Endocrine最新文献

Purpose: To investigate the relationship between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) and Immune checkpoint inhibitor (ICI)-induced thyroid dysfunction.

Methods: This was a single-center retrospective observational study of patients with solid tumors receiving ICI therapy. Clinical characteristics of patients were assessed at baseline and during ICI therapy. Logistic regression was implemented to assess the association of PLR and NLR with thyroid dysfunction. Kaplan-Meier method was used to analyze the difference in time between the onset of hypothyroidism and thyrotoxicosis.

Results: A total of 355 patients with solid tumors were included in our study. Sixty-nine (19.44%) patients developed ICI-induced thyroid dysfunction after receiving ICI therapy, with a median (IQR) time to onset of 91(34-203.5) days. Patients with high PLR (H-PLR) had an increased risk of ICI-induced thyroid dysfunction (OR = 1.87, 95% CI 1.07-3.28, P = 0.028) compared to those with low PLR (L-PLR). Specifically, H-PLR was associated with ICI-induced thyrotoxicosis but not hypothyroidism (OR = 2.40, 95% CI 1.09-5.29, P = 0.030). Meanwhile, NLR was not correlated with ICI-induced thyroid dysfunction as a continuous (P = 0.699) or categorical variable (P = 0.914). The sensitivity analysis showed that H-PLR remains positively correlated with ICI-induced thyroid dysfunction.

Conclusion: PLR rather than NLR was associated with the occurrence of ICI-induced thyroid dysfunction. Furthermore, PLR may serve as a predictive biomarker for ICI-induced thyroid dysfunction.

Background: There has been growing interest to study impact of night shift work on male reproductive health, which is regulated by the hypothalamic-pituitary-gonadal axis and influenced by circadian rhythms. This systematic review and meta-analysis aim to explore the association between night shift work and male reproductive health outcomes.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO: CRD42022379770). Studies comparing male reproductive parameters [e.g., semen profile, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH)] between night shift workers and non-shift workers were systematically searched in PubMed, Scopus and EMBASE databases. Heterogeneity (I² and Cochran-Q test), risk of bias (Newcastle-Ottawa Scale and funnel plots), sensitivity analyses were performed when applicable.

Results: Eight studies were included in this review from 6397 citations screened. The pooled mean difference in sperm count was -18.38 × 10⁶ sperm (-59.82 to 23.07; n = 3, I² = 85.12%) and serum testosterone was 15 ng/dL (-19.3 to 49.39; n = 5, I² = 63%), indicating that shift workers had lower sperm counts but marginally higher serum testosterone levels compared to controls. The majority of included studies exhibited a high risk of bias in participant selection, group comparability and exposure assessment.

Conclusion: The analysis highlights the potential impact of night shift work on sperm parameters and hormone levels. Future research with standardized methods and larger samples is needed to better understand the circadian disruption's effects, informing healthcare practices and policies for male reproductive health.

Purpose: Shear wave elastography (SWE) is a valuable tool in discerning the malignancy risk of thyroid nodules. This study investigates whether 2D-SWE can reliably differentiate malignant thyroid nodules in patients with chronic autoimmune thyroiditis (CAT), despite the challenges posed by fibrosis, which can increase tissue stiffness and complicate diagnosis.

Methods: This retrospective observational study evaluated 130 thyroid nodules (91 benign, 39 malignant) in patients with underlying CAT using conventional ultrasound (B-mode) and 2D-SWE with SuperSonic Mach30 equipment (Supersonic Imagine, Aix-en-Provence, France). Pathology reports served as the reference standard.

Results: Out of the 130 nodules, 30% were malignant, and 70% were benign. 2D-SWE proved to be an excellent distinguisher between benign and malignant nodules. Malignant nodules had significantly higher elasticity indices compared to benign nodules (mean elasticity index: 47.2 kPa vs. 18.1 kPa, p < 0.0001; maximum elasticity index: 75 kPa vs. 26.2 kPa, p < 0.0001). The mean elasticity index was the most reliable elastographic parameter (AUC 0.907, sensitivity 87.2% [95% CI: 77.3-94.0%], specificity 84.6% [95% CI: 75.4-91.5%], and NPV 93.9% for a cut-off value of 30.5 kPa).

