Hypercalcemia of malignancy is a risk factor for mortality in patients with malignancies. Although the parathyroid hormone-related protein (PTHrP) secreted by tumor cells induces hypercalcemia, the association between serum PTHrP levels and mortality remains unclear. This study aimed to investigate the association between serum PTHrP levels and mortality in patients with malignancies.
Methods
We included patients with hypercalcemia (>10 mg/dL) and elevated PTHrP levels (>1.1 pmol/L) and analyzed mortality (overall survival after cancer diagnosis, PTHrP measurement, and 5-year survival rate). Moreover, using Cox proportional hazard model analysis, we investigated the impact of PTHrP levels on survival prognosis, assessing whether this effect varied depending on calcium concentration.
Results
We analyzed the data of 183 patients. The median PTHrP level, corrected calcium level, and age were 5.5 (3.0-10.6) pmol/L, 12.5 (11.5-13.4) mg/dl, and 70 (61-76) years, respectively. PTHrP was significantly and linearly associated with serum calcium levels (correlation coefficient, 0.06; 95% CI: 0.039-0.081, t: 5.69; P < .001). The group with the highest PTHrP levels had significantly worse survival rates than the group with the lowest PTHrP levels (hazard ratio: 1.68, 95% CI 1.03-2.77, P = .038).
Conclusion
This study showed an association between PTHrP and mortality in patients with malignancy after adjusting for serum calcium levels.
{"title":"Association Between Parathyroid Hormone-Related Peptide Levels and Mortality in Patients With Malignancy","authors":"Ai Kimura MD, Kazuhiko Kato MD, Akio Nakashima MD, PhD, Yukio Maruyama MD, PhD, Ichiro Ohkido MD, PhD, Yoichi Miyazaki MD, PhD, Takashi Yokoo MD, PhD","doi":"10.1016/j.eprac.2024.09.003","DOIUrl":"10.1016/j.eprac.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Hypercalcemia of malignancy is a risk factor for mortality in patients with malignancies. Although the parathyroid hormone-related protein (PTHrP) secreted by tumor cells induces hypercalcemia, the association between serum PTHrP levels and mortality remains unclear. This study aimed to investigate the association between serum PTHrP levels and mortality in patients with malignancies.</div></div><div><h3>Methods</h3><div>We included patients with hypercalcemia (>10 mg/dL) and elevated PTHrP levels (>1.1 pmol/L) and analyzed mortality (overall survival after cancer diagnosis, PTHrP measurement, and 5-year survival rate). Moreover, using Cox proportional hazard model analysis, we investigated the impact of PTHrP levels on survival prognosis, assessing whether this effect varied depending on calcium concentration.</div></div><div><h3>Results</h3><div>We analyzed the data of 183 patients. The median PTHrP level, corrected calcium level, and age were 5.5 (3.0-10.6) pmol/L, 12.5 (11.5-13.4) mg/dl, and 70 (61-76) years, respectively. PTHrP was significantly and linearly associated with serum calcium levels (correlation coefficient, 0.06; 95% CI: 0.039-0.081, t: 5.69; <em>P</em> < .001). The group with the highest PTHrP levels had significantly worse survival rates than the group with the lowest PTHrP levels (hazard ratio: 1.68, 95% CI 1.03-2.77, <em>P</em> = .038).</div></div><div><h3>Conclusion</h3><div>This study showed an association between PTHrP and mortality in patients with malignancy after adjusting for serum calcium levels.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1119-1125"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264362","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.09.008
Jiaqi Fan MD , Mengyun Yao MD , Yuan Ma MD, PhD
Objective
To determine prevalence, trends, and subsequent outcomes of prediabetes defined by American Diabetes Association (ADA), World Health Organization (WHO), and International Expert Committee (IEC) criteria in the United States between 1999 and 2018.
Methods
Ten cycles of cross-sectional National Health and Nutrition Examination Survey data were included. Prediabetes was defined by ADA, WHO, and IEC criteria. Unadjusted or covariate adjusted prevalence and trends of prediabetes were estimated. Cox proportional regression model was performed to evaluate the association between prediabetes and all-cause, cardiovascular, or diabetes-related mortality.
