Developed to treat type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with a reduced risk of cardiovascular events in high-risk patients with diabetes, and later in obese patients with cardiovascular disease without diabetes. More recently, semaglutide and tirzepatide have demonstrated benefits in obese patients with heart failure (HF) with preserved or mildly reduced ejection fraction, including fewer HF hospitalisations and improvements in symptoms and functional capacity. Data remain limited in heart failure with reduced ejection fraction. This article summarises current evidence on these therapies, particularly in HF, and provides practical guidance for their prescription and follow-up. Les agonistes du récepteur du glucagon-likepeptide-1 développés comme traitement dans le diabète de type 2, puis dans l’obésité, ont été associés à une diminution du risque d’événements cardiovasculaires chez les diabétiques à haut risque, puis chez les patients obèses atteints de maladies cardiovasculaires sans diabète. Plus récemment, le sémaglutide et le tirzépatide ont montré des bénéfices chez ces patients obèses atteints d’insuffisance cardiaque (IC) à fraction d’éjection préservée ou modérément réduite, avec moins d’hospitalisation pour IC et une amélioration des symptômes et de la capacité fonctionnelle. Les données restent limitées dans l’IC à fraction d’éjection réduite. Cet article synthétise les données actuelles sur ces traitements, notamment dans l’IC, et propose des repères pratiques pour leur prescription et leur suivi.
Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population. HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA1c, kidney function, geriatric status, and metformin use. At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio [95% CI] 1.51 [1.11; 2.06], 1.25 [1.02; 1.53], and 1.76 [1.21; 2.56] for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 [0.32; 0.99]), whereas TIR > 50% and TBR ≤ 1% were not. Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
Antipsychotic drugs are essential for managing psychotic disorders but they increase the risk of diabetes and metabolic syndrome, leading to higher cardiovascular morbidity and mortality. This risk varies between agents, with clozapine and olanzapine showing the highest liability. Mechanisms involve both central hypothalamic effects and peripheral actions on the pancreas, liver, muscle, and adipose tissue, leading to insulin resistance and hormonal dysregulation, sometimes independent of weight gain. Despite longstanding guidelines, metabolic monitoring remains poorly implemented. Systematic screening and early preventive and therapeutic strategies are essential to reduce these complications. Les antipsychotiques sont essentiels dans le traitement des troubles psychotiques mais augmentent le risque de diabète et de syndrome métabolique, responsables d’une morbidité cardiovasculaire accrue. Ce risque varie selon les molécules, la clozapine et l’olanzapine étant les plus impliquées. Les mécanismes incluent des effets centraux hypothalamiques et périphériques sur le pancréas, le foie, le muscle et le tissu adipeux, entraînant une insulinorésistance et une dysrégulation hormonale, indépendamment de la prise de poids. Malgré les recommandations de dépistage établies, leurs applications ne sont pas suffisamment mises en œuvre. Une surveillance métabolique systématique et des mesures préventives sont essentielles pour réduire les complications.
