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Special features on insulin resistance, metabolic syndrome and vascular complications in hypopituitary patients. 垂体功能减退患者的胰岛素抵抗、代谢综合征和血管并发症专题。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-01-25 DOI: 10.1007/s11154-023-09872-8
Heraldo M Garmes

Pituitary hormone deficiency, hypopituitarism, is a dysfunction resulting from numerous etiologies, which can be complete or partial, and is therefore heterogeneous. This heterogeneity makes it difficult to interpret the results of scientific studies with these patients.Adequate treatment of etiologies and up-to-date hormone replacement have improved morbidity and mortality rates in patients with hypopituitarism. As GH replacement is not performed in a reasonable proportion of patients, especially in some countries, it is essential to understand the known consequences of GH replacement in each subgroup of patients with this heterogeneous dysfunction.In this review on hypopituitarism, we will address some particularities regarding insulin resistance, which is no longer common in these patients with hormone replacement therapy based on current guidelines, metabolic syndrome and its relationship with changes in BMI and body composition, and to vascular complications that need to be prevented taking into account the individual characteristics of each case to reduce mortality rates in these patients.

垂体激素缺乏症(垂体功能减退症)是一种由多种病因导致的功能障碍,可以是完全性的,也可以是部分性的,因此具有异质性。对病因的充分治疗和最新的激素替代改善了垂体功能减退症患者的发病率和死亡率。由于没有对相当一部分患者进行 GH 替代治疗,尤其是在一些国家,因此有必要了解 GH 替代治疗对患有这种异质性功能障碍的各个亚组患者的已知后果。在这篇关于垂体功能减退症的综述中,我们将讨论胰岛素抵抗的一些特殊性(根据现行指南,胰岛素抵抗在接受激素替代治疗的患者中已不再常见)、代谢综合征及其与体重指数(BMI)和身体成分变化的关系,以及血管并发症,这些并发症需要根据每个病例的个体特征加以预防,以降低这些患者的死亡率。
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引用次数: 0
Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management. 垂体功能减退症住院病人的发病率和死亡率:发病率、原因和管理。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-05-27 DOI: 10.1007/s11154-024-09888-8
Fahim Ebrahimi, Lukas Andereggen, Emanuel R Christ

Hypopituitarism is a highly heterogeneous multisystem disorder that can have a major impact on long-term morbidity and mortality, but even more so during acute medical conditions requiring hospitalization. Recent studies suggest a significant in-hospital burden with prolonged length of stay, increased rate of intensive care unit (ICU) admission, and initiation of mechanical ventilation - all of which may lead to an increased risk of in-hospital mortality. On the one hand, patients with hypopituitarism are often burdened by metabolic complications, including obesity, hypertension, dyslipidemia, and hyperglycemia, which alone, or in combination, are known to significantly alter relevant physiological mechanisms, including metabolism, innate and adaptive immune responses, coagulation, and wound healing, thereby contributing to adverse in-hospital outcomes. On the other hand, depending on the extent and the number of pituitary hormone deficiencies, early recognition of hormone deficiencies and appropriate management and replacement strategy within a well-organized multidisciplinary team are even stronger determinants of short-term outcomes during acute hospitalization in this vulnerable patient population. This review aims to provide an up-to-date summary of recent advances in pathophysiologic understanding, clinical implications, and recommendations for optimized multidisciplinary management of hospitalized patients with hypopituitarism.

垂体功能减退症是一种高度异质性的多系统疾病,可对长期发病率和死亡率产生重大影响,但在需要住院治疗的急性病中影响更大。最近的研究表明,垂体功能减退症患者住院时间延长、入住重症监护室(ICU)的比例增加以及开始使用机械通气,这些都会给患者带来沉重的负担,并可能导致院内死亡风险增加。一方面,垂体功能减退症患者通常会有代谢并发症,包括肥胖、高血压、血脂异常和高血糖,这些并发症单独或合并出现时会显著改变相关的生理机制,包括新陈代谢、先天性和适应性免疫反应、凝血和伤口愈合,从而导致不良的院内预后。另一方面,根据垂体激素缺乏的程度和数量,在一个组织良好的多学科团队中及早识别激素缺乏并采取适当的管理和替代策略,对这一易受伤害的患者群体在急性住院期间的短期预后具有更大的决定性作用。本综述旨在总结对垂体功能减退症住院患者的病理生理学认识、临床影响和多学科优化管理建议方面的最新进展。
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引用次数: 0
Diagnosing and treating the elderly individual with hypopituitarism. 诊断和治疗患有垂体功能减退症的老年人。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-27 DOI: 10.1007/s11154-023-09870-w
Andrea Corsello, Rosa Maria Paragliola, Roberto Salvatori

Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.

