Endocrine Practice最新文献_第3页

Effects of Teprotumumab and Role of Human Leukocyte Antigens Markers in Patients With Thyroid Eye Disease 特普鲁单抗对甲状腺眼病患者的作用以及HLA标记物的作用。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.eprac.2024.08.005

Thanh D. Hoang DO , Remigio J. Flor MD , Sebastian De La Torre MD , Christopher Nguyen BS , Sorana Raiciulescu MSc , Mohamed K.M. Shakir MD , Eva Chou MD

Objective

To evaluate the effects of teprotumumab on ophthalmologic and biochemical findings and assess potential genetic markers for response to treatment.

Methods

This is a retrospective study. Participants were 18-76 year old. All subjects were treated with teprotumumab. The primary outcome was the change in proptosis before and after teprotumumab treatment. Secondary outcomes include change in other ophthalmic measures and thyroid laboratory tests. Human leukocyte antigens (HLA) markers were analyzed for response to teprotumumab.

Results

Twenty-six patients were included in the final analysis. There was a significant decrease in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and significant increases in glycated hemoglobin A1c, fasting glucose, and total T3 levels. There was also significant reduction in proptosis, clinical activity score, retinal nerve fiber layer thickness, ganglion cell analysis, and intraocular pressure. HLA haplotypes were distinct between responders and nonresponders, with HLA-DRB3 02:02:01G, HLA-DRB4 neg, and HLA-DQB1 02:01:01G demonstrating better response to teprotumumab and HLA-A 23:01:01G strongly correlating to nonresponse.

Conclusions

Patients with both acute and chronic thyroid eye disease treated with teprotumumab had a significant reduction in thyroid stimulating immunoglobulin and thyrotropin receptor antibody levels and improvement in proptosis, clinical activity score, retinal nerve fiber layer and ganglion cell analysis thickness, and intraocular pressure. HLA may predict responders vs nonresponders. Further studies with longer duration and larger population comparing teprotumumab with steroids or other immunomodulatory agents (tocilizumab, rituximab, etc) may be helpful.

目的评估替普鲁单抗对眼科和生化检查结果的影响，并评估TED反应的潜在遗传标记：这是一项回顾性研究。参与者年龄为 18-76 岁。所有受试者均接受了替普鲁单抗治疗。主要结果是特普罗单抗治疗前后突眼的变化。次要结果包括其他眼科指标和甲状腺实验室检测的变化。此外，还分析了人类白细胞抗原（HLA）作为对替普鲁单抗反应的标记物：26名患者被纳入最终分析。TSI和TRAb水平明显下降，HbA1c、空腹血糖和总T3水平明显上升。突眼、临床活动评分（CAS）、视网膜神经纤维层（RNFL）厚度、神经节细胞厚度（GCA）和眼压（IOP）也有明显下降。HLA单倍型在有反应者和无反应者之间存在差异，HLA-DRB3*02:02:01G、HLA-DRB4*neg和HLA-DQB1*02:01:01G对替普鲁单抗的反应更好，而HLA-A*23:01:01G与无反应密切相关：接受替普鲁单抗治疗的急性和慢性TED患者的TSI和TRAb水平均显著下降，突眼、CAS、RNFL和GCA厚度以及眼压均有所改善。HLA可预测应答者与非应答者。进一步开展持续时间更长、人群更多的研究，将替普鲁单抗与类固醇或其他免疫调节剂（托珠单抗、利妥昔单抗等）进行比较，可能会有所帮助。

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引用次数: 0

Predicting Metformin Efficacy in Improving Insulin Sensitivity Among Women With Polycystic Ovary Syndrome and Insulin Resistance: A Machine Learning Study 预测二甲双胍在改善多囊卵巢综合征和胰岛素抵抗妇女胰岛素敏感性方面的疗效：一项机器学习研究。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.eprac.2024.07.014

Jiani Fu MM , Yiwen Zhang PhD , Xiaowen Cai PhD , Yong Huang PhD

Objective

Metformin is clinically effective in treating polycystic ovary syndrome (PCOS) with insulin resistance (IR), while its efficacy varies among individuals. This study aims to develop a machine learning model to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR.

