Clinical Endocrinology最新文献

Objective: Skeletal fragility is a common complication of endogenous Cushing's Syndrome (CS), although specific guidelines for managing bone health are lacking. This study aimed to assess clinicians' current engagement with bone health assessment and management in patients with endogenous CS.

Design: Retrospective-cohort design.

Patients: Seventy-nine patients with confirmed endogenous CS, treated at a tertiary endocrine centre.

Measurements: The frequency of bone health assessment, evidenced by vitamin D measurement, and bone health management, evidenced by a composite outcome of calcium and/or vitamin D optimisation and/or initiation of bone-protective agents, was recorded. Changes in bone mineral density (BMD), measured by Dual-energy X-ray absorptiometry (DEXA) and fracture prevalence were assessed pre- and post-CS treatment.

Results: Vitamin D was measured in only 43% (34/79), and bone health was managed in only 39.2% (31/79). BMD was assessed in 44.3% (35/79) during active CS; of these, 22.9% had osteoporosis. Improved BMD was observed within a year of CS remission. Fractures occurred in 17.7% (14/79) within 2 years of CS diagnosis, and 12 additional fractures occurred during follow-up despite CS remission. Treatment with bone-protective agents expedited recovery with a significant increase in lumbar spine BMD, compared to those not treated.

Conclusions: Our data demonstrate that skeletal impairment and fragility fractures are highly prevalent in endogenous CS, and fracture risk may persist despite remission. However, currently, bone health is inadequately assessed and managed. These findings identify an urgent need for improved awareness, assessment, and management of bone-health in this high-risk population and call for specific evidence-based practice guidelines.

Objective: Bariatric surgery has emerged as a potent intervention for ameliorating insulin resistance and its associated comorbidities in obese patients. Apolipoprotein J (ApoJ) and adiponectin are closely associated with insulin resistance and sensitivity, respectively. While changes in adiponectin levels following surgically induced weight loss have been intensively investigated, the response of ApoJ and its impact on metabolic parameters following bariatric surgery remain unclear. We aimed to elucidate serial changes in ApoJ levels and their associations with responses of adiponectin levels and critical metabolic parameters after Roux-en-Y gastric bypass (RYGB) surgery. Seven obese patients undergoing RYGB surgery were enrolled in this prospective study. Clinical and laboratory data were collected before surgery and at multiple time points from 1 day up to 12 months post-surgery. Serum levels of ApoJ, total adiponectin, and its multimeric forms, along with anthropomorphic and other metabolic parameters, were measured in the fasting state.

Results: Post-surgery, marked improvements were observed in anthropometric measures, and in serum levels of glucose, insulin, leptin, GLP-1, adiponectin, and homeostatic model assessment of insulin resistance (HOMA-IR) and insulin secretion (HOMA-ß). While ApoJ levels remained relatively stable, a positive association was seen with changes in leptin levels (r² = 0.499, p = 0.024); no association was found with changes in adiponectin levels.

Conclusions: These findings suggest that although overall ApoJ levels did not change significantly, individual temporal variations were associated with changes in leptin levels, indicating that ApoJ may serve as a potential biomarker after RYGB. Larger studies are needed to validate these observations.

Background: Plasma renin is measured in children with salt-wasting adrenal insufficiency (AI) as part of assessing the adequacy of mineralocorticoid (MC) replacement. It is recommended that plasma renin is used to monitor MC replacement. This can be measured as either plasma renin concentration (PRC) or activity (PRA); it is not known if one method is preferable over the other.

Methods: Samples from 129 patients less than 18-years old requested for PRC were selected randomly. PRC was measured using the IDS-iSYS chemiluminescence immunoassay, PRA was measured by LC-MS/MS. The PRC and PRA values for each sample were reviewed using published reference ranges and categorised as low, normal and high. Samples which showed disagreement between PRC and PRA results based on the reference ranges were divided into groups. Samples collected from patients attending the regional adrenal clinic were clinically reviewed in retrospect, using serum sodium and blood pressure as decision guides, to determine if MC replacement dosing would differ if PRA was used instead of PRC.

Results: Ninety-six (74%) of the samples analysed exhibited agreement between their PRC and PRA interpretation. Seventeen of 33 samples which displayed disagreement were collected from adrenal clinic patients. Of these, eight would have a different clinical decision concerning MC replacement based on PRA compared with PRC. In each of these instances, adjustments to MC dose based on PRA was strongly supported by serum sodium levels and blood pressure centiles. In one instance, PRC had been deliberately ignored by clinicians and MC dose had been adjusted according to other conventional parameters such as blood pressure and serum sodium. In this instance, PRA provided reassurance that MC replacement had been correctly assessed by clinicians.

