Daily Endocrinology Research Analysis
Analyzed 81 papers and selected 3 impactful papers.
Summary
Today's top endocrinology papers refine diagnostic and treatment pathways in thyroid and adrenal disorders. A large Hypertension study shows single-sided AV sampling metrics are unreliable for primary aldosteronism subtyping, while a JCEM prospective study demonstrates that adding elastography to ACR TI-RADS can halve FNAs without missing cancer. A JAMA Otolaryngology propensity-matched cohort suggests de-escalation to lobectomy is feasible for select N1b papillary thyroid carcinoma.
Research Themes
- Diagnostic accuracy and risk stratification in endocrine imaging
- Surgical de-escalation strategies in differentiated thyroid cancer
- Reliability of adrenal vein sampling metrics in primary aldosteronism
Selected Articles
1. Partially Successful Adrenal Vein Sampling With and Without Cross-Sectional Imaging in Primary Aldosteronism Subtyping.
In 460 PA patients, simulated single-vein RASI showed extensive overlap across lateralized and bilateral subtypes, misclassifying up to 74% and 64% of cases using prior thresholds. RASI failed to predict cure after adrenalectomy; combining with cross-sectional imaging improved lateralization only modestly, especially with cosyntropin-stimulated AVS.
Impact: This study provides strong negative evidence against using single-vein RASI to guide adrenalectomy, directly impacting decision-making in primary aldosteronism centers.
Clinical Implications: Do not rely on RASI from partially successful AVS to subtype PA or to select patients for adrenalectomy. Prioritize bilateral AVS success; if partial, incorporate high-quality cross-sectional imaging and consider repeating AVS or medical therapy.
Key Findings
- RASI from lateralized PA overlapped 98% (dominant AV) and 97% (nondominant AV) with bilateral PA RASI without cosyntropin.
- Previously proposed RASI thresholds misclassified up to 74% of lateralized PA and 64% of bilateral PA.
- RASI did not distinguish adrenalectomy patients with versus without biochemical cure.
- Cross-sectional imaging modestly improved lateralization when combined with cosyntropin-stimulated AVS.
Methodological Strengths
- Large single-center cohort (n=460) with bilateral AVS success enabling robust simulation of partial success.
- Evaluation both before and after cosyntropin stimulation and inclusion of postoperative outcomes.
Limitations
- Retrospective single-center design may limit generalizability.
- Partial success was simulated from bilateral successes rather than observed in real-time partial cannulations.
Future Directions: Prospective multicenter studies validating integrated algorithms (bilateral AVS success metrics plus imaging) and exploring repeat AVS strategies are needed.
2. Elastography enhances diagnostic accuracy of ACR TI-RADS in thyroid nodule evaluation.
In a prospective cohort of 556 thyroid nodules, adding strain elastography to ACR TI-RADS reduced FNAs from 501 to 260 without missing any cancers. Elastography showed outstanding discrimination in TI-RADS 3 nodules (AUC 0.994), supporting a refined, imaging-enhanced risk stratification.
Impact: Provides immediate, actionable imaging criteria that can halve biopsy burden without compromising cancer detection, addressing a common endocrine diagnostic bottleneck.
Clinical Implications: Incorporate strain elastography thresholds alongside TI-RADS to reduce unnecessary FNAs, particularly in TI-RADS 3 nodules; ensure protocol standardization and local validation.
Key Findings
- Adding elastography ratio thresholds (>1.60 for TI-RADS 3; >0.44 for 4; >0.54 for 5) reduced FNA procedures from 501 to 260.
- No malignant nodules were missed when elastography was used as an additional criterion.
- Elastography achieved AUC 0.994 and Youden index 0.994 in TI-RADS 3 nodules.
Methodological Strengths
- Prospective design with standardized ultrasound, CDUS, and strain elastography protocols.
- Use of Bethesda cytology and surgical pathology as reference standards when available.
Limitations
- Potential device- and operator-dependence of elastography thresholds limiting generalizability.
- Not all nodules had surgical pathology, risking verification bias.
Future Directions: Multicenter validation of elastography thresholds across vendors and integration into decision tools to optimize FNA triage.
3. Thyroid Lobectomy and Neck Dissection for N1b Papillary Thyroid Carcinoma.
In a propensity-matched cohort of unilateral N1b PTC with low-volume nodal disease, thyroid lobectomy plus neck dissection achieved similar 5-year OS, DSS, and RFS compared with total thyroidectomy plus RAI, with long median follow-up. This supports de-escalation in carefully selected patients without clinical extranodal extension.
Impact: Challenges a long-standing paradigm that mandates total thyroidectomy plus RAI for N1b PTC by providing matched long-term outcomes for lobectomy.
Clinical Implications: Consider lobectomy with neck dissection for unilateral N1b PTC with low-volume metastases and no clinical extranodal extension, after thorough multidisciplinary evaluation and patient counseling.
Key Findings
- 5-year OS: 96.9% (TL) vs 96.8% (TT+RAI); HR 0.2 (95% CI 0.03–1.58).
- 5-year DSS: 96.7% (TL) vs 100% (TT+RAI).
- 5-year RFS: 89.8% (TL) vs 88.9% (TT+RAI); HR 1.48 (95% CI 0.39–5.58).
- Survival rates remained stable from 5 to 10 years.
Methodological Strengths
- Propensity-matched cohort with long median follow-up (90–113 months).
- Single tertiary cancer center with consistent surgical and follow-up protocols.
Limitations
- Small matched TL cohort (n=37) limits power to detect small differences.
- Retrospective single-center design with potential residual confounding.
Future Directions: Prospective registries and multicenter studies to refine selection criteria for de-escalation and to quantify quality-of-life and complication differences.