Polycystic Ovary Syndrome
The pathophysiology of symptomatic polycystic ovary syndrome (PCOS) often unfolds across puberty, but the ontogeny of PCOS is difficult to study because, in general, its pathophysiology is well entrenched before the diagnosis can be confirmed. However, the study of high-risk groups (daughters of women with PCOS, girls with premature pubarche, and girls with obesity) can offer insight in this regard. Available data support the hypothesis that the pubertal development of PCOS involves various combinations of genetic predisposition, intrauterine programming, hyperinsulinism, and numerous other abnormalities that provoke repro...
Source: Endocrinology and Metabolism Clinics of North America - January 11, 2021 Category: Endocrinology Authors: Christine M. Burt Solorzano, Christopher R. McCartney Source Type: research

Management of Women with Polycystic Ovary Syndrome During Pregnancy
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive age women and is associated with subfertility and adverse perinatal outcomes, which may include early pregnancy loss, gestational diabetes mellitus, hypertensive spectrum disorder, preterm birth, fetal growth disorders, and cesarean deliveries. The phenotypic heterogeneity, different diagnostic criteria, and PCOS-related conditions that women enter pregnancy with have limited evidenced-based studies and guidelines to reduce pregnancy complications among this high-risk population. This review summarizes the available evidence on the approa...
Source: Endocrinology and Metabolism Clinics of North America - January 11, 2021 Category: Endocrinology Authors: Amy M. Valent, Linda A. Barbour Source Type: research

Risks of Testosterone for Postmenopausal Women
Transdermal testosterone therapy, dosed within premenopausal physiologic testosterone ranges, used alone or with menopausal hormone therapy for postmenopausal hypoactive sexual desire disorder, has shown short-term efficacy, with few androgenic side effects. After natural or surgical menopause, meaningful improvements include an additional satisfying sexual episode per month; improvement in desire, arousal, orgasm, pleasure, and responsiveness; and a reduction in distress. Long-term data on cardiovascular, cancer, and cognitive safety are lacking. No approved testosterone preparation is available for women. Compounded test...
Source: Endocrinology and Metabolism Clinics of North America - January 11, 2021 Category: Endocrinology Authors: JoAnn V. Pinkerton, Isabella Blackman, Edward Alexander Conner, Andrew M. Kaunitz Source Type: research

Use of Testosterone in Postmenopausal Women
This article reviews the physiology of testosterone in women, summarizes the findings from observational studies and clinical trials, and considers indications for testosterone use. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - January 11, 2021 Category: Endocrinology Authors: Susan R. Davis Source Type: research

Postmenopausal Hyperandrogenism
Evidence of clinical and/or biochemical androgen excess poses a unique differential in postmenopausal women. Some signs and symptoms of postmenopausal hyperandrogenism can be normal and attributed to the natural aging process. However, the causes of androgen excess in this group include both nontumorous and tumorous causes. Treatment of androgen excess may improve both quality of life and long-term metabolic outcomes. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - January 11, 2021 Category: Endocrinology Authors: Adnin Zaman, Micol S. Rothman Source Type: research

Nonclassic Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia encompasses a group of autosomal recessive defects in cortisol biosynthesis, and 21-hydroxylase deficiency accounts for 95% of such cases. Non-classic 21-hydroxylase deficiency is due to partial enzymatic defects, which present with normal cortisol synthesis, but excessive production of adrenal androgens, including 11-oxygenated androgens. Non-classic 21-hydroxylase deficiency is relatively common, and its phenotype resembles closely that of polycystic ovary syndrome. This review focuses primarily on non-classic 21-hydroxylase deficiency, its clinical features, diagnosis, and management. (Sou...
Source: Endocrinology and Metabolism Clinics of North America - January 8, 2021 Category: Endocrinology Authors: Smita Jha, Adina F. Turcu Source Type: research

Cardiometabolic Risk in Polycystic Ovary Syndrome
Polycystic ovary syndrome is a common endocrine disorder in reproductive-aged women and is associated with an increased risk of metabolic abnormalities, including obesity, impaired glucose tolerance, diabetes, dyslipidemia, metabolic syndrome, venous thromboembolism, and subclinical atherosclerosis. Clinicians and patients alike need to be aware of these increased risks as well as new international guidelines that recommend frequent screening and active management of metabolic abnormalities. Given that the data on risk of cardiovascular events, such as myocardial infarction and stroke, in women with PCOS is mixed, future l...
Source: Endocrinology and Metabolism Clinics of North America - January 8, 2021 Category: Endocrinology Authors: Laura G. Cooney, Anuja Dokras Source Type: research