The renin-angiotensin system (RAS) constitutes an important cornerstone in blood pressure (BP) regulation. Previous evidence on the relationship between growth hormone (GH), insulin-like growth factor I (IGF-I), and the RAS is conflicting, depending on study conditions and exposure duration. This exploratory study therefore investigated the effects of short- and long-term GH excess on RAS activity. RAS activity was assessed in 10 healthy, male volunteers (26 ± 5years, BMI 23 ± 3.4 kg/m2) before and after 1 week of daily, subcutaneous GH treatment (2 mg) serving as model of short-term GH excess. Regarding long-term GH excess, RAS activity in 19 patients with active acromegaly (54 [48-59] years, 52.6% females, IGF-I/ULN 2.8 [2.3-3.3]) was compared to a cohort of 25 controls (39 [32-47] years, 76% females). In 12 patients, measurements were re-conducted after successful treatment of acromegaly. One week of GH treatment increased IGF-I concentrations to 1.6 ± 0.5 ULN and overall RAS activity, including angiotensin II levels (117.5 ± 50.3 pMol/L vs. 205.9 ± 135.7 pMol/L, P = .03) and the surrogate of renin activity (PRA-S: 149.8 ± 63.3 pMol/L vs. 269.1 ± 177.4 pMol/L, P = .03) alongside increased concentrations of insulin and C-peptide in healthy males. In contrast, patients with acromegaly showed lower concentrations of angiotensin II (47.2 [33-145] pMol/L vs. 155.3 [64-326] pMol/L, P = .017), aldosterone (118 [71-193] pMol/L vs. 227.8 [165-305] pMol/L, P = .009), and PRA-S(84.2 [51-200] pMol/L vs. 230 [85-403] pMol/L, P = .032) despite higher mean arterial BP(105 [99-115] mmHg vs. 91 [85-97] mmHg, P < .001) compared to controls. Short-term GH excess stimulates RAS activity which may be related to the increase in insulin and C-peptide. In contrast, RAS activity is down-regulated in long-term GH excess despite high BP.
According to recent meta-analyses of clinical studies, certain plants and spices improve glycemic control. This article presents several spices with clinically significant hypoglycemic effects that have been studied outside of pregnancy: ginger, psyllium, black cumin, nettle, cinnamon, fenugreek, aloe vera, and bitter melon. Regarding pregnancy, a pilot study conducted at the CHUV evaluated the feasibility of integrating some of these spices in women with gestational diabetes. Adherence was generally satisfactory, despite obstacles related to taste and practicality. When used in conjunction with conventional treatments, these spices could represent an additional dietary resource for diabetes management, provided that their use during pregnancy is supported by larger-scale clinical studies and implemented under appropriate clinical supervision. Selon les méta-analyses d’études cliniques récentes, certaines plantes alimentaires et épices améliorent le contrôle glycémique. Cet article présente plusieurs épices à effet hypoglycémiant cliniquement significatif étudiées en dehors de la grossesse : gingembre, psyllium, cumin noir, ortie, cannelle, fenugrec, aloe vera et melon amer. Pour la grossesse, une étude pilote menée au CHUV a évalué la faisabilité de l’intégration de certaines épices chez des femmes atteintes de diabète gestationnel. L’adhérence était globalement satisfaisante, malgré des obstacles liés au goût et à la praticité. Ces épices, utilisées en complément des traitements conventionnels, pourraient être une ressource diététique supplémentaire dans la gestion du diabète, sous réserve d’études de plus grande ampleur et d’un encadrement clinique pendant la grossesse.
PTH(1-34), used off-label, effectively controls serum calcium in patients with chronic hypoparathyroidism inadequately managed by standard-of-care therapy. PTH(1-34) also strongly stimulates bone remodeling and often raises bone turnover markers above normal levels. This study aimed to visually assess the risk of excessive bone stimulation associated with prolonged PTH(1-34) replacement therapy. An observational study (N°20201026100318) was conducted in adults with chronic hypoparathyroidism treated with PTH(1-34) for over 2 years at 3 referral centers. Patients underwent whole-body 99mTc-methylenediphosphonate scintigraphy, biochemical evaluation, and bone mineral density assessment. The primary endpoint was the proportion of patients with pathological increases in bone tracer uptake. Forty-one patients received a mean daily dose of 29.9 µg [Q1; Q3 22.5; 39.9] of PTH(1-34) for a duration of 57 months [40; 70], representing an exposure of 218.3 patient-years. Median age at imaging was 44 years [30; 55]; 31 (75.6%) were women. Pathological bone uptake was observed in 25 (61%) patients despite serum calcium predominantly in the target therapeutic values. Osteoarticular pain did not differentiate affected individuals. These patients had higher weight-adjusted PTH(1-34) doses (0.44 µg/kg [0.32; 0.56] vs 0.34 µg/kg [0.24;0.40], P = .045), elevated bone remodeling markers, lower serum magnesium, and increased urinary calcium excretion. A score combining serum C-telopeptides of collagen I, osteocalcin, and magnesium correctly classified 97% of patients (95% CI: 91%-100%). Long-term PTH(1-34) therapy in chronic hypoparathyroidism is frequently associated with excessive bone remodeling despite adequate calcemic control. Careful monitoring is therefore essential, especially in patients with elevated bone remodeling markers and hypomagnesemia.
