Indian Journal of Endocrinology and Metabolism最新文献

The significance of hypoglycaemia during oral glucose tolerance tests (OGTT) in pregnancy is uncertain. This systematic review and meta-analysis (SRM) evaluated if hypoglycaemia during OGTT predicts feto-maternal outcomes. Electronic databases were searched for studies in pregnancy where an OGTT at 24-28 weeks was done and feto-maternal outcomes were documented. Hypoglycaemia during OGTT (reactive hypoglycaemia) was defined as blood glucose < 90 mg/dl or less than the fasting-glucose value. Primary outcomes were the occurrence of small-for-gestational-age (SGA) and neonatal intensive-care unit (NICU) admission. Secondary outcomes were birthweight, macrosomia, large-for-gestational-age (LGA), gestational age at delivery (GA), 5-minute Apgar score (5AS), caesarean section (CS), and pregnancy-induced hypertension (PIH). Association of hypoglycaemia with pre-pregnancy maternal weight, maternal weight gain during pregnancy, and maternal age was noted. PRISMA guidelines were followed, and the preestablished protocol was registered on PROSPERO (CRD42025644556). From initially screened 448 articles, data from 13 articles involving 30,462 women were analysed. Compared to normoglycemia, hypoglycaemia during OGTT was associated with significantly higher SGA [OR1.81;95%CI1.31-2.50; P = .0003], higher NICU admission [OR 1.44; 95% CI 1.17-1.76; P < .001; I² = 0%], lower birthweight [MD-68.38g; 95%CI -126.25- -10.52; P = .020], lower macrosomia [OR 0.60;95%CI 0.42-0.86;P < .005], higher 5AS <8 [OR2.53;95%CI1.37-4.68; P = .003], lower CS [OR 0.82;95%CI0.75-0.90; P < .0001], lower maternal pre-pregnancy weight [MD -4.90 kg; 95%CI 9.17-0.62; P = .02; I ² = 75%] and higher gestational-hypertension [OR 1.31; 95%CI 1.03 -1.66;P = .030]. The rates of SGA, LGA, 5AS <8, and maternal age were similar in women with hypoglycaemia and gestational diabetes. Hypoglycaemia during OGTT is associated with gestational hypertension, lower birthweight, increased SGA, higher NICU admission, and higher 5AS <8. Lower maternal pre-pregnancy weight was a predictor of hypoglycaemia during OGTT.

Introduction: Glucocorticoid-induced adrenal insufficiency (AI) is underestimated and under-reported in children with nephrotic syndrome (NS). This study aimed to estimate the prevalence of AI in children with steroid-sensitive NS, defined by serum cortisol level <18 mcg/dL 30 minutes after low-dose adrenocorticotropin stimulation test (LDST) and/or baseline (8 AM) serum cortisol level <5 mcg/dL, 4-12 weeks after stopping steroid therapy.

Methods: In this cross-sectional study, 73 children with steroid-sensitive NS, in remission and off steroids for 4-12 weeks, were enrolled from the Paediatrics Department at a tertiary care hospital. Baseline (8 AM) serum cortisol was measured, and LDST was done using 1 mcg tetracosactide acetate intravenously. The proportion of AI was calculated. Clinical features of AI and steroid toxicity were noted, and the association between the two was analysed.

Results: Out of 73 children (45 males), 52 (71.2%, 95% confidence interval: 59.3%-80.9%) had AI as defined by serum cortisol level <18 mcg/dL 30 min after LDST and/or baseline (8 AM) serum cortisol level <5 mcg/dL at 4-12 weeks after completion of steroid therapy. A strong positive correlation was observed between 8 AM baseline serum cortisol levels and post-LDST serum cortisol levels. Children exhibiting features of steroid toxicity, such as cushingoid facies, had 4.96 times higher odds of having AI.

Conclusion: There remains a high risk of AI even 4-12 weeks after completion of alternate-day steroid therapy in children with NS. Clinical features of steroid toxicity may serve as useful predictors of AI.

Introduction: Menarche, a critical milestone in adolescent development, is influenced by genetic, socioeconomic, and lifestyle factors. While global trends indicate a secular decline in menarcheal age, region-specific data, particularly from North Karnataka, remain limited. This study estimates the age of menarche among adolescent schoolgirls in urban and rural areas of Belagavi, Karnataka, and explores the factors contributing to the occurrence of early menarche.

