Archives of Endocrinology Metabolism最新文献

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, affects approximately 38% of the global population. MASLD's strong association with obesity and type 2 diabetes positions it as an increasingly prevalent indication for liver transplantation. Hence, this study sought to assess the prevalence of MASLD as an indication for liver transplantation, to characterize the clinical and epidemiological profile of the affected population, and to investigate the rates of post-transplant recurrence and de novo occurrence. We also compared survival outcomes between recipients with MASLD and other etiologies. Materials and methods: We conducted a retrospective analysis of 610 patients listed for liver transplantation at Hospital das Clínicas (University of São Paulo) between 2005 and 2015. Data regarding demographics, comorbidities, and post-transplant outcomes were collected from medical records. The statistical analysis encompassed both descriptive and inferential methods. Results: Out of 610 patients, 61 (10%) were diagnosed with MASLD-related cirrhosis, presenting a waitlist mortality rate of 42.6%. Among the 264 who received transplants, 36 (13.6%) had MASLD as the primary diagnosis. Post-transplantation, 58 recipients developed steatosis, with 82.8% of these cases being de novo allograft steatosis. Pre-transplant obesity and hypertension were identified as significant risk factors. Importantly, patients undergoing transplantation for MASLD showed lower survival rates compared to those with other etiologies. Conclusion: MASLD patients who undergo liver transplantation exhibit distinctive clinical outcomes and reduced survival rates. These findings underscore the critical need for targeted risk assessments and developing long-term strategies to enhance the prognosis for this increasingly common patient demographic.

Objective: To evaluate muscle functionality, physical performance and body composition in young people living with human immunodeficiency virus (PLWH).

Subjects and methods: Eighty-one HIV-infected and 54 uninfected (20 to 50 years) male and female subjects were enrolled to participate. Patient evaluation included body composition by DXA (dual energy X-rays), SARC-F questionnaire, hand grip and timed up & go (TUG) tests.

Results: Fifty PLWH and 50 age-gender matched controls completed the study. The median age was 40 (25-49) vs. 36.5 (22-50) for the HIV and control groups, respectively (p 0.120). Race, gender, body mass index, phosphorus and 25-hydroxyvitamin D were similar between groups. HDL-c was significantly lower in HIV-infected (p 0.006). Groups had similar body composition parameters, although more PLWH presented appendicular lean mass (ALM) and ALM adjusted to height (ALM/h2) below reference values (18% vs 4%). SARC-F questionnaire and TUG were significantly compromised in HIV-infected when compared to controls (p 0.001 and 0.005, respectively). Hand grip test was slightly lower in PLWH than in control group (29.0 kg (9.3-56.0) vs. 32.8 kg (13.3-57.3); p 0.052).

Conclusion: Our results suggest that there is loss of functionality, physical performance and muscle strength in young PLWH. Therefore, screening using SARC-F, hand grip and TUG test might be interesting in HIV-infected which are considered at high-risk for sarcopenia. With early diagnosis there is the possibility of decreasing muscle dysfunction, morbimortality, providing an increase in quality of life and working hours.

Objective: This study aimed to evaluate the efficacy and safety of selective estrogen receptor modulators (SERMs), specifically clomiphene and enclomiphene, in treating men with functional hypogonadism.

Materials and methods: A systematic search was conducted in PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov for randomized controlled trials comparing SERMs with placebo, testosterone (T) gel, or human chorionic gonadotropin (hCG), up to July 2024. The primary endpoints were total testosterone (TT), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Weighted mean differences (MDs) and risk ratios (RRs) were calculated for continuous and binary endpoints, respectively, with 95% confidence intervals (CIs).

Results: SERM therapy significantly improved TT (MD: 273.76 ng/dL; 95% CI: 191.87-355.66 ng/dL; p < 0.01; I2 = 89%), LH (MD: 4.66 IU/L; 95% CI: 3.37-5.94 IU/L; p < 0.01; I2 = 55%), and FSH (MD: 4.59 IU/L; 95% CI: 2.88-6.30 IU/L; p < 0.01; I2 = 68%) compared to placebo. No significant difference in TT was observed between the SERM and T gel groups. TT levels were significantly higher with SERM therapy and the combined treatment of SERM and hCG compared to hCG alone (158 vs. 153 vs. 134 ng/dL, respectively; p < 0.002 for both comparisons).

