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IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/S1530-891X(24)00849-8

引用次数: 0

Examining the Influence of the Route of Administration and Dose of Estradiol on Serum Estradiol and Testosterone Levels in Feminizing Gender-Affirming Hormone Therapy 研究在女性化性别确认激素疗法中，雌二醇的给药途径和剂量对血清雌二醇和睾酮水平的影响。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 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。

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引用次数: 0

Assessing the Quality of Care of Pregnant Patients With Thyrotoxicosis at an Urban Safety Net Hospital 评估一家城市安全网医院对甲亢孕妇的护理质量。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 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。

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引用次数: 0

Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior 利用连续葡萄糖监测数据作为胰高血糖素处方行为的额外来源。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.10.012

Jayachidambaram Ambalavanan MD , Jill Rusticelli , Diana Isaacs PharmD , Huijun Xiao MS , James Bena MS , Christopher Babiuch MD , M. Cecilia Lansang MD, MPH

Objective

Hypoglycemia can be life-threatening for patients with diabetes. We aimed to 1) evaluate percentage of glucagon prescription in patients with hypoglycemia on continuous glucose monitoring (CGM) reports, and 2) determine incident glucagon prescription after an educational letter delivered to the providers.

Research Design and Methods

The study had 2 components – retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March to October 2023 on adult patients in a tertiary care health system with type 1 diabetes or type 2 diabetes on insulin, sulfonylurea, or meglitinide. Percentages of pre-existing and incident glucagon prescription were evaluated. For the QI, we contacted providers whose patients had hypoglycemia defined as time below range ≥ 4% on CGM reports without a glucagon prescription and shared the American Diabetes Association Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription were collected 4 weeks later.

Results

Of the 1543 patients included, 170 had time below range ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (P < .001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild, 49% with moderate, and 63% with severe hypoglycemia (P < .001 mild vs severe; moderate vs no hypoglycemia; and severe vs no hypoglycemia). Among 70 patients whose providers received education, 27 (39%) prescribed glucagon. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were top choices.

Conclusion

Glucagon prescription remains suboptimal among patients with hypoglycemia on CGM reports. Provider engagement via QI can increase glucagon prescription.

目的：低血糖可危及糖尿病（DM）患者的生命。我们的目的是：1）评估 CGM 报告中低血糖患者使用胰高血糖素处方的比例；2）确定向医疗服务提供者发送教育信后的胰高血糖素处方情况：研究包括两个部分：回顾性病历审查和质量改进（QI）部分。从 2023 年 3 月到 10 月，对一家三级医疗保健系统中患有 1 型糖尿病或 2 型糖尿病、正在使用胰岛素、磺脲类药物或格列汀类药物的成年患者进行了病历审查。我们评估了患者使用胰高血糖素前的处方比例和使用胰高血糖素后的处方比例。为了开展 QI，我们联系了在 CGM 报告中低血糖定义为低于量程时间 (TBR) ≥4% 但未开具胰高血糖素处方的患者的医疗服务提供者，并与他们分享了《美国糖尿病协会低血糖护理标准》以及有关各种形式胰高血糖素的信息。4 周后收集胰高血糖素处方数据：结果：在 1543 名患者中，170 人的 TBR ≥4%。结果：在纳入的 1543 名患者中，170 人的总血糖率≥4%，其中 37% 的患者有糖皮质激素处方，14% 的患者有胰高血糖素处方：在 CGM 报告的低血糖患者中，胰高血糖素处方仍未达到最佳水平。医疗服务提供者通过 QI 参与可增加胰高血糖素处方。

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引用次数: 0

Thyroid Nodules: Past, Present, and Future 甲状腺结节：过去、现在和未来。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.05.016

Alan A. Parsa MD, FACE , Hossein Gharib MD, MACP, MACE

Background

Over the past millennia, the evaluation and management of thyroid nodules has essentially remained the same with thyroidectomy as the only reliable method to identify malignancy. However, in the last 30 years, technological advances have significantly improved diagnostic management of thyroid nodules. Advances in imaging have allowed development of a reliable risk- based stratification system to identify nodules at increased risk of malignancy. At the same time, sensitive imaging has caused collateral damage to the degree that we are now identifying and treating many small, low risk nodules with little to no clinical relevance.

