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Special Article
Adrenal gland
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism
Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung, The Committee of Clinical Practice Guideline of Korean Endocrine Society, The Korean Adrenal Study Group of Korean Endocrine Society
Endocrinol Metab. 2023;38(6):597-618.   Published online October 13, 2023
DOI: https://doi.org/10.3803/EnM.2023.1789
  • 8,200 View
  • 936 Download
  • 7 Web of Science
  • 10 Crossref
AbstractAbstract PDFPubReader   ePub   
Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

Citations

Citations to this article as recorded by  
  • Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism
    Naoki Fujiwara, Tatsuya Haze, Hiromichi Wakui, Kouichi Tamura, Mika Tsuiki, Kohei Kamemura, Daisuke Taura, Takamasa Ichijo, Yutaka Takahashi, Minemori Watanabe, Hiroki Kobayashi, Toshifumi Nakamura, Shoichiro Izawa, Norio Wada, Tetsuya Yamada, Kenichi Yok
    Hypertension Research.2025; 48(2): 540.     CrossRef
  • Major Adverse Cardiovascular Events in Primary Aldosteronism After Adrenalectomy or Mineralocorticoid Receptor Antagonist Treatment: A Systematic Review and Meta‐Analysis
    Chien‐Wei Huang, Tse‐Ying Huang, Ya‐Fei Yang, Li‐Yang Chang, Yu‐Kang Tu, Vin‐Cent Wu, Jui‐Yi Chen
    Journal of the American Heart Association.2025;[Epub]     CrossRef
  • Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
    Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
    The Journal of Clinical Endocrinology & Metabolism.2024; 109(8): e1582.     CrossRef
  • Temporal trends in clinical features of patients with primary aldosteronism over 20 years
    Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Jung-Min Koh, Seung Hun Lee, Jung Hee Kim
    Hypertension Research.2024; 47(8): 2019.     CrossRef
  • Primary aldosteronism: An underdiagnosed clinical entity
    Peeyush Jain, Atul Kaushik, Nilashish Dey, Ashwani Mehta, Shaloo Kapoor, Chhavi Agrawal
    Journal of Current Cardiology.2024; 2(2): 65.     CrossRef
  • Historical changes in the clinical features of primary aldosteronism
    Takamasa Ichijo
    Hypertension Research.2024; 47(10): 2926.     CrossRef
  • Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism
    Marco Marcelli, Caixia Bi, John W. Funder, Michael J. McPhaul
    Hypertension.2024; 81(10): 2072.     CrossRef
  • Screening and treatment of endocrine hypertension focusing on adrenal gland disorders: a narrative review
    Seung Min Chung
    Journal of Yeungnam Medical Science.2024; 41(4): 269.     CrossRef
  • Diagnostic efficacy of aldosterone-to-renin ratio to screen primary aldosteronism in hypertension: a systemic review and meta-analysis
    Ting-Wei Kao, Jui-Yi Chen, Jung-Hua Liu, Wen-Hsin Tseng, Chih-Chia Hsieh, Vin-Cent Wu, Yen-Hung Lin, Zheng-Wei Chen
    Therapeutic Advances in Endocrinology and Metabolism.2024;[Epub]     CrossRef
  • Comparative Analysis of Liquid Chromatography-Tandem Mass Spectrometry and Radioimmunoassay in Determining Plasma Aldosterone Concentration and Plasma Renin Activity for Primary Aldosteronism Screening
    So Yoon Kwon, Kyeong-Jin Kim, Soo-Youn Lee, Jae Hyeon Kim
    Endocrinology and Metabolism.2024; 39(6): 965.     CrossRef
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Review Articles
Adrenal gland
The Fascinating Interplay between Growth Hormone, Insulin-Like Growth Factor-1, and Insulin
Eline C. Nijenhuis-Noort, Kirsten A. Berk, Sebastian J. C. M. M. Neggers, Aart J. van der Lely
Endocrinol Metab. 2024;39(1):83-89.   Published online January 9, 2024
DOI: https://doi.org/10.3803/EnM.2024.101
  • 42,046 View
  • 713 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   ePub   
This review intends to provide the reader with a practical overview of several (patho)physiological conditions in which knowledge of the interplay between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin is important. This might help treating physicians in making the right decisions on how to intervene and improve metabolism for the benefit of patients, and to understand why and how metabolism responds in their specific cases. We will specifically address the interplay between GH, IGF-1, and insulin in type 1 and 2 diabetes mellitus, liver cirrhosis, and acromegaly as examples in which this knowledge is truly necessary.