Results
Among the 59 369 participants included (weighted mean age, 41.1 years; 48.7% male), the prevalence of prediabetes was 29.4% in ADA criteria, 16.3% in WHO criteria, and 5.0% in IEC criteria. The covariate adjusted prevalence of prediabetes defined by ADA criteria increased significantly in at least twofolds from 15.6% in 1999-2002 to 37.3% in 2015-2018 (P < .001). Similar significant increased trends were observed in WHO and IEC criteria (P < .001). Compared with normal glycemia, prediabetes participants had higher adjusted risk of diabetes-related mortality irrespective of the criteria used (ADA: hazard ratio [HR] 9.11 [95% CI, 5.83-14.22]; WHO: HR 5.35 [95% CI, 3.01-9.51]; IEC: HR 9.64 [95% CI, 5.92-15.71]). No significant associations between prediabetes and all-cause or cardiovascular mortality were observed in the adjusted models.
Conclusion
In the United States, approximately 1 in 3 individuals have prediabetes according to ADA criteria. The prevalence of prediabetes has shown a significant and more than twofold increase over the past 2 decades, posing an elevated risk of diabetes-related mortality, regardless of the criteria applied.
{"title":"Prevalence, Trends, and Subsequent Outcomes of Prediabetes in the United States, 1999-2018","authors":"Jiaqi Fan MD , Mengyun Yao MD , Yuan Ma MD, PhD","doi":"10.1016/j.eprac.2024.09.008","DOIUrl":"10.1016/j.eprac.2024.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>To determine prevalence, trends, and subsequent outcomes of prediabetes defined by American Diabetes Association (ADA), World Health Organization (WHO), and International Expert Committee (IEC) criteria in the United States between 1999 and 2018.</div></div><div><h3>Methods</h3><div>Ten cycles of cross-sectional National Health and Nutrition Examination Survey data were included. Prediabetes was defined by ADA, WHO, and IEC criteria. Unadjusted or covariate adjusted prevalence and trends of prediabetes were estimated. Cox proportional regression model was performed to evaluate the association between prediabetes and all-cause, cardiovascular, or diabetes-related mortality.</div></div><div><h3>Results</h3><div>Among the 59 369 participants included (weighted mean age, 41.1 years; 48.7% male), the prevalence of prediabetes was 29.4% in ADA criteria, 16.3% in WHO criteria, and 5.0% in IEC criteria. The covariate adjusted prevalence of prediabetes defined by ADA criteria increased significantly in at least twofolds from 15.6% in 1999-2002 to 37.3% in 2015-2018 (<em>P</em> < .001). Similar significant increased trends were observed in WHO and IEC criteria (<em>P</em> < .001). Compared with normal glycemia, prediabetes participants had higher adjusted risk of diabetes-related mortality irrespective of the criteria used (ADA: hazard ratio [HR] 9.11 [95% CI, 5.83-14.22]; WHO: HR 5.35 [95% CI, 3.01-9.51]; IEC: HR 9.64 [95% CI, 5.92-15.71]). No significant associations between prediabetes and all-cause or cardiovascular mortality were observed in the adjusted models.</div></div><div><h3>Conclusion</h3><div>In the United States, approximately 1 in 3 individuals have prediabetes according to ADA criteria. The prevalence of prediabetes has shown a significant and more than twofold increase over the past 2 decades, posing an elevated risk of diabetes-related mortality, regardless of the criteria applied.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1126-1133"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282264","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.09.017
Yutong Wang MBBCH , Shirui Wang MD , Siyu Liang MD , Xinke Zhou MBBCH , Xiaoyuan Guo MBBCH , Bochuan Huang MBBCH , Hui Pan MD , Huijuan Zhu MD , Shi Chen MD
Objective
Copeptin, the C-terminal glycopeptide of provasopressin, is released into the circulation in an equimolar manner with arginine vasopressin (AVP) when fluid homeostasis changes or has somatic stress. Copeptin is considered a potential alternative to AVP due to its advantages in facilitating assays. Although there have been several studies and reviews that have focused on the marker potential of copeptin in diseases involving changes in AVP, studies on its characteristics and factors that may influence its secretion have not been reviewed before.
Methods
We summarize the influencing factors associated with copeptin levels in healthy and disease states, show the changes in copeptin levels under different physiologic and pathophysiologic conditions, calculate the changes in copeptin levels under different physiologic and pathophysiologic conditions, and compare them according to the type of stimuli. We also report research advances in copeptin changes in the diagnosis and prognosis of endocrine-related diseases.