Fertility Issues in Polycystic Ovarian Disease
The triad of hirsutism, amenorrhea, and enlarged polycystic ovaries first was described in 1935 and later become known as polycystic ovarian syndrome (PCOS). Women with PCOS are more likely to have cardiometabolic challenges that also have an indirect relationship to their fertility and fertility outcomes. Despite these challenges, their fertile life span appears to be longer. Ovulation induction is considered first-line management of infertility in women with PCOS, with letrozole superior to clomiphene. Women with PCOS undergoing in  vitro fertilization are high risk for ovarian hyperstimulation syndrome but also hav...
Source: Endocrinology and Metabolism Clinics of North America - January 4, 2021 Category: Endocrinology Authors: John S. Rushing, Nanette Santoro Source Type: research

Androgens in Women: Too Much, Too Little, Just Right
It is my great pleasure to announce the new issue of the Endocrinology and Metabolism Clinics of North America dedicated to the role and pathologic condition of androgen hormones in women. The guest editor is Dr Margaret E Wierman, Professor of Medicine, Obstetrics, and Gynecology at the University of Colorado School of Medicine. Dr Wierman is a leader in the field and has authored multiple publications on the physiology of hormone secretion during the menstrual cycle, pathophysiologic pathways of hypogonadism, sexual dysfunction, androgen excess, and androgen use in women. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - December 28, 2020 Category: Endocrinology Authors: Adriana G. Ioachimescu Tags: Foreword Source Type: research

Why Focus on Androgens in Women?
Over the last 10 years, there have been major advances in our understanding of the role of testosterone, DHEA, and other adrenal prohormones in the normal physiology of women as well as their role in pathologic disorders. Advances in accurate measurements of androgens have allowed revisiting of the definitions of “low, normal, and high” levels. This issue is focused on the latest research into what is “normal, high, and potentially low” and the implications of androgen excess or deficiency in various disorders. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - December 27, 2020 Category: Endocrinology Authors: Margaret E. Wierman Tags: Preface Source Type: research

Advances in the Bone Health Assessment of Children
The last 2  decades have seen tremendous growth in understanding the clinical characteristics of various childhood bone disorders, their mechanisms and natural histories, and their responses to treatment. In this review, the authors describe advances in bone assessment techniques for children. In addition, th ey provide their skeletal site–specific applications, underscore the principles that are relevant to the biology of the growing child, show how these methods assist in the diagnosis and management of pediatric bone diseases, and highlight how these techniques have shed light on bone development an d underly...
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Authors: Leanne M. Ward, Victor N. Konji Source Type: research

Insights into the Genetic Underpinnings of Endocrine Traits from Large-Scale Genome-Wide Association Studies
Great strides have been made in genetic association studies of endocrine traits and diseases, with hundreds or thousands of variants associated with height, body mass index, bone density, pubertal timing, and diabetes in recent years. The common variants associated with these traits explain up to half of the trait variation owing to genetic factors, and when aggregated into polygenic risk scores, can also impact clinically relevant phenotypes at the tail ends of the trait distributions. However, pediatric studies tend to lag behind, and it is often unclear how adult-associated variants behave across life. (Source: Endocrin...
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Authors: Diana L. Cousminer, Struan F.A. Grant Source Type: research

Delayed and Precocious Puberty: Genetic Underpinnings and Treatments
Delayed puberty may signify a common variation of normal development, or indicate the presence of a pathologic process. Constitutional delay of growth and puberty is a strongly familial type of developmental pattern and accounts for the vast majority of children who are “late bloomers.” Individuals with sex chromosomal abnormalities frequently have hypergonadotropic hypogonadism. There are currently 4 known monogenic causes of central precocious puberty. The primary treatment goal in children with hypogonadism is to mimic normal pubertal progression, while the primary aims for the management of precocious puber...
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Authors: Anisha Gohil, Erica A. Eugster Source Type: research