Citations

Citations to this article as recorded by  
  • Insulin-Like Growth Factor Signaling in Alzheimer’s Disease: Pathophysiology and Therapeutic Strategies
    Jie Miao, Yanli Zhang, Chen Su, Qiandan Zheng, Junhong Guo
    Molecular Neurobiology.2025; 62(3): 3195.     CrossRef
  • Signaling pathways and targeted therapies in Ewing sarcoma
    Ke Jia, Li Cao, Yihan Yu, Doudou Jing, Wei Wu, Brian Andrew Van Tine, Zengwu Shao
    Pharmacology & Therapeutics.2025; 266: 108765.     CrossRef
  • IGF-1 and IGF-2 as Molecules Linked to Causes and Consequences of Obesity from Fetal Life to Adulthood: A Systematic Review
    Justyna Szydlowska-Gladysz, Adrianna Edyta Gorecka, Julia Stepien, Izabela Rysz, Iwona Ben-Skowronek
    International Journal of Molecular Sciences.2024; 25(7): 3966.     CrossRef
  • Insulin resistance reduction, intermittent fasting, and human growth hormone: secondary analysis of a randomized trial
    Benjamin D. Horne, Jeffrey L. Anderson, Heidi T. May, Tami L. Bair, Viet T. Le, Leslie Iverson, Kirk U. Knowlton, Joseph B. Muhlestein
    npj Metabolic Health and Disease.2024;[Epub]     CrossRef
  • GHRH in diabetes and metabolism
    Charlotte Steenblock, Stefan R. Bornstein
    Reviews in Endocrine and Metabolic Disorders.2024;[Epub]     CrossRef
  • Growth hormone/insulin-like growth factor I axis in health and disease states: an update on the role of intra-portal insulin
    Kevin C. J. Yuen, Rikke Hjortebjerg, Ashok Ainkaran Ganeshalingam, David R. Clemmons, Jan Frystyk
    Frontiers in Endocrinology.2024;[Epub]     CrossRef
  • Expanding the Clinical and Mutational Spectrum of Biallelic POC1A Variants: Characterization of Four Patients and a Comprehensive Review of POC1A‐Related Phenotypes
    Umut Altunoglu, Gozde Tutku Turgut, Esin Karakılıç Özturan, Tuğba Kalaycı, Mert Kaya, Güven Toksoy, Firdevs Baş, Hülya Kayserili, Feyza Darendeliler
    Clinical Genetics.2024;[Epub]     CrossRef
Close layer
Adrenal Gland
Recent Updates on the Management of Adrenal Incidentalomas
Seung Shin Park, Jung Hee Kim
Endocrinol Metab. 2023;38(4):373-380.   Published online August 16, 2023
DOI: https://doi.org/10.3803/EnM.2023.1779
  • 16,743 View
  • 2,327 Download
  • 3 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   ePub   
Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. This paper provides a concise review of the updated contents of the revised guideline. In the 2023 guideline, in patients without signs and symptoms of overt Cushing’s syndrome, a post-dexamethasone cortisol level above 50 nmol/L (>1.8 μg/dL) should be considered as mild autonomous cortisol secretion. Regarding the criteria of benign adrenal adenomas, a homogeneous adrenal mass with ≤10 Hounsfield units on non-contrast computed tomography requires no further follow-up, irrespective of its size. The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (<40 years) and pregnant women. This review of the 2023 ESE guideline underscores the ongoing evolution of the adrenal incidentaloma management landscape, emphasizing the need for further research and adaptation of diagnostic and therapeutic strategies.

