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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 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。
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引用次数: 0
Editorial on Special Issue in Memory of Aaron I. Vinik: From Autonomic Diabetic Neuropathy to Neuroendocrine Tumors. 纪念 Aaron I. Vinik 特刊》社论:从自主神经糖尿病到神经内分泌肿瘤。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-22 DOI: 10.1016/j.eprac.2024.10.010
Elias S Siraj, David C Lieb, Solomon Tesfaye, Karel Pacak
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引用次数: 0
Temozolomide Therapy in Management of Refractory Pituitary Adenomas: A Case Series of 39 Patients. 治疗难治性垂体腺瘤的替莫唑胺疗法:39例患者的病例系列。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-21 DOI: 10.1016/j.eprac.2024.10.008
Xiaohai Liu, Congxin Dai, Chenxin Tian, Xinjie Bao, Kan Deng, Yong Yao, Yiguang Chen, Mingchu Li, Ge Chen, Ming Feng, Renzhi Wang

Objective: The management of refractory pituitary adenomas (RPA) presents significant challenges. This study aimed to evaluate the long-term treatment outcomes of patients with RPA managed with temozolomide (TMZ) and to identify potential biomarkers for predicting TMZ treatment response.

Methods: This retrospective case series included patients with RPA who underwent transsphenoidal surgery (TSS) or craniotomy at a comprehensive medical center in China between January 2014 and December 2021.

Results: Thirty-nine patients with RPA (median age 42 years; 23 males (59%)) were treated with TMZ for a median of 9 cycles. The median follow-up was 34.4 months. Complete response (CR) was observed in 2 patients, partial response (PR) in 11 patients, stable disease (SD) in 9, progressive disease (PD) in 11, and death in 6 patients. MGMT (O6-methylguanine DNA methyltransferase) levels were significantly lower in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 24.2% and 58.1, respectively. MSH6 (MutS homologs 6) levels were significantly higher in patients with CR, PR, or SD compared to those with PD or mortality, with mean values of 64.2% and 36.9%, respectively. Patients who received concomitant TMZ and external beam radiotherapy showed a significant tumor size reduction of 178,837mm3 (p<0.001) compared to those treated with TMZ alone.

Conclusions: TMZ demonstrates promising efficacy in eliciting tumor responses in patients with PRA. MGMT and MSH6 have emerged as potential biomarkers for predicting treatment response. Furthermore, radiation with concurrent TMZ may significantly improve outcomes in patients with RPA.

目的:难治性垂体腺瘤(RPA)的治疗面临巨大挑战。本研究旨在评估使用替莫唑胺(TMZ)治疗的RPA患者的长期治疗效果,并确定预测TMZ治疗反应的潜在生物标志物:该回顾性病例系列包括2014年1月至2021年12月期间在中国某综合医疗中心接受经蝶窦手术(TSS)或开颅手术的RPA患者:39名RPA患者(中位年龄42岁;23名男性(59%))接受了中位9个周期的TMZ治疗。中位随访时间为 34.4 个月。2例患者观察到完全反应(CR),11例患者观察到部分反应(PR),9例患者观察到疾病稳定(SD),11例患者观察到疾病进展(PD),6例患者死亡。与进展期或死亡患者相比,CR、PR 或 SD 患者的 MGMT(O6-甲基鸟嘌呤 DNA 甲基转移酶)水平明显较低,平均值分别为 24.2% 和 58.1。CR、PR或SD患者的MSH6(MutS homologs 6)水平明显高于PD或死亡患者,平均值分别为64.2%和36.9%。同时接受TMZ和体外放射治疗的患者肿瘤体积明显缩小了178,837立方毫米(p结论:TMZ对PRA患者的肿瘤反应具有良好的疗效。MGMT和MSH6已成为预测治疗反应的潜在生物标志物。此外,放疗同时配合 TMZ 可显著改善 RPA 患者的预后。
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引用次数: 0
Investigating the Clinical Appropriateness of Short Synacthen Testing and Utility of Pretest Cortisol to Predict Short Synacthen Testing Outcomes: A Tertiary Center Experience in Southeast Asia. 研究短期综合征测试(SST)的临床适宜性以及测试前皮质醇对预测 SST 结果的作用:东南亚一家三级中心的经验。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-18 DOI: 10.1016/j.eprac.2024.10.006
Pei Chia Eng, Vijay Ramadoss, Li Ying Lyeann Tan, Li Zhen Ong, Doddabele Srinivasa Deepak, Chin Meng Khoo

