International Journal of Endocrinology最新文献

Objective: Clinical features of primary hyperparathyroidism (PHPT) differ between developed and developing countries. In past decades, patterns of PHPT have changed while there are currently few data on large cohorts in Chinese. Therefore, this study aims to describe changes in clinical features of Chinese patients with PHPT.

Materials and methods: 685 patients with PHPT were collected and divided into several subgroups by time periods, symptoms, and pathological types. Clinical characteristics were compared among subgroups.

Results: Patients were divided into 177 cases (25.8%) in group A (2013-2018) and 508 cases (74.2%) in group B (2019-2024). Compared with group A, parathyroid hormone (PTH) was significantly lower and clinical manifestations were milder, and the percentage of asymptomatic patients was higher in group B. Bone pain (46.8%), nephrolithiasis (37.3%), and fatigue (36.2%) were the most common symptoms in symptomatic patients. Serum PTH, calcium, osteocalcin, and urine pH levels in symptomatic patients were higher than those in asymptomatic patients, while serum phosphate and bone density levels were lower. In addition, among 417 surgical patients, benign parathyroid tumor was in 373 cases (89.4%), atypical parathyroid tumor was in 34 cases (8.2%), and parathyroid carcinoma was in 10 cases (2.4%). Compared with benign PHPT, serum PTH, calcium, alkaline phosphatase, and bone turnover marker (BTM) levels were significantly increased, and serum phosphate level was decreased in malignant PHPT.

Conclusion: Clinical features of PHPT changed during 2013-2024 with remarkably increasing asymptomatic PHPT patients, whose clinical manifestations were milder, and complications were less.

Objective: The long-term outcomes of discontinuing thyroxine replacement therapy in patients with persistent hypothyroidism following subacute thyroiditis are unknown. This study involved an extended follow-up of a cohort of patients who participated in a clinical trial of prednisone for the treatment of subacute thyroiditis.

Methods: This retrospective cohort study included 52 patients with moderate to severe scores who were hospitalized between August 2013 and December 2014. Patients previously received prednisone for 1 week, followed by nonsteroidal anti-inflammatory drugs for 1 week, and prednisone was administered for 6 weeks, after which the patients completed follow-up to Week 24. Thyroid-stimulating hormone, free triiodothyronine, and free thyroxine levels of the participants were measured 9 years after enrollment.

Results: Of the 52 participants randomly assigned to receive prednisone for 1 or 6 weeks, 50 completed the core trial, and 48 were eligible for extended follow-up, with a median duration of 8.61 years (IQR 8.29-8.77). Thirty participants were assessed at 9 years, 15 could not be contacted, and three refused follow-up tests. Among the 30 participants, 28 were euthyroid and 2 had subclinical hypothyroidism at 9 years. The median TSH level was 3.46 mIU/L (IQR 2.12-5.15) at 24 weeks and 2.17 mIU/L (IQR 1.83-3.77) at 9 years (p = 0.001). The median FT4 level was 14.27 pmol/L (IQR 12.15-15.72) at 24 weeks and 15.28 pmol/L (IQR 12.53-16.22) at 9 years (p = 0.959). Among the three participants diagnosed with persistent hypothyroidism at 24 weeks, one participant was diagnosed with subclinical hypothyroidism without thyroxine replacement therapy at 9 years, and two participants were diagnosed with subclinical hypothyroidism and euthyroidism after gradually withdrawing from thyroxine.

Conclusion: Thyroid function remains stable in patients with persistent hypothyroidism following subacute thyroiditis after careful dose reduction and discontinuation of thyroxine replacement therapy. This finding may have implications for the individualized management of hypothyroidism.

Background: The systemic immune-inflammation index (SII), an emerging inflammatory biomarker, has been associated with various diseases, but its relationship with thyroid function remains unclear. Our study aimed to investigate the potential connections between SII and thyroid function in the U.S. population.

Methods: We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2007-2012 data to evaluate the association between SII and thyroid function, including free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), total thyroxine (TT4), and thyroid-stimulating hormone (TSH). Furthermore, the correlation was evaluated using multiple linear regression, smooth curve fitting, and threshold effect analysis.

Results: After multivariable linear regression, higher lgSII levels were independently associated with lower FT3 (β = -0.17, p < 0.0001), TT3 (β = -3.06, p = 0.0149), and TSH (β = -0.38, p = 0.0204), whereas TT4 levels were positively associated with lgSII after full adjustment (β = 0.27, p = 0.0016). Smooth curve fitting revealed an L-shaped relationship between lgSII and FT3 and TSH. Threshold effect analysis identified an inflection point at lgSII = 2.29 (log-likelihood ratio, P < 0.001).

