Clinical Endocrinology最新文献

Adrenal vein sampling (AVS) is the current recommended procedure for identifying unilateral subtypes of primary aldosteronism (PA), which are amenable to surgery with the potential for cure. AVS is a technically challenging procedure usually undertaken by interventional radiologists at tertiary centres. However, there are numerous variations in AVS protocols relating to patient preparation, sampling techniques and interpretation which may impact the success of AVS and patient care. To reduce practice variations, improve the success rates of AVS and optimise patient outcomes, we established an Australian and New Zealand AVS Working Group and developed evidence-based expert consensus recommendations for the preparation, performance and interpretation of AVS. These recommendations can be used by all healthcare professionals in a multidisciplinary team who look after the diagnosis and management of PA.

Background: There is increasing evidence that maternal factors such as nutritional status (both under and over-nutrition) and diabetes, alongside prenatal exposure to endocrine disrupting chemicals (EDCs), are associated with early pubertal onset in offspring. Such children are also at increased risk of the metabolic syndrome during adolescence and young adulthood.

Aim: This literature review focuses on the role of the prenatal environment in programming pubertal onset, and the impact of prenatal metabolic stressors on the declining average age of puberty.

Method: A review of all relevant literature was conducted in PubMed by the authors.

Outcome: The mechanism for this appears to be mediated through metabolic signals, such as leptin and insulin, on the kisspeptin-neuronal nitric oxide-gonadotropin releasing hormone (KiNG) axis. Exposed children have an elevated risk of childhood obesity and display a phenotype of hyperinsunlinaemia and hyperleptinaemia. These metabolic changes permit an earlier attainment of the nutritional "threshold" for puberty. Unfortunately, this cycle may be amplified across subsequent generations, however early intervention may help "rescue" progression of this programming.

Purpose: Adipose tissue has an important endocrine function by secreting a variety of hormones known as adipokines, such as Visfatin, Omentin-1 and Chemerin. On the other hand, these hormones are also secreted from places other than fatty tissues in the girl's genital system. The goal of this study was to demonstrate the secretory status of adipokines in patients with central precocious puberty (CPP) and their utility in the diagnosis of precocious puberty.

Method: A total of 105 patients were included in the study (53 in the CPP group and 52 in the control group). The following were used as the CPP diagnostic criteria; breast development, basal LH measurement higher than 0.3 IU/L, peak LH level ≥ 5 IU/L, peak LH/FSH ratio ≥ 0.66 (after 0.1 mg GnRH stimulation test) and a difference of at least 1 year between bone and chronological age.

Results: A statistically significant difference was detected between the groups in serum Omentin-1 and Chemerin levels, and no significant differences were detected between the groups in Visfatin values. The cut-off values for the diagnosis of CPP were calculated as ≤ 48.9 with 81% sensitivity and 54% specificity for Omentin-1, and as ≥ 417 with 85% sensitivity and 60% specificity for Chemerin.

Conclusion: In our study, we found that Omentin-1 level decreased and Chemerin level increased in lean girls with CPP. More studies are needed to elucidate how adipokines play roles in explaining the onset of CPP, and whether they may be used as a reliable marker for the diagnosis of CPP.

Premature ovarian insufficiency (POI, defined as age at menopause < 40 years) affects 1%–3% of postmenopausal women. It is positively associated with an increased risk of diabetes mellitus, arterial hypertension, cardiovascular disease, osteoporosis, fractures, cognitive impairment, and depression. Early menopause (EM, defined as age at menopause < 45 years) is also associated with these adverse health consequences, in most cases to the same degree as in POI. Therefore, a unifying term for EM and POI, such as ‘premature menopause’, may be proposed, using the age threshold of < 45 years. This could provide broader coverage of these women, substantiating the need for prompt administration of menopausal hormone therapy (in this case, ‘hormone replacement therapy’). However, the benefits of this approach, which precludes a higher oestrogen dose up to the normal age of menopause, need to be proven in well-designed randomized controlled trials.