Daily Endocrinology Research Analysis
Direct-to-patient screening substantially increased identification of primary aldosteronism and facilitated initiation of targeted therapy. A meta-analysis shows postpartum lifestyle interventions reduce progression to type 2 diabetes after gestational diabetes, with greatest benefit in high-risk women. Histopathological subtyping of non-functioning pituitary adenomas by transcription factor immunohistochemistry correlates with invasive behavior, informing prognosis and management.
Summary
Direct-to-patient screening substantially increased identification of primary aldosteronism and facilitated initiation of targeted therapy. A meta-analysis shows postpartum lifestyle interventions reduce progression to type 2 diabetes after gestational diabetes, with greatest benefit in high-risk women. Histopathological subtyping of non-functioning pituitary adenomas by transcription factor immunohistochemistry correlates with invasive behavior, informing prognosis and management.
Research Themes
- Implementation science in endocrine screening
- Postpartum diabetes prevention
- Molecular pathology-driven risk stratification
Selected Articles
1. Nationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program.
In a nationwide pragmatic program (n=694), 25.4% of hypertensive adults screened positive for primary aldosteronism through direct-to-patient testing, despite 57% already being under specialist care. Among positives, 13.7% initiated aldosterone-targeted therapy and 24.5% reported improved blood pressure, demonstrating feasibility and clinical yield of scalable remote screening.
Impact: This study provides a scalable solution to the major screening gap in primary aldosteronism and demonstrates real-world treatment initiation and BP benefits. It aligns with new guidelines recommending universal screening in hypertension.
Clinical Implications: Health systems can adopt direct-to-patient workflows (remote consent, local labs, standardized interpretation) to increase primary aldosteronism detection and expedite mineralocorticoid receptor antagonist use or surgical referral. Primary care and specialty clinics should integrate streamlined testing for patients with resistant hypertension, hypokalemia, or sleep apnea.
Key Findings
- 25.4% of 694 hypertensive participants screened positive for primary aldosteronism using a standardized, direct-to-patient algorithm.
- Despite specialty care (endocrinology/cardiology/nephrology) in 57% of participants, most had not previously been tested for primary aldosteronism.
- Among those with positive results, 25.5% underwent additional testing, 13.7% started aldosterone-targeted therapy, and 24.5% reported improved blood pressure.
- Common indications for testing were sleep apnea, resistant hypertension, and hypokalemia; over half had ≥2 indications.
Methodological Strengths
- Pragmatic, nationwide implementation with remote consent and standardized diagnostic algorithm.
- Real-world follow-up capturing additional testing, therapy initiation, and patient-reported blood pressure outcomes.
Limitations
- Nonrandomized design with potential selection bias from online recruitment.
- Incomplete uptake of downstream confirmatory testing and therapy; outcomes limited to 6–12 months follow-up.
Future Directions: Head-to-head comparisons of direct-to-patient versus clinic-based workflows, cost-effectiveness analyses, and integration with electronic health record prompts to scale universal primary aldosteronism screening.
2. Lifestyle intervention to prevent type 2 diabetes after a pregnancy complicated by gestational diabetes mellitus: a systematic review and meta-analysis update.
Across 24 RCTs (n=9017), postpartum lifestyle interventions reduced incident type 2 diabetes by 19% overall (RR 0.81) and more strongly in high-risk women (RR 0.78), with NNT 31 in high-risk subgroups. Benefits occurred despite only modest weight differences, underscoring glycemic benefits beyond weight loss.
Impact: Provides high-level evidence to implement early postpartum prevention pathways after GDM, prioritizing high-risk women for maximal absolute benefit.
Clinical Implications: Postpartum care should include structured lifestyle programs soon after GDM pregnancy, with risk stratification to target women at highest risk where NNT is lowest. Even modest weight changes confer meaningful diabetes risk reduction.
Key Findings
- Lifestyle interventions after GDM reduced incident type 2 diabetes by 19% in lower-bias trials (RR 0.81, 95% CI 0.71–0.93).
- Greater benefit in high-risk women (RR 0.78) versus unselected GDM populations (RR 0.85; not statistically significant).
- Number needed to treat was 31 in high-risk women versus 71 in unselected GDM populations.
- Weight change was modest (−0.88 kg overall), indicating benefits beyond substantial weight loss.
Methodological Strengths
- Systematic review and meta-analysis of randomized controlled trials with PRISMA adherence and GRADE assessment.
- Sensitivity analyses and exclusion of high risk-of-bias studies support robustness of the findings.
Limitations
- Heterogeneity in timing, intensity, and components of interventions across trials.
- Follow-up durations and ascertainment methods vary; some trials had risk of bias.
Future Directions: Design pragmatic, culturally tailored postpartum programs integrated into obstetric and primary care workflows, with cost-effectiveness and implementation evaluations focusing on high-risk women.
3. Cell Lineage-Specific Differences in Clinical Behavior of Non-Functioning Pituitary Adenomas.
This systematic review/meta-analysis (27 studies) shows that non-functioning pituitary adenomas classified by transcription factor IHC exhibit distinct invasive profiles: cavernous sinus invasion is more prevalent in null cell adenomas and TPIT+ tumors versus SF1+, and higher in null cell adenomas versus PIT1+. Data for recurrence and radiotherapy were insufficient for pooling.
Impact: Integrates the 2017 WHO classification into clinical risk stratification by linking TF-defined subtypes with invasion patterns, informing surgical planning and follow-up.
Clinical Implications: Transcription factor IHC (SF1, PIT1, TPIT) should be implemented routinely for NFPAs to anticipate cavernous sinus invasion and tailor surgical approach, counseling, and surveillance intensity.
Key Findings
- Cavernous sinus invasion is more prevalent in null cell adenomas (NCAs) versus SF1+ NFPAs (PRR 1.60) and versus PIT1+ NFPAs (PRR 1.44).
- TPIT+ NFPAs show higher cavernous sinus invasion compared with SF1+ NFPAs (PRR 1.43).
- Limited data precluded pooled analyses for recurrence and radiotherapy outcomes.
Methodological Strengths
- Comprehensive multi-database search with QUIPS risk-of-bias assessment.
- Random-effects models with reporting of prediction intervals and low heterogeneity for key comparisons.
Limitations
- Underlying evidence consists of observational cohorts with potential confounding.
- Insufficient studies for meta-analysis of recurrence and radiotherapy; evolving classification may introduce misclassification.
Future Directions: Prospective registries integrating TF IHC, radiogenomics, and standardized outcomes (invasion, recurrence) to refine prognostic models and guide adjuvant therapy trials.