Endocrine and Metabolic Science最新文献

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects a large proportion of women. Due to its heterogeneity, the best diagnostic strategy has been a matter of contention. Since 1990 scientific societies in the field of human reproduction have tried to define the pivotal criteria for the diagnosis of PCOS. The consensus Rotterdam diagnostic criteria included the presence of hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology (PCOM), and have now been updated to evidence based diagnostic criteria in the 2018 and 2023 International Guideline diagnostic criteria endorsed by 39 societies internationally. Within the Rotterdam Criteria, at least two out of three of the above-mentioned features are required to be present to diagnose PCOS, resulting in four phenotypes being identified: phenotype A, characterized by the presence of all the features, phenotype B, exhibiting hyperandrogenism and oligo-anovulation, phenotype C, presenting as hyperandrogenism and PCOM and finally the phenotype D that is characterized by oligo-anovulation and PCOM, lacking the hyperandrogenic component. However, it is the hypothesis of the EGOI group that the Rotterdam phenotypes A, B, and C have a different underlying causality to phenotype D. Recent studies have highlighted the strong correlation between insulin resistance and hyperandrogenism, and the pivotal role of these factors in driving ovarian alterations, such as oligo-anovulation and follicular functional cyst formation. This new understanding of PCOS pathogenesis has led the authors to hypothesis that phenotypes A, B, and C are endocrine-metabolic syndromes with a metabolic clinical onset. Conversely, the absence of hyperandrogenism and metabolic disturbances in phenotype D suggests a different origin of this condition, and point towards novel pathophysiological mechanisms; however, these are still not fully understood. Further questions have been raised regarding the suitability of the “phenotypes” described by the Rotterdam Criteria by the publication by recent GWAS studies, which demonstrated that these phenotypes should be considered clinical subtypes as they are not reflected in the genetic picture. Hence, by capturing the heterogeneity of this complex disorder, current diagnostic criteria may benefit from a reassessment and the evaluation of additional parameters such as insulin resistance and endometrial thickness, with the purpose of not only improving their diagnostic accuracy but also of assigning an appropriate and personalized treatment. In this framework, the present overview aims to analyze the diagnostic criteria currently recognized by the scientific community and assess the suitability of their application in clinical practice in light of the newly emerging evidence.

Type 2 diabetes mellitus (T2DM) is a growing public health concern globally, and more so in developing countries like South Africa where it is characterized by an alarmingly high prevalence. Emerging evidence suggests that mitochondrial dysfunction plays a significant role in the pathophysiology of the disease in this region. This review explores the intricate relationship between mitochondrial dysfunction and T2DM in the context of South Africa by providing an in-depth analysis of the specific mitochondrial factors influencing T2DM. Furthermore, it explores South Africa's unique demographic and epidemiological landscape characterizing its increased susceptibility to T2DM. Understanding the interplay between mitochondrial dysfunction and T2DM is of paramount importance in developing tailored prevention and treatment strategies. A need for further research to elucidate the intricate mechanisms behind this relationship, ultimately aiming to mitigate the diabetes burden in South Africa and beyond is highlighted.

Background/objective

To understand the potential effects that severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) has on the endocrine system.

Case report

A 56-year-old female presented with complaints of increased appetite, generalized weakness, facial and neck swelling and a non-pruritic rash across her chest, abdomen and back. Onset of symptoms coincided with a Sars-Cov-2 infection three months prior to current admission. The physical exam revealed cushingoid features. Laboratory results confirmed Cushing's disease. Imaging studies revealed an 11 mm right-sided pituitary adenoma and mild thickening of the adrenals bilaterally. Additionally, a 9.4 × 7.9 cm mass was identified in the caudate lobe of the liver concerning for neoplastic origin. Liver biopsy confirmed a well differentiated neuroendocrine tumor. Endoscopy revealed chronic gastritis with hemorrhage and multiple oozing duodenal ulcers, along with an elevated gastrin level. Subsequently, the patient received a diagnosis of multiple endocrine neoplasia type 1 (MEN-1), attributed to the presence of endocrine tumors involving the anterior pituitary and gastroenteropancreatic tract.

