Endocrine Practice最新文献

Objective: Primary hyperparathyroidism significantly impacts bone health leading to decreased bone mineral density (BMD). We assessed changes in BMD following parathyroidectomy in patients with biochemically mild primary hyperparathyroidism.

Methods: A retrospective chart review of 93 patients with primary hyperparathyroidism who underwent parathyroidectomy between 2000 and 2022 was conducted. Dual-energy x-ray absorptiometry (DXA) scans were done at the same site pre- and postparathyroidectomy at varying time points. Statistical analyses were performed using ANOVA as the homogeneity of variance was > 0.05. A P-value of <0.05 was considered statistically significant.

Results: No statistically significant differences in DXA measurements were observed based on age, timing of DXA after parathyroidectomy, number and total weight of removed parathyroid glands, preoperative vitamin D levels, or preoperative 24-hour urinary calcium levels. In site-specific analysis based on T-scores at individual skeletal regions, only the femoral neck showed a significant postoperative BMD improvement in osteoporotic patients compared to those with osteopenia (P = .018) and normal bone density (P = .019), while the lumbar spine and total hip did not. When patients were grouped by overall osteoporosis status-defined as having osteoporosis at any site-significant BMD improvements were observed at the femoral neck and total hip compared to those with osteopenia (P = .031 and P = .015, respectively).

Conclusion: These findings underscore the potential for tailored interventions in managing bone health in patients with mild primary hyperparathyroidism, emphasizing the need for personalized approaches to optimize outcomes.

Objective: Thyroid dysfunction produces characteristic changes in weight and body composition, but treatment often results in progressive weight gain.

Methods: This review examines underlying mechanisms, predictors, and implications for patient management.

Results: There are significant changes in weight, appetite, and body composition associated with underproduction and overproduction of thyroid hormone. The disease states of hypothyroidism and hyperthyroidism can be studied in order to document and understand the significant changes in body weight that ensue with these conditions. In addition, treatment of these conditions is associated with further alterations in body weight. As will be discussed, hypothyroidism is associated with mild to modest increases in body weight and accompanying changes in body composition, with partial reversal of these alterations with its treatment with thyroid hormone. Ongoing treatment of hypothyroidism tends to be associated with ongoing weight gains. In contrast, hyperthyroidism can be accompanied by profound weight loss, with a decrease in fat mass, muscle mass, and bone mass, with reversal of the weight loss with restoration of euthyroidism. Specifically, the transition to euthyroidism with treatment of hyperthyroidism is accompanied by an increase in fat mass, muscle mass, and bone mass. However, resolution of hyperthyroidism typically is associated over time with a net increase in body weight that significantly exceeds the nadir seen during hyperthyroidism.

Conclusion: Understanding these patterns of weight changes described above is critical for clinicians to appreciate so that prior to treatment patients can be counseled about what to expect, and then after treatment strategies can be developed to prevent or minimize long-term weight gain after restoration of euthyroidism.

Currently, the total 25-hydroxyvitamin D (25(OH)D) is recognized as the indicator of vitamin D status that is used to define vitamin D sufficiency. Vitamin D binding protein (DBP) is the major carrier for circulating vitamin D and plays an important role in regulating circulating total and free vitamin D metabolites. Since the concentration of DBP and its affinity to vitamin D varies by different physiologic and clinical conditions, measuring total 25(OH)D may not accurately reflect functional vitamin D status. In addition, DBP is a potential prognostic indicator of clinical outcomes since it has other important functions beyond that as vitamin D carrier, including its role in actin scavenging after tissue injury and inflammation and immune modulation. It has been proposed that circulating DBP is altered in some clinical conditions, which affects the levels of total and free vitamin D metabolites and can explain clinical outcomes. Furthermore, in some clinical situations, total 25(OH)D levels are altered and knowing whether DBP is also changed may have diagnostic and therapeutic implications. The goal of this review is to assess clinical conditions altering DBP concentrations and then total 25(OH)D levels and their effects on prognosis. We suggest using the free 25(OH)D level as a better marker for vitamin D status in certain clinical conditions.

Objectives: Diabetic ketoacidosis (DKA)-related hospitalizations significantly burden the healthcare system. Recurrent DKA prolongs hospitalization and worsens outcome. In this study, we compared patient characteristics, clinical outcomes, and health care cost between patients with DKA who successfully transitioned from intravenous to subcutaneous insulin and those who did not.

Methods: This retrospective cohort study included 493 patients, aged ≥18 years, admitted with DKA. Divided into 2 groups: successful transition (ST) and failed transition (FT) from intravenous to subcutaneous insulin. Clinical characteristics, length of intensive care unit stay, in-hospital mortality, and healthcare costs were compared. Independent-sample t-tests and chi-square tests were used to analyze the data.

