Pub Date : 2026-01-01DOI: 10.1016/j.endien.2025.501655
Estrella Diego , María del Carmen Farnández , Beatriz de León , Andoni Monzón , Leire Isasa , Beatriz Sordo , Nuria Valdés
Introduction
Multivitamin preparations with added vitamin K in parenteral nutrition (PN) ensure the coverage of this micronutrient in all adults, as indicated by the latest ESPEN clinical practice guidelines on micronutrients.
Objectives
To monitor vitamin K levels after adding this multivitamin with vitamin K in patients requiring home parenteral nutrition (HPN) at Hospital Universitario Cruces (Bilbao, Basque County, Spain) from 2021 to 2022.
Materials and methods
We analyzed vitamin K levels were collected 6 months into therapy with the multivitamin containing vitamin K in home parenteral nutrition.
Results
At our centre, a total of 8 patients required home parenteral nutrition due to intestinal failure type III, 60% of whom were men, with a mean age of 58 ± 13 years. The cause of intestinal failure was short bowel syndrome (50%), intestinal mucosal disease (38%), and intestinal dysmotility (12%). After adding the multivitamin with vitamin K, 80% (6/8) of patients exhibited elevated vitamin K levels, with a mean of 4.4 μl/L.
Conclusions
After observing vitamin K levels above the upper limit of normal, we reached consensus with the Pharmacy Service to discontinue this multivitamin and restart conventional multivitamin. After this initiative, the vitamin K levels of our patients normalized.
{"title":"Vitamin K in home parenteral nutrition: Is it really necessary?","authors":"Estrella Diego , María del Carmen Farnández , Beatriz de León , Andoni Monzón , Leire Isasa , Beatriz Sordo , Nuria Valdés","doi":"10.1016/j.endien.2025.501655","DOIUrl":"10.1016/j.endien.2025.501655","url":null,"abstract":"<div><h3>Introduction</h3><div>Multivitamin preparations with added vitamin K in parenteral nutrition (PN) ensure the coverage of this micronutrient in all adults, as indicated by the latest ESPEN clinical practice guidelines on micronutrients.</div></div><div><h3>Objectives</h3><div>To monitor vitamin K levels after adding this multivitamin with vitamin K in patients requiring home parenteral nutrition (HPN) at <em>Hospital Universitario Cruces</em> (Bilbao, Basque County, Spain) from 2021 to 2022.</div></div><div><h3>Materials and methods</h3><div>We analyzed vitamin K levels were collected 6 months into therapy with the multivitamin containing vitamin K in home parenteral nutrition.</div></div><div><h3>Results</h3><div>At our centre, a total of 8 patients required home parenteral nutrition due to intestinal failure type III, 60% of whom were men, with a mean age of 58<!--> <!-->±<!--> <!-->13 years. The cause of intestinal failure was short bowel syndrome (50%), intestinal mucosal disease (38%), and intestinal dysmotility (12%). After adding the multivitamin with vitamin K, 80% (6/8) of patients exhibited elevated vitamin K levels, with a mean of 4.4<!--> <!-->μl/L.</div></div><div><h3>Conclusions</h3><div>After observing vitamin K levels above the upper limit of normal, we reached consensus with the Pharmacy Service to discontinue this multivitamin and restart conventional multivitamin. After this initiative, the vitamin K levels of our patients normalized.</div></div>","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"73 1","pages":"Article 501655"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.endien.2026.501747
Ignacio Ruz-Caracuel
{"title":"Recent advances in pituitary tumors following the 2022 WHO classification","authors":"Ignacio Ruz-Caracuel","doi":"10.1016/j.endien.2026.501747","DOIUrl":"10.1016/j.endien.2026.501747","url":null,"abstract":"","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"73 1","pages":"Article 501747"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146001832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.endien.2025.501654
Marta Araujo-Castro , Rogelio García-Centeno , Javier Aller , Mónica Marazuela , Alfonso Soto , María Ángeles Gálvez , Rosa Cámara , Elena Valassi , Ignacio Bernabeu , Rocío Villar-Taibo , Felicia A. Hanzu
Severe Cushing's syndrome (SCS) is usually defined as a CS with urinary free cortisol (UFC) levels above five times the upper limit of normal or associated with severe complications of hypercortisolism. Combination therapy with ketoconazole and metyrapone is a useful option for these patients. Osilodrostat is the most potent and effective oral drug in monotherapy for the treatment of SCS. For cases with very severe hypercortisolism and/or oral intolerance, etomidate is the most effective and rapid drug for reducing cortisol levels. Bilateral adrenalectomy may be indicated in cases of life-threatening severe hypercortisolism, but UFC should be reduced before surgery to reduce the perioperative morbimortality. Prompt treatment of comorbidities and thrombo- and infection prophylaxis are recommended. In conclusion, a rapid control of hypercortisolism is vital in SCS, and for this purpose combination therapy or potent drugs with a rapid onset of action such as etomidate or osilodrostat are indicated.