Methods

This is a retrospective analysis of a multicenter, randomized controlled trial involving 114 women diagnosed with PCOS and IR. All women received metformin treatment for 4 months. We incorporated 27 baseline clinical variables of the women into the construction of our machine learning model. We firstly compared 4 commonly used feature selection methods to screen valuable clinical variables. Then we used the valuable variables as inputs to evaluate the performance of 5 machine learning models, including k-Nearest Neighbors, Support Vector Machine, Logistic Regression, Random Forest, and Extreme Gradient Boosting, in predicting the efficacy of metformin.

Results

Among the 5 machine learning models, Support Vector Machine performed the best with an area under the receiver operating characteristic curve of 0.781 (95% confidence interval [CI]: 0.772-0.791). The key predictive variables identified were homeostasis model assessment of insulin resistance, body mass index, and low-density lipoprotein cholesterol.

Conclusion

The developed machine learning model could be applied to predict the efficacy of metformin in improving insulin sensitivity among women with PCOS and IR. The result could help doctors evaluate the efficacy of metformin in advance, optimize treatment plans, and thereby enhance overall clinical outcomes.

目的：二甲双胍在治疗多囊卵巢综合征（PCOS）合并胰岛素抵抗（IR）方面具有临床疗效，但其疗效因人而异。本研究旨在开发一种机器学习模型，用于预测二甲双胍在改善多囊卵巢综合征合并胰岛素抵抗妇女的胰岛素敏感性方面的疗效：这是对一项多中心随机对照试验的回顾性分析，该试验涉及 114 名被诊断患有多囊卵巢综合征和内分泌失调的女性。所有女性均接受了为期 4 个月的二甲双胍治疗。我们在构建机器学习模型时纳入了妇女的 27 个基线临床变量。我们首先比较了四种常用的特征选择方法，以筛选出有价值的临床变量。然后，我们将有价值的变量作为输入，评估了五种机器学习模型在预测二甲双胍疗效方面的性能，包括k-近邻（KNN）、支持向量机（SVM）、逻辑回归（LR）、随机森林（RF）和极梯度提升（Xgboost）：在五种机器学习模型中，SVM 的表现最佳，其接收器工作特征曲线下面积 (AUC) 为 0.781（95% 置信区间 [CI]：0.772-0.791）。关键的预测变量是胰岛素抵抗的稳态模型评估（HOMA-IR）、体重指数（BMI）和低密度脂蛋白胆固醇（LDL-C）：结论：所开发的机器学习模型可用于预测二甲双胍在改善多囊卵巢综合征和胰岛素抵抗妇女的胰岛素敏感性方面的疗效。结论：所开发的机器学习模型可用于预测二甲双胍对改善多囊卵巢综合症和红细胞增多症妇女胰岛素敏感性的疗效，其结果可帮助医生提前评估二甲双胍的疗效，优化治疗方案，从而提高整体临床疗效。

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引用次数: 0

Defining the Functional Sensitivity for the Siemens Atellica Calcitonin Assay: Insight From a Single-Center Study 确定西门子 Atellica 降钙素测定的功能敏感性：单中心研究的启示

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.eprac.2024.08.007

Jieli Li MD, PhD , Ashley Patton MD , Jason K.Y. Lee MLSMS , Matt Scheidegger MT , Irina Azaryan MD , Jennifer A. Sipos MD , Fadi Nabhan MD , JoAnna Jones MD , Alicia Algeciras-Schimnich PhD , Matthew D. Ringel MD

Background

Detectable, and especially rising postthyroidectomy serum calcitonin and carcinoembryonic antigen levels, as per American Thyroid Association guidelines, indicate potential disease presence, requiring frequent calcitonin measurement or imaging for early detection of persistent or recurrent medullary thyroid carcinoma. Thus, defining the clinical cutoff value of detection of calcitonin assays relative to imaging and clinical status is crucial for patient care. This study aimed to evaluate postoperative calcitonin levels using the new Siemens Atellica assay system to determine the most appropriate levels for clinical decision-making.

Methods

A retrospective analysis was conducted using Siemens Atellica for calcitonin testing on 56 samples from 40 patients between September 27, 2022 and August 11, 2023. Only calcitonin results performed at least 3 months post-total thyroidectomy were included. Imaging studies, within 6 months of the calcitonin report, were assessed. Carcinoembryonic antigen results were also reviewed.

