Medicine (Abingdon, England : UK ed.)最新文献

英文中文

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.003

Mohammed Abdel-Magid, Faisal Hasan

Adrenal adenomas are benign tumours of the adrenal cortex. Their incidence increases with age, reaching 10% in elderly individuals. They can be either functional (hormonally active) or non-functional. Non-functioning adenomas may not produce clinical symptoms or signs and can remain asymptomatic until discovered during imaging. Functional adrenal adenomas can produce excess glucocorticoids (resulting in Cushing's syndrome or mild autonomous cortisol secretion (MACS)), mineralocorticoids (resulting in hypertension and/or hypokalaemia) or androgens (usually symptomatic in female patients), although the latter is rare in isolation. Evaluation of an adrenal adenoma requires both imaging (non-contrast computed tomography is usually recommended, except in certain circumstances where magnetic resonance imaging might be more suitable) and hormonal work-up. Hormonal tests include a 1 mg overnight dexamethasone suppression test, plasma or urinary metanephrines and measurement of renin and aldosterone levels. If adrenocortical carcinoma is suspected, additional tests are needed which include measurement of sex hormones as well as steroid precursors. Adrenal adenomas are rare in childhood, and their incidence increases with age. The finding of adrenal adenoma in a child or young adult should raise the suspicion of malignancy. Small adenomas that are hormonally inactive can be followed up without immediate intervention. Adrenalectomy is the preferred treatment for hormonally active adenomas. This article reviews the evaluation and management of adrenal adenomas, including lesions found on routine imaging undertaken for other purposes (sometimes called adrenal ‘incidentalomas’).

肾上腺腺瘤是肾上腺皮质的良性肿瘤。其发病率随年龄增长而增加，在老年人中可达10%。它们可以是功能性的（激素活性的），也可以是非功能性的。无功能腺瘤可能不会产生临床症状或体征，并且在影像学检查中发现之前可以保持无症状。功能性肾上腺腺瘤可产生过量的糖皮质激素（导致库欣综合征或轻度自主皮质醇分泌（MACS））、矿化皮质激素（导致高血压和/或低钾血症）或雄激素（通常在女性患者中有症状），尽管后者在孤立情况下很少见。肾上腺腺瘤的评估需要影像学检查（通常推荐使用非对比计算机断层扫描，除非在某些情况下磁共振成像可能更合适）和激素检查。激素检查包括1毫克地塞米松夜间抑制试验，血浆或尿肾上腺素和肾素和醛固酮水平的测量。如果怀疑肾上腺皮质癌，则需要进行额外的检查，包括测量性激素和类固醇前体。肾上腺腺瘤在儿童时期是罕见的，其发病率随着年龄的增长而增加。在儿童或年轻人中发现肾上腺腺瘤应引起对恶性肿瘤的怀疑。激素不活跃的小腺瘤不需立即干预即可随访。肾上腺切除术是激素活性腺瘤的首选治疗方法。这篇文章回顾了肾上腺腺瘤的评估和治疗，包括在常规影像学检查中发现的其他目的的病变（有时称为肾上腺“偶发瘤”）。

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引用次数: 0

Endocrine manifestations of adult malignancy 成人恶性肿瘤的内分泌表现

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.013

Maria Michaelidou, Adhithya Sankar, Shaishav Dhage

Endocrine manifestations of adult malignancy are well documented in various forms including ectopic production of hormones from non-endocrine organs (paraneoplastic syndromes), direct involvement of endocrine organs causing hormone imbalance, chronic long-term endocrine effects in cancer survivors and, more commonly, endocrine organ dysfunction secondary to newer and systemic anti-cancer therapies. Interestingly, some of these manifestations can pre-date the onset of cancer or be a presenting symptom of more advanced cancers, detected incidentally. Although most of these manifestations are not serious, they are occasionally life-threatening and can cause significant delays and complications for continuing cancer therapies. Awareness of these endocrine manifestations and early treatment is a very important part of supportive treatment in cancer patients. This review provides a brief overview of common endocrine conditions associated with adult malignancies and newer systemic anti-cancer therapies, including immune checkpoint inhibitor-related endocrinopathies.