Discussion

MEN-1 is a condition predisposing individual with two or more endocrine gland tumors primarily pituitary, parathyroid and gastroenteropancreatric tract. The clinical presentation varies and is often associated with hormone overproduction and tumor location. Coronavirus disease 2019 (COVID-19) is caused by Sars-Cov-2. Studies have shown to link Sars-Cov-2 with endocrinopathy.

Conclusion

The impact of SARS-CoV-2 extends beyond the respiratory system, highlighting the need for further research into its direct influence on the endocrine system.

Diabetes self-management behavior is important for patients to lessen disease-related complications, obtain optimum glycemic control and achieve a better quality of life. The study aimed to determine the relationship between dietary intake, nutrition knowledge, and self-management behaviors in Bangladeshi patients with type 2 diabetes mellitus (T2DM), with a focus on achieving optimal glycemic control, improving their quality of life. A cross-sectional study was conducted among T2DM patients from seven districts throughout Bangladesh. Data were collected using a validated semi-structured questionnaire for evaluating diabetes-related self-management behavior and existing nutrition knowledge. Dietary intakes were obtained using 24 h 3-days diet recall. Logistic regression analysis, Pearson's correlation and independent t-test were used to observe correlation and association among variables. A total of 411 patients with T2DM participated in the study, 59.4 % of patients achieved good dietary control, while 14.4 % were physically active, 49.4 % adhered well to medication, 44.0 % practiced effective self-monitoring, and 27.0 % possessed good diabetic nutrition knowledge. In fully adjusted multivariate logistic regression analysis, patients with a better glycemic control showed 14 times more control in their dietary intake [AOR: 14.21; 95 % CI: 5.62–35.94], and performing a good physical exercise 5 times more than the patients with high blood glucose level [AOR: 5.671; 95 % CI: 1.55–20.686]. Adherence toward medication prescription was also significantly higher among these patients. Glucose level was significantly higher among patients who had moderate [AOR: 3.367; 95 % CI: 1.29–8.73] and poor [AOR: 9.87; 95 % CI: 3.19–30.57] diabetes related nutritional knowledge. Patients with poor glycemic control consumed significantly more carbohydrates (251 ± 62 g vs 213 ± 47 g) and less dietary fiber (16.7 ± 4.5 g vs 20.5 ± 6.1 g) compared to the patients with optimum glycemic control. Our study findings suggest that, an improved level of nutrition knowledge may be beneficial to ensure optimum dietary intake, thus aid in an effective diabetes self-management behavior among Bangladeshi T2DM patients. Efforts should be made to help patient achieve optimum glycemic control, thus reduce their health-related complications and contribute to overall well-being.

Background

Type 2 diabetes mellitus (T2DM), as a worldwide health challenge, is a multifactorial disease that environmental and genetic factors contribute to its pathogenicity. Gastric Inhibitory Polypeptide Receptor (GIPR) is a G-pro receptor that controls the gut hormones release and insulin secretion. The current study aimed to investigate the role of the GIPR rs1800437 gene variant in T2DM susceptibility.

Material and methods

A total of 108 confirmed T2DM patients and 100 normal controls were recruited in the study. The GIPR rs1800437 genotypes were determined by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) assay.

Results

A significant difference was found in genotypes (CC, CG, and GG) frequency of the GIPR rs1800437 variant between T2DM and control groups (P = 0.02). The homozygote CC genotype of the variant significantly decreased the odds ratio (OR) of diabetes mellitus risk, approximately 50 %, in comparison with the heterozygous GC genotype. The frequency of the C allele among cases was considerably lower than controls (P = 0.002, OR = 0.51, CI = 0.33–0.79).

Conclusion

The findings of the study show enough evidence that there is a significant association between the rs1800437 GIPR genetic variant and the risk of T2DM.

