European Endocrinology最新文献

In the 21st century, life expectancy has increased and consequently so has the number of elderly people. Sarcopenia is an emerging area in geriatric medicine. The European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength and/or physical performance, associated with a risk of adverse outcomes such as physical disability, poor quality of life, and death. Sarcopenia requires diagnostic and interventional methods in order to initiate timely and appropriate treatment. Diagnosing sarcopenia requires assessments of muscle mass, muscle strength and physical performance. Management of sarcopenia involves a variety of approaches. Nutritional and exercise interventions are strongly supported.

Pituitary adenomas are benign tumours comprising approximately 16% of all primary cranial neoplasms. Functioning pituitary adenomas (prolactinomas, somatotroph, corticotroph, thyrotroph and rarely gonadotroph adenomas) cause complex clinical syndromes and require prompt treatment to reduce associated morbidity and mortality. Treatment approaches include transsphenoidal surgery, medical therapy and radiation. Medical therapy is the primary therapy for prolactinomas, and surgery by a skilled neurosurgeon is the first-line approach for other functioning pituitary adenomas. A multimodal treatment is frequently necessary to achieve biochemical and clinical control, especially, when surgery is not curative or when medical therapy fails. Several emerging, novel, medical treatments for acromegaly, Cushing's disease and prolactinomas are in phase II and III clinical trials and may become effective additions to the current drug armamentarium. The availability of various management options will allow an individualised treatment approach based on the unique tumour type, clinical situation and patient preference.

Primary leiomyosarcoma (LMS) of thyroid is rare malignant neoplasm usually seen in elderly patients. These tumours are characterised by a rapidly growing mass in the neck, difficult to diagnose preoperatively and are highly aggressive with high recurrence rates in spite of radical surgery, chemotherapy and radiotherapy. We herein report a case of 50-year-old female with a rapidly growing painless mass in the neck. Total thyroidectomy with bilateral neck node clearance was done. Histology and Immunohistochemistry revealed primary LMS of thyroid gland. Within 1 month of radical surgery she developed local recurrence. Diagnosis of primary LMS is difficult and immunohistochemistry is necessary to differentiate it from other malignancies of the thyroid. Primary LMS remains a life-threatening tumour and more effective treatment are needed to improve outcome.

Diabetes distress can be managed effectively by coping-skill training. To improve coping skills, one must begin by analysing current coping styles of an individual. The GlucoCoper has been developed as a brief, simple, easy-to-administer tool for assessing the coping mechanism of people with diabetes mellitus. The GlucoCoper includes six items rated on a graphic visual analogue scale. These include four items to assess positive coping skills (acceptance, optimism, planning and action) and two items to assess negative coping mechanisms (negativity and blame). The current single centre prospective study analysed the six-item GlucoCoper as a tool to identify coping skills in antenatal women with diabetes, and correlated them with level of diabetes distress. Greater duration of diabetes was related with lower optimism; while poor glycaemic control (high glycated haemoglobin [HbA1c]) was related with high negativity and low scores for planning. Highly educated subjects revealed greater negativity, while those from a rural background exhibited higher blame scores of =7.00 for negativity, =4.00 for planning, and =5.00 for action. These factors should prompt detailed evaluation and intervention. The findings of the current study suggest that GlucoCoper can be used as a screening tool for dysfunctional coping skills in pregnancy complicated by diabetes. Negativity, planning and action, the three domains which correlate strongly with the GlucoCoper score, can be used to create a three-item GlucoCoper, to be used as a brief and effective screening tool for dysfunctional coping skills in pregnancy complicated by diabetes.

This article describes the importance of the family in diabetes care. It lists the multiple ways in which the family is related to diabetes: as a cause or culprit of diabetes, as a tool or technique for delivering diabetes care and as a target of diabetes or diabetes-care-related complications. The authors suggest an alliterative 'Five-I' approach to guide diabetes care professionals in addressing needs, and utilising strengths, of the family of a person with diabetes. The five 'I's stand for: involved independence, iterative information, interactive interviews, inspired introspection and integrated incorporation. This strategy, based upon evidence and experience, is supported by pragmatism and practicality.

