Endocrines

Background/Objectives: Nocturnal glycemic variability in pediatric type 1 diabetes (T1D) disrupts caregiver sleep and quality of life; advanced hybrid closed-loop (AHCL) systems may be associated with reduced caregiver burden by providing more stable overnight glucose control. We aimed to evaluate changes in caregiver-reported sleep quality and continuous glucose monitoring (CGM) targets three months after transition to an AHCL system. Methods: We conducted a prospective single-center real-world study in a tertiary pediatric diabetes unit that included children aged 6–17 years with T1D who switched from continuous subcutaneous insulin infusion (MiniMed) and intermittently scanned CGM (FreeStyle Libre 2) to an AHCL system (MiniMed 780G) with Guardian 4 sensor. Caregivers completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 3 months; CGM metrics (TIR 70–180 mg/dL, TAR1 180–250 mg/dL, TAR2 > 250 mg/dL, TBR1 54–70 mg/dL, TBR2 < 54 mg/dL) were extracted at the same time points. Analyses used Shapiro–Wilk, Wilcoxon signed-rank, Spearman correlations, and McNemar tests (α = 0.05). Results: Twenty-two caregivers completed baseline PSQI; 16 provided PSQI data at three months. The proportion with PSQI > 5 decreased from 56.3% to 18.8% (p = 0.034), and 81.3% showed lower global PSQI at 3 months (p = 0.018). The largest mean improvements were observed in daytime dysfunction (−0.94), subjective sleep quality (−0.81), and sleep duration (−0.63), with slight increases in sleep disturbance (+0.13) and sleep-medication use (+0.13). The proportion of participants meeting international CGM consensus targets improved: the percentage achieving TIR > 70% increased from 26.7% to 80.0% (p = 0.008); those meeting TAR > 180 mg/dL < 30% increased from 26.7% to 80.0% (p = 0.008); and those meeting TAR2 > 250 mg/dL < 5% increased from 20.0% to 53.3% (p = 0.008). Hypoglycemia-related targets showed no significant change, and no episodes of symptomatic or level 3 hypoglycemia were reported. Exploratory analyses suggested that poorer PSQI at 3 months was associated with greater Δ TBR1, and increases in TAR2 with higher sleep disturbance and sleep-medication use. Conclusions: Transition to an AHCL system was associated with improvements in caregiver-reported sleep and attainment of CGM consensus targets within three months. Residual nocturnal hyperglycemia was associated with features of ongoing sleep disturbance, highlighting the potential relevance of individualized alert settings, sleep-focused education, and inclusion of objective sleep measures in future studies. Full article

Background: Type 2 diabetes is projected to affect millions of people annually as the number of cases rises year on year. This includes children. Treating diabetes and its related comorbidities has a huge economic impact and puts pressure on healthcare providers. Understanding the disease at a molecular level is key for developing better therapeutics. The protein Islet Amyloid Polypeptide (IAPP) or amylin is important for glucose regulation; however, it is also instrumental in type 2 diabetes pathology. Human IAPP can misfold into oligomers and amyloid fibrillar aggregates within pancreatic islets, promoting β-cell dysfunction and death, contributing to progressive insulin deficiency and worsening hyperglycaemia. Methods: Based on previous studies on mutations at residues 18, 28 and 31,we have designed three novel IAPP analogues (two double and one triple mutant) to assess whether the combined amino acid substitutions impact fibril formation, solubility and toxicity. Results: All three of our analogues show a reduced propensity to aggregate and are more soluble than wild type IAPP. Compared with pramlintide, a clinically prescribed synthetic analogue of human amylin, all of our analogues appeared to have similarly reduced toxicity and improved solubility relative to human IAPP. Additionally, two of our analogues exhibited a markedly slower rate of fibril formation. Conclusions: Our results highlight the importance of targeting multiple residues as a promising strategy for developing improved diabetes therapeutics in the future. Full article

