The Journal of Clinical Endocrinology & Metabolism最新文献_第7页

Low-Dose Aspirin and Sporadic Anovulation in the EAGeR Randomized Trial EAGeR随机试验中的低剂量阿司匹林和散发性无排卵

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2095

Rose G. Radin, L. Sjaarda, N. Perkins, R. Silver, Zhen Chen, Laurie L. Lesher, N. Galai, J. Wactawski‐Wende, S. Mumford, E. Schisterman

Context Among women with a single, recent pregnancy loss, daily preconception low-dose aspirin (LDA) increased the live birth rate with no effect on pregnancy loss. Ovulation is a potential mechanism underlying this effect. Objective We estimated the effect of LDA on the per-cycle risk of anovulation among eumenorrheic women. Design Multicenter, randomized, double-blind, placebo-controlled trial of daily LDA on reproductive outcomes. Preconception follow-up lasted 1 to 6 menstrual cycles (ClinicalTrials.gov, NCT00467363). Setting Four US medical centers during 2007 to 2011. Patients or Other Participants Healthy women (n = 1214), age 18 to 40, were attempting pregnancy, had regular menstrual cycles (21 to 42 days), and had a history of 1 to 2 documented pregnancy losses, ≤2 live births, and no infertility. All participants completed at least 1 menstrual cycle of follow-up; none withdrew due to adverse events. Intervention Aspirin (81 mg) daily for 1 to 6 menstrual cycles. Main Outcome Measure Per-cycle risk of anovulation, defined as the absence of both a positive spot-urine pregnancy test and a luteinizing hormone (LH) peak (2.5-fold increase in daily urinary LH). Hypothesis formulation preceded data collection. Results Among 4340 cycles, LDA was not associated with anovulation (LDA: 13.4%, placebo: 11.1%; risk ratio = 1.16, 95% confidence interval, 0.88 to 1.52). Results were similar among women with a single, recent loss. Conclusions Daily LDA had no effect on anovulation among women with a history of 1 to 2 pregnancy losses. LDA may affect fertility via other pathways, and these warrant further study.

在最近一次流产的女性中，每日孕前低剂量阿司匹林(LDA)增加了活产率，但对流产没有影响。排卵是这种影响的潜在机制。目的评估LDA对痛经女性月经周期无排卵风险的影响。设计多中心、随机、双盲、安慰剂对照的每日LDA对生殖结局的影响试验。孕前随访持续1 - 6个月经周期(ClinicalTrials.gov, NCT00467363)。以2007年至2011年期间的四个美国医疗中心为背景。患者或其他参与者健康女性(n = 1214)，年龄18 ~ 40岁，尝试怀孕，月经周期规律(21 ~ 42天)，有1 ~ 2次有记录的妊娠失败史，≤2次活产，无不孕。所有受试者完成至少1个月经周期的随访;没有人因不良事件退出。干预措施:阿司匹林(81毫克)，每日1 - 6个月经周期。主要结果测量指标:每周期无排卵风险，定义为尿样妊娠试验阳性和黄体生成素(LH)峰值(每日尿LH升高2.5倍)均未出现。假设制定先于数据收集。结果在4340个周期中，LDA与无排卵无关(LDA: 13.4%，安慰剂:11.1%;风险比= 1.16,95%可信区间为0.88 ~ 1.52)。在最近一次减肥的女性中，结果也类似。结论每日LDA对有1 ~ 2次流产史的女性无排卵影响。LDA可能通过其他途径影响生育，这些值得进一步研究。

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引用次数: 12

Insulinlike Growth Factor Binding Protein-1 and Ghrelin Predict Health Outcomes Among Older Adults: Cardiovascular Health Study Cohort. 胰岛素样生长因子结合蛋白-1和胃饥饿素预测老年人的健康结局：心血管健康研究队列

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2779

Robert C Kaplan, Garrett Strizich, Chino Aneke-Nash, Clara Dominguez-Islas, Petra Bužková, Howard Strickler, Thomas Rohan, Michael Pollak, Lewis Kuller, Jorge R Kizer, Anne Cappola, Christopher I Li, Bruce M Psaty, Anne Newman

Context: Multiple diseases may explain the association of the growth hormone/insulinlike growth factor-I (GH/IGF-I) axis with longevity.

Objective: To relate circulating GH/IGF-I system protein levels with major health events.

Design and setting: This is a cohort study set in 4 US communities.

Participants: Adults (N = 2268) 65 years and older free of diabetes and cardiovascular disease.

Measurements: We assessed insulinlike growth factor binding protein-1 (IGFBP-1) and ghrelin in fasting and 2-hour oral glucose tolerance test (OGTT) blood samples, as well as fasting IGF-I and IGFBP-3. Hazard ratios for mortality and a composite outcome for first incident myocardial infarction, stroke, heart failure, hip fracture, or death were adjusted for sociodemographic, behavioral, and physiological covariates.

Results: During 13,930 person-years of follow-up, 48.1% of individuals sustained one or more components of the composite outcome and 31.8% died. Versus the lowest quartiles, the highest quartiles of fasting and 2-hour ghrelin were associated with 27% higher (95% confidence interval [CI]: 6%, 53%) and 39% higher (95% CI: 14%, 71%) risks of the composite outcome, respectively. The highest quartile of 2-hour IGFBP-1 was associated with 35% higher (95% CI: 1%, 52%) risk of the composite end point. Similarly, higher mortality was significantly associated with higher fasting and 2-hour ghrelin levels and with 2-hour IGFBP-1 level. When examined together, 2-hour post-OGTT levels of IGFBP-1 and ghrelin tended to predict outcomes better than fasting levels.

Conclusions: Circulating IGFBP-1 and ghrelin measured during an OGTT predicted major health events and death in older adults, which may explain the influence of the GH/IGF-I axis on lifespan and health.