Objective

To review the history of thyroid nodule evaluation with emphasis on recent changes and future pathways.

Methods

Literature review and discussion.

Results

Thyroid ultrasound remains the best initial method to evaluate the thyroid gland for nodules. Different risk-of-malignancy protocols have been developed and introduced by different societies, reporting methods have been developed and improved each, with goals of improving the ability to recognize nodules requiring further intervention and minimizing excessive monitoring of those who do not. Once identified, cytological evaluation of nodules further enhances malignancy identification with molecular markers assisting in ruling out malignancies in indeterminate nodules preventing unneeded intervention. And all societies have urged avoidance of overdiagnosis and overtreatment of low-risk cancers of little to no clinical relevance.

Conclusion

In this review, we describe advancements in nodule evaluation and management, while emphasizing caution in overdiagnosing and overtreating low-risk lesions without clinical importance.

一个多世纪以来，区分甲状腺结节良恶性的能力一直是个难题。从历史上看，甲状腺切除术是诊断甲状腺癌的唯一明确方法，考虑到大约90-95%的甲状腺结节是良性的，因此大量的甲状腺切除术都是良性疾病。包括高灵敏度超声波检查、细针穿刺细胞学检查、分子研究和未来人工智能的使用在内的诊断技术的进步有助于区分良性和恶性，并大大减少了良性结节不必要的手术数量。目前和未来可能的诊断改进使我们面临一个新的难题。在减少良性疾病手术数量的同时，我们现在却在过度诊断和过度治疗低风险亚临床恶性肿瘤。在此，我们将介绍一些导致目前状况的变化。

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引用次数: 0

Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia 研究短期综合征测试（SST）的临床适宜性以及测试前皮质醇对预测 SST 结果的作用：东南亚一家三级中心的经验。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.10.006

Pei Chia Eng MBBS, PhD , Vijay Ramadoss BSc, MBBS , Li Ying Lyeann Tan MBBS , Li Zhen Ong MBBS , Doddabele Srinivasa Deepak MBBS , Chin Meng Khoo MBBS

Objective

No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.

Methods

This is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical “pass” or “fail” on SST was compared with the Χ² test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves.

Results

Of the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs.

Conclusion

Our analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.

背景：尚未有研究调查东南亚人群对短同步测试（SST）皮质醇充分反应的预测因素，以及选择 SST 患者的适当性：目的：调查SST的预测因素、适应症以及与SST结果的一致性：设计：一项回顾性研究，调查一家三级医疗中心一年内实施的所有 SST：我们提取了2022年2月至2023年2月期间接受SST的患者的临床数据。我们确定了 SST 检测的适当性。二元逻辑回归用于评估预测皮质醇对 SST 充分反应的参数。通过卡方检验比较了 SST 生化检测 "通过 "或 "未通过 "的人数比例。使用 AuROC 曲线确定了预测 SST 通过的皮质醇基线水平：在 781 次 SST 中，83.9% 的 SST 显示皮质醇反应充分。体位性低血压（26.9%）和外源性 GC 给药（14.2%）是 SST 的常见适应症。在我们的队列中，50.2% 的 SST 使用不当。测试前血清皮质醇和白蛋白可预测 SST 的生化合格率。检测前皮质醇水平达到 300nmol/L 可预测 SST 反应，灵敏度为 93%；皮质醇水平低于 100nmol/L 可确认肾上腺功能不全 (AI)，特异性为 97.3%。使用这些皮质醇阈值可避免 302 例（38.5%）SST：我们的分析表明，AI 的临床特征并不能可靠地预测 SST 的结果。我们主张对转诊接受 SST 的患者进行仔细的 AI 检测前概率评估。测试前的皮质醇水平可减少 SST 的次数，从而节约成本。

