Endocrine最新文献

Background: This study investigated the associations between different inflammatory indices and mortality in CKM patients at various stages, with the goal of identifying the best inflammatory predictors of survival for each stage of CKM.

Patients and methods: Data from 18,700 representative CKM patients in NHANES 1999-2014 and 94,760 CKM patients from the UKB were analysed. The inflammatory index was calculated on the basis of the blood cell count and biochemical indicators. A multivariate Cox proportional hazards model was applied to analyse the associations between inflammatory indices and all-cause mortality stratified by CKM stage.

Results: The advanced lung cancer inflammation index (ALI) has the best predictive performance for early CKM stages (NHANES: stage 2: AUC(t) = 0.600; stage 3: AUC(t) = 0.636; stage 4: AUC(t) = 0.678; UKB: stage 1: AUC(t) = 0.613; stage 3: AUC(t) = 0.666), with higher ALI levels correlated with lower all-cause mortality risk. In contrast, the monocyte‒lymphocyte ratio (MLR), neutrophil‒lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) are correlated with an increased risk of all-cause mortality. The SIRI demonstrates superior predictive performance in the advanced stages of CKM.

Conclusion: This study demonstrated that the ALI was negatively associated with all-cause mortality and exhibited optimal performance and robustness in predicting the prognosis of patients with early-stage CKM, whereas the SIRI showed superior predictive performance in the advanced stages of CKM.

Purpose: Current guidelines for gender-affirming hormone therapy (GAHT) primarily focus on binary transgender (BT) individuals and provide limited recommendations for non-binary and genderqueer (NBGQ) individuals. Understanding hormone use among this heterogenous group will contribute to more personalized counseling and treatment strategies. We performed a systematic review of the scientific literature to assess the prevalence of GAHT in NBGQ individuals and potential clinical context-dependent differences.

Methods: A systematic literature search was performed aimed to assess the prevalence and type of GAHT use in NBGQ and BT individuals according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, using PubMed, Embase and Web of Science databases.

Results: Sixteen eligible articles were identified. All were retrospective cohort series published between 2018-2024, including a total of 1948 NBGQ individuals and 3991 BT individuals. Hormone use varied from 4-93% in NBGQ individuals and from 52-95% among BT individuals. Overall, significantly fewer NBGQ individuals were on GAHT compared to BT individuals, except those referred to gender-affirming care clinics. GAHT was more frequent in clinical cohorts compared with non-clinical cohorts, both among NBGQ (OR 6.4; CI 5.1-8.0) and BT (OR 3.1; CI 2.6-3.8) individuals. There was insufficient Information in the literature to be able to draw conclusions with regard to differences in types of GAHT.

Conclusion: The systematic review confirms that GAHT is less common in NBGQ compared with BT individuals. Hormone use is more frequent among NBGQ individuals seeking care in a clinical setting. These results highlight the heterogeneity in NBGQ as well as BT individuals with regard to treatment needs. Caregivers, in particular in clinical settings, should be aware that not all NBGQ individuals seek GAHT. Additional studies are needed to further explore tailored endocrine treatment needs in NBGQ individuals.

Objective: We aimed to research the effect of 6-week moderate- and low-intensity exercise combined with individualized nutrition interventions on the quality of life of obese, hypertensive adolescents.

Methods: One hundred and ten obese adolescents with hypertension were prospectively recruited for this study and were randomly divided into two groups: the control group (received routine intervention, n = 55) and the study group (received a 6-week moderate- and low-intensity exercise program combined with individualized nutritional intervention in addition to the control group's treatment, n = 55). Waist circumference, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before and 6 weeks after the intervention. The Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Children's Depression Inventory (CDI) were used to assess the adolescents' mental health status, and the Pediatric Quality of Life Inventory (PedsQL) was used to evaluate their quality of life.

Results: After the intervention, waist circumference, BMI, SBP, DBP, SCARED scores, and CDI scores decreased in both groups, while PedsQL subscale scores increased (all P < 0.05), with the study group showing lower waist circumference, BMI, SBP, DBP, SCARED scores, and CDI scores, and higher PedsQL scores than the control group (all P < 0.05).

Conclusion: The 6-week moderate- and low-intensity exercise combined with individualized nutritional intervention was found to effectively improve the quality of life of obese and hypertensive adolescents.

