Minerva endocrinology最新文献

Currently, worldwide millions of individuals, athletes, and non-athletes, of different ages and probably of all social genders (cisgender males and females, male to female (MtF) and female to male (FtM) transgenders, etc.), are current or former androgenic anabolic steroids (AAS) abusers. AAS abuse is associated with seriously increased short- and long-term risks for general, reproductive and sexual health. Indeed, to improve the knowledge and health of the population at risk of AAS misuse and standardize the current clinical practice concerning the health risks of such abuse, it is essential to also prevent, detect, diagnose, and treat all reproductive and sexual sequelae of non-therapeutic AAS assumption. The main AAS-related pathways and factors influencing reproduction and sexuality in humans, the possible reproductive and sexual signs and symptoms associated with AAS abuse and to AAS withdrawal, and the major concerns in the diagnosis and management of such clinical conditions are reported. The scientific literature has mainly evaluated male AAS abusers, but, we tried to describe/hypothesize all the possible reproductive and sexual side effects and concerns of AAS abuse also in other genders.

Background: Ageing leads to an increase in the incidence of chronic diseases, including chronic kidney disease (CKD). The increasing proportion of elderly people with reduced renal function draws attention to a sub-population of patients for whom an alternative approach to traditional pharmacological and dietary treatment may be needed. The low-protein diet (LPD) in subjects with CKD helps control complications and may contribute to slowing the progression of the disease. In the follow-up during the conservative phase, nutritional status and the LPD are key points. Of interest, ketoanalogues (KAs) in combination with a LPD significantly reduces the progression to end-stage kidney disease. The aim of this pilot study is to determine the impact at 12 months of LPD supplemented with essential amino acids (EAA) and KAs in a population of 21 over-90-year-olds with advanced CKD in the conservative phase.

Methods: The protein intake of the LPD was 0.6 g/kg body weight/day. Anthropometric measurements and biochemical parameters were monitored at baseline and after 12 months of dietary intervention. The Kidney Failure Risk Equation (KFRE) was used to predict the risk of end stage renal disease.

Results: Significant change in GFR (from 18.04±1.31 to 24.30±2.09 mL/min, P<0.001), azotemia (from 122.38±19.16 to 70.19±15.00 mg/dL, P<0.001) and KFRE score at 2 years (from 33.67±3.88 to 15.09±3.03%, P<0.001) and at 5 years (from 71.94±5.13 to 39.76±6.60% at 5 years, P<0.001). Laboratory parameters (azotemia, albumin, total protein, total cholesterol, transferrin, Hb, PTH, HbA1c, TSAT, CRP) improved. Two patients were hospitalized during the observation period, no cardiovascular events or deaths were reported.

Conclusions: LPD supplemented with EAA and KAs has proven to be a safe and effective tool in the conservative treatment of the over-aged with advanced CKD. Dietary treatment improves renal function and management of complications, reducing the risk of terminal uremia and initiation of replacement treatment by not exposing patients to the risk of malnutrition.

Introduction: Metabolic surgery is the best choice of treatment for patients with overweight; however, choosing an appropriate method remains a challenge for bariatric surgeons.

Evidence acquisition: Based on a literature search in the PubMed database, long-term metabolic and weight loss outcomes of standard care (SC) and different metabolic interventions were collected. Descriptive statistics, initial direct pairwise comparisons using the Ivhet-method and a network meta-analysis (General Pairwise Modelling) on change in Body Mass Index (BMI) and a cost-utility analysis based on the Markov model were performed.

Evidence synthesis: Analysis of the PubMed database identified 1324 unique publications. After rigorous screening, relevant publications were retrieved and 22 studies were enrolled, including a total of 12695 cases. Long-term effectiveness was unsatisfactory after SC. Surgical patients achieved good rates of resolution of comorbidities. All surgical procedures had over 25% of total weight loss (TWL%) and over 60% of excess weight loss (EWL%) at 5 years. Deterministic cost-effectiveness analysis showed the superiority of one-anastomosis gastric bypass (OAGB) (effectiveness: 4.145, cost: €22,484). Sensitivity analysis presented the absolute and relative (to SC) benefit of OAGB. Simple direct pairwise comparisons could not prove the superiority of any treatment modality; however, network meta-analysis in combination with cost-utility analysis showed OAGB to be the most efficient method (OR was 1.36, 1.24 and 1.08 for OAGB, LRYGB and LSG compared to SC, respectively).

Conclusions: Metabolic surgery seems to be a more favourable approach in weight loss management than standard treatment; however, our analysis could not prove the superiority of any kind of surgery.

