Endocrine Connections最新文献

Purpose: The transition of differentiated thyroid carcinoma (DTC) care from hospital to primary care remains controversial. Current studies suggest that low-risk patients with an excellent response to therapy are safely followed by primary care professionals. Despite this, discharge practices among Portuguese thyroidologists remain heterogeneous and the success of this clinical transition is yet unknown. This study aims to evaluate primary care compliance to follow-up recommendations for DTC patients after tertiary care discharge.

Methods: A retrospective observational study was conducted including individuals with a history of DTC who were treated in a Portuguese tertiary care hospital and discharged to follow-up at primary care setting, during 2022. Data was collected from electronic records including thyroglobulin and antithyroglobulin antibodies levels.

Results: A total of 134 individuals were discharged. The majority (n=105; 78.4%) were female, with a mean age at discharge of 64±12 years. The most frequent diagnosis was papillary thyroid carcinoma (95.5%, n=128). Regarding treatment, 52.2% (n=70) only underwent thyroidectomy, 44.8% (n=60) thyroidectomy followed by Iodine-131 ablation and 3.0% (n=4) subtotal thyroidectomy. Most DTC cases (86.6%, n=116) were classified as low risk and showed an excellent response to treatment (82.1%, n=110) according to ATA 2015 guidelines. One year after discharge, biochemical response evaluated by thyroglobulin and antithyroglobulin levels were registered in 29.1% (n=39) of individuals. Thirteen patients (9.7%) had records of either antithyroglobulin antibodies or thyroglobulin alone.

Conclusion: Patients with low-risk DTC receive suboptimal monitoring after transition to primary care, emphasizing the need to enhance follow-up practices to ensure adequate long-term surveillance.

Background: Age at puberty determines timing of pubertal growth spurt. Whether the intensity of the peri-pubertal growth velocity is also affected by pubertal timing in boys remains to be elucidated.

Objective: To study changes in growth velocity in relation to pubertal timing, Insulin-like Growth Factor-I (IGF-I) and fasting insulin in healthy boys.

Design, setting and participant: Longitudinal study with biannual assessment of testicular volume (TV), growth velocity, IGF-I and fasting insulin levels. Peak height velocity (PHV) was calculated. 105 boys (947 examinations) were included. Pubertal onset was available in 62 boys - the rest remained prepubertal throughout the study period or were in puberty at baseline.

Results: Age at pubertal onset (TV > 3 ml) was negatively correlated with PHV (ρ = -0.48; p < 0.001). The early (age of onset < 33,3 percentile) tertile of maturing boys had significantly higher growth velocity (mean Δ 0.48 (0.14 - 0.82) cm/year; p < 0.006) than late maturing boys (> 66,7 percentile) over the 6 years peri-pubertal period. However, the late maturing boys remained significantly taller throughout the study (p < 0.05). IGF-I levels were similar between the 3 groups of boys. In all boys, the increase in growth velocity was associated with a larger increase in IGF-I (p < 0.001) during the first 2 years of puberty.

Conclusion: Early maturation was associated with increased growth velocity and PHV in healthy boys. However, it was not sufficient to compensate for the shorter total growth period. IGF-I was positively associated with growth velocity.

Background and aims: This study aimed to explore whether a younger age of diabetes onset is associated with an increased risk of CVD events.

Methods: This study included 621 patients with younger-onset T2DM (age, ≤50 years) and 573 with older-onset T2DM (age, >50 years) from the original Da Qing Diabetes Prevention Study. For comparison, 310 younger individuals without diabetes (age, ≤50 years) were included in the control group. We followed-up participants for 34 years to assess the incidence of CVD events. The association between the age of diabetes onset and the risk of CVD events was analysed.

Results: The younger-onset T2DM patients had higher incidence of components of CVD events per 1000 person-years than those of the older-onset T2DM and younger non-diabetes controls ( 19.20, 15.14, and 9.22 for stroke, 7.78, 4.67 and 2.15 for myocardial infarction, and 5.38, 2.76 and 1.11 for heart failure, respectively).The more than double high risk of composite CVD events was found in the younger onset T2DM compared with the older onset T2DM (HR=2.05, 95%CI 1.64-2.55) and non-diabetic controls (HR=3.45, 95%CI 2.39-4.98) even after adjusting for the strongest confounder diabetes duration.

Conclusions: Chinese adults with younger-onset T2DM have a higher risk of developing CVD events than those with older-onset T2DM over a 34-year follow-up period.

Objective: This study aimed to investigate the association between fasting glucagon levels and the risk of comorbid stroke in hospitalized patients with type 2 diabetes mellitus (T2DM).