背景：多种疾病可能解释生长激素/胰岛素样生长因子- i （GH/IGF-I）轴与寿命的关联。目的：探讨循环GH/ igf - 1系统蛋白水平与主要健康事件的关系。设计和环境：这是一项在美国4个社区进行的队列研究。参与者：65岁及以上无糖尿病和心血管疾病的成年人（N = 2268）。测量：我们评估了空腹和2小时口服葡萄糖耐量试验（OGTT）血液样本中的胰岛素样生长因子结合蛋白-1 （IGFBP-1）和胃饥饿素，以及空腹igf -1和IGFBP-3。死亡率的危险比和首次发生心肌梗死、中风、心力衰竭、髋部骨折或死亡的综合结局根据社会人口统计学、行为和生理协变量进行调整。结果：在13930人年的随访中，48.1%的个体维持了复合结局的一个或多个组成部分，31.8%的个体死亡。与最低四分位数相比，禁食和2小时胃饥饿素的最高四分位数分别与复合结局的风险增加27%（95%置信区间[CI]: 6%， 53%）和39% （95% CI: 14%, 71%）相关。2小时IGFBP-1的最高四分位数与复合终点风险增加35%相关（95% CI: 1%, 52%）。同样，较高的死亡率与较高的禁食和2小时胃饥饿素水平以及2小时IGFBP-1水平显著相关。当一起检查时，ogtt后2小时的IGFBP-1和胃饥饿素水平倾向于比空腹水平更好地预测结果。结论：在OGTT中测量循环IGFBP-1和ghrelin可以预测老年人的主要健康事件和死亡，这可能解释了GH/IGF-I轴对寿命和健康的影响。

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引用次数: 0

Serum 1,25-Dihydroxyvitamin D as a Biomarker of the Absence of Hypercalciuria in Postsurgical Hypoparathyroidism 血清1,25-二羟基维生素D作为术后甲状旁腺功能低下患者无高钙尿的生物标志物

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2987

L. García-Pascual, M. Barahona, V. Perea, R. Simó

Context Hypercalciuria is an adverse event of postsurgical hypoparathyroidism treatment that can lead to renal complications. The collection of 24-hour urine to detect hypercalciuria is often considered unreliable. Objective The purpose of this study was to find useful predictive biomarkers of hypercalciuria in patients with permanent postsurgical hypoparathyroidism receiving treatment with oral calcium and calcitriol supplements. Design and Setting The investigation was designed as a prospective cross-sectional study. An outpatient hospital clinic served as the study setting. Patients Fifty-four consecutive observations were made of 34 stable outpatients with postsurgical hypoparathyroidism taking oral calcium and calcitriol supplements, and 17 adult controls without hypoparathyroidism. Intervention There were no interventions. Main Outcome Measure Hypercalciuria was defined as 24-hour urine calcium >300 mg. Results Patients without hypercalciuria (n = 21) vs those with hypercalciuria (n = 33) had lower levels of serum 1,25-dihydroxyvitamin D (33.5 ± 11.9 pg/mL vs 45.8 ± 9.5 pg/mL; P < 0.001), similar albumin-corrected serum calcium (8.3 ± 0.5 vs 8.6 ± 0.5 mg/dL; P = nonsignificant), and serum parathyroid hormone (12.5 ± 5.7 vs 10.7 ± 6.8 pg/mL; P = nonsignificant). Multiple linear regression analysis showed an independent relationship between 1,25-dihydroxyvitamin D and urinary calcium excretion (B = 6.2 ± 1.423; P < 0.001). A cutoff value of 33.5 pg/mL for serum 1,25-dihydroxyvitamin D to predict the absence of hypercalciuria had 100% sensitivity and 63.6% specificity, and the area under the receiver operating characteristic curve was 0.797. No patients with serum 1,25-dihydroxyvitamin D levels of <33.5 pg/mL presented with hypercalciuria, regardless of the level of albumin-corrected serum calcium. Conclusions Routine measurement of serum 1,25-dihydroxyvitamin D may be useful as a biomarker to predict the absence of hypercalciuria in patients with permanent postsurgical hypoparathyroidism who are receiving treatment with oral calcium and calcitriol supplements.

高钙尿症是术后甲状旁腺功能减退治疗的不良事件，可导致肾脏并发症。收集24小时尿液来检测高钙尿通常被认为是不可靠的。目的:本研究的目的是在接受口服钙和骨化三醇补充剂治疗的永久性术后甲状旁腺功能低下患者中寻找有用的高钙尿的预测性生物标志物。本研究设计为前瞻性横断面研究。一家医院门诊作为研究场所。患者:34例稳定的术后甲状旁腺功能减退门诊患者口服钙和骨化三醇补充剂，以及17例无甲状旁腺功能减退的成人对照，进行了54次连续观察。干预没有干预。主要观察指标高钙尿定义为24小时尿钙>300 mg。结果无高钙尿症患者(n = 21)比高钙尿症患者(n = 33)血清1,25-二羟基维生素D水平低(33.5±11.9 pg/mL vs 45.8±9.5 pg/mL);P < 0.001)，相似的白蛋白校正血清钙(8.3±0.5 vs 8.6±0.5 mg/dL;P =无统计学意义)，血清甲状旁腺激素(12.5±5.7 vs 10.7±6.8 pg/mL;P =无显著性)。多元线性回归分析显示1,25-二羟基维生素D与尿钙排泄量之间存在独立关系(B = 6.2±1.423;P < 0.001)。血清1,25-二羟基维生素D预测无高钙尿症的临界值为33.5 pg/mL，敏感性为100%，特异性为63.6%，受试者工作特征曲线下面积为0.797。无论白蛋白校正的血清钙水平如何，血清1,25-二羟基维生素D水平<33.5 pg/mL的患者均未出现高钙尿。结论血清1,25-二羟基维生素D的常规测定可作为预测永久性术后甲状旁腺功能低下患者是否存在高钙尿的生物标志物，这些患者接受口服钙和骨化三醇补充剂治疗。

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引用次数: 5

Testosterone, Dihydrotestosterone, Sex Hormone-Binding Globulin, and Incident Diabetes Among Older Men: The Cardiovascular Health Study. 老年男性中睾酮、双氢睾酮、性激素结合球蛋白与糖尿病：心血管健康研究

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2623

Katherine E Joyce, Mary L Biggs, Luc Djoussé, Joachim H Ix, Jorge R Kizer, David S Siscovick, Molly M Shores, Alvin M Matsumoto, Kenneth J Mukamal

Context: Although sex hormone-binding globulin (SHBG) and testosterone (T) have been inversely associated with risk of diabetes, few studies have examined dihydrotestosterone (DHT), a more potent androgen than T, in older adults, whose glycemic pathophysiology differs from younger adults.