Conclusion: In U.S. adults, lgSII was negatively associated with FT3 and TSH and positively associated with TT4. These findings highlight a potential link between systemic inflammation and thyroid function, warranting further prospective studies to investigate causal relationships.

Background: Childhood and adolescence are critical periods for skeletal development, yet the sex- and age-specific relationships between body composition and bone mineral density (BMD) remain inadequately explored.

Methods: This study analyzed data from 6328 participants aged 8-19 years from the NHANES (2011-2018) using dual-energy X-ray absorptiometry to assess visceral adipose tissue area (VATA), skeletal muscle mass (SMM), and total BMD. Multivariate linear regression models were employed to examine the associations, accounting for potential confounders.

Results: Initial analyses indicated a positive correlation between VATA and BMD, which reversed after covariate adjustment. SMM consistently showed positive correlations with BMD, particularly in girls aged 8-11 years. The visceral adipose tissue to SMM ratio exhibited significant negative correlations with BMD, especially in boys aged 12-19 years.

Conclusions: These findings highlight the critical importance of balanced body composition for skeletal health during development, suggesting that targeted interventions to optimize muscle mass and reduce visceral fat may enhance bone density in children and adolescents.

Objective: Diabetic nephropathy (DN) occurs in nearly 40% of Type 2 diabetes mellitus (T2DM) patients, and there is a positive correlation between DN and terminal renal disease. Thus, exploring novel biomarkers is vital to facilitate early diagnosis and intervention in DN patients; however, indicators of DN are still scant. Since the microRNA-126 (miR-126) may be related to the occurrence of diabetes, we aim to assess the association between miR-126 and DN.

Methods: This is a prospective cohort design and a nested case-control approach study that enrolled 300 individuals (100 T2DM patients, 100 DN patients, and 100 controls). miR-126 expression was analyzed by quantitative real-time PCR (qPCR) and compared among three groups. The overall survival (OS) was presented by Kaplan-Meier analysis. The area under the curve (AUC) was used to evaluate the potential of miR-126 as a biomarker for DN.

Result: DN patients, compared with T2DM and controls, had lower miR-126 content (p < 0.001), and miR-126 levels significantly decreased following a decreasing estimated glomerular filtration rate (eGFR) (r = 0.65, p < 0.001). Moreover, significant differences were also found in OS among quartiles of serum miR-126 level (p for trend < 0.001). In addition, the AUC for diagnosis DN from T2DM patients was found to be 0.804 (95% CI, 0.745-0.863), with a sensitivity of 83.0% and a specificity of 63.0%.

Conclusion: This study provides evidence to clarify that decreased levels of miR-126 were linked to an increased susceptibility to developing DN compared with healthy volunteers. More importantly, the diagnostic role of miR-126 remained significant in differentiating DN from T2DM patients.

Objective: To evaluate the efficacy of combined therapy of compound betamethasone periocular injection and oral mycophenolate mofetil (MMF) in treating active thyroid-associated ophthalmopathy (TAO).

Methods: A retrospective study was conducted on 17 patients with active TAO treated with compound betamethasone periocular injection combined with oral MMF from February 2022 to August 2023, involving a total of 31 eyes.

Results: In one eye, the Clinical Activity Score (CAS) decreased by less than two points, while in the remaining eyes, the CAS decreased by two points or more. Patients exhibited decreased proptosis, a reduction in average extraocular muscle thickness, and improvement in diplopia in six cases. Subgroup analysis indicated that this regimen showed no significant difference in efficacy for patients treated with radioactive iodine therapy or oral methimazole medication at baseline.

Conclusion: Combined therapy of compound betamethasone periocular injection and oral MMF is an effective approach for treating active TAO.

Background: Idiopathic nephrotic syndrome (NS) is a common cause of glomerulonephritis in children, often complicated by relapses and steroid dependence or resistance. Emerging evidence underscores the interplay between vitamin D metabolism and NS pathophysiology, particularly during relapse episodes.

Objective: To investigate the prevalence of vitamin D deficiency in pediatric patients aged 2-12 years with relapsing idiopathic NS and to evaluate associations with proteinuria severity, relapse frequency, and steroid exposure.

Methods: This cross-sectional study included 100 children diagnosed with idiopathic NS and at least one documented relapse. We enrolled all NS patients with completed follow-up for 1 year. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured during relapse and six months later. Clinical and biochemical data, including proteinuria, albumin, creatinine, and corticosteroid usage, were analyzed.

Results: At relapse, 84% of patients were vitamin D deficient, with only 7% reaching sufficiency after 6 months. A significant inverse correlation was observed between 25(OH)D levels and both proteinuria (r = -0.62, p < 0.001) and relapse frequency (r = -0.48, p < 0.01). Corticosteroid dosage was not significantly associated with vitamin D recovery.