{"title":"Executive summary of the consensus document for the management of severe Cushing's syndrome: Consensus document of the Neuroendocrinology Focus Group of the Spanish Society of Endocrinology and Nutrition (SEEN)","authors":"Marta Araujo-Castro , Rogelio García-Centeno , Javier Aller , Mónica Marazuela , Alfonso Soto , María Ángeles Gálvez , Rosa Cámara , Elena Valassi , Ignacio Bernabeu , Rocío Villar-Taibo , Felicia A. Hanzu","doi":"10.1016/j.endien.2025.501654","DOIUrl":"10.1016/j.endien.2025.501654","url":null,"abstract":"<div><div>Severe Cushing's syndrome (SCS) is usually defined as a CS with urinary free cortisol (UFC) levels above five times the upper limit of normal or associated with severe complications of hypercortisolism. Combination therapy with ketoconazole and metyrapone is a useful option for these patients. Osilodrostat is the most potent and effective oral drug in monotherapy for the treatment of SCS. For cases with very severe hypercortisolism and/or oral intolerance, etomidate is the most effective and rapid drug for reducing cortisol levels. Bilateral adrenalectomy may be indicated in cases of life-threatening severe hypercortisolism, but UFC should be reduced before surgery to reduce the perioperative morbimortality. Prompt treatment of comorbidities and thrombo- and infection prophylaxis are recommended. In conclusion, a rapid control of hypercortisolism is vital in SCS, and for this purpose combination therapy or potent drugs with a rapid onset of action such as etomidate or osilodrostat are indicated.</div></div>","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501654"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite several factors are associated with worse disease-free survival (DFS) and prognosis in medullary thyroid carcinoma (MTC) patients, the effect of microscopic extrathyroidal extension (mETE) on the prognosis and DFS is not well understood. This study aims to evaluate the impact of mETE on DFS and prognosis in patients with MTC.
Methods
This multicenter study included 208 patients with MTC (17.8% with hereditary disease). Patients with mETE were compared to those without mETE in terms of clinical and histopathological variables.
Results
Among the 208 patients, 16.3% (n = 34) had mETE on histopathological analysis. Patients with mETE were more likely to have larger tumors, higher serum calcitonin (CTN) levels before and after surgery, increased rates of neck lymph node (LN) and distant metastasis, multifocal disease, and advanced disease stage. Kaplan–Meier analysis showed a significantly lower DFS in patients with mETE than those without mETE (14.7% vs. 71.3%, log-rank p < 0.001). However, mETE was not an independent contributing factor for persistent/recurrent disease, whereas neck LN involvement was the strongest independent contributing factor for persistent/recurrent disease (HR: 1.1; 95% CI 0.4–1.8, p = 0.76 and HR: 9.6; 95% CI 1.21–76.9, p = 0.03, respectively).
Conclusion
mETE in patients with MTC is associated with a lower DFS, larger tumor sizes, a higher likelihood of neck LN and distant metastasis, advanced stage, higher serum CTN levels, multifocality, and persistent/recurrent disease. However, mETE was not an independent predictor of persistent/recurrent disease. Further studies with a larger number of patients with mETE could further clarify the impact of mETE on the prognosis of MTC.