Background: Vasomotor symptoms (VMS), particularly hot flashes and night sweats, are highly prevalent during the menopausal transition and have been increasingly associated with adverse cardiometabolic profiles. Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a major manifestation of systemic metabolic dysregulation and is rising globally. Emerging evidence suggests a potential overlap between menopausal symptom severity and MASLD risk; however, this relationship remains insufficiently characterized. Method: A scoping review was conducted in accordance with PRISMA-ScR guidelines to map the existing evidence on the association between VMS and MASLD. A comprehensive search of PubMed, Scopus, CINAHL, Cochrane Library, and MEDLINE was performed for English-language studies published between January 2015 and December 2025. Eligible studies included original research assessing both MASLD and menopausal symptoms. Data were extracted and synthesized narratively. Methodological quality was appraised using the CASP Cross-Sectional Studies Checklist. Results: Of 690 identified records, five cross-sectional studies met the inclusion criteria, comprising 106 to 5995 participants from Korea, Greece, and the United States. Across studies, moderate-to-severe VMS were consistently associated with increased MASLD prevalence or higher surrogate indices of hepatic steatosis. Women with more severe VMS demonstrated unfavorable metabolic profiles, including greater insulin resistance and elevated liver enzyme levels. Although adjustments for body mass index and hypertension attenuated some associations, the overall trend remained positive. Heterogeneity was observed in diagnostic tools and symptom assessment methods. Conclusions: Current evidence indicates a consistent association between VMS severity and MASLD in peri- and postmenopausal women. While causality cannot be inferred due to cross-sectional designs, VMS may represent a clinical marker of underlying metabolic and hepatic dysfunction. Longitudinal and mechanistic studies are warranted to clarify directionality and inform integrated screening strategies in midlife women. Full article

Background/Objectives: Menopause is accompanied by substantial changes in endogenous sex hormones that influence metabolic regulation. However, the associations of specific hormones with type 2 diabetes (T2D) risk in postmenopausal women remain inconsistent. This study aimed to quantify the relationships between incident T2D and follicle-stimulating hormone (FSH), oestradiol, testosterone, and sex hormone-binding globulin (SHBG), and to examine cross-sectional differences in hormone concentrations between postmenopausal women with and without T2D. Methods: MEDLINE, Embase and Cochrane CENTRAL were searched from database inception to 21 June 2024. Eligible studies included prospective cohort, nested case–control and case–control designs. Associations with incident T2D were pooled using Hartung–Knapp–Sidik–Jonkman random-effects meta-analysis. Both categorical and continuous estimates were extracted, prioritising maximally adjusted models. Risk of bias was assessed using ROBINS-E and the Newcastle–Ottawa Scale. Results: Sixteen studies (18 articles; n = 16,180) were included. Higher SHBG was consistently associated with lower T2D risk in cohort analyses (RR 0.55; 95% CI 0.38–0.72; I² ≈ 0%). Higher FSH was also associated with lower risk (high vs. low: HR 0.55, 95% CI 0.29–0.81), although continuous estimates showed heterogeneity. Higher oestradiol was associated with increased T2D risk (RR 1.61, 95% CI 1.18–2.03; I² ≈ 6%), while testosterone was not significantly associated with incident T2D (RR 1.11, 95% CI 0.73–1.50). Cross-sectional analyses indicated lower SHBG and higher testosterone in women with T2D. Conclusions: Endogenous hormone profiles and SHBG concentrations are associated with T2D in postmenopausal women, with the most consistent evidence for an inverse association between SHBG and incident T2D. Because the available evidence is observational and partly heterogeneous, these findings should be interpreted as associations rather than causal or clinically predictive effects. Standardised measurement, repeated pre-diagnostic sampling and external validation are required before these biomarkers can be considered for routine risk stratification. Full article

