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Are American follow-up recommendations in endocrinology actionable? A systematic review of clinical practice guidelines

Endocrine volume 72, pages 375–384 (2021)Cite this article

Abstract

Purpose

Clinical guidelines include recommendations to guide patient’s longitudinal care. These recommendations may differ in content and quality of supporting evidence from those guiding diagnosis and treatment. We aimed to identify recommendations guiding the follow-up of patients with endocrine conditions, describe their content and quality of evidence.

Methods

We systematically assessed the Endocrine Society and the American Thyroid Association clinical guidelines and identified recommendations guiding follow-up strategies to evaluate direction, content, strength, and quality of evidence.

Results

Out of 1540 recommendations, 138(8.9%) guided follow-up strategies. From these, 109 (79%) recommendations included goal of follow-up, 121(97.7%) suggested follow-up methods, and 56 (40.6%) a specific monitoring frequency. A total of 76 (55.1%) assessed treatment response, 65 (47.1%) disease progression, and 30 (21.7%) side effects. A total of 90 (65.2%) described the use of laboratory studies, 30 (21.7%) clinical exam/history, and 27 (19.6%) imaging studies. Finally, 91 (65.9%) suggested a monitoring time interval and 42 (30.4%) directed an action based on results. Most recommendations [88 (55.3%)] were based on low/very low-quality evidence. A total of 73 (52.9%) recommendations were labeled as strong, from which 12% were based on high-quality evidence.

Conclusions

One out of ten clinical recommendations for endocrine conditions guide follow-up and their content is variable. More than half of the follow-up recommendations are supported by low/very low-quality evidence and the majority does not provide an action threshold. A specific framework for developing follow-up recommendations can aid guideline panelists and support evidence-based monitoring.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. P. Glasziou, L. Irwig, D. Mant, Monitoring in chronic disease: a rational approach. BMJ 330, 644–8 (2005)

    PubMed  PubMed Central  Google Scholar 

  2. P. Glasziou, L. Irwig, J. Aronson. An Introduction to Monitoring Therapeutic Interventions in Clinical Practice In: Evidence-based Medical Monitoring: From Principles to Practice, pp. 3–14. (Blackwell Publishing, Wiley Online Library, 2008). https://doi.org/10.1002/9780470696323

  3. H.J. Schunemann, A.D. Oxman, J. Brozek, P. Glasziou, R. Jaeschke, G.E. Vist et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 336, 1106–10 (2008)

    PubMed  PubMed Central  Google Scholar 

  4. N. Singh Ospina, R. Rodriguez-Gutierrez, J.P. Brito, W.F. Young Jr, V.M. Montori, Is the endocrine research pipeline broken? A systematic evaluation of the Endocrine Society clinical practice guidelines and trial registration. BMC Med. 13, 187 (2015)

    PubMed  PubMed Central  Google Scholar 

  5. E.K. Alexander, E.N. Pearce, G.A. Brent, R.S. Brown, H. Chen, C. Dosiou et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27, 315–389 (2017)

    PubMed  Google Scholar 

  6. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26, 1–133 (2015)

    Google Scholar 

  7. J. Jonklaas, A.C. Bianco, A.J. Bauer, K.D. Burman, A.R. Cappola, F.S. Celi et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 24, 1670–1751 (2014)

    PubMed  PubMed Central  Google Scholar 

  8. R.C. Smallridge, K.B. Ain, S.L. Asa, K.C. Bible, J.D. Brierley, K.D. Burman et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid 22, 1104–1139 (2012)

    PubMed  Google Scholar 

  9. D.S. Ross, H.B. Burch, D.S. Cooper, M.C. Greenlee, P. Laurberg, A.L. Maia et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 26, 1343–1421 (2016)

    PubMed  Google Scholar 

  10. J.W. Funder, R.M. Carey, F. Mantero, M.H. Murad, M. Reincke, H. Shibata et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 1889–916 (2016)

    CAS  PubMed  Google Scholar 

  11. L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–51 (2014)

    CAS  PubMed  Google Scholar 

  12. L.K. Nieman, B.M. Biller, J.W. Findling, M.H. Murad, J. Newell-Price, M.O. Savage et al. Treatment of Cushing’s Syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 100, 2807–31 (2015)