McCune-Albright syndrome MAS is a rare mosaic disorder caused by post-zygotic GNAS activating mutations. MAS is characterized by fibrous dysplasia (FD) of the skeleton, café-au-lait skin macules, and hyperfunctioning endocrinopathies such as precocious puberty, thyroid disease, growth hormone excess, and FGF23-mediated phosphate wasting. Mosaicism leads to marked clinical heterogeneity and complicates molecular diagnosis. We retrospectively analyzed clinical and genotyping data of patients referred for suspected or clinically diagnosed MAS in a single French center (2014-2025). GNAS R201C and R201H mutations were detected by digital droplet PCR using peripheral blood as first-line samples, with additional testing of circulating cell-free, saliva, or tissue when indicated. We included 405 patients, from which 89 (22%) carried a GNAS mutation (52 R201C, 37 R201H). No significant clinical differences were observed between R201C and R201H. Among 578 analyzed samples, mutation detection varied by sample type, with the highest rates in tissue. Mutant allele frequency (MAF) in blood DNA was higher in patients with polyostotic than in monostotic FD (P=0.0055), but was not associated with the overall MAS-related lesion number. No correlation was found between MAF and age at diagnosis. MAS shows substantial clinical and molecular heterogeneity without clear genotype-phenotype differences between R201 variants. Mutation detection strongly depends on sample type, reflecting disease mosaicism. A multimodal diagnostic strategy and larger collaborative cohorts are needed to optimize molecular diagnosis and refine genotype-phenotype correlations in MAS patients.
While physical activity (PA) is associated in observational studies with cardiovascular and renal protection few interventional studies have assessed its long-term effect on renal outcomes. This study is the first to specifically evaluate the impact of high-intensity PA on the slowing of renal function decline in type 2 diabetes (T2D) patients at high risk for kidney disease. ActiDiaNe is an open, randomized controlled trial involving patients with T2D (pT2D) and rapid renal function decline (eGFR slope < -5 ml/min/year over 6-24 months). Participants were randomized to high-intensity PA (HIPA) or standard PA counseling (STPA) for two years. The primary endpoint was the slope of decline in cystatin C-derived eGFR (cys-eGFR). Across 21 centers, 178 patients were screened, 122 randomized, and 103 (29 women/74 men) analyzed for the primary endpoint (59 HIPA vs. 44 STPA). At baseline, mean age was 66 ± 8 years, median cys-eGFR was 54 ml/min/1.73m² (37; 65), and median eGFR decline was -9 ml/min/year (-12; -7). The primary endpoint showed a decline of -2.05 ml/min/year (95% CI: -3.46 to -0.64) in HIPA vs. -2.77 ml/min/year (95% CI: -4.40 to -1.14) in STPA (P = 0.512). Cardiovascular events and deaths occurred in 10 (17%) HIPA vs. 6 (14%) STPA patients (P = 0.646), with 3 deaths in HIPA (none of them protocol-related). Hypoglycemia was reported in 32 HIPA vs. 26 STPA patients (P = 0.623). In pT2D with rapid renal function decline, HIPA did not significantly alter renal function decline compared to STPA.
