Daily Endocrinology Research Analysis
Analyzed 123 papers and selected 3 impactful papers.
Summary
Three impactful endocrinology papers stood out: a prospective multicenter cohort shows unilateral adrenalectomy—rather than medical therapy—improves quality of life and anxiety in primary aldosteronism; an international cohort demonstrates type 2 diabetes subphenotypes predict bariatric surgery remission; and a global GBD analysis charts a steep rise and widening disparities in PCOS toward 2050. Together, these studies advance precision care and inform policy planning.
Research Themes
- Surgical versus medical management in primary aldosteronism and patient-reported outcomes
- Precision subphenotyping to predict metabolic surgery outcomes in type 2 diabetes
- Global epidemiology and health equity in polycystic ovary syndrome
Selected Articles
1. Improvement of Health-Related Quality of Life and Mental Health After Unilateral Adrenalectomy for Primary Aldosteronism.
In a prospective multicenter cohort of hypertensive patients undergoing PA workup, unilateral adrenalectomy improved SF-12 mental and physical component scores and reduced anxiety (GAD-7), whereas mineralocorticoid receptor antagonist therapy did not. Baseline QoL and anxiety did not differ between PA and non-PA hypertension.
Impact: This study provides prospective, multicenter evidence that surgery confers measurable quality-of-life and mental health benefits beyond blood pressure control in unilateral PA.
Clinical Implications: For unilateral PA, consider early referral for adrenalectomy to improve QoL and anxiety in addition to cardiometabolic benefits; relying solely on MRAs may not address patient-reported outcomes.
Key Findings
- Baseline QoL and anxiety were similar in PA vs non-PA hypertension.
- After unilateral adrenalectomy, SF-12 mental and physical scores improved (Δ 4.2 and 3.6) and GAD-7 decreased (Δ -1.9).
- No comparable improvements were seen with mineralocorticoid receptor antagonist therapy.
Methodological Strengths
- Prospective, multicenter international design with standardized patient-reported outcome measures (SF-12, GAD-7, PHQ).
- Direct comparison with hypertensive controls without PA to isolate PA-specific effects.
Limitations
- Non-randomized treatment allocation may introduce confounding.
- Short follow-up window (3–6 months) limits assessment of durability.
Future Directions: Randomized or pragmatic trials comparing surgery vs optimized medical therapy on patient-centered outcomes and longer-term follow-up are warranted.
BACKGROUND: Primary aldosteronism (PA) has been linked with reduced health-related quality of life (QoL) and increased prevalence of anxiety and depression. While most studies compared patients with PA to healthy subjects, this study focused on comparison with hypertensive patients without PA to identify PA-specific effects. Furthermore, the impact of targeted therapy on QoL and mental health was evaluated. METHODS: Mental and physical health-related QoL, anxiety and presence of depressive and panic symptoms were assessed using the SF-12, GAD-7 and PHQ questionnaires in 925 patients with arterial hypertension tested for PA in a prospective, multi-center international prospective cohort study. Questionnaires were assessed at baseline as well as 3-6 months after initiation of targeted therapy. RESULTS: Amongst 833 of 925 patients who completed the necessary diagnostic procedures, 211 were diagnosed with PA. 98 of 116 patients with unilateral PA received unilateral adrenalectomy. At baseline, QoL, anxiety and mental health scores did not differ in patients with PA vs patients with hypertension without PA. At outcome assessment, SF-12 mental and physical component summaries as well as GAD-7 specifically improved in patients with unilateral PA after adrenalectomy (mean Δ = 4.2, p = 0.018, Δ = 3.6, p = 0.038 and Δ = -1.9, p = 0.006, respectively) in contrast to no improvement in patients with PA on MRA treatment. CONCLUSIONS: There was no difference in health-related QoL, anxiety and mental health in patients with hypertension with versus without PA. Unilateral adrenalectomy but not medical therapy improved health-related QoL and decreased anxiety in patients with PA.
2. Type 2 diabetes subphenotypes are associated with differential outcomes after metabolic and bariatric surgery: An international multicentre retrospective cohort study.
Among 233 T2D patients undergoing bariatric/metabolic surgery, remission at 2 years differed by subphenotype: SIDD had markedly lower remission (36.7%) than MOD (79.3%) and SIRD (97.2%). Findings support phenotype-driven counseling and treatment expectations.
Impact: Demonstrates clinically actionable heterogeneity in surgical remission by validated T2D subphenotypes, advancing precision metabolic surgery.
Clinical Implications: Incorporate T2D subphenotypes (SIDD/SIRD/MOD) into preoperative assessment to individualize prognosis, optimize procedure selection, and consider adjunctive beta-cell–supportive strategies for SIDD.
Key Findings
- Subphenotype distribution: MOD 62.2%, SIRD 19.7%, SIDD 18.1%.
- Two-year T2D remission: SIDD 36.7% vs MOD 79.3% and SIRD 97.2% (p < 0.001).