Background/Objective: Type 1 diabetes (T1D) is a complex autoimmune disease characterized by the destruction of insulin-producing pancreatic beta cells. The TAB2/SUMO4 locus has been implicated in T1D susceptibility through a biochemical mechanism involving NFκB. Given that alterations in NFκB activity have been linked to the etiology of T1D, this study evaluated the association between single nucleotide polymorphisms (SNPs) in the TAB2/SUMO4 region (rs6942381, rs237027, rs237025, and rs7896) and T1D in a population from southern Brazil. Methods: Two T1D groups, each comprising 150 with childhood-onset (aged ≤14 years) and 150 with adulthood-onset (aged >18 years) were compared with healthy controls (165 children aged ≤14 years and 150 adults aged >18 years, respectively). Genotyping of SNPs in the TAB2/SUMO4 region was performed using real-time PCR. Results: All polymorphisms were in Hardy–Weinberg equilibrium. The genotype and allele frequencies of the studied polymorphisms in the TAB2/SUMO4 region did not differ among groups in either children or adults. The MAF of the children and adults controls are respectively for rs6942381 49.1% (95% CI 44–54%) and 48.0% (95% CI 42–52%), rs237027 12.4% (95% CI 9–16%) and 11.7% (95% CI 8–15%), rs237025 45.5% (95% CI 40–51%) and 46.0% (95% CI 41–52%) and rs7896 18.2% (95% CI 14–22%) and 24.3% (95% CI 19–29%). The haplotype frequencies were also similar between groups. The observed minor allele frequencies were similar to those reported in European populations. Conclusions: TAB2/SUMO4 locus polymorphisms (rs6942381, rs237027, rs237025, and rs7896) were not associated with childhood- or adulthood-onset T1D in the studied population. Full article

Background/Objectives: Physical activity is a cornerstone of preventive health, yet its practice often coexists with the consumption of alcoholic beverages like beer and wine. While these beverages contain bioactive compounds with potential health properties, alcohol itself carries significant risks. This systematic review aimed to synthesize and critically assess the evidence on physical activity and beer and wine consumption. Specifically, we examined their combined effects on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism); inflammation and oxidative stress markers; mental health outcomes (cognitive function, mood, sleep); and physical performance, neuromuscular recovery, and fluid balance. Methods: Following a pre-registered protocol (PROSPERO: CRD420261281945), a systematic search of PubMed/MEDLINE, Scopus, and SPORTDiscus was conducted for studies published between 2000 and 2025. Included studies were randomized controlled trials or observational studies involving physically active adults (aged ≥ 18 years) who consumed beer or wine. Studies focusing solely on sedentary populations were excluded. Outcomes assessed included metabolic syndrome components, inflammation, oxidative stress, mental health, cognitive function, and physical performance. Risk of bias was evaluated using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. Results: Eight studies were included. Moderate beer or wine consumption did not substantially negate the beneficial effects of exercise on cardiometabolic health, body composition, or cognitive function. Higher alcohol intake was associated with elevated blood pressure. Acute post-exercise consumption of alcoholic beer impaired rehydration and neuromuscular recovery, whereas non-alcoholic beer did not. Conclusions: Given the small number of studies and risk of bias, these findings should be interpreted with caution. In physically active populations, moderate beer or wine consumption does not clearly undermine the benefits of regular exercise on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism). No additional benefits on inflammation or oxidative stress were observed, nor on mental health outcomes (cognitive function, mood, or sleep). However, acute post-exercise alcohol intake impairs rehydration and neuromuscular recovery, whereas non-alcoholic beer represents a safer alternative. Full article

Background/Objectives: The dental setting has been suggested as a location for opportunistic diabetes screenings. Diabetes screening is a pathway consisting of several steps that must be completed to reach a diagnosis. Previous research has found that most patients in the dental setting, when offered the opportunity to screen for diabetes, are willing to do so; however, amongst those who are referred for medical follow-up, there is low compliance. If diabetes screening in the dental setting is to be effective, strategies are required to maximise uptake and ensure completion of the screening pathway. Methods: This qualitative study examined participants in a diabetes screening trial held at dental clinics in Victoria, Australia. Semi-structured interviews were conducted by telephone, transcribed and analysed thematically. The themes identified were then deductively mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Results: Ten individuals who were screened for diabetes and referred to their general medical practitioner (GP) for a diabetes diagnosis were interviewed. The themes identified from the interviews were mapped to five COM-B domains: reflective motivation and automatic motivation, social and physical opportunity and psychological capability. These were linked to eight TDF domains associated with issues related to knowledge, environmental context and resources, memory, attention and decision processes, social influences, beliefs about consequences, emotions, and beliefs about capability. Conclusions: This study investigated the determinants influencing individuals’ decision to participate in diabetes screening and comply with referral advice. The results demonstrate the need to increase community knowledge around diabetes and screening for the condition, facilitate risk interpretation, and streamline the referral pathway between oral health professionals (OHP) and GPs. The study provides evidence that can be utilised for the development of future interventions that promote diabetes screening participation and maximise medical follow-up of referred individuals. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article