Preface
The past decade has witnessed tremendous advances in both our understanding and our treatment of many endocrine disorders. Similarly, the care of youth with chronic medical conditions has accelerated. While some therapeutic successes celebrate the capacity to reverse or even avert development of endocrine complications, other triumphs are accompanied by the emergence of endocrine comorbidities. For some childhood disorders, the jury remains undecided as to whether endocrine comorbidities are prevented or merely delayed. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Authors: Andrea Kelly Source Type: research

Pediatric Endocrinology
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Authors: Andrea Kelly Source Type: research

Copyright
Elsevier (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Source Type: research

Contributors
ADRIANA G. IOACHIMESCU, MD, PhD, FACE (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Source Type: research

Contents
Andrea Kelly (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Source Type: research

Forthcoming Issues
Androgens in Women: Too Much, Too Little, Just Right (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - November 3, 2020 Category: Endocrinology Source Type: research

Overview of Atypical Diabetes
Although type 1 diabetes mellitus and, to a lesser extent, type 2 diabetes mellitus, are the prevailing forms of diabetes in youth, atypical forms of diabetes are not uncommon and may require etiology-specific therapies. By some estimates, up to 6.5% of children with diabetes have monogenic forms. Mitochondrial diabetes and cystic fibrosis related diabetes are less common but often noted in the underlying disease. Atypical diabetes should be considered in patients with a known disorder associated with diabetes, aged less than 25  years with nonautoimmune diabetes and without typical characteristics of type 2 diabetes ...
Source: Endocrinology and Metabolism Clinics of North America - October 14, 2020 Category: Endocrinology Authors: Jaclyn Tamaroff, Marissa Kilberg, Sara E. Pinney, Shana McCormack Source Type: research

New and Emerging Technologies in Type 1 Diabetes
There has been a rapid advancement in the pace of development of new diabetes technologies and therapies for the management of type 1 diabetes over the past decade. The Diabetes Control and Complications Trial conclusively established that tight glycemic control with intensive insulin therapy decreases the rates of diabetes complications in proportion to glycemic control, and diabetes technologies have accordingly been developed to help patients reach these goals. In this review, the authors discuss new diabetes therapeutics and technologies, including new insulin analogues, insulin pumps, continuous glucose monitoring sys...
Source: Endocrinology and Metabolism Clinics of North America - October 14, 2020 Category: Endocrinology Authors: Jordan S. Sherwood, Steven J. Russell, Melissa S. Putman Source Type: research

Pediatric Thyroid Cancer
An increasing number of children are diagnosed with thyroid cancer. Most patients do not have an identifiable cause; however, tumor predisposition syndromes may be associated with development of both differentiated and medullary thyroid cancer. With an excellent prognosis for most patients, the goal of therapy is to optimize outcome and reduce complications. The increased knowledge of the oncogenic drivers provides opportunities to improve the accuracy of diagnosis, stratify surgery, and select systemic therapy that may be considered for neoadjuvant and adjuvant treatment. Treatment complications can be reduced by referral...
Source: Endocrinology and Metabolism Clinics of North America - October 14, 2020 Category: Endocrinology Authors: Andrew J. Bauer Source Type: research

Pediatric Type 2 Diabetes: Not a Mini Version of Adult Type 2 Diabetes
Pediatric type 2 diabetes mellitus (T2DM) is increasing in incidence, with risk factors including obesity, puberty, family history of T2DM in a first-degree or second-degree relative, history of small-for-gestational-age at birth, child of a gestational diabetes pregnancy, minority racial group, and lower socioeconomic status. The pathophysiology of T2DM consists of insulin resistance and progression to pancreatic beta-cell failure, which is more rapid in pediatric T2DM compared with adult T2DM. Treatment options are limited. Treatment failure and nonadherence rates are high in pediatric T2DM; therefore, early diagnosis an...
Source: Endocrinology and Metabolism Clinics of North America - October 14, 2020 Category: Endocrinology Authors: Talia Alyssa Savic Hitt, Lorraine E. Levitt Katz Source Type: research

Endocrine Sequelae in Childhood Cancer Survivors
This article reviews the association between cancer treatments and endocrine late effects. It also summarizes recommendations regarding surveillance for endocrine late effects and referrals to endocrinologists based on treatment exposures. In addition, this article provides special considerations for the treatment of endocrinopathies in survivors. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - October 13, 2020 Category: Endocrinology Authors: Sobenna A. George, Karen E. Effinger, Lillian R. Meacham Source Type: research