Objective: To determine the associations of SHBG, T, and DHT with insulin resistance and incident diabetes in older adult men.

Design: In a prospective cohort study, we evaluated baseline levels of SHBG, T, and DHT using liquid chromatography-tandem mass spectrometry among 852 men free of diabetes and cardiovascular disease in the Cardiovascular Health Study in 1994.

Main outcome: Insulin resistance estimated by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and insulin sensitivity estimated by the Gutt index in 1996, and incident diabetes (n = 112) ascertained over a mean follow-up of 9.8 years.

Results: In linear regression models adjusted for demographics, alcohol consumption, current smoking, body mass index, and other androgens, SHBG [HOMA-IR 0.30 units lower per doubling; 95% confidence interval (CI), 0.08 to 0.52; P = 0.01] and total DHT (HOMA-IR 0.18 units lower per doubling; 95% CI, 0.06 to 0.30; P = 0.01), but not free T (P = 0.33), were inversely associated with insulin resistance. In corresponding Cox proportional hazards models, total DHT was again inversely associated with risk of diabetes (adjusted hazard ratio per doubling, 0.69; 95% CI, 0.52 to 0.92; P = 0.01), but SHBG (hazard ratio, 1.09; 95% CI, 0.74 to 1.59; P = 0.66) and free T (hazard ratio, 1.15; 95% CI, 0.92 to 1.43; P = 0.23) were not.

Conclusions: Among older men, higher levels of DHT were inversely associated with insulin resistance and risk of diabetes over the ensuing 10 years, whereas levels of T were not. Future studies are still needed to clarify the role of SHBG in risk of diabetes in this population.

背景：虽然性激素结合球蛋白（SHBG）和睾酮(T)与糖尿病风险呈负相关，但很少有研究在老年人中检测二氢睾酮（DHT），这是一种比睾酮更有效的雄激素，其血糖病理生理与年轻人不同。目的：探讨老年男性SHBG、T和DHT与胰岛素抵抗和糖尿病的关系。设计：在一项前瞻性队列研究中，我们使用液相色谱-串联质谱法评估了1994年心血管健康研究中852名无糖尿病和心血管疾病的男性的SHBG、T和DHT的基线水平。主要结局：胰岛素抵抗的稳态模型评估（HOMA-IR）估计的胰岛素抵抗和胰岛素敏感性估计的Gutt指数在1996年，和发生率糖尿病（n = 112）确定平均随访9.8年。结果：在调整了人口统计学、饮酒、当前吸烟、体重指数和其他雄激素的线性回归模型中，SHBG [HOMA-IR]每翻倍降低0.30个单位；95%置信区间（CI）， 0.08 ~ 0.52；P = 0.01]，总DHT （HOMA-IR）每翻倍降低0.18个单位；95% CI, 0.06 ~ 0.30；P = 0.01)，但游离T与胰岛素抵抗呈负相关（P = 0.33）。在相应的Cox比例风险模型中，总DHT再次与糖尿病风险呈负相关(每翻倍调整风险比，0.69；95% CI, 0.52 ~ 0.92；P = 0.01)，但SHBG(风险比1.09；95% CI, 0.74 ~ 1.59；P = 0.66)和自由T(风险比，1.15；95% CI, 0.92 ~ 1.43；P = 0.23)。结论：在老年男性中，较高水平的DHT与随后10年的胰岛素抵抗和糖尿病风险呈负相关，而睾酮水平则与此无关。未来的研究仍需要明确SHBG在这一人群中糖尿病风险中的作用。

{"title":"Testosterone, Dihydrotestosterone, Sex Hormone-Binding Globulin, and Incident Diabetes Among Older Men: The Cardiovascular Health Study.","authors":"Katherine E Joyce, Mary L Biggs, Luc Djoussé, Joachim H Ix, Jorge R Kizer, David S Siscovick, Molly M Shores, Alvin M Matsumoto, Kenneth J Mukamal","doi":"10.1210/jc.2016-2623","DOIUrl":"10.1210/jc.2016-2623","url":null,"abstract":"Context: Although sex hormone-binding globulin (SHBG) and testosterone (T) have been inversely associated with risk of diabetes, few studies have examined dihydrotestosterone (DHT), a more potent androgen than T, in older adults, whose glycemic pathophysiology differs from younger adults.Objective: To determine the associations of SHBG, T, and DHT with insulin resistance and incident diabetes in older adult men.Design: In a prospective cohort study, we evaluated baseline levels of SHBG, T, and DHT using liquid chromatography-tandem mass spectrometry among 852 men free of diabetes and cardiovascular disease in the Cardiovascular Health Study in 1994.Main outcome: Insulin resistance estimated by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and insulin sensitivity estimated by the Gutt index in 1996, and incident diabetes (n = 112) ascertained over a mean follow-up of 9.8 years.Results: In linear regression models adjusted for demographics, alcohol consumption, current smoking, body mass index, and other androgens, SHBG [HOMA-IR 0.30 units lower per doubling; 95% confidence interval (CI), 0.08 to 0.52; P = 0.01] and total DHT (HOMA-IR 0.18 units lower per doubling; 95% CI, 0.06 to 0.30; P = 0.01), but not free T (P = 0.33), were inversely associated with insulin resistance. In corresponding Cox proportional hazards models, total DHT was again inversely associated with risk of diabetes (adjusted hazard ratio per doubling, 0.69; 95% CI, 0.52 to 0.92; P = 0.01), but SHBG (hazard ratio, 1.09; 95% CI, 0.74 to 1.59; P = 0.66) and free T (hazard ratio, 1.15; 95% CI, 0.92 to 1.43; P = 0.23) were not.Conclusions: Among older men, higher levels of DHT were inversely associated with insulin resistance and risk of diabetes over the ensuing 10 years, whereas levels of T were not. Future studies are still needed to clarify the role of SHBG in risk of diabetes in this population.","PeriodicalId":22632,"journal":{"name":"The Journal of Clinical Endocrinology & Metabolism","volume":"4 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74548644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Familial Multiplicity of Estrogen Insensitivity Associated With a Loss-of-Function ESR1 Mutation. 雌激素不敏感与ESR1突变功能丧失相关的家族多样性

