International Journal of Endocrinology最新文献

Objective: Polycystic ovary syndrome (PCOS) is one of the prevalent gynecological endocrine disorders encountered in clinical practice. Women diagnosed with PCOS demonstrate increased ovarian responsiveness, rendering them more prone to ovarian hyperstimulation syndrome (OHSS) during controlled ovarian stimulation (COS) procedures. The current study aimed at investigating whether CCL25/CCR9 plays a role in the pathological process of high ovarian response (HOR) during COS procedures.

Design: Single-center retrospective cohort study. Patients. A total of 200 PCOS patients who received a fixed regimen of gonadotropin-releasing hormone (GnRH) antagonist were enrolled in this study. The cohort comprised 118 patients exhibiting HOR and 82 patients demonstrating a normal ovarian response (NOR).

Results: The age and body mass index (BMI) variances across the two groups did not differ significantly. Similarly, the two groups observed no statistically significant differences in the baseline levels of luteinizing hormone (LH), progesterone (P), estradiol (E₂), basal prolactin (PRL), and testosterone (T). Compared to the NOR group, HOR patients exhibit markedly elevated levels of anti-Müllerian hormone (AMH), antral follicle count (AFC), basal follicle-stimulating hormone (FSH), and HOMA-IR (all p  <  0.05). Conversely, no statistically significant differences were observed between the two groups with respect to COS parameters, encompassing initial gonadotropin (Gn) dose, stimulation duration, and total Gn dose. During COS, the number of oocytes with diameter ≥14 mm, the levels of E₂ on the HCG day, and the number of retrieved oocytes were significantly higher in the HOR group than in the NOR group (all p < 0.001). Additionally, the levels of CCL25/CCR9, matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinases (TIMPs), TNF-α, and IL-6 were significantly higher in the FF of the HOR group than in the NOR group (all p < 0. 001), while the variance in IL-1β levels between the two cohorts did not reach statistical significance. The relevance analysis results indicated that the levels of CCL25/CCR9 in the FF of the HOR group are positively correlated with the number of retrieved oocytes and oocytes with diameters ≥14 mm during COS, AMH levels, and AFC. Concurrently, the CCL25 levels in the FF of the HOR group were positively correlated with HOMA-IR. Multivariable linear regression analysis revealed that the elevated AFC and HOMA-IR independently increase the CCL25 levels.

Conclusion: The CCL25/CCR9 levels in FF are positively correlated with the clinical indicators of HOR, suggesting that CCL25/CCR9 may play a role in the pathogenesis of HOR in patients with PCOS.

Objective: To understand whether TSH suppressive therapy affect short-term postoperative cancer-related depression and anxiety among DTC patients. To evaluate short-term postoperative psychological problems and its relationship with baseline parameters, fatigue, sleep quality, illness perception, and patients' quality of life. Study Design and Methods: This was a prospective, observational, single center study. This study involved 831 TC patients who consecutively admitted to the inpatient department of hospital between 1^st June 2020 and 31^th February 2021. Results: Mean scores of the self-rated anxiety scale (SAS) (49.04 vs. 40.69) and self-rated depression scale (SDS) (44.61 vs. 39.86), as well as the incidence of anxiety (41.5% vs. 22.1%) and depression (22.5% vs. 2.4%) significantly decreased 3 months after surgery. For personal and clinical characteristics, low educational background (SAS, β = 1.392; SDS, β = 1.622; and p < 0.05), without children (SAS, β = 4.068; SDS, β = 1.873, and p < 0.01), FNAC (SAS, β = -0.981; SDS, β = -2.583; and p < 0.05), and multifocal tumor (SAS, β = -1.287; SDS, β = -2.681; and p < 0.05) were the main effects for both short-term postoperative anxiety and depression. Multiple linear regression analysis identified the serum TSH level as a significant variable associated with worse SAS (Beta = -0.695 and p=0.043) and SDS (Beta = -3.133 and p < 0.001) scores 3 months after surgery. FT4 was independently associated with SAS scores (Beta = -0.202 and p < 0.001). Patients with middle ATA risk had a significantly higher level of SDS scores (p=0.033). Conclusion: We confirmed that cancer-related anxiety and depression among DTC patients significantly alleviated 3 months after surgery. TSH suppression therapy has profound effects on cancer-related anxiety and depression, and the degree of anxiety and depression significantly deteriorated with the decrease of TSH level.

