Endocrine最新文献

Objetive: To analyze the Time in Tight Range (TITR) (70-140 mg/dL) and the relationship between TITR-Time in Range (TIR) and assess their possible differences according to Coefficient of Variation (CV) in a cohort of patients with type 1 Diabetes Mellitus (DM) and Multiple Daily Injections in real life.

Patients and methods: 355 adult users of Continuous Glucose Monitoring (CGM) with at least one HbA1c (October 1, 2023-October 1, 2024) and glucose data in the 90 days prior were included.

Results: Age 46.9 years (SD 13.6); 57.2% male; time of evolution 21.6 years (SD 12.6). Mean TITR was 38.4% (SD 14.6) and 20.3% had a TITR ≥ 50%. The correlation TITR-TIR was strong (β = 0.83; CI 95% 0.8-0.87; R² Adjusted 0.89; p < 0.001) and varied according to CV [CV ≤ 36% (β = 0.88; CI 95% 0.83-0.93; R² Adjusted 0.89; p < 0.001); CV > 36% (β = 0.84; CI 95% 0.81-0.87; R² Adjusted 0.93; p < 0.001)]. The cutoff value for TIR to discriminate TITR ≥ 50% varied according to CV [(CV ≤ 36% 75.9% (sensitivity 98%, specificity 94%, AUC 0.99, p < 0.001); CV > 36% 70.5% (sensitivity 100%, specificity 98%, AUC 0.99, p < 0.001)]. The variables that were independently associated with TITR in CV ≤ 36% group were TIR (β = 0.74; CI 95% 0.57-0.9; p < 0.001) and mean glucose (β = -0.11; CI 95% -0.21 to -0.01; p = 0.045). However, in CV > 36% group were time of evolution (β = 0.04; CI 95% 0.01-0.07; p = 0.008), HbA1c (β = -0.63; CI 95% -1.22 to -0.4; p = 0.036; CV (β = 0.33; CI 95% 0.24-0.41; p < 0.001) and TIR (β = 0.84; CI 95% 0.74-0.93; p < 0.001).

Conclusions: The correlation between TITR-TIR was strong and higher in patients with CV > 36%. Cutoff value for TIR to discriminate TITR ≥ 50% and factors that were associated with TITR also differ depending on CV. It is essential to take glycemic variability into account when interpreting metabolic control data.

Aims: To compare the effect on maternal and neonatal outcomes of 75-g oral glucose tolerance test (75-g OGTT) versus 50-g glucose challenge test (GCT) plus 75-g OGTT for diagnosis of gestational diabetes mellitus (GDM).

Materials and methods: A non-randomized trial was conducted in a tertiary hospital between January and December 2020. Participants were assigned into the one-step (i.e., 75-g OGTT) and two-step screening (50-g GCT plus 75-g OGTT) groups. Primary outcomes were GDM, hypertensive disorder in pregnancy (HDP), macrosomia, and Cesarean section.

Results: 2265 eligible participants were enrolled in the trial, including 1130 in the one-step group and 1135 in the two-step group. GDM was diagnosed in 197 (17.4%) participants in the one-step group and 123 (10.8%) in the two-step group (OR, 1.94; 95% CI, 1.49, 2.54). There was only borderline statistical significance in the difference of HDP between two groups (OR, 0.64; 95% CI, 0.40, 1.01), while all other outcomes showed no statistically significant differences. In pregnant women with high risk factors for GDM (maternal age ≥ 35 years, pre-pregnancy BMI ≥ 24 kg/m², multipara, history of GDM, or family history of diabetes), the incidence of GDM was higher (OR, 1.74; 95% CI, 1.19, 2.56) for the one-step versus two step-step screening, while the incidences of HDP (OR, 0.51; 95% CI, 0.29, 0.90) and macrosomia (OR, 0.62; 95% CI, 0.39, 0.97) were lower.

Conclusions: The one-step screening at least performs as well as the two-step screening, potentially more suitable for Chinese pregnant women with high risk factors for GDM. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2100054505) on Dec 18^th, 2021.

Purpose: To evaluate the efficacy and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in adolescents with idiopathic short stature during mid-to-late puberty, using knee MRI to predict therapeutic response.

