Pub Date : 2024-08-01DOI: 10.1016/j.eprac.2024.05.002
Objective
There has been increasing evidence that patients with adrenal incidentalomas (AIs) who have 1-mg dexamethasone suppression test (DST) cortisol levels >0.9 μg/dL may be exposed to the adverse consequences of hypercortisolaemia. We aim to evaluate whether there is a difference in Beck Depression Inventory-II (BDI-II) and quality of life (QoL) score in patients with AI based on the threshold of a DST cortisol level >0.9 μg/dL.
Methods
This case-control study included 42 nonfunctional adrenal incidentaloma (NFAI), 53 mild autonomic cortisol secretion (MACS) and 42 healthy controls (HCs). In addition, patients were categorized as ≤0.9 and >0.9 μg/dL according to their DST cortisol results.
Results
There was no difference in the QoL and BDI-II scores of MACS compared to NFAI. The BDI-II score was higher and QoL was lower in MACS and NFAI compared to HCs. The difference in QoL and BDI-II scores between MACS and NFAI remained insignificant when the DST cortisol levels threshold was graded upward (5.0 μg/dL). The prevalence of depression was higher in the AI >0.9 μg/dL group than the AI ≤0.9 μg/dL group (respectively, 16.7% and 55.8%, P = .003), BDI-II scores were higher in the AI >0.9 μg/dL group than in the AI ≤0.9 μg/dL group and HCs. The DST was an independent factor affecting the frequency of depression (odds ratio: 1.39, P = .037).
Conclusion
MACS and patients with NFAI had similar QoL and depression scores according to the 1.8 μg/dL and above, whereas, had lower QoL and higher depression scores according to the 0.9 μg/dL.
{"title":"Relationship Between Dexamethasone Suppression Test Cortisol Level >0.9 μg/dL and Depression and Quality of Life in Adrenal Incidentalomas: A Single Center Observational Case-Control Study","authors":"","doi":"10.1016/j.eprac.2024.05.002","DOIUrl":"10.1016/j.eprac.2024.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>There has been increasing evidence that patients with adrenal incidentalomas<span><span> (AIs) who have 1-mg dexamethasone suppression test (DST) </span>cortisol<span><span> levels >0.9 μg/dL may be exposed to the adverse consequences of hypercortisolaemia<span>. We aim to evaluate whether there is a difference in Beck Depression Inventory-II (BDI-II) and quality of life (QoL) score in patients with AI based on the threshold of a DST </span></span>cortisol level >0.9 μg/dL.</span></span></p></div><div><h3>Methods</h3><p>This case-control study included 42 nonfunctional adrenal incidentaloma (NFAI), 53 mild autonomic cortisol secretion (MACS) and 42 healthy controls (HCs). In addition, patients were categorized as ≤0.9 and >0.9 μg/dL according to their DST cortisol results.</p></div><div><h3>Results</h3><p>There was no difference in the QoL and BDI-II scores of MACS compared to NFAI. The BDI-II score was higher and QoL was lower in MACS and NFAI compared to HCs. The difference in QoL and BDI-II scores between MACS and NFAI remained insignificant when the DST cortisol levels threshold was graded upward (5.0 μg/dL). The prevalence of depression was higher in the AI >0.9 μg/dL group than the AI ≤0.9 μg/dL group (respectively, 16.7% and 55.8%, <em>P</em> = .003), BDI-II scores were higher in the AI >0.9 μg/dL group than in the AI ≤0.9 μg/dL group and HCs. The DST was an independent factor affecting the frequency of depression (odds ratio: 1.39, <em>P</em> = .037).</p></div><div><h3>Conclusion</h3><p>MACS and patients with NFAI had similar QoL and depression scores according to the 1.8 μg/dL and above, whereas, had lower QoL and higher depression scores according to the 0.9 μg/dL.</p></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904152","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}
Pub Date : 2024-08-01DOI: 10.1016/j.eprac.2024.05.013
Objective
This study examined the preoperative and postoperative variables associated with 1 year and long-term insulin independence following total pancreatectomy and islet autotransplantation (TPIAT).
Methods
46 TPIAT patients from 2010 to 2022 in a single hospital system were retrospectively analyzed. Pre- and postoperative variables were compared between short-term (1 year) and long-term (last follow-up after year 1) insulin-independent versus -dependent patients.
Results
Nine (20%) and seven (15%) patients achieved short- and long-term insulin independence, respectively. The patients were followed up for a median of 2.8 years (interquartile range [IQR] 1.0, 4.7). Short-term insulin independence was associated with higher median transplanted islet equivalents (IEQ) per kg (6981 vs 4493, P = .02), lower units of basal insulin on discharge (7 vs 12, P = .009), and lower rates of discharge with an insulin regimen (67% vs 100%, P = .006). Odds of short-term insulin independence increased by 80% for every 1000 increase in IEQ per kg (OR 1.80, CI 1.18-3.12, P = .005) and decreased by 32% for every additional basal unit of insulin on discharge (OR 0.68, CI 0.42-0.91, P = .003) on average. Long-term insulin independence was also associated with transplanted IEQ per kg. No patient on antihyperglycemic medication before surgery achieved insulin independence.
