TOPLINE:

Italian kidney transplant centres varied widely in how they managed endocrine problems, with crucial gaps seen in screening and follow-up for bone, adrenal, thyroid, and reproductive health. Clear guidelines for early detection and management would help standardise care and improve outcomes for this vulnerable patient group.

METHODOLOGY:

• A 44-item survey was distributed through email to 41 kidney transplant centres in the public health system in Italy to assess their awareness of and approach to endocrine disorders affecting kidney transplant recipients.
• Survey questions covered six key areas: general information, bone disease, thyroid disorders, pituitary disorders, adrenal disorders, and gonadal/fertility/sexuality concerns.
• Data collection maintained anonymity, with a single designated respondent per centre completing the questionnaire to prevent duplicate responses.

TAKEAWAY:

• Researchers achieved a response rate of 70.7% with the participation of 29 transplant physicians, of whom 89.7% reported following more than 150 kidney transplant recipients per year; kidney transplant recipients were routinely evaluated by an endocrinologist in around 52% of centres.
• The prevalence of osteoporosis exceeded 50% in kidney transplant recipients from certain centres; however, the prevalence of fractures was likely underreported because most centres used routine DEXA-based bone mineral density screening but not spinal radiographs to detect vertebral deformities.
• Only 14% of transplant centres regularly assessed adrenal function during follow-up, despite the risk for adrenal insufficiency from the chronic use of glucocorticoids; thyroid hormone levels were routinely monitored across centres, although the timing of evaluations varied widely.
• Gonadal function was not routinely investigated: 20% of centres did not address it during clinical history taking, and 35% were unaware of the incidence of menstrual irregularities or erectile dysfunction among their kidney transplant recipients.

IN PRACTICE:

"A thorough anamnestic evaluation and review of clinical data should be considered essential to identify populations at higher risk for endocrine disorders which may warrant more frequent and personalized assessments. Furthermore, a cost-benefit analysis is necessary to establish a standardized approach to potential laboratory and instrumental screening for endocrine disorders in transplant recipients," the authors wrote.

SOURCE:

This study was led by Bianca Pellegrini, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Calabria, Italy. It was published online on October 29, 2025, in the Journal of Endocrinological Investigation.

LIMITATIONS:

Due to the anonymity of survey responses, researchers were unable to analyse potential local or geographical disparities in the management of endocrine disorders across transplant centres.

DISCLOSURES:

This study was supported by the Ministero dell'Istruzione, dell'Università e della Ricerca. It also received financial support from the national project "Technologies for climate change adaptation and quality of life improvement" from the Italian Ministry of Research and the European Union and other sources. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.