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Outcomes of a population-based flash glucose monitoring program in adults with type 2 diabetes mellitus on intensive insulin therapy in Andalusia 安达卢西亚一项以人群为基础的成人2型糖尿病患者胰岛素强化治疗的瞬时血糖监测项目的结果
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501661
Mercedes Peinado Ruíz , Beatriz Rodríguez Jiménez , Pablo Rodríguez de Vera Gómez , Nieves Lafuente Robles , Rafael Palomares Ortega , Francisco José Sánchez-Laguna , Inmaculada Vázquez Cruz , Eduardo Mayoral Sánchez , María Jesús Sanchez-Alvarez , Celia Fernandez-Delgado , Ismael Muñoz Martínez , María Asunción Martínez-Brocca
The implementation of flash glucose monitoring (FGM) in people with type 2 diabetes mellitus (T2DM) undergoing intensive insulin therapy represents an organizational challenge for health care systems.

Objective

To evaluate the outcomes of the FGM system rollout in adults with T2DM within the Andalusian Public Health System.

Methods

We conducted a cross-sectional, population-based descriptive study in Andalusia (Spain), analyzing the shared care model between Primary Care (PC) and Hospital Care (HC) for the implementation of FGM systems in adult patients with T2DM on intensive basal-bolus insulin therapy, 34 months after starting the program (program duration: from April 2022 to February 2025).

Results

A total of 25,052 active FGM users were identified (48.6% women; mean age, 69.0 ± 12.8 years) out of an estimated target population of 29,979 patients. The main indications for FGM use were functional disability or dependency (n = 4283; 17%), severe hypoglycemia (n = 1899; 7.4%), pregestational T2DM (n = 266; 1%), and frequent non-severe hypoglycemia (n = 9104; 36.2%). The remaining cohort (n = 9683; 38.4%) included individuals without prioritization criteria. The main indication setting was PC, where 23,669 devices (80.2%) were initiated. The permanent discontinuation rate was 15%, with no serious adverse events being reported. A total of 9185 active users (36.4%) had their glucose monitoring data integrated into the electronic health record (EHR) of the Andalusian Public Health System.

