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Pseudo-Endocrine Disorders: Clinical Realities and Responsible Management

20 Jan, 2025 | 11:42h | UTC

Introduction:

This summary outlines key points from a review discussing “pseudo-endocrine disorders”—conditions that lack scientific proof but gain popularity through misinformation. The text focuses on recognizing such disorders, understanding their purported mechanisms, and guiding clinicians on how to approach patients who have received these unvalidated diagnoses. The review emphasizes evidence-based evaluation, patient education, and compassionate care.

Key Recommendations:

  • Recognize the Lack of Scientific Validation: Adrenal fatigue, Wilson’s syndrome, and reverse T3 syndrome lack credible evidence. Testing methods (such as salivary cortisol profiles or axillary temperature measurements) are not scientifically validated.
  • Avoid Non-Evidence-Based Treatments: Preparations like raw adrenal extracts, high-dose liothyronine, or unverified testosterone treatments may harm patients. Such interventions can induce secondary adrenal insufficiency or suppress endogenous hormone production. Similarly, while not strictly an endocrine issue, the use of Low-Dose Naltrexone (LDN) for autoimmune and other disorders lacks sufficient evidence to support its efficacy and should be approached with caution.
  • Thorough Diagnostic Evaluation: Use established endocrine tests (e.g., ACTH stimulation tests for adrenal function, morning testosterone levels for hypogonadism). It is paramount to differentiate between pseudo-endocrine disorders and actual endocrine conditions. Rule out genuine disorders—such as true adrenal insufficiency, primary vs. secondary hypogonadism, or autoimmune thyroid disease—before attributing symptoms to a pseudo-condition.
  • Investigate Confounding Factors: Biotin supplements, opioid use, and other medications can invalidate hormone assays or temporarily suppress hormone levels. Conditions like depression, fibromyalgia, or chronic fatigue may underlie nonspecific symptoms but can be overlooked when pseudo-endocrine labels are hastily applied.
  • Educate and Empower Patients: Counter internet-driven misinformation by explaining the importance of validated testing and proven treatments. Encourage lifestyle measures (healthy diet, exercise, sufficient sleep) while respecting patients’ concerns and emotional distress.
  • Promote Public Awareness and Professional Advocacy: Physicians can inform the public through media appearances, local or national medical organizations, and educational campaigns. Reporting harmful or fraudulent practices to medical boards can protect the public and uphold standards of care.

Conclusion: Adopting an evidence-based strategy and a patient-centered approach is vital when confronted with “pseudo-endocrine” diagnoses. Valid laboratory testing, careful clinical evaluation, and thoughtful follow-up can rule out legitimate endocrine disorders or detect root causes such as sleep apnea or depression. Honest communication and empathy foster trust, counter misinformation, and safeguard patients from unnecessary or dangerous interventions. Ultimately, a commitment to evidence-based medicine and patient-centered care is the most effective strategy in addressing the challenges posed by pseudo-endocrine disorders.

Reference: McDermott MT. “Pseudo-endocrine Disorders: Recognition, Management, and Action.” Journal of the Endocrine Society, Volume 9, Issue 1, January 2025, bvae226. https://doi.org/10.1210/jendso/bvae226


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