Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Autonomous cortisol secretion associated with 2- to 3-fold increase in mortality risk
Abstract: https://www.acpjournals.org/doi/10.7326/M20-7946
URL goes live when the embargo lifts
A retrospective cohort study found that autonomous cortisol secretion was associated with 2- to 3-fold increased risk for death and cardiovascular disease in patients with adrenal incidentalomas. This information could help to inform decisions about which patients should be recommended for adrenalectomy. The findings are published in Annals of Internal Medicine.
Autonomous cortisol secretion in patients with adrenal tumors discovered incidentally on imaging, or incidentalomas, is associated with increased mortality, but how specific levels of cortisol secretion affect mortality risk is not known.
Researchers from Skane University Hospital, Sweden, studied consecutive patients who had adrenal incidentalomas identified between 2005 and 2015 at two hospitals in Sweden to measure the association between mortality and levels of autonomous cortisol secretion. Patients were grouped according to plasma cortisol levels of less than 50, 50 to 82, 83 to 137, or 138 nmol/L and higher. Data were collected from national registers for up to 14 years.
The researchers found that the risk for mortality increased linearly until cortisol levels reached 200 nmol/L. A cortisolDST of 83 to 137 nmol/L was associated with a 2-fold increase in mortality, and a cortisolDST of 138 nmol/L or higher was associated with a 3-fold increase in mortality. A cortisol level in the 50 to 82 nmol/L range was not associated with an increased death risk within 5 to 10 years. Based on these results, the authors recommend that clinicians treat known cardiovascular risk factors in these patients and incorporate findings in treatment decisions, including whether or not to perform surgery.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Henrik Olsen, MD, please contact Magnus Aspegren at magnus.aspegren@skane.se.
2. ACP paper details transparent and trustworthy methods for developing evidence-based living, rapid practice points
Abstract: https://www.acpjournals.org/doi/10.7326/M20-7641
URL goes live when the embargo lifts
A new paper from the American College of Physicians (ACP) details the methods that its Scientific Medical Policy Committee (SMPC) uses to develop ACP living, rapid practice points. The paper is published in Annals of Internal Medicine.
ACP began developing living, rapid practice points in response to the urgent need to provide evidence-based answers to clinicians managing patients with COVID-19. This process involves evidence gathered through an independent living, rapid systematic review from which practice points are developed. In developing the practice points, ACP takes into account the balance of benefits and harms and also considers public and patient values and preferences, and other considerations including, but not limited to, cost, acceptability, and feasibility.
The paper explains in detail ACP's methods for developing trustworthy rapid clinical advice, which includes a rapid systematic review, use of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to rate the certainty of evidence for outcomes of interest, use of stringent policies on the disclosure of interests and management of conflicts, and incorporating a public (non-clinician) perspective.
When the ACP rapid practice points are based on evidence that is limited or evolving quickly, such as with the COVID-19 pandemic, the systematic review and practice points are maintained as "living" documents through ongoing surveillance and synthesis of new evidence as it emerges.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org.
New vaccine-related content:
Safety and Immunogenicity of Anti-SARS-CoV-2 Messenger RNA Vaccines in Recipients of Solid Organ Transplants
Olivier Marion, MD; Nassim Kamar, MD, PhD; Arnaud Del Bello, MD; Stanislas Faguer, MD, PhD; Florence Abravanel, PharmD, PhD; Jacques Izopet, PharmD, PhD; Chloe Couat, MSc; Laure Esposito, MD; Anne Laure Hebral, MD
Brief Research Report
Abstract: https://www.acpjournals.org/doi/10.7326/M21-1341
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Olivier Marion, MD, please contact Prof Nassim Kamar at kamar.n@chu-toulouse.fr.
Absence of Humoral Response After Two-Dose SARS-CoV-2 Messenger RNA Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: A Case Series
Caoilfhionn M. Connolly, MD, MSc; Brian J. Boyarsky, MD, PhD; Jake A. Ruddy, BS
William A. Werbel, MD; Lisa Christopher-Stine, MD, MPH; Jacqueline M. Garonzik-Wang, MD, PhD; Dorry L. Segev, MD, PhD; Julie J. Paik, MD, MHS
Brief Research Report
Abstract: https://www.acpjournals.org/doi/10.7326/M21-1451
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Dorry L. Segev, MD, please contact Michael E. Newman at mnewma25@jhmi.edu.
Also new in this issue:
Dr. Mom: Who is watching your kids?
Grace Farris, MD
Annals Graphic Medicine
Abstract: https://www.acpjournals.org/doi/10.7326/G21-0026
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Journal
Annals of Internal Medicine