Vitamin D is a key regulator of bone mineral homeostasis and may modulate maternal bone health during pregnancy and postpartum. Using previously-collected data from the Maternal Vitamin D for Infant Growth (MDIG) trial in Dhaka, Bangladesh, we aimed to investigate the effects of prenatal and postpartum vitamin D₃ supplementation on circulating biomarkers of bone formation and resorption at delivery and 6 months postpartum. MDIG trial participants were randomized to receive a prenatal;postpartum regimen of placebo or vitamin D₃ (IU/week) as either 0;0 (Group A), 4200;0 (B), 16,800;0 (C), 28,000;0 (D) or 28,000;28,000 (E) from 17 to 24 weeks' gestation to 6 months postpartum. As this sub-study was not pre-planned, the study sample included MDIG participants who had data for at least 1 biomarker of interest at delivery or 6 months postpartum, with a corresponding baseline measurement (n = 690; 53 % of 1300 enrolled trial participants). Biomarkers related to bone turnover were measured in maternal venous blood samples collected at enrolment, delivery, and 6 months postpartum: osteoprotegerin (OPG), osteocalcin (OC), receptor activator nuclear factor kappa-B ligand (RANKL), fibroblast growth factor 23 (FGF23), procollagen type 1 N-terminal propeptide, (P1NP) and carboxy terminal telopeptide of type 1 collagen (CTx). Supplementation effects were expressed as percent differences between each vitamin D group and placebo with 95 % confidence intervals (95 % CI). Of 690 participants, 64 % had 25-hydroxyvitamin D concentrations (25OHD) <30 nmol/L and 94 % had 25OHD < 50 nmol/L at trial enrolment. At delivery, mean CTx concentrations were 27 % lower in group E versus placebo (95 % CI: −38, −13; P < 0.001), adjusting for enrolment concentrations. However, at 6 months postpartum, CTx concentrations were not statistically different in group E versus placebo (14 %; 95 % CI: −5.3, 37; P = 0.168), adjusting for delivery CTx concentrations. Effects on other biomarkers at delivery or postpartum were not statistically significant. In conclusion, prenatal high-dose vitamin D supplementation reduced bone resorption during pregnancy, albeit by only one biomarker, and without evidence of a sustained effect in the postpartum period. However, further evidence is needed to substantiate potential maternal bone health benefits of vitamin D in the postpartum period.

Aims

To explore the metabolic influence of prolactin in subjects with polycystic ovary syndrome (PCOS).

Methods

This retrospective cross-sectional study analyzed data of women newly diagnosed with PCOS attending the Endocrinology outpatient department of a tertiary hospital in Mymensingh, Bangladesh, during 2017–2022. Clinical, anthropometric, and laboratory data, including results of oral glucose tolerance test, measurements of serum lipids, total testosterone (TT), thyroid-stimulating hormone (TSH), and prolactin, were extracted and analyzed. Cases of high prolactin (≥100 ng/mL) were excluded.

Results

840 cases [median age 21.5 (18.0–25.7) years] were considered for final analysis; 17.1 % had hyperprolactinemia. Serum prolactin had significant negative correlations (P < 0.05) with age (r_s = − 0.153), body mass index (r_s = − 0.172), waist circumference (r_s = − 0.193), triglyceride (r_s = − 0.174), and TT (r_s = − 0.133) levels, and the presence of metabolic syndrome (r_s = − 0.073) and positive correlations with TSH (r_s = 0.090). In multiple regression analysis, prolactin was inversely associated with fasting plasma glucose (FPG) and positively associated with TSH after correcting for age and BMI.

Conclusion

An inverse association exists between serum prolactin levels and some metabolic risk factors, such as FPG, in women with PCOS.

Background

Dyslipidemia is a major risk factor for cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). This countrywide study explored the prevalence and patterns of dyslipidemia among patients with T2DM who were not taking lipid-lowering drugs (LLD).