Purpose: Primary hyperparathyroidism (PHPT) is characterized by autonomous and excessive parathyroid hormone (PTH) secretion due to parathyroid gland lesions. Patients can be complicated with hyperuricemia (HUA), however, data about HUA in Chinese PHPT patients are lacking. This study aimed to explore the prevalence of HUA, factors influencing serum uric acid (SUA) level and the impacts of parathyroidectomy (PTX).

Methods: 328 inpatients diagnosed with PHPT were included in total. Clinical data were collected and compared between HUA and non-HUA group. Multivariate linear regression was used to explore the factors affecting preoperative SUA and its variation after PTX. The impacts of SUA on bone mineral density (BMD) under different models were also analyzed.

Results: The prevalence of HUA in PHPT patients was nearly 32%. Compared with non-HUA group, HUA group had significantly higher serum calcium (Ca) (2.92 [2.75, 3.26] vs. 2.78 [2.62, 3.03] mmol/L, P < 0.001), while PTH increased without significance. Gender, body mass index, serum Ca, triglycerides and renal function were independently associated with SUA. SUA decreased after PTX (340.00 [291.50, 421.00] vs. 315.00 [270.50, 375.00] μmol/L, P = 0.018), with change of SUA significantly associating with changes in serum Ca and phosphate. Presurgical SUA was positively related with femoral neck, total hip and lumbar spine BMDs after adjusting for confounders.

Conclusion: A relatively high proportion of HUA was found in our study. Besides the common risk factors, hypercalcemia may contribute to the increased SUA in PHPT patients, which could be significantly improved by curative PTX. SUA might have a protective effect on bone loss in PHPT patients.

Purpose: Thyrotoxicosis results from either thyroid hyperfunction, as seen in Graves' disease, or tissue destruction, as in subacute thyroiditis (SAT). Differential diagnosis is essential but can be challenging, with thyroid scintigraphy traditionally used to distinguish between these types. This study investigates the potential of Contrast-Enhanced Ultrasound (CEUS) to provide a non-invasive alternative for differentiating hyperfunction and destructive thyroid disease.

Methods: In a prospective study, 42 patients with untreated thyrotoxicosis were evaluated using CEUS to analyze both qualitative and quantitative perfusion parameters.

Results: Group 1 included 20 patients with Graves' disease, while Group 2 comprised 22 patients with destructive thyrotoxicosis (SAT, Hashitoxicosis, postpartum thyroiditis, and iatrogenic cases). Significant differences were observed in CEUS parameters between the two groups. Hyperfunction cases showed higher Peak Intensity (PKI), Area Under Curve (AUC), Wash-in AUC (WiAUC), Wash-out AUC (WoAUC), and Mean Time-Intensity Curve (mTIC), while Rise Time (RT) and Time to Peak (TTP) were prolonged in the destruction group. Strong correlations with hyperfunction were observed for PKI, AUC, WoAUC, and mTIC. Optimal cut-off values of AUC > 1991, WoAUC > 1876, and mTIC > 10 achieved 100% sensitivity and specificity for identifying hyperfunction.

Conclusion: This preliminary study suggests that CEUS, with its quantitative and qualitative assessments, could be a valuable tool in the non-invasive differential diagnosis of thyrotoxicosis, potentially reducing the need for scintigraphy and enabling rapid and accurate treatment decisions.

Purpose: Anaplastic thyroid carcinoma (ATC) is a rare, aggressive malignancy with poor prognosis. Lenvatinib has demonstrated moderate efficacy and is approved for unresectable ATC treatment in Japan. However, some patients are unable to tolerate the standard 24 mg daily dose and require dose reductions or interruptions due to its high incidence of adverse effects. This study aimed to evaluate the therapeutic effects of lenvatinib in patients with ATC, particularly assessing outcomes with reduced dosages across multiple institutions.

Methods: Sixteen patients diagnosed with ATC and treated with lenvatinib were evaluated retrospectively. Overall survival (OS) and progression-free survival (PFS) were calculated. In addition, patients were divided into two groups based on 24 mg daily dose or reduced initial dose, and their therapeutic outcomes were compared.

Results: The objective response rate was 31%, and the median OS and PFS were 2.2 and 1.7 months, respectively. Among the 16 patients, 11 (69%) initiated treatment with 24 mg daily, while the remaining 5 (31%) received a reduced dose. The median OS and PFS were 2.0 months and 1.4 months, respectively, among patients in the 24 mg daily group, compared to 6.2 months and 2.4 months, respectively, among patients in the reduced dosage group.

