Journal of Endocrinological Investigation最新文献

Context: Obstructive Sleep Apnea (OSA) has been implicated in the pathophysiology of primary aldosteronism (PA), yet its specific relationship with bilateral primary aldosteronism (BPA) remains unclear. Clarifying this association is essential for optimizing diagnostic and therapeutic strategies.

Objective: To investigate the independent association between OSA and BPA, and compare clinical and sleep parameters between unilateral primary aldosteronism (UPA) and BPA.

Methods: In this single-center cross-sectional cohort study, a total of 136 PA patients (79 UPA, 57 BPA) underwent comprehensive clinical, biochemical, and polysomnographic evaluations. Prevalence and severity of OSA were compared between groups. Logistic regression analyses, both crude and adjusted, assessed the independent association between OSA and BPA.

Results: Compared to UPA, BPA patients exhibited significantly higher body weight, BMI, waist circumference, triglycerides, serum potassium, and baseline plasma renin concentration, but lower 24-hour urinary potassium, and plasma aldosterone concentrations (all P < 0.05). Patients with BPA demonstrated higher apnea-hypopnea index (AHI) [21.5(3,32.2) vs. 14.0(10.9,52.7), P = 0.008], higher obstructive apnea counts and lower the lowest oxygen saturation during sleep. Moderate-to-severe OSA prevalence was greater in BPA than UPA (61% vs. 48%; P = 0.004). Among patients with OSA, BPA prevalence significantly exceeded UPA (91% vs. 66%; P = 0.001). OSA patients also had higher BPA prevalence compared to non-OSA patients (50% vs. 16%; P = 0.001). Logistic regression revealed an independent association between OSA and BPA in both crude (OR 5.400, 95% CI 1.930-15.107; P = 0.001) and adjusted analyses (OR 9.91, 95% CI 1.19-82.67; P = 0.034).

Conclusion: OSA is significantly associated with increased BPA risk, exhibiting higher prevalence and severity in BPA patients compared to UPA. Our findings underscore the importance of routine OSA screening in PA patients, especially those with BPA, to improve outcomes and reduce cardiovascular risk.

Purpose: Bilateral inferior petrosal sinus sampling (BIPSS) is considered the most accurate procedure to confirm the diagnosis of Cushing's disease (CD). However, it is a cumbersome and costly procedure. We aim to determine whether the corticotropin-releasing hormone (CRH) test alone might differentiate CD from ectopic adrenocorticotropin (ACTH) syndrome (EAS).

Methods: In this retrospective, observational study we investigated 523 consecutive patients with ACTH-dependent hypercortisolism: 502 with CD and 21 with EAS. All patients underwent a CRH test and surgery for the removal of the ACTH-secreting tumor. Two hundred patients with CD and 17 with EAS underwent BIPSS. The diagnostic CRH test performance included sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

Results: using a 50% ACTH increase as the threshold, the CRH test correctly classified 438 cases of CD (87%) and 20 cases of EAS (95%). The diagnostic metrics were as follows: SE 87%, SP 95%, PPV 99%, NPV 23%, accuracy 92%, PLR 18.35, and NLR 0.05. BIPSS correctly diagnosed all cases of EAS (100%) and 188 cases of CD (94%).

Conclusions: Our study shows that a positive CRH test reliably differentiates CD from EAS and obviates the need for BIPSS. The performance of CRH test is similar in patients with and without a visible pituitary microadenoma or a microadenoma < 6 mm. Accepting the very low probability of EAS in a patient with positive ACTH response to CRH, we can propose pituitary surgery without performing BIPSS.

Purpose: Impaired insulin clearance has been found in women with PCOS and contribute to generate hyperinsulinemia in these subjects. However, the mechanisms underlying this phenomenon remain unknown. The aim of this retrospective study was to explore if the heterogeneous treatments used in these patients to counteract their hormonal and metabolic alterations can also affect insulin clearance.

Methods: Forty-seven women with PCOS were included in the study. They belonged to different experimental groups, submitted to treatments with the following drugs: GnRH-agonist (buserelin, n = 10), antiandrogens (spironolactone, n = 9), metformin (n = 18), or placebo (n = 10). Metabolic clearance rate of insulin (MCRI) and insulin sensitivity were measured by the hyperinsulinemic euglycemic clamp, performed before and after treatment. Insulin secretion was estimated by the HOMA β-index.