Conclusions

Coordinated action across health care levels is an effective strategy for equitable access to technologies such as FGM among Andalusian patients with T2DM on intensive insulin therapy. Integration of glucose data into the EHR is a key tool for ensuring continuity of care.
在接受胰岛素强化治疗的2型糖尿病(T2DM)患者中实施瞬时血糖监测(FGM)是卫生保健系统面临的一个组织挑战。目的评价安达卢西亚公共卫生系统在成年2型糖尿病患者中推行女性生殖器切割系统的效果。方法:我们在西班牙安达卢西亚(Andalusia)进行了一项基于人群的横断面描述性研究,分析了初级保健(PC)和医院保健(HC)在开始该项目34个月后(项目持续时间:2022年4月至2025年2月)对接受强化基础胰岛素治疗的成年T2DM患者实施女性生殖器切割系统的共享护理模式。结果在估计的目标人群29,979例患者中,共鉴定出25,052例活跃的女性生殖器切割使用者(48.6%为女性,平均年龄69.0±12.8岁)。使用女性生殖器切割的主要适应症是功能残疾或依赖(n = 4283, 17%)、严重低血糖(n = 1899, 7.4%)、妊娠期T2DM (n = 266, 1%)和频繁的非严重低血糖(n = 9104, 36.2%)。其余队列(n = 9683, 38.4%)包括没有优先级标准的个体。主要指示设置为PC,其中23,669个设备(80.2%)启动。永久停药率为15%,无严重不良事件报告。共有9185名活跃用户(36.4%)将血糖监测数据整合到安达卢西亚公共卫生系统的电子健康记录(EHR)中。结论跨卫生保健水平的协调行动是安达卢西亚T2DM患者在强化胰岛素治疗中公平获得技术(如女性生殖器切割)的有效策略。将葡萄糖数据整合到电子病历中是确保护理连续性的关键工具。
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引用次数: 0
Metástasis ovárica en mujer joven con carcinoma folicular de tiroides: diagnóstico diferencial con struma ovarii 患有甲状腺滤泡癌的年轻妇女卵巢转移:卵巢工具鉴别诊断
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501676
Dolores Tejedo-Flors , Thalía Argüello-Gordillo , Elena Argente-Martínez , Beatriz López-Muñoz , Pedro López-Mondéjar
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引用次数: 0
Segunda edición de las recomendaciones para «no hacer» de la Sociedad Española de Endocrinología y Nutrición (SEEN) 西班牙内分泌和营养学会(SEEN)的“不做”建议第二版
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501687
Juan José Díez , Manuel Gargallo Fernández , José Antonio Gimeno Orna , Elena González Arnaiz , Isabel Huguet Moreno , Sílvia Martínez Couselo , María Miguélez González , María Julia Ocón , Gilberto Pérez López , Francisco Pita Gutiérrez , Jordi Luis Reverter Calatayud , Cristina Tejera Pérez , Eulàlia Urgell Rull , Alberto Fernández
Low-value clinical practices —defined as diagnostic or therapeutic interventions that provide limited clinical benefit and may be associated with unnecessary risks or costs— remain common in endocrinology and nutrition. The Spanish Society of Endocrinology and Nutrition (SEEN) presents this second edition as an updated set of recommendations on “what not to do” in clinical practice, developed by its sections and working groups. The methodological process included the selection of relevant topics, systematic literature review, and multidisciplinary consensus. Key areas addressed include diabetes, obesity, nutrition, gonads, lipids, laboratory, mineral metabolism, and imaging, identifying low-value interventions and offering alternatives based on the best available evidence. The implementation of these recommendations aims to optimize care quality, reduce risks, and contribute to the sustainability of the healthcare system.
低价值临床实践-定义为提供有限临床效益的诊断或治疗干预,可能与不必要的风险或成本相关-在内分泌学和营养学中仍然很常见。西班牙内分泌与营养学会(SEEN)将第二版作为一套更新的关于临床实践中“不该做什么”的建议,由其部门和工作组开发。方法学过程包括选择相关主题、系统文献综述和多学科共识。涉及的关键领域包括糖尿病、肥胖、营养、性腺、脂质、实验室、矿物质代谢和成像,识别低价值干预措施,并根据现有的最佳证据提供替代方案。这些建议的实施旨在优化护理质量,降低风险,并有助于卫生保健系统的可持续性。
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引用次数: 0
Prevalencia, incidencia y marcadores de riesgo ocupacionales de dislipidemias en trabajadores peruanos 秘鲁工人血脂异常的流行率、发病率和职业危险标志
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501672
Jhosmer Ballena-Caicedo , Fiorella E. Zuzunaga-Montoya , Juan Carlos Bustamante-Rodríguez , Nataly Mayely Sanchez-Tamay , Luisa Erika Milagros Vásquez-Romero , Joan A. Loayza-Castro , Carmen Inés Gutierrez De Carrillo , Víctor Juan Vera-Ponce

Introduction

Dyslipidemias are a significant risk factor for cardiovascular diseases. In Peru, nutritional transition and lifestyle changes may be contributing to an increase in the incidence of these metabolic disorders, particularly among the working population.

Objective

To determine the incidence of dyslipidemias and evaluate associated occupational factors in Peruvian workers.

Methods

A retrospective cohort study was conducted using electronic medical records from 4,200 workers attending an occupational health clinic between 2013 and 2022. Incidence rates of hypertriglyceridemia, hypercholesterolemia, and combined dyslipidemia were calculated. Specific occupational factors (type of work, sitting time, and night shift work) were analyzed using Cox regression models adjusted for age (with splines) and sex.