Objective: No studies have investigated the predictors of an adequate cortisol response to the short synacthen test (SST) and the appropriateness of patient selection for SST in the Southeast Asian population. The aim of our study is to investigate the predictors and indications of SSTs and concondance of SSTs conducted with outcomes.

Methods: This is a retrospective study investigating all SSTs performed over a year in a tertiary center. Clinical data of patients with SSTs between February 2022 and February 2023 were extracted. We determined the appropriateness of SST testing. Binary logistic regression was used to assess the parameters that predict adequate cortisol response on SST. The proportion of individuals with biochemical "pass" or "fail" on SST was compared with the Χ2 test. Baseline cortisol levels that predicted SST pass were determined using area under receiving operating characteristics curves.

Results: Of the 781 SSTs, 83.9% of SSTs showed an adequate cortisol response. Postural hypotension (26.9%) and exogenous glucocorticoid administration (14.2%) were common indications for SST. In our cohort, 50.2% of the SSTs were inappropriately indicated. Pretest serum cortisol and albumin predict biochemical pass on SST. A pretest cortisol level of 300 nmol/L predicted SST response with 93% sensitivity and a cortisol level of <100 nmol/L confirmed adrenal insufficiency (AI) with 97.3% specificity. Using these cortisol thresholds could avoid 302 (38.5%) of SSTs.

Conclusion: Our analysis showed that clinical features of AI do not reliably predict SST outcomes. We advocate careful assessment of the pretest probability of AI in patients referred for SST. A pretest cortisol level can reduce the number of SSTs, with cost savings implications.

背景:尚未有研究调查东南亚人群对短同步测试(SST)皮质醇充分反应的预测因素,以及选择 SST 患者的适当性:目的:调查SST的预测因素、适应症以及与SST结果的一致性:设计:一项回顾性研究,调查一家三级医疗中心一年内实施的所有 SST:我们提取了2022年2月至2023年2月期间接受SST的患者的临床数据。我们确定了 SST 检测的适当性。二元逻辑回归用于评估预测皮质醇对 SST 充分反应的参数。通过卡方检验比较了 SST 生化检测 "通过 "或 "未通过 "的人数比例。使用 AuROC 曲线确定了预测 SST 通过的皮质醇基线水平:在 781 次 SST 中,83.9% 的 SST 显示皮质醇反应充分。体位性低血压(26.9%)和外源性 GC 给药(14.2%)是 SST 的常见适应症。在我们的队列中,50.2% 的 SST 使用不当。测试前血清皮质醇和白蛋白可预测 SST 的生化合格率。检测前皮质醇水平达到 300nmol/L 可预测 SST 反应,灵敏度为 93%;皮质醇水平低于 100nmol/L 可确认肾上腺功能不全 (AI),特异性为 97.3%。使用这些皮质醇阈值可避免 302 例(38.5%)SST:我们的分析表明,AI 的临床特征并不能可靠地预测 SST 的结果。我们主张对转诊接受 SST 的患者进行仔细的 AI 检测前概率评估。测试前的皮质醇水平可减少 SST 的次数,从而节约成本。
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引用次数: 0
Parathyroidectomy reduces inflammatory cytokines and increases vitamin D metabolites in patients with primary hyperparathyroidism. 甲状旁腺切除术可减少原发性甲状旁腺功能亢进症患者的炎性细胞因子,并增加维生素 D 代谢物。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-17 DOI: 10.1016/j.eprac.2024.10.005
Lingqiong Meng, Sue A Shapses, Xiangbing Wang

Context: Primary hyperparathyroidism (PHPT) is accompanied by a decreased 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (DBP). High parathyroid hormone (PTH) is associated with elevated interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), yet the role of parathyroidectomy (PTX) on DBP and cytokines is not clear.

