Endocrine Practice最新文献

Objectives: Metabolically-active brown adipose tissue (aBAT) is a common finding on ¹⁸FDG-PET imaging in patients with pheochromocytoma or paraganglioma (PPGL). In addition to its clinical significance, we aimed to explore the prevalence of this finding on FDG-PET imaging in patients with PPGL.

Methods: We conducted a systematic review and meta-analysis of prospective and retrospective studies. Publications were identified through searches in MEDLINE/PubMed, Embase, and SCOPUS from inception until 2022-11-26, with an update check performed on 2024-05-02. Eligible studies included patients with PPGL who had completed FDG-PET imaging. Data on catecholamine levels stratified by the presence of aBAT was extracted and pooled using the random-effects model with the inverse variance method. For the quantitative synthesis, we used standardized mean differences (SMD) and meta-analysis of proportions. A risk of bias assessment was performed using the QUIPS tool.

Results: Our search yielded 6 studies suitable for inclusion. Pooled data showed a statistically significant positive difference in isolated demethylated catecholamine levels in aBAT positive groups compared to aBAT negative. No significant differences were found in multiple domains, including tumor size, tumor burden, germline mutations, or location. The proportion of patients with PPGL who present with aBAT stands at approximately 25%.

Conclusions: The demethylated metabolite levels could have potential use in predicting the presence of active brown adipose tissue in patients with PPGL. There is no convincing evidence of increased aBAT prevalence in patients with PPGL and germline mutations. There was, however, evidence suggesting that the presence of aBAT may confer poorer outcomes and decreased life expectancy.

Objective: Some patients with Pheochromocytoma and Paraganglioma (PPGL) suffer from glucose metabolic disorders. The aim was to investigate the relationship between glucose metabolic disorders and catecholamine levels in 705 patients with PPGL.

Methods: A retrospective analysis was conducted on the clinical data of 705 patients diagnosed with PPGL at Peking Union Medical College Hospital from 2018 to 2023. Bar chart was utilized to depict the manifestations of glycemic disorder across different genders, age groups, BMI, and catecholamine secretion types. Comparison of characteristics between patients with PPGL who had glycemic disorders and those who did not was conducted. Binary logistic regression analysis coupled with Receiver Operating Characteristic (ROC) curves was utilized to predict the occurrence of glycemic disorders.

Results: Of 705 patients, 492 patients were diagnosed with glucose abnormalities, while the remaining 213 had normal glucose metabolism. Compared to the normal glycemic group, the glycemic disorder group had significantly higher levels of HOMA-IR and TyG index, as well as higher HDL, LDL, and TC. Univariate logistic regression identified age, norepinephrine, and epinephrine as independent risk factors for the occurrence of glucose metabolism disorders.After adjusting for confounding variables, age at diagnosis and norepinephrine levels both remained significant, confirming their roles as key risk factors.

Conclusions: Almost 70% of the patients manifested disturbances in glucose metabolism, with over one-third diagnosed with diabetes. These findings underscore the pivotal role catecholamines play in metabolic processes and emphasize the imperative need for close monitoring of blood glucose levels in patients with PPGL.

Introduction: Inadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection.

Methods: We performed a retrospective analysis of patients who underwent fine needle aspiration (FNA) for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Of 2446 patients included, the majority were white (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs. 45.9%, p < 0.001) or clinic visits (53.7% vs. 61.2%, p = 0.001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64 - 0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24 - 0.81).

Conclusion: There is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.

Background: Abaloparatide and teriparatide are osteoanabolic treatments indicated for postmenopausal women and men with osteoporosis at high risk of fracture. In the ACTIVE study, BMD improvements were significantly greater with abaloparatide compared to teriparatide at the total hip and femoral neck. We conducted a retrospective claims study to examine the incidences of hip and nonvertebral fractures and cardiovascular events in women aged ≥50 years initiating abaloparatide or teriparatide therapy, expanding on a previous retrospective claims study.

Methods: This retrospective observational study used anonymized claims data from ICON's Symphony Health, PatientSource® for women aged ≥50 years with ≥1 prescription fill for abaloparatide or teriparatide. The index date was the date of the initial prescription dispensed. Times to first hip fracture, nonvertebral fracture, and serious cardiovascular event were compared between logistic regression-based propensity score-matched cohorts and in predefined subgroups by age, prior antiresorptive use, and prior fracture using Cox proportional hazards models.

Results: Patients (21,676 per cohort) were well matched on 73 baseline parameters. Over 18 months (+30 days follow-up), 245 (1.1%) and 296 (1.4%) women in the abaloparatide and teriparatide cohorts, respectively, had a hip fracture (HR [95% CI] 0.83 [0.70, 0.98]; P=0.027); 947 (4.4%) and 1078 (5.0%) had a nonvertebral fracture (0.88 [0.80, 0.96]; P=0.003). There were no significant treatment-subgroup interactions (P≥0.2). Cardiovascular events were similar between groups.