Purpose: Metabolic syndrome (MetS) is closely related to insulin resistance (IR), and the sex differences have not been fully explored. This study was aimed to investigate the sex differences in the associations among IR indexes with MetS in a large population.

Methods: A total of 60,799 participants were enrolled in the current study. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The following IR indexes were evaluated: triglyceride-glucose (TyG) index, TyG-waist circumference (TyG-WC), TyG-waist to height ratio (TyG-WHtR), TyG-body mass index (TyG-BMI), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C), and metabolic score for IR (MetS-IR). Factors associated with MetS were examined using logistic regressions. The receiver operating characteristic curves were used to evaluate the predictive value of the IR indexes for MetS.

Results: The prevalence of MetS was 11.8% (n = 4097) for males and 5.4% (n = 1390) for females and increased with age in both subgroups. The IR index levels of male patients were higher than female patients (all p < 0.001). The IR indexes were independent risk factors for MetS except for TyG-WHtR and TG/HDL-C in female patients. TyG had the greatest area under the curve (AUC) (AUC, 0.930; 95% CI, 0.928-0.933; p < 0.001) in the male patients and TyG-WHtR (AUC, 0.916; 95% CI, 0.913-0.920; p < 0.001) in the female patients. The AUCs of 6 IR indexes combination were 0.960 (95% CI, 0.957-0.962; p < 0.001) and 0.962 (95% CI, 0.959-0.964; p < 0.001), with the sensitivities of 91.29% and 90.94%, the specificities of 88.27% and 89.51% in male and female groups, respectively.

Conclusions: The IR index levels are higher in male than female patients. In IR indexes, TyG has the highest AUC in male patients and TyG-WHtR in female patients. The combination of IR indexes improved diagnostic efficiency compared with a single parameter. Moreover, the IR indexes are independently associated with MetS except for TyG-WHtR and TG/HDL-C in female patients. Our findings indicate that the multi-index association of IR indexes may play a potential role in MetS diagnosis, and understanding the sex differences in risk factors for MetS may help doctors properly implement more individualized prevention strategies.

Objective: The metabolic effects of metabolic syndrome (MetS) on musculoskeletal metabolism are controversial. This study explored the effect of MetS on bone mineral density (BMD) and muscle quality index (MQI).

Methods: Data from the NHANES database from 2011 to 2014 were extracted, and nonpregnant participants aged 45-59 years were included. The included data were first weighted by complex sampling, and then, the effect of MetS on BMD and MQI was analyzed using multifactorial linear regression. We then performed a stratified analysis by gender and BMI classification. Moreover, a mediation analysis of MetS on BMD was conducted, with MQI as a mediating variable. A propensity score matching analysis method with a complex sampling design was additionally performed to verify the stability of the results.

Results: A total of 1943 participants were eventually included. After adjusting for covariates, the results of linear regression show that MetS is associated with elevated pelvic BMD (beta = 0.03; 95% CI = 0.01, 0.06; P=0.02) and reduced MQI, especially arm MQI (beta = -1.02; 95% CI = -1.27, -0.77; P < 0.0001). MetS is more associated with BMD in women, MQI in normal or heavyweight, and BMD in lightweight, according to stratified analysis. MQI explains the indirect effect of MetS on BMD (beta = 0.007; 95% CI = 0.003, 0.010).

Conclusion: This study provides evidence that MetS elevates BMD and reduces MQI, and further, that there is a mediating effect of MQI on elevated BMD.

Objective: Hashimoto's thyroiditis (HT), also known as chronic lymphocytic thyroiditis, represents the most prevalent autoimmune thyroid disorder globally. The potential influence of HT on the clinical and pathological attributes, as well as the clinical outcomes of differentiated thyroid carcinoma (DTC), remains a point of ongoing debate within the medical community. The central focus of this study was to analyze the influence of HT on clinico-pathological characteristics and its prognostic impact in a large cohort of DTC from Middle Eastern ethnicity. Design, Patients, Measurements. An extensive analysis involving 1822 DTC patients was conducted to determine the association with clinico-pathological characteristics as well as prognosis, using Chi-square tests and Kaplan-Meier curves.

