Archives of Endocrinology Metabolism最新文献

Objective: To evaluate the effect of diabetes mellitus and its chronic complications on thiol/disulfide homeostasis.

Methods: The study included 381 participants divided into six groups: healthy controls (Group 1; n = 91), patients with prediabetes (Group 2; n = 50), patients with diabetes mellitus without complications (Group 3; n = 70), patients with diabetic retinopathy (Group 4; n = 47), patients with diabetic nephropathy (Group 5; n = 70), and patients with diabetic foot (Group 6; n = 53). Thiol/disulfide homeostasis was determined by measuring the reduction reaction of oxidized thiols.

Results: Native thiol levels were low in patients with diabetes mellitus complications (Group 4, 264.7 ± 58.5 µmol/L; Group 5, 246.6 ± 67.5 µmol/L; Group 6, 174.3 ± 65.9 µmol/L), as were total thiol levels. The highest and lowest disulfide levels were observed in Group 1 (controls; 20.4 ± 5.2 µmol/L) and Group 6 (16.2 ± 5.7 µmol/L), respectively. The disulfide/native thiol ratio was increased in Groups 4, 5, and 6 compared with Groups 1, 2, and 3.

Conclusion: The presence of diabetes mellitus complications substantially decreased native thiol, total thiol, and disulfide levels.

Objective: To investigate the association of copeptin levels in the postpartum period with previous gestational diabetes mellitus, as well as its cardiometabolic phenotypes and biomarkers.

Methods: In this cross-sectional analysis, women followed at a specialized gestational diabetes mellitus outpatient clinic were studied. Eligibility criteria included age ≥ 18 years and body mass index > 25 kg/m2. Participants were divided into two groups: those with (n = 42) and without gestational diabetes mellitus (n = 43). In the postpartum period (2 to 6 months), between September 2018 and May 2020, blood samples were collected for measurement of copeptin and E-selectin (by enzyme-linked immunosorbent assay), adiponectin, blood glucose, insulin, glycated hemoglobin, lipid profile, thyroid stimulating hormone, and gamma-GT.

Results: Eighty-five women were studied; 42 had previous gestational diabetes mellitus and 43 did not. There were no significant differences in copeptin levels between women with and without previous gestational diabetes mellitus (1.48 ± 0.66 versus 1.49 ± 0.68 pmol/L; p = 0.89). No associations were observed between copeptin levels and the other studied parameters. However, a positive association was found between copeptin and E-selectin levels in both groups (Kruskal-Wallis; p = 0.007).

Conclusion: Circulating copeptin levels were not associated with previous gestational diabetes mellitus or other related phenotypes in the postpartum period. A positive association was observed between copeptin and plasma E-selectin levels in women with and without previous gestational diabetes mellitus, which warrants further investigation.

Objective: This study aimed to investigate the presence of tertiary lymphoid structures (TLSs) and tumor-infiltrating B cells within the germinal centers of TLSs in the tumor microenvironment of thyroid cancer, utilizing a morphological approach.

Materials and methods: Histological samples from patients with papillary thyroid carcinoma (PTC) (n = 112) stained with hematoxylin and eosin were examined. The presence of lymphoid neogenesis in PTC was determined based on morphological features and classified according to TLS location and maturation status. Immunofluorescence staining was performed on selected cases to identify B cells within mature TLSs. Additionally, 499 scanned slides from the PTC cohort in The Cancer Genome Atlas - Thyroid Carcinoma (TCGA-THCA) dataset were accessed via cBioPortal to assess the presence of TLSs and compare the clinical and molecular characteristics of PTC cases with and without TLSs.

Results: Tertiary lymphoid structures, resembling ectopic lymph nodes, were identified in 41% (46/112) of the histological PTC samples. Among these, 63% (29/46) were located in peritumoral regions, while 13% (6/46) were found within the intratumoral area. Mature TLSs containing germinal centers, in which B cells were detected, were observed in 15% (7/46) of cases. Immature TLSs were detected in 52% (24/46) of PTC cases with TLSs. Analysis of PTC scanned images from cBioPortal revealed TLSs in 8.4% of cases, of which 62% harbored the BRAFV600E mutation, along with upregulation of immune cell markers and SLC5A5 (NIS) expression.

Conclusion: The identification of TLSs across multiple malignancies underscores their functional significance in modulating tumor-immune interactions with clinical implications. Therefore, the identification and morphological characterization of TLSs in PTC may provide valuable insights into their potential as immunobiomarkers in thyroid cancer.

Objective: To develop a practical and cost-effective test to distinguish patients with malignant thyroid nodules eligible for active surveillance from those requiring immediate surgery.

