Commentary on the Endocrine Society Practice Guidelines: Consequences of adjustment of antihypertensive medication in screening of primary aldosteronism

ObjectiveTo compare universal vs targeted screening for thyroid dysfunction and to estimate the prevalence of hypothyroidism in pregnant Egyptian women.Subjects and methodsA total of 168 of pregnant women who attended the outpatient obstetric clinic at Ain Shams University Hospital (Cairo, Egypt) for antenatal care between September 2011 and December 2011 were enrolled. Based on the detailed data collection and results of laboratory testing, they were subdivided into the high- and low-risk group for thyroid disease according to the most recent Endocrine Society clinical practice guidelines, as well as into groups by trimester for application of American Thyroid Association guidelines. The group values were subjected to statistical analysis for estimating the prevalence of clinical and subclinical hypothyroidism and for identifying significant differences.ResultsOf the 168 patients, 104 were classified into the low-risk group and 64 into the high-risk group. Using the trimesteric and normal population cutoff values for thyroid functions, the prevalence of hypothyroidism was found to be 56% (n=94) and 44.6% (n=75) respectively. No statistically significant differences were found between the high- and low-risk group regarding prevalence of either clinical or subclinical hypothyroidism, and no significant differences were found regarding the prevalence of hypothyroidism in the first, second, or third trimester.ConclusionUse of the most recent Endocrine Society clinical practice guidelines led to missed detection of clinical or subclinical hypothyroidism in 34.5% of pregnant women. Universal screening of pregnant women for thyroid dysfunction should thus be adopted throughout Egypt.

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Conflicts of Interest in Clinical Practice Guidelines: Accelerating an Evolution. An Endocrine Society Consensus Statement*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01878 ◽

2018 ◽

Vol 103 (12) ◽

pp. 4339-4342 ◽

Cited By ~ 2

Author(s):

Christopher R McCartney ◽

Clifford J Rosen

Keyword(s):

Clinical Practice ◽

Best Practices ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Development Process ◽

Consensus Statement ◽

Conflicts Of Interest ◽

Best Interests ◽

Endocrine Society ◽

Open Payments

Abstract An analysis of the Endocrine Society’s clinical practice guidelines (CPGs) published from 2010 to 2017—presented by Irwig et al. in the current issue of The Journal of Endocrinology and Metabolism—suggested that the Endocrine Society met five of seven National Academy of Medicine (NAM) standards concerning financial conflicts of interest in CPGs. As current contributors to the Endocrine Society’s CPG efforts, we offer additional context related to the 2011 NAM standards and the current environment concerning industry support in medicine, and we comment on the nature of industry support received by the Society’s CPG authors according to Irwig and colleagues’ analysis of the Centers for Medicare and Medicaid Services’ Open Payments database. Perhaps most importantly, we outline the Society’s recent and ongoing efforts to enhance the value of its CPGs. Such efforts include a 2016 revision of CPG author conflict of interest rules—a change that was invisible to the investigatory methods used by Irwig et al.—in addition to other processes designed to enhance CPG objectivity. We conclude our commentary by recognizing that good-faith attempts to enhance transparency and to reduce conflicts of interest (real or apparent) in CPGs will ultimately serve the best interests of patients and providers; we confirm the Endocrine Society’s resolute commitment to providing high-quality, evidence-based clinical guidance via a CPG development process that faithfully accords with current CPG best practices.

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Functional imaging by 11C-metomidate PET: a really useless technique for Primary Aldosteronism subtyping?

Acta Endocrinologica ◽

10.1530/eje-20-1402 ◽

2021 ◽

Author(s):

Filippo Crimì ◽

Alessandro Spimpolo ◽

Diego Cecchin ◽

Gian Paolo Rossi

Keyword(s):

Diagnostic Accuracy ◽

Functional Imaging ◽

Primary Aldosteronism ◽

Adrenal Venous Sampling ◽

Venous Sampling ◽

Endocrine Society ◽

Great Caution ◽

Diagnostic Usefulness

Soinio et al. recently compared the diagnostic accuracy of 11C-metomidate PET (11C-MTO-PET) and cosyntropin-stimulated adrenal venous sampling (AVS) for the subtyping of patients with primary aldosteronism (PA), who were diagnosed according to the 2008 Endocrine Society guidelines. They concluded that 11C-MTO-PET offered no diagnostic usefulness in subtyping of PA patients. In our view, this conclusion needs to be taken with great caution owing to a number of concerns that can be raised concerning their study

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Splitting atoms: the Endocrine Society guideline for the management of primary aldosteronism

The Lancet Diabetes & Endocrinology ◽

10.1016/s2213-8587(16)30154-1 ◽

2016 ◽

Vol 4 (10) ◽

pp. 805-807 ◽

Cited By ~ 4

Author(s):

Morris J Brown ◽

William M Drake

Keyword(s):

Primary Aldosteronism ◽

Endocrine Society ◽

Society Guideline

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Primary Aldosteronism in the Elderly

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa206 ◽

2020 ◽

Vol 105 (7) ◽

pp. e2320-e2326

Author(s):

Paolo Mulatero ◽

Jacopo Burrello ◽

Tracy Ann Williams ◽

Silvia Monticone

Keyword(s):

Primary Aldosteronism ◽

Molecular Mechanisms ◽

Sodium Intake ◽

Evidence Synthesis ◽

Expression Patterns ◽

The Elderly ◽

Zona Glomerulosa ◽

Endocrine Society ◽

Age Related ◽

Serum Aldosterone

Abstract Context The clinical spectrum and knowledge of the molecular mechanisms underlying primary aldosteronism (PA), the most frequent form of endocrine hypertension, has evolved over recent years. In accordance with the Endocrine Society guidelines and in light of the growing evidence showing adverse cardiovascular outcomes, it is expected that a progressively wider population of patients affected by hypertension will be screened for PA, including the elderly. Evidence Acquisition A systematic search of PubMed was undertaken for studies related to the renin-angiotensin-aldosterone system (RAAS), PA, and adrenal histopathology in the elderly population. Evidence Synthesis Several studies showed an age-dependent decrease in the activity of RAAS, together with a progressive decrease of the aldosterone response to sodium intake, particularly after the sixth decade of life. The positive correlation between age and serum aldosterone during liberal sodium intake over serum aldosterone during sodium restriction is paralleled by histological changes in adrenal aldosterone synthase (CYP11B2) expression patterns. Immunohistochemical studies showed a progressive loss of the continuous expression of CYP11B2 in the adrenal zona glomerulosa with aging and a concomitant increase of aldosterone-producing cell clusters, which might be responsible for relatively autonomous aldosterone production. Additionally, following PA confirmation and subtype diagnosis, older age is correlated with a lower benefit after adrenalectomy for unilateral PA. Conclusions Accumulating evidence suggests that RAAS physiology and regulation show age-related changes. Further studies may investigate to what extent these variations might affect the diagnostic workup of patients affected by PA.

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