Results

Precision analysis at 2.94 and 5.24 pg/mL revealed coefficients of variation at 16.49% and 8.87%, respectively. For the evidence of post-total thyroidectomy persistent or recurrent medullary thyroid carcinoma confirmed by imaging, using a 1.89 pg/mL cutoff for calcitonin yielded 43% sensitivity and 67% specificity. Using a 5.00 pg/mL cutoff resulted in 0% sensitivity and 100% specificity.

Conclusions

Our findings indicate the potential suitability of a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform for evaluating tumor persistence or recurrence in post-thyroidectomy patients in our institution. However, individual laboratories should establish their own clinical cutoff value when evaluating calcitonin levels for monitoring tumor recurrence post-thyroidectomy.

背景：根据美国甲状腺协会（ATA）指南，甲状腺切除术后血清降钙素原和癌胚抗原（CEA）水平可检测到，尤其是不断升高，表明可能存在疾病，需要经常测量降钙素原或进行成像检查，以早期发现持续性或复发性甲状腺髓样癌（MTC）。因此，根据影像学和临床状况确定降钙素检测的临床临界值对患者护理至关重要。本研究旨在使用新型西门子 Atellica 检测系统评估术后降钙素水平，以确定最适合临床决策的水平：在 2022 年 9 月 27 日至 2023 年 11 月 8 日期间，使用西门子 Atellica 对 40 名患者的 56 份样本进行了降钙素检测，并进行了回顾性分析。仅纳入了甲状腺全切除术后至少 3 个月的降钙素结果。对降钙素报告后 6 个月内的影像学研究进行了评估。同时还审查了 CEA 结果：精度分析显示，2.94 和 5.24 pg/mL 的变异系数（CV）分别为 16.49% 和 8.87%。对于经影像学证实的甲状腺全切除术后顽固性或复发性 MTC 证据，使用 1.89 pg/mL 的降钙素临界值可获得 43% 的灵敏度和 67% 的特异性。使用 5.00 pg/mL 临界值的敏感性为 0%，特异性为 100%：我们的研究结果表明，西门子 Atellica 平台上的 5 pg/mL 降钙素截止值可能适用于评估本机构甲状腺切除术后患者的肿瘤持续存在或复发情况。不过，各实验室在评估降钙素水平以监测甲状腺切除术后肿瘤复发时，应确定自己的临床临界值。

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引用次数: 0

Info for Readers/Subscription page 读者信息/订阅页面

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-11-01 DOI: 10.1016/S1530-891X(24)00682-7

引用次数: 0

Evaluating the Risk of Venous Thromboembolism in Transfeminine and Gender Diverse People: A Retrospective Analysis 评估变性人和不同性别人群的静脉血栓栓塞风险：回顾性分析。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-11-01 DOI: 10.1016/j.eprac.2024.08.014

Daniel J. Slack MD , Nithya Krishnamurthy BA , Derek Chen MS , Felix G. Contreras-Castro BA , Joshua D. Safer MD

Objective

The risk of venous thromboembolism (VTE) with feminizing gender-affirming hormone therapy is an area of concern. This analysis aimed to assess whether gender-affirming hormone therapy and other potential risk factors are associated with VTE in transfeminine and gender diverse individuals.

Methods

We conducted a chart review of 2126 transfeminine and gender diverse adults receiving care within a large urban health system. The primary outcomes were the prevalence of VTE and odds ratios for the association of VTE with insurer, use of estrogen, and select comorbidities.

Results

A history of VTE was documented in 0.8% of the cohort. Those with a history of VTE were older (P < .001), more often self-identified as Hispanic or Black compared to White or Asian (P < .05) and were more likely to have Medicaid or Medicare (P < .01) when compared to those without a history of VTE. The prevalence of hyperlipidemia (P < .001), diabetes mellitus (P < .05), and hypercoagulable conditions (P < .001) were all greater in the positive VTE group. Hyperlipidemia (P < .001), diabetes mellitus (P < .05), and insurer (P < .05) were associated with increased odds of VTE in univariate analyses. None of the exposure variables analyzed were associated with VTE when controlling for age, race, and the number of comorbidities.