Results

The incidence of hypercholesterolemia (87.22 cases per 1,000 person-years; 95% CI: 79.99–94.45) was significantly higher than that of hypertriglyceridemia (65.71 cases per 1,000 person-years; 95% CI: 59.71–71.72). Combined dyslipidemia showed an incidence of 48.28 cases per 1,000 person-years (95% CI: 43.60–52.97). Workers in social services had a higher risk of developing dyslipidemias (aHR: 1.78; 95% CI: 1.27–2.49) compared to office workers. Prolonged sitting time (>4 hours) was significantly associated with an increased risk of hypertriglyceridemia (aHR: 1.28; 95% CI: 1.05–1.56) and combined dyslipidemia (aHR: 1.42; 95% CI: 1.15–1.76).

Conclusions

The high incidence of dyslipidemias—particularly hypercholesterolemia—may reflect the increasing consumption of ultra-processed foods and the ongoing nutritional transition in the Peruvian population. Occupational factors play a crucial role in the development of these metabolic disorders, highlighting the need for specific preventive strategies in the workplace.
血脂异常是心血管疾病的重要危险因素。在秘鲁,营养的转变和生活方式的改变可能导致这些代谢紊乱的发病率增加,特别是在劳动人口中。目的了解秘鲁工人血脂异常的发病率及相关职业因素。方法对2013年至2022年在某职业健康诊所就诊的4200名工人的电子病历进行回顾性队列研究。计算高甘油三酯血症、高胆固醇血症和合并血脂异常的发生率。具体职业因素(工作类型、坐着时间和夜班工作)使用Cox回归模型进行分析,调整年龄(样条)和性别。结果高胆固醇血症发生率(87.22例/ 1000人年,95% CI: 79.99 ~ 94.45)显著高于高甘油三酯血症发生率(65.71例/ 1000人年,95% CI: 59.71 ~ 71.72)。合并血脂异常的发生率为每1000人年48.28例(95% CI: 43.60-52.97)。与办公室工作人员相比,社会服务工作者患血脂异常的风险更高(aHR: 1.78; 95% CI: 1.27-2.49)。长时间坐着(4小时)与高甘油三酯血症(aHR: 1.28; 95% CI: 1.05-1.56)和合并血脂异常(aHR: 1.42; 95% CI: 1.15-1.76)的风险增加显著相关。结论高发的血脂异常,特别是高胆固醇血症,可能反映了秘鲁人口中超加工食品消费的增加和正在进行的营养转变。职业因素在这些代谢紊乱的发展中起着至关重要的作用,强调需要在工作场所采取具体的预防策略。
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引用次数: 0
Hipogonadismo hipogonadotropo familiar: cuando dos mutaciones se encuentran 家族性促性腺功能减退症:当两个突变相遇时
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501675
Luis Muñoz Arenas, Mercedes Senent Capote, Javier Olmedo Pérez-Montaut, Antonio Ballesteros Martín-Portugués, Esteban Sánchez-Toscano, Maria Gloria Baena-Nieto
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引用次数: 0
Influence of oncostatin M and leukemia inhibitor factor on sarcopenia in individuals with cancer and malnutrition 肿瘤抑制素M和白血病抑制因子对癌症和营养不良患者肌肉减少症的影响
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501677
Daniel de Luis, David Primo, Olatz Izaola, Juan José López Gómez

Objectives

Oncostatin-M (OSM) and leukemia inhibitor factor (LIF) have shown relationship with muscle catabolism in Disease Related Malnutrition (DRM). We aimed to investigate the role of OSM and LIF in sarcopenia among patients with cancer and DRM.

Design and methods

33 cancer patients with DRM were included. Muscle mass assessment via ultrasound at the rectus femoris (RF) level, bioimpedance (skeletal muscle mass (SMM), appendicular SMM (aSMM), and the aSMM index (aSMMI)), and circulating OSM and LIF levels were evaluated. Confirmed sarcopenia was diagnosed based on the criteria of low muscle strength combined with an abnormal aSMMI.

