Dehydroepiandrosterone Sulfate in Diagnosing Mild Autonomous Cortisol Secretion and Adrenal Insufficiency.

Context: Data on diagnostic accuracy of dehydroepiandrosterone sulfate (DHEA-S) for mild autonomous cortisol secretion (MACS) and adrenal insufficiency (AI) are discrepant.

Objective: We conducted a systematic review and meta-analysis of published studies assessing the accuracy of DHEA-S in diagnosing MACS or AI.

Methods: From inception to January 8, 2024, we searched databases for original studies of at least 20 participants with MACS or AI.

Mentorship in endocrinology training: a cross-sectional study of the United States and Europe.

Background: Mentorship is crucial for developing both scientific and professional competencies in medical training, yet its role in endocrinology training remains underexplored. We aimed to assess the prevalence of mentorship in endocrinology trainees, analyse demographic and training programme factors, and evaluate the impact of mentor characteristics on trainee outcomes.

Methods: We conducted a cross-sectional study of endocrinology trainees in the United States and Europe (23 countries) between June 2023 to January 2024.

A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on Management of Primary Aldosteronism.

Context: Primary aldosteronism (PA) is a leading endocrine cause of secondary hypertension.

Objective: To support the development of the Endocrine Society Clinical Practice Guideline on managing PA.

Data Source: MEDLINE, Embase, Scopus, and others were searched on October 4, 2024.

A supervised machine learning approach for predicting the need for postsurgical intervention in acromegaly.

Objective: Patients with growth hormone (GH)-secreting pituitary adenomas (PAs) experience various symptoms and comorbidities, which can ultimately lead to increased mortality. This study aimed to develop and validate a machine learning (ML) model for predicting long-term outcomes in patients with GH-secreting PAs following endonasal transsphenoidal surgery (ETS).

Methods: The authors conducted a retrospective three-institution cohort study that included patients with GH-secreting PAs treated with ETS between 2013 and 2023.

Bilateral Adrenal Nodules Presenting With Mild Autonomous Cortisol Secretion.

Objective: Benign adrenocortical adenomas are frequently diagnosed on cross-sectional imaging performed for unrelated reasons. Up to 15% to 20% of adrenal nodules are bilateral, representing bilateral adenomas or primary bilateral macronodular adrenal hyperplasia.

Methods: Mild autonomous cortisol secretion (MACS), diagnosed based on an abnormal dexamethasone suppression test, is seen in 19% to 44% of patients with adrenal adenomas.

A global real-world study assessing total time to adrenalectomy in primary aldosteronism.

Background: Primary aldosteronism (PA) is a common treatable cause of hypertension. When caused by unilateral adrenal disease, it is potentially curable by adrenalectomy. However, specialized tests and other factors may delay definitive treatment.

Pituitary incidentaloma: a Pituitary Society international consensus guideline statement.

This Pituitary Society Consensus article presents an evidence-based consensus on the management of pituitary incidentaloma, defined as an unexpected sellar or parasellar finding incidentally discovered on an imaging study that was not performed for a clinically suspected pituitary lesion. Recommendations are offered for when endocrinology, neurosurgery and ophthalmology consultation, dedicated pituitary imaging, pituitary hormone testing and visual assessment are warranted for macroadenomas, microadenomas, cystic lesions and empty sella, as well as when surgical resection is indicated for incidental pituitary adenomas and cystic sellar lesions. Special considerations in patients with multiple endocrine neoplasia type 1, children and adolescents, older people, and pregnant women are addressed.

Pituitary Photon Counting Detector CT for Cushing Disease: Pre-operative Lesion Localization, Intraoperative Findings, and Post-operative Outcomes.

Background And Purpose: MRI fails to localize a tumor in up to 40% of cases of ACTH dependent Cushing Disease (CD), impacting patient outcomes and creating uncertainty in the diagnosis. Photon-counting detector CT (PCD-CT) is a new CT technology with better imaging performance than conventional CT. PCD-CT is a novel imaging technique for CD, especially for MR-negative cases, however its application to CD remains unknown.

Impact of hydrocortisone vs prednisone therapy on postsurgical recovery in patients with endogenous hypercortisolism: a prospective cohort study.

Objective: Glucocorticoid withdrawal syndrome (GWS) may develop in patients following successful surgery for endogenous hypercortisolism. Effective strategies to minimize GWS and improve quality of life (QoL) are currently lacking. We aimed to determine the impact of hydrocortisone vs prednisone therapy on GWS and QoL during the first 12 weeks postsurgery.

Genotype-specific neoplastic risk profiles in patients with VHL disease.

