This Week in Endocrinology — May 14, 2026

Welcome to This Week in Endocrinology. This week we're covering 8 notable papers spanning evolving paradigms in diagnosis and risk assessment, as well as new strategies for optimizing treatment and long-term outcomes. Let's dive in. First, we look at several papers that challenge long-held beliefs and reshape our diagnostic and risk assessment frameworks. In a landmark publication in The Lancet, an international consensus process has led to a new name for polycystic ovary syndrome, or PCOS. The condition will now be known as polyendocrine metabolic ovarian syndrome, or PMOS [2]. The change addresses long-standing concerns that the term PCOS is inaccurate, as it implies pathological ovarian cysts which are not always present, and that it obscures the condition's diverse endocrine and metabolic features. The old name has been linked to delayed diagnosis, fragmented care, and stigma. The global consensus process, involving over 14,000 patients and health professionals, prioritized scientific accuracy and clarity. The new name, PMOS, was chosen to better reflect the multisystem pathophysiology involving polyendocrine, metabolic, and ovarian dysfunction. This is not just a name change; it's a strategic evolution intended to improve patient care, research funding, and policy framing by accurately describing the condition's systemic nature. Also challenging established dogma, a study in The Lancet Diabetes & Endocrinology questions the absolute contraindication for biopsying phaeochromocytomas and paragangliomas, or PPGLs [3]. This recommendation has historically been based on case reports of catastrophic catecholamine release. This new international, multicenter study provides the most robust data to date on the procedure's safety. The Study Investigators retrospectively analyzed 234 percutaneous biopsies performed in 222 patients with PPGLs across 19 hospitals. Sixty-seven percent of patients had elevated catecholamines, and only a small fraction, about 12 percent, received alpha-blockade before the procedure. Results The primary outcome, biopsy-related mortality, was very low, with only one death reported, which was due to infection, not a catecholamine crisis. Serious catecholamine-related complications, such as hypertensive crisis or tachyarrhythmia, occurred after just four biopsies, a rate of only 1.7 percent. Notably, no such complications occurred in patients who had normal catecholamine levels, in those who underwent fine-needle aspiration instead of core biopsy, or when the biopsy was of a metastatic lesion. Conclusions The authors conclude that the complication rates are low, challenging the current recommendation to avoid biopsy at all costs. Instead, they support a personalized, risk-benefit-based approach, which could be critical in cases where malignancy is suspected and a tissue diagnosis is needed. Shifting to thyroid disease, a study in the journal Thyroid provides new insights on the risks of subclinical hyperthyroidism, particularly in younger populations [7]. The Study This large retrospective cohort study from the Netherlands used primary care data to compare over 11,000 patients with subclinical hyperthyroidism to more than 46,000 matched euthyroid controls. Results Overall, subclinical hyperthyroidism was associated with a roughly 40% increased risk of atrial fibrillation, a 20% increased risk of heart failure, and a 50% increased risk of all-cause mortality. The most striking finding, however, was the effect in younger adults. In individuals aged 30 to 49 years, the condition was associated with a nearly doubled risk of atrial fibrillation, an almost four-fold higher risk of heart failure, and a nearly three-fold higher risk of all-cause mortality. These findings challenge the traditional focus on cardiovascular risks primarily in older patients. Conclusions While the study has limitations, including its retrospective design and lack of data on certain lifestyle factors, it underscores that subclinical hyperthyroidism is not a benign condition, even in younger adults, and warrants careful, individualized risk assessment. Rounding out this theme, a Personal View in The Lancet Diabetes & Endocrinology revisits the long-standing controversy surrounding prophylactic central neck dissection in patients with clinically node-negative papillary thyroid cancer [4]. The authors highlight the central dilemma: while small, undetected metastases in central neck nodes are common, clinically apparent recurrence in those nodes occurs in fewer than 10 percent of patients who do not undergo the prophylactic dissection. Existing data have not shown a survival advantage for the procedure, and while it may incrementally reduce regional recurrence, it comes at the cost of increased morbidity, particularly temporary hypoparathyroidism. The paper concludes that current guidelines appropriately leave the decision open for discussion, and it calls for new research to finally resolve this surgical challenge. Next, we turn to papers focused on refining our therapeutic strategies and improving long-term patient care. Leading this section is the announcement in Nature Medicine of a new framework for the pharmacological treatment of obesity from the European Association for the Study of Obesity, or EASO [1]. This 2026 update is designed to guide clinicians through the rapidly