Endocrine Research最新文献

Objective: Orexin-A (OXA) is a hypothalamic neuropeptide implicated in glucose regulation and insulin sensitivity. Given the central role of insulin resistance in polycystic ovary syndrome (PCOS), this study evaluated serum OXA levels in women with PCOS.

Methods: This cross-sectional case-control study included 88 women with PCOS and 88 age- and body mass index-matched controls. Serum OXA levels were quantified using a commercial ELISA kit.

Results: Serum OXA levels were significantly lower in women with PCOS than in controls (321.53 ng/L vs. 385.06 ng/L, p = 0.012). A significant negative correlation was observed between the modified Ferriman-Gallwey score and serum OXA level. In the ROC analysis, a serum OXA level of 369.55 ng/L yielded a sensitivity of 55.7% and a specificity of 55.7% (AUC: 0.610) for detecting PCOS.

Conclusions: Serum OXA concentrations were reduced in women with PCOS. Whether this reduction contributes to PCOS pathogenesis or reflects a secondary alteration remains uncertain.

Introduction: Continuous glucose monitoring (CGM) demonstrates significant benefits in glycemic control for both type 1 and type 2 diabetes, including reductions in HbA1c, increased time-in-range, and decreased hypoglycemia.

Methods: In this article, we review the recent American Diabetes Association guidelines recommending real-time CGM for adults with type 2 diabetes, including those not using insulin.

Results: While acknowledging the documented advantages, CGM remains underutilized, with many barriers, particularly in primary care settings and among racially diverse or lower socioeconomic populations.

Discussion: This review outlines positive strategies to address barriers to CGM-adoption, optimize glycemic control and thereby potentially reduce cardiovascular-kidney-metabolic complications.

Objective: Herein, we aimed to reveal the factors affecting the early treatment responses and the normalization process of thyroid hormone levels in childhood Graves' disease..

Methods: This retrospective study included 46 pediatric patients who were diagnosed with Graves' disease and started treatment during a period of 10 years, and whose at least one of their free T3 (fT3) or free T4 (fT4) levels decreased to the reference range during follow-up.

Results: The normalization time of fT3 and fT4 were 5 (3-8) and 3.5 (2-7) weeks after the treatment initiation, respectively. Gender, age, pubertal status, presence of goiter, ophthalmopathy or tachycardia, basal thyroid hormone levels, initial dose of methimazole, and addition of beta-blockers did not show an effect on the normalization time of either fT3 or fT4 (p > 0.05). In those under the age of 12 (n = 15) with a high TRAb titer (>10 IU/L), the time for normalization of fT3 was longer (p = 0.024), and in those with ophthalmopathy, this process was longer for fT4 (p = 0.017).

Conclusions: By these results, we showed that early treatment response and the normalization period of thyroid hormones were not related to the initial treatment dose.

Background: Testosterone plays multifaceted roles in cardiovascular health. However, the prospective sex-specific impact of serum testosterone on atherosclerotic cardiovascular disease (ASCVD) risk remains unclear.

Methods: This prospective study included 2978 participants (1184 men and 1794 women) with a followed-up 10.66 years. The Cox proportional hazards model was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for ASCVD events according to testosterone tertiles. Additionally, structural equation modeling was used to investigate whether hypertension and metabolic factors mediate the association between serum testosterone levels and ASCVD risk.

Results: During follow-up, 142 and 203 ASCVD events occurred in men and women, respectively. Compared with participants in the lowest serum testosterone tertile, men in the highest tertile exhibited a reduced ASCVD risk (HR: 0.59, 95% CI: 0.38-0.90), while women in the highest tertile showed an increased risk of ASCVD (HR: 1.79, 95% CI:1.26-2.55). Structural equation modeling revealed that in men, the association between testosterone and ASCVD risk was indirectly mediated by metabolic factors (β = -0.119). Among women, the results indicated a total effect of testosterone on ASCVD risk (β = 0.051), comprising a significant direct positive effect (β = 0.056) and a negative indirect effect mediated by hypertension and metabolic factors (β = -0.005).

Conclusions: Elevated serum testosterone levels are associated with a reduced risk of ASCVD in men but an increased risk in women.