Results

The average age was 66.5 ± 15.5 years. The gender distribution was 16 females (48.5%) and 17 males (51.5%). Sixteen patients (48.5%) were diagnosed with sarcopenia. Patients with sarcopenia showed worse values: phase angle (−0.4 ± 0.1°; p = 0.01), reactance (−4.9 ± 1.8 Ω; p = 0.03), SMM (−2.0 ± 0.3 kg; p = 0.03), aSMM (−1.6 ± 0.2 kg; p = 0.03), aSMMI (−0.6 ± 0.2 kg/m2; p = 0.02), muscle area RF (−0.7 ± 0.2 cm2; p = 0.04), Y-axis RF (−0.4 ± 0.1 cm; p = 0.03), muscle strength (−8.1 ± 1.5 kg; p = 0.01) and albumin levels (−0.3 ± 0.1 g/dl; p = 0.03). Circulating levels of OSM and LIF were elevated in patients with sarcopenia, with values of 10.6 ± 1.3 pg/ml (p = 0.01) and 6.4 ± 2.3 pg/ml (p = 0.02), respectively. Logistic regression analysis indicated a significant OR (odds ratio) of sarcopenia associated with elevated median levels of OSM (OR = 3.6, 95% CI = 1.4–9.9; p = 0.01) and LIF-1 (OR = 3.3, 95% CI = 1.3–10.1; p = 0.01)