Background and aims: Knowledge of therapeutic lifestyle interventions is one of the most important pillars of diabetes care; however, its incorporation in real-world settings is poor. This review evaluates the role of partner and family support in diabetes management. Methods: Literature searches were performed in PubMed, Medline and Embase for articles published before July 2018, using the terms "therapeutic lifestyle intervention" [MeSH Terms], OR "diet changes" [All Fields], OR "spousal participation" [All Fields], OR "lifestyle interventions" [All Fields], "lifestyle changes" [All Fields] AND "diabetes" [All Fields]. The search was not restricted to English-language literature; literature in Spanish, French and German were also evaluated. Results: A total of 66 of articles were reviewed, which included 33 original work, 21 review articles, and 12 systematic reviews and meta-analyses. Studies and meta-analyses have showed that if one partner has type-2 diabetes this increases the risk in other by 5-26%. Partner and family have similar diet, lifestyle, and micro- and macro-environments which could explain the similar increased risk of diabetes and non-communicable diseases. Studies have consistently shown that spousal and family support plays a key role in overcoming negative behaviours and optimising behaviours in diabetes control. Partner support has major role in prevention and control of diabetes distress, associated depression, and medication non-compliance which have an adverse impact in glycaemic outcomes. These data are predominantly available from observational studies. There is paucity of data from interventional trials evaluating effects of family and spousal participation on health, glycaemic control and quality of life. Conclusion: The support of family and spouse/partner is beneficial to improve adherence to the lifestyle interventions and pharmacotherapy required to achieve optimum glycaemic control and avoid associated complications.

Thyroid abscesses are rare as the gland has a rich blood supply, well-developed capsule and is high in iodine. However, clinicians must be aware of this fact and make an early diagnosis as it can lead to serious morbidity if left untreated. Infection may involve one or both lobes of the thyroid gland, although the left lobe is more often affected and is successfully treated with surgery and antibiotics. This case study involves a 22-year-old woman with a history of painful swelling over the neck accompanied by low-grade fever without any underlying cause. Both the ultrasound and computed tomography revealed a heterogeneous mass within the left lobe of the thyroid gland. Fine needle aspiration revealed an abscess collection and culture Staphylococcus aureus had grown. She was successfully treated with intravenous and oral amoxicillin clavulanate and no surgical treatment was carried out. In conclusion, thyroid abscesses are rare as the gland is resistant to infection and must be differentiated from an infected branchial cleft cyst or sinus, infected thyroid tumour or lymphadenitis in the region of the thyroid in order to avoid serious morbidity if left untreated.

Purpose: The purpose of this study was to develop a measure of type 1 diabetes mellitus (T1DM) knowledge that is aimed at youth and is based on contemporary management standards. Methods: An 88-item test was derived from the American Association of Diabetes Educators 7 Self-Care Behaviors. Results: A multidisciplinary team selected the best 49 items which were piloted in a sample of 119 youths (59 males, aged 12-18, having a mean ± standard deviation glycated haemoglobin (A1C) of 9.9%±1.80 (84.7±19.7 mmol/mol). A minimum absolute point-biserial correlation coefficient of 0.250 was used to choose 49 items from the original 88 questions. Categorical principal component analysis was then used to identify the best factor analytical model that consisted of five factors composed of 19 items. These five factors explained 57% of item variances. Factors were associated with the latent variables: advanced problem-solving, hypoglycaemia prevention and management, taking insulin/medication administration, daily management and healthy active living. Conclusion: A new T1D knowledge test for youth was refined from 88 to 49 questions based on expert opinion and empirical test construction. The instrument was then refined to 19 items based on exploratory factor analysis. Future goals are to validate this factor model with another cohort and confirm concurrent validity based on youth's glycated haemoglobin and adherence behaviours. Our new T1DM knowledge measure initially appears valid and promising as a new clinical and research tool.

Physical activity and nutritional factors, such as calcium and vitamin D intake, have been shown in numerous studies to be beneficial to musculoskeletal health at different points in the lifecourse. However, the evidence that physical activity and nutrition may act synergistically for benefit is far more sparce; the best data come from studies that consider calcium, vitamin D or creatine supplementation in combination with physical activity interventions to promote better musculoskeletal health. Some observational data also suggest that a 'healthier' lifestyle, characterised by a more 'prudent' diet and higher reported levels of physical activity is also associated with better musculoskeletal health in late adulthood. Given the public health burden of osteoporosis and sarcopenia in our aging population, well designed randomised controlled trials are now timely and much needed.

The kidney is important in the context of diabetes not only because it is involved in normal glucose homeostasis, but also because it is one of the most important end organs to be involved in diabetes complications. Glomeruli are the meeting point of both microvascular, or renal; and macrovascular, or cardiovascular, health in diabetes. Sulfonylureas are effective glucose-lowering drugs. While a sulfonylurea-based glucose-lowering strategy is nephro-safe and nephro-protective, this aspect of sulfonylurea pharmaco-biology has not been highlighted earlier. In this editorial, we discuss current preclinical and clinical trial evidence regarding the performance of modern sulfonylureas at the glomerular battlefield.