Conclusion
Short- and long-term insulin independence after TPIAT is associated with higher transplanted IEQ per kg and immediate postoperative variables that can be used to inform the discussions clinicians have with their patients regarding glycemic prognosis following TPIAT.
研究目的本研究探讨了与全胰腺切除术和胰岛自体移植术(TPIAT)术后一年和长期胰岛素独立性相关的术前和术后变量:方法: 回顾性分析了2010年至2022年在一家医院系统就诊的46名TPIAT患者的病历。比较了短期(一年)和长期(一年外的最后一次随访)胰岛素依赖型和依赖型患者的术前和术后变量:结果:分别有九名(20%)和七名(15%)患者实现了短期和长期胰岛素独立。患者的随访时间中位数为 2.8 年(IQR 1.0 - 4.7)。短期胰岛素独立与较高的移植胰岛素当量中位数(IEQ/kg)(6,981 vs 4,493,P=0.02)、较低的出院基础胰岛素单位(7 vs 12,P=0.009)和较低的出院胰岛素方案使用率(67% vs 100%,P=0.006)有关。IEQ/kg每增加1000,胰岛素短期独立的几率增加80%(OR 1.80,CI 1.18至3.12,p=0.005),出院时胰岛素基础单位每增加一个,胰岛素短期独立的几率平均降低32%(OR 0.68,CI 0.42至0.91,p=0.003)。在单变量分析中,胰岛素的长期独立性也与移植 IEQ/kg 有关。没有一位术前服用降糖药的患者实现了胰岛素独立:结论:TPIAT术后短期和长期胰岛素独立性与较高的移植IEQ/kg和术后即刻变量有关,临床医生在与患者讨论TPIAT术后血糖预后时可借鉴这些变量。TPIAT 术后胰岛素的完全独立性仍然很低。
{"title":"Preoperative and Postoperative Predictors of Insulin Independence From Total Pancreatectomy and Islet Autotransplantation","authors":"","doi":"10.1016/j.eprac.2024.05.013","DOIUrl":"10.1016/j.eprac.2024.05.013","url":null,"abstract":"<div><h3>Objective</h3><p>This study examined the preoperative and postoperative variables associated with 1 year and long-term insulin independence following total pancreatectomy and islet autotransplantation (TPIAT).</p></div><div><h3>Methods</h3><p>46 TPIAT patients from 2010 to 2022 in a single hospital system were retrospectively analyzed. Pre- and postoperative variables were compared between short-term (1 year) and long-term (last follow-up after year 1) insulin-independent versus -dependent patients.</p></div><div><h3>Results</h3><p>Nine (20%) and seven (15%) patients achieved short- and long-term insulin independence, respectively. The patients were followed up for a median of 2.8 years (interquartile range [IQR] 1.0, 4.7). Short-term insulin independence was associated with higher median transplanted islet equivalents (IEQ) per kg (6981 vs 4493, <em>P</em> = .02), lower units of basal insulin on discharge (7 vs 12, <em>P</em> = .009), and lower rates of discharge with an insulin regimen (67% vs 100%, <em>P</em> = .006). Odds of short-term insulin independence increased by 80% for every 1000 increase in IEQ per kg (OR 1.80, CI 1.18-3.12, <em>P</em> = .005) and decreased by 32% for every additional basal unit of insulin on discharge (OR 0.68, CI 0.42-0.91, <em>P</em> = .003) on average. Long-term insulin independence was also associated with transplanted IEQ per kg. No patient on antihyperglycemic medication before surgery achieved insulin independence.</p></div><div><h3>Conclusion</h3><p>Short- and long-term insulin independence after TPIAT is associated with higher transplanted IEQ per kg and immediate postoperative variables that can be used to inform the discussions clinicians have with their patients regarding glycemic prognosis following TPIAT.</p></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1530891X24005500/pdfft?md5=d24255354d2a7ad2fa7c8ccb065d32a5&pid=1-s2.0-S1530891X24005500-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: In male congenital hypogonadotropic hypogonadism (CHH), it was observed that lower dose human gonadotropic hormone (hCG) can maintain normal intratesticular testosterone levels. We propose this study to compare the low-dose hCG, follicle stimulating hormone (FSH), and Testosterone (T) [LFT Regimen] to conventional treatment to induce virilization and fertility.
Design: This open-label randomized pilot study was conducted from June 2020 to December 2021.
Subjects and outcome measures: CHH were randomly assigned to either the LFT regimen (Group A)-low-dose hCG (500U thrice per week), FSH (150U thrice per week), and T(100 mg biweekly) or conventional therapy(GroupB) with high hCG dose(2000U thrice per week) and the same FSH dose. The hCG dosage was titrated to reduce anti-mullerian hormone (AMH) by 50% and normalization of plasma T in groups A and B, respectively. The primary objective was to compare the percentage of individuals who achieved spermatogenesis between the two groups.