Objective: To prospectively evaluate the effect of PTX on inflammatory profiles, total and free 25OHD, and DBP in patients with PHPT.

Methods: Newly diagnosed patients with PHPT were recruited in the study (n=70). Twenty-eight patients returned after PTX, 3 months later. Biochemical markers were measured before and after PTX. A group of age and BMI-matched healthy subjects were included as controls (n=70).

Results: Prior to PTX, patients had lower serum DBP (37.5±6.0 vs 41.5±6.1mg/dL, p<0.001) and total 25OHD (30.1±9.5 vs 33.3±7.9ng/mL, P<0.05), but similar free 25OHD when compared to controls. Serum IL-6, C-reactive protein (CRP), and MCP-1 were higher in PHPT patients (p<0.05), whereas interleukin-10 (IL-10) was similar to controls. PTX increased total and free 25OHD and DBP (p<0.001), and decreased serum IL-6 and MCP-1 (p<0.05), but not CRP and IL-10. Multiple regression analysis indicated that the preoperative PTH explained a significant portion of the variance of IL-6 and MCP-1 (p<0.05).

Conclusions: These findings suggest that PTH may upregulate the production of MCP-1 and IL-6 and downregulate circulating DBP in patients with PHPT, that are normalized by PTX. The exact effect of IL-6 and MCP-1 on DBP, vitamin D metabolites and the role on clinical outcomes in patients with PHPT is an area requiring further study.

背景:原发性甲状旁腺功能亢进症(PHPT)伴有 25- 羟维生素 D(25OHD)和维生素 D 结合蛋白(DBP)的降低。高甲状旁腺激素(PTH)与白细胞介素-6(IL-6)和单核细胞趋化蛋白-1(MCP-1)升高有关,但甲状旁腺切除术(PTX)对DBP和细胞因子的作用尚不明确:目的:前瞻性评估 PTX 对 PHPT 患者的炎症特征、总 25OHD 和游离 25OHD 以及 DBP 的影响:研究招募了新诊断的 PHPT 患者(70 人)。28名患者在PTX治疗3个月后复诊。在 PTX 之前和之后测量了生化指标。一组年龄和体重指数相匹配的健康人作为对照组(70 人):结果:在 PTX 之前,患者的血清 DBP 较低(37.5±6.0 vs 41.5±6.1mg/dL,p):这些研究结果表明,PTH 可上调 MCP-1 和 IL-6 的产生,并下调 PHPT 患者的循环 DBP,而 PTX 可使其恢复正常。IL-6和MCP-1对DBP、维生素D代谢物的确切影响以及对PHPT患者临床预后的作用还需要进一步研究。
{"title":"Parathyroidectomy reduces inflammatory cytokines and increases vitamin D metabolites in patients with primary hyperparathyroidism.","authors":"Lingqiong Meng, Sue A Shapses, Xiangbing Wang","doi":"10.1016/j.eprac.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.eprac.2024.10.005","url":null,"abstract":"<p><strong>Context: </strong>Primary hyperparathyroidism (PHPT) is accompanied by a decreased 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (DBP). High parathyroid hormone (PTH) is associated with elevated interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), yet the role of parathyroidectomy (PTX) on DBP and cytokines is not clear.</p><p><strong>Objective: </strong>To prospectively evaluate the effect of PTX on inflammatory profiles, total and free 25OHD, and DBP in patients with PHPT.</p><p><strong>Methods: </strong>Newly diagnosed patients with PHPT were recruited in the study (n=70). Twenty-eight patients returned after PTX, 3 months later. Biochemical markers were measured before and after PTX. A group of age and BMI-matched healthy subjects were included as controls (n=70).</p><p><strong>Results: </strong>Prior to PTX, patients had lower serum DBP (37.5±6.0 vs 41.5±6.1mg/dL, p<0.001) and total 25OHD (30.1±9.5 vs 33.3±7.9ng/mL, P<0.05), but similar free 25OHD when compared to controls. Serum IL-6, C-reactive protein (CRP), and MCP-1 were higher in PHPT patients (p<0.05), whereas interleukin-10 (IL-10) was similar to controls. PTX increased total and free 25OHD and DBP (p<0.001), and decreased serum IL-6 and MCP-1 (p<0.05), but not CRP and IL-10. Multiple regression analysis indicated that the preoperative PTH explained a significant portion of the variance of IL-6 and MCP-1 (p<0.05).</p><p><strong>Conclusions: </strong>These findings suggest that PTH may upregulate the production of MCP-1 and IL-6 and downregulate circulating DBP in patients with PHPT, that are normalized by PTX. The exact effect of IL-6 and MCP-1 on DBP, vitamin D metabolites and the role on clinical outcomes in patients with PHPT is an area requiring further study.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460847","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}
引用次数: 0
Characterization of Interchanging Incretin Analogs in Clinical Practice: A Descriptive Report. 临床实践中交替使用的胰岛素类似物的特征:描述性报告
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-15 DOI: 10.1016/j.eprac.2024.09.117
Christopher M Hvisdas, Natalie D Goode, Diane H Kim, Michael J Silvey, Jeremy J Flood

