European Endocrinology最新文献

Objective: The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients.

Methods: Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life.

Results: The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles.

Conclusion: In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient.

Introduction: Separately, polycystic ovary syndrome (PCOS) and subclinical hypothyroidism (SCH) exert adverse effects on several reproductive and metabolic parameters; however, in conjunction, their effects are unclear. This study evaluated the impact of SCH on reproductive and metabolic parameters in women with PCOS.

Methods: In this cross-sectional study, women with newly diagnosed PCOS were evaluated. Data on their clinical presentation and anthropometric measurements were recorded, in addition to oral glucose tolerance test, fasting lipid profile, serum thyroid-stimulating hormone (TSH), free thyroxine (FT4) and anti-thyroid peroxidase (anti-TPO).

Results: Four hundred and sixty-five women, aged 12-40 years, with PCOS were included in this study; 10.8% of them had SCH and 18.3% were positive for anti-TPO. All participants had statistically similar mean age, body mass index (BMI), waist circumference, systolic blood pressure (BP) and diastolic BP. A similar number of participants in both the euthyroid PCOS and PCOS-SCH groups had menstrual irregularity, acne, subfertility, a first-degree family member with thyroid dysfunction, acanthosis nigricans and elevated BP. Participants with SCH-PCOS had a lower modified Ferriman-Gallwey score and hirsutism frequency, though serum total testosterone levels were similar in the two groups. More subjects in the SCH group were overweight/obese, and had central obesity and goiter compared to the euthyroid group. Blood glucose, lipids and prolactin levels were similar between the two groups; the frequencies of dysglycaemia and dyslipidaemia were also similar. A higher frequency of metabolic syndrome was observed in the SCH group, though the difference was not statistically significant (p=0.098).

Conclusion: In women with PCOS, the presence of SCH does not amplify the risk of metabolic and reproductive dysfunctions.

The coronavirus disease 2019 (COVID-19) pandemic has created significant challenges for healthcare systems across the world. The disease seems to infect men and women in equal numbers, though trends suggest that men have greater morbidity. This has been attributed to differences in immunological response, expression of angiotensin-converting enzyme 2 (ACE2), prevalence of comorbidities, and health-related behaviours, such as smoking. However, this cannot be taken to mean that women are somehow protected. Advanced age, smoking, diabetes, hypertension, cardiovascular disease and chronic obstructive pulmonary disease have emerged as the leading contributors to increased morbidity and mortality from the disease. Women with diabetes form a vulnerable group as they often receive suboptimal diabetes care and support, even though they have a high burden of comorbidities and complications. While there are challenges in healthcare delivery during the pandemic, cardiometabolic care cannot be compromised, which calls for exploring new avenues of healthcare delivery, such as telemedicine. Pregnant women with diabetes should continue to receive quality care for optimal outcomes, and the psychological health of women also needs special consideration. The management of hyperglycaemia during COVID-19 infection is important to reduce morbidity and mortality from the infection. The gendered impact of outbreaks and quarantine goes beyond biomedical and psychological aspects, and the socioeconomic impact of the pandemic is likely to affect the long-term care of women with diabetes, which creates an urgent need to create effective policies and interventions to promote optimal care in this vulnerable group.

Introduction: Statin-associated muscle symptoms (SAMS) can lead to medication non-adherence among statin users. There is a complex relationship between SAMS, vitamin D and low-density lipoprotein cholesterol (LDL-C). The objective of this study was to evaluate the relationship between vitamin D, LDL-C and occurrence of SAMS.

Methods: This was a cross-sectional study in patients using statins. Thorough patient histories were taken, a clinical examination was conducted and SAMS were recorded. Levels of vitamin D, creatine phosphokinase (CPK) and LDL-C were measured. These parameters were compared amongst statin users with SAMS and those without SAMS. Levels of vitamin D and LDL-C were converted into percentiles and their relationship with SAMS was evaluated in terms of odds ratio. Receiver operating characteristics (ROC) were drawn, taking vitamin D and LDL-C as predictors of SAMS.

