This Week in Endocrinology — Jun 27, 2026

Welcome to This Week in Endocrinology. This week we're covering 9 notable papers spanning advances in diabetes management and risk prediction, clinical practice updates in thyroid and adrenal care, and systemic endocrine disorders. Let's dive in.

We begin with a focus on diabetes technology and risk stratification, where recent publications highlight how automated insulin delivery is expanding to complex populations, and how we must adjust our diagnostic thresholds for type 1 diabetes progression. A comprehensive review in Diabetes Care traces the translation of hybrid automated insulin delivery systems from bench to bedside, highlighting the push toward next-generation fully automated systems and their expanding role in vulnerable populations, including those with type 2 diabetes and inpatient cohorts [3]. Translating this technology to a particularly challenging clinical cohort, a prospective, open-label, randomized crossover trial published in Diabetologia evaluated automated insulin delivery in adults with diabetes and advanced chronic kidney disease, stage 3b or higher, including patients on dialysis [8]. Managing glucose in advanced kidney disease is notoriously difficult due to glycemic instability and altered insulin clearance. Over an eight-week period, the use of automated insulin delivery significantly improved all hyperglycemic continuous glucose monitoring metrics compared with usual care. The percentage of time in range, defined as 3.9 to 10.0 millimoles per liter, increased from 60% during usual care to 73% during the automated delivery phase, while hypoglycemia rates remained unchanged. Although a quarter of these predominantly pre-frail participants required hospital admissions for unrelated medical issues, the system proved safe and highly effective. Meanwhile, identifying who is at risk for developing type 1 diabetes in the first place requires careful biochemical threshold adjustments. A study in Diabetes Care analyzed over 5,000 islet autoantibody-positive relatives to determine if standard dysglycemia definitions overestimate progression risk in adults [9]. Currently, guidelines use an HbA1c threshold of 5.7% or greater to define dysglycemia in at-risk individuals. However, because HbA1c naturally increases with age, this standard threshold resulted in a much lower calculated one-year progression risk for adults compared to children. The investigators demonstrated that adjusting HbA1c for age, or applying a higher threshold of 6.0% or greater for adults aged 30 or older, aligns adult progression risk with that of children, thereby refining risk stratification in clinical prevention trials.

Moving on to diagnostic refinements and endocrine guidelines, several new papers offer practical updates for routine clinical practice. First, evaluating the hypothalamic-pituitary-adrenal axis in women using oral contraceptives has long required a six-week discontinuation period to allow corticosteroid-binding globulin and total cortisol levels to normalize. A prospective observational study in The Journal of Clinical Endocrinology and Metabolism evaluated 24 healthy women to determine if this wash-out period could be shortened [4]. Following contraceptive cessation, both corticosteroid-binding globulin and total cortisol concentrations decreased exponentially, with nearly half of the baseline elevation clearing by week four. Because changes between week four and week six were non-significant, the authors conclude that the minimum discontinuation period can be safely reduced from six weeks to four weeks, accelerating diagnostic workups for adrenal insufficiency. In thyroid care, the newly released 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer, discussed in The Journal of Clinical Endocrinology and Metabolism, focus heavily on de-escalating care in patients with low-risk disease who remain recurrence-free [5]. The guidelines emphasize shared decision-making and long-term survivorship care, advising clinicians to scale back aggressive surveillance when appropriate. Diagnostic and management clarity is also the focus of a comprehensive clinical review of adult male hypogonadism published in JAMA [7]. The authors note that while primary hypogonadism is rare, affecting less than 1% of men, secondary hypogonadism due to obesity is far more common, affecting between 2% and 8% of men with a body mass index of 30 or higher. Confirming a diagnosis requires at least two fasting morning testosterone measurements below 264 to 300 nanograms per deciliter, and clinicians must calculate free testosterone in patients with obesity or diabetes due to low sex hormone-binding globulin. For obesity-induced hypogonadism, the review emphasizes that weight loss of at least 5% is the recommended first-line treatment, as it significantly increases total testosterone and improves erectile function and libido, reserving exogenous testosterone for permanent pathology.

Next, we examine systemic endocrine and cardiometabolic disorders, starting with primary aldosteronism. A primer in Nature Reviews Disease Primers highlights that primary aldosteronism remains widely underdiagnosed despite being a highly treatable cause of secondary hypertension and associated cardio-renal disease [2]. The authors recommend simplified screening using renin and aldosterone measurements for all hypertensive patients. For the majority who have bilateral disease, management relies on dietary sodium restriction, mineralocorticoid receptor antagonists, and upcoming aldosterone synthase inhibitors, with a rising renin level serving as a key biomarker of treatment adequacy. This complex interplay of metabolic, renal, and cardiovascular diseases is further explored in a Lancet review on cardiometabolic multiple long-term conditions [6]. The authors detail how shared pathways, including insulin resistance, adiposity, and chronic inflammation, interact with environmental factors and social determinants of health over a lifespan to drive disease clustering, calling for integrated systems approaches to precision prevention. Finally, long-term therapeutic stability in rare endocrine disease is addressed in an open-label extension study published in The Journal of Clinical Endocrinology and Metabolism, which evaluated the oral somatostatin receptor 2 agonist paltusotine for acromegaly over a four-year period [1]. For patients transitioning from injected somatostatin receptor ligands, once-daily oral paltusotine maintained biochemical control, with median insulin-like growth factor I levels remaining stable at 1.01 times the upper limit of normal at year four. Growth hormone levels, symptoms, and pituitary tumor size remained stable throughout the study, demonstrating that oral therapy can provide safe, durable, long-term disease control.

If you only have time for one paper this week, make it the prospective study on stopping estrogen-containing contraceptives in The Journal of Clinical Endocrinology and Metabolism [4]. This paper provides high-quality, actionable evidence that allows us to shorten the wash-out period before hypothalamic-pituitary-adrenal axis testing from six weeks to four weeks, directly reducing clinical delays and improving the patient experience.

Here are the key takeaways from this week in Endocrinology: First, automated insulin delivery is safe and highly effective for patients with advanced chronic kidney disease, significantly improving time in range without increasing hypoglycemia. Second, the diagnostic wash-out period for oral contraceptives before total cortisol testing can be safely shortened from six weeks to four weeks. Third, the 2025 American Thyroid Association guidelines emphasize de-escalating care and prioritizing shared decision-making for patients with low-risk differentiated thyroid cancer. Fourth, when evaluating islet autoantibody-positive adults for type 1 diabetes progression, using an HbA1c threshold of 6.0% or greater for those aged 30 or older more accurately reflects their true risk by accounting for age-related baseline increases. And fifth, first-line management for obesity-induced secondary male hypogonadism is a weight loss of at least 5%, which significantly restores testosterone levels and improves symptoms.

That's your roundup for This Week in Endocrinology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.