Results: Of 493 participants, 84.6% successfully transitioned, while 15.4% failed transition. Compared with the ST group, the FT group had higher mean body mass index (BMI), more comorbidities, longer intensive care unit stay (6.9 ± 7.7 vs2.3 ± 4.5 days; P < .001), and higher in-hospital mortality (9.2% vs1.0%; P < .001). The FT group incurred greater healthcare costs, with mean hospital charge of $224,362 ± 317 628 compared to $75 226 ± 128 042 in the ST group (P < .001). Multivariable logistic regression identified higher BMI (odds ratio [OR]: 1.05; P = .029), the presence of comorbidities (OR: 2.53; P = .034), lower bicarbonate during transition (OR: 0.88; P = .004), and higher anion gap (OR: 1.11; P = .049) as significant predictors of transition failure.

Conclusions: The FT group had worse clinical outcomes and utilized more health care resources than the ST group. Key factors such as higher BMI, more comorbidities, higher post-transition glucose and lower bicarbonate levels are associated with transition failure.

Objective: To investigate the prognostic value of the B-type Raf kinase (BRAF) V600E mutation in papillary thyroid carcinoma.

Methods: A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science up to August 31, 2025 identified 46 eligible studies including 20,570 patients, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies version 2 quality assessment. Random-effects models were applied to evaluate associations between BRAF status and major oncological outcomes.

Results: BRAF V600E mutation was significantly associated with lymph node metastasis (odds ratios [OR] = 1.38; 95% confidence interval [CI], 1.17-1.61) and showed a borderline association with recurrence risk (OR = 1.56; 95% CI, 1.00-2.41). In contrast, no significant associations were observed for distant metastases (OR = 0.75; 95% CI, 0.48-1.17) or cancer-related mortality (OR = 0.97; 95% CI, 0.64-1.49). Sensitivity analyses confirmed the robustness of all pooled estimates. Meta-regressions revealed an inverse relationship between BRAF mutation prevalence and its prognostic impact, suggesting that the higher the mutation prevalence in a population, the lower its discriminative prognostic power. Funnel plot inspection and Egger's tests indicated no major publication bias.

Conclusion: Overall, these findings confirm that BRAF V600E mutation is associated with an increased risk of nodal metastasis and recurrence in papillary thyroid carcinoma. However, its lack of impact on distant metastases and disease-specific mortality limits its role as an independent prognostic marker in clinical decision-making.

Objective: A clinically nonfunctioning pituitary adenoma (CNFPA) is the likely diagnosis in patients presenting with a sellar mass consistent with an adenoma on imaging and without clinical or laboratory evidence of hormone excess. A better understanding of the outcome of observation alone for CNFPAs not requiring surgery at diagnosis is needed.

Methods: We conducted a prospective, observational study of apparent CNFPAs ≥6 mm in diameter following the Endocrine Society guidelines for clinical, endocrine, and imaging follow-ups.

Results: A total of 118 patients aged 56 years (range: 24.7-81)-of which 62% were female, and 72% had macroadenomas-were followed for a median of 3.9 years (range: 0.42-16). On follow-up, 49% of tumors increased in size (56% of macroadenomas and 31% of microadenomas), 12% decreased, and 39% remained unchanged. The median time to increase in size was 2.2 years (range: 0.43-12.8) for macroadenomas and 3.44 years (range: 0.41-7.4) for microadenomas (P = .16). Twenty-nine (24.6%) patients (26 who had macroadenomas and 3 who had microadenomas at diagnosis) underwent pituitary surgery after 2.58 years of follow-up (range: 0.4-7.6). Multivariable analysis found male sex to be a significant predictor of tumor growth, and macroadenoma to be a significant predictor of surgery. Most surgically removed CNFPAs were typical, hormone-immunonegative, or gonadotropin-staining tumors.

Conclusion: In this prospective study of 6 to 9 mm micro-CNFPAs and macro-CNFPAs followed conservatively, growth and surgery can occur within the first year or after many years of observation. Risks of enlargement and surgery are increased for certain patient groups. These factors should be considered in designing a plan for follow-up.

Objective: The aim of this study is to investigate the natural growth and post-unilateral total adrenalectomy changes of bilateral macronodular adrenocortical disease (BMAD).