Methods: This one-year prospective cohort study included 50 idiopathic short stature adolescents and 100 healthy controls. Participants underwent knee MRI to classify growth plates into "continuous" and "discontinuous" subgroups. Growth response to growth hormone was measured through height and height standard deviation score changes, while cost-effectiveness was assessed using cumulative growth hormone dose and growth outcomes. Kaplan-Meier analysis was performed to evaluate therapy response, and linear mixed models analyzed height growth differences.

Results: After one year, the treatment group showed significant height gains (6.08 ± 2.73 cm) compared to controls (3.91 ± 2.70 cm; P < 0.001). Subgroup analysis revealed that adolescents with continuous growth plates at proximal tibia exhibited greater height improvements (ΔHtSDS = 0.92 ± 0.37) than those with discontinuous plates (ΔHtSDS = 0.73 ± 0.49; P = 0.016); subgroups categorized by distal femur achieved ΔHtSDS 0.91 ± 0.44 and 0.56 ± 0.29, respectively (P = 0.004). Cost-effectiveness was higher in the continuous growth plate subgroup, requiring lower rhGH doses per centimeter of growth.

Conclusions: Knee MRI classification of growth plate continuity is a reliable predictor of rhGH therapy response and cost-effectiveness in mid-to-late pubertal adolescents with idiopathic short stature. Continuous growth plates correlate with better treatment outcomes and more favorable cost-effectiveness, emphasizing the importance of early intervention for optimal results.

Objectives: The Captopril Challenge Test (CCT) is favored in the diagnosis of primary aldosteronism (PA) for its simplicity and high patient compliance, yet optimal diagnostic criteria for CCT remain controversial. This study compared the accuracy of different CCT criteria for the diagnosis of PA.

Methods: This study included retrospective and prospective cohorts. High-risk PA patients were enrolled to complete aldosterone-to-renin ratio (ARR) screening, CCT, and the saline infusion test (SIT). SIT was used as the reference standard, and receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic accuracy.

Results: The retrospective cohort included 871 patients with PA and 464 with EH. The AUC for PAC post-CCT in diagnosing PA was 0.90, significantly higher than that of ARR post-CCT (0.73) or PAC suppression percentage (0.72). The prospective cohort included 134 patients with PA and 162 with EH, showing an AUC for PAC post-CCT of 0.89, significantly higher than that of ARR post-CCT (0.71) or PAC suppression percentage (0.58). Using a PAC post-CCT cutoff of 11 ng/dL for diagnosing PA achieved a sensitivity of 0.89 and specificity of 0.66 in the retrospective cohort, and a sensitivity of 0.77 and specificity of 0.84 in the prospective cohort, respectively.

Conclusion: PAC post-CCT served as a superior indicator for the diagnosis of PA, with 11 ng/dL recommended as the optimal diagnostic cutoff.

Purpose: The consistency of pituitary adenomas (PAs) significantly influences the success of complete tumor resection, which is crucial for prognosis in patients. The aim of this study is to use preoperative diffusion-weighted imaging (DWI) to evaluate tumor consistency, thereby assisting surgeons in achieving optimal resection outcomes during neuroendoscopic procedures.

Methods: We collected clinical data (including age, sex, symptoms, and consistency), pathological data (including collagen content), and imaging data (including tumor size and ADC ratio) from 264 patients with pituitary macroadenomas. Patients were categorized based on intraoperative consistency assessments and postoperative resection rates to analyze the efficacy of DWI in predicting consistency and identifying determinants of the completeness of resection. Correlation analysis and multiple linear regression were used to explore the relationships among the ADC ratio, tumor consistency, and collagen content. Logistic regression was applied to analyze the factors influencing tumor resection.

Results: This study included 264 patients. There were 202 patients with a soft consistency and 62 patients with a hard consistency. A total of 212 patients achieved complete resection. The median ADC ratio for the soft consistency group was 1.27 [1.04, 1.59], and that for the hard consistency group was 0.89 [0.83, 0.94] (P < 0.05). The median collagen content in the soft group was 4.55 [2.13, 6.69], and that in the hard group was 13.91 [10.30, 19.20] (P < 0.05). The ADC ratio was significantly related to the collagen content (ρ = -0.965; 95% CI: -0.973 ~ -0.955; P < 0.05). The ADC ratio was a significant predictor for achieving gross-total tumor resection (OR: 5.714; 95% CI: 1.032-31.628; P < 0.05).