{"title":"Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia","authors":"Pei Chia Eng MBBS, PhD , Vijay Ramadoss BSc, MBBS , Li Ying Lyeann Tan MBBS , Li Zhen Ong MBBS , Doddabele Srinivasa Deepak MBBS , Chin Meng Khoo MBBS","doi":"10.1016/j.eprac.2024.10.006","DOIUrl":"10.1016/j.eprac.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.</div></div><div><h3>Methods</h3><div>This is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical “pass” or “fail” on SST was compared with the Χ<sup>2</sup> test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves.</div></div><div><h3>Results</h3><div>Of the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs.</div></div><div><h3>Conclusion</h3><div>Our analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 34-41"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460846","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}

引用次数: 0

Temozolomide Therapy in Management of Refractory Pituitary Adenomas: A Case Series of 39 Patients 治疗难治性垂体腺瘤的替莫唑胺疗法：39例患者的病例系列。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.10.008

Xiaohai Liu MD , Congxin Dai MD , Chenxin Tian MS , Xinjie Bao MD , Kan Deng MD , Yong Yao MD , Yiguang Chen MD , Mingchu Li MD , Ge Chen MD , Ming Feng MD , Renzhi Wang MD

Objective

The management of refractory pituitary adenomas (RPAs) presents significant challenges. This study aimed to evaluate the long-term treatment outcomes of patients with RPA managed with temozolomide (TMZ) and to identify potential biomarkers for predicting TMZ treatment response.

Methods

This retrospective case series included patients with RPA who underwent trans-sphenoidal surgery (TSS) or craniotomy at a comprehensive medical center in China between January 2014 and December 2021.

Results

39 patients with RPA (median age 42 years; 23 males [59%]) were treated with TMZ for a median of 9 cycles. The median follow-up was 34.4 months. Complete response (CR) was observed in 2 patients, partial response (PR) in 11 patients, stable disease (SD) in 9, progressive disease (PD) in 11, and death in 6 patients. O6-methylguanine DNA methyltransferase levels were significantly lower in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 24.2% and 58.1, respectively. MutS homologs 6 levels were significantly higher in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 64.2% and 36.9%, respectively. Patients who received concomitant TMZ and external beam radiotherapy showed a significant tumor size reduction of 178,837 mm³ (P < .001) compared to those treated with TMZ alone.

Conclusions

TMZ demonstrates promising efficacy in eliciting tumor responses in patients with PRA. O6-methylguanine DNA methyltransferase and MutS homologs 6 have emerged as potential biomarkers for predicting treatment response. Furthermore, radiation with concurrent TMZ may significantly improve outcomes in patients with RPA.

目的：难治性垂体腺瘤（RPA）的治疗面临巨大挑战。本研究旨在评估使用替莫唑胺（TMZ）治疗的RPA患者的长期治疗效果，并确定预测TMZ治疗反应的潜在生物标志物：该回顾性病例系列包括2014年1月至2021年12月期间在中国某综合医疗中心接受经蝶窦手术（TSS）或开颅手术的RPA患者：39名RPA患者（中位年龄42岁；23名男性（59%））接受了中位9个周期的TMZ治疗。中位随访时间为 34.4 个月。2例患者观察到完全反应（CR），11例患者观察到部分反应（PR），9例患者观察到疾病稳定（SD），11例患者观察到疾病进展（PD），6例患者死亡。与进展期或死亡患者相比，CR、PR 或 SD 患者的 MGMT（O6-甲基鸟嘌呤 DNA 甲基转移酶）水平明显较低，平均值分别为 24.2% 和 58.1。CR、PR或SD患者的MSH6（MutS homologs 6）水平明显高于PD或死亡患者，平均值分别为64.2%和36.9%。同时接受TMZ和体外放射治疗的患者肿瘤体积明显缩小了178,837立方毫米（p结论：TMZ对PRA患者的肿瘤反应具有良好的疗效。MGMT和MSH6已成为预测治疗反应的潜在生物标志物。此外，放疗同时配合 TMZ 可显著改善 RPA 患者的预后。