Conclusion: Our results confirm that 2D-SWE can accurately diagnose malignant thyroid nodules in cases with CAT (p < 0.0001), supporting its use as a complementary tool to conventional ultrasound.

Purpose: Adrenal vascular tumors are mainly represented by adrenal cavernous hemangiomas (ACHs) and adrenal cystic lymphangiomas (ACLs). Their radiological features often overlap with malignant tumors, therefore ruling out malignancy becomes mandatory. We analyzed clinical, radiological, and histopathological data to identify specific characteristics of these tumors.

Methods: We reviewed 21 patients with ACHs (n = 12), ACLs (n = 8), or adrenal cysts (n = 1) confirmed by histopathology. We selected 82 papers from PubMed to provide a systematic review of the literature.

Results: In our cohort, median age at diagnosis was 58 years, with sex evenly distributed. All tumors were unilateral (median size = 44 mm), with 6 cases of increasing tumor size. All tumors exhibited non-contrast CT density > 10 Hounsfield Unit (HU). Calcifications were found in 5 cases. Hormonal studies revealed 11 non-functioning tumors and 2 cortisol-secreting tumors. Elevated urinary metanephrines were found in 2 cases. Immunostaining showed CD31/CD34/factor VIII expression in ACHs (n = 5, 24%) and podoplanin expression in ACLs (n = 6, 29%). The literature review revealed 71 reported cases of ACHs and 104 reported cases of ACLs. Median age at diagnosis was 46 years, with slightly female prevalence (63%). Median tumor size was 48 mm. 84 cases were symptomatic, with life-threatening hemorrhage reported in only 3 patients. Calcifications were found in 23% of cases. Surgical approaches varied, with open and laparoscopic adrenalectomy performed in 55 and 42 patients respectively.

Conclusions: ACHs and ACLs represent a diagnostic dilemma in clinical practice due to their rarity and their misleading imaging features.

Purpose: To evaluate the diagnostic value of different subtypes of non-punctate echogenic foci in thyroid malignancy.

Methods: Retrospective research of 342 thyroid nodules with calcification was performed. The echogenic foci were divided into punctate echogenic foci (type I) and non-punctate echogenic foci (type II), and type II were further divided into four subtypes: macrocalcification (type IIa), continuous peripheral calcification (type IIb), discontinuous peripheral calcification (type IIc) and isolated calcification (type IId). Postoperative histopathological results were used as the gold standard to evaluate the correlation between non-punctate echogenic foci subtypes and thyroid malignancy.

Results: The malignant risk of nodules with echogenic foci was type I (82.1%) > type IIa (66.2%) > type IIc (52.9%) > type IId (16.7%) > type IIb (13.9%), P < 0.001. Type I and type IIa echogenic foci were independent risk factors for thyroid cancer (OR = 16.593, 7.785). Solid, hypoechogenicity/marked hypoechogenicity and a single lesion in a unilateral thyroid lobe were independently associated with malignant thyroid nodules with macrocalcification(OR = 6.825, 40.042, 5.201). Irregular margins and uneven calcification thickness were independent factors for malignant thyroid nodules with peripheral calcification (OR = 5.676, 2.750).

Conclusion: Type IIa echogenic foci could independently predict thyroid malignancy. The diagnostic value of non-punctate echogenic foci depended on the differentiated combination of ultrasound characteristics. Type IIa nodules with solid composition, irregular margins, and a single lesion in a unilateral thyroid lobe implied a higher risk of malignancy; peripheral calcified nodules with irregular margins and uneven calcification thickness suggested an increased risk of malignancy.