目的：尽管多种因素与甲状腺髓样癌（MTC）患者较差的无病生存（DFS）和预后有关，但显微甲状腺外展（mETE）对预后和DFS的影响尚不清楚。本研究旨在评价mETE对MTC患者DFS及预后的影响。方法本研究纳入208例MTC患者（17.8%为遗传性疾病）。将mETE患者与未mETE患者在临床和组织病理学变量方面进行比较。结果208例患者中，16.3% （n = 34）的组织病理学分析为mETE。mETE患者更可能有较大的肿瘤，术前和术后血清降钙素（CTN）水平较高，颈部淋巴结（LN）和远处转移、多灶性疾病和晚期疾病的发生率增加。Kaplan-Meier分析显示，mETE患者的DFS显著低于非mETE患者（14.7% vs. 71.3%, log-rank p < 0.001）。然而，mETE不是持续/复发性疾病的独立影响因素，而颈部LN受累是持续/复发性疾病的最强独立影响因素（HR: 1.1; 95% CI 0.4-1.8, p = 0.76; HR: 9.6; 95% CI 1.21-76.9, p = 0.03）。结论MTC患者的mete与较低的DFS、较大的肿瘤大小、较高的颈部LN和远处转移可能性、晚期、较高的血清CTN水平、多灶性和持续/复发性疾病相关。然而，mETE并不是疾病持续/复发的独立预测因子。更多mETE患者的进一步研究可以进一步阐明mETE对MTC预后的影响。
{"title":"The impact of microscopic extrathyroidal extension on the prognosis of medullary thyroid carcinoma: A multicenter cohort study","authors":"Beyza Olcay Ozturk , Umran Keskin , Serhat Uysal , Aysa Hacioglu , Seda Karsli , Burak Andac , Umit Nur Ozbay , Hulyanur Sodan , Sebnem Burhan , Coskun Ates , Ugur Avci , Faruk Kilinc , Selvinaz Erol , Merve Catak , Zafer Pekkolay , Gulhan Akbaba , Goknur Yorulmaz , Sakin Tekin , Birol Topcu , Mazhar Muslum Tuna , Sayid Shafi Zuhur","doi":"10.1016/j.endien.2025.501633","DOIUrl":"10.1016/j.endien.2025.501633","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite several factors are associated with worse disease-free survival (DFS) and prognosis in medullary thyroid carcinoma (MTC) patients, the effect of microscopic extrathyroidal extension (mETE) on the prognosis and DFS is not well understood. This study aims to evaluate the impact of mETE on DFS and prognosis in patients with MTC.</div></div><div><h3>Methods</h3><div>This multicenter study included 208 patients with MTC (17.8% with hereditary disease). Patients with mETE were compared to those without mETE in terms of clinical and histopathological variables.</div></div><div><h3>Results</h3><div>Among the 208 patients, 16.3% (<em>n</em> <!-->=<!--> <!-->34) had mETE on histopathological analysis. Patients with mETE were more likely to have larger tumors, higher serum calcitonin (CTN) levels before and after surgery, increased rates of neck lymph node (LN) and distant metastasis, multifocal disease, and advanced disease stage. Kaplan–Meier analysis showed a significantly lower DFS in patients with mETE than those without mETE (14.7% vs. 71.3%, log-rank <em>p</em> <!--><<!--> <!-->0.001). However, mETE was not an independent contributing factor for persistent/recurrent disease, whereas neck LN involvement was the strongest independent contributing factor for persistent/recurrent disease (HR: 1.1; 95% CI 0.4–1.8, <em>p</em> <!-->=<!--> <!-->0.76 and HR: 9.6; 95% CI 1.21–76.9, <em>p</em> <!-->=<!--> <!-->0.03, respectively).</div></div><div><h3>Conclusion</h3><div>mETE in patients with MTC is associated with a lower DFS, larger tumor sizes, a higher likelihood of neck LN and distant metastasis, advanced stage, higher serum CTN levels, multifocality, and persistent/recurrent disease. However, mETE was not an independent predictor of persistent/recurrent disease. Further studies with a larger number of patients with mETE could further clarify the impact of mETE on the prognosis of MTC.</div></div>","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501633"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.endien.2025.501632
Bryan-Josué Flores-Robles , Juan Antonio López Martín , María Jesús Chinchetru Ranedo , José Miguel Lázaro Guevara , José Fernando Marín Díez , Núria Guañabens
{"title":"Gastroileal bypass reversal as a treatment for iatrogenic hyperparathyroidism and refractory hypocalcemia","authors":"Bryan-Josué Flores-Robles , Juan Antonio López Martín , María Jesús Chinchetru Ranedo , José Miguel Lázaro Guevara , José Fernando Marín Díez , Núria Guañabens","doi":"10.1016/j.endien.2025.501632","DOIUrl":"10.1016/j.endien.2025.501632","url":null,"abstract":"","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501632"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.endien.2025.501630
María Carmen Dameto Pons, Elena González Arnáiz, María Antequera González, Xavier F. Pérez Candel, Diana Ariadel Cobo, Javier Castañón Alonso, María D. Ballesteros Pomar
Immunotherapy is an increasingly used treatment for different types of cancer. The most widely used are cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, PD-1 ligand (PD-L1) inhibitors and PD-1 receptor inhibitors. All of them can produce endocrine autoimmune side effects in multiple organs. The most frequent are thyroid disorders and hypophysitis although, less frequently, they can also cause autoimmune adrenalitis and autoimmune diabetes. Thyroid involvement is usually transient but can become chronic in the form of hypothyroidism in more than 50% of cases. Diabetes is due to autoimmune destruction of pancreatic β-cells, in many cases abrupt and irreversible. The 2 entities occur more frequently with PD-1 or PD-L1 inhibitors. This is the case of a patient with cutaneous melanoma on pembrolizumab who simultaneously developed thyroiditis and fulminant autoimmune diabetes.
