Archives of Endocrinology Metabolism最新文献

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.

Objective: To explore the impact of obesity on social phobia and the therapeutic effect of the antioxidant glutathione on this disorder.

Methods: A total of 600 subjects were divided into an Obese Group and a Control Group. Four scales were utilized to determine social phobia, and magnetic resonance spectroscopy was applied to evaluate the central glutathione levels. Multivariate logistic regression was used for analysis. A mouse obesity model was subsequently established using a high-fat diet. Agonists or inhibitors were used to upregulate or downregulate hippocampal glutathione. The social interaction test was used to evaluate the social phobia of the mice, and the ELISA method was used to measure the levels of oxidative stress indicators in the hippocampus. Anova was used for analysis.

Results: Compared with the control subjects, obese subjects had higher social phobia scores. A higher central glutathione level was associated with a lower social phobia score. In the animal experiments, obese mice exhibited more social phobia behaviours. When the glutathione level in the hippocampus was increased and decreased, the oxidative stress level in the hippocampus of the mice decreased and increased accordingly, whereas social phobia behaviours were alleviated and exacerbated, respectively.

Conclusion: Obesity may induce social phobia. However, the antioxidant glutathione attenuates the central oxidative stress response and alleviates obesity-related social phobia.

Objective: To investigate the role of PON1 in diabetic nephropathy and elucidate the underlying mechanisms using a cellular model.

Materials and methods: A diabetic nephropathy model was established using high glucose-induced HK-2 cells. Potential target genes and signaling pathways were identified through bioinformatics databases, and PON1 expression was manipulated to interfere with these pathways. The effects of different treatments on cell conditions were systematically evaluated.

Results: PON1, the targeted gene in diabetic nephropathy, was significantly downregulated in high glucose-induced cells. The PPARγ signaling pathway was identified as closely associated with PON1, with both PPARα and PPARγ emerging as key regulators within this pathway. We observed significant increases in lactate dehydrogenase activity, malondialdehyde levels, and cell apoptosis, along with notable decreases in superoxide dismutase levels, cell viability, and cell proliferation, in the high glucose-treated group. Additionally, the expression levels of PPARα and PPARγ were also decreased. Overexpression of PON1 (pc-PON1) in the high glucose group mitigated these effects, whereas treatment with the PPARγ antagonist GW9662 reversed the protective changes induced by pc-PON1.

Conclusion: Elevated PON1 levels mitigated oxidative stress and inhibited cell death, thereby promoting cell growth and alleviating diabetic nephropathy through activation of the PPARγ signaling pathway.

Objective: To investigate the practices of Brazilian endocrinologists in educating patients with adrenal insufficiency about stress-induced glucocorticoid adjustments.

Methods: This was a cross-sectional online survey carried out with 280 endocrinologists across Brazil. The survey included demographic questions and ten clinical vignettes assessing knowledge of appropriate glucocorticoid adjustments during various stressful situations. All participants provided informed consent, and the study protocol was approved by the local Ethics Committee. Statistical analysis compared responses based on physician demographics and practice settings.

Results: The mean percentage of correct answers was 63.3%. A significant proportion of respondents (41.1%) incorrectly believed that patients should not self-administer intramuscular hydrocortisone during an adrenal crisis. Older physicians tended to provide more conservative (and potentially harmful) glucocorticoid dosing recommendations in certain scenarios. Physicians working in both outpatient and hospital settings demonstrated better knowledge of patient education and emergency glucocorticoid administration.

Conclusion: The results of this study revealed moderate adherence to guidelines among Brazilian endocrinologists regarding adrenal insufficiency management and patient education. There is a need for improved education on glucocorticoid self-administration and targeted interventions to address knowledge gaps across different clinical scenarios. Further research is needed to evaluate the impact of these findings on patient outcomes and develop strategies to optimize the management of adrenal insufficiency in Brazil.

Objective: Graves' disease (GD) is the leading cause of hyperthyroidism globally, with 40% of affected individuals developing thyroid eye disease (TED). Treatment options for TED have advanced in recent years. This study aimed to investigate the prevalence of TED at a single center in Brazil, contributing more robust data for cost-analysis studies assessing the financial implications of novel TED treatments. Subjects and.

Methods: This study evaluated the clinical histories of 660 patients diagnosed with GD from 1999 to 2019. The patients were categorized into four groups based on the presence and severity of TED.

Results: The prevalence of TED within the study population, categorized according to severity, was as follows: absent (n = 325; 49%), mild (n = 221; 33%), moderate to severe (n = 107; 16%), and sight-threatening (n = 7; 1%). A significant correlation was observed between older age at diagnosis, smoking, larger goiters, and the presence and severity of TED.

Conclusion: The prevalence of TED identified in this single-center study contributes valuable insights for the design of cost-analysis studies and the assessment of the financial implications of novel treatments for TED within both the public and private healthcare systems in Brazil.

Objective: To identify factors potentially associated with radioiodine-refractory disease among patients treated for differentiated thyroid carcinoma at a referral center in Northeastern Brazil.

Methods: A total of 554 medical records of patients with differentiated thyroid carcinoma treated between January 2010 and August 2024 were evaluated. Radioiodine-refractory disease tumors were detected in 44 (7.9%) patients. Clinical, laboratory, and radiological data were compared between the radioiodine-refractory disease and non-radioiodine-refractory disease groups to determine factors associated with poor differentiated thyroid carcinoma outcomes.

Results: Factors most strongly associated with progression to radioiodine-refractory disease included older age, increased number of surgeries performed, aggressive histological subtypes, larger tumor size, vascular invasion, extrathyroidal extension, compromised margins, lymph node metastasis, distant metastasis at diagnosis and during follow-up, higher malignant tumor classification staging, high risk of recurrence, high thyroglobulin levels prior to radioiodine therapy, higher doses and greater number of radioiodine therapy doses, and higher frequency of incomplete responses within the first year post-treatment.

Conclusion: Identifying possible factors associated with radioiodine-refractory disease development may allow early diagnosis and a more effective treatment.