Citations

Citations to this article as recorded by  
  • Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach
    Mara Carsote, Mihai-Lucian Ciobica, Oana-Claudia Sima, Adrian Ciuche, Ovidiu Popa-Velea, Mihaela Stanciu, Florina Ligia Popa, Claudiu Nistor
    Cancers.2024; 16(10): 1868.     CrossRef
  • Temporal trends in clinical features of patients with primary aldosteronism over 20 years
    Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Jung-Min Koh, Seung Hun Lee, Jung Hee Kim
    Hypertension Research.2024; 47(8): 2019.     CrossRef
  • Steroid Profiling in the Differential Diagnosis of Cushing's Syndrome and Diagnosis of MACS
    A. Nankova, T. Kamenova, V. Vasilev, At. Elenkova, D. Svinarov, G. Kirilov, S. Zaharieva
    Acta Medica Bulgarica.2024; 51(2): 1.     CrossRef
  • Adrenal incidentalomas
    Ivana Ságová
    Vnitřní lékařství.2024; 70(5): E9.     CrossRef
  • Ectopic Mediastinal Thyroid: A Crossroad Between a Multi-Layered Endocrine Perspective and a Contemporary Approach in Thoracic Surgery
    Claudiu Nistor, Mihai-Lucian Ciobica, Oana-Claudia Sima, Anca-Pati Cucu, Florina Vasilescu, Lucian-George Eftimie, Dana Terzea, Mihai Costachescu, Adrian Ciuche, Mara Carsote
    Life.2024; 14(11): 1374.     CrossRef
  • Mature Adrenal Ganglioneuroma With Lipomatous Content: A Radiological and Histopathological Diagnostic Challenge
    Mohammed Lameir Hussein, Shams O Alkhateeb, Jouhar J Kolleri, Ala' Saleem Abu-Dayeh, Khaled Murshed, Nabil Sherif Mahmood
    Cureus.2024;[Epub]     CrossRef
  • Comparative Analysis of Liquid Chromatography-Tandem Mass Spectrometry and Radioimmunoassay in Determining Plasma Aldosterone Concentration and Plasma Renin Activity for Primary Aldosteronism Screening
    So Yoon Kwon, Kyeong-Jin Kim, Soo-Youn Lee, Jae Hyeon Kim
    Endocrinology and Metabolism.2024; 39(6): 965.     CrossRef
Close layer
Adrenal gland
A Contemporary Approach to the Diagnosis and Management of Adrenal Insufficiency
Suranut Charoensri, Richard J. Auchus
Endocrinol Metab. 2024;39(1):73-82.   Published online January 22, 2024
DOI: https://doi.org/10.3803/EnM.2024.1894
  • 6,861 View
  • 1,226 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   ePub   
Adrenal insufficiency (AI) can be classified into three distinct categories based on its underlying causes: primary adrenal disorders, secondary deficiencies in adrenocorticotropin, or hypothalamic suppression from external factors, most commonly glucocorticoid medications used for anti-inflammatory therapy. The hallmark clinical features of AI include fatigue, appetite loss, unintentional weight loss, low blood pressure, and hyponatremia. Individuals with primary AI additionally manifest skin hyperpigmentation, hyperkalemia, and salt craving. The diagnosis of AI is frequently delayed due to the non-specific symptoms and signs early in the disease course, which poses a significant challenge to its early detection prior to an adrenal crisis. Despite the widespread availability of lifesaving glucocorticoid medications for decades, notable challenges persist, particularly in the domains of timely diagnosis while simultaneously avoiding misdiagnosis, patient education for averting adrenal crises, and the determination of optimal replacement therapies. This article reviews recent advancements in the contemporary diagnostic strategy and approaches to optimal treatment for AI.