Methods: Retrospective analysis included BMAD patients with ≥2 computed tomography scans: 52 in the natural course cohort (median follow-up 31 months, range 7-150) and 23 in the post-unilateral adrenalectomy cohort (median follow-up 36 months, range 2-98), with their adrenal volumes measured precisely. A linear mixed-effects model was applied to longitudinal data from patients with ≥3 computed tomography scans to analyze adrenal growth patterns.

Results: In BMAD patients with a natural course, total adrenal volume ranged from 5.5 to 92.8 mL. The left adrenal volume was significantly larger than the right, and males had greater volumes than females (P < 0.001). The exponential growth model best fitted volume changes, with a median volume doubling time (VDT) of 11.82 years (range: 1.72-102.70) and a median specific growth rate (SGR) of 5.87%/year (range: 0.67% to 40.41%). In post-unilateral adrenalectomy patients, contralateral adrenal volume showed a significant postoperative increase (P < .05), with exponential growth (median VDT: 9.08 years, range: 2.56-61.86; median SGR: 7.63%/year, range: 0.17% to 29.96%). Receiver operating characteristic analysis demonstrated that postoperative contralateral adrenal volume had superior diagnostic performance (area under the curve = 0.913, 95% CI: 0.813-1.000) for diagnosing autonomous cortisol secretion.

Conclusion: BMAD exhibits exponential growth despite variability in size and growth speed, which supports using VDT and SGR for the individualized growth assessment and imaging follow-up. Postoperative adrenal volume may help assess autonomous cortisol secretion status after unilateral adrenalectomy.

Objective: Age-related variability in the response to testosterone-based gender-affirming hormone therapy (GAHT) among transgender and gender-diverse individuals assigned female at birth remains poorly understood. We investigated 1-year changes in muscle strength and mass after GAHT initiation and examined whether outcomes differ by age at treatment onset.

Methods: In this prospective longitudinal observational study, a total of 107 transgender and gender-diverse individuals assigned female at birth adults naïve to GAHT and gender-affirming surgeries were enrolled and stratified into 4 baseline age groups (20-24, 25-29, 30-34, and ≥35 years). Handgrip strength and body composition (dual-energy x-ray absorptiometry) were assessed at baseline and after 12 months of testosterone therapy. Within-group changes and age-related trends were evaluated using linear mixed models and quantile regression.

Results: Handgrip strength increased after 1 year across all age groups, with a clear age-related gradient in magnitude. Gains were largest and significant in younger participants: +4.35 kg in the 25-29 group (P = .001) and +2.14 kg in the 20-24 group (P = .025). In the 30-34 and ≥ 35 groups, mean increases were smaller and not significant. Appendicular skeletal muscle mass index showed modest, non-significant increases in younger participants and plateaued or declined from age 30 onward, with the 30-34 groups displaying a decline most evident at the 25th percentile.

Conclusions: Age at GAHT initiation markedly influences the anabolic response to testosterone therapy. Strength gains are more pronounced in early adulthood and decline with age, information that may assist clinicians in providing age-appropriate counseling for individuals beginning testosterone therapy.

Objective: Sellar germ cell tumors (GCTs) commonly cause growth hormone deficiency (GHD) and impaired growth in children. A subset of patients maintains near-normal growth despite GHD, a phenomenon termed growth without growth hormone (GWGH), with unclear mechanisms. This study aimed to characterize the clinical features and predictors of GWGH in pediatric sellar GCTs.

Methods: Patients with sellar GCTs and GHD presenting to our hospital between July 2021 and December 2024, with hypogonadotropic hypogonadism or prepubertal status, were included. Patients with annual growth ≥5 cm were classified as GWGH, and a 1:2 age- and sex-matched non-GWGH group served as controls. Clinical characteristics, pituitary dysfunction, hormone replacement therapy, hypothalamic syndrome manifestations, and fasting insulin levels were compared. Logistic regression identified independent predictors of GWGH.

Results: Among 130 patients, 15 (11.5%) exhibited GWGH. GWGH patients had more obesity, larger tumors, and greater hypothalamic involvement, and more hypothalamic syndrome components. Pituitary dysfunction and hormone replacement therapy did not differ significantly between groups. Fasting insulin was significantly higher in the GWGH group than in controls (22.58 ± 8.76 vs 7.41 ± 4.38 μIU/mL, p < 0.001). Multivariate logistic regression identified fasting insulin as an independent predictor of GWGH (OR = 1.61, 95% CI 1.14-2.25, p = 0.006).

Conclusion: GWGH occurs in 11.5% of children with sellar GCTs and GHD, and is associated with hypothalamic involvement, obesity, and hyperinsulinemia. Elevated fasting insulin may partly explain GWGH, but prospective studies are needed to clarify the underlying mechanisms.