1.- In this issue we found an article about new endocrine disruptors: perfluoroalkylated, bisphenols, ptalates, organophosphate pesticides, and flame retardants. Their consequences are mostly centered in the gonadal sphere (sperm quality, polycystic ovary, hypogonadism), metabolic (diabetes, obesity). Besides, it seems that some of them could lead to Attention Deficit Disorder in case of prenatal exposure.
2.- There is also a review of COVID-19 infection in Cushing's syndrome. Despite its low frequency, as endocrinologists we must know what to do in case of finding one. The main points are: a) hypercortisolism could be a factor of severity, although there are no data so far, due to its concentratin of cardiovascular risk factors and immune deficiency; b) the initial cortisol response that occurs in patients with normal pituitary adrenal axis is suppressed in Cushing syndrome, blocking the natural initial immunity to the virus; c) the frequency of symptoms can vary, with less frequency of fever and more dyspnea; d) paradoxically, the response of cytokines may be lower, with could hypothetically lead to lower risk of ADRS; e) the thrombotic risk is high, so heparins should be used; f) prolonged antivirals and empirical antibiotics should be considered due to the risk of viral persistence and bacterial superinfections.
3.- Phase 3 results of osilodrostat (Novartis 11 beta hydroxylase inhibitor) in Cushing syndrome have been published "online first". Oral BID treatment, with initial daily dose adjustment from 1 to 30 mg, controls hypercortisolism in a high percentage (86%), but at the expense of high risk of adrenal failure (1/3 to half according to the analyzed parameter).
4.- Finally, a study on the value of the urinary adrenal steroid metabolome in the management of adrenal incidentaloma. The authors propose a strategy based on 3 criteria: mass size (> 4cm), CT density (> 20 HU), and the metabolome that, in case you are not familiar with it (like us before reading it), it is basically a liquid chromatography - tandem spectrometry measuring 15 urinary steroids and using a machine learning algorithm. This improves diagnostic performance and so contributes to early detection of more adrenal carcinomas.
For those who want to expand all this, go to https://www.thelancet.com/journals/landia/home.