Results: Out of 30 patients, 23 (76·7%) subjects achieved spermatogenesis, and the median time was 12 (9-14·9) months. There was no difference in achieving spermatogenesis between the two groups (64·3% vs 7·5%,P = 0·204), and even the median time for spermatogenesis was similar (15months vs 12months,P = 0·248). Both groups had nonsignificant median plasma AMH at spermatogenesis, [6·6 ng/ml (3·3-9·76) vs4·41 ng/ml (2·3-6·47), P = 0·298]. Similarly, the median plasma Inhibin B at spermatogenesis between groups were comparable [152·4 pg/ml (101·7-198·0) vs49·1 pg/ml (128·7-237·3), P = 0·488].
Conclusions: A reasonable approach to induce fertility in male CHH is to initiate combination therapy using FSH, low-dose hCG targeting AMH <6·9 ng/ml, along with T to achieve normal range. Monitoring AMH could serve as a proxy indicator of spermatogenesis.
研究目的在男性先天性性腺功能减退症(CHH)中,观察到低剂量的人类促性腺激素(hCG)可以维持正常的睾丸内睾酮(ITT)水平。我们建议本研究比较低剂量促性腺激素(hCG)、促卵泡激素(FSH)和睾酮(T)[LFT方案]与常规治疗,以诱导男性化和生育:这项开放标签随机试验研究于2020年6月至2021年12月进行:受试者被随机分配到LFT方案(A组)--低剂量hCG(500U,每周三次)、FSH(150U,每周三次)和T(100mg,每两周一次)或常规治疗(B组)--高剂量hCG(2000U,每周三次)和相同剂量的FSH。A组和B组的hCG剂量分别控制在抗苗勒氏管激素(AMH)降低50%和血浆T正常的水平。主要目的是比较两组实现精子发生的比例:结果:30 名患者中,23 人(76-7%)实现了生精,中位时间为 12(9-14-9)个月。两组患者的生精率没有差异(64-3%vs87-5%,P=0-204),甚至生精的中位时间也相似(15个月vs12个月,P=0-248)。两组患者精子发生时的血浆 AMH 中位数均无显著差异(6-6ng/ml(3-3-9-76) vs 4-41ng/ml(2-3-6-47),P=0-298)。同样,各组精子发生时的血浆抑制素 B 中位数也相当[152-4pg/ml(101-7-198-0)vs149-1pg/ml(128-7-237-3),p=0-488]:诱导男性CHH生育的合理方法是使用FSH、小剂量hCG和AMH联合治疗。
{"title":"Effect of Combined Low Dose Human Gonadotropic Hormone , Follicle Stimulating Hormone, and Testosterone Therapy (LFT Regimen) Versus Conventional High Dose Human Gonadotropic Hormone and Follicle Stimulating Hormone on Spermatogenesis and Biomarkers in Men With Hypogonadotropic Hypogonadism.","authors":"Nikhil Singhania, Konsam Biona Devi, Japleen Kaur, Anil Bhansali, Ujjwal Gorsi, Naresh Sachdeva, Sunil Arora, Ashutosh Rai, Rama Walia","doi":"10.1016/j.eprac.2024.07.007","DOIUrl":"10.1016/j.eprac.2024.07.007","url":null,"abstract":"<p><strong>Objective: </strong>In male congenital hypogonadotropic hypogonadism (CHH), it was observed that lower dose human gonadotropic hormone (hCG) can maintain normal intratesticular testosterone levels. We propose this study to compare the low-dose hCG, follicle stimulating hormone (FSH), and Testosterone (T) [LFT Regimen] to conventional treatment to induce virilization and fertility.</p><p><strong>Design: </strong>This open-label randomized pilot study was conducted from June 2020 to December 2021.</p><p><strong>Subjects and outcome measures: </strong>CHH were randomly assigned to either the LFT regimen (Group A)-low-dose hCG (500U thrice per week), FSH (150U thrice per week), and T(100 mg biweekly) or conventional therapy(GroupB) with high hCG dose(2000U thrice per week) and the same FSH dose. The hCG dosage was titrated to reduce anti-mullerian hormone (AMH) by 50% and normalization of plasma T in groups A and B, respectively. The primary objective was to compare the percentage of individuals who achieved spermatogenesis between the two groups.</p><p><strong>Results: </strong>Out of 30 patients, 23 (76·7%) subjects achieved spermatogenesis, and the median time was 12 (9-14·9) months. There was no difference in achieving spermatogenesis between the two groups (64·3% vs 7·5%,P = 0·204), and even the median time for spermatogenesis was similar (15months vs 12months,P = 0·248). Both groups had nonsignificant median plasma AMH at spermatogenesis, [6·6 ng/ml (3·3-9·76) vs4·41 ng/ml (2·3-6·47), P = 0·298]. Similarly, the median plasma Inhibin B at spermatogenesis between groups were comparable [152·4 pg/ml (101·7-198·0) vs49·1 pg/ml (128·7-237·3), P = 0·488].</p><p><strong>Conclusions: </strong>A reasonable approach to induce fertility in male CHH is to initiate combination therapy using FSH, low-dose hCG targeting AMH <6·9 ng/ml, along with T to achieve normal range. Monitoring AMH could serve as a proxy indicator of spermatogenesis.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723254","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}
Pub Date : 2024-07-25DOI: 10.1016/j.eprac.2024.07.011
Horatiu F Coman, Adriana Rusu, Norina A Gavan, Cosmina I Bondor, Alexandru D Gavan, Cornelia G Bala
Objective: The aim of this study was to evaluate the trends in the incidence of diabetic neuropathy (DN) and nondiabetic neuropathy (non-DN) in a hospital-based cohort between 2010 and 2019 in Romania.