Patients with type 2 diabetes (T2D) and obesity are at increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD) with advanced fibrosis (AF), requiring systematic non-invasive assessment using liver stiffness measurement (LSM) or the ELF test. However, access to these biomarkers remains limited in diabetology. We therefore evaluated the diagnostic performance of a new point-of-care ultrasound device, Hepatoscope, for the risk stratification of AF. Participants with T2D and/or obesity and MASLD age 40-80 years, BMI <40 kg/m2 prospectively included in a multi-centre study (NCT04435054) underwent LSM using vibration controlled transient elastography (LSM-VCTE, FibroScan) and 2D-transient elastography (LSM-2DTE) using Hepatoscope version 1 and ELF. Post-acquisition reprocessing of the LSM-2DTE data using the CE approved version 2 (LSM-2DTE-2) was performed in a subgroup of n = 120 participants. The area under the ROC curve (AUROC) and 95% confidence interval (CI) were assessed for the detection of intermediate to high-risk of AF, defined by LSM-VCTE ≥ 8 kPa. Among 294 participants (83.3% T2D, 42.5% female, 71.4% obesity), 24.8% had LSM-VCTE ≥ 8 kPa. Significant correlation was observed between LSM-VCTE and LSM-2DTE-1 r: 0.37 [0.26-0.47], P < 0.001 and was higher between LSM-VCTE and LSM-2DTE-2: r: 0.61 [0.47-0.71], P < 0.001. In the subgroup of 120 participants, the AUROC (95%CI) of LSM-2DTE-2 for the detection of LSM-VCTE ≥ 8 kPa was 0.81 (0.72-0.89) compared to 0.64 (0.52-0.75) for ELF. This proof-of-concept study provides evidence supporting the role of LSM-2DTE using the Hepatoscope in the risk stratification of AF in diabetology settings. Larger studies are needed to validate its performance.
The quality of care of patients with endocrine diseases depends on the training of trainees. To ensure this, the European Society of Endocrinology (ESE) and the UEMS (European Union of Medical Specialists) Section and Board of Endocrinology (SBE) have recently published the updated curriculum and formulated recommendations on postgraduate training. To complement this, information on the number of training centres and trainees in endocrinology in European countries, on the process of accreditation and re-accreditation of training centres and on the organisation of training is presented here. Delegates to the General Assembly of the UEMS SBE were asked to complete a questionnaire. Delegates from 35 countries provided data. In three countries, endocrine training occurs in other countries, and in one country, endocrinology is not a recognised independent speciality. Thirty-one delegates reported 767 training centres, 18 reported having rotation centres, and 26 reported a total of 4,248 trainees. An accreditation process, which varies across countries, is in place in 27 countries. Re-accreditation is mandatory in 22 countries at intervals ranging from 1 to 7 years. Thirteen countries have a train-the-trainer programme, and the trainee-to-trainer ratio varies from 3:1 to 1:1. The accreditation and re-accreditation process of training centres varies across European countries. Information on the number of trainees might provide a basis to estimate whether a sufficient number of endocrinologists are produced in Europe to ensure optimal care of the growing number of patients with endocrine and metabolic diseases.
The ACTH stimulation test is the gold standard for diagnosing NCAH. However, this test has a human and material cost. While some teams perform it as a second-line test, others use it as a first-line test to avoid false negatives associated with single basal 17-hydroxyprogesterone (17-OHP) serum levels. In this prospective, single-center, cross-sectional observational study, we included 210 women aged from 15 to 41 who were referred for oligoanovulation and/or hyperandrogenism from November 2022 to June 2024. In this population, we determined the proportion of false negatives for NCAH using basal 17-OHP serum levels by performing ACTH stimulation tests. Among the 210 patients included, no NCAH was diagnosed, and no false negatives of basal 17-OHP serum levels were identified. Basal 17-OHP serum levels were significantly higher in PCOS patients but remained below the 2 ng/ml threshold and were significantly correlated with hormonal and ultrasound markers of PCOS. Consequently, the systematic use of the ACTH stimulation test in women with hyperandrogenism and/or oligoanovulation does not appear to be a cost-effective diagnostic strategy.