Objective: To characterize the tolerability associated with incretin analog interchanges to equipotent or higher strengths based on an interchange process in an adult outpatient setting.

Methods: This was a retrospective chart review of adult patients receiving care through a participating family medicine or endocrinology clinic between January 1, 2022, and November 30, 2022 at a major academic medical center. An incretin analog equivalency table and protocol for interchange was created in response to ongoing shortages and need for therapy adjustments to different medications within the same class. Patients were included if a recommended incretin analog interchange was initiated and a tolerability assessment was conducted. Patients were excluded if they did not meet inclusion criteria or if they were unreachable for tolerability assessments for interchanged agents.

Results: There were 156 patients included for characterization and response to tolerability of interchange. It was determined that 96% of patients tolerated the incretin analog interchange. A dose escalation occurred in 58% of patients, 41% were transitioned to an equipotent dose, and a dose decrease was considered in 1 patient. Prior authorizations were required 74% of the time for the new therapy. The most common interchanges were dulaglutide 4.5 mg to tirzepatide 7.5 mg, dulaglutide 4.5 mg to tirzepatide 10 mg, and dulaglutide 3 mg to tirzepatide 7.5 mg. These interchanges made up 37.3% of the total population and were observed to have 93% tolerability. Seven patients did not tolerate incretin analog interchange. Five experienced gastrointestinal effects and 2 experienced injection site reactions. The interchange of incretin analog was estimated to reduce time to maximum dose by a median of 3 months. During this study, no patients experienced interruption of therapy defined as missing a dose of incretin analog.

Conclusion: This characterization report demonstrates an effective approach to addressing incretin analog interchanges. A high level of tolerability is evident with the defined interchange process. Future studies should continue to confirm effective and safe interchanges of incretin analogs from outcomes and tolerability reports.