Bone Health in Childhood Chronic Disease
Many children with chronic disease are now surviving into adulthood. As a result, there is a growing interest in optimizing bone health early in the disease course with the dual goals of improving quality of life during childhood and reducing life-long fracture risk. Risk factors for impaired bone health in these children include immobility, nutritional deficiency, exposure to bone toxic therapies, hormonal deficiencies affecting growth and pubertal development, and chronic inflammation. This review focuses on the chronic diseases of childhood most commonly associated with impaired bone health. Recent research findings and...
Source: Endocrinology and Metabolism Clinics of North America - October 13, 2020 Category: Endocrinology Authors: David R. Weber Source Type: research

Inhaled Corticosteroids and Endocrine Effects in Childhood
This article reviews 4 areas critical to understanding potential adverse endocrine outcomes of ICSs and placing them in proper perspective: (1) influence of drug/delivery device properties on systemic steroid burden; (2) adrenal insufficiency during ICS treatment; (3) growth effects of ICS and asthma itself; and (4) bone mineral accretion during ICS therapy. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - October 13, 2020 Category: Endocrinology Authors: David B. Allen Source Type: research

Phthalate Exposure, Adolescent Health, and the Need for Primary Prevention
This article discusses the potential effects of phthalate exposure on adiposity, puberty, and neurodevelopment during late childhood and adolescence. It also highlights studies of behavioral interventions to reduce phthalate exposures and the roles of health care professionals and policy makers in preventing phthalate exposure. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - October 13, 2020 Category: Endocrinology Authors: Clara G. Sears, Joseph M. Braun Source Type: research

Nelson ’s Syndrome
Nelson ’s syndrome (NS) is a condition which may develop in patients with Cushing’s disease after bilateral adrenalectomy. Although there is no formal consensus on what defines NS, corticotroph tumor growth and/or gradually increasing ACTH levels are important diagnostic elements. Pathogenesis is uncle ar and well-established predictive factors are lacking; high ACTH during the first year after bilateral adrenalectomy is the most consistently reported predictive parameter. Management is individualized and includes surgery, with or without radiotherapy, radiotherapy alone, and observation; medical treatments hav...
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Authors: Athanasios Fountas, Niki Karavitaki Source Type: research

Update on the Genetics of Pituitary Tumors
This article summarizes the genes and the syndromes associated with pituitary tumors. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Authors: Sayka Barry, M árta Korbonits Source Type: research

Endoscopic Surgery for Pituitary Tumors
This article presents the philosophy, surgical techniques, and outcomes of a high-volume pituitary adenoma center. Three surgical videos illustrate some procedures. The experience has reinforced the authors ’ belief that experience and surgical volume are key to high quality of care. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Authors: Wouter R. van Furth, Friso de Vries, Daniel J. Lobatto, Maarten C. Kleijwegt, Pieter J. Schutte, Alberto M. Pereira, Nienke R. Biermasz, Marco J.T. Verstegen Source Type: research

Pituitary Disorders
ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Authors: Niki Karavitaki Source Type: research

Copyright
Elsevier (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Source Type: research

Contributors
Adriana G. Ioachimescu, MD, PhD, FACE (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Source Type: research

Contents
Adriana G. Ioachimescu (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Source Type: research

Endocrinology and Metabolism Clinics of North America
Pediatric Endocrinology (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 31, 2020 Category: Endocrinology Source Type: research

World Health Ozganization 2017 Classification of Pituitary Tumors
The 2017 (fourth edition) World Health Organization Classification of Endocrine Tumors has recommended major changes in classification of tumors of the pituitary gland and region. In addition to the accurate tumor subtyping, assessment of the tumor proliferative potential (mitotic and/or Ki-67 index) and other clinical parameters such as tumor invasion is strongly recommended in individual cases for consideration of clinically aggressive adenomas. It is expected that this new WHO classification will establish more uniform biologically and clinically groups of pituitary tumors and contribute to understanding of clinical out...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: M. Beatriz S. Lopes Source Type: research