Citations

Citations to this article as recorded by  
  • Adrenal insufficiency in severely wounded men with combat gunshot injury
    N.Yu. Seliukova, K.V. Misiura, E.M. Khoroshun, V.V. Makarov, V.V. Nehoduiko, O.I. Zalyubovska, E. Szucsik
    INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 20(8): 573.     CrossRef
  • Post-Traumatic Hypopituitarism
    Nissa Blocher
    Current Physical Medicine and Rehabilitation Reports.2024; 12(4): 405.     CrossRef
  • Severe Fatigue in Uncontrolled Asthma: Contributing Factors and Impact of Rehabilitation
    Karin B. Fieten, Lianne ten Have, Linde N. Nijhof, Lucia Rijssenbeek-Nouwens, Anneke ten Brinke
    The Journal of Allergy and Clinical Immunology: In Practice.2024; 12(12): 3292.     CrossRef
  • Adrenal Insufficiency in Patients with Beta Thalassemia: A Meta-Analysis
    Christos Savvidis, Dimitra Ragia, Sophia Delicou, Aikaterini Xydaki, Manfredi Rizzo, Ioannis Ilias
    Medicina.2024; 60(10): 1571.     CrossRef
  • 長期間の呼吸管理および遷延する低血圧から診断に至ったACTH単独欠損症の1例(A case of isolated ACTH deficiency diagnosed after long–term respiratory management and persistent hypotension)
    古谷 慎太郎, 神山 治郎, 多喜 亘, 山本 大輔, 五木田 昌士, 田口 茂正, 清田 和也
    Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine.2024; 35(12): 965.     CrossRef
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Hypothalamus and pituitary gland
Update on Current Evidence for the Diagnosis and Management of Nonfunctioning Pituitary Neuroendocrine Tumors
Elizabeth Whyte, Masahiro Nezu, Constance Chik, Toru Tateno
Endocrinol Metab. 2023;38(6):631-654.   Published online November 15, 2023
DOI: https://doi.org/10.3803/EnM.2023.1838
  • 6,209 View
  • 356 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   ePub   
Pituitary neuroendocrine tumors (PitNETs) are the third most frequently diagnosed intracranial tumors, with nonfunctioning PitNETs (nfPitNETs) accounting for 30% of all pituitary tumors and representing the most common type of macroPitNETs. NfPitNETs are usually benign tumors with no evidence of hormone oversecretion except for hyperprolactinemia secondary to pituitary stalk compression. Due to this, they do not typically present with clinical syndromes like acromegaly, Cushing’s disease or hyperthyroidism and instead are identified incidentally on imaging or from symptoms of mass effects (headache, vision changes, apoplexy). With the lack of effective medical interventions, first-line treatment is transsphenoidal surgical resection, however, nfPitNETs often have supra- or parasellar extension, and total resection of the tumor is often not possible, resulting in residual tumor regrowth or reoccurrence. While functional PitNETs can be easily followed for recurrence using hormonal biomarkers, there is no similar parameter to predict recurrence in nfPitNETs, hence delaying early recognition and timely management. Therefore, there is a need to identify prognostic biomarkers that can be used for patient surveillance and as therapeutic targets. This review focuses on summarizing the current evidence on nfPitNETs, with a special focus on potential new biomarkers and therapeutics.

Citations

Citations to this article as recorded by  
  • Phenotype Transformation of PitNETs
    Zhenwei Li, Yinzi Wu, Guannan He, Renzhi Wang, Xinjie Bao
    Cancers.2024; 16(9): 1731.     CrossRef
  • Donor–Acceptor–Donor Strategy Rouses the Photodynamic Therapy Anticancer Activity of a Bis-terpyridyl Ru(II) Complex
    Zhongyu Wang, Li Wei, Junfeng Lin, Can Huang, Huitong Chen, Dong Fan, Weiyu Hu, Jing Liu, Huaiyi Huang, Zongming Wang, Xin Wang
    Journal of Medicinal Chemistry.2024; 67(15): 13435.     CrossRef
  • A Study in Pituitary Neuroendocrine Tumors (PitNETs): Real-Life Data Amid Baseline and Serial CT Scans
    Mihai Costachescu, Oana-Claudia Sima, Mihaela Stanciu, Ana Valea, Mara Carsote, Claudiu Nistor, Mihai-Lucian Ciobica
    Cancers.2024; 16(20): 3477.     CrossRef
  • Editorial: Prognostic factors in pituitary tumors: clinical, biochemical, imaging, and pathological aspects
    Toru Tateno, Roxana-Ioana Dumitriu Stan, Stephanie Du Four
    Frontiers in Endocrinology.2024;[Epub]     CrossRef
  • Adaptive evaluation of gross total resection rates for endoscopic endonasal approach based on preoperative MRI morphological features of pituitary adenomas
    Ao Shen, Yue Min, Dongjie Zhou, Lirui Dai, Liang Lyu, Wenyi Zhan, Shu Jiang, Peizhi Zhou
    Frontiers in Oncology.2024;[Epub]     CrossRef
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Original Article
Adrenal gland
Big Data Articles (National Health Insurance Service Database)
Mortality and Severity of Coronavirus Disease 2019 in Patients with Long-Term Glucocorticoid Therapy: A Korean Nationwide Cohort Study
Eu Jeong Ku, Keeho Song, Kyoung Min Kim, Gi Hyeon Seo, Soon Jib Yoo
Endocrinol Metab. 2023;38(2):253-259.   Published online March 21, 2023
DOI: https://doi.org/10.3803/EnM.2022.1607
  • 3,828 View
  • 115 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
The severity of coronavirus disease 2019 (COVID-19) among patients with long-term glucocorticoid treatment (LTGT) has not been established. We aimed to evaluate the association between LTGT and COVID-19 prognosis.
Methods
A Korean nationwide cohort database of COVID-19 patients between January 2019 and September 2021 was used. LTGT was defined as exposure to at least 150 mg of prednisolone (≥5 mg/day and ≥30 days) or equivalent glucocorticoids 180 days before COVID-19 infection. The outcome measurements were mortality, hospitalization, intensive care unit (ICU) admission, length of stay, and mechanical ventilation.
Results
Among confirmed patients with COVID-19, the LTGT group (n=12,794) was older and had a higher proportion of comorbidities than the control (n=359,013). The LTGT group showed higher in-hospital, 30-day, and 90-day mortality rates than the control (14.0% vs. 2.3%, 5.9% vs. 1.1%, and 9.9% vs. 1.8%, respectively; all P<0.001). Except for the hospitalization rate, the length of stay, ICU admission, and mechanical ventilation proportions were significantly higher in the LTGT group than in the control (all P<0.001). Overall mortality was higher in the LTGT group than in the control group, and the significance remained in the fully adjusted model (odds ratio [OR], 5.75; 95% confidence interval [CI], 5.31 to 6.23) (adjusted OR, 1.82; 95% CI, 1.67 to 2.00). The LTGT group showed a higher mortality rate than the control within the same comorbidity score category.
Conclusion
Long-term exposure to glucocorticoids increased the mortality and severity of COVID-19. Prevention and early proactive measures are inevitable in the high-risk LTGT group with many comorbidities.