目的根据成人门诊环境中的换药流程,描述增量素类似物换成等效或更高浓度时的耐受性:这是一项回顾性病历审查,对象是 2022 年 1 月 1 日至 2022 年 11 月 30 日期间在一家大型学术医疗中心的参与家庭医学或内分泌诊所接受治疗的成人患者。由于胰岛素类药物持续短缺,需要对同类不同药物进行治疗调整,因此制定了胰岛素类似物等效表和换药协议。如果患者开始接受推荐的胰岛素类似物换药治疗,并进行了耐受性评估,则将其纳入治疗范围。如果患者不符合纳入标准或无法联系到他们进行换药耐受性评估,则将其排除在外:结果:共有 156 名患者被纳入研究,以确定其特征和对换药耐受性的反应。结果显示,96% 的患者可以耐受胰岛素类似物的互换。58%的患者接受了剂量升级,41%的患者过渡到了同等剂量,1 名患者被视为剂量减少。74%的新疗法需要事先授权。最常见的换药是将 4.5 毫克度拉鲁肽换成 7.5 毫克替扎帕肽、将 4.5 毫克度拉鲁肽换成 10 毫克替扎帕肽以及将 3 毫克度拉鲁肽换成 7.5 毫克替扎帕肽。这些换药患者占总人数的 37.3%,据观察,耐受性达 93%。七名患者不能耐受胰岛素类似物换药。其中五人出现胃肠道反应,两人出现注射部位反应。据估计,换用胰岛素类似物可将达到最大剂量的时间中位数缩短三个月。在这项研究中,没有患者出现中断治疗的情况,即错过一次胰岛素类似物剂量:这份特征分析报告展示了解决胰岛素类似物换药问题的有效方法。通过定义的换药过程可以看出,患者的耐受性很高。未来的研究应继续从疗效和耐受性报告中确认胰岛素类似物换药的有效性和安全性。
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引用次数: 0
Examining the Influence of the Route of Administration and Dose of Estradiol on Serum Estradiol and Testosterone Levels in Feminizing Gender-Affirming Hormone Therapy. 研究在女性化性别确认激素疗法中,雌二醇的给药途径和剂量对血清雌二醇和睾酮水平的影响。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-12 DOI: 10.1016/j.eprac.2024.10.002
Daniel J Slack, Anaïs Di Via Ioschpe, Michael Saturno, Sky Kihuwa-Mani, Uchechukwu O Amakiri, Daniel Guerra, Subha Karim, Joshua D Safer

Introduction: Individuals may seek gender-affirming hormone therapy (GAHT) to align their physical appearance with their gender identity. Feminizing GAHT typically involves the use of estrogen. This study investigates the effect of route of administration (ROA) and dose of estradiol on estradiol (E2) and testosterone (T) levels in transfeminine individuals.

Methods: We conducted a chart review of 573 patients with an active prescription for estradiol for feminizing GAHT and serum hormone levels available. Multiple linear regression and analysis of variance were used to analyze the effect of dose and ROA of estradiol on serum E2 and T.

Results: Oral estradiol was the only ROA demonstrating a linear dose-response, with each 1 mg/d increase associated with a reduction in T of 19.03 ng/dL (P = .005). Lower T levels were seen with higher doses of transdermal estradiol but a significant dose-response was not demonstrated. Intramuscular estradiol was associated with lower T and higher E2 compared to oral and transdermal ROAs (P < .001), with many achieving target hormone levels even at low doses. Higher doses of oral estradiol were associated with lower mean serum leutenizing hormone and follicle stimulating hormone levels (P < .05).

Conclusion: Oral estradiol can be titrated to achieve a stepwise decrease in serum T. The intramuscular ROA appears to be the most potent delivery of estradiol with impact on serum hormone levels with doses on the low end of guideline-suggested ranges. Serum leutenizing hormone and follicle stimulating hormone may also help with the management of feminizing GAHT.

导言:个人可能会寻求性别确认荷尔蒙疗法(GAHT),以使自己的外貌符合自己的性别认同。女性化激素疗法通常需要使用雌激素。本研究调查了给药途径(ROA)和雌二醇剂量对转女性患者体内雌二醇(E2)和睾酮(T)水平的影响:我们对 573 名开具雌二醇处方治疗女性化 GAHT 且血清激素水平可用的患者进行了病历审查。采用多元线性回归和方差分析来分析雌二醇的剂量和 ROA 对血清 E2 和 T 的影响:结果:口服雌二醇是唯一显示出线性剂量反应的 ROA,每增加 1 毫克/天,T 降低 19.03 纳克/分升(p=0.005)。经皮雌二醇剂量越大,T水平越低,但未显示出显著的剂量反应。与口服和透皮 ROA 相比,肌肉注射雌二醇与较低的 T 值和较高的 E2 值相关(p 结论:口服雌二醇可以滴定,而透皮雌二醇可以滴定:口服雌二醇可以通过滴定来实现血清 T 的逐步下降。肌肉注射 ROA 似乎是最有效的雌二醇给药方式,其对血清激素水平的影响剂量在指南建议范围的低端。在管理女性化 GAHT 方面,血清 T 可能是比 E2 更可靠的生物标志物。血清 LH 和 FSH 也有助于管理女性化 GAHT。
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引用次数: 0
Assessing the Quality of Care of Pregnant Patients With Thyrotoxicosis at an Urban Safety Net Hospital. 评估一家城市安全网医院对甲亢孕妇的护理质量。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-12 DOI: 10.1016/j.eprac.2024.10.001
Cassandra Chua, Elizabeth N Pearce, Sun Y Lee