Results: 23.9% (435/1822) of DTC patients were diagnosed with HT. Univariate analysis revealed a positive correlation between presence of HT and clinico-pathological factors such as female gender, younger age, and early stage tumor. In contrast, HT demonstrated a negative association with several aggressive clinical features, including extrathyroidal extension, distant metastasis, recurrent/persistent disease and high-risk categorization by the American Thyroid Association (ATA) guidelines. Despite HT being associated with favorable clinico-pathological features in Middle Eastern DTC patient, our study found no significant influence on overall survival or recurrence-free survival.

Conclusion: The finding of an association between HT and favorable clinico-pathological characteristics, but lack of impact on prognosis, underscores the complexity of HT-DTC relationship, necessitating further comprehensive research to fully understand these interactions.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are an intriguing class of antihyperglycemic drugs for type 2 diabetes mellitus (T2DM). Such drugs not only play a primary role in regulating blood glucose levels but also exhibit additional pleiotropic effects, including potential impacts on bone metabolism and fracture risk. However, the mechanism of such drugs is unclear. The purpose of this study was to evaluate the effect of GLP-1 RAs on bone metabolism in T2DM.

Methods: From database inception to May 1, 2023, the searches were conducted on multiple databases such as Web of Science, Embase, PubMed, CNKI, the Cochrane Library, Wanfang, and VIP. We systematically collected all randomized controlled trials of bone metabolism in patients with T2DM treated with GLP-1 RAs. The quality evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was analyzed using Review Manager 5.4 software, and funnel plots were drawn to evaluate publication bias.

Results: Twenty-six randomized controlled trials that met the inclusion criteria were included, involving a total of 2268 participants. In this study, compared to other antidiabetic drugs or placebo, GLP-1 RAs were found to significantly increase serum calcium (mean difference (MD) = 0.05, 95% confidence interval (CI) (0.01, 0.09), P = 0.002], bone alkaline phosphatase [standardized MD (SMD) = 0.76, 95% CI (0.29, 1.24), and P = 0.001), and osteocalcin (SMD = 2.04, 95% CI (0.99, 3.08), and P = 0.0001) in T2DM. Specifically, liraglutide increased procollagen type 1 N-terminal propeptide (SMD = 0.45, 95% CI (0.01, 0.89), and P = 0.04). GLP-1 RAs were also associated with a reduction in cross-linked C-terminal telopeptides of type I collagen (SMD = -0.36, 95% CI (-0.70, -0.03), and P = 0.03). In additionally, GLP-1 RAs increased lumbar spine bone mineral density (BMD) (SMD = 1.04, 95% CI (0.60, 1.48), and P < 0.00001) and femoral neck BMD (SMD = 1.29, 95% CI (0.36, 2.23), and P = 0.007).

Conclusions: GLP-1 RAs can not only improve BMD in the lumbar spine and femoral neck of patients with T2DM but also protect bone health by inhibiting bone resorption and promoting bone formation. Systematic Review Registration. PROSPERO, identifier CRD42023418166.

Objective: This study aimed to analyse the etiology and clinical characteristics of hypercalcemic crisis in a large cohort of Chinese patients and summarised our clinical experience in the management of this serious endocrinological emergency.

Methods: This was a retrospective analysis of a cohort of patients with hypercalcemic crisis hospitalized in the First Medical Center of Chinese PLA General Hospital between January 2009 and March 2024. The general data, clinical manifestations, etiology, photographic examination, emergency treatment, etiological treatment, and prognosis were analysed.

