Clinical Endocrinology最新文献

Purpose: To analyze the dexamethasone bioavailability in the 1mg-dexamethasone suppression test (DST) in patients with adrenal incidentalomas (AIs) to assess the reliability of the DST for the diagnosis of mild autonomous cortisol secretion (MACS).

Methods: A prospective cross-sectional study of 140 consecutive patients with AIs who underwent simultaneous testing of serum dexamethasone and cortisol levels after the DST. MACS diagnosis was based on a DST value > 1.8 µg/dL in absence of specific clinical data of Cushing's syndrome, and nonfunctioning adrenal incidentaloma (NFAIs) diagnosis was established when cortisol post-DST was ≤ 1.8 µg/dL and no evidence of other adrenal hormonal hypersecretion. Serum dexamethasone was measured with liquid chromatography coupled to mass spectrometry (LC-MS/MS).

Results: We enrolled 89 patients with MACS and 51 patients with NFAIs. Patients with MACS had higher late-nigh salivary cortisol and cortisol post-DST levels and lower DHEAS and ACTH values than NFAIs. In addition, they were older, had a higher prevalence of hypertension, diabetes and bilateral and larger adrenal tumors than NFAIs. Considering the 3.3 nmol/L serum dexamethasone threshold, we found that only 3.6% (n = 5) of the patients who underwent DST did not achieve proper serum dexamethasone levels during the DST. A weak positive correlation between age and serum dexamethasone levels (r = 0.191, p = 0.024) was observed. In addition, patients with MACS, hypertension and dyslipidemia reached higher serum dexamethasone levels after DST than those without these comorbidities.

Conclusion: Up to 4% of the patients with MACS diagnosis based on a DST > 1.8 µg/dl do not achieve enough dexamethasone levels to suppress the hypothalamic pituitary adrenal axis, suggesting that the positive results in the DST were not related with autonomous cortisol secretion.

Background: Fibromyalgia (FM) is a chronic pain syndrome increasingly linked to immune and endocrine dysfunction. This study aimed to evaluate the prevalence of endocrine comorbidities in FM patients compared to matched controls using a large healthcare database.

Methods: A population-based case-control study was conducted using data from Leumit Health Services, Israel. The cohort included 9,232 adults diagnosed with FM according to ACR criteria, matched by age and sex to 46,160 control subjects. Endocrine disorders were identified via ICD-9 codes. Statistical analyses included Student's t-test or Mann-Whitney U test for continuous variables, Pearson's chi-squared or Fisher's exact test for categorical variables, and multivariable logistic regression adjusting for age, sex, and BMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Both statistical significance and effect sizes are reported to facilitate assessment of clinical relevance.

Results: FM patients showed a significantly higher prevalence of endocrine comorbidities compared to controls. Thyroid disorders, including Hashimoto's thyroiditis (13.3% vs. 10.0%; OR = 1.38, p < 0.001) and Graves' disease (4.1% vs. 3.0%; OR = 1.38, p < 0.001), were more common. Diabetes mellitus type 1 (0.9% vs. 0.3%; OR = 3.64, p < 0.001) and type 2 (23.5% vs. 18.6%; OR = 1.34, p < 0.001), adrenal disorders such as Cushing's syndrome (OR = 5.01, p < 0.001), prolactinoma (OR = 1.81, p = 0.014), osteoporosis (19.1% vs. 11.6%; OR = 1.80, p < 0.001), and vitamin D deficiency (39.9% vs. 30.3%; OR = 1.53, p < 0.001) were also significantly associated. Less common conditions (e.g., thyroiditis subtypes and thyroid malignancy) also appeared more frequent among FM patients, though effect sizes varied and some associations did not reach robust significance.

Conclusion: This is among the largest datasets to date to systematically examine a comprehensive spectrum of endocrine comorbidities in FM. Our findings suggest that FM and endocrine disorders may share overlapping pathophysiological mechanisms. Future studies should clarify causal pathways and assess the clinical utility of routine endocrine screening in FM patients.

Context: Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is widely used in malignancy diagnosis and surveillance. However, benign conditions also increase avidity. Distinguishing between benign and pathological uptake is critical. Rising PET-CT utilisation has led to increased detection of incidental pituitary FDG uptake. Referral pathways and secondary imaging remain inconsistent, and no UK guidelines exist. This study aims to review our current practice and assess the potential role of SUVmax to differentiate physiological from pathological uptake in the pituitary gland.

Design: A retrospective single-centre cohort study was conducted at a UK tertiary hospital.

Patients: Among 15824 PET-CT scans between 01/01/2017-30/06/2024, 70 patients (mean age 72.1 ± 1.3 years, 25.7% female) were included.

Measurements: Demographics, primary pathology, oncological treatment, SUVmax on initial PET-CT, secondary imaging findings, endocrine referral, and pituitary biochemistry were collected.

Results: 48 patients (68.6%) underwent secondary imaging; 70.8% (n = 34) were normal. Pathological findings included macroadenomas (n = 6), microadenomas (n = 3), and other lesions (n = 5). Mean SUVmax was significantly higher in patients with pituitary pathology (pituitary adenomas- 20.62 ± 4.82; all pathology- 16.74 ± 3.80) versus normal imaging- 4.66 ± 0.26 (p < 0.001). A SUVmax threshold of 4.75 yielded 100% sensitivity and 53.9% specificity for detecting pituitary pathology (ROC curve; 95% CI: 69%-100%).

Conclusions: Our review highlights significant variation in referral patterns for secondary imaging and to the Endocrine department. We suggest potential use of SUVmax threshold to distinguish physiological from pathological pituitary FDG uptake. Further validation in larger cohorts is warranted before routine clinical application.