Conclusions

The prevalence of VTE in our cohort was lower than previously observed. VTE was not associated with any one risk factor, including estrogen use, when controlling for age, race, and the number of comorbidities. Those of advanced age and those with multiple cardiometabolic comorbidities may benefit from increased surveillance and mitigation of modifiable risk factors.

目的：女性化性别确认激素疗法（GAHT）的静脉血栓栓塞症（VTE）风险是一个值得关注的领域。本分析旨在评估GAHT和其他潜在风险因素是否与变性和性别多元化（TGD）人群的VTE相关：我们对一个大型城市医疗系统中接受治疗的 2,126 名 TGD 成人进行了病历审查。主要结果是 VTE 的患病率以及 VTE 与保险人、雌激素的使用和特定合并症相关的几率比：结果：0.8%的患者有 VTE 病史。有 VTE 病史的患者年龄较大（p 结论：该群体中 VTE 患病率为 0.8%：我们队列中的 VTE 患病率低于之前的观察结果。在控制年龄、种族和合并症数量的情况下，VTE 与包括使用雌激素在内的任何一个风险因素都无关。那些高龄和患有多种心脏代谢合并症的人可能会从加强监测和减少可改变的风险因素中获益。

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引用次数: 0

Revisiting Vitamin D Guidelines: A Critical Appraisal of the Literature. 重新审视维生素 D 指南：文献批判性评估。

IF 4.3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-10-30 DOI: 10.1016/j.eprac.2024.10.011

Michael F Holick

Background/objective: The goal of this review is to compare the 2024 and 2011 Endocrine Society's Clinical Practice Guidelines on vitamin D₂ or vitamin D₃ (vitamin D). The 2024 Guideline made recommendations for the general healthy population for skeletal and extra skeletal health benefits of vitamin D. This contrasts with the 2011 Guidelines which provided clinicians with guidance on how to evaluate and treat patients with vitamin D deficiency and prevent recurrence.

Discussion: The 2024 Guideline focused on randomized controlled trials and ignored association studies and other studies that have supported the skeletal and extra skeletal health benefits of vitamin D. The 2024 Guideline recommended empiric vitamin D in children and adolescents aged 1 to 18 years to reduce risk of upper respiratory tract infections, pregnant women to improve pregnancy-related outcomes, prediabetic patients to reduce risk of diabetes, and to improve mortality in those over 75 years.

Conclusion: These guidelines do not apply to individuals with abnormalities in calcium, phosphate, vitamin D, and bone metabolism which were provided in the 2011 Guidelines. For nonpregnant adults up to the age of 75, they recommend the Dietary Reference Intakes of 600 IUs (international units; 1 IU = 25 ng of vitamin D), and 800 IUs as recommended by The Institute of Medicine. Association studies have suggested that to obtain maximum extraskeletal benefits from vitamin D including reducing risk of upper respiratory tract infection for children and adults, autoimmune disorders, pre-eclampsia, low birth weight, neonatal dental caries, and deadly cancers circulating concentrations of 25-hydroxyvitamin D should be at least 30 ng/mL with a preferred range of 40-60 ng/mL as recommended by the 2011 Guidelines.

2024 年指南为普通健康人群提供了维生素 D 对骨骼和骨骼外健康益处的建议。这与 2011 年指南形成了鲜明对比，后者为临床医生提供了如何评估和治疗维生素 D 缺乏症患者并预防复发的指导。2024 年指南》重点关注随机对照试验、被忽视的关联研究以及其他支持维生素 D 对骨骼和骨骼外健康益处的研究。《2024 年指南》建议对 1 至 18 岁的儿童和青少年、孕妇、糖尿病前期患者和 75 岁以上老人进行经验性维生素 D 治疗，以降低上呼吸道感染风险，改善妊娠相关结果，降低糖尿病风险，并改善死亡率。这些指导原则不适用于钙、磷酸盐、维生素 D 和骨代谢异常的人群，2011 年的指导原则已对此做出规定。对于 75 岁以下的非怀孕成年人，《指南》建议其膳食维生素 D 参考摄入量为 600 IUs 和医学研究所建议的 800 IUs。相关研究表明，要从维生素 D 中获得最大的骨骼外益处，包括降低儿童和成人上呼吸道感染、自身免疫性疾病、先兆子痫、低出生体重、新生儿龋齿和致命癌症的风险，25-羟基维生素 D 的循环浓度应至少为 30 纳克/毫升，《2011 年指南》建议的首选范围为 40-60 纳克/毫升。