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2749

Valérie Bernard, Sakina Kherra, Bruno Francou, Jérôme Fagart, Say Viengchareun, Jérôme Guéchot, Asmahane Ladjouze, Anne Guiochon-Mantel, Kenneth S Korach, Nadine Binart, Marc Lombès, Sophie Christin-Maitre

Context: Estrogens influence many physiological processes in mammals, including reproduction. Estrogen peripheral actions are mainly mediated through estrogen receptors (ERs) α and β, encoded by ESR1 and ESR2 genes, respectively.

Objective: The study's aim was to describe a family in which 3 members presented with estrogen insensitivity.

Design and setting: Clinical evaluation and genetic and mutational analysis were performed in an academic medical center.

Patients and interventions: An ESR1 mutation was identified in 2 sisters and 1 brother, originating from a consanguineous Algerian family, who did not enter puberty and presented with delayed bone maturation consistent with estrogen insensitivity. The 2 sisters had enlarged multicystic ovaries. Hormonal evaluation as well as genetic and mutational analysis were performed.

Results: Hormonal evaluation revealed extremely high plasma 17β-estradiol (>50-fold normal range) associated with elevated gonadotropin levels (greater than threefold normal range), highly suggestive of estrogen resistance. The 3 affected patients carried a homozygous mutation of a highly conserved arginine 394 for which histidine was substituted through an autosomal recessive mode of transmission. Structural and functional analysis of the mutant ERα revealed strongly reduced transcriptional activity and the inability to securely anchor the activating hormone, estradiol, compared with wild-type ERα. A group of other potential ER activating ligands were tested, but none overcame the estrogen insensitivity in these patients.

Conclusion: Description and analysis of this family of patients with mutant ERα provide additional clinical findings toward identification and characterization of what was previously thought to be a highly rare clinical condition.

背景：雌激素影响哺乳动物的许多生理过程，包括生殖。雌激素外周作用主要通过雌激素受体α和β介导，分别由ESR1和ESR2基因编码。目的：本研究的目的是描述一个家庭，其中3名成员表现为雌激素不敏感。设计和环境：临床评估和基因和突变分析在学术医疗中心进行。患者和干预措施：在2个姐妹和1个兄弟中发现了ESR1突变，他们来自阿尔及利亚的一个近亲家庭，未进入青春期，表现为骨骼成熟延迟，与雌激素不敏感一致。两姐妹多囊卵巢肿大。进行激素评估以及遗传和突变分析。结果：激素评估显示血浆中17β-雌二醇含量极高（约为正常范围的50倍），与促性腺激素水平升高（超过正常范围的3倍）相关，高度提示雌激素抵抗。3例患者携带高度保守的精氨酸394纯合突变，组氨酸通过常染色体隐性传播模式被取代。对ERα突变体的结构和功能分析显示，与野生型ERα相比，ERα突变体的转录活性明显降低，无法安全地固定激活激素雌二醇。一组其他潜在的雌激素受体激活配体进行了测试，但没有一个能克服这些患者的雌激素不敏感。结论：对这一ERα突变患者家族的描述和分析，为鉴定和表征以前被认为是非常罕见的临床疾病提供了额外的临床发现。

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引用次数: 0

Sex Differences in Associations of Adiposity Measures and Insulin Resistance in US Hispanic/Latino Youth: The Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). 美国西班牙裔/拉丁裔青年肥胖测量和胰岛素抵抗相关性的性别差异：西班牙裔社区儿童健康研究/拉丁裔青年研究（SOL Youth）。

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2279

Qibin Qi, Simin Hua, Krista M Perreira, Jianwen Cai, Linda Van Horn, Neil Schneiderman, Bharat Thyagarajan, Alan M Delamater, Robert C Kaplan, Carmen R Isasi

Context: US Hispanic/Latino youth are disproportionally affected by the obesity and diabetes.

Objective: We examined associations of adiposity measures with insulin resistance (IR) and hyperglycemia and the influences of sex and pubertal development on these associations.

Design, setting, and participants: We performed a cross-sectional analysis of 1223 8- to 16-year-old Hispanic/Latino youth from a community-based study in the United States (SOL Youth).

Main outcome measures: We measured IR (≥75th percentile of sex-specific Homeostatic Model Assessment of Insulin Resistance) and hyperglycemia (fasting glucose ≥100 mg/dL or hemoglobin a1c ≥5.7%).