    CAS  PubMed  PubMed Central  Google Scholar 

  13. C.M. Apovian, L.J. Aronne, D.H. Bessesen, M.E. McDonnell, M.H. Murad, U. Pagotto et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 100, 342–362 (2015)

    CAS  PubMed  Google Scholar 

  14. L. Berglund, J.D. Brunzell, A.C. Goldberg, I.J. Goldberg, F. Sacks, M.H. Murad et al. Evaluation and treatment of hypertriglyceridemia: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 2969–2989 (2012)

    CAS  PubMed  PubMed Central  Google Scholar 

  15. S. Bhasin, J.P. Brito, G.R. Cunningham, F.J. Hayes, H.N. Hodis, A.M. Matsumoto et al. Testosterone therapy in men with hypogonadism: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 103, 1715–1744 (2018)

    PubMed  Google Scholar 

  16. I. Blumer, E. Hadar, D.R. Hadden, L. Jovanovič, J.H. Mestman, M.H. Murad et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4227–4249 (2013)

    CAS  PubMed  Google Scholar 

  17. S.R. Bornstein, B. Allolio, W. Arlt, A. Barthel, A. Don-Wauchope, G.D. Hammer et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 364–389 (2016)

    CAS  PubMed  Google Scholar 

  18. P.E. Cryer, L. Axelrod, A.B. Grossman, S.R. Heller, V.M. Montori, E.R. Seaquist et al. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 94, 709–728 (2009)

    CAS  PubMed  Google Scholar 

  19. L. De Groot, M. Abalovich, E.K. Alexander, N. Amino, L. Barbour, R.H. Cobin et al. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 2543–2565 (2012)

    PubMed  Google Scholar 

  20. R. Eastell, C.J. Rosen, D.M. Black, A.M. Cheung, M.H. Murad, D. Shoback, Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 104, 1595–1622 (2019)

    PubMed  Google Scholar 

  21. M. Fleseriu, I.A. Hashim, N. Karavitaki, S. Melmed, M.H. Murad, R. Salvatori et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 3888–3921 (2016)

    CAS  PubMed  Google Scholar 

  22. P.U. Freda, A.M. Beckers, L. Katznelson, M.E. Molitch, V.M. Montori, K.D. Post et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 894–904 (2011)

    CAS  PubMed  PubMed Central  Google Scholar 

  23. J.W. Funder, R.M. Carey, F. Mantero, M.H. Murad, M. Reincke, H. Shibata et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 1889–1916 (2016)

    CAS  PubMed  Google Scholar 

  24. C.M. Gordon, K.E. Ackerman, S.L. Berga, J.R. Kaplan, G. Mastorakos, M. Misra et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 102, 1413–1439 (2017)

    PubMed  Google Scholar 

  25. D. Heber, F.L. Greenway, L.M. Kaplan, E. Livingston, J. Salvador, C. Still, Endocrine and nutritional management of the post-bariatric surgery patient: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 95, 4823–4843 (2010)

    CAS  PubMed  Google Scholar 

  26. W.C. Hembree, P.T. Cohen-Kettenis, L. Gooren, S.E. Hannema, W.J. Meyer, M.H. Murad et al. Endocrine treatment of gender-Dysphoric/Gender-incongruent persons: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 102, 3869–3903 (2017)

    PubMed  Google Scholar 

  27. M.F. Holick, N.C. Binkley, H.A. Bischoff-Ferrari, C.M. Gordon, D.A. Hanley, R.P. Heaney et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1911–1930 (2011)

    CAS  PubMed  Google Scholar 

  28. L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–3951 (2014)

    CAS  PubMed  Google Scholar 

  29. D.C. Klonoff, B. Buckingham, J.S. Christiansen, V.M. Montori, W.V. Tamborlane, R.A. Vigersky et al. Continuous glucose monitoring: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 2968–2979 (2011)

    CAS  PubMed  Google Scholar 

  30. R.S. Legro, S.A. Arslanian, D.A. Ehrmann, K.M. Hoeger, M.H. Murad, R. Pasquali et al. Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4565–4592 (2013)

    CAS  PubMed  PubMed Central  Google Scholar 

  31. J.W.M. Lenders, Q.-Y. Duh, G. Eisenhofer, A.-P. Gimenez-Roqueplo, S.K.G. Grebe, M.H. Murad et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 1915–1942 (2014)