Introduction: Intraoperative parathyroid gland (PG) localization remains challenging during thyroid surgeries, contributing to postoperative hypocalcemia and hypoparathyroidism. This study assessed the efficacy of indocyanine green (ICG) fluorescence in identifying and preserving PGs during thyroid surgeries and its correlation with postoperative outcomes.

Materials and methods: This ambispective observational study included 57 patients undergoing thyroid surgeries using ICG and compared outcomes with 56 historical controls. ICG was administered intravenously in two 5 mg boluses. Parathyroid identification rates, fluorescence intensity, and postoperative calcium and parathormone levels were assessed. Fluorescence intensity was qualitatively scored on a 1-3 scale.

Results: ICG significantly improved PG identification (92.5% vs 69.3% with white light alone). Postoperative hypocalcemia occurred in 22.81% of ICG patients compared to 39.29% in controls (p = 0.045). Hypoparathyroidism rates were 10.53% and 32.14% respectively (p = 0.005). Higher fluorescence intensity (FI) correlated with lower risk of postoperative hypocalcemia (p = 0.026) and combined hypocalcemia and hypoparathyroidism (p = 0.046). Considering both FI 2 and 3 as positive yielded 100% sensitivity and 85.7% accuracy. When only FI 3 was considered positive, sensitivity was 78.4%, specificity was 50%, and accuracy was 69.4%.

Conclusion: ICG fluorescence is a safe and effective tool for enhancing PG identification and preservation in thyroid surgeries, significantly reducing postoperative hypocalcemia and hypoparathyroidism. It also helps in confirming the vascularity of the PGs post thyroidectomy. Fluorescence intensity of preserved PGs, rather than quantity, better predicts postoperative outcomes. These findings support the integration of ICG fluorescence imaging and the application of our methodology in thyroid surgeries to improve postoperative results.

Purpose: Congenital isolated adrenocorticotropic hormone deficiency (CIAD) is an autosomal recessive disorder. This study identifies novel TBX19 variants for CIAD patients, explores its possible effect mechanism at the structural, functional and protein levels, and guides clinicians better understand the condition.

Methods: The clinical characteristics of three CIAD children were summarized. Multiple sequence alignment was performed and five algorithms, PROVEA, PolyPhen2, Mutation Taster, FATHMM, and I Mutant2.0, were used for the pathogenicity prediction. In addition, the three-dimensional protein structure of wild-type TBX19 was generated by Alphafold 3 and its variants were shown using PyMOL. Furthermore, immunoblotting analysis was applied to examine changes in the protein levels and the luciferase reporter assay was performed to further investigate the effects of TBX19 and its variants on pro-opiomelanocortin (POMC) transcriptional activity.

Results: We describe three Chinese patients with CIAD caused by TBX19 variants. The TBX19 variant, c.856C>T (p.R286*) was classified as pathogenic according to ACMG, whereas the other four variants, c.377C>T (p.P126L), c.602A>T (p.E201V), c.401A>G (p.H134R) and c.299G>A (p.R100H) were predicted to be disease-causing. Variants lead to alter interactions, conformational changes in proteins or truncate protein. TBX19 and PITX1 cooperated, resulting in a strong synergistic activation effect on POMC transcriptional expression. A functional study showed that the variants in our study result in a significant suppression of POMC transcriptional activity compared to wild-type TBX19.

Conclusions: Our study identifies five TBX19 loss-of-function variants, two of which are novel and that provides new perspectives into the pathophysiological mechanism and expands the variant spectrum in IAD.

Objective: The existing evidence regarding the impact of tamoxifen on lipoprotein(a) and apolipoproteins remains inconsistent. Therefore, this updated meta-analysis of randomized controlled trials (RCTs) aims to enhance the quality of evidence concerning the effects of tamoxifen on these lipid parameters.

Methods: Eligible RCTs published up to October 2024 were meticulously selected through a comprehensive search. A meta-analysis was then performed using a random-effects model, and results were presented as the weighted mean difference (WMD) with a 95% confidence interval (CI).