Conclusion: Vitamin D deficiency is highly prevalent among children with relapsing idiopathic NS and correlates with greater disease activity. Routine monitoring and timely supplementation of vitamin D may be essential components in managing NS flares and preventing long-term complications.

Background: The visceral adiposity index (VAI) is recognized as a crucial metabolic risk indicator associated with mortality and is widely used in clinical and epidemiological studies. Evidence suggests that systemic inflammation may mediate this link; however, the underlying mechanisms remain poorly understood. To advance our understanding of these critical health risks, additional studies are required to clarify the underlying pathways connecting VAI, inflammation, and mortality.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), to investigate the link between log₂-VAI and all-cause mortality. To evaluate correlations, this study applied Kaplan-Meier survival curves alongside Cox proportional hazards models, and potential nonlinear associations were analyzed through the application of restricted cubic spline (RCS) models. The consistency of associations in populations with different demographic and clinical characteristics was assessed by subgroup analyses, and the role of inflammatory markers was investigated by mediation analyses.

Results: This study highlighted a nonlinear connection between log₂-VAI and all-cause mortality, pinpointing a risk threshold at log₂-VAI = 1.81. Beyond this threshold, the likelihood of all-cause mortality increased significantly. Subgroup analyses identified a notably stronger association among middle-aged groups (40-60 years) and those without coronary heart disease (CHD). Mediation analysis demonstrated that systemic inflammatory markers, specifically white blood cell count (WBC) and neutrophil count, mediated 45.07% and 37.91% of the association, respectively. E-value analysis suggested robustness to unmeasured confounding.

Conclusion: This study underscores the importance of WBC and neutrophil counts as key mediators linking VAI to all-cause mortality, offering fresh perspectives on the metabolic and inflammatory pathways underlying this association. These results highlight the critical role of public health interventions targeting inflammation to mitigate obesity-related mortality risks.

Aims: It is unknown if dysglycemia at 24-28 weeks of pregnancy is preceded by glycemic changes earlier in pregnancy. This study therefore examines the association between glucose excursion in the first 20 gestational weeks and the onset of gestational diabetes mellitus (GDM) in the early third trimester.

Methods: A cohort study was conducted using data from the electronic medical record of the public health system in Qatar, and women with glycemic assessments done before 20 weeks and again in the early third trimester were assessed. The main outcome of the study was to examine glucose excursion (using Doi's weighted average glucose; dwAG) in early pregnancy to see if it was indicative of GDM diagnosis at the usual time.

Results: At the upper normal cutoff for dwAG (6 mmol/L), the sensitivity and specificity were 71.5% and 54.1%, respectively, and the diagnostic odds ratio was ∼3, meaning that for women beyond this threshold before 20 weeks gestation, they had, on average, a 3-fold increase in odds of developing uGDM compared to women not meeting this threshold.

Conclusions: It is concluded that early pregnancy glucose excursion remains in the normal range in women destined for third trimester GDM but is higher than that in those who do not develop GDM at this time and is a predictor of women at high risk early in pregnancy.

Prolactin (PRL) is secreted by various cells in the anterior pituitary gland, mammary glands, placenta, uterus, ovaries, testes, skin, adipose tissue, endothelial cells, immune system, and central nervous system. The expression and secretion of PRL are influenced by several factors such as suckling, thyrotropin-releasing hormone (TRH), cytokines, dopamine, estrogen, and vasoactive intestinal polypeptide. It operates through a complex receptor, which is expressed in mammary gland cells, pancreatic beta cells, adipocytes, and immune cells. PRL is essential for various physiological functions, in particular milk production, breast development, metabolism, and immune regulation. Serum PRL levels fluctuate daily and can be affected by exercise, diet, and stress. Hyperprolactinemia is linked to autoimmune diseases and viral infections. In viral infections such as HIV, HCMV, HCV, and COVID-19, PRL levels are often increased, which may influence the immune responses. PRL can modulate the activity of various immune cells, including T cells, B cells, natural killer cells, and macrophages, mounting an effective immune response against viral infections. Moreover, PRL influences the production of cytokines that mediate and regulate immunity and inflammation. PRL stimulates B cells to produce antivirus antibodies that are essential for neutralizing viruses and preventing their spread within the body. PRL levels, varying by sex and life stage, may affect immune responses and susceptibility to viral infections. Moreover, overexpression of PRL was indicated in various autoimmune diseases. Overall, PRL is a complex hormone with significant implications for endocrine function, immune regulation, and immune responses to viral infections, highlighting the need for further research into its diverse roles in health and disease. This review summarizes current knowledge of the immunomodulatory effects of PRL in human viral infections and possibly its contribution to the development of autoimmune diseases.