A Novel Etiology of Hypophysitis
This article reviews the function of immune checkpoint inhibitors and pituitary adverse effects with immune checkpoint inhibitor use. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Stuti Fernandes, Elena V. Varlamov, Shirley McCartney, Maria Fleseriu Source Type: research

The Role of Dopamine Agonists in Pituitary Adenomas
Dopamine agonist therapy is the primary therapy for prolactin-secreting adenomas and usually results in normoprolactinemia, eugonadism, and tumor reduction. Cabergoline is superior to bromocriptine with regard to efficacy and tolerance. Withdrawal of cabergoline can be attempted in patients with normal prolactin levels on low doses of medication and evidence of radiographic tumor involution. Dopamine agonists have been used off label in patients with acromegaly, Cushing disease, and nonfunctioning adenomas. A trial of cabergoline monotherapy can be effective in patients with biochemically mild acromegaly. Cabergoline combi...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Erica A. Giraldi, Adriana G. Ioachimescu Source Type: research

Acromegaly
is a systemic disease associated with great morbidity and increased mortality if not adequately treated. In the past decades much improvement has been achieved in its treatment and in the knowledge of its comorbidities. We provide an update of acromegaly management with current recommendations. We also address long-term comorbidities emphasizing the changing face of the disease in more recent series, with a decrease of cardiovascular disease severity and an increased awareness of comorbidities like bone disease, manifested mainly as vertebral fractures and the change in the main cause of death (from cardiovascular disease...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Leandro Kasuki, Ximene Antunes, Elisa Baranski Lamback, M ônica R. Gadelha Source Type: research

Management of Hypothalamic Obesity
Energy homeostasis, appetite, and satiety are modulated by a complex neuroendocrine system regulated by the hypothalamus. Dysregulation of this system resulting in hypothalamic obesity (HO) is caused by brain tumors, neurosurgery, and/or cranial irradiation. Craniopharyngioma (CP) is a paradigmatic disease with regard to the development of HO. Initial hypothalamic involvement of CP and/or treatment-related damage to hypothalamic-pituitary axes result in HO. Attempts to control HO with lifestyle interventions have not been satisfactory. No generally accepted pharmacologic or bariatric therapy for HO in CP has been effective...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Hermann L. M üller Source Type: research

Pituitary Tumors Centers of Excellence
Pituitary tumors are common and require complex and sophisticated procedures for both diagnosis and therapy. To maintain the highest standards of quality, it is proposed to manage patients in pituitary tumors centers of excellence (PTCOEs) with patient-centric organizations, with expert clinical endocrinologists and neurosurgeons forming the core. That core needs to be supported by experts from different disciplines such as neuroradiology, neuropathology, radiation oncology, neuro-ophthalmology, otorhinolaryngology, and trained nursing. To provide high-level medical care to patients with pituitary tumors, PTCOEs further pi...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Stefano Frara, Gemma Rodriguez-Carnero, Ana M. Formenti, Miguel A. Martinez-Olmos, Andrea Giustina, Felipe F. Casanueva Source Type: research

Diabetes Insipidus
The differential diagnosis of diabetes insipidus involves the distinction between central or nephrogenic diabetes insipidus and primary polydipsia. Differentiation is important because treatment strategies vary; the wrong treatment can be dangerous. Reliable differentiation is difficult especially in patients with primary polydipsia or partial forms of diabetes insipidus. New diagnostic algorithms are based on the measurement of copeptin after osmotic stimulation by hypertonic saline infusion or after nonosmotic stimulation by arginine and have a higher diagnostic accuracy than the water deprivation test. Treatment involve...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Julie Refardt, Bettina Winzeler, Mirjam Christ-Crain Source Type: research

Pituitary Disorders: Striving for Excellence
Pituitary disease remains a vibrant, fascinating, and often challenging field throughout the whole patient journey: from presentation and diagnosis to treatment and long-term outcomes. Over the last several years, we have witnessed advances in this arena opening exciting perspectives in research and guiding optimal patient care. Just to name a few: elucidation of the burden of pituitary disease; development of elegant diagnostic approaches; progress in the genetics, pathologic classification, and management of pituitary tumors and their related morbidities; insights on rare entities; crosstalk with other disciplines; and s...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: Niki Karavitaki Tags: Preface Source Type: research