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引用次数: 0

The Complex Web of Interferences with Thyroid Function Tests. 甲状腺功能检测的复杂干扰网。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-10-28 DOI: 10.1016/j.eprac.2024.10.007

Huda Al-Bahadili, Jennifer Powers Carson, Alexander Markov, Sina Jasim

Objective: Thyroid disorders are common. Serum TSH is frequently measured and is the single best initial biomarker to diagnose thyroid disease. Automated immunoassays used to evaluate thyroid function are susceptible to interferences that can affect test results and therefore clinical decisions. In this comprehensive review, our aim is to discuss common assay and drug interferences leading to abnormal thyroid function tests.

Methods: Authors conducted a literature review of PubMed to include studies on drug related and laboratory assay interferences leading to primary and secondary thyroid dysfunction in addition to interferences with thyroid hormone replacement and thyroid function tests.

Results: Overall, there are several assay interferences as well as drug interferences leading to primary thyroid dysfunction including iodine-containing drugs such as amiodarone, lithium, immune checkpoint inhibitors and tyrosine kinase inhibitors, drug interferences leading to secondary thyroid dysfunction such as glucocorticoids, and drug interferences affecting thyroid hormone absorption, metabolism, and thyroid binding globulin levels. In addition, assay interferences from biotin, heterophile antibodies, Macro-TSH or anti-streptavidin antibodies may occur without underlying thyroid dysfunction, leading to abnormal thyroid function tests.

Conclusion: For appropriate patient management, it is imperative to identify assay interferences when discrepancies between clinical presentation and thyroid function test results are noted.

目的：甲状腺疾病很常见。血清促甲状腺激素是诊断甲状腺疾病的最佳初始生物标志物。用于评估甲状腺功能的自动免疫测定很容易受到干扰，从而影响检测结果和临床决策。在这篇综述中，我们旨在讨论导致甲状腺功能检测异常的常见检测方法和药物干扰：作者在PubMed上进行了文献综述，除了甲状腺激素替代品和甲状腺功能检测的干扰外，还包括导致原发性和继发性甲状腺功能障碍的药物相关和实验室检测干扰的研究：总体而言，导致原发性甲状腺功能障碍的检测干扰和药物干扰有多种，包括胺碘酮、锂、免疫检查点抑制剂和酪氨酸激酶抑制剂等含碘药物，糖皮质激素等导致继发性甲状腺功能障碍的药物干扰，以及影响甲状腺激素吸收、代谢和甲状腺结合球蛋白水平的药物干扰。此外，在没有潜在甲状腺功能障碍的情况下，生物素、嗜异性抗体、巨TSH或抗链霉亲和素抗体也可能产生测定干扰，导致甲状腺功能检测异常：为了对患者进行适当的管理，当发现临床表现与甲状腺功能检测结果不一致时，必须识别检测干扰。

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引用次数: 0

Leveraging Continuous Glucose Monitoring Data as an Additional Source for Glucagon Prescription Behavior. 利用连续葡萄糖监测数据作为胰高血糖素处方行为的额外来源。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-10-25 DOI: 10.1016/j.eprac.2024.10.012

Jayachidambaram Ambalavanan, Jill Rusticelli, Diana Isaacs, Huijun Xiao, James Bena, Christopher Babiuch, M Cecilia Lansang

Objective: Hypoglycemia can be life-threatening for patients with diabetes (DM). We aimed to 1) evaluate percentage of glucagon prescription in patients with hypoglycemia on CGM reports, and 2) determine incident glucagon prescription after an educational letter delivered to the providers.

Research design and methods: The study had two components - retrospective chart review and a quality improvement (QI) component. Chart review was conducted from March-October 2023 on adult patients in a tertiary care health system with type 1 DM, or type 2 DM on insulin, sulfonylurea, or meglitinide. Percentages of pre-existing and incident glucagon prescription were evaluated. For the QI, we contacted providers whose patients had hypoglycemia defined as time below range (TBR) ≥4% on CGM reports without a glucagon prescription and shared the ADA Standards of Care on hypoglycemia along with information about various forms of glucagon. Data on glucagon prescription was collected 4 weeks later.