Background/Objectives: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition often managed exclusively with insulin. However, the search for adjuvant therapies has gained attention, including dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), despite limited evidence in pediatric populations. To evaluate the impact of DPP4i, alone or combined with SGLT2i, on glycemic control (HbA1c), lipid profile (ApoB and ApoA-I), and renal function (eGFR and albuminuria) in children, adolescents, and young adults with T1DM, this study was conducted. Methods: This cohort study analyzed data from 76 patients with T1DM aged under 25, followed for 4 to 20 months. Patients were grouped based on exposure to DPP4i alone, DPP4i + SGLT2i, or no additional therapy. Glycemic, lipid, and renal parameters were assessed at baseline and follow-up. Results: A significant reduction in HbA1c was observed in the overall sample (p < 0.001), regardless of treatment group, suggesting a positive effect of interdisciplinary care. There were no statistically significant differences in HbA1c variation among the groups. ApoB decreased significantly over time (p < 0.001), and ApoA-I levels were initially higher in the DPP4i + SGLT2i group. A significant reduction in albuminuria was identified in the DPP4i-only group compared to controls (p = 0.029), indicating a potential renoprotective effect. No significant changes in eGFR were observed. The use of DPP4i, with or without SGLT2i, was not associated with significant improvements in glycemic or lipid outcomes compared to standard therapy. However, DPP4i monotherapy was associated with a reduction in albuminuria, suggesting a possible benefit for renal protection. Conclusions: These findings highlight the need for larger, randomized studies to confirm the therapeutic role of these agents in young individuals with T1DM. Full article

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a prevalent condition with a significant annual incidence, particularly increasing with age. Its pathophysiology is explained by Virchow’s triad (venous stasis, vascular injury, and hypercoagulability). Tirzepatide, a dual receptor agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), is approved for type 2 diabetes mellitus (T2DM) and obesity, showing efficacy in lowering HbA_1c and promoting weight loss. Recent case reports have linked tirzepatide to VTE events, particularly in patients experiencing significant weight loss, raising concerns about its safety profile. We present a case of a male T2DM subject who developed PE after five injections of tirzepatide in a patient with grade I obesity. We also review emerging literature on VTE associated with tirzepatide, emphasizing the need for further research to clarify the drug’s risk and underlying mechanisms. Full article

Objectives: Families play a pivotal role in the care of adolescents with chronic illnesses, such as type 1 diabetes (T1D). This study’s aim was to evaluate family functioning in families of adolescents with T1D and to assess its relationship with metabolic control. Methods: Fifty-eight adolescents and young adults diagnosed with T1D, aged 14–21 years, and 116 healthy adolescents (controls) matched for age, gender and socioeconomic status were included in this study. The participants’ mean age was 15.9 years (±1.6 years). The demographics and family functioning were reported by the participants. The McMaster Family Assessment Device (FAD) measured family functioning across six dimensions. Results: In problem-solving and behavioral involvement, T1D adolescents self-reported similar scores to healthy controls. On the contrary, in the domains of communication (p = 0.048), family roles (p = 0.045), affective responsiveness (p = 0.048), affective involvement (p = 0.043) and general functioning (p = 0.044), the T1D group scored lower than the controls, indicating better family functioning. Furthermore, within the T1D group, better metabolic control, assessed by glycated hemoglobin (HbA1c), was associated with a trend toward improved affective responsiveness, although this did not reach statistical significance (p = 0.091). Conclusions: Our findings highlight the importance of family functioning among adolescents with T1D and point toward distinct family processes that can be addressed in the context of routine care to enhance wellbeing and facilitate T1D management. Full article