Conclusion: For most patients with pituitary macroadenomas, neuroendoscopic transsphenoidal surgery is the first-line treatment. Preoperative apparent diffusion coefficient (ADC) ratios obtained from diffusion-weighted imaging (DWI) can help to evaluate tumor consistency and collagen content, thus guiding neurosurgeons in predicting resection ability under neuroendoscopy and thereby improving preoperative assessments for these patients.

Objective: To clarify the possible mechanism of leptin and α-MSH on the onset of puberty in female offspring rats after prenatal androgen exposure.

Methods: Sixteen 8-week-old specific pathogen free (SPF) healthy Sprague Dawley (SD) pregnant rats were randomly divided into the testosterone-treated group (TG, female offspring termed PNA group) or the olive oil control group (OOG, female offspring termed VEH group). The female offspring rats of two groups were raised to 21 days (PND21) and weaned. Six female offspring rats at PND21 (VEH:PNA = 3:3) were randomly selected for transcriptome sequencing. Twenty-seven offspring female rats were randomly divided into three groups (VEHI:VEHII:PNA = 9:9:9). VEHI group was observed until the onset of puberty, VEHII and PNA groups were observed until the 8th week.

Results: Compared with VEH group, onset of puberty was not observed in PNA group, and hypothalamic Pomc gene expression at PND21 was lower. Compared with the VEHI group, the body weight, abdominal fat, serum testosterone (T), dehydroepiandrosterone (DHEA) and leptin (LEP) levels were upregulated in the PNA group, while serum gonadotropin-releasing hormone (GnRH), mRNA of hypothalamic estrogen receptor α (ERα), α-melanocyte stimulating hormone (α-MSH), melanocortin receptor-4 (MC4R), GnRH and adipose AR, and the protein of androgen receptor (AR) and leptin receptor (LEPR) in the hypothalamic arcuate nucleus (ARC) were decreased. In the PNA group, there were positive correlations between serum DHEA and mRNA of hypothalamic ERα, MC4R and AR, negative correlations between mRNA of adipose AR and serum T and free testosterone (FT).

Conclusion: Prenatal androgen exposure delayed the onset of puberty in female offspring, the possible mechanism of which is that prenatal androgen exposure may increase the levels of androgen and LEP, decreases their sensitivity and the expression of AR, LEPR, and MC4R, reducing GnRH secretion.

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: Adolescents with type 1 diabetes mellitus (T1D) may differ from their healthy peers in respect to sexually transmitted diseases (STDs) knowledge and contraceptive use. We aimed to explore sexual knowledge and contraceptive use and associated factors in T1D adolescents compared to healthy peers.

Methods: Fifty- eight T1D adolescents (mean ± SD age 16.3 ± 2.0 years, disease duration 6.7 ± 3.5 years) were compared to 116 healthy controls (matching 1:2 for school, age and gender). Anonymous questionnaires were used to evaluate sexual knowledge and contraceptive methods.

Results: The commonest contraceptive method at the last sexual contact was the condom. The use of birth pill was reported by 11.8% patients and by 8.3% controls, withdrawal was reported by 33.3% of T1D and 24% of controls, no protection by 23.5% patients and by 10.2% controls, while double protection (≥2 methods) was reported by 35% patients and 27.7% controls. No study participant used long-acting reversible contraception (LARC). The high protection (dual protection) group was characterized by younger age and older age at sexual debut (16.4 vs 15.8 years, p = 0.010). The low protection group (no contraception/withdrawal) was characterized by older patients' age (p = 0.023) and younger paternal age (p = 0.046). Among controls, the use of dual protection was more common in the group whose parents were married versus those with divorced parents (34.3 vs. 10%, p = 0.042).

Conclusions: Among the study population, the condom was the commonest contraceptive method for both groups, while 23.5% of patients and 10.2% controls used no protection. The degree of contraception use among patients was associated with patients' age and parental age and with the family structure in controls. The above underline the necessity for health care professionals to provide sexual education and contraception counseling to young adolescents with T1D and their healthy peers.