Anorexia nervosa (AN) is a serious illness in which more than half of all deaths are due to malnutrition. Critically low energy and protein intake are known causes of massive weight loss, whereas micronutrient deficiencies due to a low-calorie food pattern remain poorly characterized in children with AN. Micronutrient deficiencies in AN, such as selenium deficiency, are known to increase anxiety and the risk of suicide. Two large studies in adults highlighted frequent selenium and copper deficiencies; this information is lacking in children. The present study aimed to provide a comprehensive description of the micronutrient status in pediatric AN and evaluate whether deficiencies differ according to AN subtype (restricting, R, binge-eating/purging, BP). A retrospective, single-center, descriptive study was conducted in a cohort of children with AN who were evaluated at a specialist eating disorders center from 2016 to 2022. The sample comprised 349 patients (mean age 14.7 ± 1.8 years); 91.4% had AN-R, 8.6% BP. Mean weight loss was 18.2% ± 10.7%, and initial BMI was 16.7 ± 1.1 kg/m2 according to the International Obesity Task Force. At least one micronutrient deficiency was found in 90% of patients; 51.3% experienced multiple deficiencies. The most common were selenium (23.5%), copper (18.4%), and vitamin A (29.1%). The prevalence of deficiencies was similar between AN-R and AN-BP, except for potassium and calcium which were significantly lower in AN-BP. Micronutrients deficiencies are frequent in pediatric AN with no difference according to subtype. The functional impact and the benefit of supplementation remain to be studied.
Adult growth hormone deficiency (GHD) is associated with increased adiposity, reduced lean mass, adverse lipid profile, decreased bone density and impaired quality of life. Growth hormone (GH) replacement therapy provides significant metabolic, cardiovascular, musculoskeletal and psychological benefit. Traditional stimulation tests, such as the insulin tolerance and glucagon tests, are gold standards for diagnosis, but the oral macimorelin test offers a safe, reliable and well-tolerated alternative. GH replacement should be titrated to achieve age-appropriate insulin-like growth factor 1 (IGF-1) levels. Monitoring should address potential side effects, including glucose intolerance and fluid retention. Long-acting growth hormone (LAGH) formulations, such as somapacitan, lonapegsomatropin and somatrogon, now enable weekly administration, improving adherence while maintaining efficacy and safety comparable to daily therapy. Early evidence suggests enhanced patient satisfaction and similar metabolic outcomes. Ongoing longitudinal studies are essential to clarify long-term safety.
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The weekly insulin-like growth factor I (IGF-I) profile for children and adolescents treated with long-acting growth hormone differs from that of daily growth hormone (GH). The objective of this study is to provide guidance on the use of once-weekly somapacitan and IGF-I monitoring in prepubertal short children and adolescents born small for gestational age (SGA) or with idiopathic short stature (ISS), Noonan syndrome (NS), or Turner syndrome (TS). Modeling, including population pharmacokinetic/pharmacodynamic (PK/PD) modeling, were utilized, analyzing IGF-I data from 4 clinical studies, including 2 phase 3 trials (REAL8: NCT05330325; REAL9: NCT05723835) involving children and adolescents born SGA (N = 80), ISS (N = 69), NS (N = 62), and TS (N = 79), along with additional data from phase 2 (REAL5: NCT03878446, N = 59) and phase 1 trials (NCT01973244, N = 24). Relationships between somapacitan dose, exposure, baseline IGF-I SD score (SDS), and height velocity (HV) were established in children born SGA, with similar responses anticipated for those with ISS, NS, or TS. A linear model enabled the estimation of average weekly IGF-I exposure from a single sample collected during the somapacitan dosing interval. IGF-I SDS simulations support flexible dosing changes while maintaining a minimum of 4 days between doses. Somapacitan 0.24 mg/kg/week produced similar IGF-I SDS changes and height velocity increases as daily GH in prepubertal short children and adolescents born SGA or with ISS, NS, or TS. The results support that the guidance already established for GHD regarding somapacitan initiation, dosing flexibility, and IGF-I monitoring remain appropriate for prepubertal short children and adolescents born SGA or with ISS, NS, or TS.