Results: In boys, body mass index (BMI) showed the strongest association with IR [prevalence ratio (PR), 2.10; 95% confidence interval (CI), 1.87 to 2.36 per standard deviation], which was not statistically different compared with body fat percentage (%BF) (PR, 2.03; 95% CI, 1.81 to 2.29) and waist circumference (WC) (PR, 1.89; 95% CI, 1.67 to 2.13) but was significantly stronger compared with fat mass index (FMI) (PR, 1.79; 95% CI, 1.63 to 1.96), waist-to-hip ratio (WHR) (PR, 1.32; 95% CI, 1.21 to 1.44), and waist-to-height ratio (WHtR) (PR, 1.76; 95% CI, 1.54 to 2.01) (P for difference, <0.05). In girls, %BF (PR, 2.73; 95% CI, 2.34 to 3.20) showed a significantly stronger association with IR compared with BMI (PR, 1.48; 95% CI, 1.29 to 1.70), FMI (PR, 1.71; 95% CI, 1.49 to 1.95), WC (PR, 1.96; 95% CI, 1.70 to 2.27), WHR (PR, 1.95; 95% CI, 1.70 to 2.23), and WHtR (PR, 1.79; 95% CI, 1.53 to 2.09) (P for difference, <0.003). Associations between adiposity measures and IR were generally stronger among children in puberty versus those who had completed puberty, with significant interactions for WC and WHtR in boys and for BMI in girls (P for interaction, <0.01). Adiposity measures were modestly associated with hyperglycemia (PR, 1.14 to 1.25), with no interactions with sex or pubertal status.

Conclusions: Sex and puberty may influence associations between adiposity measures and IR in US Hispanic/Latino youth. Multiple adiposity measures are needed to better assess IR risk between boys and girls according to pubertal status.

背景：美国西班牙裔/拉丁裔青年受到肥胖和糖尿病的不成比例的影响。目的：探讨肥胖指标与胰岛素抵抗（IR）和高血糖的关系，以及性别和青春期发育对这些关系的影响。设计、环境和参与者：我们对来自美国一项社区研究（SOL youth）的1223名8至16岁的西班牙/拉丁裔青年进行了横断面分析。主要结局指标：我们测量了IR（胰岛素抵抗性别特异性稳态模型评估≥75百分位数）和高血糖（空腹血糖≥100 mg/dL或糖化血红蛋白≥5.7%）。结果：在男孩中，体重指数（BMI）与IR的相关性最强[患病率（PR）为2.10；95%可信区间（CI）， 1.87 ~ 2.36 /标准差]，与体脂率（%BF）比较无统计学差异(PR, 2.03；95% CI, 1.81 ~ 2.29)和腰围（WC） (PR, 1.89；95% CI, 1.67 ~ 2.13)，但与脂肪质量指数（FMI）相比显著增强(PR, 1.79；95% CI, 1.63 ~ 1.96)，腰臀比（WHR） (PR, 1.32；95% CI, 1.21 ~ 1.44)，腰高比（WHtR） (PR, 1.76；95% CI， 1.54至2.01)(P为差异，结论：性别和青春期可能影响美国西班牙裔/拉丁裔青年肥胖测量和IR之间的关联。根据青春期状况，需要多种肥胖测量来更好地评估男孩和女孩之间的IR风险。

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引用次数: 0

Contribution of LHX4 Mutations to Pituitary Deficits in a Cohort of 417 Unrelated Patients LHX4突变对417例不相关患者垂体功能缺陷的影响

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-3158

Enzo Cohen, M. Maghnie, N. Collot, J. Léger, F. Dastot, M. Polak, S. Rose, P. Touraine, P. Duquesnoy, M. Tauber, B. Copin, A. Bertrand, F. Brioude, D. Larizza, T. Edouard, Laura G González Briceño, I. Netchine, I. Oliver-Petit, M. Sobrier, S. Amselem, M. Legendre

Context LHX4 encodes a LIM-homeodomain transcription factor that is implicated in early pituitary development. In humans, only 13 heterozygous LHX4 mutations have been associated with congenital hypopituitarism. Objective The aims of this study were to evaluate the prevalence of LHX4 mutations in patients with hypopituitarism, to define the associated phenotypes, and to characterize the functional impact of the identified variants and the respective role of the 2 LIM domains of LHX4. Design and Patients We screened 417 unrelated patients with isolated growth hormone deficiency or combined pituitary hormone deficiency associated with ectopic posterior pituitary and/or sella turcica anomalies for LHX4 mutations (Sanger sequencing). In vitro studies were performed to assess the functional consequences of the identified variants. Results We identified 7 heterozygous variations, including p.(Tyr131*), p.(Arg48Thrfs*104), c.606+1G>T, p.Arg65Val, p.Thr163Pro, p.Arg221Gln, and p.Arg235Gln), that were associated with variable expressivity; 5 of the 7 were also associated with incomplete penetrance. The p.(Tyr131*), p.(Arg48Thrfs*104), p.Ala65Val, p.Thr163Pro, and p.Arg221Gln LHX4 variants are unable to transactivate the POU1F1 and GH promoters. As suggested by transactivation, subcellular localization, and protein-protein interaction studies, p.Arg235Gln is probably a rare polymorphism. Coimmunoprecipitation studies identified LHX3 as a potential protein partner of LHX4. As revealed by functional studies of LIM-defective recombinant LHX4 proteins, the LIM1 and LIM2 domains are not redundant. Conclusion This study, performed in the largest cohort of patients screened so far for LHX4 mutations, describes 6 disease-causing mutations that are responsible for congenital hypopituitarism. LHX4 mutations were found to be associated with variable expressivity, and most of them with incomplete penetrance; their contribution to pituitary deficits that are associated with an ectopic posterior pituitary and/or a sella turcica defect is ∼1.4% in the 417 probands tested.