Advances in the Imaging of Pituitary Tumors
In most patients with pituitary adenomas magnetic resonance imaging (MRI) is essential to guide effective decision-making. T1- and T2-weighted sequences allow the majority of adenomas to be readily identified. Supplementary MR sequences (e.g. FLAIR; MR angiography) may also help inform surgery. However, in some patients MRI findings are ‘negative’ or equivocal (e.g. with failure to reliably identify a microadenoma or to distinguish postoperative change from residual/recurrent disease). Molecular imaging [e.g. 11C-methionine PET/CT coregistered with volumetric MRI (Met-PET/MRCR)] may allow accurate localisation ...
Source: Endocrinology and Metabolism Clinics of North America - July 14, 2020 Category: Endocrinology Authors: James MacFarlane, Waiel A. Bashari, Russell Senanayake, Daniel Gillett, Merel van der Meulen, Andrew S. Powlson, Angelos Kolias, Olympia Koulouri, Mark Gurnell Source Type: research

Aggressive Pituitary Adenomas and Carcinomas
This article presents key clinical aspects regarding aggressive pituitary tumors and carcinomas, and also discusses some of the unanswered questions of the ESE guidelines, focusing on both diagnosis and treatment. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - July 7, 2020 Category: Endocrinology Authors: Mirela Diana Ilie, Emmanuel Jouanneau, G érald Raverot Source Type: research

Advances in the Medical Treatment of Cushing Disease
Medical therapy has an adjunctive role in management of Cushing disease. Medical therapy is recommended for patients who received pituitary radiotherapy and are awaiting its salutary effects. Medications are used preoperatively to stabilize the condition of seriously ill patients before surgery. Medical therapy is used to control hypercortisolism in patients with uncertain tumor location. Medical therapies available for management of patients with Cushing disease include steroidogenesis inhibitors, centrally acting agents, and glucocorticoid receptor antagonists. All agents require careful monitoring to optimize clinical e...
Source: Endocrinology and Metabolism Clinics of North America - July 1, 2020 Category: Endocrinology Authors: Nicholas A. Tritos, Beverly M.K. Biller Source Type: research

Pituitary Endocrinology in 2020: An Update
The “Pituitary Disorders” issue of the Endocrinology and Metabolism Clinics of North America features current best standards of practice and the important advances in recent years. The guest editor is Dr Niki Karavitaki, Senior Lecturer of Endocrinology at University of Birmingham, United Kingdom an d Honorary Consultant Endocrinologist at the Queen Elizabeth Hospital Birmingham, where she codirects the pituitary multidisciplinary team. Dr Karavitaki, a distinguished pituitary clinician and researcher, gathered an international group of authors to deliver a clinically meaningful pituitary updat e. (Source: Endo...
Source: Endocrinology and Metabolism Clinics of North America - June 23, 2020 Category: Endocrinology Authors: Adriana G. Ioachimescu Tags: Foreword Source Type: research

The Epidemiology of Pituitary Adenomas
Pituitary adenomas are usually nonmalignant, but have a heavy burden on patients and health care systems. Increased availability of MRI has led to an increase in incidentally found pituitary lesions and clinically relevant pituitary adenomas. Epidemiologic studies show that pituitary adenomas are increasing in incidence (between 3.9 and 7.4 cases per 100,000 per year) and prevalence (76 to 116 cases per 100,000 population) in the general population (approximately 1 case per 1000 of the general population). Most new cases diagnosed are prolactinomas and nonsecreting pituitary adenomas. Most clinically relevant pituitary ade...
Source: Endocrinology and Metabolism Clinics of North America - June 9, 2020 Category: Endocrinology Authors: Adrian F. Daly, Albert Beckers Source Type: research

Barriers and Solutions for Prescribing Obesity Pharmacotherapy
This article examines the barriers and changes that are increasing the use of anti-obesity medications. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - May 15, 2020 Category: Endocrinology Authors: Ken Fujioka, Samantha R. Harris Source Type: research

Iatrogenic Obesity
This article highlights medications known to cause weight gain. (Source: Endocrinology and Metabolism Clinics of North America)
Source: Endocrinology and Metabolism Clinics of North America - May 15, 2020 Category: Endocrinology Authors: Rekha B. Kumar, Louis J. Aronne Source Type: research