Objective: Thyrotoxicosis can adversely affect pregnancy. The quality of care (QoC) for thyrotoxicosis in pregnancy at a tertiary care safety net hospital was evaluated based on current guidelines.

Methods: Pregnant patients with thyrotoxicosis or a history of Graves disease who delivered in 2015-2021 were divided into 3 groups: low thyroid stimulating hormone (TSH), active Graves disease, and past Graves disease. The QoC was assessed using thyroid hormone and thyroid stimulating immunoglobulin (TSI) levels, fetal ultrasound, and endocrine referrals. We assessed potential impacts of race/ethnicity and socioeconomic status (SES).

Results: We included 147 subjects (mean age 31.5 years, 76% Black, 86% non-Hispanic). Of patients with low TSH (n = 95), 75% had repeat TSH measurements and 33% had TSI measured. Hispanic patients were more likely to have TSI and repeat TSH measured than non-Hispanics (58% vs 29%; P = .04, and 100% vs 71%; P = .03, respectively). In patients with active Graves disease (n = 23, 70% treated with thionamides), 35% had free thyroxine levels at goal and 90% had endocrine care or referral. In patients with past Graves disease (n = 27), 56% had TSI measured, 78% had first-trimester TSH measurements, and 58% had TSH at goal. Black patients were less likely to have TSH checked in the first trimester than other races (85% vs 100%, P = .048).

Conclusion: The QoC of thyrotoxicosis in pregnancy at this tertiary care center can be improved. A larger study is needed to assess the potential impacts of race and SES on the care of pregnant patients with thyrotoxicosis.

背景介绍甲亢会对妊娠产生不利影响。根据现行指南,对一家三级安全网医院的妊娠期甲亢护理质量(QoC)进行了评估:将2015-2021年分娩的甲亢或有巴塞杜氏病史的孕妇分为三组:低促甲状腺激素、活动性巴塞杜氏病和既往巴塞杜氏病。通过甲状腺激素和促甲状腺免疫球蛋白(TSI)水平、胎儿超声波检查和内分泌转诊来评估QoC。我们评估了种族/民族和社会经济地位(SES)的潜在影响:我们纳入了 147 名受试者(平均年龄 31.5 岁,76% 为黑人,86% 为非西班牙裔)。在 TSH 偏低的患者(95 人)中,75% 的患者重复测量了 TSH,33% 的患者测量了 TSI。西班牙裔患者比非西班牙裔患者更有可能测量TSI和重复测量TSH(分别为58% vs 29%; p=0.04和100% vs 71%; p=0.03)。在活动性巴塞杜氏病患者中(人数=23,70%接受硫酰胺类药物治疗),35%的患者FT4水平达到目标,90%的患者接受了内分泌治疗或转诊。在既往患过巴塞杜氏病的患者中(人数=27),56%的患者测量了TSI,78%的患者在第一次怀孕时测量了促甲状腺激素,58%的患者促甲状腺激素达到目标水平。与其他种族的患者相比,黑人患者在妊娠头三个月进行 TSH 检测的可能性较低(85% vs 100%,P=0.048):结论:该三级医疗中心的妊娠期甲亢质量控制水平有待提高。需要进行更大规模的研究,以评估种族和社会经济地位对甲亢孕妇护理的潜在影响。
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引用次数: 0
Factors Associated With 30-Day Readmissions After Transsphenoidal Pituitary Surgery. 经蝶垂体手术后 30 天再入院的相关因素。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-11 DOI: 10.1016/j.eprac.2024.10.003
Aditi Kumar, Mona Vahidi Rad, Alyssa K McGary, Janna C Castro, Curtiss B Cook

Purpose: Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.

