Archives of Endocrinology Metabolism最新文献

Bonehealth is influenced by a dynamic interplay of genetic, hormonal, and environmental factors, with nutrition playing a vital role throughout life. This review consolidates the current evidence on the roles of essential micronutrients, specifically calcium, vitamin D, vitamin K, magnesium, and phosphorus, in skeletal metabolism and integrity. Calcium and vitamin D, the most extensively studied, have been shown to reduce bone loss and fracture risk, particularly in institutionalized individuals or those with deficiencies, while evidence is less consistent in the general population. Although vitamin K, magnesium, and phosphorus are important for bone physiology, the clinical evidence supporting their supplementation is either limited or context dependent. Additionally, this review explores the current status of micronutrient intake in Brazil and discusses potential risks associated with excessive or inappropriate supplementation, such as cardiovascular issues and mineral metabolism disturbances. An individualized, evidence-informed approach may be beneficial in optimizing bone health while minimizing adverse effects.

The thyroid-gut axis represents a dynamic interaction between the intestinal microbiota and thyroid function, with growing evidence linking gut dysbiosis to thyroid diseases. The gut microbiome, comprising over 100 trillion microorganisms, influences immune modulation, iodine metabolism, and thyroid hormone regulation. Short-chain fatty acids, produced by beneficial gut bacteria, support immune homeostasis and thyroid function, while pathogenic bacteria and lipopolysaccharides trigger inflammatory pathways that impair thyroid activity. Alterations in gut microbiota composition have been associated with autoimmune thyroid diseases, including Hashimoto's thyroiditis and Graves' disease. Dysbiosis increases intestinal permeability, antigen exposure, and immune activation, exacerbating thyroid autoimmunity. A reduction in short-chain fatty acids-producing bacteria weakens immune tolerance, promoting inflammatory cytokine release and autoantibody production. Recent studies highlight microbial metabolites such as tryptophan derivatives and their role in immune regulation. Gut dysbiosis is also implicated in thyroid nodules and cancer. Decreased butyrate-producing bacteria and increased inflammatory bacterial taxa have been observed in thyroid malignancies. Microbiota influence iodine and selenium bioavailability, essential for thyroid hormone synthesis, and modulate sodium-iodide symporter expression, affecting thyroid cancer response to radioactive iodine therapy. Microbiome-targeted interventions, including probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation, may restore microbial balance, enhance immune regulation, and improve thyroid treatments. This review synthesizes our current understanding of the thyroid-gut axis, indicating that the intestinal microbiota and its metabolites may act directly or indirectly on the thyroid gland, highlighting potential clinical implications and paving the way for therapeutic strategies targeting the intestinal microbiota.

The pleiotropic role of vitamin D in human health has been implicated in modulating bone metabolism and other several extraskeletal areas, including muscle and adipose tissues regulation, and in influencing general and systemic outcomes. In the elderly, vitamin D deficiency is considered as an emerging public health issue affecting 40%-70% of older adults worldwide with higher rates occurring in institutionalized individuals or patients with multiple chronic comorbidities. The pathophysiology of vitamin D deficiency in the elderly is multifactorial and includes age-related reduced skin synthesis, limited sun exposure, declined renal and liver function, and long-term use of interfering medications. Given its pleiotropic effects, vitamin D deficiency in the elderly has been consistently associated with progressive bone deterioration and muscle and adipose dysfunctions, concurring to the occurrence of the osteosarcopenic obese phenotype. This multifaced deleterious scenario is strongly correlated with an increasing risk of fragility fractures, falls, functional and metabolic decline, all of which contribute to higher morbidity and mortality. Early diagnosis and screening with individualized criteria, targeted and personalized strategies for supplementation, and structured follow-up monitoring are required to reduce the clinically significant impact of vitamin D deficiency in this highly vulnerable population.

Over the past year, three new key guidelines have been published in the area of female hypogonadism, one from the Society for Endocrinology covering the full spectrum of causes of female hypogonadism in adult life, which will form the core of this review; another solely covering premature ovarian insufficiency from a consortium comprising the International Menopause Society (IMS), the European Society of Human Reproduction & Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) that updates the 2016 ESHRE guidance, and a third covering Turner syndrome across all stages of life from the International Turner Syndrome Consensus Group. In this review, we aim to synthesize the key elements from all of these documents, providing a timely update for clinicians managing affected women.