老年人垂体功能减退症是一种被低估的疾病,这主要是由于衰老的影响和合并症的存在而导致的非特异性表现。垂体功能减退症的诊断和治疗往往是一项极具挑战性的任务,这一点在老年人身上体现得更为明显。由于随着年龄增长而发生的生理变化会使激素检查的解释变得复杂,而且需要避免一些对老年人群具有较高副作用风险的刺激性检查,因此诊断可能很隐蔽。治疗垂体功能减退症的目标通常是补充缺乏的荷尔蒙,以恢复尽可能接近健康人的生理平衡,但对于老年人来说,这必须与过度补充荷尔蒙和合并症恶化的风险相平衡。此外,一些激素替代疗法(包括性激素和生长激素)对老年人的益处仍存在争议。
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引用次数: 0
Cognition and psychological wellbeing in hypopituitary patients. 垂体功能减退患者的认知和心理健康。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-26 DOI: 10.1007/s11154-023-09869-3
Syed Ali Imran, Michael Wilkinson

Hypopituitarism (HP) frequently occurs in patients presenting with sellar masses and despite recent advances in therapeutic options, HP patients consistently suffer from impaired quality of life due to psychological distress and cognitive dysfunction. These neurocognitive complications tend to persist in spite of surgical or biochemical remission of the disease making it especially challenging to segregate the effect of HP per se from other comorbidities such as the effect of tumour, surgery, radiation therapy, or complications caused by excess hormone production. Regardless, there is ample evidence to suggest that receptors for various pituitary hormones are abundantly expressed in key areas of central nervous system that are associated with memory and behaviour function and HP is also associated with poor sleep which can further exacerbate neurocognitive dysfunction. There is also evidence that hormonal replacement in HP patients partially restores these neurocognitive functions and improves sleep disorders. However, there is a need for creating better awareness among healthcare providers interacting with HP patients to enhance an earlier recognition of these disorder and their impact on quality of life despite initial remission. Importantly, there is a need to not only develop better and more cost-effective replacement therapies that would closely mimic the physiological hormonal release patterns, but also develop coping strategies for HP patients suffering from these complications.

垂体功能减退症(HP)经常发生在蝶窦肿块患者身上,尽管近年来治疗方案不断改进,但由于心理压力和认知功能障碍,HP 患者的生活质量始终受到影响。这些神经认知并发症往往在手术或生化治疗缓解后仍会持续存在,因此将高泌乳素血症本身的影响与其他合并症(如肿瘤、手术、放疗的影响或激素分泌过多引起的并发症)区分开来尤其具有挑战性。无论如何,有大量证据表明,各种垂体激素的受体大量表达于中枢神经系统中与记忆和行为功能有关的关键区域,而 HP 还与睡眠质量差有关,这可能会进一步加剧神经认知功能障碍。也有证据表明,对 HP 患者进行激素替代可部分恢复这些神经认知功能并改善睡眠障碍。然而,有必要提高与 HP 患者打交道的医疗服务提供者的认识,以便更早地识别这些疾病及其对生活质量的影响,尽管这些疾病在初期有所缓解。重要的是,我们不仅需要开发更好、更经济的替代疗法,使其接近生理荷尔蒙的释放模式,还需要为患有这些并发症的 HP 患者制定应对策略。
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引用次数: 0
Subclinical central hypothyroidism in patients with hypothalamic-pituitary disease: does it exist? 下丘脑-垂体疾病患者的亚临床中枢性甲状腺功能减退症:存在吗?
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-02-07 DOI: 10.1007/s11154-024-09876-y
Julio Abucham, Manoel Martins

