Endocrine Practice

OBJECTIVE: To determine the frequency of "invalid" 1-mg overnight dexamethasone (Dex) suppression tests (DST) on a large series of patients investigated for hypercortisolism and examine the interference of substances and clinical conditions that may explain low serum Dex levels. METHODS: A retrospective analysis of 1,300 Dex-controlled 1-mg DST applied to patients screened for SC or MACS, in a single center for which there were identified invalid tests and distinctive characteristics that may have interfered with the outcome...

OBJECTIVE: To identify the types of osteoporosis-related questions being asked by primary care providers (PCPs) and describe the impact of the advice provided by osteoporosis specialists using eConsult. METHODS: We performed a cross-sectional study of osteoporosis-related eConsults submitted to endocrinologists between January 2018 and December 2020 on the Champlain eConsult BASE™ Service in Ontario, Canada. Each eConsult was coded according to clinical question and answer type through consensus between two authors, based on pre-determined taxonomies...

OBJECTIVE: Excessive use of thyroid ultrasound (TUS) contributes to the overdiagnosis of thyroid nodules and thyroid cancer. In this study, we evaluated drivers of and clinical trajectories following TUS orders. METHODS: We conducted a retrospective review of 500 adult patients who underwent an initial TUS between 2015 and 2017 at Mayo Clinic in Rochester, MN. A framework was employed to classify the indication for TUS, and it was characterized as inappropriate when ordered without a guideline-based indication...

INTRODUCTION: Refractory hypothyroidism (RH) represents a challenge in the diagnosis and treatment within the field of thyroidology. It is defined as the inability to achieve disease control despite using levothyroxine (LT4) doses of 1.9 μg/kg/day or higher. METHODS: A comprehensive review, encompassing 103 articles, was conducted using the Scielo, Scopus, and EMBASE databases, providing an approach to evaluation and diagnosis of this condition. RESULTS: Levothyroxine disintegrates and dissolves within an acidic gastric environment before being absorbed in the jejunum and ileum...

OBJECTIVE: To characterize the time-course of triglyceride (Tg) lowering in hypertriglyceridemic pancreatitis according to initial values, causes, and interventions. METHODS: Patients hospitalized from October 2013 through December of 2018 with a diagnosis of pancreatitis associated with hypertriglyceridemia (Tg ≥ 500 mg/dL), in absence of other causes, were identified by medical record review. Tg lowering was retrospectively assessed for differences in relation to initial Tg values, use of iv insulin, ethanol vs...

OBJECTIVE: In this narrative review we discuss the current evidence as well as the knowledge gaps concerning assisted reproductive technology (ART) indications, protocols, and results in the presence of polycystic ovary syndrome (PCOS). METHODS: An electronic literature search was performed for English-language publications in the last decade in databases such as PubMed, Medline, Web of Sciences, Embase and Scopus. RESULTS: We found evidence that ovarian steroidogenesis and folliculogenesis are deeply altered by PCOS but, nevertheless, oocyte quality and pregnancy rates following ART are not affected...

BACKGROUND: Thyroid nodules are associated with significant symptoms and currently, surgery is the primary management option for symptomatic nodules. This can result in complications and cosmetic disfigurement. Laser ablation is an alternative treatment option. We conducted a single-center, prospective, non-randomized, open-label, interventional pilot study to evaluate the effects of a single ultrasound-guided laser ablation treatment on symptomatic benign thyroid nodules in an outpatient setting...

Primary aldosteronism (PA) is the most common form of endocrine hypertension, yet screening rates are abysmally low. Major reasons for low screening rates include misconceptions about the drug interference and limited access to adrenal vein sampling (AVS) expertise for subtyping. The workup of PA is greatly simplified by considering the condition as a continuum with low-renin primary hypertension. Thus, the purpose of the evaluation is not a yes/no dichotomous diagnosis but rather a gauging of how likely the patient has a lateralized source and will benefit from unilateral adrenalectomy...

OBJECTIVES: Due to a perceived rise in hyperinsulinemic hypoglycemia (HH) cases over time, notably during the COVID-19 pandemic, institutional experiences between 2013-2021 were reviewed to evaluate trends, characteristics, and outcomes in children with HH. METHODS: Charts of all children diagnosed with HH during the study period and evaluated by Pediatric Endocrinology were reviewed. HH was defined per Pediatric Endocrine Society guidelines. Regression analysis compared rates of change in HH cases and maternal risk factors over time...