Methods

This cross-sectional study included 2241 subjects with T2DM visiting several endocrinology outpatient clinics throughout Bangladesh from January to December 2021. Lipid profiles were measured in fasting blood samples using automatic analyzers. Data were analyzed using Stata 17 (Stata Corp LLC, TX, USA).

Results

2241 patients were investigated; their mean age was 46.27 (±11.27, SD) years, and 57.16 % were women. Overall, the prevalence of dyslipidemia was 96.83 %. Total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), and triglyceride (TG) were high in 42.88 %, 63.54 %, and 71.40 % of patients, respectively; high-density lipoprotein cholesterol (HDLC) was low in 77.60 %. Mixed dyslipidemia (including raised TC, LDLC, TG, and low HDLC) was the most prevalent (24.05 %) type. Being woman (adjusted OR: 5.63, 95%CI: 3.07–11.1) and uncontrolled diabetes (HbA1c <7 %) (adjusted OR: 2.64, 95%CI: 1.54–4.52) were independently associated with dyslipidemia. Dyslipidemia was associated with microvascular complications of diabetes.

Conclusion

Dyslipidemia is a highly prevalent abnormality among LLD-naïve T2DM patients in Bangladesh. Early detection and prompt management are required to prevent complications arising from dyslipidemia.

Aim

This study compares levels of insulin resistance and beta-cell function and their relationship with liver enzymes in recovered COVID-19 participants and their uninfected counterparts in a cross-sectional study design in the Tamale metropolis of Ghana.

Methods

Biochemical indices for liver function, lipid metabolism, inflammation and oxidative stress were assessed under fasting state in 110 recovered COVID-19 and 116 uninfected participants. The homeostatic model assessment of insulin resistance (HOMA-IR) and the triglyceride-glucose index (TyG) were employed for the assessment of insulin resistance.

Results

Recovered COVID-19 participants presented lower (P < 0.05) levels of fasting glucose, insulin, alkaline phosphatase, creatinine and beta-cell function but higher (P < 0.05) levels of alanine/aspartate transferase, total bilirubin, direct bilirubin, total cholesterol, high-density lipoprotein cholesterol and HOMA-IR than their uninfected counterparts. The mean levels of the remaining indices were comparable (P > 0.05) between the study groups. Prevalence of insulin resistance ranged from 61 % (71/116) to 81 % (89/110) for the uninfected and recovered COVID-19 participants respectively. Selected liver enzymes associated with HOMA-IR and TyG.

Conclusion

The risk of developing type 2 diabetes mellitus appears higher in recovered COVID-19 participants than their uninfected counterparts despite the high prevalence of insulin resistance in both groups.

Background

Serum cortisol levels vary according to the daily circadian cycle, with peak levels seen in the morning. There is evidence in ambulatory patients that a morning cortisol level can predict an adequate cortisol response to Synacthen (tetracosactide) stimulation.

Aim

The aim of this study is to determine the utility of baseline analysis of the serum cortisol levels in the morning “baseline morning cortisol”, determined using a newer immunoassay, in the screening for adrenal insufficiency amongst non-critically ill hospital inpatients.

Methods

This is a retrospective cross-sectional cohort study.

Results

64 adult inpatients had undergone a short Synacthen test (SST) (measurement of serum cortisol levels 30 and 60 min after administration of tetracosactide) during the study period. 17 patients returned an abnormal SST result. The measured level of cortisol in the morning correlated to both the 30 min and 60 min stimulated cortisol values (r = 0.612, p < 0.001 and r = 0.639, p < 0.001). After inspecting the receiver operating characteristic curve, a cortisol concentration of 200nmmol/L measured in the morning was selected as a threshold for predicting the SST result. Using this cut off, sensitivity for predicting a normal SST was 100 %, specificity 56 %, positive predictive value 45 % and negative predictive value 100 %.

Conclusion

A morning cortisol measurement, determined using a newer immunoassay, is sufficient in most cases to screen for adrenal insufficiency amongst non-critically ill hospital inpatients. Use of clinical judgement in conjunction with single morning cortisol measurement is likely to reduce the need for SST testing amongst inpatients.