Methods: This study included 1,745 T2DM patients hospitalized at Tianjin Medical University General Hospital from September 1, 2022, to September 30, 2025. Patients were divided into a T2DM group and a T2DM with stroke group based on the presence of stroke. Fasting glucagon levels and other clinical data were collected. Binary logistic regression models were used to analyze the relationship between fasting glucagon and stroke risk.

Results: Among female T2DM patients, fasting glucagon levels were significantly higher in the T2DM with stroke group compared to the T2DM group (13.38 vs. 11.56 pmol/L, P=0.011). Multivariable logistic regression analysis showed that after adjusting for multiple confounding factors, including age, diabetes duration, BMI, hypertension, eGFR, HbA1c, dyslipidemia, and medication use, higher fasting glucagon levels are independently associated with the presence of comorbid stroke in female T2DM patients (Model 3: Q4 vs. Q1: OR = 2.396, 95% CI: 1.075-5.339, P=0.037). Additionally, the prevalence of stroke increased with ascending quartiles of glucagon levels in female patients (P=0.023). However, no significant association was observed between fasting glucagon levels and stroke risk in male patients.

Conclusion: This study demonstrates that among hospitalized female patients with T2DM, higher fasting glucagon levels are independently associated with the presence of comorbid stroke. This association suggests a potential link between glucagon and cerebrovascular disease in this population, warranting further investigation to explore its role.

Objective: CT attenuation value is useful in the differential diagnosis of adrenal masses, and values < 10 Hounsfield units (HU) can exclude malignancy and pheochromocytoma. However, few reports have examined the reliability of CT attenuation measurements. We examined the reliability of CT attenuation measurements made by surgeons not specialized in image reading.

Design: A retrospective analysis of 313 patients (325 lesions) who underwent surgery at a single institution was performed.

Methods: One general surgeon and one endocrine surgeon independently measured CT attenuation values. The intraclass correlation coefficient and Cohen's kappa coefficient were used to analyze interobserver reliability. All cases were subjected for endocrine function tests, and histopathologically diagnosed. Additional analyses included segmented regression for size-related measurement variability and multivariable analyses comparing aldosterone-producing adenomas (APAs) and cortisol-producing adenomas (CPAs).

Results: The intraclass correlation coefficient between observers was 0.938 (95%CI, 0.923-0.949) and Cohen's kappa coefficient was 0.851 (95%CI, 0.781-0.922). Both observers measured all malignant adrenal tumors (such as adrenocortical carcinoma, metastatic adrenal carcinoma, and malignant lymphoma) and pheochromocytomas as ≥ 10 HU. CT attenuation values were significantly higher in CPAs than in APAs, independent of mass size (p < 0.001 for both observers).

Conclusions: CT attenuation value was shown to be reliable enough for simple measurements that could be performed by non-radiologists and was useful for excluding malignancy and pheochromocytoma.

Significance statement: This study reinforced evidence for the reliability of CT attenuation value. Even with a simple method that can be performed by non-radiologists, CT attenuation values were highly reliable and useful for excluding malignancy and pheochromocytoma. In addition, all lesions in this study were evaluated both endocrinologically and pathologically, giving high validity to the reference standard. These findings complement and further substantiate the latest clinical practice guidelines of the European Society of Endocrinology.

Background: Patients with adrenal insufficiency require glucocorticoid replacement therapy either as hydrocortisone in multiple daily doses or low-dose prednisolone once daily. Data on the long-term safety, cardiovascular risk, and quality of life (QoL) outcomes of prednisolone remain limited.

Methods: In this prospective longitudinal cohort study, patients with adrenal insufficiency underwent a pre-specified switch from multiple-daily dose hydrocortisone to once-daily low-dose prednisolone (2-4mg) as part of routine clinical care and followed for at least four months. Cardiovascular risk was assessed using anthropometric and biochemical markers (lipid profile, HbA1c, C-reactive protein, blood pressure, waist and hip circumference). QoL was evaluated using a modified SF-36 questionnaire. Baseline and follow-up measures were compared using paired t-tests or non-parametric equivalents.

Results: Of the 62 enrolled patients, 48 completed follow-up. Mean age was 54.5 ± 13 years; 56% were female; 83% had secondary adrenal insufficiency. After at least four months on prednisolone, weight decreased significantly (90.6 kg to 89.6 kg, p=0.007), accompanied by a reduction in systolic blood pressure (-5 mmHg, p=0.032). Lipid parameters, HbA1c, and CRP remained unchanged (p>0.05). Energy scores improved significantly (+9 points, p=0.003), and patients reported increased treatment convenience (p=0.002).

