound, and endocrine referrals. We assessed potential impacts of race/ethnicity and socioeconomic status (SES).
Results
We included 147 subjects (mean age 31.5 years, 76% Black, 86% non-Hispanic). Of patients with low TSH (n = 95), 75% had repeat TSH measurements and 33% had TSI measured. Hispanic patients were more likely to have TSI and repeat TSH measured than non-Hispanics (58% vs 29%; P = .04, and 100% vs 71%; P = .03, respectively). In patients with active Graves disease (n = 23, 70% treated with thionamides), 35% had free thyroxine levels at goal and 90% had endocrine care or referral. In patients with past Graves disease (n = 27), 56% had TSI measured, 78% had first-trimester TSH measurements, and 58% had TSH at goal. Black patients were less likely to have TSH checked in the first trimester than other races (85% vs 100%, P = .048).
Conclusion
The QoC of thyrotoxicosis in pregnancy at this tertiary care center can be improved. A larger study is needed to assess the potential impacts of race and SES on the care of pregnant patients with thyrotoxicosis.
背景介绍甲亢会对妊娠产生不利影响。根据现行指南，对一家三级安全网医院的妊娠期甲亢护理质量（QoC）进行了评估：将2015-2021年分娩的甲亢或有巴塞杜氏病史的孕妇分为三组：低促甲状腺激素、活动性巴塞杜氏病和既往巴塞杜氏病。通过甲状腺激素和促甲状腺免疫球蛋白（TSI）水平、胎儿超声波检查和内分泌转诊来评估QoC。我们评估了种族/民族和社会经济地位（SES）的潜在影响：我们纳入了 147 名受试者（平均年龄 31.5 岁，76% 为黑人，86% 为非西班牙裔）。在 TSH 偏低的患者（95 人）中，75% 的患者重复测量了 TSH，33% 的患者测量了 TSI。西班牙裔患者比非西班牙裔患者更有可能测量TSI和重复测量TSH（分别为58% vs 29%; p=0.04和100% vs 71%; p=0.03）。在活动性巴塞杜氏病患者中（人数=23，70%接受硫酰胺类药物治疗），35%的患者FT4水平达到目标，90%的患者接受了内分泌治疗或转诊。在既往患过巴塞杜氏病的患者中（人数=27），56%的患者测量了TSI，78%的患者在第一次怀孕时测量了促甲状腺激素，58%的患者促甲状腺激素达到目标水平。与其他种族的患者相比，黑人患者在妊娠头三个月进行 TSH 检测的可能性较低（85% vs 100%，P=0.048）：结论：该三级医疗中心的妊娠期甲亢质量控制水平有待提高。需要进行更大规模的研究，以评估种族和社会经济地位对甲亢孕妇护理的潜在影响。
{"title":"Assessing the Quality of Care of Pregnant Patients With Thyrotoxicosis at an Urban Safety Net Hospital","authors":"Cassandra Chua BS , Elizabeth N. Pearce MD, MSc , Sun Y. Lee MD, MSc","doi":"10.1016/j.eprac.2024.10.001","DOIUrl":"10.1016/j.eprac.2024.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Thyrotoxicosis can adversely affect pregnancy. The quality of care (QoC) for thyrotoxicosis in pregnancy at a tertiary care safety net hospital was evaluated based on current guidelines.</div></div><div><h3>Methods</h3><div>Pregnant patients with thyrotoxicosis or a history of Graves disease who delivered in 2015-2021 were divided into 3 groups: low thyroid stimulating hormone (TSH), active Graves disease, and past Graves disease. The QoC was assessed using thyroid hormone and thyroid stimulating immunoglobulin (TSI) levels, fetal ultrasound, and endocrine referrals. We assessed potential impacts of race/ethnicity and socioeconomic status (SES).</div></div><div><h3>Results</h3><div>We included 147 subjects (mean age 31.5 years, 76% Black, 86% non-Hispanic). Of patients with low TSH (<em>n</em> = 95), 75% had repeat TSH measurements and 33% had TSI measured. Hispanic patients were more likely to have TSI and repeat TSH measured than non-Hispanics (58% vs 29%; <em>P</em> = .04, and 100% vs 71%; <em>P</em> = .03, respectively). In patients with active Graves disease (<em>n</em> = 23, 70% treated with thionamides), 35% had free thyroxine levels at goal and 90% had endocrine care or referral. In patients with past Graves disease (<em>n</em> = 27), 56% had TSI measured, 78% had first-trimester TSH measurements, and 58% had TSH at goal. Black patients were less likely to have TSH checked in the first trimester than other races (85% vs 100%, <em>P</em> = .048).</div></div><div><h3>Conclusion</h3><div>The QoC of thyrotoxicosis in pregnancy at this tertiary care center can be improved. A larger study is needed to assess the potential impacts of race and SES on the care of pregnant patients with thyrotoxicosis.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 80-84"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460842","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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