Conclusion

High levels of serum OSM and LIF-1 were closely associated with sarcopenia in patients with cancer and DRM.
目的探讨癌他汀- m (OSM)和白血病抑制因子(LIF)与疾病相关性营养不良(DRM)患者肌肉分解代谢的关系。我们的目的是研究OSM和LIF在癌症和DRM患者肌肉减少症中的作用。设计与方法纳入33例肿瘤DRM患者。通过超声评估股直肌(RF)水平的肌肉质量,生物阻抗(骨骼肌质量(SMM),阑尾SMM (aSMM)和aSMM指数(aSMMI)),以及循环OSM和LIF水平。根据低肌力并aSMMI异常的标准确诊肌少症。结果患者平均年龄66.5±15.5岁。性别分布为女性16例(48.5%),男性17例(51.5%)。16例(48.5%)患者被诊断为肌肉减少症。患者sarcopenia显示差值:相角(−0.4±0.1°;p = 0.01),电抗(−4.9±1.8Ω;p = 0.03),多发性骨髓瘤(−2.0±0.3公斤;p = 0.03), aSMM(−1.6±0.2公斤;p = 0.03), aSMMI(−0.6±0.2 kg / m2; p = 0.02),肌肉面积射频(−0.7±0.2平方厘米;p = 0.04),轴射频(−0.4±0.1厘米;p = 0.03),肌肉力量(−8.1±1.5公斤;p = 0.01)和白蛋白水平(−0.3±0.1 g / dl; p = 0.03)。肌少症患者血液中OSM和LIF水平升高,分别为10.6±1.3 pg/ml (p = 0.01)和6.4±2.3 pg/ml (p = 0.02)。Logistic回归分析显示,骨骼肌减少症与OSM (OR = 3.6, 95% CI = 1.4 ~ 9.9; p = 0.01)和lif1 (OR = 3.3, 95% CI = 1.3 ~ 10.1; p = 0.01)中位水平升高相关。结论肿瘤合并DRM患者血清OSM和lif1水平升高与骨骼肌减少症密切相关。
{"title":"Influence of oncostatin M and leukemia inhibitor factor on sarcopenia in individuals with cancer and malnutrition","authors":"Daniel de Luis,&nbsp;David Primo,&nbsp;Olatz Izaola,&nbsp;Juan José López Gómez","doi":"10.1016/j.endinu.2025.501677","DOIUrl":"10.1016/j.endinu.2025.501677","url":null,"abstract":"<div><h3>Objectives</h3><div>Oncostatin-M (OSM) and leukemia inhibitor factor (LIF) have shown relationship with muscle catabolism in Disease Related Malnutrition (DRM). We aimed to investigate the role of OSM and LIF in sarcopenia among patients with cancer and DRM.</div></div><div><h3>Design and methods</h3><div>33 cancer patients with DRM were included. Muscle mass assessment via ultrasound at the rectus femoris (RF) level, bioimpedance (skeletal muscle mass (SMM), appendicular SMM (aSMM), and the aSMM index (aSMMI)), and circulating OSM and LIF levels were evaluated. Confirmed sarcopenia was diagnosed based on the criteria of low muscle strength combined with an abnormal aSMMI.</div></div><div><h3>Results</h3><div>The average age was 66.5<!--> <!-->±<!--> <!-->15.5 years. The gender distribution was 16 females (48.5%) and 17 males (51.5%). Sixteen patients (48.5%) were diagnosed with sarcopenia. Patients with sarcopenia showed worse values: phase angle (−0.4<!--> <!-->±<!--> <!-->0.1°; <em>p</em> <!-->=<!--> <!-->0.01), reactance (−4.9<!--> <!-->±<!--> <!-->1.8<!--> <!-->Ω; <em>p</em> <!-->=<!--> <!-->0.03), SMM (−2.0<!--> <!-->±<!--> <!-->0.3<!--> <!-->kg; <em>p</em> <!-->=<!--> <!-->0.03), aSMM (−1.6<!--> <!-->±<!--> <!-->0.2<!--> <!-->kg; <em>p</em> <!-->=<!--> <!-->0.03), aSMMI (−0.6<!--> <!-->±<!--> <!-->0.2<!--> <!-->kg/m<sup>2</sup>; <em>p</em> <!-->=<!--> <!-->0.02), muscle area RF (−0.7<!--> <!-->±<!--> <!-->0.2<!--> <!-->cm<sup>2</sup>; <em>p</em> <!-->=<!--> <!-->0.04), <em>Y</em>-axis RF (−0.4<!--> <!-->±<!--> <!-->0.1<!--> <!-->cm; <em>p</em> <!-->=<!--> <!-->0.03), muscle strength (−8.1<!--> <!-->±<!--> <!-->1.5<!--> <!-->kg; <em>p</em> <!-->=<!--> <!-->0.01) and albumin levels (−0.3<!--> <!-->±<!--> <!-->0.1<!--> <!-->g/dl; <em>p</em> <!-->=<!--> <!-->0.03). Circulating levels of OSM and LIF were elevated in patients with sarcopenia, with values of 10.6<!--> <!-->±<!--> <!-->1.3<!--> <!-->pg/ml (<em>p</em> <!-->=<!--> <!-->0.01) and 6.4<!--> <!-->±<!--> <!-->2.3<!--> <!-->pg/ml (<em>p</em> <!-->=<!--> <!-->0.02), respectively. Logistic regression analysis indicated a significant OR (odds ratio) of sarcopenia associated with elevated median levels of OSM (OR<!--> <!-->=<!--> <!-->3.6, 95% CI<!--> <!-->=<!--> <!-->1.4–9.9; <em>p</em> <!-->=<!--> <!-->0.01) and LIF-1 (OR<!--> <!-->=<!--> <!-->3.3, 95% CI<!--> <!-->=<!--> <!-->1.3–10.1; <em>p</em> <!-->=<!--> <!-->0.01)</div></div><div><h3>Conclusion</h3><div>High levels of serum OSM and LIF-1 were closely associated with sarcopenia in patients with cancer and DRM.</div></div>","PeriodicalId":37725,"journal":{"name":"Endocrinologia, Diabetes y Nutricion","volume":"73 2","pages":"Article 501677"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ATA 2025: Menos es más—Implicaciones prácticas para el manejo del cáncer diferenciado de tiroides ATA 2025:少即是多——管理分化型甲状腺癌的实际意义
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2026.501760
Garcilaso Riesco Eizaguirre , Emma Anda Apiñániz , Cecilia Sánchez Ragnarsson , Jordi Lluis Reverter Calatayud , Carles Zafon
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引用次数: 0
Incidentally vs nonincidentally diagnosed paragangliomas: Experience of a tertiary referral center 偶然与非偶然诊断副神经节瘤:三级转诊中心的经验
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501673
Patrícia Ferreira , Sara Ribeiro , Inês Meira , Marta Canha , Diana Festas Silva , Joana Queirós

Purpose

Incidental detection of paragangliomas (PGLs) is increasing due to the increased use and advancements in imaging modalities. Therefore, its clinical presentation is changing. We aimed to compare the clinical characteristics of incidentally discovered PGLs with the clinically suspected.