    CAS  PubMed  Google Scholar 

  32. D. LeRoith, G.J. Biessels, S.S. Braithwaite, F.F. Casanueva, B. Draznin, J.B. Halter et al. Treatment of diabetes in older adults: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 104, 1520–1574 (2019)

    PubMed  PubMed Central  Google Scholar 

  33. K.A. Martin, R.R. Anderson, R.J. Chang, D.A. Ehrmann, R.A. Lobo, M.H. Murad et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 103, 1233–1257 (2018)

    PubMed  Google Scholar 

  34. S. Melmed, F.F. Casanueva, A.R. Hoffman, D.L. Kleinberg, V.M. Montori, J.A. Schlechte et al. Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 96, 273–288 (2011)

    CAS  PubMed  Google Scholar 

  35. M.E. Molitch, D.R. Clemmons, S. Malozowski, G.R. Merriam, M.L. Vance, Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1587–1609 (2011)

    CAS  PubMed  Google Scholar 

  36. L.K. Nieman, B.M.K. Biller, J.W. Findling, M.H. Murad, J. Newell-Price, M.O. Savage et al. Treatment of Cushing’s Syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 100, 2807–2831 (2015)

    CAS  PubMed  PubMed Central  Google Scholar 

  37. L.K. Nieman, B.M.K. Biller, J.W. Findling, J. Newell-Price, M.O. Savage, P.M. Stewart et al. The Diagnosis of Cushing’s Syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93, 1526–1540 (2008)

    CAS  PubMed  PubMed Central  Google Scholar 

  38. A.L. Peters, A.J. Ahmann, T. Battelino, A. Evert, I.B. Hirsch, M.H. Murad et al. Diabetes technology—continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 3922–3937 (2016)

    CAS  PubMed  Google Scholar 

  39. J.L. Rosenzweig, G.L. Bakris, L.F. Berglund, M.-F. Hivert, E.S. Horton, R.R. Kalyani et al. Primary prevention of ASCVD and T2DM in patients at metabolic risk: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 104, 3939–3985 (2019)

    Google Scholar 

  40. F.R. Singer, H.G. Bone III, D.J. Hosking, K.W. Lyles, M.H. Murad, I.R. Reid et al. Paget’s disease of bone: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 4408–4422 (2014)

    CAS  PubMed  Google Scholar 

  41. C.A. Sklar, Z. Antal, W. Chemaitilly, L.E. Cohen, C. Follin, L.R. Meacham et al. Hypothalamic–pituitary and growth disorders in survivors of childhood cancer: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 103, 2761–2784 (2018)

    PubMed  Google Scholar 

  42. P.W. Speiser, W. Arlt, R.J. Auchus, L.S. Baskin, G.S. Conway, D.P. Merke et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society* clinical practice guideline. J. Clin. Endocrinol. Metab. 103, 4043–4088 (2018)

    PubMed  PubMed Central  Google Scholar 

  43. C.A. Stuenkel, S.R. Davis, A. Gompel, M.A. Lumsden, M.H. Murad, J.V. Pinkerton et al. Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 100, 3975–4011 (2015)

    CAS  PubMed  Google Scholar 

  44. D.M. Styne, S.A. Arslanian, E.L. Connor, I.S. Farooqi, M.H. Murad, J.H. Silverstein et al. Pediatric obesity—assessment, treatment, and prevention: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 102, 709–757 (2017)

    PubMed  PubMed Central  Google Scholar 

  45. G.E. Umpierrez, R. Hellman, M.T. Korytkowski, M. Kosiborod, G.A. Maynard, V.M. Montori et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 16–38 (2012)

    CAS  PubMed  Google Scholar 

  46. N.B. Watts, R.A. Adler, J.P. Bilezikian, M.T. Drake, R. Eastell, E.S. Orwoll et al. Osteoporosis in men: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 1802–1822 (2012)

    CAS  PubMed  Google Scholar 

  47. M.E. Wierman, W. Arlt, R. Basson, S.R. Davis, K.K. Miller, M.H. Murad et al. Androgen therapy in women: a reappraisal: an endocrine society Clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3489–3510 (2014)