Methods: We retrospectively analyzed cases with a primary or secondary discharge International Classification of Diseases, Tenth Revision, diagnosis code of neuropathy reported throughout Romania.
Results: A total of 1 725 729 hospitalizations with a diagnosis of neuropathy (DN, 769 324 - 44.6%, and non-DN, 956 405- 55.4%) were identified. Women accounted for more DN cases (40 0 936- 52.1%), and men accounted for more non-DN cases (63 7 968- 61.0%). The incidence rate showed an increasing trend during the index period, by a mean rate of 4.3%/year for non-DN and 1.4%/year for DN. Type 2 diabetes was responsible for the overall increase in the incidence rate of DN, whereas in type 1 diabetes, the incidence rate decreased; in both types of diabetes, diabetic polyneuropathy was predominant, whereas autonomic neuropathy had an incidence rate of 10 to 20 times lower than polyneuropathy. The incidence rates of non-DNs increased mainly due to inflammatory polyneuropathies (+3.8%) and uremic neuropathy (+10.3%).
Conclusion: Using a nationally representative database of hospital-admitted cases, we found that the incidence rates of DN and non-DN increased from 2010 to 2019. The main contributors were type 2 diabetes, inflammatory polyneuropathy, and uremic neuropathy.
{"title":"Recent Trends in Diabetic and Nondiabetic Neuropathies: A Retrospective Hospital-based Nationwide Cohort Study.","authors":"Horatiu F Coman, Adriana Rusu, Norina A Gavan, Cosmina I Bondor, Alexandru D Gavan, Cornelia G Bala","doi":"10.1016/j.eprac.2024.07.011","DOIUrl":"10.1016/j.eprac.2024.07.011","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the trends in the incidence of diabetic neuropathy (DN) and nondiabetic neuropathy (non-DN) in a hospital-based cohort between 2010 and 2019 in Romania.</p><p><strong>Methods: </strong>We retrospectively analyzed cases with a primary or secondary discharge International Classification of Diseases, Tenth Revision, diagnosis code of neuropathy reported throughout Romania.</p><p><strong>Results: </strong>A total of 1 725 729 hospitalizations with a diagnosis of neuropathy (DN, 769 324 - 44.6%, and non-DN, 956 405- 55.4%) were identified. Women accounted for more DN cases (40 0 936- 52.1%), and men accounted for more non-DN cases (63 7 968- 61.0%). The incidence rate showed an increasing trend during the index period, by a mean rate of 4.3%/year for non-DN and 1.4%/year for DN. Type 2 diabetes was responsible for the overall increase in the incidence rate of DN, whereas in type 1 diabetes, the incidence rate decreased; in both types of diabetes, diabetic polyneuropathy was predominant, whereas autonomic neuropathy had an incidence rate of 10 to 20 times lower than polyneuropathy. The incidence rates of non-DNs increased mainly due to inflammatory polyneuropathies (+3.8%) and uremic neuropathy (+10.3%).</p><p><strong>Conclusion: </strong>Using a nationally representative database of hospital-admitted cases, we found that the incidence rates of DN and non-DN increased from 2010 to 2019. The main contributors were type 2 diabetes, inflammatory polyneuropathy, and uremic neuropathy.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765744","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}
Pub Date : 2024-07-23DOI: 10.1016/j.eprac.2024.07.012
Bithika Thompson, Mary E Boyle, Janna C Castro, Christopher Dodoo, Curtiss B Cook
Objective: Automated insulin delivery (AID) systems are a rapidly growing component in the area of continuous subcutaneous insulin infusion (CSII) therapy. As more patients use these systems in the outpatient setting, it is important to assess safety if their use is allowed to continue in the inpatient setting.
Methods: Analysis was conducted of the records of patients using AID technology upon admission to our hospital between June 2020 and December 2022. Adverse events and glycemic control of AID users were compared with patients using non-AID systems and with patients who had CSII discontinued.
Results: There were 185 patients analyzed: 64 on AID, 86 on non-AID, and 35 who had CSII discontinued. The number of patients on AID increased over the course of the observation period, whereas non-AID users decreased. Pairwise comparisons indicated that patient-stay mean glucose levels and percentage of hypoglycemic events were similar between all groups, but the percentage of patient hyperglycemic measurements was significantly lower in the AID cohort. No adverse events (diabetic ketoacidosis, pump site complications, equipment malfunction) were reported in any either CSII cohort.
Conclusion: The type of CSII technology encountered in the hospital is shifting from non-AID toward AID technologies. This analysis supports earlier findings that outpatient AID systems can be successfully transitioned into the inpatient setting. Further study is needed to define if AID systems offer any advantage in glycemic control.