Central hypothyroidism (CH) is characterized by decreased thyroid hormone production due to insufficient stimulation of an otherwise normal thyroid gland by TSH. In patients with established hypothalamic-pituitary disease, a low FT4 concentration is considered highly specific, although poorly sensitive, for the diagnosis of CH. That would be comparable to diagnosing primary hypothyroidism in patients at risk only when serum FT4 concentrations are below the reference range, missing all patients with subclinical primary hypothyroidism and preventing proper therapy in patients in which thyroxine replacement is clearly beneficial. Cardiac time intervals, especially the isovolumic contraction time (ICT), have been considered the gold standard of peripheral thyroid hormone action. Using Doppler echocardiography, we have previously shown a very high proportion of prolonged ICT in patients with hypothalamic-pituitary disease and serum FT4 levels indistinguishable from controls. As ICT decreased/normalized after thyroxine-induced increases in FT4 concentrations within the normal reference range, prolonged ICT was considered a bona fide diagnostic biomarker of subclinical CH. Those findings challenge the usual interpretation that FT4 concentrations in the mid-reference range exclude hypothyroidism in patients with hypothalamic-pituitary disease. Rather, subclinical central hypothyroidism, a state analogous to subclinical primary hypothyroidism, seems to be frequent in patients with hypothalamic-pituitary disease and normal FT4 levels. They also challenge the notion that thyroid function is usually the least or the last affected in acquired hypopituitarism. The relevance of Doppler echocardiography to correctly diagnose and monitor replacement therapy in both clinical and subclinical forms of CH should improve quality of life and decrease cardiovascular risk, as already demonstrated in patients with clinical and subclinical primary hypothyroidism.

中枢性甲状腺功能减退症(CH)的特点是由于促甲状腺激素对原本正常的甲状腺刺激不足而导致甲状腺激素分泌减少。在已确诊患有下丘脑-垂体疾病的患者中,低FT4浓度被认为对CH的诊断具有高度特异性,但敏感性较差。这相当于只有当血清FT4浓度低于参考范围时,才对高危患者进行原发性甲减诊断,从而漏诊了所有亚临床原发性甲减患者,并妨碍了对甲状腺素替代明显有益的患者进行适当治疗。心脏时间间期,尤其是等容收缩时间(ICT),一直被认为是外周甲状腺激素作用的黄金标准。我们曾使用多普勒超声心动图显示,在下丘脑-垂体疾病患者中,ICT延长的比例非常高,而血清FT4水平与对照组无异。由于在甲状腺素诱导下FT4浓度升高后,ICT下降/正常化在正常参考范围内,因此ICT延长被认为是亚临床CH的真正诊断生物标志物。这些发现对通常认为下丘脑-垂体疾病患者的FT4浓度在参考值范围中段就可以排除甲减的解释提出了质疑。相反,亚临床中枢性甲减(一种类似于亚临床原发性甲减的状态)似乎经常出现在下丘脑-垂体疾病和FT4水平正常的患者中。他们还对甲状腺功能通常在获得性垂体功能减退症中受影响最小或最后受影响的观点提出了质疑。多普勒超声心动图对于正确诊断和监测临床和亚临床甲状腺功能减退症的替代治疗具有重要意义,它可以提高生活质量,降低心血管风险,这一点在临床和亚临床原发性甲状腺功能减退症患者身上已经得到了证实。
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引用次数: 0
The relationship between low prolactin and type 2 diabetes. 低催乳素与 2 型糖尿病之间的关系。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2024-05-18 DOI: 10.1007/s11154-024-09886-w
Gie Ken-Dror, David Fluck, Michael E J Lean, Felipe F Casanueva, Thang Sieu Han