Citations

Citations to this article as recorded by  
  • Hormonal Implications of SARS‐CoV‐2: A Review of Endocrine Disruptions
    Aliya Yskak, Yevgeniy Sokharev, Kuanysh Zhumalynov, Elizaveta Koneva, Natalia Afanasyeva, Dmitri Borodulin, Dmitrii Babaskin, Almabek Nugmanov, Murat Nurushev, Vadim Chashkov, Gianmarco Ferrara
    Scientifica.2025;[Epub]     CrossRef
  • Outpatient glucocorticoid use and COVID-19 outcomes: a population-based study
    Almudena Rodríguez-Fernández, Irene Visos-Varela, Maruxa Zapata-Cachafeiro, Samuel Pintos-Rodríguez, Rosa M. García-Álvarez, Teresa M. Herdeiro, María Piñeiro-Lamas, Adolfo Figueiras, Ángel Salgado-Barreira, Rosendo Bugarín-González, Eduardo Carracedo-Mar
    Inflammopharmacology.2024; 32(4): 2305.     CrossRef
  • Glucocorticoids as a Double-Edged Sword in the Treatment of COVID-19: Mortality and Severity of COVID-19 in Patients Receiving Long-Term Glucocorticoid Therapy
    Eun-Hee Cho
    Endocrinology and Metabolism.2023; 38(2): 223.     CrossRef
  • Pituitary Diseases and COVID-19 Outcomes in South Korea: A Nationwide Cohort Study
    Jeonghoon Ha, Kyoung Min Kim, Dong-Jun Lim, Keeho Song, Gi Hyeon Seo
    Journal of Clinical Medicine.2023; 12(14): 4799.     CrossRef
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Songwon Lecture 2022
Hypothalamus and pituitary gland
Multiomics Approach to Acromegaly: Unveiling Translational Insights for Precision Medicine
Kyungwon Kim, Cheol Ryong Ku, Eun Jig Lee
Endocrinol Metab. 2023;38(5):463-471.   Published online October 13, 2023
DOI: https://doi.org/10.3803/EnM.2023.1820
  • 3,449 View
  • 182 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
The clinical characteristics and prognoses of acromegaly vary among patients. Assessment of current and novel predictors can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and a reduction in the increased morbidity and mortality associated with acromegaly. Despite advances in the diagnosis and treatment of acromegaly, its pathophysiology remains unclear. Recent advancements in multiomics technologies, including genomics, transcriptomics, proteomics, metabolomics, and radiomics, have offered new opportunities to unravel the complex pathophysiology of acromegaly. This review comprehensively explores the emerging role of multiomics approaches in elucidating the molecular landscape of acromegaly. We discuss the potential implications of multiomics data integration in the development of novel diagnostic tools, identification of therapeutic targets, and the prospects of precision medicine in acromegaly management. By integrating diverse omics datasets, these approaches can provide valuable insights into disease mechanisms, facilitate the identification of diagnostic biomarkers, and identify potential therapeutic targets for precision medicine in the management of acromegaly.