evolving landscape of anti-obesity medications and the management of associated complications, reflecting a critical need for updated, evidence-based guidance in this area. From broad guidelines to a specific, high-risk population, a study in Diabetologia investigated the use of automated insulin delivery, or AID, in people with diabetes and advanced chronic kidney disease [5]. The Study This randomized crossover trial, conducted in Australia and Denmark, enrolled 40 adults with either type 1 or insulin-treated type 2 diabetes and CKD stage 3b or higher, including patients on dialysis. Participants were assigned to 8 weeks of AID and 8 weeks of usual care with real-time continuous glucose monitoring. Results The primary outcome was time in range, defined as 3.9 to 10.0 millimoles per liter. AID therapy significantly improved time in range from 60 percent during usual care to 73 percent. All hyperglycemia metrics improved with AID, and importantly, this was achieved without any increase in hypoglycemia. The study also noted the fragility of this cohort, with 25 percent of participants experiencing hospital admissions for unrelated medical issues during the trial. Conclusions The findings demonstrate that AID is a feasible, safe, and superior glucose management strategy compared to usual care in this very challenging patient population. Building on the theme of managing complex metabolic conditions, a review in The Journal of Clinical Endocrinology and Metabolism provides a practical approach to diagnosing and treating polycystic ovary syndrome in adolescents [6]. The authors stress the diagnostic difficulty in this age group, as normal pubertal changes can overlap with features of the syndrome. They recommend that a definitive diagnosis should only be made with clear, persistent evidence of both hyperandrogenism and menstrual irregularity. Adolescents with only one of these features should be considered 'at risk' and followed longitudinally to prevent both over- and under-diagnosis. The review underscores that this is a critical window for intervention. Management Lifestyle modification is the foundation of therapy. For pharmacologic treatment, combined oral contraceptive pills remain first-line for menstrual irregularity and hyperandrogenism, while metformin is recommended as first-line therapy for metabolic comorbidities, mirroring its role in adults. Finally, looking at the long-term iatrogenic effects of our treatments, a review in Endocrine Reviews examines neurocognitive changes following radiation therapy to the pituitary region [8]. Radiotherapy is a cornerstone of treatment for pituitary tumors and other nearby diseases. However, despite technological advances, late effects like neurocognitive decline remain a significant problem that reduces quality of life. The authors found that while many published studies report no additional cognitive decline from radiotherapy after surgery, these studies are often hampered by methodological issues, such as lenient assessment techniques or unrepresentative patient samples. The paper argues for a more rigorous and standardized framework for assessing neurocognitive decline in these patients, both in future research and in routine clinical follow-up, to better understand and mitigate this important late effect. If you only have time for one paper this week, make it the study on the safety of biopsy in phaeochromocytoma and paraganglioma in The Lancet Diabetes & Endocrinology [3]. This paper provides robust, multicenter evidence to challenge a decades-old dogma, potentially opening up a crucial diagnostic path for patients with indeterminate adrenal masses where cancer is a concern. It shifts the paradigm from an absolute contraindication to a nuanced, risk-benefit discussion. Here are the key takeaways from this week in Endocrinology. First: Consider a risk-benefit approach for percutaneous biopsy in suspected pheochromocytomas or paragangliomas, especially for metastatic lesions or in patients without biochemical evidence of catecholamine excess. The procedure has a low rate of serious catecholamine-related complications [3]. Second: Adopt the new terminology, Polyendocrine Metabolic Ovarian Syndrome or PMOS, to more accurately reflect the systemic nature of the condition previously known as PCOS. This can help frame conversations with patients about its endocrine and metabolic features beyond just the ovaries [2]. Third: In patients with diabetes and advanced chronic kidney disease, including those on dialysis, automated insulin delivery is a safe and superior option to usual care for improving time in range without increasing hypoglycemia [5]. Fourth: Be aware that subclinical hyperthyroidism carries a significant risk for atrial fibrillation, heart failure, and all-cause mortality, even in younger adults aged 30 to 49. These patients may warrant closer monitoring or consideration for treatment rather than a simple watch-and-wait approach [7]. Fifth: When diagnosing PCOS in adolescents, require persistent evidence of both hyperandrogenism and menstrual irregularity. Treat those with single features as 'at risk' and focus on lifestyle as the foundational therapy, using oral contraceptives for menstrual regulation and metformin for metabolic concerns [6]. 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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