- Multidimensional assessment included HOMA2 indices, %TWL, and intraoperative liver histology (MASLD/MASH).
Methodological Strengths
- International multicentre cohort with standardized subphenotyping (Ahlqvist methodology).
- Clinically relevant endpoints at 2 years, including remission and mechanistic surrogates.
Limitations
- Retrospective design with potential selection bias.
- Moderate sample size and 2-year horizon may limit generalizability and long-term inference.
Future Directions: Prospective validation of subphenotype-guided pathways, procedure-specific effects, and integration with genetic/omic markers to refine surgical precision.
AIMS: Type 2 diabetes (T2D) is characterized by its clinical heterogeneity. Newly described T2D subphenotypes, each with distinct metabolic and co-morbidity risk profiles, may enable a more personalized care. This study examined whether these subphenotypes can predict outcomes in patients undergoing metabolic and bariatric surgery (MBS). MATERIALS AND METHODS: A total of 233 people with T2D from four clinical centres undergoing MBS were retrospectively assigned to T2D subphenotypes based on the Ahlqvist methodology. The primary outcome was T2D remission at 2 years; secondary outcomes included changes in HOMA2-%B, HOMA2-IR, and total body weight loss (%TWL). Intraoperative liver biopsies were evaluated for metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). RESULTS: All participants were classified as mild obesity-related diabetes (MOD) (62.2%), severe insulin-resistant diabetes (SIRD) (19.7%), or SIDD (18.1%). At 2 years, diabetes remission was lower in severe insulin-deficient diabetes (SIDD) (36.7%) than MOD (79.3%) and SIRD (97.2%; p < 0.001). SIDD had lower BMI (38.3 vs. 45.2 and 43.2 kg/m
3. Global Burden of Polycystic Ovary Syndrome: Socioeconomic Disparities, Reproductive Impacts, and Projections to 2050.
GBD-based analyses show PCOS prevalence nearly doubled since 1990, with highest current burden in high-middle SDI regions but fastest growth in low-SDI settings. Infertility drives most disability, peaking in ages 25–29; projections indicate >100 million cases by 2050.
Impact: Defines temporal trends and inequities in PCOS at scale, informing resource allocation, screening strategies, and reproductive health policy worldwide.
Clinical Implications: Prioritize early detection and access to fertility and metabolic care in rapidly rising low-SDI regions; develop population-specific screening and personalized management to reduce disability.
Key Findings
- Global PCOS prevalent cases rose from 36.65M (1990) to 69.47M (2021), ASPR 1757.8/100,000 (AAPC 0.81).
- Highest burden in high-middle SDI regions; steepest rise in low-SDI regions (AAPC 2.22).
- Infertility accounted for the majority of YLDs, peaking at ages 25–29; projections estimate 103.91M cases by 2050.
Methodological Strengths
- Use of GBD 2021 with age–period–cohort modelling, decomposition, inequality analysis, and Bayesian projections.
- Comprehensive reporting of prevalence, incidence, and YLDs across global, regional, and national strata.
Limitations
- Heterogeneity in diagnostic criteria and underdiagnosis may affect estimates.
- Model-based inferences may not capture local clinical nuances or rapid policy changes.
Future Directions: Harmonize PCOS diagnostic criteria globally, strengthen surveillance in low-SDI regions, and evaluate targeted interventions to reduce reproductive disability.
BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 11%-13% globally and representing a primary cause of anovulatory infertility, with substantial socioeconomic disparities influencing its worldwide burden. However, data on temporal trends, regional variations, and sociodemographic drivers of PCOS are limited. We aimed to evaluate global, regional, and national PCOS trends from 1990 to 2021 and project future impacts to 2050. METHODS: In this trend analysis based on the 2021 Global Burden of Diseases (GBD) study, we report on the prevalence, incidence, and years lived with disability (YLDs) rates per 100,000 individuals, as well as average annual percentage changes (AAPCs) for PCOS at the global, regional, and national levels. We analyzed these trends by age, SDI, and reproductive outcomes using age-period-cohort (APC) modelling, decomposition, inequality analysis, and Bayesian projections. RESULTS: From 1990 to 2021, global PCOS prevalent cases increased from 36.65 million to 69.47 million (89.6% rise), with an age-standardised prevalence rate (ASPR) of 1757.8 per 100,000 in 2021 (AAPC 0.81 [95% CI 0.77-0.85]). High-middle SDI regions exhibited the highest burden (ASPR: 5237.6 per 100,000), while low-SDI regions showed the steepest rise (AAPC: 2.22). Infertility accounted for the majority of YLDs, peaking at ages 25-29. Socioeconomic inequalities decreased (Slope Index of Inequality from 28.55 to 22.28). Projections indicate 103.91 million cases by 2050. CONCLUSION: From 1990 to 2021, global PCOS burden increased substantially, with marked socioeconomic and regional disparities. This underscores the need for enhanced screening, personalised treatments, and targeted interventions in low-SDI regions to promote reproductive health equity.