Citations

Background: This qualitative study sought to understand factors related to low rates of screening mammography among transgender and gender-diverse (TGD) individuals and how these rates might be improved. Methods: Individuals who self-reported as TGD were recruited from multiple sites and national patient advocates. Consenting participants completed an individual interview using a semistructured guide informed by the Health Belief Model (HBM). Interview data were analyzed using thematic analysis. Results: A total of 44 individuals completed the interview (median age, 44.9 years; range, 19–77 years); 11% were a racial/ethnic minority; and 52%, 20%, and 25%, respectively, self-identified as a transgender woman, transgender man, or nonbinary. Three themes emerged around constructs in the HBM. First, individuals voiced a hope to be treated equally (“I just want to go to work, pay my taxes, love my family, and go along my day and be a good human”) and described how such equitable treatment during screening guarded against gender dysphoria and favored gender affirmation (“it is affirming…being treated as any other woman”). Second, barriers and facilitators related to mammography were identified, including the need to address cost/low cost (“screenings are a luxury”); prior negative/positive experiences (“they would call my name and look at me but dismiss me”); absence/presence of education (“none of the doctors…ever told me what that process looks like”); and perceived low/high cancer risk (“my mom died pretty young from breast cancer”). Finally, practical recommendations were offered, including individual changing/waiting rooms, hiring gender-diverse staff, and engaging clinicians who provide whole-person, trauma-informed care. Conclusions: Mammographic screening among TGD individuals could be improved by proactively creating safe, affirming spaces; working to lower costs; providing educational materials tailored to the TGD community about cancer risk and the practical aspects of screening; and hiring gender-diverse staff. These recommendations from TGD participants merit implementation as well as further study.

Acanthosis nigricans (AN) is a common dermatologic condition characterized by hyperpigmented, velvety plaques that most frequently affect intertriginous areas. Although often associated with insulin resistance and obesity, AN may also serve as a cutaneous marker of underlying endocrinologic disorders, medication effects, genetic syndromes, or internal malignancy. Recognition of AN provides an important opportunity for early identification of systemic disease and implementation of targeted management strategies. This review summarizes the pathogenesis and etiologic subtypes of AN, highlights key clinical features and differential diagnoses, and outlines an evidence-based diagnostic approach. Management strategies are discussed with emphasis on lifestyle modification, pharmacologic therapies, topical treatments, procedural interventions, and the strength of supporting evidence. Practical considerations relevant to physician assistants are emphasized throughout, including interdisciplinary care and patient education. Early recognition and appropriate management of AN can improve both dermatologic outcomes and overall patient health.

Abstract Context Limited data are available on quality of life (QoL) and adrenal crises in patients with immune checkpoint inhibitor–induced secondary adrenal insufficiency (ICI-SAI). Objective To (1) characterize the presentation, management, and outcomes of patients with ICI-SAI; (2) compare outcomes of ICI-SAI with other etiologies of secondary adrenal insufficiency (oSAI); and (3) identify variables associated with QoL and adrenal crisis. Methods In this single-center cross-sectional study, adults with ICI-SAI or oSAI (2018-2025) completed questionnaires assessing symptoms, management, adrenal crises, and the Addison’s Disease–Specific QoL survey (AddiQoL); outcomes included AddiQoL score and adrenal crisis events. Results Patients with ICI-SAI (n = 109) were older (median age 66 vs 60 years), more often women (59% vs 43%), and more frequently diagnosed within 1 year of symptom onset (88% vs 42%, P < .001), compared to patients with oSAI (n = 139). Patients with ICI-SAI had higher AddiQoL scores (median 87 vs 85, P = .020). In a multivariable analysis of age, sex, glucocorticoid dose and type, insurance support, and duration of SAI, ICI-SAI remained independently associated with higher AddiQoL (estimate 5.4, P = .010). The prevalence of reported adrenal crises within the prior year was similar between groups (15% vs 14%, P = .782). In a multivariable analysis, higher AddiQoL scores were independently associated with lower odds of adrenal crisis (OR 0.57; 95% CI 0.42-0.76). Conclusion Patients with ICI-SAI report better QoL compared with patients with other causes of SAI, despite similar adrenal crisis rates. These differences may be related to earlier diagnosis and differing clinical contexts, underscoring the importance of timeline recognition and patient-centered management.