背景:自动胰岛素输送系统(AID)是持续皮下胰岛素输注(CSII)治疗领域中发展迅速的组成部分。随着越来越多的患者在门诊环境中使用这些系统,如果允许在住院环境中继续使用这些系统,那么对其安全性进行评估就显得非常重要:方法:对 2020 年 6 月至 2022 年 12 月期间入住本院时使用 AID 技术的患者记录进行分析。将 AID 使用者的不良事件和血糖控制情况与使用非 AID 系统的患者以及停用 CSII 的患者进行比较:结果:共分析了 185 名患者:64 名使用 AID 系统,86 名使用非 AID 系统,35 名停用 CSII。在观察期间,使用 AID 的患者人数有所增加,而非 AID 用户则有所减少。配对比较结果表明,所有组别患者在留期间的平均血糖水平和低血糖事件的百分比相似,但在 AID 组别中,患者高血糖测量值的百分比明显较低。两组 CSII 患者均未发生不良事件(糖尿病酮症酸中毒、泵部位并发症、设备故障):结论:医院使用的 CSII 技术类型正从非 AID 转向 AID 技术。这项分析支持了之前的研究结果,即门诊 AID 系统可以成功过渡到住院环境中。还需要进一步研究来确定 AID 系统在血糖控制方面是否具有优势。
{"title":"Automated Insulin Delivery Technology in the Hospital: Update on Safety and Efficacy Data.","authors":"Bithika Thompson, Mary E Boyle, Janna C Castro, Christopher Dodoo, Curtiss B Cook","doi":"10.1016/j.eprac.2024.07.012","DOIUrl":"10.1016/j.eprac.2024.07.012","url":null,"abstract":"<p><strong>Objective: </strong>Automated insulin delivery (AID) systems are a rapidly growing component in the area of continuous subcutaneous insulin infusion (CSII) therapy. As more patients use these systems in the outpatient setting, it is important to assess safety if their use is allowed to continue in the inpatient setting.</p><p><strong>Methods: </strong>Analysis was conducted of the records of patients using AID technology upon admission to our hospital between June 2020 and December 2022. Adverse events and glycemic control of AID users were compared with patients using non-AID systems and with patients who had CSII discontinued.</p><p><strong>Results: </strong>There were 185 patients analyzed: 64 on AID, 86 on non-AID, and 35 who had CSII discontinued. The number of patients on AID increased over the course of the observation period, whereas non-AID users decreased. Pairwise comparisons indicated that patient-stay mean glucose levels and percentage of hypoglycemic events were similar between all groups, but the percentage of patient hyperglycemic measurements was significantly lower in the AID cohort. No adverse events (diabetic ketoacidosis, pump site complications, equipment malfunction) were reported in any either CSII cohort.</p><p><strong>Conclusion: </strong>The type of CSII technology encountered in the hospital is shifting from non-AID toward AID technologies. This analysis supports earlier findings that outpatient AID systems can be successfully transitioned into the inpatient setting. Further study is needed to define if AID systems offer any advantage in glycemic control.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757868","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}
Pub Date : 2024-07-19DOI: 10.1016/j.eprac.2024.07.009
Lourdes Herrera-Quintana, Héctor Vázquez-Lorente, Almudena Carneiro-Barrera, Luis Gutiérrez-Rojas, Manuel J Castillo, Francisco J Amaro-Gahete
Objective: Mental health has emerged as a worldwide concern given the increasing incidence of anxiety and depression disorders in the last years. Cortisol and sex steroid hormones have been demonstrated to be important regulators of mental health processes in older adults. However, the evidence considering these integrated variables in apparently healthy middle-aged individuals has not been thoroughly addressed. The present study aimed to investigate the association of the plasma cortisol, testosterone, free testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS) levels with mental health in middle-aged adults.
Methods: This cross-sectional study included a cohort of 73 middle-aged adults aged 45 to 65 years (women, 53%). Plasma cortisol, testosterone, SHBG, and DHEAS were assessed using a competitive chemiluminescence immunoassay. Free testosterone was calculated from the total testosterone and SHBG. Self-reported depression severity, generic health-related quality of life, hope, satisfaction with life, and optimism-pessimism were evaluated using the Beck Depression Inventory-II (BDI-II), 36-Item Short-Form Health Survey, Adult Hope Scale, Satisfaction with Life Scale, and Life Orientation Test-Revised, respectively-with higher total scores of these scales indicating greater levels of these variables.
Results: The testosterone and free testosterone levels were inversely associated with the BDI-II values in men (all P ≤ .042). The cortisol levels were positively related with the Satisfaction with Life Scale scores, whereas the testosterone, free testosterone, SHBG, and DHEAS levels were negatively correlated with the BDI-II values in women (all P ≤ .045).
Conclusion: In summary, these results suggest that the increased levels of steroid hormones-within the normal values-are associated with better mental health in middle-aged adults.