Conclusion: Our study demonstrated that lenvatinib has moderate efficacy for ATC. In addition, initiating treatment at a reduced dose could provide therapeutic benefit. Lenvatinib may serve as a treatment option for unresectable ATC when targeted therapies, including BRAF, RET, and NTRK inhibitors, are unavailable. Furthermore, although the standard 24 mg daily dose is recommended, a lower initial dosage may be effective for patients unable to tolerate the full dose.

Purpose: This study aimed to evaluate the prognostic significance of tumor deposits (TD) in patients with differentiated thyroid cancer (DTC) undergoing postoperative radioiodine (RAI) therapy. Additionally, it explored the potential role of TD in refining the TNM staging system.

Methods: A retrospective analysis was performed on 11,278 thyroid cancer patients who underwent surgery. After applying stringent inclusion and exclusion criteria, 2162 patients were included in the final analysis. The association between TD and various clinicopathological characteristics was assessed. Propensity Score Matching (PSM) was employed to minimize selection bias, comparing outcomes between TD-positive [TD(+)] and TD-negative [TD(-)] groups. Kaplan-Meier survival analysis was utilized to estimate cumulative incidence rate of excellent response (ER) to RAI therapy. Prognostic comparisons were conducted by stratifying patients based on TD and lymph node (LN) status. Furthermore, a novel staging system incorporating TD status into the N stage of the TNM system was developed, and its prognostic accuracy was evaluated.

Results: Out of the 11,278 patients, 235 (2.08%) were identified as TD(+). In the 2162 patients analyzed, TD was significantly associated with T stage, N stage, extrathyroidal invasion, cumulative RAI dose, preablative stimulated thyroglobulin (Ps-Tg) levels, lymph node metastasis (LNM) count, primary tumor multiplicity, and maximum tumor diameter. Using a (1:2) PSM strategy, 95 TD(+) patients were matched with 185 TD(-) counterparts. Kaplan-Meier analysis revealed a significant difference in treatment outcomes between TD(+) and TD(-) groups (40.0% vs. 62.7%, P = 0.001). When comparing LN(+)TD(-) and LN(-)TD(+), no significant difference in outcomes was observed (59.8% vs. 44.4%, P = 0.235). However, outcomes differed significantly between LN(+)TD(+) and LN(+)TD(-) groups (39.5% vs. 59.8%, P = 0.004). No significant difference was noted between LN(+)TD(+) and LN(-)TD(+) groups (39.5% vs. 44.4%, P = 0.974). In N0 and N1a stages, TD(+) patients had significantly poorer prognoses compared to TD(-) patients (44.4% vs. 93.8%, P = 0.029 and 42.4% vs. 77.6%, P < 0.001, respectively). However, in the N1b stage, there was no significant difference between TD(+) and TD(-) groups (37.3% vs. 48.0%, P = 0.229). Interestingly, TD(+) patients in N0 and N1a stages exhibited outcomes comparable to N1b stage patients (44.4% vs. 44.5%, P = 0.603 and 42.4% vs. 44.5%, P = 0.108, respectively).

Conclusion: The presence of TD significantly affected the prognosis of DTC patients undergoing postoperative RAI therapy and should be considered an essential factor in assessing patient prognosis. Incorporating TD status into the TNM staging system is recommended, with TD(+) patients proposed to be classified under the N1b stage.

Introduction: Lactic acidosis frequently accompanies diabetic ketoacidosis. The cause of lactic acidosis, its effects on treatment success, and the related factors remain unclear. This study identified the key factors contributing to lactic acidosis in diabetic ketoacidosis and their implications for treatment success.

Materials and methods: In total, 102 patients with diabetic ketoacidosis were included in this study. The 42 patients with lactic acidosis and 60 patients with normal lactate levels were compared in terms of laboratory and clinical follow-up. Patients treated with metformin and SGLT-2 inhibitors were compared to those who did not use them in terms of ketoacidosis and lactic acidosis.

Conclusion: A relationship has been found between lactic acidosis observed in diabetic ketoacidosis and glucose, presence of infection, kidney function, potassium level, and duration of diabetes. Inflammation, renal dysfunction, and degree of acidosis affect the duration of intensive care and hospital stay. Lactic acidosis had no effect on the duration of the intensive care or hospital stay.