Methods

We conducted a retrospective cohort study with patients diagnosed with PGLs between 2004 and 2023 at a tertiary referral center. Our cohort was divided into 2 groups: clinically suspected PGLs and incidentally discovered PGLs. Data on age, tumor location, size, symptoms, metastasis, and genetic testing were collected and compared between the groups. A subgroup analysis was conducted to evaluate adrenal and extra-adrenal PGLs separately.

Results

Of the 140 included patients, 64.3% were diagnosed incidentally and 35.7% through clinical suspicion. Incidentalomas were older at diagnosis (54.6 ± 16.3 vs 46.2 ± 16.5 years; p = 0.002) and had smaller tumors (4.5 ± 2.5 cm vs 5.4 ± 2.4 cm; p = 0.030). Clinically suspected cases were more likely to have metastatic disease (16.3% vs 3.5%; p = 0.009) and exhibit classic symptoms, including palpitations (44.7% vs 8.4%; p < 0.001), sweating (29.8% vs 7.2%; p < 0.001), and headaches (29.8% vs 9.6%; p = 0.003). In addition, sustained hypertension was more common in the clinically suspected group (68.8% vs 47.1%; p = 0.016). In extra-adrenal PGLs, differences in tumor size and metastatic rates were more pronounced. Genetic testing showed a higher prevalence of mutations in the clinically suspected group (75% vs 47.6%; p = 0.003).

Conclusions

This study supports the shift in the predominant mode of paraganglioma presentation toward incidental findings. Enhanced recognition and proper follow up will refine the management of paragangliomas and ultimately improve patient outcomes.
目的:副神经节瘤(PGLs)的偶然检测越来越多,由于越来越多的使用和成像方式的进步。因此,其临床表现正在发生变化。我们的目的是比较偶然发现的pgl与临床怀疑的临床特征。方法:我们对2004年至2023年在三级转诊中心诊断为pgl的患者进行了回顾性队列研究。我们的队列分为两组:临床怀疑的pgl和偶然发现的pgl。收集年龄、肿瘤位置、大小、症状、转移和基因检测的数据,并在组间进行比较。亚组分析分别评价肾上腺和肾上腺外pgl。结果140例患者中,64.3%为偶然诊断,35.7%为临床怀疑。偶发瘤在诊断时年龄较大(54.6±16.3岁vs 46.2±16.5岁,p = 0.002),肿瘤较小(4.5±2.5 cm vs 5.4±2.4 cm, p = 0.030)。临床疑似病例更有可能有转移性疾病(16.3% vs 3.5%; p = 0.009),并表现出典型症状,包括心悸(44.7% vs 8.4%; p < 0.001)、出汗(29.8% vs 7.2%; p < 0.001)和头痛(29.8% vs 9.6%; p = 0.003)。此外,持续高血压在临床怀疑组中更为常见(68.8% vs 47.1%; p = 0.016)。在肾上腺外pgl中,肿瘤大小和转移率的差异更为明显。基因检测显示临床疑似组突变发生率较高(75% vs 47.6%; p = 0.003)。结论:本研究支持副神经节瘤的主要表现模式向偶然发现的转变。增强识别和适当的随访将改进副神经节瘤的管理,并最终改善患者的预后。
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引用次数: 0
New cortisol assay-specific thresholds for the biochemical diagnosis of adrenal insufficiency after ACTH stimulation ACTH刺激后肾上腺功能不全生化诊断的新皮质醇测定特异性阈值
4区 医学 Q3 Nursing Pub Date : 2026-02-01 DOI: 10.1016/j.endinu.2025.501685
Pablo Fernández Velasco , Lucia Estévez Asensio , Beatriz Torres Torres , Ana Ortolá Buigues , Emilia Gómez Hoyos , Esther Delgado García , Daniel de Luis Román , Gonzalo Díaz Soto

Purpose

Adrenal insufficiency (AI) is traditionally diagnosed using the corticotropin stimulation test (CST) with a cortisol threshold of 18.0 μg/dL. However, newer immunoassays suggest revising this threshold to enhance diagnostic accuracy. This study aimed to evaluate the diagnostic performance of baseline cortisol (CB) and stimulated cortisol levels at 30 min (C30 min) and 60 min (C60 min) post-CST, using a revised threshold of 15.6 μg/dL.