Results: A total of 155 patients with hypercalcemic crisis (91 males and 64 females) with a mean age of 54.60 ± 16.99 years old were enrolled. The most frequent disease-causing hypercalcemic crisis was hyperparathyroidism (41.94%), followed by solid malignancy (41.29%) and multiple myeloma (9.03%), et al. Patients mainly presented with symptoms of the digestive system (78.10%), nervous system (63.30%), skeletal system (59.60%), urinary system (59.50%), and cardiovascular system (34.90%). These 155 patients with hypercalcemic crisis got effective therapies that included simultaneous administration of intravenous injection (IV) isotonic saline, subcutaneous calcitonin, bisphosphonate, or hemodialysis in serious cases. After emergency treatment, all the symptoms in the patients were relieved obviously. The cure rate of hypercalcemic with etiological treatments was 84.50% (131/155).

Conclusion: Hypercalcemic crisis is a serious endocrinological emergency with a variety of etiologies and a high risk of mortality. A prompt diagnosis and the implementation of a comprehensive and effective treatment can efficiently alleviate this endocrinological emergency. Etiological treatment targeting different causes can improve prognosis significantly.

The majority of acromegaly and gigantism are caused by growth hormone-secreting pituitary neuroendocrine tumors (PitNETs). Most cases can be cured or controlled by surgery, medical therapy, and/or radiotherapy. However, a few of these tumors are resistant to traditional therapy and always have a poor prognosis. The title aggressive/refractory is used to differentiate them from pituitary carcinomas. To date, there is no definitive conclusion on how to diagnose aggressive/refractory growth hormone-secreting PitNETs, which may have slowed the process of exploring new therapeutical strategies. We summarized the literature described diagnosis and treatment of the disease. Potential disease markers and prospective therapies were also included.

Background: Obesity is recognized as a major public health issue worldwide, characterized by a growing prevalence among adult males. Several studies have identified an association between obesity and sex steroid hormone levels but only a few have considered the relationship between waist circumference (WC) and sex hormone levels in adult males. This study therefore aimed to evaluate the relationships between waist circumference (WC) and various sex steroid hormone levels in adult males in the United States.

Methods: This study analyzed data from 3,359 adult males aged 20 years and above, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013-2016 in the United States. We collected demographic data, including WC, and serum levels of testosterone, estradiol, SHBG, FAI, and T/E₂ ratio. We adjusted the variables using multiple linear regression models with R 4.2.2 and EmpowerStats.

Results: After adjusting for confounders, WC was found to be negatively associated with testosterone (β = -0.117, P < 0.001) but positively correlated with estradiol (β = 0.002, P=0.002), especially beyond a WC of 104.5 cm (β = 0.004, P < 0.001). Underweight individuals showed a contrasting positive correlation between WC and testosterone (β = 0.351, P=0.016). WC was inversely related to SHBG, particularly when WC was ≤99.1 cm (β = -0.036, P < 0.001). The FAI initially increased and then decreased with WC, peaking at 98.6 cm. The T/E₂ ratio negatively correlated with WC (β = -0.074, P < 0.001). These relationships varied among subgroups but remained unaffected by age or physical activity time.

Conclusions: Waist circumference is inversely correlated with testosterone, SHBG, and T/E₂ ratio but positively correlated with estradiol, except for a positive correlation with testosterone in underweight males. Waist circumference serves as a crucial anthropometric measurement indicator for predicting sex steroid hormone levels in adult males.

Familial glucocorticoid deficiency is caused by variants in the MC2R and MRAP genes. We report an Iranian patient with congenital glucocorticoid deficiency and cholestasis due to pathogenic variants in the MC2R gene. This is the first documented case of a patient with conditions. Clinical evaluations and lab assessments were conducted on a six-month-old male infant. Next-generation sequencing identified the genetic causes of the disease, and Sanger sequencing confirmed the variants through segregation analysis. The clinical presentation included prolonged jaundice, progressive skin hyperpigmentation, seizures, fever, and a large umbilical hernia. Two variants in the MC2R gene, c.560delT and c.676G > C, were detected and classified as pathogenic and likely pathogenic, respectively. The cooccurrence of cholestasis and glucocorticoid deficiency illustrates the clinical heterogeneity caused by MC2R variants. The prevalence of c.560delT and c.676G > C between Iranian populations suggests these variants may be common. The high frequency of c.560delT could be attributed to a founder effect.