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition, particularly among at-risk populations such as patients with obesity, diabetes, or chronic respiratory disease. There is a growing need for simplified, automated diagnostic approaches that can be implemented outside specialized sleep laboratories. We conducted a prospective, interventional study in two hospital centers in Alsace (France), comparing an automated mandibular movement analysis device (Sunrise®) with standard ventilatory polygraphy (VP). Agreement between the two methods for determining the apnea-hypopnea index (AHI) was assessed using Bland-Altman analysis. Thirty-seven patients were enrolled, from whom 29 pairs of recordings (78%) were suitable for analysis. Seven Sunrise® failures and one ventilatory polygraphy failure, were due mainly to sensor malfunctions or connectivity issues. In comparison with VP, Sunrise® tended to overestimate AHI, with a mean difference of +4.76 events/h. The limits of agreement ranged from -15.4 to +24.9 events/h, indicating moderate variability between the methods. The Sunrise® device demonstrates feasibility for use in non-expert clinical settings and shows reasonable agreement with ventilatory polygraphy, supporting its potential as a simplified screening tool for OSAS. However, these results should be interpreted cautiously, especially for high AHI, and technical limitations must be addressed in future "real world" studies.
Adrenocortical carcinoma (ACC) is a rare cancer. The French ENDOCAN-COMETE network was established in 2009 to coordinate care locally and nationally, and to promote research and education on malignant adrenal tumors. Evidence demonstrating the benefits of this organization is currently lacking. Patients diagnosed with ACC between 2010 and 2017 were identified from the French Network of Cancer Registries (FRANCIM). Patients were categorized based on referral to the ENDOCAN-COMETE network as either referred at diagnosis (R-ACC) or not referred, or referred late (nR-ACC). Median overall survival (OS) and OS rates at 1, 5, and 10 years were compared between the R-ACC and nR-ACC groups after adjustment for prognostic parameters. A total of 134 patients with ACC were identified from the FRANCIM registries, corresponding to an incidence of 1.4 cases per million person-years. Ten patients were excluded because of insufficient information regarding their health care pathway. The final analysis included 124 patients (mean age, 53.6 years; female-to-male ratio, 2:1). At diagnosis, 45.2% had European Network for the Study of Adrenal Tumours (ENSAT) stage I-II disease, 48.4% had stage III-IV disease, and 6.4% had an unknown stage; endocrine and/or tumour-related symptoms were present in 62.9% of patients. Among the analyzed patients, 87 (70%) were R-ACC, whereas 37 (30%) were nR-ACC. In patients with localized stage I-II ACC, OS rates were significantly higher in the R-ACC group than in the nR-ACC group: 1-year OS was 92% versus 85%, 5-year OS was 81% versus 55%, and 10-year OS was 75% versus 35%, respectively. This survival advantage remained significant after adjustment for prognostic factors (hazard ratio, 3.9; P=.026). In contrast, among patients with advanced ACC, OS rates were similar between the 2 groups. Our study demonstrates an OS benefit for patients with stage I-II ACC who were referred early to specialized centers within the ENDOCAN-COMETE network. The combined use of the French cancer registries and dedicated national networks provides the strongest evidence to date demonstrating the impact of such a network.