Results: Of the 1,543 patients included 170 had TBR ≥4%. Among them, 37% had pre-existing prescription and 14% incident glucagon prescription, compared with patients without hypoglycemia (p<0.001). Pre-existing or incident glucagon prescription was seen in 28% without hypoglycemia, 38% with mild , 49% with moderate, and 63% with severe hypoglycemia (p<0.001 mild vs severe; moderate vs no hypoglycemia; severe vs no hypoglycemia). Among 70 patients whose providers received education, 27 (39%) prescribed glucagon. Glucagon emergency kit, glucagon autoinjector, and inhaled glucagon were top choices.

Conclusion: Glucagon prescription remains suboptimal among patients with hypoglycemia on CGM reports. Provider engagement via QI can increase glucagon prescription.

目的：低血糖可危及糖尿病（DM）患者的生命。我们的目的是：1）评估 CGM 报告中低血糖患者使用胰高血糖素处方的比例；2）确定向医疗服务提供者发送教育信后的胰高血糖素处方情况：研究包括两个部分：回顾性病历审查和质量改进（QI）部分。从 2023 年 3 月到 10 月，对一家三级医疗保健系统中患有 1 型糖尿病或 2 型糖尿病、正在使用胰岛素、磺脲类药物或格列汀类药物的成年患者进行了病历审查。我们评估了患者使用胰高血糖素前的处方比例和使用胰高血糖素后的处方比例。为了开展 QI，我们联系了在 CGM 报告中低血糖定义为低于量程时间 (TBR) ≥4% 但未开具胰高血糖素处方的患者的医疗服务提供者，并与他们分享了《美国糖尿病协会低血糖护理标准》以及有关各种形式胰高血糖素的信息。4 周后收集胰高血糖素处方数据：结果：在 1543 名患者中，170 人的 TBR ≥4%。结果：在纳入的 1543 名患者中，170 人的总血糖率≥4%，其中 37% 的患者有糖皮质激素处方，14% 的患者有胰高血糖素处方：在 CGM 报告的低血糖患者中，胰高血糖素处方仍未达到最佳水平。医疗服务提供者通过 QI 参与可增加胰高血糖素处方。

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引用次数: 0

Evaluating Latent Adrenal Insufficiency in Elderly Patients With Nocturnal Hypoglycemia: A Retrospective Observational Study. 评估夜间低血糖老年患者的潜在肾上腺功能不全：回顾性观察研究

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-10-24 DOI: 10.1016/j.eprac.2024.10.009

Ken Kanazawa, Mai Hijikata, Koichiro Kuwabara

Objective: To evaluate the association between nocturnal hypoglycemia (NH) and latent adrenal insufficiency (LAI) among elderly aged >65 years.

Methods: This propensity-matched, retrospective observational study was conducted in an outpatient setting, assessing 1238 elderly aged >65 years between November 2017 and February 2020. Of them, 430 patients with unassessed LAI were monitored for NH using continuous glucose monitoring with Freestyle Libre Pro. The primary outcome was the combined prevalence of newly diagnosed and suspected LAI in patients with NH.

Results: After propensity score matching, 192 patients were included (96 each in the NH and non-NH group). The overall incidence rate of NH was 28.8% (124/430). The association of NH with newly diagnosed and suspected LAI was significantly higher in the NH group (26.04%, 50/192) than in the non-NH (12.5%, 24/192) (odds ratio: 3.26; 95% confidence interval: 2.59-9.06; P < .001). In the NH, compared with patients without LAI, those with new-diagnosed LAI had a higher incidence of hypoglycemia.

Conclusions: Diagnosing and treating LAI in the elderly with NH may prevent complications, including fatal diseases, and extend their life expectancy.

