Clinical Practice Guideline Methodology

Method of Development of the Endocrine Society’s Clinical Practice Guidelines

To address the compelling need for evidence-based endocrine clinical practice guidelines, the Endocrine Society has implemented a rigorous guideline development process. The Society’s Clinical Guidelines Subcommittee (CGS) selects topics by considering those subjects for which there are no guidelines or where existing guidelines are either out of date or do not meet the needs of our members.

Each guideline is developed by a task force consisting of international experts in the field. Task forces undertake reviews of the scientific literature that provide support for the recommendations. In addition, the Society contracts with the Evidence Based Practice Center of the Mayo Clinic to conduct systematic reviews and meta-analyses on guideline-specific critical research questions.

All recommendations are constructed and classified using the GRADE system for evidence review. This system considers relative strengths and weaknesses of the best available evidence.  Strong recommendations use the phrase “we recommend” and the number 1, and weak recommendations use the phrase “we suggest” and the number 2. Cross-filled circles indicate the quality of the evidence, such that ⊕⚪⚪⚪ denotes very low-quality evidence; ⊕⊕⚪⚪, low quality; ⊕⊕⊕⚪, moderate quality; and ⊕⊕⊕⊕, high quality. The Task Force has confidence that persons who receive care according to the strong recommendations will derive, on average, more good than harm. Weak recommendations require more careful consideration of the person’s circumstances, values, and preferences to determine the best course of action.

Linked to each recommendation is a description of the evidence and the values that the Task Force considered in making the recommendation. In some instances, there are also technical remarks, where the Task Force offers technical suggestions such as dosing. These technical comments reflect the best available evidence applied to a typical person being treated. Some task forces may also include Ungraded Good Practice Statements in a guideline. Here, evidence was either unavailable or not systematically reviewed, yet the task force wished to remind providers of certain care delivery principles. Finally, a task force may also include ungraded statements to emphasize the importance of shared decision-making or preventive care measures, dependent upon the topic of the guideline.

Conflict of Interest

The Endocrine Society maintains a rigorous conflict of interest review process for developing clinical practice guidelines. All Task Force members must declare any potential conflicts of interest by completing a conflict-of interest form. The CGS reviews all conflicts of interest before the Society’s Council approves the members to participate on the Task Force and periodically during the development of the guideline. All those participating in the guideline’s development must also disclose any conflicts of interest in the matter under study, and a majority of these participants must be without any conflicts of interest. The CGS and the Task Force have reviewed all disclosures for this guideline and resolved or managed all identified conflicts of interest. Conflicts of interest are defined as remuneration in any amount from commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (eg, stocks, stock options [excluding diversified mutual funds]); honoraria or other payments for participation in speakers’ bureaus, advisory boards, or boards of directors; or other financial benefits.


Funding for this guideline was derived solely from the Endocrine Society; the Task Force received no funding or remuneration from commercial or other entities.


The Endocrine Society's clinical practice guidelines are developed to be of assistance to endocrinologists by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgement of healthcare providers and each patient's individual circumstances.

The Endocrine Society makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.


If you have questions about the Society’s guidelines, please contact Melanie Stephens-Lyman, Associate Director of Clinical Practice Guidelines, at