    CAS  PubMed  Google Scholar 

  48. S. American Thyroid Association Taskforce On Radioiodine, J.C. Sisson, J. Freitas, I.R. McDougall, L.T. Dauer, J.R. Hurley et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I: practice recommendations of the American Thyroid Association. Thyroid 21, 335–46 (2011)

    Google Scholar 

  49. A.C. Bianco, G. Anderson, D. Forrest, V.A. Galton, B. Gereben, B.W. Kim et al. American Thyroid Association Guide to investigating thyroid hormone economy and action in rodent and cell models. Thyroid 24, 88–168 (2014)

    PubMed  PubMed Central  Google Scholar 

  50. G.L. Francis, S.G. Waguespack, A.J. Bauer, P. Angelos, S. Benvenga, J.M. Cerutti et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25, 716–59 (2015)

    PubMed  PubMed Central  Google Scholar 

  51. M.S. Rosenthal, P. Angelos, D.S. Cooper, C. Fassler, S.G. Finder, M.T. Hays et al. Clinical and professional ethics guidelines for the practice of thyroidology. Thyroid 23, 1203–10 (2013)

    PubMed  Google Scholar 

  52. S.A. Wells Jr, S.L. Asa, H. Dralle, R. Elisei, D.B. Evans, R.F. Gagel et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 25, 567–610 (2015)

    PubMed  PubMed Central  Google Scholar 

  53. N.J. Marciano, T.L. Merlin, T. Bessen, J.M. Street, To what extent are current guidelines for cutaneous melanoma follow up based on scientific evidence? Int. J. Clin. Pract. 68, 761–770 (2014)

    CAS  PubMed  PubMed Central  Google Scholar 

  54. M. Johansson, P. Stattin, Guidelines are too important to be left to clinical experts. Can. Med. Assoc. J. 184, 159 (2012)

    Google Scholar 

  55. J.P. Brito, J.P. Domecq, M.H. Murad, G.H. Guyatt, V.M. Montori, The Endocrine Society Guidelines: when the confidence cart goes before the evidence horse. J. Clin. Endocrinol. Metab. 98, 3246–3252 (2013)

    CAS  PubMed  Google Scholar 

  56. K.G.Bautista-Orduno, E.G.Dorsey-Trevino, J.G.Gonzalez-Gonzalez, D.A.Castillo-Gonzalez, M.Garcia-Leal, K.Raygoza-Cortez et al. American thyroid association guidelines are inconsistent with Grading of Recommendations Assessment, Development, and Evaluations-A meta-epidemiologic study. J. Clin. Epidemiol. 123, 180–180–188.e2 (2020).

    PubMed  Google Scholar 

  57. E. Javorsky, A. Robinson, A. Boer Kimball, Evidence-based guidelines to determine follow-up intervals: a call for action. Am. J. Manag Care 20, 17–9 (2014)

    PubMed  Google Scholar 

  58. R. Rodriguez-Gutierrez, M.R. Gionfriddo, N.S. Ospina, S. Maraka, S. Tamhane, V.M. Montori et al. Shared decision making in endocrinology: present and future directions. Lancet Diabetes Endocrinol. 4, 706–716 (2016)

    PubMed  Google Scholar 

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Funding

NSO was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA248972. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Affiliations

  1. Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico

    Francisco J. Barrera & René Rodríguez-Gutiérrez

  2. Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico

    Francisco J. Barrera, Karina Raygoza-Cortez, Mariana García-Leal & René Rodríguez-Gutiérrez

  3. Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA

    Francisco J. Barrera, Juan P. Brito, Naykky M. Singh Ospina & René Rodríguez-Gutiérrez

  4. Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA

    Juan P. Brito & Naykky M. Singh Ospina

  5. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    René Rodríguez-Gutiérrez

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  1. Francisco J. Barrera
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  2. Karina Raygoza-Cortez
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  3. Mariana García-Leal
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Correspondence to Naykky M. Singh Ospina or René Rodríguez-Gutiérrez.

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Barrera, F.J., Raygoza-Cortez, K., García-Leal, M. et al. Are American follow-up recommendations in endocrinology actionable? A systematic review of clinical practice guidelines. Endocrine 72, 375–384 (2021). https://doi.org/10.1007/s12020-020-02592-y

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Keywords

  • Follow-up
  • Clinical practice guidelines
  • Endocrine Society
  • American Thyroid Association
  • Evidence-based medicine