{"title":"Pembrolizumab-induced dual endocrine disruption: A case report","authors":"María Carmen Dameto Pons, Elena González Arnáiz, María Antequera González, Xavier F. Pérez Candel, Diana Ariadel Cobo, Javier Castañón Alonso, María D. Ballesteros Pomar","doi":"10.1016/j.endien.2025.501630","DOIUrl":"10.1016/j.endien.2025.501630","url":null,"abstract":"<div><div>Immunotherapy is an increasingly used treatment for different types of cancer. The most widely used are cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, PD-1 ligand (PD-L1) inhibitors and PD-1 receptor inhibitors. All of them can produce endocrine autoimmune side effects in multiple organs. The most frequent are thyroid disorders and hypophysitis although, less frequently, they can also cause autoimmune adrenalitis and autoimmune diabetes. Thyroid involvement is usually transient but can become chronic in the form of hypothyroidism in more than 50% of cases. Diabetes is due to autoimmune destruction of pancreatic β-cells, in many cases abrupt and irreversible. The 2 entities occur more frequently with PD-1 or PD-L1 inhibitors. This is the case of a patient with cutaneous melanoma on pembrolizumab who simultaneously developed thyroiditis and fulminant autoimmune diabetes.</div></div>","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501630"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.endien.2025.501640
Francisco Pita Gutiérrez , Irene Breton Lesmes , Julia Álvarez Hernández , María D. Ballesteros-Pomar , Rocío Campos del Portillo , Ana Hernández Moreno , Francisco Botella Romero
Introduction
Despite the available scientific evidence, the use of enteral tube feeding in people with advanced dementia is currently controversial. Given this situation, and following the position paper promoted by the SEEN (Spanish Society of Endocrinology and Nutrition), a consensus is sought to contribute to improving the management of this condition.
Material and methods
A Delphi consultation was conducted, a formal and systematic method for obtaining consensus. The project was developed in the following stages: (1) questionnaire development by the Scientific Committee; (2) first round of Delphi consultation; (3) second round of Delphi consultation, and; (4) a meeting to present the results.
Results
A total of 340 expert members of the SEEN Nutrition Department were invited to participate through the society itself. Of these, 128 panellists completed the questionnaire in the first round (response rate of 38%) and 53 in the second round (response rate of 41%, compared to the first round). Of the 24 statements initially proposed, 14 (58%) reached consensus. Of these, 13 achieved this goal in the first round and one in the second.
Conclusions
Advanced dementia represents a significant challenge for both healthcare professionals and patients' families, raising ethical and practical dilemmas regarding appropriate treatment and management to improve the quality of life of those affected. This paper draws several key conclusions that can guide the care and attention of these patients.
{"title":"Delphi Consensus of the Nutrition Area of the SEEN (NutriSEEN) on the use of enteral tube nutrition in people with advanced dementia","authors":"Francisco Pita Gutiérrez , Irene Breton Lesmes , Julia Álvarez Hernández , María D. Ballesteros-Pomar , Rocío Campos del Portillo , Ana Hernández Moreno , Francisco Botella Romero","doi":"10.1016/j.endien.2025.501640","DOIUrl":"10.1016/j.endien.2025.501640","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the available scientific evidence, the use of enteral tube feeding in people with advanced dementia is currently controversial. Given this situation, and following the position paper promoted by the SEEN (Spanish Society of Endocrinology and Nutrition), a consensus is sought to contribute to improving the management of this condition.</div></div><div><h3>Material and methods</h3><div>A Delphi consultation was conducted, a formal and systematic method for obtaining consensus. The project was developed in the following stages: (1) questionnaire development by the Scientific Committee; (2) first round of Delphi consultation; (3) second round of Delphi consultation, and; (4) a meeting to present the results.</div></div><div><h3>Results</h3><div>A total of 340 expert members of the SEEN Nutrition Department were invited to participate through the society itself. Of these, 128 panellists completed the questionnaire in the first round (response rate of 38%) and 53 in the second round (response rate of 41%, compared to the first round). Of the 24 statements initially proposed, 14 (58%) reached consensus. Of these, 13 achieved this goal in the first round and one in the second.</div></div><div><h3>Conclusions</h3><div>Advanced dementia represents a significant challenge for both healthcare professionals and patients' families, raising ethical and practical dilemmas regarding appropriate treatment and management to improve the quality of life of those affected. This paper draws several key conclusions that can guide the care and attention of these patients.</div></div>","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501640"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.endien.2025.501730
Ildefonso Hernández-Aguado , Elisa Chilet-Rosell
{"title":"The unavoidable decision for medical societies: Commercial drift or integrity","authors":"Ildefonso Hernández-Aguado , Elisa Chilet-Rosell","doi":"10.1016/j.endien.2025.501730","DOIUrl":"10.1016/j.endien.2025.501730","url":null,"abstract":"","PeriodicalId":48650,"journal":{"name":"Endocrinologia Diabetes Y Nutricion","volume":"72 10","pages":"Article 501730"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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