Abstract Background Polycystic ovary syndrome (PCOS) affects 10% to 13% of individuals assigned female at birth (AFAB), although a greater prevalence is reported in transgender/gender diverse individuals (TGD) (23.8-38.8%). Testosterone therapy (TT) in TGD individuals is linked to worsening cardiovascular risk factors (CVRFs). Whether TT induces more adverse cardiometabolic changes in TGD with PCOS than TGD without PCOS remains uncertain. Objective To compare the effects of TT on CVRF in TGD with and without PCOS. Methods We retrospectively reviewed 373 records to identify 62 TGD with PCOS (withestablished guideline criteria) and 132 age-matched TGD without PCOS. Data included longitudinal anthropometric measurements, hormone and metabolic parameters, and CVRF before and after TT. Group comparison of PCOS vs without PCOS before and after TT was conducted via independent t-tests, Mann–Whitney-U, and Chi-square. Results At baseline, TGD with PCOS had significantly greater body mass index (BMI), obesity prevalence, and, after controlling for BMI, baseline metformin use. There were no significant differences between TGD with and without PCOS when comparing intra-participant changes after TT. Controlling for BMI, TGD with PCOS on TT exhibited significantly greater hyperlipidemia prevalence, alanine transaminase (ALT) levels, and bioavailable testosterone concentrations than TGD without PCOS on TT. Conclusion Greater baseline cardiometabolic risk was largely BMI-related in TGD with PCOS compared to TGD without PCOS. Only hyperlipidemia and elevated ALT were more prevalent during TT after adjusting for BMI. These findings support cardiometabolic monitoring during TT in all TGD individuals without significant increased risk with PCOS history.

OBJECTIVE Early discharge following uncomplicated endonasal resection of pituitary adenoma has been described as safe and feasible. Discharge on postoperative day (POD) 1 is not a widely implemented practice in the United States. This study aimed to evaluate the safety of routine POD1 discharges by assessing postoperative unplanned medical care rates compared with those of patients discharged on POD 2 or later (POD2+). The secondary endpoint was to identify predictors of delayed discharge in the POD2+ cohort. METHODS A retrospective database review of the medical records of 534 patients who underwent endonasal resection of pituitary adenoma at the Mayo Clinic was performed. Relevant demographics, tumor characteristics, and perioperative metrics were abstracted from the medical record, including intraoperative CSF leakage, postoperative complications, emergency department visits, or inpatient readmissions within 30 days. Descriptive, univariate, and multivariate analyses were performed. RESULTS In comparison to 422 (79%) patients discharged on POD1, 112 (21%) patients discharged on POD2+ had a higher unplanned medical care rate (13% vs 5.5%, p = 0.019). There were significantly more men in the POD1 group (48%) than in the POD2+ group (37%) (p < 0.04). The most common reasons for POD1 unplanned care were endocrine dysfunction (2.4%), split evenly between syndrome of inappropriate antidiuretic hormone and adrenal insufficiency, whereas the most frequent reason in the POD2+ cohort was medical (0.06%). Univariate analyses indicated that female sex, higher BMI, intensive care unit (ICU) admission, obstructive sleep apnea, continuous positive airway pressure dependence, intraoperative CSF leakage, and diabetes insipidus (DI) increased the likelihood of POD2+ discharge. The reduced logistic regression model demonstrated a higher likelihood of POD2+ discharge with older age, ICU admission, intraoperative CSF leakage, and DI (p < 0.001). Common factors contributing to discharge after POD1 included endocrine (n = 66, 35%) and/or medical (n = 65, 34%) reasons. CONCLUSIONS Routine patient discharge on POD1 following uncomplicated endonasal resection of pituitary adenoma is a safe practice, as evidenced by the significantly lower rates of unplanned medical care and complications compared with those of patients discharged on POD2 or later. Delayed discharge was associated with older age, ICU admission, intraoperative CSF leakage, and DI. The most frequent reasons for POD1 readmission were endocrine versus medical reasons for POD2+. Preoperative identification of risk factors for delayed discharge and preemptive management of endocrine and medical complications may reduce the length of stay and return to medical care.