Results
Males have higher copeptin levels. Decreased copeptin levels are mainly caused by reduced blood volume and some diseases (eg, obesity). Under normal physiologic conditions, the effects of stress, endocrine axis stimulation, and blood volume increase on copeptin levels gradually increase. Under severe disease conditions (eg, sepsis), copeptin would remain at consistently high levels under compound stimuli and these elevated levels are associated with a poor prognosis of the disease.
Conclusion
Summarizing the influencing factors of copeptin can help us better understand the biologic features of copeptin and the similarities and differences between AVP and copeptin.
{"title":"Impact Factors of Blood Copeptin Levels in Health and Disease States","authors":"Yutong Wang MBBCH , Shirui Wang MD , Siyu Liang MD , Xinke Zhou MBBCH , Xiaoyuan Guo MBBCH , Bochuan Huang MBBCH , Hui Pan MD , Huijuan Zhu MD , Shi Chen MD","doi":"10.1016/j.eprac.2024.09.017","DOIUrl":"10.1016/j.eprac.2024.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>Copeptin, the C-terminal glycopeptide of provasopressin, is released into the circulation in an equimolar manner with arginine vasopressin (AVP) when fluid homeostasis changes or has somatic stress. Copeptin is considered a potential alternative to AVP due to its advantages in facilitating assays. Although there have been several studies and reviews that have focused on the marker potential of copeptin in diseases involving changes in AVP, studies on its characteristics and factors that may influence its secretion have not been reviewed before.</div></div><div><h3>Methods</h3><div>We summarize the influencing factors associated with copeptin levels in healthy and disease states, show the changes in copeptin levels under different physiologic and pathophysiologic conditions, calculate the changes in copeptin levels under different physiologic and pathophysiologic conditions, and compare them according to the type of stimuli. We also report research advances in copeptin changes in the diagnosis and prognosis of endocrine-related diseases.</div></div><div><h3>Results</h3><div>Males have higher copeptin levels. Decreased copeptin levels are mainly caused by reduced blood volume and some diseases (eg, obesity). Under normal physiologic conditions, the effects of stress, endocrine axis stimulation, and blood volume increase on copeptin levels gradually increase. Under severe disease conditions (eg, sepsis), copeptin would remain at consistently high levels under compound stimuli and these elevated levels are associated with a poor prognosis of the disease.</div></div><div><h3>Conclusion</h3><div>Summarizing the influencing factors of copeptin can help us better understand the biologic features of copeptin and the similarities and differences between AVP and copeptin.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1197-1205"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364894","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.10.011
Michael F. Holick PhD, MD
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。
{"title":"Revisiting Vitamin D Guidelines: A Critical Appraisal of the Literature","authors":"Michael F. Holick PhD, MD","doi":"10.1016/j.eprac.2024.10.011","DOIUrl":"10.1016/j.eprac.2024.10.011","url":null,"abstract":"<div><h3>Background/Objective</h3><div>The goal of this review is to compare the 2024 and 2011 Endocrine Society’s Clinical Practice Guidelines on vitamin D<sub>2</sub> or vitamin D<sub>3</sub> (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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1227-1241"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563996","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.08.012
Li Li MD , Xiaoxia Ding MD , Xihui Zhang MD , Shuangming Kong MD , Ming Chen MD
Objective
Thyroid immune-related thyrotoxicosis is one of the most common adverse effects in patients treated with programmed cell death protein-1 (PD-1) inhibitors. We investigated the significance of levels of serum anti-thyroglobulin antibodies (TgAbs), anti-thyroid peroxidase antibodies (TPOAbs), and thyroid-stimulating hormone receptor antibodies (TRAbs) in the identification of anti-PD-1-induced thyroid thyrotoxicosis.
Methods
We divided 161 patients with thyroid dysfunction who received PD-1 inhibitors at our hospital between January 2022 and June 2024 into 3 groups: primary hypothyroidism group, primary hyperthyroidism group, and destructive thyroiditis group. The characteristics of the 3 groups were determined, and the positivity rates of serum TgAbs, TPOAbs, and TRAbs were assessed. An additional 42 patients diagnosed with Hashimoto’s thyroiditis were selected as the control group for PD-1 inhibition-induced destructive thyroiditis. Age, sex, and time of transition from thyrotoxicosis to hypothyroidism in the 2 groups were compared.