Methods: A cross-sectional study was conducted among 1,150 schoolgirls aged 12-16, equally distributed across urban and rural areas. Data on demographics, lifestyle factors, and pubertal milestones were collected via structured questionnaires. Anthropometric measurements were recorded, and body mass index (BMI) was classified using the Indian Academy of Pediatrics BMI growth chart for girls. Statistical analyses included t-tests, Analysis of variance, and Pearson correlation.

Results: The mean age at menarche was 12.15 years (95% confidence interval: 10.37-13.93), while the mean age at thelarche was 10.04 years (95% CI: 8.24-11.84). Overweight and obese girls exhibited significantly earlier thelarche and menarche compared to their normal-weight and underweight peers (P < 0.001). BMI negatively correlated with the ages of both thelarche and menarche (P < 0.001). Rural girls had slightly earlier thelarche than urban girls (P = 0.012), though no significant difference was noted in menarcheal age (P = 0.887), likely due to similar BMI percentiles in both groups. Dietary habits and physical activity showed no significant association with pubertal timing.

Conclusion: The mean menarcheal age in our study was 12.15 years (10.37-13.93) and the mean thelarcheal age was 10.04 years (8.24-11.84). BMI was identified as a significant factor influencing earlier puberty.

Introduction: Appropriate gonadotropin therapy regimen for the induction of spermatogenesis in congenital Hypogonadotropic Hypogonadism (HH) patients is a matter of debate. Pre-treatment with hCG is discouraged, while the rationale for FSH pre-treatment is that it mimics minipuberty, thereby being expected to be better than upfront combined hCG and FSH therapy.

Methods: A prospective RCT was conducted in the Department of Endocrinology of a tertiary centre. 24 azoospermic males between 17y and 40y of age with congenital HH were randomized into two groups. Group A (n = 12) received upfront combined hCG and FSH, while group B (n = 12) was given pre-treatment with FSH for 3 months, before addition of hCG.

Results: Patients were followed up for a maximum duration of 18 months. Overall success rate was 91.3% (21/23). In group A, 100% (12/12) responded to treatment compared with 81.8% (9/11) in group B, with significantly lesser median (IQR) time to spermatogenesis of 10.5 (9-12) months in group A, compared to 15 (13.5-16.5) months in group B (P = 0.007). Maximum sperm concentration [median (IQR)] attained in group A and B was 30 (15.5-47) million/mL and 20 (7.5-34.5) million/mL, respectively (P = 0.292). Sonographic bi-testicular volume (median) increased to 8.05 (7.13-10.57) mL in group A and 9.2 (5.45-14) mL in group B.

Conclusion: Both FSH pre-treatment and upfront combined hCG and FSH have a favourable outcome in initiating spermatogenesis in congenital HH, with the time to initiation of spermatogenesis favouring combined treatment.

Introduction: Hypopituitarism is a serious endocrine illness with life-threatening implications. There is a lack of reliable Indian epidemiological data, with very few studies on hypopituitarism across the country. Our research aimed to study the clinical profile of hypopituitarism in a tertiary care centre in Central India.

Methods: This was an ambispective study conducted at a tertiary care centre in Central India in General Medicine and Endocrinology OPDs and wards, including patients ≥18 years of age diagnosed with hypopituitarism between 01/07/19 and 30/06/23. The clinical, laboratory, and imaging data at the time of diagnosis was considered, and hormone deficiencies were defined as per the standard recommendations.

Results: The study included 54 patients diagnosed with hypopituitarism with a mean age of 37.6 ± 15.37 years at diagnosis (range: 18-75 years). It included 52% (n = 28) males and 48% (n = 26) females. Headache (50%, n = 27) was the most common initial presentation, followed by visual disturbance (40.7%, n = 22). Pituitary adenoma (42.6%, n = 23) constituted the most common aetiology of hypopituitarism in our study, followed by extrapituitary tumours (33.3%, n = 18). Sheehan's syndrome (14.8%, n = 8) was the third most common aetiology. Adrenocorticotropic hormone deficiency (90.5%, n = 48) was the most common abnormality noted, followed by thyroid-stimulating hormone (87%, n = 47) and growth hormone (GH) deficiency (70.6%, n = 12 [assessed in 17 patients]). Panhypopituitarism was seen in 59.2% (n = 32) of patients.

Conclusion: Hypopituitarism has diverse aetiologies and presentations. Pituitary and other sellar/suprasellar tumours constituted the most common cause of hypopituitarism in our study, while headache was the most common presentation.