{"title":"Temozolomide Therapy in Management of Refractory Pituitary Adenomas: A Case Series of 39 Patients","authors":"Xiaohai Liu MD , Congxin Dai MD , Chenxin Tian MS , Xinjie Bao MD , Kan Deng MD , Yong Yao MD , Yiguang Chen MD , Mingchu Li MD , Ge Chen MD , Ming Feng MD , Renzhi Wang MD","doi":"10.1016/j.eprac.2024.10.008","DOIUrl":"10.1016/j.eprac.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>The management of refractory pituitary adenomas (RPAs) presents significant challenges. This study aimed to evaluate the long-term treatment outcomes of patients with RPA managed with temozolomide (TMZ) and to identify potential biomarkers for predicting TMZ treatment response.</div></div><div><h3>Methods</h3><div>This retrospective case series included patients with RPA who underwent trans-sphenoidal surgery (TSS) or craniotomy at a comprehensive medical center in China between January 2014 and December 2021.</div></div><div><h3>Results</h3><div>39 patients with RPA (median age 42 years; 23 males [59%]) were treated with TMZ for a median of 9 cycles. The median follow-up was 34.4 months. Complete response (CR) was observed in 2 patients, partial response (PR) in 11 patients, stable disease (SD) in 9, progressive disease (PD) in 11, and death in 6 patients. O6-methylguanine DNA methyltransferase levels were significantly lower in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 24.2% and 58.1, respectively. MutS homologs 6 levels were significantly higher in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 64.2% and 36.9%, respectively. Patients who received concomitant TMZ and external beam radiotherapy showed a significant tumor size reduction of 178,837 mm<sup>3</sup> (<em>P</em> < .001) compared to those treated with TMZ alone.</div></div><div><h3>Conclusions</h3><div>TMZ demonstrates promising efficacy in eliciting tumor responses in patients with PRA. O6-methylguanine DNA methyltransferase and MutS homologs 6 have emerged as potential biomarkers for predicting treatment response. Furthermore, radiation with concurrent TMZ may significantly improve outcomes in patients with RPA.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 42-51"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497254","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}

引用次数: 0

Editorial on Special Issue in Memory of Aaron I. Vinik: From Autonomic Diabetic Neuropathy to Neuroendocrine Tumors 纪念 Aaron I. Vinik 特刊》社论：从自主神经糖尿病到神经内分泌肿瘤。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.10.010

Elias S. Siraj MD, Dr Med, David C. Lieb MD, Solomon Tesfaye MB ChB, MD, Karel Pacak MD, PhD, DSc

引用次数: 0

Characterization of Interchanging Incretin Analogs in Clinical Practice: A Descriptive Report 临床实践中交替使用的胰岛素类似物的特征：描述性报告

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2025-01-01 DOI: 10.1016/j.eprac.2024.09.117

Christopher M. Hvisdas PharmD , Natalie D. Goode PharmD, BCACP , Diane H. Kim PharmD, BCACP , Michael J. Silvey PharmD , Jeremy J. Flood MD, FACE

Objective

To characterize the tolerability associated with incretin analog interchanges to equipotent or higher strengths based on an interchange process in an adult outpatient setting.

Methods

This was a retrospective chart review of adult patients receiving care through a participating family medicine or endocrinology clinic between January 1, 2022, and November 30, 2022 at a major academic medical center. An incretin analog equivalency table and protocol for interchange was created in response to ongoing shortages and need for therapy adjustments to different medications within the same class. Patients were included if a recommended incretin analog interchange was initiated and a tolerability assessment was conducted. Patients were excluded if they did not meet inclusion criteria or if they were unreachable for tolerability assessments for interchanged agents.