Citations

Citations to this article as recorded by  
  • “Micromegaly”: Acromegaly with apparently normal GH, an entity on its own?
    Lucio Vilar, Luciana Ansaneli Naves, Manoel Ricardo Alves Martins, Antônio Ribeiro-Oliveira Jr
    Best Practice & Research Clinical Endocrinology & Metabolism.2024; 38(3): 101878.     CrossRef
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Original Articles
Hypothalamus and pituitary gland
Clinical Characteristics, Diagnosis, and Treatment of Thyroid Stimulating Hormone-Secreting Pituitary Neuroendocrine Tumor (TSH PitNET): A Single-Center Experience
Jung Heo, Yeon-Lim Suh, Se Hoon Kim, Doo-Sik Kong, Do-Hyun Nam, Won-Jae Lee, Sung Tae Kim, Sang Duk Hong, Sujin Ryu, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Jae Hyeon Kim, Kyu Yeon Hur
Endocrinol Metab. 2024;39(2):387-396.   Published online February 5, 2024
DOI: https://doi.org/10.3803/EnM.2023.1877
  • 3,135 View
  • 114 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Thyroid-stimulating hormone (TSH)-secreting pituitary neuroendocrine tumor (TSH PitNET) is a rare subtype of PitNET. We investigated the comprehensive characteristics and outcomes of TSH PitNET cases from a single medical center. Also, we compared diagnostic methods to determine which showed superior sensitivity.
Methods
A total of 17 patients diagnosed with TSH PitNET after surgery between 2002 and 2022 in Samsung Medical Center was retrospectively reviewed. Data on comprehensive characteristics and treatment outcomes were collected. The sensitivities of diagnostic methods were compared.
Results
Seven were male (41%), and the median age at diagnosis was 42 years (range, 21 to 65); the median follow-up duration was 37.4 months. The most common (59%) initial presentation was hyperthyroidism-related symptoms. Hormonal co-secretion was present in four (23%) patients. Elevated serum alpha-subunit (α-SU) showed the greatest diagnostic sensitivity (91%), followed by blunted response at thyrotropin-releasing hormone (TRH) stimulation (80%) and elevated sex hormone binding globulin (63%). Fourteen (82%) patients had macroadenoma, and a specimen of one patient with heavy calcification was negative for TSH. Among 15 patients who were followed up for more than 6 months, 10 (67%) achieved hormonal and structural remission within 6 months postoperatively. A case of growth hormone (GH)/TSH/prolactin (PRL) co-secreting mixed gangliocytoma-pituitary adenoma (MGPA) was discovered.
Conclusion
The majority of the TSH PitNET cases was macroadenoma, and 23% showed hormone co-secretion. A rare case of GH/TSH/PRL co-secreting MGPA was discovered. Serum α-SU and TRH stimulation tests showed great diagnostic sensitivity. Careful consideration is needed in diagnosing TSH PitNET. Achieving remission requires complete tumor resection. In case of nonremission, radiotherapy or medical therapy can improve the long-term remission rate.