Conclusions: There were significantly lower rates of hip and nonvertebral fractures with abaloparatide compared to teriparatide, which were consistent across subgroups. No differences in cardiovascular safety were noted between cohorts.

Objective: An assay artifact known as the "hook effect" causes spuriously low serum prolactin levels. This systematic review aimed to examine clinical reports on the "hook effect" in patients with macroprolactinomas to describe associated clinical features.

Methods: We systematically searched multiple databases from database inception to April 16, 2024 for case reports, case series, or observational studies of macroprolactinomas presenting with the hook effect. Original data for hook effect cases from our institution were also included. Data pertaining to patient and tumor characteristics were extracted for data analysis.

Results: A total of 61 macroprolactinoma patients demonstrating the hook effect were analyzed. The mean (SD) age was 40.0 years (15.7 years) with no statistically significant difference between genders. Seventy percent of the patients were male. The smallest reported macroprolactinoma volume demonstrating the hook effect was 3.4 cm³ with its largest dimension measuring 2.9 cm. Mean pre- and post-dilution serum prolactin levels were 108.1 ng/mL and 38526.9 ng/mL, respectively. Ophthalmologic symptoms were the most commonly reported manifestations, (80.9%), followed by headaches (66.0%). Galactorrhea was reported in 4 out of 15 females and in none of the males. Central hypogonadism (63.6%) and central hypothyroidism (44.1%) were the most common associated pituitary hormonal deficiencies. No significant gender differences were noted in tumor size or serum prolactin levels.

Conclusion: Clinical characteristics of macroprolactinomas that demonstrate the hook effect greatly resemble those that do not, underscoring the need to perform dilution studies of prolactin in all patients with pituitary macroadenomas with normal or mildly elevated serum prolactin.

Objective: Radioactive Iodine treatment for thyroid carcinoma may induce nasolacrimal duct obstruction. Evidence-based recommendations regarding nasolacrimal screening and prophylactic management in thyroid cancer survivors are lacking.

Methods: A case control study of patients treated with radioactive iodine for thyroid carcinoma was performed, comparing those who developed symptomatic nasolacrimal duct obstruction (Group 1) to age- and gender-matched controls who did not develop nasolacrimal duct obstruction (Group 2), to identify risk factors.

Results: Fifty patients with history of radioactive iodine treatment for thyroid carcinoma were reviewed, including 25 patients who subsequently developed epiphora and were diagnosed with nasolacrimal duct obstruction, and 25 age and gender-matched RAI-treated patients who did not develop nasolacrimal duct obstruction. The mean cumulative RAI dose was 223.4 mCi (8.27 Gbq) for Group 1 and 121.4 mCi (4.49 Gbq) for Group 2 (p = 0.0092). The mean initial treatment dose was 128.9 mCi (4.77 Gbq) and 100.0 mCi (3.70 Gbq) for the two groups, respectively (p = 0.0317). The mean number of radioactive iodine treatment sessions in patients who developed nasolacrimal duct obstruction was 1.48 (range 1-3), compared to 1.16 (range 1-2) in the group that did not (p = 0.0387).

Conclusions: Higher initial and cumulative treatment dose of radioactive iodine, and multiple treatment sessions, increased likelihood of subsequent development of nasolacrimal duct obstruction. We recommend increased counseling and screening of thyroid cancer survivors undergoing radioactive iodine for thyroid carcinoma at lower doses than previously indicated, particularly in those who undergo multiple treatment sessions.

Purpose: Black patients fracture less than White patients at any given BMD. This may be related to superior bone structure; however, bone structure is challenging to measure in clinical practice. Advances in 3D modeling have allowed for the measurement of trabecular and cortical parameters from DXA. This technology, known as 3D-DXA, may provide a way to assess hitherto unexplained differences in bone structure between Black and White patients.

Methods: This is a secondary analysis of 775 women (368 Black, 407 White) previously recruited from an osteoporosis clinic. All women had undergone DXA and VFA, and 3D-DXA was run retrospectively on the proximal femur BMD scan. Participants were classified as having a prior fracture if there was a fracture on VFA or a self-reported history of fragility fracture.

Results: Black women had generally superior 3D-DXA parameters, with the largest differences in cortical thickness of the femoral neck (FN) and buckling ratio of the FN. There were substantial differences in associations between fracture and 3D-DXA parameters in Black as compared to White women. After adjusting for age, glucocorticoids, and areal BMD T-score, cortical thickness of the FN was significantly associated with prior fracture (OR 1.4 per standard deviation decline, 95% CI 1.0-1.9, p=0.04) in Black but not White women.