Conclusion: Low-dose once-daily prednisolone offers comparable cardiovascular risk to hydrocortisone while improving treatment convenience, systolic blood pressure, and SF-36 subjective energy scores. These findings support its use as a potentially preferable alternative in patients with adrenal insufficiency.

Primary hyperparathyroidism (PHPT), increasingly diagnosed in its asymptomatic form, is associated with clinically significant neuromuscular dysfunction. Growing evidence indicates that skeletal muscle is a direct target of parathyroid hormone (PTH), with chronic PTH excess impairing mitochondrial bioenergetics, promoting proteolysis, and altering muscle-bone-adipose endocrine crosstalk. Experimental studies confirm PTH receptor type 1 (PTHR1) expression in muscle fibers and satellite cells, while transcriptomic analyses of PHPT muscle reveal dysregulation of calcium signaling and oxidative metabolic pathways. Clinically, patients with PHPT, irrespective of hypercalcemia, demonstrate reduced grip strength, slower gait speed, impaired chair-stand performance, and diminished postural stability. Parathyroidectomy improves several of these deficits, with studies reporting increases in grip strength, knee extension force, ambulatory capacity, and, in some cohorts, improved muscle composition and metabolic gene expression. However, available data are heterogeneous and derived primarily from small cohorts with variable functional measures. Current evidence implicates PTH-mediated skeletal muscle dysfunction as a reversible component of PHPT, yet key mechanistic and clinical gaps remain. Standardized functional assessments and larger prospective studies are needed to clarify biological pathways, identify predictors of postoperative recovery, and inform the integration of muscle health into PHPT management. The focus of this review was to explore evidence linking PTH excess and skeletal muscle pathophysiology and review the relationship between PHPT and parathyroidectomy on physical function.

Background: Epidermal growth factor (EGF) plays a crucial role in cellular growth, differentiation, and pancreatic β-cell maintenance. Despite reports on EGF deficiency in diabetic animal models, its relevance in type 2 diabetes (T2D), particularly in relation to obesity, remains underexplored. The present study aimed to evaluate plasma EGF levels in individuals with and without T2D, assess its associations with glycaemic status and clinical parameters, and evaluate the influence of obesity on these relationships.

Methods: A total of 838 eligible participants were selected from the Kuwait Diabetes Epidemiology Program. Of those, 428 were included in a 1:1 case-control analysis (214 T2D and 214 non-diabetics). EGF was measured in plasma using ELISA. Associations between EGF with glycaemic and clinical variables were evaluated using Pearson's correlation, multiple linear regression, and logistic regression analyses.

Results: Plasma EGF levels were significantly lower in individuals with T2D compared to non-diabetics (P < 0.001). Among non-diabetics, obese participants had a significantly lower EGF level than their non-obese counterparts (P = 0.03), while no such difference was observed in T2D. EGF negatively correlated with fasting blood glucose in both non-diabetics (P = 0.004) and T2D individuals (P < 0.001). In T2D, EGF negatively correlated with haemoglobin A1C (HbA1C) (P = 0.001), triglyceride (TG) (P = 0.021), and waist-to-hip ratio (WHR) (P = 0.014). Logistic regression confirmed that lower EGF levels were independently associated with T2D but not with general obesity (OR = 0.996, P = 0.001).

Conclusion: Reduced EGF levels are associated with poor glycaemic control in T2D. These findings highlight EGF's potential as a biomarker for glycaemic dysregulation and support further investigation into its role in diabetes pathophysiology and complications.

RTN4IP1 encodes a mitochondrial oxidoreductase essential for Coenzyme Q biosynthesis; pathogenic variants have been reported mainly in optic neuropathy and encephalopathy. We describe a 30-year-old woman carrying three novel pathogenic RTN4IP1 variants by exome sequencing (c.1163G>A p.Arg388Gln, c.949A>C p.Met317Leu, c.1109T>C p.Phe370Ser), who presented with panhypopituitarism, optic-nerve hypoplasia, corpus callosum agenesis, bicuspid aortic valve disease, seizures, and muscle pain, already on conventional hormone replacement. Coenzyme Q10 (CoQ10) (200 mg) was administered orally for six months; outcomes were assessed using BPI, WOMAC, TUG, LEFS, grip-strength dynamometry, SF-36, CPK and LDH and after six months of daily 200 mg CoQ10 the patient showed marked reductions in pain (BPI 4 → 0.8; -80 %) and muscle-damage markers (CPK 254 → 110 U/L) together with gains in grip strength (+49 %) and lower-extremity function (LEFS 31 → 60; +94 %). SF-36 domains related to physical health showed marked gains, while emotional scores remained stable. This is the first report linking RTN4IP1 mutations to endocrine failure and suggesting a therapeutic role for CoQ10 in mitochondrial-related endocrine disease.