Introduction: A leading endocrine illness affecting women of reproductive age is autoimmune thyroid disease (AITD), which can have a significant impact on the course of a pregnancy. Thyroid dysfunction is more likely to occur during pregnancy due to hormonal and immunological changes. Women are more susceptible to thyroid dysfunction during pregnancy because of physiological changes that increase the need for thyroid hormones.

Methods: This review summarizes the most recent research on alterations in thyroid function during pregnancy, investigates the mechanisms underlying autoimmune thyroid imbalance and its effects on reproduction, and emphasizes the importance of early detection and specialized clinical management.

Results: Infertility, miscarriage, preterm birth, and decreased fetal development are among the negative reproductive consequences that can result from AITD, which affects up to 2-5% of pregnant women and is frequently asymptomatic and undetected.

Discussion: To maximize outcomes for both the mother and the fetus, early detection and specialized clinical management are essential, particularly because AITD is often asymptomatic and can go undetected during pregnancy.

Background: Sleep Apnea Syndrome (SAS) is a common problem in acromegaly. This study examines changes in apnea hypopnea index (AHI) and sleep quality following treatment for acromegaly.

Methods: Subjects with active acromegaly underwent polysomnography to identify SAS and Pittsburgh Sleep Quality Index (PSI) questionnaire for the assessment of subjective sleep quality at baseline, which were repeated after treatment.

Results: Twenty patients were recruited. Obstructive SAS was present in 85% and poor sleep quality was reported in 65% patients. AHI positively correlated with age, duration of disease, male gender, and PSQI score. After treatment, there was a significant decrease in tumor volume (72%) and insulin-like growth hormone (IGF-1) levels (44%), although IGF-1 normalization was seen in only 34% subjects. There was a significant reduction in mean AHI (35 ± 20 vs 23 ± 19; p = 0.008) and mean PSQI (7.8 ± 3.9 vs 5.6 ± 3.6; p = 0.002) after treatment.

Conclusion: Mean AHI and mean PSQI improved significantly after treatment, although normalization of IGF-1 was seen in only one-third of patients.

Methods: MEDLINE (PubMed), Embase, Web of Science, and Cochrane Library were searched for relevant articles published before August 1, 2023. Studies assessing the association between circulating metabolites and CVD, including coronary heart disease, strokes, heart failure, CV death, DKD, and DR in T2D were eligible for review. We performed meta-analyses for metabolites with ≥2 estimates and reported adjusted odds ratios (ORs) of outcome per SD increase of metabolite. I² tests were used to assess the study heterogeneity.

Results: We identified 74 total studies (n = 48 cross-sectional and n = 26 cohort; 33 exclusively for CVD, 21 exclusively for DKD, and 20 exclusively for DR, 19 for more than one outcome; a total of 49,866 T2D patients, mean age 60 years, 55% male) describing metabolism of Trimethylamine N-oxide (TMAO), amino acids, fatty acids, sugars, sphingolipids, phospholipids, organic compounds, bacteria, and enzymes. Eleven metabolites were included in meta-analyses for their association with CVD. These include TMAO (OR 1.1, 95% confidence interval (CI) 0.91-1.3) and derivatives (choline: 0.95, 0.76-1.18, carnitine: 1.08, 0.86-1.36, betaine: 1.00, 0.91-1.11), branched-chain amino acids (leucine: 1.12, 0.05-25.5, valine: 1.14, 0.09-14.2, isoleucine: 1.02, 0.76-1.35), other amino acids (glutamine: 1.02, 0.35-2.9, alanine: 0.99, 0.87-1.13), and metabolites for energy metabolism (lactate: 1.11, 0.81-1.52, glycerol: 1.05, 0.61-1.81). I² for all studies >30%.

Conclusions: In this review, TMAO and amino acids are the most studied circulating metabolites for diabetic complications. TMAO was marginally associated with the CVD risk among people with T2D. However, the studies were subject to high heterogeneity and the findings are inconclusive. Our review indicates limited evidence linking circulating metabolites to the prediction of vascular complications in T2D. To strengthen the evidence in this field, large prospective studies are required.

Objective: Postoperative hypothyroidism, a complication of thyroid lobectomy, occurs frequently. Unique cases of post-lobectomy painless thyroiditis, a pathology not previously reported, were recently observed in our practice. In this study, we aimed to retrospectively investigate the frequency and characteristics of thyroid dysfunction after lobectomy, focusing on painless thyroiditis.