Results
In the primary hypothyroidism group, only 1 case was TPOAbs-positive (1/1%). In the destructive thyroiditis group, the positivity rate for TPOAbs or TgAbs was 92.9%, and TPOAbs and TgAbs were negative in the primary hyperthyroidism group. TRAbs were undetectable in all 3 groups. There were statistically significant differences in age, sex, and time from thyrotoxicosis to hypothyroidism in the PD-1 induced destructive thyroiditis and Hashimoto’s thyroiditis groups.
Conclusions
In patients with thyrotoxicosis caused by PD-1 inhibitors, serum TgAb, and TPOAb levels can be used to distinguish between primary hyperthyroidism and destructive thyroiditis. This study provides insights into novel treatment targets and effective management strategies for PD-1-induced thyrotoxicosis.
{"title":"Clinical Significance of Thyroid Autoantibodies in Differential Diagnosis and Predicting the Course of Programmed Cell Death Protein-1 Inhibitor-Induced Thyroid Dysfunction","authors":"Li Li MD , Xiaoxia Ding MD , Xihui Zhang MD , Shuangming Kong MD , Ming Chen MD","doi":"10.1016/j.eprac.2024.08.012","DOIUrl":"10.1016/j.eprac.2024.08.012","url":null,"abstract":"<div><h3>Objective</h3><div>Thyroid immune-related thyrotoxicosis is one of the most common adverse effects in patients treated with programmed cell death protein-1 (PD-1) inhibitors. We investigated the significance of levels of serum anti-thyroglobulin antibodies (TgAbs), anti-thyroid peroxidase antibodies (TPOAbs), and thyroid-stimulating hormone receptor antibodies (TRAbs) in the identification of anti-PD-1-induced thyroid thyrotoxicosis.</div></div><div><h3>Methods</h3><div>We divided 161 patients with thyroid dysfunction who received PD-1 inhibitors at our hospital between January 2022 and June 2024 into 3 groups: primary hypothyroidism group, primary hyperthyroidism group, and destructive thyroiditis group. The characteristics of the 3 groups were determined, and the positivity rates of serum TgAbs, TPOAbs, and TRAbs were assessed. An additional 42 patients diagnosed with Hashimoto’s thyroiditis were selected as the control group for PD-1 inhibition-induced destructive thyroiditis. Age, sex, and time of transition from thyrotoxicosis to hypothyroidism in the 2 groups were compared.</div></div><div><h3>Results</h3><div>In the primary hypothyroidism group, only 1 case was TPOAbs-positive (1/1%). In the destructive thyroiditis group, the positivity rate for TPOAbs or TgAbs was 92.9%, and TPOAbs and TgAbs were negative in the primary hyperthyroidism group. TRAbs were undetectable in all 3 groups. There were statistically significant differences in age, sex, and time from thyrotoxicosis to hypothyroidism in the PD-1 induced destructive thyroiditis and Hashimoto’s thyroiditis groups.</div></div><div><h3>Conclusions</h3><div>In patients with thyrotoxicosis caused by PD-1 inhibitors, serum TgAb, and TPOAb levels can be used to distinguish between primary hyperthyroidism and destructive thyroiditis. This study provides insights into novel treatment targets and effective management strategies for PD-1-induced thyrotoxicosis.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1166-1170"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105527","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.09.002
Yiran Jiang MD , Lihua Zhou MD , Cui Zhang MD , Tingwei Su MD , Lei Jiang MD , Weiwei Zhou MD , Xu Zhong MD , Luming Wu MD , Weiqing Wang MD
Objective
Mineralocorticoid receptor antagonists are the recommended medical therapy for bilateral primary aldosteronism (BPA). Patients with BPA have higher risk of cardiocerebrovascular disease (CCVD) than those with essential hypertension. There is no consensus on the criteria to assess the effectiveness of medical therapy for BPA. This study aimed to investigate the incidence of and risk factors for CCVD after medical therapy of BPA.
Methods
We conducted a retrospective cohort study including 240 patients with BPA treated with mineralocorticoid receptor antagonists. The posttreatment plasma renin activity (PRA) was defined as unsuppressed (PRA, ≥1 ng/mL/h); otherwise, it was defined as suppressed. We analyzed the association of posttreatment PRA status with CCVD outcomes.