Conclusions: Our investigation found PRA performed superiorly to PRC for assessing MC replacement in paediatric patients, based on supporting biochemical and clinical parameters. Our results indicated that use of PRA may help to standardise practice when assessing MC replacement; this is likely to have patient benefit through improved blood-pressure and electrolyte control.

Background: The purpose of the study was to determine changes in anabolic and catabolic hormone levels in response to various training regimens and to analyse their effect on skeletal muscle adaptation mechanisms through experimental measurement of physiological changes.

Design: The study used laboratory biochemical assays to assess anabolic and catabolic hormone levels, clinical observation to measure physiological changes (muscle mass, strength, endurance), and statistical methods (ANOVA, t-tests, correlation analysis) to assess group differences.

Methods and measurements: The study conducted an experimental analysis of hormonal changes in response to various types of physical activity, in particular, strength training, HIIT, and aerobic exercise.

Results: It was found that strength training contributed to the greatest increase in the level of anabolic hormones, which correlated with an increase in muscle mass (+12%) and strength (+35%), while HIIT provided a balanced improvement in strength indicators and endurance. Aerobic exercise caused minor changes in anabolic hormone levels but a significant increase in VO₂max (+30%) with an increase in cortisol (+5%). Changes in the levels of myokines were also found; in particular, irisin and osteocalcin, which play an important role in metabolic adaptation. The anabolic response was more pronounced in the younger participants (18-35 years), while in the older groups (36-50 and 51-60 years), the increase in muscle mass was less significant.

Conclusions: The identified patterns are important for sports medicine, endocrinology, and rehabilitation, in particular, for maintaining muscle mass and correcting hormonal changes in different age groups.

Background: University exams are recognised as naturalistic stressors that may elicit psychosocial and physiological responses in students. This pilot study investigated the short- and long-term effects of exam-related stress on hypothalamic-pituitary-adrenal (HPA) axis activity, focusing on cortisol production and rhythmicity.

Methods: Twenty-seven undergraduate students (aged 18-24 years) from a biological sciences programme participated. Hair cortisol concentrations were analysed for October (non-exam month) and November (exam month), while salivary cortisol was collected during 3 consecutive exam weekdays (Monday to Wednesday) at five daily time points to assess diurnal variation and the cortisol awakening response (CAR).

Results: Hair cortisol levels were significantly higher in November than in October, suggesting greater cumulative HPA activation during the exam period. Salivary cortisol displayed a general diurnal pattern and CAR across the week. Morning cortisol values showed a nonsignificant numerical increase across days, though overall daily cortisol output (AUC) remained stable.

Conclusion: Exam periods may be accompanied by elevated cumulative cortisol exposure while short-term HPA rhythmicity remains preserved. The combined use of hair and salivary biomarkers offers a multidimensional and feasible approach to investigating acute and cumulative stress responses in students. Larger longitudinal studies incorporating behavioural measures are warranted to confirm these findings.

Objective: To assess long-term tumour behaviour after surgery for non-functioning pituitary neuroendocrine tumours (NF-PiTNETs) and to propose a risk-adapted postoperative MRI surveillance strategy based on real-world data.

Methods: This single-centre retrospective cohort study included 174 adults with histologically confirmed NF-PiTNETs who underwent first-line pituitary surgery at our tertiary referral centre between 2005 and 2020, with a minimum follow-up of 36 months. Serial MRI was used to assess postoperative residual tumour and recurrence. The primary outcomes were time to progression of residual tumour and time to recurrence after complete resection. Secondary outcomes included management strategies and cumulative MRI burden. Predictors of residual progression and recurrence were evaluated using multivariable Cox proportional hazards models.

Results: Residual tumour was present in 107 patients (61.5%) and progressed in 29 (27.1%) after a median of 47 months. Among 67 patients with complete resection, recurrence occurred in 15 (22.4%) after a median of 67 months. Most residual growths (62.1%) occurred within 5 years, while two-thirds of recurrences appeared after 5 years. Residual growth was independently associated with younger age (HR 0.94 per year, 95% CI 0.91-0.97, p < 0.001) and larger tumour size (HR 1.05 per mm, 95% CI 1.01-1.09, p = 0.015), whereas Ki-67 showed a non-significant trend. In the complete resection cohort, Cox regression did not identify robust baseline predictors of recurrence, despite the predominance of late events. Applying a risk-adapted surveillance schedule-MRI at 2, 3, 7, 10 years for complete resection and 1, 2, 3, 5, 7, 10 years for residual tumour-would reduce imaging by 36% without missing any clinically relevant event.