Methods: A total of 193 patients with thyroid tumors, including 66 with Hashimoto's thyroiditis and 127 without Hashimoto's thyroiditis, underwent thyroid lobectomy. These patients were followed up for 49.6 (12-118) months.

Results: Thyroid dysfunction occurred in 20.7% of patients, including 31.8% (21/66) and 14.9% (19/127) of those with and without Hashimoto's thyroiditis, respectively. The types of thyroid dysfunction included thyrotoxicosis (10.0%), subclinical hypothyroidism (47.5%), and overt hypothyroidism (42.5%). Nine of 21 patients with Hashimoto's thyroiditis who developed thyroid dysfunction 1-4 months after lobectomy were diagnosed with painless thyroiditis, based on the characteristic transient hypoechogenic pattern on ultrasonography during hormonal fluctuations. Four patients developed thyrotoxicosis, one of whom subsequently become hypothyroid. Thyroid function returned to normal in all four patients. Two patients tested negative for TSH receptor antibody during the thyrotoxic period. The remaining five patients developed hypothyroidism, which was transient in three patients.

Conclusion: Painless thyroiditis develops as post-lobectomy thyroid dysfunction in patients with Hashimoto's thyroiditis. We propose naming this condition "post-lobectomy thyroiditis," as it is believed to be triggered by surgical manipulation of the thyroid gland in individuals with underlying subclinical thyroid autoimmunity. Given its transient nature in most cases, distinguishing this condition from postoperative permanent hypothyroidism is essential.

Introduction: To evaluate the cardiorenal protective effects of finerenone in patients with diabetes and heart failure through a meta-analysis of randomized controlled trials (RCTs).

Methods: This meta-analysis included 12 RCTs (total n = 65,226) assessing finerenone versus placebo. Primary outcomes included cardiovascular composite endpoints (major adverse cardiovascular events [MACE]) and kidney composite outcomes (sustained eGFR decline, end-stage kidney disease, or renal mortality). Secondary outcomes encompassed total worsening heart failure events and cardiovascular mortality. Random-effects models were applied to pool hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was quantified using Cochran's Q and I² statistics. Sensitivity analyses and publication bias assessments (Egger's/Begg's tests, funnel plots) were performed.

Results: Finerenone significantly reduced major adverse cardiovascular events (9 RCTs, n = 21,542; hazard ratio [HR] 0.858, 95% CI: 0.786-0.937; p = 0.001) and kidney composite outcomes (n = 23,109; HR 0.827, 95% CI: 0.760-0.901; p < 0.001), despite substantial heterogeneity (I² = 78.2% and 64.4%, respectively). Sensitivity analyses confirmed robustness, with consistent effects after sequential trial exclusion. Finerenone also reduced worsening heart failure events (n = 12,874; HR 0.790, 95% CI: 0.700-0.891; p < 0.001; I² = 4.7%), though cardiovascular mortality reduction was nonsignificant (HR 0.914, 95% CI: 0.831-1.005; p = 0.063). No publication bias was detected for primary outcomes.

Conclusion: Finerenone demonstrates consistent cardiorenal protection in patients with diabetes and heart failure, significantly reducing cardiovascular and kidney complications.

Background: The gut microbiota (GM) comprises diverse microorganisms that inhabit the gastrointestinal tract (GIT) and play crucial roles in maintaining the host's health. The fascinating interrelations between the GM and various organs lead to establishing the "gut-organ" axis, including the gut-thyroid axis, an emerging research area that requires exploration. Changes in diversity and functionality of GM (dysbiosis) may impact the gut locally and significantly affect other organs, raising concerns about potential systemic effects.

Method: We performed a literature search on PubMed/Google-Scholar using the keywords GM and: autoimmune-diseases/inflammation/dietary-supplements/neuropeptides. The search included original studies/reviews/meta-analyses.

Discussion/conclusion: Dysbiosis is correlated with many diseases, where alterations in gut-associated neuropeptide levels have been detected. Gut-neuropeptides, secreted by entero-endocrine-cells, are potent neuro-immune modulators, regulate GM homeostasis through antimicrobial and inflammation-modulating properties, and serve as a communication intermediary between GM and host. This review offers a concise overview of the association between GM and neuropeptides, and the roles of microbial metabolites and GIT-neuropeptides during inflammation and stress.