Results
Of patients with BPA, 7.1% (17/240) developed CCVD at a median follow-up of 5.0 (range, 2.96-7.66) years. Moreover, 57.1% of patients had a PRA of ≥1 ng/mL/h after treatment. Patients with a PRA of <1 ng/mL/h had a higher incidence of CCVD (12.6% vs 2.9%, P < .05) and were at higher risk than those with a PRA of ≥1 ng/mL/h (hazard ratio, 4.50 [95% CI, 1.47-13.83; P < .05]; adjusted hazard ratio, 3.98 [95% CI, 1.22-13.02; P < .05]).
Conclusion
Patients with BPA who receive pharmacologic treatment have a high incidence of CCVD. PRA may be an indicator that mineralocorticoids are being adequately antagonized.
{"title":"Suppressed Renin Status Is a Risk Factor for Cardiocerebrovascular Events in Bilateral Primary Aldosteronism Treated With Mineralocorticoid Receptor Antagonists","authors":"Yiran Jiang MD , Lihua Zhou MD , Cui Zhang MD , Tingwei Su MD , Lei Jiang MD , Weiwei Zhou MD , Xu Zhong MD , Luming Wu MD , Weiqing Wang MD","doi":"10.1016/j.eprac.2024.09.002","DOIUrl":"10.1016/j.eprac.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>Mineralocorticoid receptor antagonists are the recommended medical therapy for bilateral primary aldosteronism (BPA). Patients with BPA have higher risk of cardiocerebrovascular disease (CCVD) than those with essential hypertension. There is no consensus on the criteria to assess the effectiveness of medical therapy for BPA. This study aimed to investigate the incidence of and risk factors for CCVD after medical therapy of BPA.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including 240 patients with BPA treated with mineralocorticoid receptor antagonists. The posttreatment plasma renin activity (PRA) was defined as unsuppressed (PRA, ≥1 ng/mL/h); otherwise, it was defined as suppressed. We analyzed the association of posttreatment PRA status with CCVD outcomes.</div></div><div><h3>Results</h3><div>Of patients with BPA, 7.1% (17/240) developed CCVD at a median follow-up of 5.0 (range, 2.96-7.66) years. Moreover, 57.1% of patients had a PRA of ≥1 ng/mL/h after treatment. Patients with a PRA of <1 ng/mL/h had a higher incidence of CCVD (12.6% vs 2.9%, <em>P</em> < .05) and were at higher risk than those with a PRA of ≥1 ng/mL/h (hazard ratio, 4.50 [95% CI, 1.47-13.83; <em>P</em> < .05]; adjusted hazard ratio, 3.98 [95% CI, 1.22-13.02; <em>P</em> < .05]).</div></div><div><h3>Conclusion</h3><div>Patients with BPA who receive pharmacologic treatment have a high incidence of CCVD. PRA may be an indicator that mineralocorticoids are being adequately antagonized.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1180-1187"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142187322","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}
Pub Date : 2024-12-01DOI: 10.1016/j.eprac.2024.09.013
Marieke Tienstra MSc , Janneke W. de Boer MD , Jaap A. van Doesum MD , Kylie Keijzer MSc , Linde M. Morsink MD , Carin L.E. Hazenberg MD , Emanuele Ammatuna MD, PhD , Gerwin A. Huls MD, PhD , Pratik Choudhary MD, PhD , Rijk O.B. Gans MD, PhD , Valerie R. Wiersma PhD , Tom van Meerten MD, PhD , Peter R. van Dijk MD, PhD
Objective
During intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care.
Methods
Patients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes).
Results
Hyperglycemia (glucose level, >10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid.
Conclusion
These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.