Methods

This retrospective study analyzed a total of 140 patients with suspected AI who underwent CST from 2016 to 2022. Demographic, clinical, and biochemical data were collected. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis to compare the performance of the traditional 18.0 μg/dL threshold with the proposed 15.6 μg/dL cutoff.

Results

The study population had a mean age of 45.6 ± 19.3 years (68.6%, women). Mean cortisol levels were CB 12.3 ± 5.7 μg/dL, C30 min 20.2 ± 6.7 μg/dL, and C60 min 22.9 ± 7.8 μg/dL. A strong correlation was observed between CB and maximum stimulated cortisol (R = 0.610, p = 0.0003.) The revised 15.6 μg/dL threshold reduced false-positive diagnoses by 17.9% (p = 0.029). ROC analysis demonstrated high diagnostic accuracy for CB (AUC, 0.901), with CB > 13.1 μg/dL predicted a normal response, and CB < 1.5 μg/dL was always suggestive of pathology.

Conclusion

The revised 15.6 μg/dL cortisol threshold enhances CST diagnostic accuracy by reducing false positives and avoiding unnecessary glucocorticoid therapy. Additionally, CB alone showed strong predictive value, and a single C30 min measurement may be sufficient for diagnosis in most cases. Further validation studies across different immunoassay platforms are necessary.
目的肾上腺皮质激素刺激试验(CST)诊断肾上腺功能不全(AI),皮质醇阈值为18.0 μg/dL。然而,较新的免疫测定建议修改这一阈值以提高诊断准确性。本研究旨在评估基线皮质醇(CB)和刺激皮质醇水平在cst后30分钟(C30分钟)和60分钟(C60分钟)的诊断性能,使用修正阈值15.6 μg/dL。方法回顾性分析2016 - 2022年140例疑似AI行CST的患者。收集了人口学、临床和生化数据。采用受试者工作特征(ROC)曲线分析评估诊断准确性,比较传统的18.0 μg/dL阈值与建议的15.6 μg/dL截止值的性能。结果研究人群平均年龄为45.6±19.3岁(68.6%为女性)。平均皮质醇水平CB为12.3±5.7 μg/dL, C30 min为20.2±6.7 μg/dL, C60 min为22.9±7.8 μg/dL。CB与最大刺激皮质醇之间存在很强的相关性(R = 0.610, p = 0.0003)。修订后的15.6 μg/dL阈值使假阳性诊断减少了17.9% (p = 0.029)。ROC分析显示,CB的诊断准确率较高(AUC, 0.901), CB >; 13.1 μg/dL预测正常反应,CB <; 1.5 μg/dL提示病理反应。结论修订后的15.6 μg/dL皮质醇阈值可减少假阳性,避免不必要的糖皮质激素治疗,提高CST诊断的准确性。此外,单独的CB具有很强的预测价值,在大多数病例中,单个c30min测量可能足以诊断。需要在不同的免疫分析平台上进行进一步的验证研究。
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引用次数: 0
Vitamin K in home parenteral nutrition: Is it really necessary? 家庭肠外营养中的维生素K:真的有必要吗?
4区 医学 Q3 Nursing Pub Date : 2026-01-01 DOI: 10.1016/j.endinu.2025.501655
Estrella Diego , María del Carmen Farnández , Beatriz de León , Andoni Monzón , Leire Isasa , Beatriz Sordo , Nuria Valdés

Introduction

Multivitamin preparations with added vitamin K in parenteral nutrition (PN) ensure the coverage of this micronutrient in all adults, as indicated by the latest ESPEN clinical practice guidelines on micronutrients.

Objectives

To monitor vitamin K levels after adding this multivitamin with vitamin K in patients requiring home parenteral nutrition (HPN) at Hospital Universitario Cruces (Bilbao, Basque County, Spain) from 2021 to 2022.

