Indian Journal of Endocrinology and Metabolism最新文献

Diabetes mellitus (DM) is a metabolic disorder that leads to the destruction of various tissues including bones. The pathogenesis of osteoporosis (OP) varies in DM due to many specific factors. DM increases the risk of fracture as well as post-fracture mortality. It is because of this fact that OP treatment should not be neglected in patients with DM. OP therapy comprises anabolic as well as anti-resorptive agents. Primary OP as observed in post-menopausal women is associated with high bone turnover, whereas OP in DM is a disease of low bone turnover. Therefore, anabolic agents seem to be quite promising in cases of OP in DM. Although the anti-fracture efficacy of these drugs is proven beyond any doubt in the general population without DM, evidence in persons with DM is limited. Among the anabolic agents, teriparatide has the most evidence in favor of its efficacy and safety in persons with DM. Studies evaluating other anabolic agents such as abaloparatide and romosozumab in diabetic osteopathy are scarce in the literature. Future studies specifically in both type 1 and type 2 DM populations are needed to evaluate the effects of osteoanabolic agents.

Introduction: Cortisol concentration is often estimated by competitive chemiluminescent immunoassays, which are prone to interference due to cross-reactivity. The extent of interference is inconsistent across different adrenal disorders and among different analyzers. Although liquid chromatography-mass spectrometry (LC-MS/MS) possesses better analytical specificity, it is not widely available. We aimed to compare cortisol values measured across four different analyzers across different adrenal disorders.

Methods: Cortisol concentrations were measured in the serum of patients with congenital adrenal hyperplasia (CAH) (n = 12), primary adrenal insufficiency (PAI) (n = 11), endogenous Cushing's syndrome (CS) (n = 6), adrenal incidentaloma (AI) (n = 8), and healthy subjects (HS) (n = 10) in the following analyzers: Advia Centaur XP (Siemens) (SACXP), Immulite1000 (Siemens) (SI1000), Cobas e411 (Roche) (RCe411), and Architect (Abbott)(AA).

Results: In CAH patients, a poor agreement was observed between SAC XP [median (IQR) 14.6 (4.7) μg/dL] and RC e411 [median (IQR) 4.6 (3.9) μg/dL] [ICC: -0.016, (-0.55, 0.55)]. The correlation was also poor between SAC XP and SI 1000 [ICC: 0.00, (0.558, 0.551)] as well as between SAC XP and AA [ICC: 0.089, (-0.488, 0.612)]. The agreement was good between RCe411, SI 1000 [median (IQR) 9.6 (3) μg/dL], and AA [median (IQR) 5.1 (3.4) μg/dL] platforms in the same group. Measured cortisol values correlated well across all analyzers in PAI, CS, AI, and HS.

Conclusions: Cortisol concentration demonstrated variable agreement among different analyzers in different adrenal disorders. In CAH, cortisol values measured by SAC XP poorly correlate with RC e411, SI 1000, and AA platforms. Reassessment in another analyzer therefore would be prudent to avoid devastating consequences of unrecognized hypocortisolism in this subset of patients. A good concordance was observed among platforms in other conditions.

Introduction: Inadvertent devascularisation or removal of parathyroid glands (PT) during thyroidectomy necessitates their autotransplantation after Frozen section (FS). FS is time-consuming, tedious and expensive, disrupts the pathology department and is not universally available. This study aimed to determine the ratio of aspartate aminotransferase to lactate dehydrogenase (AST/LDH) of PT extracts to differentiate it from fat, thyroid, and lymph node (LN).

Methods: This prospective study was conducted on all patients planned for any thyroid or parathyroid surgery. Intra-operatively, a 2.5 × 2.5 × 2.5 mm³ of the devascularised or inadvertently removed PT was excised, minced in 2 mL normal saline and the supernatant fluid was sent to the standard lab for AST/LDH estimation. The minced tissue was sent for histopathological examination for confirmation. Thyroid, LN and fat samples were taken as controls and analysed similarly. Parathyroid adenoma (PTA) was analysed separately.

Results: The mean AST/LDH ratios of PT (0.311 ± 0.176) were significantly higher than that of thyroid, fat and LN. A cut-off of ≥0.165 for PT had a sensitivity and specificity of 83.8% and 83.1% against thyroid tissue, 83.8% and 74% against fat, and 83.8% and 100% against LN. AST/LDH ratio of PTA was found to be 0.318.

Conclusion: AST/LDH ratio can be a simple, reliable, less labour-intensive method of identification of PT and can be a replacement for FS. The high specificity to differentiate an LN is clinically relevant in central compartment lymph node dissections with a higher probability of inadvertent removal or devascularisation of PT.

Introduction: The exponential increase in obesity is responsible for the increased prevalence of obstructive sleep apnoea (OSA). Weight loss is critical to improvement in OSA. Glucagon-like peptide-1 receptor (GLP1R) agonism-based therapies (GLP1RA-BT) have been associated with significant weight loss. Several randomized controlled trials have been published evaluating the use of GLP1RA-BT on OSA. However, the literature review revealed that no systematic review and meta-analysis (SRM) has been published evaluating the efficacy and safety of GLP1RA-BT in OSA.

Methods: Electronic databases were searched for studies documenting the use of GLP1RA-BT in OSA. The primary outcome was to evaluate the impact on the apnea-hypopnea index (AHI). Secondary outcomes were to evaluate the impact on percent change in AHI, Epworth Sleepiness Score, body weight, blood pressure, and side-effect profile.

