Bioethics
Pseudo-Endocrine Disorders: Clinical Realities and Responsible Management
20 Jan, 2025 | 11:42h | UTCIntroduction:
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
Cohort Study: One in Four Patients Demonstrates Covert Cognition Despite Behavioral Unresponsiveness
3 Jan, 2025 | 08:30h | UTCBackground: Cognitive motor dissociation (CMD) refers to the presence of specific neuroimaging or electrophysiological responses to commands in patients otherwise incapable of voluntary behavioral output. Detecting CMD is clinically relevant because its underdiagnosis may lead to premature decisions regarding goals of care, life-sustaining treatment, and rehabilitation efforts. Although several single-center studies have suggested that CMD may exist in 10–20% of patients with disorders of consciousness, larger multinational data were lacking, particularly using both functional magnetic resonance imaging (fMRI) and electroencephalography (EEG).
Objective: To determine how often CMD occurs in a large, multinational cohort of adults with impaired consciousness and to evaluate the clinical variables potentially associated with this phenomenon.
Methods: This prospective cohort study included 353 adults with disorders of consciousness recruited from six international centers between 2006 and 2023. Enrolled participants had at least one behavioral assessment using the Coma Recovery Scale–Revised (CRS-R) and underwent task-based fMRI, EEG, or both. Sites utilized validated analytic pipelines and automated data processing to minimize false positives. Participants were divided into two groups: those without observable responses to verbal commands (coma, vegetative state, or minimally conscious state–minus) and those with observable responses (minimally conscious state–plus or emerged). CMD was defined as the absence of any observable behavioral response to commands, combined with a positive command-following signal on fMRI or EEG.
Results: Among 241 participants with no overt command-following, 25% showed CMD through either fMRI alone, EEG alone, or both. CMD was more common in younger patients, those assessed later after injury, and those with traumatic brain injury. Interestingly, in 112 participants who did exhibit command-following on bedside exams, only 38% demonstrated confirmatory responses on fMRI or EEG. These findings support the notion that the tasks used for neuroimaging and electrophysiological assessments may require more sustained cognitive engagement than typical bedside evaluations.
Conclusions: CMD was identified in about one in four patients who lacked behavioral command-following. Combining fMRI with EEG likely increases detection rates compared to either modality alone. The results highlight the need for increased awareness of covert cognitive activity in this population, given potential ramifications for prognosis, family counseling, and clinical care.
Implications for Practice: Clinicians should consider the possibility of CMD in patients who appear unresponsive at the bedside. When feasible, employing both fMRI and EEG might reveal hidden cognitive capacities that can guide patient-centered decisions, encourage targeted therapies, and allow healthcare teams to respect potential consciousness and autonomy. However, such technologies remain limited to specialized centers.
Study Strengths and Limitations: Strengths include a diverse sample from multiple international sites and the integration of two complementary neurodiagnostic techniques. Limitations involve heterogeneous recruitment practices, variations in local data acquisition methods, and potential selection biases toward patients who survived until advanced testing was available. Additionally, the absence of standardized paradigms across sites reduced consistency of results.
Future Research: Further large-scale investigations should standardize fMRI and EEG protocols and determine whether earlier and more consistent identification of CMD affects functional outcomes. Efforts to refine and validate automated analytic pipelines could facilitate widespread adoption of these techniques in routine clinical settings.
Reference: Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. New England Journal of Medicine. 2024;391:598-608. DOI: http://doi.org/10.1056/NEJMoa2400645
Perspective | Clinicians debate the usefulness of NAFLD name change
11 Aug, 2023 | 15:39h | UTCClinicians debate the usefulness of NAFLD name change – MDedge
Original article: From NAFLD to MASLD | New consensus changes fatty liver disease terminology to avoid stigmatization
BMJ Investigation | Medical royal colleges receive millions from drug and medical devices companies
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News Release: Medical royal colleges receive millions from drug/medical device companies – BMJ Newsroom
Commentary on Twitter
Drug and medical device companies have given £9m to UK royal colleges in recent years.
Scroll through our series of #BMJInfographics to see how much individual companies have paid each college 👇 https://t.co/s03xSl18BP pic.twitter.com/PX1Lzmtb4N
— The BMJ (@bmj_latest) July 27, 2023
JAMA guidance for authors, peer reviewers, and editors on use of AI, language models, and chatbots
28 Jul, 2023 | 14:18h | UTCGuidance for Authors, Peer Reviewers, and Editors on Use of AI, Language Models, and Chatbots – JAMA
See also, just published: New recommendations of the International Committee of Medical Journal Editors: use of artificial intelligence – European Heart Journal
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Comparing scientific abstracts generated by ChatGPT to real abstracts with detectors and blinded human reviewers
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Chat GPT will change Medicine – Vinay Prasad’s Observations and Thoughts
The use of ChatGPT and other large language models in surgical science – BJS Open
ChatGPT vs. NCI: analyzing the quality of cancer information on myths and misconceptions
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ChatGPT’s responses to patient questions rated higher for quality and empathy than physicians
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Commentaries:
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Commentary on Twitter (thread – click for more)
Here's what's under appreciated about Chat GPT paper🧵
PCP panel can be 2 to 5k
Doc in clinic 40 hours++ already
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In the @JCO_ASCO‼️‼️, @ravi_b_parikh & I make the case for 🎯"Precision Palliative Care" 🎯as a pragmatic solution for a care delivery problem
A 🧵
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ChatGPT et al? Not so fast, say journal editors
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Chat GPT will change Medicine – Vinay Prasad’s Observations and Thoughts
The use of ChatGPT and other large language models in surgical science – BJS Open
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Perspective | Generating scholarly content with ChatGPT: ethical challenges for medical publishing
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ChatGPT and the future of medical writing (ChatGPT itself wrote this paper)
ChatGPT: five priorities for research – Nature
The path forward for ChatGPT in academia – Lumo’s Newsletter
ChatGPT is fun, but not an author – Science
Tools such as ChatGPT threaten transparent science; here are our ground rules for their use – Nature
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Commentary from the author on Twitter (thread – click for more)
New @bmj_latest paper📭
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How can companies develop more innovative & affordable medicines?Read the thread 🧵https://t.co/YYznD4Tvwq@ojwouters @ElsTorreele @martinmckee
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