{"title":"High Frequency of Severe Hyperglycemia Observed During Intensive Hematologic Care: A Prospective Study Using Continuous Glucose Monitoring","authors":"Marieke Tienstra MSc , Janneke W. de Boer MD , Jaap A. van Doesum MD , Kylie Keijzer MSc , Linde M. Morsink MD , Carin L.E. Hazenberg MD , Emanuele Ammatuna MD, PhD , Gerwin A. Huls MD, PhD , Pratik Choudhary MD, PhD , Rijk O.B. Gans MD, PhD , Valerie R. Wiersma PhD , Tom van Meerten MD, PhD , Peter R. van Dijk MD, PhD","doi":"10.1016/j.eprac.2024.09.013","DOIUrl":"10.1016/j.eprac.2024.09.013","url":null,"abstract":"<div><h3>Objective</h3><div>During intensive hematologic care, patients are exposed to high-dose chemotherapy, corticosteroids, immunosuppressants, and total parenteral nutrition. Combined with physiologic stress and increased release of cytokines and hormones, this can lead to dysglycemia, which is associated with adverse clinical outcomes. This prospective study aimed to investigate continuous glucose monitoring (CGM) to identify dysglycemia during intensive hematologic care.</div></div><div><h3>Methods</h3><div>Patients receiving chimeric antigen receptor T-cell therapy or allogeneic or autologous stem cell transplantation were eligible. Throughout the study, glucose levels were concurrently monitored using CGM and point-of-care (POC) glucose measurements in 60 patients (71% male, median age of 64 [interquartile range, 58-68] years, and 10% with diabetes).</div></div><div><h3>Results</h3><div>Hyperglycemia (glucose level, >10 mmol/L) was prevalent in 93% of patients, of whom 90% had no history of diabetes. Severe hyperglycemia (glucose level, >13.1 mmol/L) was present in 38%. Additionally, hyperglycemia was associated with prolonged hospitalization in patients undergoing chimeric antigen receptor T-cell treatment (β, 0.19; 95% CI, 0.04-0.35) and autologous stem cell transplantation (β, 0.16; 95% CI, 0.01-0.32). CGM outperformed POC in detecting hyperglycemia (>10 mmol/L: 1060 vs 124, detected 2.8 [interquartile range, 0.7-4.0]) hours earlier. The mean absolute relative difference between CGM and POC was 21.5%, with 99.8% of measurements in the clinical acceptable zone A + B of the Clarke error grid.</div></div><div><h3>Conclusion</h3><div>These findings emphasize the potential and importance of glucose monitoring with CGM for improved and earlier detection of hyperglycemia, in this patient population, which seems feasible. Our results suggest a need for further studies into CGM as method to optimize glucose levels, which could improve outcomes in patients receiving intensive hematologic care.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1141-1148"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343891","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}
Pub Date : 2024-12-01DOI: 10.1016/j.eprac.2024.09.011
Juan Carlos Lizarzaburu-Robles MD , Alonso Garro-Mendiola MD , María Lazo-Porras PhD , Alba Galdón Sanz-Pastor MD , Flor Vento MD , Oscar Lorenzo PhD
Objective
To compare the 1-hour postload glucose (1h-PG) value of an oral glucose tolerance test (OGTT) with the metabolic syndrome (MetS) and the Finish Diabetes Risk Score (FINDRISC) in patients with impaired fasting glucose (IFG) to predict type 2 diabetes mellitus (T2DM).
Methods
A cohort study was conducted in patients at a general hospital in Lima, Perú. An OGTT was performed in subjects with IFG who were followed-up for 7 years for T2DM development. The exposure variables were 1h-PG ≥ 155 mg/dL, MetS, and a FINDRISC ≥ 13 points, and the outcome was the presence of T2DM. The relative risk, confidence interval, and area under the curve (AUROC) were also estimated.
Results
Among 324 subjects with IFG, 218 completed the 7-year follow-up. The mean age was 56.2 ± 11.5 years, 64.0% were woman, and 63.8% were overweight/obese. Of these, 36.8% had 1h-PG ≥ 155 mg/dL and normal glucose tolerance, 66.8% had MetS, and 64.5% had FINDRISC ≥ 13 points. After 7 years, 21.1% of participants developed T2DM, with 68.8% of them who had 1h-PG ≥ 155 mg/dL (P < .001), 62.2% had MetS (P = .013), and 67.9% had FINDRISC ≥ 13 (P = .68). After adjusting by age, sex, and body mass index, the relative risk was 3.52 (1.64-7.54; 95% CI), 1.81 (0.96-3.38; 95% CI), and 1.17 (0.51-2.70; 95% CI) for each exposure variable, respectively. Also, the AUROC was 0.72 (0.60-0.83), 0.63 (0.51-0.75), and 0.51 (0.38-0.63) (P = .01), respectively.