Background: Covering a significant part of a woman's life, the postmenopausal phase is often associated with the onset of obesity, metabolic dysfunction, osteoporosis, and their most disabling complications. In this context, scant evidence from both preclinical and clinical studies suggests that single nucleotide polymorphisms (SNPs) of the follicle-stimulating hormone receptor (FSHR) gene might be involved in the etiopathogenesis of these conditions, posing them as possible molecular predictors of their development. Therefore, this study aimed to evaluate the role of the FSHR gene SNPs c.2039A>G and c.-29 G>A on Body Mass Index (BMI), metabolic parameters, and bone metabolism in postmenopausal women.

Methods: To achieve this goal, 49 postmenopausal Caucasian women aged from 45 to 80 years and with no factors known to influence metabolism and/or bone mineral density (BMD) were enrolled and assessed for their medical history, medical family history, anthropometric parameters and hormonal, metabolic and lipid profiles, and BMD. Then, they were genotyped for the FSHR gene SNPs c.2039A>G and c.-29G>A. Finally, the resulting data were classified according to woman's genotypes and subjected to statistical analysis.

Results: No significant differences were found between the distributions of most endpoint parameters examined by genotype. However, none of the women with the c.2039A>G FSHR GG gene SNP were affected by obesity and had the highest lumbar BMD z-score within the cohort. Additionally, those with the FSHR c.-29G>A AA genotype had the lowest serum glucose levels.

Conclusions: This preliminary study suggests that the FSHR c.2039A>G GG SNP, which is associated with reduced sensitivity of the FSHR, may have a protective role against obesity, offering further evidence for the possible association among FSH, FSHR polymorphisms, and insulin metabolism.

Background: Overweight and obesity are major public health issues with increasing incidence and prevalence, affecting more than 50% of the population in developed countries. Due to its complex pathophysiology and multifactorial etiology, disease understanding, diagnostic approach and management remain suboptimal. Together with a structured nutritional intervention and physical activity plan, pharmacological treatment has the potential to magnify weight loss and health related benefits. Liraglutide is one of the most effective and frequently prescribed weight loss medication. Its efficacy and safety have been demonstrated in randomized clinical trials, however, real world data in Portugal is scarce. The authors report on the experience of a University Hospital Endocrine Clinic in the management of patients with overweight and obesity with liraglutide on top of lifestyle intervention. The aim of the study was to evaluate the effectiveness of liraglutide in the management of overweight and obesity.

Methods: Retrospective, longitudinal observational study. Inclusion criteria were adult patients (>18 years old) with obesity (BMI>30 kg/m²) or overweight (≥27 kg/m²) with at least one obesity related co-morbidity (hypertension, dyslipidemia, obstructive sleep apnea, non-alcoholic fatty liver disease) with at least three months of liraglutide treatment. Diabetes diagnosis and prior bariatric surgery were exclusion criteria. Demographic and clinical variables were included and weight was recorded before and after at least 3 months of liraglutide treatment.

Results: One hundred forty-eight patients (85.8% females) with a mean age of 48.7±11.9 years were treated with liraglutide. Mean baseline BMI was 33.8±5.2 kg/m² and median follow-up was 13 months. At the last appointment, 85.8% were still taking liraglutide. Among patients still taking liraglutide, mean weight loss was 7.6 kg (7.9%), with significantly greater losses in patients treated for more than 6 months (8.6kg vs. 6.2 kg, P=0.016). Patients with obesity lost significantly more weight than overweight patients (8.3 kg vs. 4.5 kg, P=0.028), despite similar treatment duration. The reasons for liraglutide withdrawal were gastrointestinal intolerance (7), medication cost (2), inefficacy (10) and physician instructions (1).

Conclusions: The present study documents the long-term efficacy of liraglutide in the treatment of patients with overweight and obesity, with a low rate of drug withdrawal. Mean weight loss was significant and more evident from the 6th month of treatment on. Liraglutide, along with lifestyle intervention, is a good option for weight management in the majority of patients with obesity.

Background: The aim of our retrospective study was to describe the immunophenotypic characteristics of neuroendocrine breast neoplasm (BNEN), a peculiar and rare type of breast carcinoma.

Methods: Pathological data from 51 patients affected by BNEN were retrospectively evaluated, and 44 patients were considered eligible (7 patients with incomplete data were excluded). The patients were followed in six different Italian hospitals between 2009 and 2019. The histological samples, collected by biopsies and/or surgery pieces, were analyzed to determine: 1) tumor histology; 2) immunophenotypic pattern; 3) presence of lymphatic infiltration; 4) presence of necrosis.

Results: The median age of the patients included in our analysis was 70 years (67.6±13.7 years). As concerns the histological type we identified 7 cases of well-differentiated neuroendocrine carcinomas (16%), 8 cases of poorly differentiated/small cell neuroendocrine carcinoma (18%), 29 cases of breast carcinomas with neuroendocrine differentiation (66%). From the analysis of breast-specific immunophenotype we identified: 24 cases (54%) of Luminal A pattern; 9 cases (20%) of Luminal B pattern; 8 case (18%) of triple negative pattern. The presence of lymphatic infiltration was assessed in 29 samples and it was observed in 13 cases (45%), necrosis was assessed in 29 samples and was absent in 72% of all cases (21 samples). Neuroendocrine markers expression was heterogeneous with a prevalence of synaptophysin (positivity in 95%); chromogranin A was evaluated in 31 samples and it was positive in 58% of cases.