Results: Treatments were associated, as expected, with different clinical effects. In ANOVA analysis, changes in MCRI significantly differed between treatment groups. In particular, metformin increased MCRI as compared with other treatments or placebo. Mediation analysis showed that about 25% of this effect of metformin was mediated by the concurrent BMI change, whereas it was not influenced by changes in peripheral insulin sensitivity or insulin secretion.

Conclusion: The impairment of MCRI, which contributes to the hyperinsulinemia typical of PCOS, significantly improved after treatment with metformin. This effect was only partially explained by the reduction of BMI, whereas changes in insulin sensitivity did not show a mediation effect in this phenomenon, suggesting that other metformin-induced mechanisms are involved.

Purpose: Adult-onset craniopharyngiomas (CPs) often present after diagnostic delays, yet the prognostic relevance of duration of history (DOH) and specific clinical manifestations remains unexplored.

Method: Data of patients aged > 18 years at CP diagnosis between June 2012 and October 2024 at the First Affiliated Hospital of Nanchang University were retrospectively reviewed. Associations between DOH, specific symptoms, and tumor characteristics at diagnosis, as well as long-term outcomes, were systematically analyzed.

Results: Among 151 patients (median follow-up, 71 months) in our cohort, the median DOH was 5 months and showed no significant correlation with tumor volume at diagnosis, hypothalamic involvement, extent of resection, or long-term prognosis including mortality, recurrence, and hypothalamic syndrome at last visit. Patients with amenorrhea/sexual dysfunction in history demonstrated significantly longer DOH (p < 0.001), while those with neurological deficits (p = 0.043) or hydrocephalus (p = 0.044) were associated with shorter DOH. Neurological deficits in history was associated with larger tumor volume at diagnosis (p = 0.016). Headache presented as the first symptom was linked to significantly shorter DOH (p = 0.003) and neurological deficits as the first symptom was associated with worse progression-free survival (p = 0.047).

Conclusion: Diagnostic delays are common in adult-onset CP patients but appear unrelated to tumor burden or long-term prognosis. Neurological deficits in history or as the first symptom should trigger prompt diagnostic workup and more rigorous follow-up, while prolonged diagnostic delays in those with endocrine symptoms underscore the need for heightened awareness among clinicians to expedite referral and diagnosis.

Purpose: The aim of the study was to compare the efficacy, procedural features, and safety profile of radiofrequency ablation (RFA) versus microwave ablation (MWA) for the treatment of non-functioning benign thyroid nodules (BTNs).

Methods: This retrospective, single-centre, cohort study included 203 nodules treated with RFA and 71 with MWA by a single experienced operator. Multivariate linear regression analysis was performed to identify independent predictors of treatment response, defined as 12-month volume reduction rate (VRR). Complication rates were also compared between RFA and MWA. A 1:1 case-control matching was performed based on baseline nodule volume and composition, yielding two matched cohorts of 66 patients each. VRRs after 6 and 12 months were compared between two groups.

Results: In the overall population, similar VRRs were observed after 6 and 12 months. Significant differences in baseline nodule volume (24.35 ± 17.15 ml vs. 17.25 ± 15.22ml; p = 0.001) and in procedure times (519.96 ± 289.45s vs. 649.61 ± 321.05s; p = 0.003) were found for MWA and RFA, respectively. Multivariate analysis identified baseline volume (p < 0.001) and composition (p < 0.033) as significant and independent predictors of VRR. Both techniques showed comparable safety. In the matched cohorts, VRRs after 6-months were similar, while a higher VRR after 12-months was observed for MWA compared to RFA (64.70 ± 13.89% vs. 58.71 ± 16.81%; p = 0.028).

Conclusion: RFA and MWA are both safe and effective for treating BTNs. In the overall population, VRRs were similar between RFA and MWA, with MWA requiring shorter procedure times. After matching for key predictors of therapeutic response, MWA demonstrated superior efficacy at 12-months.