Materials and methods

We analyzed vitamin K levels were collected 6 months into therapy with the multivitamin containing vitamin K in home parenteral nutrition.

Results

At our centre, a total of 8 patients required home parenteral nutrition due to intestinal failure type III, 60% of whom were men, with a mean age of 58 ± 13 years. The cause of intestinal failure was short bowel syndrome (50%), intestinal mucosal disease (38%), and intestinal dysmotility (12%). After adding the multivitamin with vitamin K, 80% (6/8) of patients exhibited elevated vitamin K levels, with a mean of 4.4 μl/L.

Conclusions

After observing vitamin K levels above the upper limit of normal, we reached consensus with the Pharmacy Service to discontinue this multivitamin and restart conventional multivitamin. After this initiative, the vitamin K levels of our patients normalized.
根据最新的ESPEN微量营养素临床实践指南,在肠外营养(PN)中添加维生素K的多种维生素制剂可确保所有成年人都能获得这种微量营养素。目的监测2021年至2022年在西班牙巴斯克县毕尔巴鄂大学医院(Universitario Cruces)需要家庭肠外营养(HPN)的患者添加该复合维生素和维生素K后的维生素K水平。材料与方法采用含维生素K复合维生素的家庭肠外营养治疗6个月后收集患者的维生素K水平。结果本中心共有8例III型肠衰竭患者需要家庭肠外营养,其中60%为男性,平均年龄58±13岁。肠衰竭的原因是短肠综合征(50%)、肠黏膜疾病(38%)和肠蠕动障碍(12%)。加维生素K复合维生素后,80%(6/8)的患者维生素K水平升高,平均为4.4 μl/L。结论在观察到维生素K水平超过正常上限后,我们与药房达成共识,停止使用该复合维生素,重新使用常规复合维生素。这一举措后,我们的病人的维生素K水平恢复正常。
{"title":"Vitamin K in home parenteral nutrition: Is it really necessary?","authors":"Estrella Diego ,&nbsp;María del Carmen Farnández ,&nbsp;Beatriz de León ,&nbsp;Andoni Monzón ,&nbsp;Leire Isasa ,&nbsp;Beatriz Sordo ,&nbsp;Nuria Valdés","doi":"10.1016/j.endinu.2025.501655","DOIUrl":"10.1016/j.endinu.2025.501655","url":null,"abstract":"<div><h3>Introduction</h3><div>Multivitamin preparations with added vitamin K in parenteral nutrition (PN) ensure the coverage of this micronutrient in all adults, as indicated by the latest ESPEN clinical practice guidelines on micronutrients.</div></div><div><h3>Objectives</h3><div>To monitor vitamin K levels after adding this multivitamin with vitamin K in patients requiring home parenteral nutrition (HPN) at <em>Hospital Universitario Cruces</em> (Bilbao, Basque County, Spain) from 2021 to 2022.</div></div><div><h3>Materials and methods</h3><div>We analyzed vitamin K levels were collected 6 months into therapy with the multivitamin containing vitamin K in home parenteral nutrition.</div></div><div><h3>Results</h3><div>At our centre, a total of 8 patients required home parenteral nutrition due to intestinal failure type III, 60% of whom were men, with a mean age of 58<!--> <!-->±<!--> <!-->13 years. The cause of intestinal failure was short bowel syndrome (50%), intestinal mucosal disease (38%), and intestinal dysmotility (12%). After adding the multivitamin with vitamin K, 80% (6/8) of patients exhibited elevated vitamin K levels, with a mean of 4.4<!--> <!-->μl/L.</div></div><div><h3>Conclusions</h3><div>After observing vitamin K levels above the upper limit of normal, we reached consensus with the Pharmacy Service to discontinue this multivitamin and restart conventional multivitamin. After this initiative, the vitamin K levels of our patients normalized.</div></div>","PeriodicalId":37725,"journal":{"name":"Endocrinologia, Diabetes y Nutricion","volume":"73 1","pages":"Article 501655"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Endocrinologia, Diabetes y Nutricion
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