Conclusion: 3D-DXA parameters were superior in Black than White women, and cortical thickness of the femoral neck was associated with fractures only in Black women. 3D-DXA may improve fracture risk assessment in Black patients.

Background: Cushing's syndrome (CS) is a condition caused by an increase in blood cortisol levels, leading to elevated blood sugar, osteoporosis, neuropsychiatric disorders, and weight gain and abnormal fat distribution. Its diagnostic process is cumbersome, and the process of clinical confirmation is influenced by many factors.

Objectives: In this study, we investigated the relationship between the 24-hour urinary cortisol/urinary creatinine ratio (24hUCor/Cr) and other relevant biological markers associated with CS in an attempt to find novel ways to diagnose the disease.

Methods: This cross-sectional study included 395 hospitalized patients. Urinary cortisol and creatinine were measured by retaining a 24-hour urine sample. Multivariate binary logistic regression analysis was used to test the correlation between the 24hUCor/Cr and CS. All patients diagnosed with CS underwent a standardized diagnostic process.

Results: Of the 395 subjects, 94 (23.8%) were diagnosed with CS. In the unadjusted model, the likelihood of subjects having CS increased with increasing 24hUCor/Cr (odds ratio: 2.05, 95% confidence interval: 1.56-2.71; P<0.001). In the fully adjusted model, the risk of patients developing CS increased by 74% for each standard deviation increase in the 24hUCor/Cr (95% confidence interval: 1.02-2.97; P<0.05). Based on the subject working characteristic curve analysis and Youden's index, the sensitivity and specificity of the 24hUCor/Cr for predicting CS were 88.3% and 91.7%, respectively, in all subjects (cutoff value: 52.3554, AUC: 0.942; P<0.001) CONCLUSION: A higher 24hUCor/Cr helped to identify CS with an optimal cutoff value of 52.3554.

Iodine is a trace element found in the Earth's crust that is necessary for the biosynthesis of thyroid hormones. Excessive iodine exposure can lead to hyperthyroidism due to the failure of normal homeostatic mechanisms. Iodine-induced hyperthyroidism occurs most frequently in historically iodine-deficient regions, where there is an increased prevalence of autonomously functioning thyroid nodules, but this can also occur in regions with optimal background iodine intakes. Potential sources of iodine excess include iodized salt, seaweed, iodine-containing supplements, drinking water, iodinated contrast media, and amiodarone. In addition to being a potential cause of hyperthyroidism, inorganic iodine may be used to treat Graves' hyperthyroidism and thyroid storm, although there is a risk that this may worsen hyperthyroidism in some patients. Inorganic iodine is also used as a preoperative treatment to reduce thyroid vascularity before thyroidectomy. Recognizing potential sources of iodine and patients who may be particularly vulnerable to the effects of iodine excess can help to identify and prevent hyperthyroidism. This article serves as an update to a 1995 review by Braverman and Roti that was published in the inaugural issue of Endocrine Practice.

Objective: The mechanism behind prolactin (PRL) elevation in stress-induced hyperprolactinaemia (si-HP) in humans is unclear. This study aimed to investigate the effect of psychological stress and venous puncture (VP) pain on si-HP.

Methods: The study included 91 individuals (nine males, 82 females) referred for HP. Anxiety levels were assessed using the Anxiety Sensitivity Index-3 (ASI-3) and the State-Trait Anxiety Inventory (STAI-1 and STAI-2), and visual scales were used to evaluate trypanophobia, nosocomephobia, and scanxiety. Serial PRL measurements (SPM) were performed with venous cannula (VC) at 0 minutes (min), 30 min, and 60 min for the first 32 patients and with the VP method at the same intervals for the following 59 patients. si-HP was defined as PRL levels at 60 min (PRL60min) decreasing to normal limits according to gender.

Results: There were 23 HP (-), 25 HP (+), and 19 si-HP individuals, as well as 24 with macroprolactinaemia. The frequency of si-HP in the VC group (n = 7/32) was similar to that in the VP group (12/59, p=0.9). The PRL0min and PRL60min levels of the VC group were similar to those of the VP group. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1, and STAI-2 scale scores were similar between the si-HP group and other groups. Trypanophobia, nosocomephobia, scanxiety, ASI-3, STAI-1 and STAI-2 scales scores were not correlated with PRL0min, or PRL60min levels.

Conclusion: Si-HP is independent of states momentary or trait anxiety, and phobias trypanophobia, nosocomephobia and scanxiety. In this context, the relevance of the nomenclature of si-HP is controversial.