Prolactin (PRL) is secreted throughout life in men and women. At elevated levels, its physiological role in pregnancy and lactation, and pathological effects, are well known. However clinical implications of low circulating PRL are not well established. We conducted a meta-analysis to examine the relationship between low PRL levels and type 2 diabetes. Five papers included cross-sectional studies comprising 8,720 men (mean age range 51.4-60 years) and 3,429 women (49.5-61.6 years), and four papers included cohort studies comprising 2,948 men (52.1-60.0 years) and 3,203 women (49.2-60.1 years). Individuals with pregnancy, lactation and hyperprolactinemia, drugs known to alter circulating PRL levels, or pituitary diseases had been excluded. Although most studies used quartiles to categorize PRL groups for analysis, PRL cut-off values (all measured by chemiluminescence immunoassay) were variably defined between studies: the lowest PRL quartiles ranged from 3.6 ng/ml to 7.2 ng/ml in men and between 4.5 ng/ml to 8 ng/ml in women; and the highest PRL quartiles ranged from 6.9 ng/ml to 13 ng/ml in men and 9.6 ng/ml to 15.8 ng/ml in women. Type 2 diabetes was defined variably using self-reported physician's diagnosis, fasting blood glucose, oral glucose tolerance test or glycated hemoglobin (HbA1C). In cross-sectional studies, compared to individuals in the highest PRL groups (reference), those in the lowest PRL groups had greater risk of type 2 diabetes both in men: odds ratio (OR) and 95% confidence interval = 1.86 (1.56-2.22) and in women: OR = 2.15 (1.63-2.85). In cohort studies, women showed a significant association between low PRL and type 2 diabetes: OR = 1.52 (1.02-2.28) but not men: OR = 1.44 (0.46-4.57). Relatively low heterogeneity was observed (I2 = 25-38.4%) for cross-sectional studies, but higher for cohort studies (I2 = 52.8-79.7%). In conclusion, low PRL is associated with type 2 diabetes, but discrepancy between men and women in the relationship within cohort studies requires further research.

催乳素(PRL)在男性和女性的一生中都会分泌。在水平升高时,它在怀孕和哺乳期的生理作用以及病理影响已众所周知。然而,低水平的循环 PRL 对临床的影响尚未得到充分证实。我们进行了一项荟萃分析,研究低PRL水平与2型糖尿病之间的关系。五篇论文纳入了横断面研究,包括8720名男性(平均年龄范围为51.4-60岁)和3429名女性(49.5-61.6岁);四篇论文纳入了队列研究,包括2948名男性(52.1-60.0岁)和3203名女性(49.2-60.1岁)。这些研究排除了妊娠、哺乳和高催乳素血症患者、已知会改变循环 PRL 水平的药物或垂体疾病患者。虽然大多数研究使用四分位数来划分 PRL 组别进行分析,但不同研究对 PRL 临界值(均通过化学发光免疫测定法测量)的定义各不相同:最低 PRL 四分位数从 3.男性 PRL 最低四分位数介于 3.6 纳克/毫升至 7.2 纳克/毫升之间,女性介于 4.5 纳克/毫升至 8 纳克/毫升之间;男性 PRL 最高四分位数介于 6.9 纳克/毫升至 13 纳克/毫升之间,女性介于 9.6 纳克/毫升至 15.8 纳克/毫升之间。2 型糖尿病的定义各不相同,使用的是自我报告的医生诊断、空腹血糖、口服葡萄糖耐量试验或糖化血红蛋白 (HbA1C)。在横断面研究中,与 PRL 最高组(参照组)的人相比,PRL 最低组的人罹患 2 型糖尿病的风险更大,男性:几率比(OR)和 95% 置信区间 = 1.86(1.56-2.22),女性:几率比(OR)和 95% 置信区间 = 2.15(1.56-2.22):或=2.15(1.63-2.85)。在队列研究中,女性的低 PRL 与 2 型糖尿病之间存在显著关联:OR = 1.52 (1.02-2.28),而男性则不然:OR = 1.44 (0.46-4.57)。横断面研究的异质性相对较低(I2 = 25-38.4%),但队列研究的异质性较高(I2 = 52.8-79.7%)。总之,低PRL与2型糖尿病有关,但在队列研究中男女之间的关系存在差异,需要进一步研究。
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引用次数: 0
Uterine fibroids in women diagnosed with acromegaly: a systematic review. 被诊断患有肢端肥大症的妇女中的子宫肌瘤:系统综述。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2024-04-26 DOI: 10.1007/s11154-024-09883-z
Konrad Górski, Stanisław Zgliczyński, M. Stelmachowska-Banaś, I. Czajka-Oraniec, W. Zgliczyński, M. Ciebiera, M. Zgliczyńska
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引用次数: 0
Diagnostic and therapeutic use of oral micronized progesterone in endocrinology. 口服微粒化黄体酮在内分泌学中的诊断和治疗用途。
IF 8.2 2区 医学 Q1 Medicine Pub Date : 2024-04-23 DOI: 10.1007/s11154-024-09882-0
Eleni Memi, Polina Pavli, Papagianni Maria, N. Vrachnis, G. Mastorakos
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引用次数: 0
Correction to: Potential therapeutic strategies for osteoarthritis via CRISPR/Cas9 mediated gene editing. 更正:通过 CRISPR/Cas9 介导的基因编辑治疗骨关节炎的潜在策略。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-04-01 DOI: 10.1007/s11154-023-09867-5
Rexhina Vlashi, Xingen Zhang, Haibo Li, Guiqian Chen
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引用次数: 0
Circadian alignment of food intake and glycaemic control by time-restricted eating: A systematic review and meta-analysis. 限时饮食对食物摄入和血糖控制的昼夜节律一致性:一项系统综述和荟萃分析。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-04-01 Epub Date: 2023-11-22 DOI: 10.1007/s11154-023-09853-x
Susana Rovira-Llopis, Clara Luna-Marco, Laura Perea-Galera, Celia Bañuls, Carlos Morillas, Victor M Victor