Methods: Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N = 174).

Results: In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, P = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, P = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, P = .016), with the Southeast site being comparable to the Southwest.

Conclusion: Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.

目的:确定垂体手术后临床和人口学因素与 30 天再入院风险之间的关联:对 2018 年 1 月至 2022 年 12 月间接受垂体手术的患者进行回顾性研究。病例从融合的电子病历中提取,其中包括在同一医疗企业的中西部、东南部和西南部校区进行的手术。对垂体手术后出院 30 天内再次入院的患者(83 例)和随机抽样的垂体手术后 30 天内未再次入院的患者队列(174 例)进行了变量比较:在研究患者特征与再入院风险关系的多变量回归模型中,医疗保险严重程度诊断相关组评分每增加一项,再入院风险就增加近2.3倍(OR=2.335,95% CI 1.050,5.562,p=0.045)。存在 AVP 缺乏症的患者再次入院的几率增加了 2 倍多(OR=2.784,95% CI 1.118,7.124,P=0.029)。与西南地区相比,中西部地区的再入院风险降低了近 67%(OR=0.334,95% CI 0.134,0.813,p=0.016),东南部地区与西南地区相当:我们的研究发现,术后 AVP 缺乏、合并疾病较多和地理位置是垂体手术后 30 天再入院的风险因素。我们还需要进一步研究,以确定在同一医疗机构的其他地点如何采用特定地点的护理流程来降低再入院风险。
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引用次数: 0
Random C-Peptide and Islet Antibodies at Onset Predict β Cell Function Trajectory and Insulin Dependence in Pediatric Diabetes. 发病时的随机 C 肽和胰岛抗体可预测小儿糖尿病患者的 β 细胞功能轨迹和胰岛素依赖性。
IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-10-03 DOI: 10.1016/j.eprac.2024.09.116
Mustafa Tosur, Saima Deen, Xiaofan Huang, Serife Uysal, Marcela Astudillo, Richard A Oram, Maria J Redondo, Farook Jahoor, Ashok Balasubramanyam

Objective: Identification of prognostic biomarkers in pediatric diabetes is important for precision medicine. We assessed whether C-peptide and islet autoantibodies are useful to predict the natural history of children with new-onset diabetes.

Methods: We prospectively studied 72 children with new-onset diabetes (median follow-up: 8 months) by applying the Aβ classification system ("A+": islet autoantibody positive, "β+": random serum C-peptide ≥1.3 ng/mL at diagnosis). Beta-cell function was assessed longitudinally with 2 hours postprandial/stimulated urinary C-peptide-to-creatinine ratio (UCPCR) 3-12 weeks (V1) and 6 to 12 months after diagnosis (V2). We obtained a type 1 diabetes genetic risk score for each participant, and compared characteristics at baseline, and clinical outcomes at V2.

Results: The cohort was 50% male. Racial distribution was 76.4% White, 20.8% Black, and 2.8% Asian or other races. A total of 46.5% participants were Hispanic. Median age (Q1-Q3) was 12.4 (8.3-14.5) years. The Aβ subgroup frequencies were 46 A+β-(63.9%), 1 A-β-(1.4%), 4 A+β+(5.6%), and 21 A-β+(29.2%). Baseline serum C-peptide correlated with UCPCR at both V1 (r = 0.36, P = .002) and V2 (r = 0.47, P < .001). There were significant subgroup differences in age, race, frequency of diabetic ketoacidosis, and type 1 diabetes genetic risk score (P < .01). At V2, the 2 β-subgroups had lower UCPCR and higher hemoglobin A1c compared with the 2 β+ subgroups (P < .001 and P = .02, respectively). Thirty-eight percent of A-β+ but none of the other subgroups were insulin-independent at V2 (P < .001).

Conclusion: C-peptide and islet autoimmunity at diagnosis define distinct phenotypes and predict beta-cell function and insulin dependence 6 to 12 months later in racially/ethnically diverse children with new-onset diabetes.