Results: Findings from the random-effects model revealed an increase in ApoA-I (WMD: 15.22 mg/dL, 95% CI: 6.43-24.01, P = 0.001), alongside decreases in ApoB (WMD: -9.33 mg/dL, 95% CI: -15.46 to -3.19, P = 0.003) and lipoprotein(a) (WMD: -3.35 mg/dL, 95% CI: -5.78 to -0.91, P = 0.007) levels following tamoxifen treatment in women. Subgroup analyses indicated a more significant reduction in lipoprotein(a) levels in RCTs with a duration of ≤24 weeks (WMD: -3.65 mg/dL) and in studies using tamoxifen doses of ≥20 mg/day (WMD: -4.53 mg/dL).

Conclusion: This meta-analysis provides evidence that tamoxifen leads to a decrease in lipoprotein(a) levels, along with reductions in ApoB and increases in ApoA-I among women.

Diabetes mellitus (DM) and neuroendocrine tumors (NET) can exert unfavorable effects on each other prognosis. In this narrative review, we evaluated the effects of NET therapies on glycemic control and DM management and the effects of anti-diabetic therapies on NET outcome and management. For this purpose, we searched the PubMed, Science Direct, and Google Scholar databases for studies reporting the effects of NET therapy on DM as well as the effect of DM therapy on NET. The majority of NET treatments appear to impair glycaemic control, both inducing hypoglycemic or, more commonly, hyperglycemia and even new-onset DM. However, glucose metabolism imbalance can be effectively managed by modulating anti-diabetic therapy and adopting an appropriate nutritional approach. On the other hand, the effects of anti-diabetic treatment, like insulin, sulfonylureas, thiazolidinediones, ipeptidyl-peptidase-4 inhibitors, Glucagon-like peptide-1 receptor agonists, and Sodium-glucose cotransporter-2 inhibitors on NET are unclear. Recently, metformin has been investigated in patients with gastroenteropancreatic NET resulting in improved progression free survival suggesting a potential antineoplastic role. Finally, the management of DM in patients with NET is of great clinical relevance to correctly perform radiological procedures and even more functional imaging procedures, as well as to optimize the therapy and avoid treatment withdrawal or discontinuation. In conclusion, understanding the mechanisms underlying therapy-induced DM and implementing appropriate monitoring and management strategies of DM are essential for optimizing NET patient outcome and quality of life.

Background: The incidence of thyroid cancer has increased annually, but the risk factors for thyroid cancer are still unclear. In this umbrella review, we aimed to identify associations between nongenetic risk factors and thyroid cancer incidence, and assess the quality and validity of the evidence.

Methods: PubMed, Embase and the Cochrane Database of Systematic Reviews were searched to identify related meta-analyses or systematic reviews of epidemiological studies. We extracted the estimated summary effect and 95% confidence interval (CI) through fixed or random effects models of each meta-analysis. AMSTAR2 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used to evaluate the methodological quality of the included meta-analyses and the quality of evidence respectively. Further subgroup analyses by sex and sensitivity analyses were conducted.

Results: We identified 53 articles with 112 associations, of which 69 had significant relationships with thyroid cancer risk, including factors related to iodine, nitrates, fish, vitamin D, tea, alcohol, smoke, body mass index (BMI), pesticides, X-ray, I¹³¹, oral contraceptives, flavonoids, reproductive factors and some medical conditions. However, most studies (65%) were categorized as "critically low" on the basis of AMSTAR2, and most evidence (86%) was of weak quality since the classification by GRADE was very low. Moreover, subgroup and sensitivity analyses revealed more risk factors in women than in men.

Conclusion: We found that several modifiable factors have essential effects in the primary prevention of thyroid cancer, but few high-quality studies exist. In the future, more well-conducted, especially prospective, studies are needed to confirm the results.

Trial registration: The protocol for this review was registered in PROSPERO (CRD42022352841).