{"title":"Is There a Relationship of Cortisol and Sex Steroid Hormones With Mental Health in Middle-Aged Adults? The FIT-AGEING Study.","authors":"Lourdes Herrera-Quintana, Héctor Vázquez-Lorente, Almudena Carneiro-Barrera, Luis Gutiérrez-Rojas, Manuel J Castillo, Francisco J Amaro-Gahete","doi":"10.1016/j.eprac.2024.07.009","DOIUrl":"10.1016/j.eprac.2024.07.009","url":null,"abstract":"<p><strong>Objective: </strong>Mental health has emerged as a worldwide concern given the increasing incidence of anxiety and depression disorders in the last years. Cortisol and sex steroid hormones have been demonstrated to be important regulators of mental health processes in older adults. However, the evidence considering these integrated variables in apparently healthy middle-aged individuals has not been thoroughly addressed. The present study aimed to investigate the association of the plasma cortisol, testosterone, free testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS) levels with mental health in middle-aged adults.</p><p><strong>Methods: </strong>This cross-sectional study included a cohort of 73 middle-aged adults aged 45 to 65 years (women, 53%). Plasma cortisol, testosterone, SHBG, and DHEAS were assessed using a competitive chemiluminescence immunoassay. Free testosterone was calculated from the total testosterone and SHBG. Self-reported depression severity, generic health-related quality of life, hope, satisfaction with life, and optimism-pessimism were evaluated using the Beck Depression Inventory-II (BDI-II), 36-Item Short-Form Health Survey, Adult Hope Scale, Satisfaction with Life Scale, and Life Orientation Test-Revised, respectively-with higher total scores of these scales indicating greater levels of these variables.</p><p><strong>Results: </strong>The testosterone and free testosterone levels were inversely associated with the BDI-II values in men (all P ≤ .042). The cortisol levels were positively related with the Satisfaction with Life Scale scores, whereas the testosterone, free testosterone, SHBG, and DHEAS levels were negatively correlated with the BDI-II values in women (all P ≤ .045).</p><p><strong>Conclusion: </strong>In summary, these results suggest that the increased levels of steroid hormones-within the normal values-are associated with better mental health in middle-aged adults.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733826","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}
Pub Date : 2024-07-18DOI: 10.1016/j.eprac.2024.07.010
Roger R Perry, Eric C Feliberti, Marybeth S Hughes
Objective: Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors.
Methods: Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included PNETs, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed.
Results: Surgery continues to have a major role in the treatment of sporadic functional and nonfunctional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for non-functional PNETs < 2 cm in size. Surgical decision-making in multiple endocrine neoplasia type 1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients.
Conclusions: Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery is essential to manage these patients.
{"title":"Management of Pancreatic Neuroendocrine Tumors: Surgical Strategies and Controversies.","authors":"Roger R Perry, Eric C Feliberti, Marybeth S Hughes","doi":"10.1016/j.eprac.2024.07.010","DOIUrl":"10.1016/j.eprac.2024.07.010","url":null,"abstract":"<p><strong>Objective: </strong>Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors.</p><p><strong>Methods: </strong>Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included PNETs, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed.</p><p><strong>Results: </strong>Surgery continues to have a major role in the treatment of sporadic functional and nonfunctional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for non-functional PNETs < 2 cm in size. Surgical decision-making in multiple endocrine neoplasia type 1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients.</p><p><strong>Conclusions: </strong>Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery is essential to manage these patients.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733827","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}
Objective: This study was designed to develop and validate a predictive model for assessing the risk of thyroid toxicity following treatment with immune checkpoint inhibitors.
Methods: A retrospective analysis was conducted on a cohort of 586 patients diagnosed with malignant tumors who received programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Logistic regression analyses were performed on the training set to identify risk factors of thyroid dysfunction, and a nomogram was developed based on these findings. Internal validation was performed using K-fold cross-validation on the validation set. The performance of the nomogram was assessed in terms of discrimination and calibration. Additionally, decision curve analysis was utilized to demonstrate the decision efficiency of the model.
Results: Our clinical prediction model consisted of 4 independent predictors of thyroid immune-related adverse events, namely baseline thyrotropin (TSH, OR = 1.427, 95%CI:1.163-1.876), baseline thyroglobulin antibody (TgAb, OR = 1.105, 95%CI:1.035-1.180), baseline thyroid peroxidase antibody (TPOAb, OR = 1.172, 95%CI:1.110-1.237), and baseline platelet count (platelet, OR = 1.004, 95%CI:1.000-1.007). The developed nomogram achieved excellent discrimination with an area under the curve of 0.863 (95%CI: 0.817-0.909) and 0.885 (95%CI: 0.827-0.944) in the training and internal validation cohorts respectively. Calibration curves exhibited a good fit, and the decision curve indicated favorable clinical benefits.
Conclusion: The proposed nomogram serves as an effective and intuitive tool for predicting the risk of thyroid immune-related adverse events, facilitating clinicians making individualized decisions based on patient-specific information.