Introduction: The use of oral glucose tolerance test (OGTT) is limited by an inconvenient procedure and poor reproducibility. This study aimed to develop and evaluate prediction models for gestational diabetes mellitus (GDM) diagnosis based on clinical and biochemical parameters.

Methods: An observational cross-sectional study was conducted among pregnant women aged 20-40 years in their second trimester (14-28 weeks) in Puducherry, South India, from May 2018 to March 2023. GDM was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Results: The study included 234 normoglycemic women and 115 GDM women. Model 1 comprised the biomarkers: fasting plasma insulin, serum sex hormone binding globulin (SHBG), homeostatic model assessment of insulin resistance (HOMA IR), and triglyceride glycemic index (TyG index) (area under the curve (AUC): 0.8870; 95% confidence interval (CI): 0.8440-0.9299; sensitivity: 80.87%; specificity: 86.32%); Model 2 incorporated the following clinical parameters: age, body mass index (BMI), gravida, parity, waist circumference, hip circumference, systolic and diastolic blood pressure, family history of GDM, family history of type 2 diabetes mellitus (T2DM), and family history of hypertension (AUC: 0.6846; 95% CI: 0.6269-0.7422; sensitivity: 90.43%; specificity: 31.6%); and Model 3 combined Models 1 and 2 (AUC: 0.9194; 95% CI: 0.8855-0.9531; sensitivity: 80.8%; specificity: 89.74%).

Conclusion: The predictive models highlighted in the study serve as effective screening tools for GDM and may help overcome the limitations of OGTT, particularly in settings where procedural challenges exist.

The prevalence of obesity has increased significantly in the last few years. Addressing obesity needs multifaceted strategy including prevention, accurate diagnosis, treatment of secondary causes, diet and exercise, behavioral changes and long term management. In addition it involves integration of multiple teams including endocrinologist, respiratory medicine, ENT, psychiatry, physiotherapy, diet, and bariatric surgeon. Artificial intelligence can help with each of these aspects by enabling predictive analysis, behavioral intervention in real time and improving patient outcome. There are certain challenges in integrating AI with patient management including ensuring data privacy and mitigating algorithm bias. But overall, it represents a promising tool to empower both the individual and the physician treating obesity.

Survodutide is a twincretin having dual glucagon-like peptide-1 and glucagon receptor agonist activity, conceptually based on endogenous peptide oxyntomodulin. This systematic review and meta-analysis (SRM) holistically analyzed the body weight lowering, glycemic efficacy, and safety of survodutide. Electronic databases were searched for RCTs involving diabetes and/or obesity patients receiving once-weekly subcutaneous survodutide in intervention arm and placebo/active comparator in control arm. Co-primary outcomes were the percent changes in body weight and HbA1c. Secondary outcomes were to evaluate absolute changes in absolute weight, blood pressure, fatty-liver disease parameters, and adverse events (AEs). Data from 3 RCTs (1088 patients) having follow-up duration ranging from 4-11 months were analyzed. Survodutide at 2.4 mg [MD (mean difference) -7.79% (95% confidence interval [CI]: -11.54, -4.07); I² = 98%; P < 0.01] and 3.6 mg [MD - 9.08% (95% CI: -11.63, -6.54); I² = 96%; P < 0.001] was associated with significantly greater percent reductions in body weight compared to placebo. The corresponding absolute body-weight reduction with survodutide 2.4 mg and 3.6 mg was - 9.14 kg (95% CI: -13.76, -4.53) and - 10.23 kg (95% CI: -15.43, -5.04), respectively. Survodutide of 2.4 mg was associated with significant HbA1c reduction [MD: -0.88% (95% CI - 1.72, -0.05); I² = 99%; P = 0.040]. Survodutide of 2.4 mg [odds ratio (OR): 2.93 (95% CI: 1.66, 5.18); I² = 0%; P < 0.001] and 3.6 mg [OR: 4.61 (95% CI: 2.33, 9.12); I² = 0%; P < 0.001] was associated with significantly higher treatment-emergent AEs, compared to placebo, although severe AEs were not increased. Gastrointestinal AEs were the predominant AEs and were dose dependent. Treatment discontinuation due to AEs was significantly higher with survodutide and was dose dependent. Survodutide demonstrates impressive weight and glucose-lowering properties over short-term clinical use. The optimal dose for clinical use ranges from 2.4 to 4.8 mg/week.