OBJECTIVE While endonasal transsphenoidal surgery (ETS) is the standard treatment for nonfunctioning pituitary adenomas (NFPAs), the postoperative recovery rates of secondary adrenal insufficiency and their predictive factors remain poorly understood. The authors investigated the relationship between the tumor resection rate and adrenal function recovery in patients with NFPAs. METHODS This retrospective study included 450 patients with NFPAs who underwent ETS between January 2013 and November 2023. The rates of preoperative hypopituitarism and postoperative recovery rates of secondary adrenal insufficiency and their associated factors were analyzed. Recovery was defined as normalization of serum cortisol levels without replacement therapy for at least 24 hours, accompanied by symptom resolution. The tumor resection rate was calculated as the percentage of the tumor volume resected. RESULTS The median follow-up period for the entire cohort was 52 months (range 1–131 months). A total of 246 (55%) patients had dysfunction in one or more pituitary axes. Fifty-three (47%) of 114 patients with preoperative adrenal insufficiency showed postoperative adrenal insufficiency recovery. The cumulative adrenal insufficiency recovery rates were 12% at 1 month, 19% at 3 months, 32% at 6 months, and 41% at 12 months. Among the 114 patients with preoperative adrenal insufficiency, the factors associated with postoperative adrenal insufficiency recovery were investigated. Patients with smaller tumor sizes of < 20 mm (log-rank test, p = 0.001) and those with tumor resection rates of more than 85% (log-rank test, p = 0.032) demonstrated better postoperative adrenal insufficiency improvement. Bivariate Cox proportional hazards analysis demonstrated that smaller tumor sizes (continuous, HR 0.97, 95% CI 0.93–0.98; p = 0.043) and higher tumor resection rates (HR 1.03, 95% CI 1.01–1.07; p = 0.001) were significantly associated with better postoperative adrenal insufficiency recovery. Multivariable analysis confirmed that only higher tumor resection rates were significantly associated with better postoperative adrenal insufficiency recovery (HR 1.03, 95% CI 1.01–1.06; p = 0.019). CONCLUSIONS Nearly half of the patients with preoperative adrenal insufficiency achieved recovery after ETS for NFPAs. The enhanced extent of tumor removal was an independent factor associated with better postoperative recovery, indicating that optimizing safe maximal resection procedures may be crucial in enhancing adrenal function.

Abstract Disclosure: J. Herndon: None. Y. Hleibiehova: None. A. Bancos: None. S. Achenbach: None. E. Atkinson: None. D. Donegan: Camarus, Recordati. I. Bancos: None. Introduction: Studies show that quality of life (QOL) among patients with adrenal insufficiency (AI) (primary (PAI) or secondary (SAI)) improves following adequate glucocorticoid replacement, however decreased QOL persists. SAI due to hypophysitis or infrequently PAI due to adrenalitis are recognized complications of immune-checkpoint-inhibitors (ICI). It is unknown if patients with ICI induced AI (ICI-AI) would report similar findings in QOL. Aim: To assess the impact of ICI-AI on specific determinants of health-related QOL (HRQOL) and compare management and outcomes to SAI due to other etiologies (oSAI). Methods: A cross-sectional survey study of adult patients who completed at least 1 AddiQOL survey with a diagnosis of ICI- AI or oSAI evaluated between 2015 and 2024 were included. Patients with opioid- or glucocorticoid-induced-AI were excluded. A study survey obtained information regarding diagnosis and treatment. Results: 112 patients with ICI-AI were included (SAI n=109, PAI n=3). Among those with ICI-AI, 59% were female, median age at diagnosis was 59.7 ±12.8 years and melanoma was the most common indication for ICI use (51%). The median time to ICI-AI diagnosis was 5.5 (range 0.3-80.8) months and 46% used combination ICI therapy. When compared to those with oSAI (n=139), patients with central ICI-AI were older at diagnosis (59 ±12.7 vs 46 ±18.1 years, p &lt;0.01), more were female (59 vs 43%, p=0.015) and most were diagnosed in the last year (88% vs 42%, p&lt;0.01). Those with ICI-AI received higher hydrocortisone (HC) equivalent daily doses than those with oSAI (25.1± 18.3 vs 22.1 ±16.9 mg/day, p&lt;0.01), however there was no difference in the number of adrenal crises (AC) reported within the last year (14 vs 16, p=0.78). Patients with ICI-AI felt that emergency personnel understood their diagnosis and treated them promptly (75% vs 0% p=0.012). Logistic regression analysis of the entire group (ICI-AI + oSAI) did not identify an association between the occurrence of AC in the last year and HC dose &gt;20 mg/day or type of glucocorticoid. Furthermore, there was no difference in number of AC per person year assessed between the ICI-AI and oSAI (0.23 ±0.5 vs 0.21 ±0.5, p= 0.4). The mean total AddiQOL score was higher in those with ICI-AI (87.2 ±13.9 vs 81.8 ±15.8, p=0.02). When adjusted for age and sex, total AddiQOL score was inversely related to number of symptoms present (r: -0.49, p&lt;0.01; r: -0.58, p&lt;0.01), occurrence of AC in the last year (r: -0.27, p=0.01; r: -0.33, p&lt;0.01) and positively related to current employment (r:0.33 p&lt;0.01 0.2,p=0.02) in ICI-AI and oSAI respectively. Conclusion: This is the first study to compare management and HRQOL in patients with ICI-AI compared to oSAI and although there were no significant differences in total number of AC events between the 2 groups, differences exist in terms of AI presentation, management and reported QOL. Presentation: Sunday, July 13, 2025