研究目的本研究旨在开发并验证一个预测模型,用于评估免疫检查点抑制剂(ICIs)治疗后的甲状腺毒性风险:该研究对586例接受程序性细胞死亡1(PD-1)/程序性死亡配体1(PD-L1)抑制剂治疗的恶性肿瘤患者进行了回顾性分析。患者按 7:3 的比例随机分为训练组和验证组。对训练组进行逻辑回归分析,以确定甲状腺功能障碍的风险因素,并根据这些结果绘制了提名图。在验证集上使用 K 倍交叉验证进行内部验证。从区分度和校准方面对提名图的性能进行了评估。此外,还利用决策曲线分析(DCA)来证明模型的决策效率:我们的临床预测模型由四个独立的甲状腺免疫相关不良事件(irAEs)预测因子组成,即基线甲状腺素(TSH,OR=1.427,95%CI:1.163-1.876)、基线甲状腺球蛋白抗体(TgAb,OR=1.105,95%CI:1.035-1.180)、基线甲状腺过氧化物酶抗体(TPOAb,OR=1.172,95%CI:1.110-1.237)和基线血小板计数(PLT,OR=1.004,95%CI:1.000-1.007)。所开发的提名图具有极佳的区分度,在训练组和内部验证组中的曲线下面积(AUC)分别为 0.863(95%CI:0.817-0.909)和 0.885(95%CI:0.827-0.944)。校准曲线拟合良好,决策曲线显示了良好的临床效益:所提出的提名图是预测甲状腺虹膜AEs风险的有效而直观的工具,有助于临床医生根据患者的具体信息做出个体化决策。
{"title":"Development and Validation of a Prediction Model for Thyroid Dysfunction in Patients During Immunotherapy.","authors":"Qian Wang, Tingting Wu, Ru Zhao, Yuanqin Li, Xuetao Chen, Shanmei Shen, Xiaowen Zhang","doi":"10.1016/j.eprac.2024.07.006","DOIUrl":"10.1016/j.eprac.2024.07.006","url":null,"abstract":"<p><strong>Objective: </strong>This study was designed to develop and validate a predictive model for assessing the risk of thyroid toxicity following treatment with immune checkpoint inhibitors.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a cohort of 586 patients diagnosed with malignant tumors who received programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Logistic regression analyses were performed on the training set to identify risk factors of thyroid dysfunction, and a nomogram was developed based on these findings. Internal validation was performed using K-fold cross-validation on the validation set. The performance of the nomogram was assessed in terms of discrimination and calibration. Additionally, decision curve analysis was utilized to demonstrate the decision efficiency of the model.</p><p><strong>Results: </strong>Our clinical prediction model consisted of 4 independent predictors of thyroid immune-related adverse events, namely baseline thyrotropin (TSH, OR = 1.427, 95%CI:1.163-1.876), baseline thyroglobulin antibody (TgAb, OR = 1.105, 95%CI:1.035-1.180), baseline thyroid peroxidase antibody (TPOAb, OR = 1.172, 95%CI:1.110-1.237), and baseline platelet count (platelet, OR = 1.004, 95%CI:1.000-1.007). The developed nomogram achieved excellent discrimination with an area under the curve of 0.863 (95%CI: 0.817-0.909) and 0.885 (95%CI: 0.827-0.944) in the training and internal validation cohorts respectively. Calibration curves exhibited a good fit, and the decision curve indicated favorable clinical benefits.</p><p><strong>Conclusion: </strong>The proposed nomogram serves as an effective and intuitive tool for predicting the risk of thyroid immune-related adverse events, facilitating clinicians making individualized decisions based on patient-specific information.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616132","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}
Pub Date : 2024-07-09DOI: 10.1016/j.eprac.2024.07.004
Lakshmi Nagendra, Deep Dutta, Sunetra Mondal, Ashmita Yadav, Fatema Tuz Zahura Aalpona, A B M Kamrul-Hasan
{"title":"Reply to the Letter to the Editor, Endocrine Practice for \"Role of Teplizumab, a Humanized Anti-CD3 Monoclonal Antibody, in Managing Newly Diagnosed Type 1 Diabetes: An Updated Systematic Review and Meta-Analysis\".","authors":"Lakshmi Nagendra, Deep Dutta, Sunetra Mondal, Ashmita Yadav, Fatema Tuz Zahura Aalpona, A B M Kamrul-Hasan","doi":"10.1016/j.eprac.2024.07.004","DOIUrl":"10.1016/j.eprac.2024.07.004","url":null,"abstract":"","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589979","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}
Pub Date : 2024-07-09DOI: 10.1016/j.eprac.2024.07.002
Ida Karoline Bach Jensen, Caroline Borup Roland, Signe de Place Knudsen, Anne Dsane Jessen, Saud Abdulaziz Alomairah, Ole H Mortensen, Lennart J Friis-Hansen, Jane M Bendix, Stig Molsted, Bente Stallknecht, Tine D Clausen, Ellen Løkkegaard
Objective: Maternal blood lipid and glucose concentrations during pregnancy affect fetal growth and the risk of pregnancy and delivery complications. We aimed to investigate the effects of physical activity (PA) during pregnancy on maternal blood lipid and hemoglobin A1c (HbA1c) concentrations. We hypothesized that higher PA was associated with improved lipid profile and glycemic control.
