Therapeutic Advances in Endocrinology and Metabolism最新文献

Background: Inpatient hypoglycaemia has been well studied around the world, and more tools are being developed to understand and predict hypoglycaemic episodes. Most published data, however, focuses on patient characteristics and predictions of whether a patient would have a hypoglycaemic episode during inpatient stay. There is a paucity of data concerning the timing, as well as types of diabetic medications used, surrounding a hypoglycaemia episode.

Objectives: To characterise inpatient hypoglycaemia episodes by time and associated diabetes medications, on top of baseline patient characteristics.

Design: Retrospective observational study of 425 hypoglycaemia episodes, over a 2 month period from two general internal medicine wards, in a tertiary medical hospital.

Methods: A discrete hypoglycaemic episode is defined as a capillary blood glucose (CBG) reading of <4 mmol/L. Hypoglycaemic episodes were further sub-analysed by dividing them into three time frames - day (0801-1600), evening (1601-2359) and night (0000-0800).

Results: In total, 425 hypoglycaemia episodes from 207 patients were analysed. Sulphonylurea (SU), premixed, basal and basal-bolus insulin regimens were associated with 31.8%, 30.4%, 15.1% and 5.9% of the hypoglycaemia episodes, respectively. All agents revealed significant intra-day differences (p < 0.05) except for the basal-bolus insulin regimen (p = 0.76). Basal insulin and sulphonylurea-associated hypoglycaemia occurred mostly in the midnight timeframe (0000-0800) at 65.6% and 47.4%, respectively, whereas premixed insulin-associated hypoglycaemia occurred mostly in the evening timeframe (1601-2359) at 51.2%. In total, there were significant differences in the distribution of hypoglycaemia across the three time frames associated with different diabetes medications (p < 0.05).

Conclusion: There are marked differences in the medications associated with inpatient hypoglycaemia at differing time points. These time points offer insight into appropriate CBG testing timings for different diabetes medications. Hence, stratified monitoring and strategic 3 a.m. testing of CBG for patients on sulphonylurea and basal insulin should be considered in tackling inpatient hypoglycaemia.

Introduction: Adrenal insufficiency can be life-threatening due to the lack of cortisol elevation in times of stress. The short Synacthen test (SST) is the most common diagnostic test for adrenal insufficiency. This study aimed to assess the diagnostic performance of morning basal serum cortisol during an SST to assess normal adrenal reserve in a local Emirati population.

Methods: We retrospectively analyzed the electronic medical records of adult patients who underwent morning SST to assess adrenal reserve between August 2012 and August 2022.

Results: This study included 344 patients (201 women) with a mean age of 49.1 ± 22.6 years. Based on the previously published cutoff data for SST peak values at 30 min (408 nmol/L for Beckman-Access used from 2012 to 2017 and 402 nmol/L for Roche-Cobas Generation-II used since 2018) as a gold standard to identify patients with adequate adrenal reserve, 106 patients (30.8%) were diagnosed with adrenal insufficiency and 238 (69.2%) with adequate adrenal reserve. Using the receiver-operator characteristics curve for morning cortisol, we identified a cutoff of 332 nmol/L, which corresponded to adequate Synacthen stimulation with 100% specificity and 73% sensitivity. Morning cortisol levels of <96 nmol/L corresponded to suboptimal adrenal response to SST, with 95% specificity and 55% sensitivity.

Conclusion: We propose that a morning cortisol cutoff of >332 nmol/L can help identify patients with adequate adrenal reserve, thereby avoiding unnecessary SSTs.

Background: Craniopharyngioma, a benign suprasellar tumor, is typically treated surgically with radiotherapy when indicated. Due to its proximity to the pituitary-hypothalamic region, patients often experience endocrine deficiencies.

Objective: To explore the body composition components and their interaction with metabolic syndrome (MetS) components in pediatric craniopharyngioma patients after surgery.

Design: Longitudinal single-center real-life study of 33 pediatric patients who were diagnosed with craniopharyngioma for which they underwent surgery between 2012 and 2024.

Methods: Electronic medical reports were reviewed for clinical data, and a bioimpedance analysis (BIA) database was searched for body composition. Fifty-four BIA reports of 21 patients with craniopharyngioma were analyzed. The latest reported values were compared to those of 63 sex- and age-matched healthy controls. Changes in anthropometric measurements and indices of muscle and adiposity were assessed by linear mixed models.

Results: Patients with craniopharyngioma exhibited higher adiposity compared to controls, with significantly elevated total body fat percentage (FATP; p < 0.001), trunk-to-total body FATP ratio (p = 0.012), and lower muscle-to-fat ratio (MFR) z-scores (p < 0.001). The appendicular skeletal muscle mass (ASMM) z-scores were similar. A sex- and age-adjusted model revealed that the diagnosis of MetS components was positively associated with FATP [odds ratio = 1.13, confidence interval (1.04, 1.23), p = 0.006]. Patients with craniopharyngioma demonstrated an increase in ASMM z-score over time (β = 0.14, SE = 0.04, p = 0.002) together with a decline in sex- and age-adjusted FATP (β = -0.99, SE = 0.41, p = 0.018).