OBJECTIVE Nonfunctioning pituitary adenomas (NFPAs) often present with associated mild hyperprolactinemia, described in literature as "stalk effect." The presence of preoperative hyperprolactinemia caused by tumor compression of the pituitary stalk and endocrinological outcomes has been noted; however, a detailed investigation on the impact on perioperative endocrinological outcome is lacking. The authors aimed to determine whether elevated preoperative serum prolactin concentrations are associated with increased risk of perioperative pituitary dysfunction in patients with NFPAs undergoing endonasal transsphenoidal surgery (ETS). METHODS The authors conducted a single-center retrospective cohort study of patients who underwent ETS for NFPAs between January 2013 and April 2023. Patients were divided into two groups based on preoperative prolactin concentrations: normal or hyperprolactinemic (prolactin values above upper limit of reference range, adjusted for sex). Outcomes included perioperative endocrinological function and surgical outcomes. Multivariable analysis was conducted to identify factors associated with perioperative endocrinological function outcomes. RESULTS Of 244 patients (140 [57%] males; median age 59 years) with a median follow-up of 65 months, 131 (54%) had hyperprolactinemia. Compared with patients with normal preoperative prolactin levels (n = 113), the hyperprolactinemia group had similar tumor size (median diameter 2.5 cm vs 2.3 cm, p = 0.102) but higher rates of cavernous sinus invasion (99% vs 91%, p = 0.035), pituitary stalk deviation (95% vs 74%, p = 0.001), stalk bending (14% vs 1%, p = 0.001), preoperative secondary hypothyroidism (39% vs 22%, p = 0.005), and adrenal insufficiency (AI; 34% vs 22%, p = 0.048). Postoperatively, the hyperprolactinemia group showed higher rates of new secondary hypothyroidism (16% vs 7%, p = 0.048) and new permanent AI (16% vs 6%, p = 0.046). Multivariable analysis revealed preoperative high prolactin as an independent predictor of preoperative secondary hypothyroidism (OR 1.83, 95% CI 1.17–3.44; p = 0.046) and its postoperative deterioration (OR 2.65, 95% CI 1.02–7.69; p = 0.042). Maximum tumor diameter was also a significant predictor of various endocrinological dysfunctions both pre- and postoperatively. CONCLUSIONS Preoperative hyperprolactinemia in patients with NFPA is associated with higher risks of specific perioperative endocrinological dysfunction and pronounced pituitary stalk deviation. These findings highlight the utility of preoperative prolactin levels as a biomarker for predicting postoperative endocrinological outcomes, potentially enhancing risk assessment and guiding personalized perioperative management.