Citations

Citations to this article as recorded by  
  • TSH-secreting pituitary adenomas and bone
    Marco Losa, Alberto Vassallo, Stefano Frara, Pietro Mortini, Andrea Giustina
    Pituitary.2024; 27(6): 752.     CrossRef
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Hypothalamus and pituitary gland
Preoperative Serum Copeptin Can Predict Delayed Hyponatremia after Pituitary Surgery in the Absence of Arginine Vasopressin Deficiency
Ho Kang, Seung Shin Park, Yoo Hyung Kim, Hwan Sub Lim, Mi-Kyeong Lee, Kyoung-Ryul Lee, Jung Hee Kim, Yong Hwy Kim
Endocrinol Metab. 2024;39(1):164-175.   Published online January 3, 2024
DOI: https://doi.org/10.3803/EnM.2023.1792
  • 2,025 View
  • 80 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Delayed postoperative hyponatremia (DPH) is the most common cause of readmission after pituitary surgery. In this study, we aimed to evaluate the cutoff values of serum copeptin and determine the optimal timing for copeptin measurement for the prediction of the occurrence of DPH in patients who undergo endoscopic transsphenoidal approach (eTSA) surgery and tumor resection.
Methods
This was a prospective observational study of 73 patients who underwent eTSA surgery for pituitary or stalk lesions. Copeptin levels were measured before surgery, 1 hour after extubation, and on postoperative days 1, 2, 7, and 90.
Results
Among 73 patients, 23 patients (31.5%) developed DPH. The baseline ratio of copeptin to serum sodium level showed the highest predictive performance (area under the curve [AUROC], 0.699), and its optimal cutoff to maximize Youden’s index was 2.5×10–11, with a sensitivity of 91.3% and negative predictive value of 92.0%. No significant predictors were identified for patients with transient arginine vasopressin (AVP) deficiency. However, for patients without transient AVP deficiency, the copeptin-to-urine osmolarity ratio at baseline demonstrated the highest predictive performance (AUROC, 0.725). An optimal cutoff of 6.5×10–12 maximized Youden’s index, with a sensitivity of 92.9% and a negative predictive value of 94.1%.
Conclusion
The occurrence of DPH can be predicted using baseline copeptin and its ratio with serum sodium or urine osmolarity only in patients without transient AVP deficiency after pituitary surgery.

Citations

Citations to this article as recorded by  
  • Impact Factors of Blood Copeptin Levels in Health and Disease States
    Yutong Wang, Shirui Wang, Siyu Liang, Xinke Zhou, Xiaoyuan Guo, Bochuan Huang, Hui Pan, Huijuan Zhu, Shi Chen
    Endocrine Practice.2024; 30(12): 1197.     CrossRef
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Hypothalamus and pituitary gland
Obstructive Sleep Apnea Screening and Effects of Surgery in Acromegaly: A Prospective Study
Jaeyoung Cho, Jung Hee Kim, Yong Hwy Kim, Jinwoo Lee
Endocrinol Metab. 2024;39(4):641-652.   Published online June 26, 2024
DOI: https://doi.org/10.3803/EnM.2024.1933
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Background
To identify a screening tool for obstructive sleep apnea (OSA) and evaluate the effects of endoscopic transsphenoidal surgery on improving OSA in patients with acromegaly.
Methods
We prospectively enrolled adults with acromegaly scheduled for endoscopic transsphenoidal surgery. All measurements were conducted when participants were admitted for a baseline work-up for acromegaly before surgery and surveillance approximately 3 to 6 months after surgery. Respiratory event index (REI) was used as a surrogate for apnea-hypopnea index (Trial Registration: NCT03526016).
Results
Of the 35 patients with acromegaly (median age, 47 years; 40% men; median body mass index, 24.4 kg/m2), 24 (68.6%) had OSA (REI ≥5/hour), 15 (42.9%) had moderate-to-severe OSA (REI ≥15/hour). At baseline, serum insulin-like growth factor 1 (IGF-1) levels were positively correlated with the REI (ρ=0.53, P=0.001). The sensitivity and negative predictive value of a Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, age, Neck circumference, and Gender (STOP-Bang) score ≥ 3 were 93.3% and 87.5%, respectively, detecting moderate-to-severe OSA. Biochemical acromegaly remission was achieved in 32 (91.4%) patients. The median difference in the REI was –9.5/hour (95% confidence interval, –13.3 to –5.3). Half of the 24 patients diagnosed with OSA preoperatively had REI <5/hour postoperatively. In a linear mixed-effects model, changes in the REI across surgery were related to changes in IGF-1 levels.
Conclusion
The STOP-Bang questionnaire is a reliable tool for OSA among patients with acromegaly. Improvement in OSA severity after surgery is related to decreased IGF-1 levels.

Citations

Citations to this article as recorded by  
  • How Different Treatments for Acromegaly Modulate Sleep Quality: A Psychometric Study
    Gaspare Alfì, Danilo Menicucci, Dalì Antonia Ciampa, Vito Di Giura, Giulia Marconcini, Claudio Urbani, Fausto Bogazzi, Angelo Gemignani
    Endocrines.2024; 5(3): 408.     CrossRef
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Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma
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AbstractAbstract PDFPubReader   ePub   
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