Methods: In a secondary analysis of a randomized controlled trial, we included 216 pregnant women before week 15 + 0 and tested the effects of two different PA interventions throughout pregnancy compared to standard care on maternal blood lipid and HbA1c concentrations. Additionally, we investigated the effect of PA per se measured by an activity tracker. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, and HbA1c concentrations were measured at week ≤15 + 0, 28+0-6, 34+0-6, and at delivery (week 32 + 1 to 42 + 0). Effects of the interventions and PA per se were tested using linear mixed effects models and linear regression analyses, respectively.
Results: No effects of the PA interventions were detected on maternal lipids or HbA1c during pregnancy. In PA per se analyses, more minutes per week of moderate-to-vigorous intensity PA were associated with less increase in TC (-1.3E-04, P = .020) and LDL-C (-8.5E-05, P = .035) as pregnancy progresses. More active kilocalories were associated with less increase in TC (-5.5E-05, P < .001), HDL-C (-9.5E-06, P = .024), and LDL-C (-3.2E-05, P = .005).
Conclusion: Whilst there were no effects of offering PA interventions, higher PA was associated with reduced increases in TC, HDL-C, and LDL-C as pregnancy progressed.
目的孕期母体血脂和血糖浓度会影响胎儿的生长以及妊娠和分娩并发症的风险。我们旨在研究孕期体力活动(PA)对母体血脂和血红蛋白 A1c(HbA1c)浓度的影响。我们假设,较高的体力活动与血脂和血糖控制的改善有关:在一项随机对照试验的二次分析中,我们纳入了第 15+0 周前的 216 名孕妇,并测试了在整个孕期两种不同的 PA 干预方法与标准护理相比对孕妇血脂和 HbA1c 浓度的影响。此外,我们还调查了通过活动追踪器测量的 PA 本身的效果。总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL-C)、低密度脂蛋白胆固醇 (LDL-C)、甘油三酯和 HbA1c 的浓度分别在第 ≤15+0、28+0-6、34+0-6 周和分娩时(第 32+1 至 42+0 周)进行测量。分别使用线性混合效应模型和线性回归分析检验了干预措施和 PA 本身的效果:结果:未发现 PA 干预对孕期母体血脂或 HbA1c 有任何影响。在 PA 本身的分析中,随着妊娠的进展,每周进行更多分钟的中强度至高强度 PA 与 TC(-1.3E-04,p=0.020)和 LDL-C (-8.5E-05,p=0.035)的增加较少有关。更多的活跃千卡热量与较低的总胆固醇(-5.5E-05,P=0.035)的增加有关:虽然提供 PA 干预没有效果,但随着孕期的延长,较高的 PA 与总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇的增加减少有关。
{"title":"Effects of Physical Activity on Blood Lipids and Hemoglobin A1c in Healthy Pregnant Women: The FitMum Randomized Controlled Trial.","authors":"Ida Karoline Bach Jensen, Caroline Borup Roland, Signe de Place Knudsen, Anne Dsane Jessen, Saud Abdulaziz Alomairah, Ole H Mortensen, Lennart J Friis-Hansen, Jane M Bendix, Stig Molsted, Bente Stallknecht, Tine D Clausen, Ellen Løkkegaard","doi":"10.1016/j.eprac.2024.07.002","DOIUrl":"10.1016/j.eprac.2024.07.002","url":null,"abstract":"<p><strong>Objective: </strong>Maternal blood lipid and glucose concentrations during pregnancy affect fetal growth and the risk of pregnancy and delivery complications. We aimed to investigate the effects of physical activity (PA) during pregnancy on maternal blood lipid and hemoglobin A1c (HbA1c) concentrations. We hypothesized that higher PA was associated with improved lipid profile and glycemic control.</p><p><strong>Methods: </strong>In a secondary analysis of a randomized controlled trial, we included 216 pregnant women before week 15 + 0 and tested the effects of two different PA interventions throughout pregnancy compared to standard care on maternal blood lipid and HbA1c concentrations. Additionally, we investigated the effect of PA per se measured by an activity tracker. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, and HbA1c concentrations were measured at week ≤15 + 0, 28+0-6, 34+0-6, and at delivery (week 32 + 1 to 42 + 0). Effects of the interventions and PA per se were tested using linear mixed effects models and linear regression analyses, respectively.</p><p><strong>Results: </strong>No effects of the PA interventions were detected on maternal lipids or HbA1c during pregnancy. In PA per se analyses, more minutes per week of moderate-to-vigorous intensity PA were associated with less increase in TC (-1.3E-04, P = .020) and LDL-C (-8.5E-05, P = .035) as pregnancy progresses. More active kilocalories were associated with less increase in TC (-5.5E-05, P < .001), HDL-C (-9.5E-06, P = .024), and LDL-C (-3.2E-05, P = .005).</p><p><strong>Conclusion: </strong>Whilst there were no effects of offering PA interventions, higher PA was associated with reduced increases in TC, HDL-C, and LDL-C as pregnancy progressed.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589888","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}