背景:鉴定儿童糖尿病的预后生物标志物对精准医疗非常重要:我们评估了C肽和胰岛自身抗体是否有助于预测新发糖尿病患儿的自然病史:我们采用 Aβ 分类系统("A+":胰岛自身抗体阳性;"β+":诊断时随机血清 C 肽≥1.3 ng/mL)对 72 名新发糖尿病患儿进行了前瞻性研究(中位随访时间:8 个月)。在确诊后 3-12 周(V1)和 6-12 个月(V2),用餐后 2 小时/受刺激尿 C 肽-肌酐比值(UCPCR)对β细胞功能进行纵向评估。我们获得了每位参与者的 1 型糖尿病遗传风险评分(T1D GRS2),并比较了基线时的特征和 V2 时的临床结果:结果:组群中 50%为男性。种族分布为白人占 76.4%,黑人占 20.8%,亚裔或其他种族占 2.8%。46.5%的参与者为西班牙裔。中位年龄(Q1-Q3)为 12.4(8.3-14.5)岁。Aβ 亚组频率为 46 A+β-(63.9%)、1 A-β-(1.4%)、4 A+β+(5.6%)和 21 A-β+(29.2%)。基线血清 C 肽与 UCPCR 在 V1(r=0.36,p=0.002)和 V2(r=0.47,pConclusions:诊断时的C肽和胰岛自身免疫定义了不同的表型,可预测6-12个月后不同种族/族裔新发糖尿病患儿的β细胞功能和胰岛素依赖性。
{"title":"Random C-Peptide and Islet Antibodies at Onset Predict β Cell Function Trajectory and Insulin Dependence in Pediatric Diabetes.","authors":"Mustafa Tosur, Saima Deen, Xiaofan Huang, Serife Uysal, Marcela Astudillo, Richard A Oram, Maria J Redondo, Farook Jahoor, Ashok Balasubramanyam","doi":"10.1016/j.eprac.2024.09.116","DOIUrl":"10.1016/j.eprac.2024.09.116","url":null,"abstract":"<p><strong>Objective: </strong>Identification of prognostic biomarkers in pediatric diabetes is important for precision medicine. We assessed whether C-peptide and islet autoantibodies are useful to predict the natural history of children with new-onset diabetes.</p><p><strong>Methods: </strong>We prospectively studied 72 children with new-onset diabetes (median follow-up: 8 months) by applying the Aβ classification system (\"A+\": islet autoantibody positive, \"β+\": random serum C-peptide ≥1.3 ng/mL at diagnosis). Beta-cell function was assessed longitudinally with 2 hours postprandial/stimulated urinary C-peptide-to-creatinine ratio (UCPCR) 3-12 weeks (V1) and 6 to 12 months after diagnosis (V2). We obtained a type 1 diabetes genetic risk score for each participant, and compared characteristics at baseline, and clinical outcomes at V2.</p><p><strong>Results: </strong>The cohort was 50% male. Racial distribution was 76.4% White, 20.8% Black, and 2.8% Asian or other races. A total of 46.5% participants were Hispanic. Median age (Q1-Q3) was 12.4 (8.3-14.5) years. The Aβ subgroup frequencies were 46 A+β-(63.9%), 1 A-β-(1.4%), 4 A+β+(5.6%), and 21 A-β+(29.2%). Baseline serum C-peptide correlated with UCPCR at both V1 (r = 0.36, P = .002) and V2 (r = 0.47, P < .001). There were significant subgroup differences in age, race, frequency of diabetic ketoacidosis, and type 1 diabetes genetic risk score (P < .01). At V2, the 2 β-subgroups had lower UCPCR and higher hemoglobin A1c compared with the 2 β+ subgroups (P < .001 and P = .02, respectively). Thirty-eight percent of A-β+ but none of the other subgroups were insulin-independent at V2 (P < .001).</p><p><strong>Conclusion: </strong>C-peptide and islet autoimmunity at diagnosis define distinct phenotypes and predict beta-cell function and insulin dependence 6 to 12 months later in racially/ethnically diverse children with new-onset diabetes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375189","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}
引用次数: 0
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Endocrine Practice
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