Objective: Current knowledge surrounding the diagnosis and mechanisms that result in immune checkpoint inhibitor-associated diabetes (ICI-DM) remain to be fully defined. We present clinical vignettes of patients that have presented to our hospital to illustrate the heterogenous clinical profiles that patients with ICI-DM can experience. We also provide an update on ICI-DM, focusing on current and future perspectives and emerging therapies. Methods: We performed a retrospective review of the electronic records of five ICI-DM patients who presented to St. Vincent’s Hospital Melbourne between 2020 and 2024, with patients identified from the hospital endocrinology and oncology databases. We also performed a literature review via a PubMed search using the keywords “checkpoint inhibitors” and “diabetes” between the years 2015 and 2025 to allow us to collate a descriptive review on ICI-DM. Results: Our cases show some heterogeneity in presentation, with biochemical evidence of diabetic ketoacidosis (DKA) in 4/5 patients, presentation 18–253 days (median 47 days) from ICI commencement, HbA1c 59–78 mmol/mol (median 66 mmol/mol), and c-peptide 0.06–0.77 pmol/mL (median 0.09 pmol/mL). Islet autoantibodies were present in 4/5 cases and high-risk HLA alleles identified in 1/2 tested patients. The findings from our descriptive review support a similar heterogeneity in ICI-DM presentations. Inconsistent diagnostic criteria for ICI-DM were noted with low c-peptide being the most common biochemical presentation. Pancreatic volume is emerging as a useful predictive marker of ICI-DM development. We found no reports of the reversal of ICI-DM with immunosuppression in humans, although recent preclinical studies suggest that this approach is feasible. Conclusions: Diagnostic criteria should include new-onset hyperglycaemia with low paired c-peptide, and may be supported with T1DM-associated autoantibodies and evidence of pancreatic atrophy on imaging. Further research is needed in the realm of predicting ICI-DM and considering the role of immunosuppression as a treatment modality. Full article

Background/Objectives It is known that failure to gain sufficient bone during skeletal growth and maturation phases predisposes to the development of senile osteoporosis as age-related bone loss ensues. There is limited knowledge about factors that are necessary for the pubertal growth spurt and achievement of peak bone mass. Diminution or disappearance of Juvenile Protective Factors (JPFs) after a given maturational stage could contribute to the onset of age-related declines in a variety of physiological functions, including bone physiology. Methods With available pediatric platelet-poor plasma (PPP) and mesenchymal/skeletal stem cells (MSCs), we tested whether proteomics and RNA-seq methodology have potential for the discovery of novel regulators of pubertal skeletal growth. Results Our data demonstrate that pediatric PPP rejuvenates age-related compromised MSC functions; that Mass Spectrometry (MS)-based proteomics identified known and novel circulating tissue growth/trophic factors in human PPP of pubertal, as compared with pre-pubertal, and post-pubertal subjects; and that the unbiased RNA-Seq approach revealed new genes and networks of genes that are dramatically elevated or diminished in pubertal MSCs. Conclusions The findings support the hypothesis that the characterization of pro-osteogenic JPFs could lead to the identification of novel therapeutic approaches to promote bone health in the elderly and of potential treatment regimens for senile osteoporosis. Full article

Background/Objectives: Patients with adrenal insufficiency (AI) are at an increased risk of adverse events (AEs) during cardiovascular hospitalization. However, the association between AI and takotsubo cardiomyopathy (TCM) remains unclear. We investigated the association between AI and cardiovascular outcomes in patients with TCM. Methods: We analyzed data on patients with TCM included in the 2019 Nationwide Readmissions Database to compare in-hospital outcomes between patients with and without AI. The primary outcome measure was inpatient mortality. Secondary outcomes included the odds of all-cause 90-day readmission, acute kidney injury (AKI), mechanical ventilation use, vasopressor use, cardiogenic shock, length of stay (LOS), and total hospitalization charges (THC). Multivariate regression models were used to adjust for confounding variables. Results: Among 30,987 cases, 0.59% (n = 183) had concomitant AI. AI was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 1.43–7.74, p = 0.005), cardiogenic shock (aOR 5.28, 95% CI 3.16–8.82, p < 0.001), mechanical ventilation use (aOR 3.20, 95% CI 1.78–5.74, p < 0.001), AKI (aOR 1.96, 95% CI 1.11–3.48, p = 0.021), vasopressor use (aOR 4.59, 95% CI 1.56–13.47, p = 0.006), longer LOS (6.84 vs. 3.67 days, p < 0.001), and higher THC ($97,419 vs. $54,574, p < 0.001). Additionally, AI was associated with lower odds of all-cause 90-day readmissions (aOR 0.44, 95% CI 0.25–0.79, p = 0.006). Conclusions: Among patients with TCM, AI was associated with higher odds of fatal and non-fatal adverse events. Further studies are required to confirm these findings and better understand how to improve outcomes in this high-risk population. Full article