lhx4编码一个与垂体早期发育有关的lim同源结构域转录因子。在人类中，只有13个杂合LHX4突变与先天性垂体功能低下有关。目的本研究的目的是评估LHX4突变在垂体功能低下患者中的患病率，确定相关表型，并表征所鉴定的变异对功能的影响以及LHX4的2个LIM结构域的各自作用。设计和患者:我们筛选了417例与LHX4突变无关的单独生长激素缺乏或合并垂体激素缺乏与垂体后叶异位和/或蝶鞍异常相关的患者(Sanger测序)。进行体外研究以评估鉴定的变异的功能后果。结果共鉴定出7个杂合变异，包括p.(Tyr131*)、p.(Arg48Thrfs*104)、c.606+1G>T、p. arg65val、p. thr163pro、p. arg221gln和p. arg235gln，这些变异与表达性变化相关;7个中有5个也与不完全外显率有关。p.(Tyr131*)、p.(Arg48Thrfs*104)、p. ala65val、p. thr163pro和p. arg221gln LHX4变体不能反激活POU1F1和GH启动子。通过反活化、亚细胞定位和蛋白-蛋白相互作用研究表明，p.a g235gln可能是一种罕见的多态性。共免疫沉淀研究发现LHX3是LHX4的潜在蛋白伴侣。LIM1缺陷重组LHX4蛋白的功能研究表明，LIM1和LIM2结构域不是冗余的。本研究在迄今为止筛选LHX4突变的最大患者队列中进行，描述了导致先天性垂体功能低下的6种致病突变。发现LHX4突变与可变表达性相关，且大多数具有不完全外显性;在417个先证中，它们对与垂体后叶异位和/或蝶鞍缺损相关的垂体缺陷的贡献约为1.4%。

{"title":"Contribution of LHX4 Mutations to Pituitary Deficits in a Cohort of 417 Unrelated Patients","authors":"Enzo Cohen, M. Maghnie, N. Collot, J. Léger, F. Dastot, M. Polak, S. Rose, P. Touraine, P. Duquesnoy, M. Tauber, B. Copin, A. Bertrand, F. Brioude, D. Larizza, T. Edouard, Laura G González Briceño, I. Netchine, I. Oliver-Petit, M. Sobrier, S. Amselem, M. Legendre","doi":"10.1210/jc.2016-3158","DOIUrl":"https://doi.org/10.1210/jc.2016-3158","url":null,"abstract":"Context LHX4 encodes a LIM-homeodomain transcription factor that is implicated in early pituitary development. In humans, only 13 heterozygous LHX4 mutations have been associated with congenital hypopituitarism. Objective The aims of this study were to evaluate the prevalence of LHX4 mutations in patients with hypopituitarism, to define the associated phenotypes, and to characterize the functional impact of the identified variants and the respective role of the 2 LIM domains of LHX4. Design and Patients We screened 417 unrelated patients with isolated growth hormone deficiency or combined pituitary hormone deficiency associated with ectopic posterior pituitary and/or sella turcica anomalies for LHX4 mutations (Sanger sequencing). In vitro studies were performed to assess the functional consequences of the identified variants. Results We identified 7 heterozygous variations, including p.(Tyr131*), p.(Arg48Thrfs*104), c.606+1G>T, p.Arg65Val, p.Thr163Pro, p.Arg221Gln, and p.Arg235Gln), that were associated with variable expressivity; 5 of the 7 were also associated with incomplete penetrance. The p.(Tyr131*), p.(Arg48Thrfs*104), p.Ala65Val, p.Thr163Pro, and p.Arg221Gln LHX4 variants are unable to transactivate the POU1F1 and GH promoters. As suggested by transactivation, subcellular localization, and protein-protein interaction studies, p.Arg235Gln is probably a rare polymorphism. Coimmunoprecipitation studies identified LHX3 as a potential protein partner of LHX4. As revealed by functional studies of LIM-defective recombinant LHX4 proteins, the LIM1 and LIM2 domains are not redundant. Conclusion This study, performed in the largest cohort of patients screened so far for LHX4 mutations, describes 6 disease-causing mutations that are responsible for congenital hypopituitarism. LHX4 mutations were found to be associated with variable expressivity, and most of them with incomplete penetrance; their contribution to pituitary deficits that are associated with an ectopic posterior pituitary and/or a sella turcica defect is ∼1.4% in the 417 probands tested.","PeriodicalId":22632,"journal":{"name":"The Journal of Clinical Endocrinology & Metabolism","volume":"48 1","pages":"290–301"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79093831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 20

Loss of Functional Osteoprotegerin: More Than a Skeletal Problem 功能性骨保护素的丧失:不仅仅是骨骼问题

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2905

C. Grasemann, N. Unger, M. Hövel, D. Arweiler-Harbeck, R. Herrmann, Michael M. Schündeln, O. Müller, B. Schweiger, E. Lausch, T. Meissner, C. Kiewert, B. Hauffa, N. Shaw

Introduction Juvenile Paget's disease (JPD), an ultra-rare, debilitating bone disease due to loss of functional osteoprotegerin (OPG), is caused by recessive mutations in TNFRFSF11B. A genotype-phenotype correlation spanning from mild to very severe forms is described. Aim This study aimed to describe the complexity of the human phenotype of OPG deficiency in more detail and to investigate heterozygous mutation carriers for clinical signs of JPD. Patients We investigated 3 children with JPD from families of Turkish, German, and Pakistani descent and 19 family members (14 heterozygous). Results A new disease-causing 4 bp-duplication in exon 1 was detected in the German patient, and a microdeletion including TNFRFSF11B in the Pakistani patient. Skeletal abnormalities in all affected children included bowing deformities and fractures, contractures, short stature and skull involvement. Complex malformation of the inner ear and vestibular structures (2 patients) resulted in early deafness. Patients were found to be growth hormone deficient (2), displayed nephrocalcinosis (1), and gross motor (3) and mental (1) retardation. Heterozygous family members displayed low OPG levels (12), elevated bone turnover markers (7), and osteopenia (6). Short stature (1), visual impairment (2), and hearing impairment (1) were also present. Conclusion Diminished OPG levels cause complex changes affecting multiple organ systems, including pituitary function, in children with JPD and may cause osteopenia in heterozygous family members. Diagnostic and therapeutic measures should aim to address the complex phenotype.