Results: A total of 121 statin users were enrolled in this study. Thirty-eight patients (31.4%) presented with SAMS. Significantly lower levels of serum vitamin D were observed amongst statin users with SAMS compared with those without SAMS (19.8 ± 9.67 ng/mL versus 25.0 ± 14.6 ng/mL; 95% confidence interval -10.4 to -0.07; p=0.04). With vitamin D levels less than or equal to 5th, 10th and 25th percentile, the chances of occurrence of SAMS were significantly higher, but not at the 50th percentile (corresponding vitamin D level of 20.21 ng/mL). LDL-C did not show any conclusive relationship with SAMS. ROC curves showed a significant discrimination for vitamin D levels, but not for LDL-C.

Conclusion: Statin users with low levels of vitamin D are at increased risk of developing SAMS. However, LDL-C status of statin users failed to predict any meaningful association with SAMS. Given the small sample size of this study, these results should be regarded as preliminary.

The evidence derived from observational studies suggests male gender, diabetes and central obesity to be risk factors associated with an increased COVID-19-related case fatality. The precise pathophysiology behind this gender difference in mortality outcomes remains unclear at this stage, although it is worth exploring a possible role of testosterone as one of the contributory factors. The observed role of androgens in transcription of transmembrane protease serine-2, which facilitates COVID-19 anchoring to angiotensin-converting enzyme 2 cell surface receptors, seems to suggest that higher testosterone levels might be detrimental for outcomes. On the other hand, men with type 2 diabetes mellitus and central obesity have an increased prevalence of hypogonadotropic hypogonadism, with inhibition of gonadotropin-releasing hormone secretion induced by inflammatory cytokines being one of the postulated mechanisms. The increased COVID-19 case fatality in this cohort might perhaps reflect an underlying pro-inflammatory state, with low testosterone levels being either a surrogate marker of a poor metabolic state or playing a more active role in propagation of inflammation and thrombosis.

The coronavirus disease 2019 (COVID-19) pandemic has affected almost every country in the world and has changed the way we access healthcare. People with pre-existing conditions, such as diabetes, are at high risk of a severe disease course and it is essential that, as well as good hygiene and social distancing measures, blood glucose is carefully monitored, as chronic hyperglycaemia can lead to immune dysfunction. People with diabetes should be encouraged to continue medication prescribed for hypertension, diabetes or dyslipidaemia. Furthermore, patients with diabetes and COVID-19 infection should follow their usual antidiabetic treatment with the exception of sodium-glucose cotransporter-2 inhibitors. As the current pandemic situation has rendered some patients unable to access routine healthcare, telehealth may help those with travel restrictions.

The presentation of adrenocortical carcinoma (ACC) with bilateral adrenal masses and acute adrenal insufficiency is exceedingly rare and has only been seen in anecdotal case reports. Herein, we describe the case of a 50-year-old male who presented with a painful abdominal lump, loss of weight and appetite, several episodes of vomiting, and hypotension. Imaging studies were suggestive of bilateral adrenal masses and a lung mass. Hormonal work-up was suggestive of acute adrenal insufficiency, with the adrenal masses being non-secretory. An ultrasound-guided biopsy from one of the adrenal masses was suggestive of ACC, thus confirming the diagnosis as bilateral ACC with distant metastases. Bilateral adrenalectomy was planned for the patient, but unfortunately, he succumbed to his disease before the surgery.

Insulin autoimmune syndrome, or Hirata's disease, is a rare cause of hypoglycaemia. It is characterised by spontaneous episodes of hypoglycaemia, without any exposure to exogenous insulin. The majority of cases are seen in the Japanese population and it is rarely found to affect other ethnicities. The recognition of this disease is important to avoid unnecessary investigations and procedures. Here, we report two cases of insulin autoimmune syndrome, which were diagnosed and managed in our institute.

Colloid goitres are a common, benign lesion of the thyroid gland, that involve a diffuse or nodular pattern. An important feature of colloid goitre is the contained colloid material inside and the comet-tail artefacts, which show up on ultrasound. However, some cases of colloid goitre do not show a comet-tail sign and sometimes these artefacts need to be distinguished from microcalcifications in malignant lesions. This review discusses the epidemiology, pathophysiology, clinical manifestations, ultrasound features and management of colloid goitres.