Conclusions: Residual tumour progression and recurrence display distinct temporal patterns. Early imaging is warranted for patients with residual tumour, whereas those with complete resection may safely omit MRI within the first 2 years. A risk-adapted follow-up protocol can reduce unnecessary imaging while maintaining patient safety.

Objective: Clinical autoimmune thyroid disease (AITD), presenting as either hypo- or hyperthyroidism, can occur at any age. Autoantibodies against thyroid peroxidase or thyroglobulin precede the onset of clinical AITD. We aimed to assess factors associated with AITD in children and determine if risk factors for AITD differ among the subset who have developed thyroid autoantibodies.

Design: Prospective cohort study.

Patients: The TEDDY Study is a cohort of 8676 children with increased genetic susceptibility for type 1 diabetes, followed to age 15 years.

Measurements: Hypothyroidism and hyperthyroidism clinical diagnoses as well as medications used for treating AITD were reported to study staff at every visit, 2 to 4 times per year. Children were screened for thyroid autoantibodies at ages 9 and 14, and if positive, previously collected samples were retrospectively analyzed to determine the age when autoantibodies first appeared.

Results: Of 5203 children screened for thyroid autoantibodies, 99 were diagnosed with AITD. Female sex, human leukocyte antigen (HLA) haplogenotype, and family history of hypothyroidism, hyperthyroidism, type 1 diabetes, and celiac disease were associated with risk of AITD. Among the 575 children positive for thyroid autoantibodies, HLA remained associated with AITD, while the estimates for family history were attenuated, and no association was present for sex.

Conclusions: Female sex, family history of autoimmune disease, and HLA haplogenotype are risk factors for AITD in genetically high-risk children, but these trends differ for progression from thyroid autoimmunity to AITD.

Background and aims: Prediabetes-a reversible metabolic condition characterized by impaired fasting glucose, elevated HbA1c, or reduced glucose tolerance-is a major precursor to type 2 diabetes mellitus (T2DM), especially in high-risk populations like India. This review evaluates the impact of culturally tailored lifestyle interventions in preventing type 2 diabetes in adults with prediabetes.

Methods: This PRISMA-compliant systematic review (PROSPERO: CRD420251085667) included RCTs from 2020 to 2025 on adults (≥18 years) with prediabetes. It assessed lifestyle interventions-diet, exercise, yoga, and behavioral support-using the Jadad scale and Downs & Black checklist.

Results: Six high-quality RCTs demonstrated significant improvements in glycemic parameters, cardiometabolic profiles, and reductions in diabetes incidence. Yoga-based protocols yielded notable declines in HbA1c and stress biomarkers. Dietary counseling and formula diets achieved normoglycemia and metabolic benefits independent of weight loss. Long-duration interventions also reduced frailty and disability risks, enhancing overall health outcomes.

Conclusions: Culturally adapted lifestyle interventions show strong efficacy and scalability in reversing prediabetes and reducing progression to T2DM. Integration of such strategies into national diabetes prevention programs may enhance sustainable metabolic health and address the unique needs of high-risk populations.

Objective: Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease that requires long-term glycemic control. The long-term real-world evidence for glucagon-like peptide-1 receptor agonists remains limited. This study aimed to evaluate the sustained glycemic and weight-lowering effects of dulaglutide in patients with T2DM who had maintained therapy for at least 3 years.

Methods: This retrospective cohort study analyzed 403 patients with T2DM who were treated continuously with weekly doses of dulaglutide for ≥ 3 years between 2016 and 2023 at a single tertiary hospital. Baseline and follow-up data on glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body weight were also assessed.

Results: The participants had a mean age of 60.0 years, with a mean diabetes duration of 17.4 years. Over a mean follow-up of 4.3 years, HbA1c decreased from 8.7% (72 mmol/mol) to 7.6% (60 mmol/mol), reflecting a mean reduction of 1.1% (12 mmol/mol) (p < 0.001), and body weight decreased by 2.9 kg (p < 0.001). Baseline HbA1c level was the strongest predictor of glycemic improvement.

Conclusions: Dulaglutide provided durable improvements in glycemic control and weight reduction for more than 3 years, even in patients with long-standing T2DM and comorbidities. These results support its role as a long-term treatment option in real-world clinical practice.