Methods: This prospective observational study included patients with malignant thyroid nodules (3 to 15 mm) who were assigned to either an Active Surveillance Group (n = 30) or a Surgery Group (n = 21) based on the institutional protocol. The Surgery Group was further stratified according to the American Thyroid Association risk of recurrence/persistence. Preoperative serum levels of miR-146b-5p and miR-204, normalized to miR-16, were analyzed. Receiver operating characteristic curves were used to establish cut-off values to differentiate between low and intermediate/high risk of recurrence/persistence, which were subsequently applied to the Active Surveillance Group.

Results: Patients were initially assigned to the active surveillance (n = 30; 53.5 ± 12.6 years old) or Surgery Group (n = 21; 41.9 ± 7.9 years old). The mean follow-up duration for the Active Surveillance Group was 36.4 ± 25.8 months, during which no patients experienced disease progression. Five patients in the Active Surveillance Group were subsequently transitioned to the Surgery Group. Molecular analysis of the Surgery Group indicated that upregulation of miR-146b-5p/miR-16 and downregulation of miR-204/miR-16 were significantly associated with intermediate/high risk of recurrence/persistence (p = 0.005 and 0.006, respectively). Downregulation of miR-204/miR-16 demonstrated a sensitivity of 75% and a negative predictive value of 86.7%. The combination of upregulation of miR-146b-5p/miR-16 and downregulation of miR-204/miR-16 yielded both a specificity and negative predictive value of 100%.

Conclusion: Decision-making for patients with low-risk papillary thyroid carcinoma regarding eligibility for active surveillance can be facilitated through serum analysis of miR-204/miR-16 expression, which may be used as a rule-out test. In contrast, combined analysis of miR-146b-5p/miR-16 and miR-204/miR-16 can serve as a rule-in test.

Objective: To investigate the impact of laparoscopic sleeve gastrectomy (SG) on plasma metabolites in obese patients with type 2 diabetes mellitus (T2DM) and identify key metabolites associated with weight loss. Subjects and.

Methods: Nineteen obese T2DM patients who underwent SG surgery were selected as the study participants. Preoperative and postoperative plasma samples and clinical data were collected. High-performance liquid chromatography-mass spectrometry (LC-MS/MS) was used to detect plasma metabolites, and changes in the levels of metabolites before and after surgery were analysed and compared.

Results: After the surgery, metabolic indicators such as body weight, BMI, fasting blood glucose, and glycated haemoglobin significantly decreased. Metabolomic analysis revealed 85 metabolites with differential abundance, among which the levels of 50 metabolites (such as homocysteine and oleic acid) significantly increased after the surgery, and the levels of 35 metabolites (such as corticosterone and glutamic acid) significantly decreased. The changes in the abundance of these metabolites were closely related to surgical weight loss and improvements in glycolipid metabolism.

Conclusion: Laparoscopic sleeve gastrectomy effectively improves glycolipid metabolism in obese patients with T2DM by affecting the levels of specific metabolites. Metabolites such as homocysteine and chenodeoxycholic acid can serve as potential markers for assessing surgical efficacy. This study provides an important basis for developing a deeper understanding of the metabolic mechanisms of SG surgery and can aid clinicians in evaluating surgical outcomes and the prognosis of this surgery in patients.

Objective: Population-based data on the surgical treatment of adrenal diseases in Brazil remain limited. Therefore, this retrospective cohort study aimed to characterize patients treated within the Brazilian public health system who underwent adrenalectomy over the past 15 years.

Materials and methods: Records of adrenalectomies from the Sistema Único de Saúde (Datasus) database were analyzed from January 2008 to December 2022. Descriptive demographic information was evaluated using incidence rates. Clinical, therapeutic, and mortality data were compared according to hospital procedure volume stratification.

Results: Over the study period, there was a 49.6% increase in procedures, totaling 6,771 adrenalectomies, with high-volume hospitals performing 62.3% of the cases. Most patients were female (65.5%), white (52%), and had a median age of 48 years. Oncological adrenalectomies increased by 154%, particularly in the southern region of Brazil. Although an overall reduction in in-hospital mortality rates was observed, a higher risk persisted in low-volume centers for both oncological (OR: 2.75; 95% CI: 1.53-4.93; p < 0.01) and non-oncological surgeries (OR: 6.60; 95% CI: 3.98-10.96; p < 0.01).

Conclusion: Given the increasing number of adrenalectomies performed within the Brazilian public health system and the likely continuation of this trend, health policies should prioritize referral to high-volume centers equipped with advanced techniques and appropriate infrastructure.

Objective: To evaluate the factors associated with knowledge of diabetic ketoacidosis among individuals with type 1 diabetes mellitus and to analyze how sociodemographic, clinical, and healthcare access variables influence understanding of the condition's prevention and management.