青少年佩吉特病(JPD)是一种因功能性骨保护素(OPG)缺失而导致的超罕见、衰弱性骨病，由TNFRFSF11B的隐性突变引起。基因型-表型相关性从轻度到非常严重的形式被描述。目的本研究旨在更详细地描述人类OPG缺乏表型的复杂性，并探讨杂合突变携带者与JPD临床症状的关系。我们调查了3名来自土耳其、德国和巴基斯坦血统家庭的JPD患儿和19名家庭成员(14名杂合子)。结果在德国患者的1号外显子中检测到新的致病4 bp重复，在巴基斯坦患者中检测到包括TNFRFSF11B的微缺失。所有受影响儿童的骨骼异常包括弯曲畸形和骨折、挛缩、身材矮小和颅骨受累。内耳及前庭结构复杂畸形(2例)导致早期耳聋。患者发现生长激素缺乏(2)，肾钙质沉着(1)，大运动(3)和智力(1)发育迟缓。杂合子家族成员表现为低OPG水平(12)，骨转换标志物升高(7)和骨质减少(6)。身材矮小(1)，视力障碍(2)和听力障碍(1)也存在。结论OPG水平降低可引起JPD患儿包括垂体功能在内的多器官系统的复杂变化，并可能导致杂合子家族成员骨质减少。诊断和治疗措施应旨在解决复杂的表型。

{"title":"Loss of Functional Osteoprotegerin: More Than a Skeletal Problem","authors":"C. Grasemann, N. Unger, M. Hövel, D. Arweiler-Harbeck, R. Herrmann, Michael M. Schündeln, O. Müller, B. Schweiger, E. Lausch, T. Meissner, C. Kiewert, B. Hauffa, N. Shaw","doi":"10.1210/jc.2016-2905","DOIUrl":"https://doi.org/10.1210/jc.2016-2905","url":null,"abstract":"Introduction Juvenile Paget's disease (JPD), an ultra-rare, debilitating bone disease due to loss of functional osteoprotegerin (OPG), is caused by recessive mutations in TNFRFSF11B. A genotype-phenotype correlation spanning from mild to very severe forms is described. Aim This study aimed to describe the complexity of the human phenotype of OPG deficiency in more detail and to investigate heterozygous mutation carriers for clinical signs of JPD. Patients We investigated 3 children with JPD from families of Turkish, German, and Pakistani descent and 19 family members (14 heterozygous). Results A new disease-causing 4 bp-duplication in exon 1 was detected in the German patient, and a microdeletion including TNFRFSF11B in the Pakistani patient. Skeletal abnormalities in all affected children included bowing deformities and fractures, contractures, short stature and skull involvement. Complex malformation of the inner ear and vestibular structures (2 patients) resulted in early deafness. Patients were found to be growth hormone deficient (2), displayed nephrocalcinosis (1), and gross motor (3) and mental (1) retardation. Heterozygous family members displayed low OPG levels (12), elevated bone turnover markers (7), and osteopenia (6). Short stature (1), visual impairment (2), and hearing impairment (1) were also present. Conclusion Diminished OPG levels cause complex changes affecting multiple organ systems, including pituitary function, in children with JPD and may cause osteopenia in heterozygous family members. Diagnostic and therapeutic measures should aim to address the complex phenotype.","PeriodicalId":22632,"journal":{"name":"The Journal of Clinical Endocrinology & Metabolism","volume":"2 1","pages":"210–219"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89959121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Vascular Disease Is Associated With the Expression of Genes for Intestinal Cholesterol Transport and Metabolism 血管疾病与肠道胆固醇转运和代谢基因表达相关

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-2728

W. Widdowson, A. McGowan, J. Phelan, G. Boran, J. Reynolds, J. Gibney

Context Intestinal cholesterol metabolism is important in influencing postprandial lipoprotein concentrations, and might be important in the development of vascular disease. Objective This study evaluated associations between expression of intestinal cholesterol metabolism genes, postprandial lipid metabolism, and endothelial function/early vascular disease in human subjects. Design/Patients One hundred patients undergoing routine oesophago-gastro-duodenoscopy were recruited. mRNA levels of Nieman-Pick C1-like 1 protein (NPC1L1), ABC-G5, ABC-G8, ABC-A1, microsomal tissue transport protein (MTTP), and sterol-regulatory element-binding protein (SREBP)-2 were measured in duodenal biopsies using quantitative reverse transcription polymerase chain reaction. Postprandially, serum lipid and glycemic profiles were measured, endothelial function was assessed using fasting, and postprandial flow-mediated dilatation (FMD) and carotid intima-media thickness (IMT). Subjects were divided into those above and below the median value of relative expression of each gene, and results were compared between the groups. Results There were no between-group differences in demographic variables or classical cardiovascular risks. For all genes, the postprandial triglyceride incremental area under the curve was greater (P < 0.05) in the group with greater expression. Postprandial apolipoprotein B48 (ApoB48) levels were greater (P < 0.05) in groups with greater expression of NPC1L1, ABC-G8, and SREBP-2. For all genes, postprandial but not fasting FMD was lower (P < 0.01) in the group with greater expression. Triglyceride and ApoB48 levels correlated significantly with postprandial FMD. Carotid artery IMT was greater (P < 0.05) in groups with greater expression of MTTP, ABC-A1, and SREBP-2. Conclusion Intestinal cholesterol metabolism gene expression is significantly associated with postprandial increment in triglycerides, intestinal ApoB48, and reduced postprandial FMD. Some genes were also associated with increased IMT. These findings suggest a role of intestinal cholesterol metabolism in development of early vascular disease.