Results

There were 156 patients included for characterization and response to tolerability of interchange. It was determined that 96% of patients tolerated the incretin analog interchange. A dose escalation occurred in 58% of patients, 41% were transitioned to an equipotent dose, and a dose decrease was considered in 1 patient. Prior authorizations were required 74% of the time for the new therapy. The most common interchanges were dulaglutide 4.5 mg to tirzepatide 7.5 mg, dulaglutide 4.5 mg to tirzepatide 10 mg, and dulaglutide 3 mg to tirzepatide 7.5 mg. These interchanges made up 37.3% of the total population and were observed to have 93% tolerability. Seven patients did not tolerate incretin analog interchange. Five experienced gastrointestinal effects and 2 experienced injection site reactions. The interchange of incretin analog was estimated to reduce time to maximum dose by a median of 3 months. During this study, no patients experienced interruption of therapy defined as missing a dose of incretin analog.

Conclusion

This characterization report demonstrates an effective approach to addressing incretin analog interchanges. A high level of tolerability is evident with the defined interchange process. Future studies should continue to confirm effective and safe interchanges of incretin analogs from outcomes and tolerability reports.

目的根据成人门诊环境中的换药流程，描述增量素类似物换成等效或更高浓度时的耐受性：这是一项回顾性病历审查，对象是 2022 年 1 月 1 日至 2022 年 11 月 30 日期间在一家大型学术医疗中心的参与家庭医学或内分泌诊所接受治疗的成人患者。由于胰岛素类药物持续短缺，需要对同类不同药物进行治疗调整，因此制定了胰岛素类似物等效表和换药协议。如果患者开始接受推荐的胰岛素类似物换药治疗，并进行了耐受性评估，则将其纳入治疗范围。如果患者不符合纳入标准或无法联系到他们进行换药耐受性评估，则将其排除在外：结果：共有 156 名患者被纳入研究，以确定其特征和对换药耐受性的反应。结果显示，96% 的患者可以耐受胰岛素类似物的互换。58%的患者接受了剂量升级，41%的患者过渡到了同等剂量，1 名患者被视为剂量减少。74%的新疗法需要事先授权。最常见的换药是将 4.5 毫克度拉鲁肽换成 7.5 毫克替扎帕肽、将 4.5 毫克度拉鲁肽换成 10 毫克替扎帕肽以及将 3 毫克度拉鲁肽换成 7.5 毫克替扎帕肽。这些换药患者占总人数的 37.3%，据观察，耐受性达 93%。七名患者不能耐受胰岛素类似物换药。其中五人出现胃肠道反应，两人出现注射部位反应。据估计，换用胰岛素类似物可将达到最大剂量的时间中位数缩短三个月。在这项研究中，没有患者出现中断治疗的情况，即错过一次胰岛素类似物剂量：这份特征分析报告展示了解决胰岛素类似物换药问题的有效方法。通过定义的换药过程可以看出，患者的耐受性很高。未来的研究应继续从疗效和耐受性报告中确认胰岛素类似物换药的有效性和安全性。

{"title":"Characterization of Interchanging Incretin Analogs in Clinical Practice: A Descriptive Report","authors":"Christopher M. Hvisdas PharmD , Natalie D. Goode PharmD, BCACP , Diane H. Kim PharmD, BCACP , Michael J. Silvey PharmD , Jeremy J. Flood MD, FACE","doi":"10.1016/j.eprac.2024.09.117","DOIUrl":"10.1016/j.eprac.2024.09.117","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the tolerability associated with incretin analog interchanges to equipotent or higher strengths based on an interchange process in an adult outpatient setting.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of adult patients receiving care through a participating family medicine or endocrinology clinic between January 1, 2022, and November 30, 2022 at a major academic medical center. An incretin analog equivalency table and protocol for interchange was created in response to ongoing shortages and need for therapy adjustments to different medications within the same class. Patients were included if a recommended incretin analog interchange was initiated and a tolerability assessment was conducted. Patients were excluded if they did not meet inclusion criteria or if they were unreachable for tolerability assessments for interchanged agents.</div></div><div><h3>Results</h3><div>There were 156 patients included for characterization and response to tolerability of interchange. It was determined that 96% of patients tolerated the incretin analog interchange. A dose escalation occurred in 58% of patients, 41% were transitioned to an equipotent dose, and a dose decrease was considered in 1 patient. Prior authorizations were required 74% of the time for the new therapy. The most common interchanges were dulaglutide 4.5 mg to tirzepatide 7.5 mg, dulaglutide 4.5 mg to tirzepatide 10 mg, and dulaglutide 3 mg to tirzepatide 7.5 mg. These interchanges made up 37.3% of the total population and were observed to have 93% tolerability. Seven patients did not tolerate incretin analog interchange. Five experienced gastrointestinal effects and 2 experienced injection site reactions. The interchange of incretin analog was estimated to reduce time to maximum dose by a median of 3 months. During this study, no patients experienced interruption of therapy defined as missing a dose of incretin analog.</div></div><div><h3>Conclusion</h3><div>This characterization report demonstrates an effective approach to addressing incretin analog interchanges. A high level of tolerability is evident with the defined interchange process. Future studies should continue to confirm effective and safe interchanges of incretin analogs from outcomes and tolerability reports.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"31 1","pages":"Pages 59-64"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460843","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}

