Endocrine dysfunction is an under-recognized but significant driver of morbidity and mortality in the critically ill. This review highlights how biomarkers enable earlier detection, diagnosis, and monitoring of life-threatening endocrine crises—such as adrenal insufficiency, thyroid storm, and hyperglycemic emergencies—that may initially present with non-specific symptoms.

Highlights:

• Biomarkers—classified as prognostic, predictive, pharmacodynamic, or exposure-related—help guide both diagnosis and treatment decisions.

• Established markers include TSH for thyroid disease, cortisol for adrenal insufficiency, IGF-1 for growth hormone deficiency, and HbA1c for glycemic status.

• Advantages include earlier, objective detection and individualized therapy; limitations involve sensitivity, clinical validation, and interpretive complexity.

• Emerging tools like extracellular vesicles, serum diiodotyrosine, and neutrophil gelatinase-associated lipocalin (NGAL) may offer precision diagnostics.

• Advances in multiplexed and ultra-sensitive detection platforms are improving accuracy and accelerating clinical adoption.

What sets this study apart:

It synthesizes current and emerging biomarker evidence, positioning these tools to shift critical care endocrinology from reactive to precision-guided, proactive management.

Limitations:

Many novel markers lack large-scale validation. Regulatory hurdles and workflow integration also limit clinical translation in intensive care.

How are you leveraging biomarkers to detect endocrine crises earlier in the ICU? Could multiplex technology help improve diagnostic accuracy and resource utilization in your unit?

For patients recovering from myocardial infarction (MI), early initiation of high-intensity statin therapy is standard. Yet, sustaining LDL-C control in the months and years that follow is often overlooked despite its potential to reduce recurrent cardiovascular events.

Despite clear guideline targets, real-world data show that many post-MI patients fail to achieve or maintain LDL-C levels below 70 mg/dL. Delays in follow-up testing, therapeutic inertia, and disparities in care contribute to this gap. Real-world data suggest that women and older adults may be less likely to receive high-intensity lipid-lowering therapy (LLT) or timely reassessment, reflecting disparities in access or treatment patterns.

For patients who remain above target despite maximally tolerated statins—or who are unable to tolerate them—adjunctive therapies that enhance LDL receptor activity offer a chance to drive LDL-C lower and reduce residual risk. But these benefits hinge on timely recognition of inadequate response and a proactive approach to intensification.

The 2025 AACE lipid management guidelines recommend a treatment goal of LDL-C <70 mg/dL in adults with ASCVD or at increased risk. Reaching—and maintaining—this threshold has been linked to fewer recurrent events, including MI, stroke, and revascularization. But success depends not just on what we prescribe, but on how closely we monitor, reassess, and adapt over time.

How do you coordinate post-MI lipid management in your practice? What prompts you to intensify treatment when targets aren't met?

Obesity disrupts endocrine health through insulin resistance, chronic inflammation, and altered adipokine signaling. This narrative review explores how different dietary patterns influence hormonal balance in men and women.

Highlights:

• In men, obesity is linked to decreased testosterone, reduced thyroid function, possibly reflecting thyroid hormone resistance, and elevated cortisol
• In women, it increases risks for PCOS, infertility, and androgen excess
• Calorie restriction, low-carbohydrate diets, Mediterranean, and plant-based patterns show hormonal benefits
• Hormonal effects of dietary changes are often sex-specific

What sets this study apart:

Unlike conventional reviews that focus on single nutrients, this synthesis examines whole dietary patterns and their interaction with sex-specific hormonal physiology. It emphasizes the importance of individualized nutrition plans based on reproductive and metabolic profiles, underscoring that one-size-fits-all approaches are inadequate for endocrine health.

Limitations:

As a narrative review, conclusions are drawn from existing literature rather than new clinical data. Long-term outcomes and sustainability of restrictive diets, such as ketogenic or very low-carbohydrate regimens, remain underexplored.

What role does gender play in how dietary choices influence endocrine health?