Conclusions: in our series BNENs mainly affect a post-menopausal population and luminal A pattern is the most frequent immunophenotype. As expected, lymphatic infiltration is most frequently reported in invasive breast cancer with neuroendocrine differentiation; necrosis is absent in well-differentiated neuroendocrine carcinomas. Synaptophysin and chromogranin A are important markers for the diagnosis of BNEN.

Introduction: Several data demonstrated that chemical pollutants can be endocrine disruptors and they have an important role in tumorigenic processes. It has been shown that pollution exposure can affect pituitary cells' function and biology, indeed an increased prevalence of acromegaly has been reported in highly polluted areas.

Evidence acquisition: One transcription factor that has a role in both carcinogenesis and in xenobiotics' detoxification is the aryl hydrocarbon receptor (AHR). Its deregulation could have a pivotal role in pituitary tumors, especially in GH-secreting pituitary tumors. Environmental chemicals affect the expression and function of ncRNAs (miRNA, lncRNA and circRNA) through different mechanisms.

Evidence synthesis: However, to date, few data on the role of the environmental pollutants in the clinical expression and pathogenesis of GH-secreting pituitary tumors are available.

Conclusions: This article presents a summary of the AHR signaling pathways that are triggered by various ligands and emphasizes the significant distinctions between the potential biological and toxicological effects of AHR gene activation. We also deepen the functions of ncRNAs and acromegaly and provide current data on their regulation by the AHR. Overall, more studies are still needed to fully understand the dynamic interplay between the AHR signaling pathway and ncRNAs in GH-secreting pituitary adenomas.

Background: The use of inpatient palliative care (IPC) in advanced cancer patients represents a well-established guideline recommendation. This study examines the utilization rates and patterns of IPC among patients with metastatic adrenocortical carcinoma (mACC).

Methods: Relying on the Nationwide Inpatient Sample database (2007-2019), we tabulated IPC rates in mACC patients. Estimated annual percentage changes (EAPC) analyses as well as multivariable logistic regression models (MLRM) predicting IPC use were fitted.

Results: Of 2040 mACC patients, 238 (12%) received IPC. Overall, the rate of IPC increased from 3.7% to 19.1% between 2007 and 2019 (EAPC +9.6%, P=0.001). During the same period, in-hospital mortality remained unchanged from 12.1 to 13.8% (EAPC 0.1%; P=0.97). Younger age at admission (<60 years; MLRM OR=0.70, P=0.013), solitary metastatic site (OR=0.63; P=0.015), and non-brain metastases (OR=0.62; P=0.033) were all associated with lower IPC use.

Conclusions: In mACC patients, IPC use has increased from a marginal 3.7% to a moderate annual value of 19.1% in the most recent study year. These rates were not driven by a concomitant increase in in-hospital mortality (12.1% to 13.8%; P=0.9). and may be interpreted as an improvement in quality of care. Despite this encouraging increase, some patient characteristics herald lower IPC use. In consequence, younger patients, those with solitary metastatic sites, and non-brain metastases should be carefully considered for IPC to decrease or completely reduce the IPC access barrier maximally.

Background: Treatment-resistant schizophrenia (TRS) is a severe psychiatric disorder that is associated with a high level of psychotic symptoms and cognitive deficit as well as poor functioning, and an increased risk of mortality for cardiometabolic diseases. Some studies suggest that lifestyle, particularly diet, could represent a risk factor for obesity and its metabolic complications in these patients.

Methods: This cross-sectional study aimed to evaluate diet quality and eating habits in individuals with TRS. Seventeen participants (13M/4F aged 37.8±13 years) were recruited to assess dietary composition and food groups consumption by a 7days food record to assess. In addition, demographic and clinical data were collected.

Results: Most of the participants were overweight/obese (82%) and only 35% performed physical activity. As compared to nutritional recommendations, participants presented an insufficient intake of fiber (15.9±3.2 g/day), vitamins (thiamine, riboflavin, vitamin A, D, and E), minerals (calcium, magnesium, selenium, and iron), and polyunsaturated fatty acids (2.11±0.8%), likely triggered by the low consumption plant-based foods (legumes, fruit, vegetables, and nuts) and fish. Participants exceeded the intake of saturated fatty acids (11.6±3.4%) and cholesterol (242±124 mg/day), and simple sugars (15.2±3.9%) which were mainly related to greater consumption of red meat and processed meat, and sweet foods, respectively.

Conclusions: Individuals with TRS presented low diet quality and did not comply with the nutritional recommendations. These results support the importance of including nutritional assessment in the management of individuals with TRS.