Introduction: Evidence on the use of dopamine agonists (DAs) for managing residual or recurrent non-functioning pituitary adenomas (NFPAs) is limited. We aim to evaluate the use of cabergoline (CAB) for NFPAs. Methods: A retrospective cohort study was conducted at a single UK centre, between November 2011 and December 2025. Twenty-six patients were identified. Ten patients were excluded due to CAB intolerance or discontinuation (n = 5), insufficient data (n = 4), or invalid scan due to patient movement (n = 1). The remaining 16 patients (mean age 68.9 ± 4 years (range 42–89 years old), 7/16 females) were included. CAB was initiated in cases where surgery or radiotherapy were not appropriate (e.g., due to age and/or comorbidities, or patient choice). Radiological response was assessed using at least two scans separated by a minimum interval of six months. Tumour shrinkage was defined as a reduction in volume of 20% or more, growth as an increase of 20% or more, and stabilisation as interval change of less than 20%. Results: Overall, tumour shrinkage was observed in 7/16 (43.8%) patients, stabilisation in the remaining 9/16 (56.3%) patients, over 503 ± 51 days (range of 117–934 days) (from the date of CAB initiation to latest MRI scan). There was a statistically significant reduction in tumour volume (p = 0.0335). In five patients with documented tumour growth prior to CAB initiation, growth rates retarded or reversed post-CAB initiation. Conclusions: Our findings in this small cohort potentially suggests that cabergoline can retard, arrest, or even reverse tumour growth in selected patients with NFPAs. Our review also highlights ongoing uncertainty regarding optimal dosing, approaches to dose up-titration, follow-up imaging intervals, and objective criteria for defining radiological response. Our results may provide a proof of concept for future, larger-scale prospective studies and controlled trials to validate the conclusions drawn. Full article

Background: Although technology has improved the quality of diabetes management, it may also introduce subjective burdens and reveal barriers to its use. The primary aim of this research was to investigate the association between the use of advanced diabetes technology, such as continuous glucose monitoring, insulin pumps, mobile applications, and diabetes distress in adults with type 1 diabetes mellitus (T1DM). Methods: This multicenter, cross-sectional study conducted across Southeastern European countries included 499 adults with T1DM. All participants signed informed consent and completed the 20-item Problem Areas in Diabetes (PAID) Questionnaire. A total score of 40 or above was classified as high diabetes distress. Statistical analyses were performed using ANOVA, χ2 test, and logistic regression. Results: The mean age of participants was 49.11 ± 13.99 years, with a mean HbA1c value of 7.9 ± 1.46%. The mean PAID total score was 29.19 ± 19.51. High levels of diabetes distress were found in 28.86% of the participants. About 20% of participants used advanced diabetes technologies. Significant predictors of diabetes distress were gender, BMI, and HbA1c. After accounting for these predictors, advanced technology use was associated with a 42% lower likelihood of experiencing high levels of diabetes distress compared to those who used blood glucose meters. Conclusions: Diabetes distress remains a frequent issue among individuals with T1DM. However, patients using advanced diabetes technologies exhibited less distress. Our findings highlight the importance of a comprehensive approach to T1DM management that integrates technological advancements and psychosocial support. Full article

Menin, the product of the Multiple Endocrine Neoplasia type 1 (MEN1) gene, is a scaffold protein, the lack of which leads to the development of a tumor syndrome primarily affecting endocrine organs. Although it is classified as an oncosuppressor, menin is a ubiquitous protein whose expression is also abundant in non-endocrine tissues such as the central nervous system, where knowledge of menin’s role still remains limited. In this article, we aim to draw attention to an underestimated clinical aspect of MEN1 syndrome, i.e., the psychological/psychiatric manifestations, in which menin deficiency could have an important function. Our aim is to highlight that a multidisciplinary team caring for patients with MEN1 throughout their lives should include professionals such as psychologists and psychiatrists in order to better manage any mental illness associated with the syndrome and to further improve the patient’s quality of life. Full article