Hereditary tumor predisposition syndromes pose a challenge for early detection and timely treatment of tumors. In von Hippel-Lindau disease, desirable personalized surveillance programs are lacking due to insufficient data on genotype-specific risk profiles of individual mutations. To describe neoplastic risk profiles for carriers of pathogenic and likely pathogenic VHL germline mutations, our observational study recruited 1,350 participants from 40 centers worldwide.

Osilodrostat Treatment for Adrenal and Ectopic Cushing Syndrome: Integration of Clinical Studies With Case Presentations.

Although most cases of endogenous Cushing syndrome are caused by a pituitary adenoma (Cushing disease), approximately one-third of patients present with ectopic or adrenal causes. Surgery is the first-line treatment for most patients with Cushing syndrome; however, medical therapy is an important management option for those who are not eligible for, refuse, or do not respond to surgery. Clinical experience demonstrating that osilodrostat, an oral 11β-hydroxylase inhibitor, is effective and well tolerated comes predominantly from phase III trials in patients with Cushing disease.

Machine learning-based model to predict long-term tumor control and additional interventions following pituitary surgery for Cushing's disease.

Objective: In this study, the authors aimed to establish a supervised machine learning (ML) model based on multiple tree-based algorithms to predict long-term biochemical outcomes and intervention-free survival (IFS) after endonasal transsphenoidal surgery (ETS) in patients with Cushing's disease (CD).

Methods: The medical records of patients who underwent ETS for CD between 2013 and 2023 were reviewed. Data were collected on the patient's baseline characteristics, intervention details, histopathology, surgical outcomes, and postoperative endocrine functions.

Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery.

Objective: Stereotactic radiosurgery (SRS) offers excellent tumor control for pituitary adenoma (PA); however, treatment failure occasionally necessitates salvage surgery. Comprehensive studies on salvage surgical outcomes for recurrent PA after SRS remain scarce. This study aimed to elucidate the outcomes of salvage endonasal transsphenoidal surgery (sETS) for progressive PA failing SRS.

Glucocorticoid therapy in classic congenital adrenal hyperplasia: traditional and new treatment paradigms.

Introduction: Classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) is a rare genetic condition characterized by cortisol deficiency and excess adrenal androgens. CAH treatment is a lifelong balancing act between the need to reduce excess androgens, typically with supraphysiologic glucocorticoid (GC) doses, and concerns about potentially serious GC-related adverse events. Tradeoffs between the consequences of excess androgens versus GCs must be constantly reassessed throughout each patient's lifetime, based on current clinical needs and treatment goals.

Cognition in patients with mild autonomous cortisol secretion at baseline and post-adrenalectomy.

Objectives: The impact of mild autonomous cortisol secretion (MACS) on cognition is incompletely characterized. We aimed to assess cognition in patients with MACS, identify factors associated with lower cognition, and determine the impact of adrenalectomy on cognition.

Methods: We conducted a cross-sectional study (4/2019 to 10/2022) and a longitudinal cohort study (10/2021 to 9/2023) of adults with MACS and referent subjects.

Women With Congenital Adrenal Hyperplasia Have Favorable Pregnancy Outcomes but Prolonged Time to Conceive.

Objective: To study pregnancy outcomes and complications in women with congenital adrenal hyperplasia (CAH).

Methods: A retrospective multicenter study was conducted at tertiary reference centers in 5 countries (Austria, Germany, Italy, Sweden, USA), including 72 adult women with CAH (nonclassic [NC] n = 34, simple virilizing [SV] n = 21, salt wasting [SW] n = 17).

Results: A total of 133 pregnancies, 112 live births, and 25 abortions were documented.

Performance of Dehydroepiandrosterone Sulfate and Baseline Cortisol in Assessing Adrenal Insufficiency.

Context: Diagnosing adrenal insufficiency (AI) often requires complex testing, which can be time-consuming and expensive. Dehydroepiandrosterone sulfate (DHEAS) is a promising marker of hypothalamic-pituitary-adrenal axis function; however, its diagnostic performance has not yet been evaluated in a large-scale study.

Objective: Evaluate the performance of DHEAS and baseline cortisol in assessing AI.

Contrast-Enhanced CISS/FIESTA Imaging for Increased Conspicuity of Pituitary Microadenomas in Cushing Disease.

Background And Purpose: Pituitary microadenomas can be challenging to see on MRI, particularly when they are small. The detection of microadenomas commonly relies on contrast-enhanced sequences, highlighting the adenoma that demonstrates hypoenhancement relative to the native pituitary gland on T1-weighted sequences. Detecting adenomas in patients with Cushing disease is crucial because surgery is the standard of care treatment.