Daily rhythms of metabolic function are supported by molecular circadian clock systems that are strongly regulated by feeding and fasting. Intermittent fasting diets have been associated with weight loss and improved metabolism. However, the effects of time-restricted eating (TRE) on glycemic parameters are still under debate. In this review, we aim to systematically analyze the effects of TRE on glycemic parameters. We searched on PubMed, EMBASE, and the Cochrane Library for controlled studies in which subjects followed TRE for at least 4 weeks. 20 studies were included in the qualitative systematic review, and 18 studies (n = 1169 subjects) were included in the meta-analysis. Overall, TRE had no significant effect on fasting glucose (Hedges's g = -0.08; 95% CI:-0.31,0.16; p = 0.52), but it did reduce HbA1c levels (Hedges's g = -0.27; 95% CI: -0.47, -0.06; p = 0.01). TRE significantly reduced fasting insulin (Hedges's g = -0.40; 95% CI: -0.73,-0.08; p = 0.01) and showed a tendency to decrease HOMA-IR (Hedges's g = -0.32; 95% CI:-0.66,0.02; p = 0.06). Interestingly, a cumulative analysis showed that the beneficial effects of TRE regarding glucose levels were less apparent as studies with later TRE windows (lTRE) were being included. Indeed, a subgroup analysis of the early TRE (eTRE) studies revealed that fasting glucose was significantly reduced by eTRE (Hedges's g = -0.38; 95% CI:-0.62, -0.14; p < 0.01). Our meta-analysis suggests that TRE can reduce HbA1c and insulin levels, and that timing of food intake is a crucial factor in the metabolic benefit of TRE, as only eTRE is capable of reducing fasting glucose levels in subjects with overweight or obesity.PROSPERO registration number CRD42023405946.

代谢功能的日常节律是由分子昼夜节律时钟系统支持的,该系统受到摄食和禁食的强烈调节。间歇性禁食与减肥和改善新陈代谢有关。然而,限时饮食(TRE)对血糖参数的影响仍存在争议。在这篇综述中,我们旨在系统地分析TRE对血糖参数的影响。我们在PubMed、EMBASE和Cochrane图书馆检索了受试者遵循TRE至少4周的对照研究。20项研究被纳入定性系统评价,18项研究(n = 1169名受试者)被纳入meta分析。总体而言,TRE对空腹血糖无显著影响(Hedges’s g = -0.08;95%置信区间:-0.31,0.16;p = 0.52),但确实降低了HbA1c水平(Hedges的g = -0.27;95% ci: -0.47, -0.06;p = 0.01)。TRE显著降低空腹胰岛素(Hedges’s g = -0.40;95% ci: -0.73,-0.08;p = 0.01),有降低HOMA-IR的趋势(Hedges’s g = -0.32;95%置信区间:-0.66,0.02;p = 0.06)。有趣的是,一项累积分析表明,当研究纳入较晚的TRE窗口(lTRE)时,TRE对葡萄糖水平的有益影响不那么明显。事实上,早期TRE (eTRE)研究的亚组分析显示,eTRE显著降低了空腹血糖(Hedges的g = -0.38;95% ci:-0.62, -0.14;p
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引用次数: 0
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Reviews in Endocrine & Metabolic Disorders
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