Conclusion: Despite struggling with obesity and hormonal deficiencies, survivors of craniopharyngioma showed favorable changes in body composition with appropriate medical interventions. Strategies to prevent metabolic complications and tailored hormone replacement therapies are essential for managing metabolic decline.

Background: In recent years, the incidence of type 1 diabetes has been rising steadily, positioning its prevention and treatment as a central focus of global public health initiatives. Previous Mendelian randomization (MR) studies have investigated the relationship between proteomics and type 1 diabetes. Consequently, this study aims to identify prospective therapeutic targets for type 1 diabetes through a comprehensive multi-omics analysis.

Methods: This study primarily utilized the MR method, drawing on genetic data from several large-scale, publicly accessible genome-wide association studies. Within this framework, we applied two-sample MR to evaluate the relationship between five omics components and type 1 diabetes. Finally, we conducted various sensitivity analyses and bidirectional MR to ensure the robustness and reliability of our findings.

Results: The inverse variance weighted method revealed that, following false discovery rate correction, 39 plasma proteins and 3 plasma protein ratios exhibited significant associations with type 1 diabetes. The genetically predicted risk of type 1 diabetes ranged from 0.05 for RBP2 to 394.51 for FMNL1. Furthermore, 4-chlorobenzoic acid levels demonstrated a potential association with type 1 diabetes.

Conclusion: Our research identified numerous omics components associated with type 1 diabetes. These findings offer novel insights into the disease's etiology, diagnosis, and treatment.

Background: Oncocytic adrenocortical neoplasms (OANs) are extremely rare adrenal tumors whose diagnosis is challenging. This study aimed to identify risk factors for predicting poor prognosis in patients with OAN of uncertain malignant potential (OANUMP) and oncocytoma, OAN subtypes, and to evaluate the diagnostic utility of the current Lin-Weiss-Bisceglia (LWB) criteria.

Methods: We retrospectively reviewed 14 patients diagnosed with OANUMP or oncocytoma after adrenalectomy from February 2002 to May 2022. Patients re-classified as oncocytic adrenocortical carcinoma by the LWB criteria were excluded. We compared the clinicopathological and radiological features between patients with and without recurrence.

Results: Among the 14 patients, recurrence occurred in 3 (21%; 2 (67%) and 1 (33%) patients with OANUMP and oncocytoma, respectively). The proportion of patients with necrosis (66.7% vs 9.1%, p = 0.093), a Helsinki score >5 (66.7% vs 9.1%, p = 0.093), and malignancy by the reticulin algorithm (66.7% vs 9.1%, p = 0.093) were higher in the recurrence group than in the no-recurrence group but were not statistically significant. The percentages of patients with an indeterminate pathological resection margin (100% vs 63.6%, p = 0.192) tended to be higher in the recurrence group than in the no-recurrence group. Of the three patients with recurrence, two had tumor necrosis on the final pathology and were classified as malignant by the reticulin algorithm. One patient diagnosed as OANUMP by the LWB criteria had tumor necrosis and was classified as malignant by the reticulin algorithm and Helsinki scoring system.

Conclusion: Necrosis was associated with the recurrence of disease in patients with OANUMP according to the LWB criteria. The absence of necrosis as a major criterion in the current LWB criteria highlights its potential limitation in accurately assessing disease aggressiveness in OANs.

Objective: Body mass index (BMI) and sarcopenia are linked to osteoporosis, but the extent to which BMI influences osteoporosis through sarcopenia remains unclear. This study aims to assess the associations between BMI, sarcopenia, and osteoporosis, and to explore the predictive value of their combined biochemical markers for osteoporosis.

Methods: We retrospectively collected clinical data from 813 inpatients in the endocrinology department to explore the relationships between serum markers and skeletal muscle mass or BMI, and to evaluate the predictive value of BMI and sarcopenia for osteoporosis. Mediation analysis was employed to examine the associations among BMI, sarcopenia, and osteoporosis. Participants were randomly divided into training (n = 407) and testing (n = 406) sets (5:5). Independent risk factors were identified using least absolute shrinkage and selection operator and logistic regression, leading to the development of a nomogram model. Model evaluation was conducted through receiver operating characteristic curves, confusion matrices, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC).

Results: BMI and skeletal muscle mass were negatively correlated with serum 25-hydroxyvitamin D and calcium levels. The "BMI < 28 and Non-Sarcopenia" emerged as a protective factor against osteoporosis. Sarcopenia significantly mediated the association between BMI and osteoporosis (46.88%). Gender, age, high-density lipoprotein, alkaline phosphatase, BMI, and sarcopenia emerged as independent predictors of osteoporosis. The area under the curve (AUC) for the training and testing sets was 0.859 and 0.866, respectively, with calibration curves indicating good consistency. DCA and CIC demonstrated clinical net benefits at risk thresholds of 0.02-0.82 and 0.02-0.67. Sankey diagrams and partial AUCs (1.00-0.75 sensitivity and specificity) illustrate the significant negative predictive value of BMI and sarcopenia.

