A Deep Dive Into Endocrine and Reproductive Health in Patients With Cystic Fibrosis: Before and Beyond Solid Organ Transplantations.

Patients with cystic fibrosis often have significant baseline endocrine comorbidities that may worsen following organ transplantation, necessitating long-term surveillance, and close follow-up. Post-transplant glycemic control is critical due to the risk of worsening cystic fibrosis-related diabetes or new-onset post-transplant diabetes mellitus associated with glucocorticoids, calcineurin inhibitors, and additional metabolic stressors. Poor glycemic control is linked to increased rates of hospitalization, graft dysfunction, rejection, morbidity, and mortality. Intensive patient education, close glucose monitoring, and timely initiating or escalating antidiabetes medication use are fundamental care goals. Cystic fibrosis also increases baseline osteoporosis and fracture risk due to gonadal dysfunction, chronic malabsorption, and frequent GC use, which may be further exacerbated post-transplant due to additional insults from high dose GCs and immunosuppression. Routine assessment on bone health, including bone mineral density and vitamin D monitoring, is essential to prevent osteoporosis and reduce fracture risk. In addition, adrenal insufficiency remains an under-recognized complication related to prolonged GC use, and clinicians should maintain a lower threshold to actively screen for adrenal insufficiency routine visits. Furthermore, post-transplant improvements in fertility and increased use of assisted reproductive technologies underscore the growing need for comprehensive, multidimensional monitoring protocols. Optimizing endocrine health and providing structured preconception counseling are essential to prevent unplanned post-transplant pregnancies and mitigating adverse maternal and fetal outcomes. This comprehensive review explores key challenges in endocrine care among patients with cystic fibrosis, with special emphasis on post-transplant patients, including glycemic control, bone health, adrenal and thyroid dysfunction, and reproductive endocrine management.