引用次数: 0

Physician Assistants in Clinical Endocrinology: Characteristics and Demographics. 临床内分泌学医师助理：特征和人口统计学。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-12-27 DOI: 10.1016/j.eprac.2024.12.016

Robert E McKenna, Roderick S Hooker, Mirela Bruza-Augatis, Kasey Puckett, Andrzej Kozikowski

Objective: Physician assistants (PAs) are employed in endocrinology, but little is known about their roles and activities. The study aimed to assess PAs' employment characteristics in endocrinology compared to those in all other specialties.

Methods: This descriptive observational study used the 2022 National Commission on Certification of PAs dataset. The study includes 117 748 board-certified PAs who indicated a clinical specialty in 2022. The characteristics of PAs in endocrinology were examined using descriptive statistics, including counts and percentages for categorical variables; means (with standard deviations), and medians (with interquartile ranges) for continuous variables. Bivariate analyses (ꭙ² and Mann-Whitney U tests) were used to determine statistical differences between PAs practicing in endocrinology versus PAs in all other specialties.

Results: This study found that as of 2022, 685 PAs reported practicing in endocrinology. PAs in endocrinology, compared to PAs in all other specialties (all P < .001), were more likely to identify as female (82.0% vs 69.6%), work in an office-based private practice (61.3% vs 37.0%), and participate in telemedicine (70.8% vs 40.1%). Conversely, PAs in endocrinology were less likely to work in a secondary position, saw slightly fewer patients weekly, and earned $10,000 less yearly than their PA colleagues in all other specialties.

Conclusion: Examining the PA endocrinology workforce is essential due to the shortage of endocrinologists and the increased prevalence of diabetes as the U.S. population ages. Understanding where PAs in endocrinology are employed and their attributes could assist efforts in specialty modeling to address supply and demand projections.

目的：医师助理在内分泌科工作，但对其作用和活动了解甚少。这项研究的目的是评估在内分泌科的助理医生的就业特点，并将其与其他所有专业的助理医生进行比较。方法：这项描述性观察研究使用了2022年国家执业医师认证委员会（NCCPA）的数据集。该研究包括117,748名董事会认证的PAs，他们在2022年指明了临床专业。采用描述性统计，包括分类变量的计数和百分比，检验内分泌学PAs的特征；连续变量的平均值（带标准差）和中位数（带四分位数范围）。使用双变量分析（ꭙ2和Mann-Whitney U检验）来确定内分泌科执业PAs与所有其他专业执业PAs之间的统计学差异。结果：本研究发现，截至2022年，685名PAs报告从事内分泌学工作。结论：由于内分泌专家的短缺和美国人口老龄化导致糖尿病患病率的增加，检查内分泌专家的工作人员是必要的。了解内分泌学中pa的使用位置及其属性可以帮助专业建模以解决供需预测问题。

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引用次数: 0