Daily Endocrinology Research Analysis
Policies and tools in endocrinology advanced on three fronts: health-economic modeling supports universal first-trimester TSH screening in pregnancy; brain-predicted age difference emerged as a potential biomarker reflecting reversible brain changes in anorexia nervosa; and a 23-year single-surgeon pituitary series provides robust real-world benchmarks for outcomes and recurrence risk. These studies collectively inform screening policy, biomarker development, and surgical quality counseling.
Summary
Policies and tools in endocrinology advanced on three fronts: health-economic modeling supports universal first-trimester TSH screening in pregnancy; brain-predicted age difference emerged as a potential biomarker reflecting reversible brain changes in anorexia nervosa; and a 23-year single-surgeon pituitary series provides robust real-world benchmarks for outcomes and recurrence risk. These studies collectively inform screening policy, biomarker development, and surgical quality counseling.
Research Themes
- Thyroid screening cost-effectiveness in pregnancy
- Neuroendocrine biomarkers in eating disorders
- Real-world outcomes in pituitary neuroendocrine tumors
Selected Articles
1. Cost-Effectiveness Analysis of Universal Screening for Subclinical Hypothyroidism in Pregnancy Based on the Czech Nation-Wide Pilot Screening Program in Light of Current Evidence.
Using a national pilot program and best-available evidence, universal first-trimester TSH screening in pregnancy was modeled as cost-effective (ICER ≈ €20,035/QALY) with modest QALY gains, prevention of miscarriages and preterm births, and low budget impact. Adding anti-TPO testing may further improve outcomes (lower ICER) but requires more resources and rests on lower-quality evidence.
Impact: This analysis directly informs national screening policy by quantifying trade-offs between health gains and resource use, grounded in a real-world pilot program. It provides decision-grade parameters to potentially standardize thyroid screening in pregnancy.
Clinical Implications: Health systems could adopt universal first-trimester TSH screening as a cost-effective policy, anticipating modest maternal QALY gains and prevention of miscarriages/preterm births with limited budget impact. Anti-TPO extension should be considered cautiously, balancing potential benefits against increased referrals and costs.
Key Findings
- Universal TSH screening modeled ICER: €20,035/QALY with 32.9 maternal QALYs gained per 100,000 pregnancies.
- Estimated prevention of 65 miscarriages and 52 preterm births annually under universal TSH screening.
- Anti-TPO extension improved ICER to €15,703/QALY with additional 111 QALYs but increased budget impact and referrals, based on lower-quality evidence.
- Budget impact for TSH screening estimated at ~€0.66 million with ~2,290 additional endocrinology referrals per 100,000 pregnancies.
Methodological Strengths
- Decision-analytic model parameterized with national pilot program data and best-available evidence.
- Probabilistic sensitivity analysis (3,000 simulations) supporting robustness of cost-effectiveness estimates.
Limitations
- Economic model depends on assumptions and external evidence; not a randomized trial.
- Anti-TPO extension relies on lower-quality evidence and may strain resources due to increased referrals.
Future Directions: Prospective implementation studies comparing universal versus targeted screening, with registry-based follow-up on maternal-fetal outcomes and healthcare utilization, and randomized evaluation of anti-TPO triage strategies.
2. Does restrictive anorexia nervosa impact brain aging? A machine learning approach to estimate age based on brain structure.
A multi-dataset ML model accurately predicted brain age and revealed overestimation of brain age in acute anorexia nervosa (+2.25 years), which normalized after weight restoration. The effect was stronger in younger patients and inversely related to BMI, supporting brain-PAD as a candidate biomarker reflecting reversible neurobiological impact of malnutrition.
Impact: Introduces an interpretable brain-age biomarker with evidence of reversibility tied to weight restoration, bridging neuroimaging, endocrinology, and clinical outcomes in anorexia nervosa.
Clinical Implications: Brain-PAD could aid risk stratification and monitoring of neurobiological recovery alongside nutritional and endocrine restoration in AN, especially in younger patients.
Key Findings
- ML brain-age model trained on 3,487 healthy females achieved MAE 1.93 years and r=0.88 in controls.
- Acute AN showed +2.25 years brain-PAD (advanced brain aging), while weight-restored AN normalized to HC levels (p=0.98 vs HC; p=0.0026 vs acute AN).
- Brain-age deviation was most pronounced in younger acute AN patients (group-by-age interaction p<0.001).
- Brain-PAD correlated negatively with BMI in acute AN (r ≈ -0.29).
Methodological Strengths
- Large, diverse training corpus (10 datasets) and external validation across two institutions.
- Robust model performance with clinically interpretable biomarker (brain-PAD) and subgroup analyses.
Limitations
- Cross-sectional design limits causal inference; longitudinal validation needed.
- Female-only sample aged 10–40 years limits generalizability to males and older adults.
Future Directions: Prospective longitudinal studies linking brain-PAD trajectories with endocrine recovery, cognitive outcomes, and relapse; testing intervention effects on brain-PAD as a surrogate outcome.
3. Pituitary surgery in New Zealand: A single neurosurgeon case series of 1,224 operations.
In a 23-year, single-surgeon series of 1,224 pituitary operations, transsphenoidal surgery showed low serious complication rates and endocrine remission rates in acromegaly and Cushing’s disease comparable to international standards. In non-functioning PitNETs, 20% recurred (median 3.7 years); cavernous sinus invasion strongly predicted recurrence, while older age was protective.
Impact: Provides comprehensive, real-world benchmarks for complication, remission, and recurrence across PitNET subtypes, informing surgical counseling, surveillance intensity, and quality metrics.
Clinical Implications: Counsel patients on expected remission and complication risks; consider closer surveillance in cases with cavernous sinus invasion; data support benchmarking for pituitary centers.
Key Findings
- Transsphenoidal surgery complications: CSF leak 7.3%, permanent diabetes insipidus 3.4%, meningitis 2.4%, visual deterioration 1.2%; carotid injury/stroke/mortality <1%.
- Non-functioning PitNETs: 20% recurrence at median 3.7 years; cavernous sinus invasion predicts recurrence (HR 2.9), older age protective (HR 0.98).
- Endocrine remission: acromegaly 76% (microadenomas) and 75% (macroadenomas); Cushing’s disease 82% (microadenomas) and 75% (macroadenomas).
Methodological Strengths
- Large single-surgeon cohort with consistent surgical technique over 23 years.
- Multivariate analyses and long-term follow-up enabling identification of recurrence predictors.
Limitations
- Single-surgeon, single-center retrospective series may limit generalizability.
- Potential selection and information biases inherent to retrospective design.
Future Directions: Prospective multicenter registries to validate recurrence predictors, integrate molecular markers, and harmonize outcome reporting across PitNET subtypes.