Daily Endocrinology Research Analysis
Analyzed 89 papers and selected 3 impactful papers.
Summary
Analyzed 89 papers and selected 3 impactful articles.
Selected Articles
1. Teriparatide Plus Zoledronic Acid for Osteogenesis Imperfecta: A Randomized Clinical Trial.
In 349 adults with osteogenesis imperfecta, teriparatide for 2 years followed by a single zoledronic acid infusion increased lumbar spine and hip BMD and improved several quality-of-life measures but did not reduce imaging-confirmed incident fractures versus standard care (HR 0.97, 95% CI 0.68–1.38). Adverse events were similar between groups.
Impact: This large multicenter RCT answers a pivotal clinical question in a rare disease: BMD gains from anabolic–antiresorptive sequencing do not necessarily prevent fractures in osteogenesis imperfecta, reframing therapeutic goals toward bone quality.
Clinical Implications: Avoid assuming fracture risk reduction from BMD gains in osteogenesis imperfecta; prioritize fracture-centered outcomes, fall prevention, and therapies targeting bone material properties. Off-label teriparatide use should be individualized with shared decision-making.
Key Findings
- No reduction in imaging-confirmed incident fractures with teriparatide plus zoledronic acid vs standard care (HR 0.97; absolute risk difference −1.57%).
- Lumbar spine and total hip BMD increased significantly more with active therapy.
- Several health-related quality-of-life measures favored the active sequence; adverse events were similar between groups.
Methodological Strengths
- Multicenter randomized design with blinded fracture adjudication
- Pre-registered trial with clearly defined primary and secondary endpoints
Limitations
- Open-label design may introduce performance bias
- Predominance of type I osteogenesis imperfecta limits generalizability to other subtypes
Future Directions: Develop and test therapies improving bone material properties and microarchitecture; identify biomarkers correlating with fracture risk beyond BMD; conduct subtype-specific trials and longer-term fracture follow-up.
IMPORTANCE: Osteogenesis imperfecta causes multiple fractures throughout life, causing substantial morbidity. OBJECTIVE: To determine whether the parathyroid hormone analogue teriparatide followed by zoledronic acid reduces the risk of fractures in adults with osteogenesis imperfecta. DESIGN, SETTING, AND PARTICIPANTS: Multicenter open-label, parallel-group, randomized clinical trial, conducted between May 17, 2017, and March 21, 2025, in adults attending one of 27 referral centers with a clinical diagnosis of osteogenesis imperfecta. Bone mineral d
2. Comparative Effectiveness of Individual Sodium Glucose Transporter 2 Inhibitors on Cardiovascular Outcomes in Type 2 Diabetes With Moderate Cardiovascular Risk: Emulation of a Target Trial.
In 137,232 balanced patients with type 2 diabetes at moderate cardiovascular risk, SGLT2 inhibitors showed broadly similar cardiovascular effectiveness. Empagliflozin had a slightly lower risk of MACE vs canagliflozin (HR 0.92), driven by reduced all-cause mortality (HR 0.86); no other between-drug differences were observed.
Impact: Provides large-scale, methodologically robust head-to-head effectiveness data where RCTs are lacking, guiding pragmatic drug selection and health-system formulary decisions.
Clinical Implications: Given small between-drug differences, prioritize access, affordability, and patient-specific factors to expand SGLT2 inhibitor use in moderate-risk T2D, with no need to switch stable patients solely for cardiovascular benefit.
Key Findings
- Weighted cohort of 137,232 new users: canagliflozin (42,877), dapagliflozin (17,871), empagliflozin (7,648).
- Empagliflozin vs canagliflozin: lower MACE risk (HR 0.92) via reduced all-cause mortality (HR 0.86).
- No significant differences for empagliflozin vs dapagliflozin or dapagliflozin vs canagliflozin; safety outcomes comparable.
Methodological Strengths
- Target-trial emulation with super-learner propensity weighting and balanced covariates
- Large, multi-payer US datasets with extended follow-up through 2022
Limitations
- Observational design with potential residual confounding and channeling bias
- Race distribution skewed (75% non-Hispanic White); adherence and dose not captured
Future Directions: Prospective head-to-head trials in diverse populations; evaluation of renal outcomes and heart failure stratified by baseline risk; cost-effectiveness analyses to optimize access.
BACKGROUND: SGLT2 (sodium-glucose cotransporter 2) inhibitors reduce major adverse cardiovascular events (MACE) in type 2 diabetes. However, no direct comparison of individual SGLT2 inhibitor drugs has been conducted, particularly among adults with moderate cardiovascular risk who comprise most people with type 2 diabetes. METHODS: We used data for commercial, Medicare Advantage, and Medicare fee-for-service beneficiaries to emulate a target trial of adults (≥21 years) with type 2 diabetes and moderate cardiovascular risk who started canagliflozin, dapagliflozin, or empagliflozin between 2015 and 2020. We estimated p
3. Prolactinoma Course and Management in Transgender Women: case report and systematic review.
A 22-year-old transgender woman with a residual macroprolactinoma experienced marked biochemical (to 128.4× ULN) and radiologic progression after estrogen initiation despite cabergoline, requiring estrogen withdrawal and subsequent radiotherapy before safe reintroduction. A systematic review identified 24 reported cases in transgender women, most diagnosed after GAHT initiation with limited baseline prolactin data, and no specific guideline recommendations.
Impact: Highlights a plausible risk of GAHT-triggered progression and dopamine-agonist resistance in residual macroprolactinoma, a rapidly growing clinical population lacking guidelines.
Clinical Implications: Obtain baseline pituitary imaging and prolactin before GAHT in transgender women with pituitary disease or symptoms; monitor PRL and visual fields closely after estrogen initiation; coordinate multidisciplinary care and consider dose-modified GAHT or adjuvant radiotherapy if progression or cabergoline resistance occurs.
Key Findings
- Estrogen initiation led to rapid biochemical (128.4× ULN prolactin) and radiologic progression of a residual macroprolactinoma despite cabergoline, necessitating estrogen withdrawal.
- Disease was stabilized with radiotherapy, permitting safe reintroduction of estrogen.
- Systematic review identified 24 cases in transgender women, mostly diagnosed after GAHT, with lack of baseline PRL data and absent specific guideline recommendations.
Methodological Strengths
- Integrates detailed clinical course with systematic review of published cases
- Highlights consistent clinical signal across reports to generate practice-alert hypotheses
Limitations
- Evidence base is case-level with potential reporting bias and heterogeneous follow-up
- Lack of standardized GAHT dosing and baseline prolactin data in many reports
Future Directions: Prospective registries and trials to define monitoring protocols, GAHT dosing strategies with pituitary disease, and management algorithms for dopamine-agonist resistance in transgender populations.
OBJECTIVE: Prolactinomas are the most common functioning pituitary neuroendocrine tumours (PitNETs). In transgender women, gender-affirming hormone therapy (GAHT) usually combines high doses of oestrogen and anti-androgen therapy, both of which can elevate serum prolactin levels. Whether GAHT influences tumour behaviour in patients with pre-existing prolactinomas remains unclear. DESIGN AND METHODS: Case report illustrating the clinical challenges in managing a prolactinoma in the context of GAHT initiation combined with a systematic review of all published cases and available guidelines of GAHT in the prolactinoma c