Background: Risk stratification of indeterminate thyroid nodules (Bethesda III–IV) remains difficult and often triggers unnecessary procedures. Ultrasound-based ACR TI-RADS and the 2023 Bethesda System are widely used, but the incremental value of combining them and the role of size thresholds needs prospective validation. Objective: The objective of this study was to prospectively compare the diagnostic performance of ACR TI-RADS and the 2023 Bethesda System, alone and in combination, for predicting malignancy in thyroid nodules, with dedicated analyses of indeterminate lesions (Bethesda categories III–IV), including subtypes of Bethesda III (nuclear atypia vs. other atypia), and the impact of nodule size. Methods: Histopathology was available for 131 nodules. Diagnostic metrics (sensitivity, specificity, PPV, NPV), ROC curves (DeLong comparison), and Youden indices were calculated for individual and combined thresholds; a 16 mm size cut-off was explored. Results: Malignancy was confirmed in 105/131 nodules (80.2%). Bethesda outperformed TI-RADS (AUC 0.87 vs. 0.69; DeLong p = 0.041). Malignancy rates rose with higher categories (e.g., TI-RADS 5: 93.6%; Bethesda category V: 100%; Bethesda category VI: 100%) and were markedly elevated in the histologically confirmed subset for Bethesda category III (32/41; 78.0%) and IV (6/8; 75.0%). The combined requirement of TI-RADS ≥ 4 and Bethesda ≥ 4 maximized specificity (96.2%) and PPV (98.4%) with a high Youden J (0.552), supporting a rule-in strategy in category IV of Bethesda. Size alone was a weak discriminator (AUC 0.66); within Bethesda III–IV nodules, malignancy did not differ significantly by the 16 mm threshold (p = 1.00). ROC using continuous tumor size yielded AUC = 0.66; the ROC-derived optimal cut-off was 16 mm. Applying this split produced sensitivity 0.80 and specificity 0.50. Conclusions: Integrating ACR TI-RADS with Bethesda cytology significantly improves specificity and PPV for indeterminate thyroid nodules, supporting a morphology-driven approach over traditional size-based thresholds. Incorporation of combined sonographic–cytologic criteria into management algorithms may reduce unnecessary interventions and optimize patient care. Full article

Background/Objectives: The aim of this study is to describe sex- and age-specific patterns of HbA1c in adults with type 2 diabetes (T2D) mellitus across three temporal cohorts from Southern Italy (2012, 2017, and 2024), and to assess whether glycemic differences between men and women persist, narrow, or evolve over time. Methods: We analyzed three independent cohorts of adults with T2D, including 1249 patients in 2012 and 1125 patients in both 2017 and 2024. HbA1c values were summarized as medians and interquartile ranges within sex- and age-stratified groups. Temporal variation in cohort-specific median HbA1c was examined across timepoints within each sex and age category, and sex differences were assessed within each cohort year. Results: At the population level, median HbA1c values remained within a narrow range across all three cohorts, indicating overall temporal stability of glycemic control. No significant sex differences were observed in 2012 or 2024, and only one age stratum (≥80 years) showed a significant sex difference in 2017, with men exhibiting slightly higher median HbA1c. Age-stratified analyses revealed heterogeneous temporal patterns. In older adults (≥70 years), HbA1c medians were remarkably stable in both sexes (approximately 7.2–7.4% in women and 7.2–7.6% in men). In midlife (40–59 years), women tended to show modest increases or partial reversals in HbA1c, whereas men displayed worsening between 2012 and 2017 followed by stabilization thereafter. The youngest adults (18–29 and 30–39 years) showed the highest HbA1c levels in 2017 and the largest subsequent improvements between 2017 and 2024 in both sexes, with median values decreasing toward approximately 7.1–7.6%. Conclusions: Despite well-described biological and social sex differences in T2D, median HbA1c values in this real-world setting were broadly comparable between men and women and largely stable over a 12-year period. Sex differences were small, inconsistent, and age-dependent, with age, and not sex, emerging as the primary determinant of HbA1c over time. These findings suggest that sex-related disparities in glycemic control may be better understood through a dynamic, life-course perspective rather than static cross-sectional comparisons. Full article