Archives of Endocrinology Metabolism最新文献

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.

Objective: This study investigated the clinical value of ultrasound-guided fine-needle aspiration biopsy (US-FNAB), computed tomography (CT) and BRAFV600E combination for papillary thyroid carcinoma (PTC) diagnosis.

Subjects and methods: A total of 300 patients with thyroid nodules were assigned to the PTC group (n = 184) and the nodular goiter (NG) group (n = 116). The positive detection rates of US-FNAB, CT and BRAFV600E gene mutation and their relationship with tumor number, tumor diameter, lymphatic metastasis, capsule invasion and tumor-node-metastasis (TNM) staging were analyzed, with their diagnostic value for PTC analyzed by the receiver operating characteristic (ROC) curve. The area under multiple ROC curves (AUCs) were compared using MEDCALC software.

Results: The positive detection rates of US-FNAB, CT and BRAFV600E gene mutation were 78.80%, 72.28% and 83.15% in the PTC group, and 30.17%, 27.59% and 9.48% in the NG group, while the negative detection rates were 21.20%, 27.72% and 16.85% in the PTC group, and 69.82%, 72.41% and 90.52% in the NG group. Positive US-FNAB and BRAFV600E gene mutation in PTC patients related to TNM staging. Positive CT and BRAFV600E gene mutation linked to lymphatic metastasis. US-FNAB (AUC: 0.743, sensitivity: 78.80%, specificity: 69.83%), CT (AUC: 0.723, sensitivity: 77.28%, specificity: 72.41%) and BRAFV600E (AUC: 0.868, sensitivity: 83.15%, specificity: 90.52%) gene detections helped PTC diagnosis, with their combined diagnostic value (AUC: 0.938, sensitivity: 78.26%, specificity: 96.55%) surpassing that of them alone.

Conclusion: US-FNAB, CT and BRAFV600E gene tests helped PTC diagnosis, and their combined detection had higher diagnostic value for PTC than their single detection.

Introduction: Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder that affects approximately 1 to 10 individuals per million and is caused by variants in the genes encoding for the lipoprotein lipase (LPL) enzyme. In addition to its heterogeneous clinical presentation, FCS is characterized by a higher risk of life-threatening, recurrent acute pancreatitis and type 3 diabetes. Since available evidence on FCS in Latin America is limited, there is a clear need for a consensus document that provides relevant recommendations to guide the management of suspected cases and optimize disease diagnosis across the region.

Methods: A panel of specialists from Latin America with extensive experience in the diagnosis of chylomicronemia was invited to participate in the creation of this document. The modified Delphi technique was used to reach group consensus through multiple rounds of questionnaires using statistical techniques and controlled feedback. Results and discussion: Seventeen recommendations on diagnosis of FCS were generated. This consensus reflects the collaborative efforts of Latin American scientific societies and is essential to suspect and diagnose FCS. The organizations that support this document, including Sociedad Argentina de Lípidos, Federación Argentina de Sociedades de Endocrinología, Fundación Bioquímica Argentina, Corporación Grupo Chileno de Trabajo en Ateroesclerosis, Asociación Colombiana de Endocrinología, Diabetes y Metabolismo, Departamento de Aterosclerose da Sociedade Brasileira de Cardiología, and Sociedad Mexicana de Nutrición y Endocrinología, are a robust support network that might aid the adoption of these recommendations in local healthcare systems.

Objective: To investigate the Mitochondrial Open Reading Frame of the 12S rRNA type-c (MOTS-c) peptide levels in individuals with obesity compared to those with a normal body mass index and to examine the association of MOTS-c levels with markers of insulin resistance, endothelial function, and inflammation.

Methods: In this study 85 individuals were enrolled, including 48 with a body mass index ≥ 30 kg/m2 and 37 with a body mass index between 18.5 and 24.9 kg/m2. Individuals with smoking, pregnancy, type 2 diabetes mellitus and other chronic conditions were excluded. Blood samples were collected after at least 8 hours of fasting to measure serum MOTS-c, insulin, high-sensitivity C-reactive protein, and asymmetric dimethylarginine levels. Statistical analyses included t-tests, Mann-Whitney U tests, Chi-squared tests, correlation analyses, and multiple regression analyses.

Results: We found no significant difference in serum MOTS-c levels between individuals with obesity and those with normal body mass index (14.33 ± 3.76 pg/mL versus 13.67 ± 3.44 pg/mL; p = 0.395). Serum MOTS-c levels showed a significant positive correlation with the HOMA-IR index (p < 0.05) but did not correlate with high-sensitivity C-reactive protein or asymmetric dimethylarginine levels. Multiple regression analysis indicated that age and HOMA-IR were significant predictors of MOTS-c levels, with MOTS-c decreasing with age and increasing with higher insulin resistance.

Conclusion: Serum MOTS-c levels were similar in individuals with obesity and those with normal weight. The study highlighted age and insulin resistance as significant determinants of MOTS-c levels.

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.