OBJECTIVE: Hungry bone syndrome (HBS) is a known complication of parathyroidectomy for patients with renal hyperparathyroidism. Patients with end stage kidney disease (ESKD) are particularly vulnerable to HBS due to their prolonged exposure to electrolyte abnormalities and elevated parathyroid hormone (PTH). However, in-depth characterization of predictive factors for HBS in these patients is lacking. METHODS: A retrospective analysis was performed of all patients with renal hyperparathyroidism who underwent parathyroidectomy for renal hyperparathyroidism at a single institution from 2011-2021...

Bioinactive growth hormone (BGH) is a structurally abnormal, biologically inactive, but immunoreactive form of growth hormone encoded by pathogenic GH1 gene variants. The underlying cause of the defective physiology is decreased BGH binding affinity to both growth hormone binding proteins (GBP) and growth hormone receptors (GHR). GHR cannot dimerize when it is in a quiescent state because BGH cannot activate it. Nondimerized GHR is unable to activate intracytoplasmic signaling pathway molecules such as Janus kinase (JAK2) and signal transducer and activator of transcription (STAT), which initiate IGF-1 (insulin-like growth factor) transcription...

No abstract text is available yet for this article.

OBJECTIVE: To evaluate the effect of soy intake on levothyroxine (L-T4) absorption among different L-T4 formulations. METHODS: A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Case reports, case series, and original studies written in English and published online up to November 30, 2022, were selected and reviewed. The final reference list was defined based on the relevance of each study to the scope of this review. RESULTS: Few data, mainly case reports, seemed to suggest a possible interference of soy products on L-T4 tablets absorption...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Thyroid disease is a prominent endocrine disorder, yet the clinical epidemiology of this condition remains unclear. This study aims to describe the recent trends in the prevalence of thyroid disease in the US adults from 1999 to 2018. METHODS: This cross-sectional study utilized nationally representative data collected through the National Health and Nutrition Examination Survey (NHANES) from January 1, 1999, to December 31, 2018. Thyroid disease was defined as patients who reported having a thyroid disease and were on thyroid related treatment...

OBJECTIVE: In the last decade, new systemic treatment options have been made available for patients with advanced thyroid cancer. However, little is known about the real-world utilization of these systemic therapies. METHODS: We used the Optum Clinformatics database to characterize trends in the use of 15 systemic therapies that are available for treatment of advanced thyroid cancer between 2013-2021. Joinpoint regression was used to calculate annual percentage changes (APCs) in use of systemic therapy by patients' race/ethnicity...

OBJECTIVE: To examine the extent to which metformin increases the risk of vitamin B12 deficiency and borderline deficiency over time in participants with type 2 diabetes (T2DM). METHODS: Using the All of Us database, adults aged 18 or older with T2DM and a documented history of metformin use were included for evaluation of B12 deficiency. Those with B12 deficiency prior to metformin use were excluded. Adjusted logistic regression models were used to evaluate the association between metformin use and long-term metformin use (≥4 years), and the risk of B12 deficiency...

OBJECTIVE: To evaluate discriminant and convergent validity of the Hypoglycemia Awareness Questionnaire Impaired Awareness subscale (HypoA-Q IA) and establish a diagnostic threshold for classification of impaired awareness of hypoglycemia (IAH) in adults with type 1 diabetes (T1D). METHODS: 21 adults with T1D (48% male; median age 36 years and T1D duration 21 years) completed HypoA-Q IA, Clarke, and hypoglycemia severity (HYPO) scores, continuous glucose monitoring (CGM), and hyperinsulinemic hypoglycemic clamp testing...

BACKGROUND: Small molecule inhibitors (SMI) are targeted therapies increasingly used in advanced thyroid carcinomas. This study aimed to evaluate survival outcomes of thyroid cancer on SMI treatment, including in patients with brain metastases. METHODS: This retrospective study included patients with thyroid carcinomas who received at least one SMI between 2008-2022 at a tertiary-level, academic institution. SMI included lenvatinib, sorafenib, dabrafenib-trametinib, selpercatinib, and cabozantinib...