Conclusion: SERM therapy is associated with significantly improved levels of TT, LH, and FSH in hypogonadal men compared to placebo, and significantly enhanced levels of LH and FSH compared to T gel. The findings suggest that SERM therapy effectively increases TT levels in men with functional hypogonadism and should be considered as an alternative to T gel therapy.

Objective: The current study was conducted to investigate whether thyroid-stimulating hormone (TSH) and thyroid hormone sensitivity are associated with hyperuricemia probability in euthyroid population.

Materials and methods: The observational analysis was based on a Chinese community-based cohort (n = 1,972). The prospective associations of TSH levels, TSH index (TSHI), thyrotrophic thyroxine resistance index (TT4RI), thyroid feedback quantile-based index (TFQI) and free triiodothyronine to free thyroxine (FT3/FT4) ratio with the risk of hyperuricemia were examined. Two-sample Mendelian randomization (MR) analysis was then used to test the causal effects of TSH on serum uric acid (SUA) levels and gout.

Results: Among 1,972 participants with normal thyroid function, 244 new hyperuricemia cases were identified during follow-up. The results suggested that the higher levels of TSH (HR = 1.87, 95% CI: 1.28-2.73, p-value < 0.01), TSHI (HR = 2.02, 95% CI: 1.38-2.95, p-value < 0.01), TFQI (HR = 1.92, 95% CI: 1.33-2.76, p-value < 0.01) and TT4RI (HR = 1.93, 95% CI: 1.34-2.80, p-value < 0.01) were significantly associated with hyperuricemia incidence. The MR results further indicated causal effects of TSH on SUA levels (inverse variance weighting [IVW] β = 0.037, 95% CI: 0.017-0.057) and gout (IVW OR = 1.0018, 95% CI: 1.0004-1.0032).

Conclusion: The higher levels of TSH, TSHI, TFQI and TT4RI are significantly associated with the risk of hyperuricemia in euthyroid population. The MR analysis supports the causal effects of TSH on SUA levels and gout.

Objective: To identify cytologic characteristics in a suspicious for malignancy cohort that may help to recognize false positives in cytopathological tests of thyroid nodules in a "real world scenario", with histopathological reports as the gold standard.

Methods: Cytomorphologic features of suspicious for malignancy thyroid nodules in a 13-year retrospective database were reviewed. Therefore, we identified false positive cases, analyzed the possible causes of cytopathological diagnostic failure and calculated the frequency of false positive results and the risk of malignancy in the suspicious for malignancy cohort.

Results: Among the 289 suspicious for malignancy type nodules, 283 were malignant, 5 were benign, and 1 was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The most frequently reported cytology features were nuclear grooves and pseudoinclusions; however, they were present in malignant and benign specimens. Statistical analysis revealed that the presence of micronucleoli (p < 0.001) and/or irregular/oval nuclei (p = 0.05) were the characteristics most strongly associated with malignancy. The risk of malignancy was 98% in this study.

Conclusion: The presence of micronucleoli and nuclear irregularity was highly predictive of malignancy according to suspicious for malignancy cytology and were not present in false positive patients. Hence, careful examination of nuclear characteristics can be helpful for identifying true malignancies via suspicious for malignancy cytology. This was significant even when only a qualitative analysis was taken into account.

Objective: To determine the prevalence of protective sensory loss in patients with diabetes mellitus at a university hospital and to identify clinical and sociodemographic factors associated with this condition.

Methods: This cross-sectional study was conducted with diabetic patients attending specialized outpatient clinics. Data were collected through patient interviews and medical record reviews, in conjunction with using the monofilament test to assess protective sensory loss in the feet. Statistical analyses included descriptive and exploratory tests, as well as bivariate and multivariate analyses to identify factors associated with sensory loss (p < 0.05).

Results: A total of 184 patients were interviewed, but only 169 were included in the primary outcome analyses. The median age was 61 years, with the majority being female (72%), self-identifying as mixed-race (54%), and diagnosed with type 2 diabetes mellitus (87%). The prevalence of protective sensory loss was 20%. Factors such as a longer duration of diabetes mellitus (95%CI 1.01-1.09; p = 0.022), the presence of target organ damage (95%CI 1.25-6.84; p = 0.015), and increased body weight (OR = 1.04; 95%CI 1.01-1.07; p = 0.007) were significantly associated with sensory loss. Although systemic arterial hypertension was initially associated in the bivariate analysis, it did not remain an independent predictor.

Conclusion: The significant prevalence of protective sensory loss and the lack of awareness about the monofilament test among many patients emphasize the need to expand neuropathy screening and health education in diabetes management.