The clinical presentation of acromegaly reflects systemic effects of chronic growth hormone (GH) and insulin-like growth factor 1 (IGF-I) excess. Diagnostic delay frequently ranges from 6 to 10 years. While classical manifestations such as acral enlargement and facial coarsening are diagnostically important, many patients initially develop nonspecific symptoms, including sleep apnea, carpal tunnel syndrome, arthralgia, and metabolic disturbances. The lack of symptom/comorbidity specificity highlights the need for improved screening strategies, particularly for patients without overt acral changes. Comorbidity cluster analyses, potentially supported by artificial intelligence, may facilitate earlier identification, prompting biochemical confirmation of the diagnosis. Biochemical evaluation has benefited from advances in hormone assay harmonization and the establishment of robust age-adjusted reference ranges. Serum IGF-I is the preferred initial screening test due to its stability and reflection of integrated GH secretion. However, interpretation of assay values should consider age, sex, assay variability, and confounding conditions such as diabetes, liver or renal disease, obesity, pregnancy, and estrogen exposure. For discordant biochemical and clinical findings, it is recommended to repeat IGF-I and to measure GH during an oral glucose tolerance test (OGTT). Although random GH levels are often elevated and correlate with somatotroph adenoma size, GH suppression during OGTT is the gold-standard confirmatory test, especially in patients with borderline results. The use of ultrasensitive GH assays has lowered the recommended nadir GH cut-off threshold to ∼0.4 µg/L, with assay-specific considerations. Advances in high-resolution MRI and PET/MRI, alongside AI-driven facial recognition, electronic medical record analysis, and radiomics, offer promising avenues for earlier and more accurate diagnosis of acromegaly.
The primary objective of this study was to assess the contribution of fetal echocardiography in a population of women with pre-gestational diabetes to the detection of severe fetal heart disease. The secondary objective was to analyse the prevalence of heart disease according to periconceptional HbA1c levels. Observational, single-centre, retrospective study conducted over ten years (2014-2024), including all pregnancies complicated by pre-gestational diabetes monitored in a type III maternity unit. The type of diabetes, periconceptional HbA1c, ultrasound data and perinatal outcomes were collected. Severe congenital heart disease was confirmed postnatally and defined by the need for neonatal surgical intervention. A total of 331 women corresponding to 428 pregnancies were included. All underwent fetal echocardiography by a paediatric cardiologist. The overall prevalence of congenital heart disease was 4.4% (19/428), including 1.5% of severe forms (6/428). All severe heart defects were detected during screening ultrasound. 6.9% of women with a periconceptional HbA1c ≥ 10% had severe heart disease. Systematic fetal echocardiography by a paediatric cardiologist does not appear to offer any additional benefit for the sensitivity of primary screening for severe diabetes-related heart disease. Echocardiography should be reserved for the precise characterisation of heart disease if it is detected during screening and diagnostic ultrasound and/or in cases of uncontrolled diabetes.
Hypophysitis is an inflammation of the pituitary gland or stalk. There are no standardized guidelines for diagnosis and treatment. The present study investigated the role of surgery in diagnosing and treating hypophysitis. A retrospective observational study was conducted in the University referral hospital of Marseille, France. Patients over 15 years of age diagnosed with histologically proven hypophysitis between January 1st, 1994 and October 31st, 2023 were included. Additionally, a literature review was performed, focusing on cases with surgical and/or medical management, during the same period. Immune checkpoint inhibitor-related hypophysitis was not included. In 9 of our 61 patients (14.5%), surgery was indicated mainly for visual disorder (75%). Four showed suspected adenoma. All patients recovered visual function. There was no endocrine improvement. The literature review of surgical management, with 21 studies, included 289 operated patients (40% due to misdiagnosis of adenoma, and 40% for visual impairment). After surgery, 20% developed new endocrine deficits, while 13% showed hormonal improvement. Visual improvement was seen in 80-90% of cases. Non-endocrine complications were rare (5%). The literature review of all forms of management included 661 patients from 22 studies. Glucocorticoids improved endocrine deficits in 30% of cases, and worsened pituitary function in 2%. Patients managed by monitoring had a lower incidence of new deficits than patients managed by surgery. In hypophysitis not related to immune checkpoint inhibitors, surgery should not be performed systematically. It may be indicated in patients with severe visual impairment unresponsive to glucocorticoids or in situations of diagnostic uncertainty after complete medical assessment. In other cases, surgery seems to worsen pituitary function more than glucocorticoids or conservative follow-up, restricting its role to these specific cases after multidisciplinary discussion.