Conclusion: Lower BMI and non-sarcopenia are negatively associated with the risk of osteoporosis. In addition, the nomogram demonstrates good predictive value, with a greater negative predictive value of the BMI and sarcopenia.

Background: The effectiveness of vitamin D supplementation in the progression of diabetic kidney disease (DKD) remains controversial. Our review tries to provide a comprehensive summary of all the relevant articles in the area to assess the association of vitamin D deficiency with the development of DKD and the effect of vitamin D supplementation on the progression of DKD.

Methods: PubMed, Embase, Scopus, Cochrane Library and Web of Science were accessed from inception till June 2024 to obtain all the relevant meta-analyses assessing the function of vitamin D in the onset and prognosis of DKD. The summary data were extracted by two independent reviewers. A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for the assessment of the methodological quality of the included meta-analyses.

Results: A total of 4579 articles were obtained from 5 databases in the initial search, of which 8 meta-analyses were included for the evidence synthesis. The methodological quality of the retrieved articles ranged from critically low to high. Serum vitamin D levels were significantly correlated with the prevalence of DKD. The review suggested that vitamin D supplementation could help in reducing proteinuria. However, no such changes were observed in other renal function parameters of DKD patients following vitamin D supplementation.

Conclusion: The current evidence indicates that vitamin D supplementation could be beneficial in reducing proteinuria among DKD patients.PROSPERO registration number: CRD42022375194.

Background: Vitamin D (VD) deficiency has become a global public health problem, and published studies have demonstrated that patients with subacute thyroiditis (SAT) have worse VD nutritional status and that VD supplementation may alleviate thyroid-related diseases by fighting against infections and mediating autoimmunity.

Objectives: This study explored the correlation between serum VD levels and the risk and extent of disease in patients with SAT.

Design: A case-control study.

Methods: We included patients with SAT diagnosed at the First People's Hospital of Jining City between September 2021 and September 2023 and a healthy population during the same period. We collected clinical and laboratory data to determine differences in VD levels between the two populations and identify risk factors for the onset and extent of SAT.

Results: The 25(OH)D level of SAT patients was significantly lower than that of the healthy population (p < 0.05). Multifactorial logistic regression analysis showed that low 25(OH)D level, low body mass index (BMI), elevated leukocytes, and low lymphocyte count were independent risk factors for SAT. No significant difference was noted in VD levels between patients with mild SAT and those with moderately severe SAT (p > 0.05). Additionally, fever, thyroid tenderness, high BMI, and elevated free thyroxine (FT4) were independent risk factors for SAT severity; serum 25(OH)D levels were positively correlated with FT4/FT3 levels in SAT patients.

Conclusion: VD levels are lower in patients with SAT than in healthy controls, and low VD levels increase SAT risk. Although VD levels are not related to SAT severity, adequate VD inhibits the conversion of FT4 to FT3, likely playing a protective role in SAT development.

Background: Previous research has established a link between high blood levels of parathyroid hormone (PTH) levels and hyperglycemia, as well as early mortality. However, the extent of this relationship and the predictive value of PTH for mortality risk in hyperglycemic populations have been minimally explored.

Methods: The National Health and Nutrition Examination Survey study conducted from 2003 to 2006 identified 932 adults with diabetes and 1645 adults with prediabetes. A weighted multivariate logistic regression analysis was utilized to examine the association between PTH levels and hyperglycemia. Furthermore, Cox proportional hazards regression models were employed to examine the correlation between PTH levels and both cardiovascular and overall mortality within the hyperglycemia cohort.

Results: (1) The research findings revealed a negative association between PTH levels (per 10-pg/mL increase) and diabetes status (OR, 0.79; 95% confidence interval (CI), 0.73-0.86). (2) There was a significant correlation between the risk of all-cause mortality (hazard ratios (HR), 1.13; 95% CI, 1.01-1.29) and cardiovascular disease mortality (HR, 1.39; 95% CI, 1.05-1.84) among individuals with diabetes for every 10-pg/mL increase in PTH levels.

Conclusion: The current research shows that individuals with elevated PTH spectrum within the normal range are less likely to have diabetes, while those with higher PTH levels in adults with diabetes are linked to worse outcomes, particularly cardiovascular mortality.

Understanding the hypothalamic-pituitary-gonadal (HPG) axis is essential for grasping human responses under extreme physiological and pathological conditions. The HPG axis regulates reproductive and gonadal hormone activities and significantly impacts the body's response to acute and chronic illnesses. This review explores the fundamental functions of the HPG axis, modifications under critical conditions, and impacts on disease progression and treatment outcomes. In addition, it examines interactions between sex hormones and biomolecules like cytokines and gastrointestinal microorganisms, highlighting their roles in immune response regulation. Clinically, this knowledge can enhance patient prognoses. The review aims to provide a comprehensive framework, based on existing research, for understanding and applying the functions of the HPG axis in managing critical diseases, thereby broadening clinical applications and guiding future research.