肠道胆固醇代谢在影响餐后脂蛋白浓度方面是重要的，并且可能在血管疾病的发生中起重要作用。目的本研究评估人类肠道胆固醇代谢基因表达、餐后脂质代谢和内皮功能/早期血管疾病之间的关系。设计/患者100例患者接受常规食管-胃-十二指肠镜检查。采用定量逆转录聚合酶链反应测定十二指肠活检组织中尼曼-匹克c1样1蛋白(NPC1L1)、ABC-G5、ABC-G8、ABC-A1、微粒体组织转运蛋白(MTTP)和甾醇调节元件结合蛋白(SREBP)-2的mRNA水平。餐后测量血脂和血糖水平，空腹评估内皮功能，餐后血流介导扩张(FMD)和颈动脉内膜-中膜厚度(IMT)。将受试者分为高于和低于各基因相对表达中位数的组，比较各组结果。结果两组间在人口统计学变量和经典心血管风险方面没有差异。对于所有基因，高表达组餐后甘油三酯曲线下增量面积更大(P < 0.05)。NPC1L1、ABC-G8和SREBP-2表达高的组餐后载脂蛋白B48 (ApoB48)水平较高(P < 0.05)。在所有基因中，高表达组的餐后FMD低于空腹FMD (P < 0.01)。甘油三酯和ApoB48水平与餐后FMD显著相关。MTTP、ABC-A1、SREBP-2表达高的组颈动脉IMT升高(P < 0.05)。结论肠道胆固醇代谢基因表达与餐后甘油三酯升高、肠道载脂蛋白48升高及餐后FMD降低相关。一些基因也与IMT增加有关。这些发现提示肠道胆固醇代谢在早期血管疾病发展中的作用。

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引用次数: 3

Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan 使用68Ga-DOTATATE PET/CT扫描定位胰岛素瘤

The Journal of Clinical Endocrinology & Metabolism

Pub Date : 2017-01-01 DOI: 10.1210/jc.2016-3445

P. Nockel, Bruna Babic, C. Millo, P. Herscovitch, Dhaval Patel, N. Nilubol, S. Sadowski, Craig S. Cochran, P. Gorden, E. Kebebew

Context Reliable localization of insulinoma is critical for successful treatment. Objective This study compared the accuracy of 68Gallium DOTA-(Tyr3)-octreotate (Ga-DOTATATE) positron emission tomography (PET)/computed tomography (CT) to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IO ultrasound) and palpation for localizing insulinoma in patients who were biochemically cured. Design, Setting, and Patients We conducted a retrospective analysis of 31 patients who had an insulinoma. The results of CT, magnetic resonance imaging (MRI), ultrasound, IO ultrasound, 68Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed. Intervention, Main Outcome Measures, and Results The insulinomas were correctly localized in 17 out of 31 (55%) patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by ultrasound, and in 9 out of 10 (90%) by 68Ga-DOTATATE. In 29 of 31 patients (93.5%) who had IO ultrasound, an insulinoma was successfully localized. Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all 4 noninvasive imaging studies, CT was concordant with 68Ga-DOTATATE in 6 out of 9 patients (67%), MRI in 8 out of 9 (78%), ultrasound in 0 out of 9; the lesion was only seen by 68Ga-DOTATATE in 1 out of 9 (11%). Conclusions 68Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.

胰岛素瘤的可靠定位是成功治疗的关键。目的比较68镓DOTA-(Tyr3)-奥曲酸盐(Ga-DOTATATE)正电子发射断层扫描(PET)/计算机断层扫描(CT)与解剖成像方式、选择性动脉分泌剂注射(SASI)、术中超声(IO超声)及触诊对生化治愈患者胰岛素瘤定位的准确性。设计、环境和患者我们对31例胰岛素瘤患者进行了回顾性分析。分析CT、MRI、超声、IO超声、68Ga-DOTATATE PET/CT、SASI及手术表现。干预、主要结局测量和结果:31例患者中有17例(55%)CT正确定位胰岛素瘤，28例患者中有17例(61%)MRI正确定位胰岛素瘤，28例患者中有6例(21%)超声正确定位胰岛素瘤，10例患者中有9例(90%)68ga - dotate正确定位胰岛素瘤。31例接受IO超声检查的患者中有29例(93.5%)胰岛素瘤被成功定位。30例患者接受了SASI, 30例患者中有28例(93%)胰岛素瘤被区域化。在23例患者中，有19例(83%)的手触诊发现了胰岛素瘤。在所有4项无创影像学检查的患者中，9例患者中有6例(67%)CT与68Ga-DOTATATE一致，9例患者中有8例(78%)MRI与68Ga-DOTATATE一致，9例患者中有0例超声与68Ga-DOTATATE一致;只有1 / 9(11%)的68Ga-DOTATATE检测到病变。结论68ga - dotatate PET/CT可识别大多数胰岛素瘤，当所有影像学检查均为阴性且计划微创手术入路时，可考虑将其作为辅助影像学检查。

{"title":"Localization of Insulinoma Using 68Ga-DOTATATE PET/CT Scan","authors":"P. Nockel, Bruna Babic, C. Millo, P. Herscovitch, Dhaval Patel, N. Nilubol, S. Sadowski, Craig S. Cochran, P. Gorden, E. Kebebew","doi":"10.1210/jc.2016-3445","DOIUrl":"https://doi.org/10.1210/jc.2016-3445","url":null,"abstract":"Context Reliable localization of insulinoma is critical for successful treatment. Objective This study compared the accuracy of 68Gallium DOTA-(Tyr3)-octreotate (Ga-DOTATATE) positron emission tomography (PET)/computed tomography (CT) to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IO ultrasound) and palpation for localizing insulinoma in patients who were biochemically cured. Design, Setting, and Patients We conducted a retrospective analysis of 31 patients who had an insulinoma. The results of CT, magnetic resonance imaging (MRI), ultrasound, IO ultrasound, 68Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed. Intervention, Main Outcome Measures, and Results The insulinomas were correctly localized in 17 out of 31 (55%) patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by ultrasound, and in 9 out of 10 (90%) by 68Ga-DOTATATE. In 29 of 31 patients (93.5%) who had IO ultrasound, an insulinoma was successfully localized. Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all 4 noninvasive imaging studies, CT was concordant with 68Ga-DOTATATE in 6 out of 9 patients (67%), MRI in 8 out of 9 (78%), ultrasound in 0 out of 9; the lesion was only seen by 68Ga-DOTATATE in 1 out of 9 (11%). Conclusions 68Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.","PeriodicalId":22632,"journal":{"name":"The Journal of Clinical Endocrinology & Metabolism","volume":"26 1","pages":"195–199"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81092364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 78