Results: From initially screened 59 articles, data from 4 articles having 5 different randomized cohorts (937 patients) were analysed in this SRM. Use of GLP1RA-BT was associated with a significant reduction in AHI [MD-12.50 events/ hour (95% CI:-17.33 - -7.67); P < 0.001; I²=95%], percent-reduction in AHI [MD-52.17% (95% CI: -64.49 - -39.85); P < 0.001; I² = 0%], percent-reduction in body-weight [MD-12.46% (95% CI:-22.54 - -2.39); P < 0.001; I² = 99%] and systolic blood-pressure [MD -4.59 mm of Hg (95% CI:-6.61 - -2.58); P < 0.001; I² = 67%]. The considerable heterogeneity was because of greater improvement in outcomes withtirzepatide compared to liraglutide. The occurrence of nausea [RR4.23 (95% CI: 2.73-6.55); P < 0.001; I² = 0%], vomiting [RR4.22 (95% CI: 2.12-8.41); P < 0.001; I² = 0%], diarrhoea [RR2.81 (95% CI: 1.84-4.31); P < 0.001; I² = 0%], and constipation [RR4.51 (95% CI: 2.47-8.26); P < 0.001; I² = 0%] were significantly higher with GLP1RA-BT compared to placebo.

Conclusion: This SRM provides encouraging data on the use of GLP1RA-BT in improving different respiratory aspects of OSA and reducing body weight and blood pressure.

Introduction: India is referred to as the "Diabetes Capital of the World" with a weighted prevalence of diabetes of 11.4%. In addition to microvascular and macrovascular complications, musculoskeletal manifestations of diabetes mellitus (MMDMs) also cause significant pain, morbidity, and a decrease in quality of life. Previous studies in our country were from tertiary healthcare centres, and the actual community-based prevalence of MMDMs is unknown. The study aims to determine the prevalence of MMDMs and the factors associated with them in the Ernakulam district of Kerala.

Methods: A community-based cross-sectional study was done in 600 adults with diabetes in the Ernakulam district of Kerala. Cluster sampling was adopted. Through the probability proportional to sample size method, 20 clusters were identified with each having 30 participants. The study participants were clinically examined for various MMDMs.

Results: The prevalence of MMDMs was found to be 44.83%. Osteoarthritis knee emerged as the most prevalent MMDM involving 22% of the participants, followed by frozen shoulder, in 12.2%. Diabetic cheiroarthropathy, trigger finger, and carpal tunnel syndrome were noted in 6.7%, 4.7%, and 3.8% of participants, respectively. Multivariable analysis showed a significant association between MMDMs and increased BMI, higher socioeconomic status, longer duration of diabetes, and unsatisfactory physical activity.

Conclusion: This study highlights the need for regular musculoskeletal system assessment in patients with diabetes which needs to be made mandatory in clinical practice and also conducting screening for the same in the community level to prevent further complications and to improve quality of life.

Medical Science is ever-evolving, advancing and progressing for better understanding and management of diseases. However, despite these advancements and progression, even today we can find superstition, non-scientific thinking and supernatural beliefs influencing the way people think and behave to manage their diseases. Supernatural beliefs are beliefs in things that do not and cannot exist to the best of scientific knowledge, but which appear real to believers. Supernatural beliefs involve the acceptance of phenomena that transcend scientific understanding and can affect health behaviour and understanding. Endocrinology is the branch of science that deals with endocrine glands and hormones, which regulate mood, growth, development, metabolism and the way our organs work to maintain internal homeostasis. Supernatural beliefs may have an impact on endocrine health. So, in this review, we will discuss supernatural beliefs and endocrine health.

Previous studies have demonstrated that in certain medical conditions, fragility fractures tend to occur even at bone mineral density (BMD) levels that are in the nonosteoporotic range. This warrants the assessment of other factors beyond BMD that might confer an increased propensity to fracture. Hip structural analysis (HSA) is also performed by the DXA scanner and evaluates different variables pertaining to proximal hip geometry. Bone Strain Index (BSI) is another novel DXA-based tool that was recently developed to further assess bone health. This has been based on a finite element analysis of grey scale images of density distribution of the femoral and lumbar spine scans obtained from a DXA scanner. Preliminary studies assessing the utility of BSI in predicting fragility fractures have been promising. This review will focus on the technical details and utility of the HSA and BSI beyond conventional BMD assessment.

Introduction: Studies on diagnostic accuracy of revised ACR-TIRADS have been mostly retrospective and includes selection bias for surgery.

Methods: Consecutive subjects >12 years of age, with palpable or ultrasound-revealed thyroid nodule, were included in the study. Nodules of size >1 cm or TIRADS score 4 or 5 >5 mm underwent ultrasound-guided FNAC. All Bethesda 4, 5 and 6 nodules underwent thyroidectomy. Patients with Bethesda 3 nodules were given options of close follow up or surgery.

Results: There were 253 benign (Bethesda 2), 23 malignant (Bethesda 6) and 41 indeterminate (Bethesda 3,4,5) nodules. Among 41 indeterminate nodules, 19 underwent surgery of which 14 were malignant. 295 nodules had a definitive outcome (defined as final outcome variable); which could be a benign cytology report or a histopathology report. Proportion of thyroid cancer was 12.5%. ACR-TIRADS had a sensitivity of 100% and specificity of 60.5%, considering final outcome variable as gold standard and ACR-TIRADS 1-3 as test negative and score 4-5 positive. Lower age and higher serum TSH level were associated with malignancy (P < 0.05). Predictive scoring system was formulated with age, TSH, ACR-TIRADS and Bethesda. Cumulative score of 6 (IQR 4.5- 6.5) or above had a sensitivity and specificity of 96.2%, and 97.5% respectively and negative predictive value of 99.5%.

Conclusion: Owing to high sensitivity, ACR-TIRADS can be considered as a good tool to rule-out malignancy, but not to predict the same due to lower specificity. Cumulative scoring system had high diagnostic accuracy for prediction of malignancy risk and can be a useful tool for selecting nodules for surgery.