目的评估年龄大于 65 岁的老年人夜间低血糖（NH）与潜在肾上腺功能不全（LAI）之间的关联：这项倾向匹配、回顾性观察研究在门诊环境中进行，评估了 2017 年 11 月至 2020 年 2 月期间年龄大于 65 岁的 1238 名老年人。其中，430 名未评估 LAI 的患者使用 Freestyle Libre Pro® 连续血糖监测仪（CGM）接受了 NH 监测。主要结果是NH患者中新诊断和疑似LAI的综合患病率：经过倾向评分匹配，共纳入 192 名患者（NH 组和非 NH 组各 96 名）。NH的总发病率为28.8%（124/430）。在 NH 组（26.04%，50/192）中，NH 与新诊断和疑似 LAI 的关系明显高于非 NH 组（12.5%，24/192）（几率比：3.26；95% 置信区间：2.59-9.06；P <0.001）。在 NH 中，与没有 LAI 的患者相比，新诊断出 LAI 的患者发生低血糖的几率更高结论：对患有 NH 的老年人进行 LAI 诊断和治疗可预防包括致命疾病在内的并发症，并延长他们的预期寿命。

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引用次数: 0

Diagnostic Performance of European and American College of Radiology Thyroid Imaging Reporting and Data System Classification Systems in Thyroid Nodules Over 20 mm in Diameter. 欧洲和 ACR-TIRADS 分类系统对直径超过 20 毫米的甲状腺结节的诊断性能。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice

Pub Date : 2024-10-22 DOI: 10.1016/j.eprac.2024.10.004

Nikolaos Angelopoulos, Dimitrios G Goulis, Ioannis Chrisogonidis, Sarantis Livadas, Rodis Paparodis, Ioannis Androulakis, Ioannis Iakovou

Objective: The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.

Methods: From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).

Results: Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (P > .05). Two malignancies were missed.

Conclusion: EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.

背景：选择甲状腺结节进行细针穿刺（FNA）细胞学检查的挑战促使甲状腺成像报告和数据系统（TIRADS）的发展，该系统主要有两种格式：主要有两种格式：EU-TIRADS 和 ACR-TIRADS。临床观察表明，TIRADS 3 结节≥20 毫米的风险评估并不完善。本研究旨在评估 TIRADS 系统在区分该亚组良性和恶性结节方面的有效性：从 2023 年 5 月到 2024 年 3 月，1094 名甲状腺结节患者在一家大学医院接受了超声检查（US）。收集了临床、超声、细胞学和组织病理学参数数据。根据欧盟-TIRADS和ACR-TIRADS对≥20毫米的结节进行分类，并通过甲状腺切除术后组织病理学或FNA细胞学（贝塞斯达分类）评估其对恶性肿瘤的预测能力。其中记录了 22 例恶性肿瘤和 286 例良性结节。使用 25 毫米和 30 毫米阈值重新计算 EU-TIRADS 3 性能（ACR 修正版 EU-TIRADS）分别避免了 24% 和 41% 的 FNA，而 ACR-TIRADS 将避免 26.6% 的 FNA（P>0.05）。结论：结论：当使用 25 mm FNA 临界值时，EU-TIRADS 和 ACR-TIRADS 显示出相似的疗效。提高 EU-TIRADS 3 结节的 FNA 临界值可减少不必要的手术，但可能会增加漏诊恶性肿瘤的风险，影响患者的预后。

{"title":"Diagnostic Performance of European and American College of Radiology Thyroid Imaging Reporting and Data System Classification Systems in Thyroid Nodules Over 20 mm in Diameter.","authors":"Nikolaos Angelopoulos, Dimitrios G Goulis, Ioannis Chrisogonidis, Sarantis Livadas, Rodis Paparodis, Ioannis Androulakis, Ioannis Iakovou","doi":"10.1016/j.eprac.2024.10.004","DOIUrl":"10.1016/j.eprac.2024.10.004","url":null,"abstract":"<p><strong>Objective: </strong>The challenge of selecting thyroid nodules for fine needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System, primarily in 2 formats: European Thyroid Imaging Reporting and Data System (EU-TIRADS) and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup.</p><p><strong>Methods: </strong>From May 2023 to March 2024, 1094 patients with thyroid nodules were referred for ultrasound at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through postthyroidectomy histopathology or FNA cytology (Bethesda classification).</p><p><strong>Results: </strong>Two hundred sixty-seven patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating European Thyroid Imaging Reporting and Data System 3 performance using 25-mm and 30-mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (P > .05). Two malignancies were missed.</p><p><strong>Conclusion: </strong>EU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cutoff for FNA in European Thyroid Imaging Reporting and Data System 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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