The separation of the interior from the exterior environment through the skin was fundamental for the evolutionary progression from prevertebrates into vertebrates. The development of the skin also established an internal environment controlled by hormones. The skin is influenced by different hormones; it is also the largest endocrine organ, producing several hormones. Skin inspections often save lives from skin cancer but can also diagnose potentially deadly endocrine diseases. The objectives of this review were to describe the emergence and definition of dermatoendocrinology and to focus on the clinical diagnosis of cutaneous manifestations of endocrine disorders, some of which are potentially fatal. This narrative review was based on a comprehensive search using the term "dermatoendocrinology" since its creation in 2001 in the PubMed® database. Subsequently, a complementary search was performed with combinations of the keywords "skin", "insulin", "diabetes", "thyroid", "adrenal", "sex hormones", "parathyroid hormone", and "growth hormone." A total of 111 articles were included. The cutaneous manifestations of Itabaianinha syndrome (isolated growth hormone deficiency) and five anecdotal cases that enabled life-saving therapeutic measures are reported. The dermatoendocrine conditions described include acanthosis nigricans and androgenetic alopecia (insulin resistance), necrobiosis lipoidica diabeticorum and granuloma annulare (diabetes), pretibial myxedema (hyperthyroidism), xerosis cutis (hypothyroidism), purple striae and facial plethora (hypercortisolism), hyperpigmentation (primary adrenal insufficiency), dryness and urogenital atrophy (hypoestrogenism), hirsutism and virilization (hyperandrogenism), pruritus and calcium deposition (hyperparathyroidism), thinness, wrinkling, and reduced sweating (growth hormone deficiency), and thick oily skin with excessive sweating (acromegaly). Skin inspection allows the diagnosis of serious endocrinopathies.

The recently proposed cardio-kidney-metabolic (CKM) framework underscores the interconnected nature of cardiovascular, renal, and metabolic diseases and represents an important step toward preventive, integrated care. However, its application in kidney care remains limited and dependent on additional supportive evidence. Chronic kidney disease (CKD) is often underrecognized in cardiovascular risk models and receives delayed attention within the CKM pathway. Nephrologists face unique challenges - including workforce shortages, late referrals, and fragmented care systems - particularly in lowand middleincome countries. Early detection is further hindered by the lack of CKD-specific risk assessment tools and limited access to essential diagnostics and therapies. Real-world data from global and national studies highlight substantial implementation gaps, suboptimal outcomes, and the heavy economic burden of delayed CKD management. Importantly, as emphasized by the American Heart Association, implementation of the CKM approach is still under construction and must remain data-driven, ensuring that strategies are grounded in robust evidence. This review offers a nephrology-oriented perspective on the CKM framework, emphasizing the bidirectional relationship between CKD and other CKM components, the prognostic implications of delayed diagnosis, and the need for improved multidisciplinary coordination.

Diabetic autonomic neuropathy (DAN) is a serious and often under-recognized complication of diabetes that can affect any division of the autonomic nervous system (ANS), presenting with a wide range of signs and symptoms. The pathophysiology of DAN involves a complex interplay of hyperglycemia-driven metabolic and vascular pathways, oxidative stress, inflammation, and autonomic imbalance, ultimately leading to progressive nerve dysfunction. Cardiovascular autonomic neuropathy (CAN) has emerged as a particularly severe condition, associated with heightened risk of arrhythmia, silent myocardial ischemia, heart failure, and mortality. DAN, however, extends beyond the cardiovascular system, encompassing gastrointestinal (GI), genitourinary (GU), and sudomotor dysfunctions, that strongly impair quality of life. Despite its impact, DAN remains largely overlooked in clinical practice due to its subclinical onset, non-specific symptoms, and limited routine screening. This review integrates basic, epidemiological, and clinical data to provide a practical understanding of DAN with the aim of helping clinicians to suspect, investigate and manage DAN, with particular attention to its cardiovascular (CV), GI, and GU manifestations.

Substantial evidence highlights the pervasive nature of weight stigma, reported by people of all ages and backgrounds. Weight stigma is experienced across the life course and in many settings across society. These harmful experiences may include verbal and physical behaviours, with long-lasting effects on mental and physical health. They may also impact the patient-practitioner when weight stigma is experienced in a healthcare setting, as well as reducing health seeking behaviour and avoidance of healthcare. It is therefore essential that weight stigma in healthcare is addressed given the important implications of these experiences in this setting, Interventions need to be longer term and given the widespread nature of weight stigma, change is needed throughout society from policy to practice. Thus, a whole system approach to weight stigma is needed to address the entrenched and often robust nature of weight stigma attitudes.