Conclusion
By performing an OGTT in patients with IFG, an 1h-PG ≥ 155 mg/dL value may be helpful to predict T2DM at 7 years better than the use of MetS or the FINDRISC.
{"title":"Assessment of 1-Hour Postload Plasma Glucose, the Metabolic Syndrome, and the Finish Diabetes Risk Score in the Prediction of Type 2 Diabetes","authors":"Juan Carlos Lizarzaburu-Robles MD , Alonso Garro-Mendiola MD , María Lazo-Porras PhD , Alba Galdón Sanz-Pastor MD , Flor Vento MD , Oscar Lorenzo PhD","doi":"10.1016/j.eprac.2024.09.011","DOIUrl":"10.1016/j.eprac.2024.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the 1-hour postload glucose (1h-PG) value of an oral glucose tolerance test (OGTT) with the metabolic syndrome (MetS) and the Finish Diabetes Risk Score (FINDRISC) in patients with impaired fasting glucose (IFG) to predict type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>A cohort study was conducted in patients at a general hospital in Lima, Perú. An OGTT was performed in subjects with IFG who were followed-up for 7 years for T2DM development. The exposure variables were 1h-PG ≥ 155 mg/dL, MetS, and a FINDRISC ≥ 13 points, and the outcome was the presence of T2DM. The relative risk, confidence interval, and area under the curve (AU<sub>ROC</sub>) were also estimated.</div></div><div><h3>Results</h3><div>Among 324 subjects with IFG, 218 completed the 7-year follow-up. The mean age was 56.2 ± 11.5 years, 64.0% were woman, and 63.8% were overweight/obese. Of these, 36.8% had 1h-PG ≥ 155 mg/dL and normal glucose tolerance, 66.8% had MetS, and 64.5% had FINDRISC ≥ 13 points. After 7 years, 21.1% of participants developed T2DM, with 68.8% of them who had 1h-PG ≥ 155 mg/dL (<em>P</em> < .001), 62.2% had MetS (<em>P</em> = .013), and 67.9% had FINDRISC ≥ 13 (<em>P</em> = .68). After adjusting by age, sex, and body mass index, the relative risk was 3.52 (1.64-7.54; 95% CI), 1.81 (0.96-3.38; 95% CI), and 1.17 (0.51-2.70; 95% CI) for each exposure variable, respectively. Also, the AU<sub>ROC</sub> was 0.72 (0.60-0.83), 0.63 (0.51-0.75), and 0.51 (0.38-0.63) (<em>P</em> = .01), respectively.</div></div><div><h3>Conclusion</h3><div>By performing an OGTT in patients with IFG, an 1h-PG ≥ 155 mg/dL value may be helpful to predict T2DM at 7 years better than the use of MetS or the FINDRISC.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1134-1140"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343889","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 : 2024-12-01DOI: 10.1016/j.eprac.2024.09.116
Mustafa Tosur MD , Saima Deen MD , Xiaofan Huang MS , Serife Uysal MD , Marcela Astudillo MD , Richard A. Oram PhD , Maria J. Redondo MD, PhD , Farook Jahoor PhD , Ashok Balasubramanyam MD
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.
{"title":"Random C-Peptide and Islet Antibodies at Onset Predict β Cell Function Trajectory and Insulin Dependence in Pediatric Diabetes","authors":"Mustafa Tosur MD , Saima Deen MD , Xiaofan Huang MS , Serife Uysal MD , Marcela Astudillo MD , Richard A. Oram PhD , Maria J. Redondo MD, PhD , Farook Jahoor PhD , Ashok Balasubramanyam MD","doi":"10.1016/j.eprac.2024.09.116","DOIUrl":"10.1016/j.eprac.2024.09.116","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = .002) and V2 (r = 0.47, <em>P</em> < .001). There were significant subgroup differences in age, race, frequency of diabetic ketoacidosis, and type 1 diabetes genetic risk score (<em>P</em> < .01). At V2, the 2 β-subgroups had lower UCPCR and higher hemoglobin A1c compared with the 2 β+ subgroups (<em>P</em> < .001 and <em>P</em> = .02, respectively). Thirty-eight percent of A-β+ but none of the other subgroups were insulin-independent at V2 (<em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":"30 12","pages":"Pages 1149-1157"},"PeriodicalIF":3.7,"publicationDate":"2024-12-01","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}
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