Methods: This cross-sectional study was conducted with 465 individuals with type 1 diabetes mellitus via an online questionnaire. The instrument included sociodemographic and clinical variables and a 13-item test assessing participant's knowledge of diabetic ketoacidosis. Data analysis employed the Kruskal-Wallis test and the Dwass-Steel-Critchlow-Fligner multiple comparisons to identify variability scores.

Results: The median score was 6.0 (on a scale of zero to 13). The lowest accuracy rates were observed regarding ketonemia thresholds (18.5%) and specific warning signs of diabetic ketoacidosis (26.0%). Participants with prior knowledge of diabetic ketoacidosis scored higher (median 6) than those unfamiliar with the term (median 2). Individuals with glycated hemoglobin levels between 4 and 6% achieved higher scores (median = 6), as did those who received medical guidance (median = 6) compared to those who did not (median = 3). The use of an artificial pancreas was associated with the highest scores.

Conclusion: Prior knowledge of diabetic ketoacidosis, access to insulin pumps, medical guidance, and better glycemic control were associated with a greater understanding of diabetic ketoacidosis. These findings reinforce the need for educational interventions and equitable access to healthcare technologies to improve disease management and reduce diabetic ketoacidosis-related complications.

Primaryhyperparathyroidism (PHPT) is a disorder of mineral metabolism caused by inappropriate or excessive secretion of parathyroid hormone. It occurs sporadically in approximately 95% of cases but may also be associated with complex syndromes and/or a familial (i.e., hereditary) history. We report the clinical, laboratory, and genetic profiles of a case series with familial isolated hyperparathyroidism. Diagnosis was established in patients aged 22-41 years (median = 32), and recurrence was identified in four patients (three with adenoma and one with hyperplasia and parathyroid carcinoma). Six family members presented with a heterozygous mutation in the CDC73 gene, and one patient had a copy number variation of undetermined clinical significance in the same gene. In addition, we review the particularities of each condition associated with PHPT, indications for genetic evaluation, and recommendations for follow-up and treatment.

Background: A U-shaped relationship exists between maternal urinary iodine concentration (UIC) and the risk of thyroid dysfunction, adverse pregnancy outcomes, and neurological deficits in offspring. Both iodine deficiency and excess should be avoided during pregnancy. The WHO recommends increased iodine intake during pregnancy due to elevated thyroid hormone production and fetal iodine transfer. In countries with universal salt iodization, additional supplementation is generally not advised, although iodization alone may be insufficient. In Brazil, salt iodization has reduced iodine deficiency disorders, but in 2013, regulatory agencies lowered iodine levels in salt due to high population-wide salt intake. Without national surveys, it remains unclear whether current iodine levels in table salt are sufficient for pregnant women.

Materials and methods: The clinical questions addressed in this document were derived from stakeholder feedback and input from panel members. The group synthesized the available knowledge on this topic by conducting electronic database searches, reviewing and selecting relevant citations, and critically appraising selected studies.

Results: The group recommends exclusive use of regulated iodized salt during pregnancy. Iodine supplementation should be individualized for at-risk pregnant women, including those with chronic gastrointestinal disorders, restricted diets, or malabsorption conditions. Excess iodine intake should be avoided. In alignment with public policies under PNAISAL, health education on appropriate salt use and storage should be reinforced in primary care. Urinary iodine tests should be used for population-level assessment only.

Conclusion: These recommendations aim to support clinical decision-making regarding iodine supplementation during pregnancy in Brazil, thereby improving maternal and fetal health outcomes.

Objective: To evaluate the putative association of age and insulin resistance with sex hormone-binding globulin levels in healthy men.

Methods: In total, 136 healthy men without obesity, aged 18 years or older, were included. Total testosterone was measured by electrochemiluminescence, and sex hormone-binding globulin by chemiluminescence. Calculated free testosterone was obtained by Vermeulen's equation. Insulin resistance index was estimated as triglycerides/HDL ratio.

Results: The sample was divided into tertiles according to age (18 to 29; 30 to 49; 50 to 67 years). Sex hormone-binding globulin levels were higher in men > 50 years old compared to those of the second and first tertiles (41 ± 17 versus 35 ± 12 and 29 ± 9 nmol/L; p < 0.001), while values of calculated free testosterone were lower in the older tertile (7.7 ± 1.9 versus 8.8 ± 2.2 and 10.4 ±3.1 ng/dL; p < 0.001). Age did not influence total testosterone levels. Insulin resistance index was inversely and significantly correlated with sex hormone-binding globulin (r = -0.371; p < 0.001).

Conclusion: There is a significant increase in serum sex hormone-binding globulin in older healthy men, highlighting the need for age-specific reference values. Furthermore, insulin resistance seems to reduce this globulin levels, perhaps pointing out low sex hormone-binding globulin as a putative predictor of related chronic diseases.