成人恶性肿瘤的内分泌表现有多种形式的文献记载，包括非内分泌器官的激素异位产生（副肿瘤综合征），直接涉及内分泌器官导致激素失衡，癌症幸存者的慢性长期内分泌影响，以及更常见的继发于更新和系统性抗癌治疗的内分泌器官功能障碍。有趣的是，其中一些表现可能早于癌症的发病，或者是偶然发现的更晚期癌症的表现症状。虽然大多数这些表现并不严重，但它们偶尔会危及生命，并可能导致持续癌症治疗的严重延误和并发症。对这些内分泌表现的认识和早期治疗是癌症患者支持治疗的重要组成部分。本文综述了与成人恶性肿瘤和较新的系统性抗癌治疗相关的常见内分泌疾病，包括免疫检查点抑制剂相关的内分泌疾病。

引用次数: 0

Endocrine effects of immunotherapy for cancer 免疫疗法对肿瘤内分泌的影响

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.009

Mark Quinn, Mamta Joshi, Paul V Carroll

Modern cancer immunotherapies have changed the way many cancers are treated. Their use is now first line in many advanced malignancies. These therapies, including immune checkpoint inhibitors (iCPIs), involve directing T cell activity against cancer cells. Adverse effects or immune-related adverse events (irAEs) are common and can affect any system. Endocrine organs are particularly vulnerable to dysfunction because of the underlying mechanism of action. Given their increasing use and rapid advances in the field it is imperative that specialists in both oncology and endocrinology keep up to date on the latest guidelines and protocols for recognizing and treating endocrine irAEs. It is essential to implement strategies that ensure minimal disruption to the anti-cancer therapy during the investigation and diagnosis of irAEs. Here we discuss the various endocrine irAEs described in the literature, focusing on those related to iCPI use. Using up-to-date data, we describe the natural history expected in these conditions. Importantly, as newer iCPI agents are introduced the rates of endocrine irAEs appear consistent.

现代癌症免疫疗法已经改变了许多癌症的治疗方式。它们现在是许多晚期恶性肿瘤的一线治疗药物。这些疗法，包括免疫检查点抑制剂（icpi），涉及引导T细胞活性对抗癌细胞。不良反应或免疫相关不良事件（irAEs）是常见的，可以影响任何系统。由于其潜在的作用机制，内分泌器官特别容易受到功能障碍的影响。鉴于该领域越来越多的应用和快速发展，肿瘤学和内分泌学的专家必须跟上最新的识别和治疗内分泌肿瘤的指南和协议。在研究和诊断癌症期间，实施确保对抗癌治疗干扰最小的策略至关重要。在这里，我们讨论文献中描述的各种内分泌干扰素，重点是那些与iCPI使用有关的干扰素。利用最新的数据，我们描述了在这些条件下预期的自然历史。重要的是，随着新的iCPI药物的引入，内分泌irae的发生率似乎一致。

引用次数: 0

Prevention and management of osteoporosis 骨质疏松症的预防和管理

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-10-01 DOI: 10.1016/j.mpmed.2025.07.012

Sarah Khan, Hamad Y Almatar, Aliya A Khan

Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing individuals to an increased fracture risk. The diagnosis of osteoporosis in postmenopausal women and men over the age of 50 is confirmed in the presence of low bone density on a bone mineral density (BMD) dual energy xray absorptiometry (DXA) study. BMD is evaluated in g/cm² and expressed as standard deviation (T-score) above or below the mean BMD in the young adult female Caucasian population. A T-score of −2.5 or lower at the lumbar spine, femoral neck, total hip or one-third radius site confirm the diagnosis of osteoporosis by DXA technology. In postmenopausal women of any age and men over age 50, osteoporosis can also be diagnosed clinically in the presence of a low trauma fracture. Fracture risk assessment, incorporating the Fracture Risk Assessment Tool (FRAX), is crucial in guiding treatment decisions. Clinical evaluation should include a detailed history, physical examination and investigations to exclude secondary causes of osteoporosis, including endocrinopathies, gastrointestinal disorders, inflammatory conditions, malignancies as well as medication-related bone loss. Management strategies include ensuring adequate calcium, phosphate and vitamin supplementation. Pharmacological interventions are offered in the presence of an increased fracture risk.

Antiresorptive therapies include bisphosphonates, denosumab and selective oestrogen receptor modulators. They reduce bone turnover and fracture risk. Anabolic agents, include teriparatide, abaloparatide and romosozumab. These molecules promote bone formation and improve bone microstructure and dramatically improve bone density while significantly reducing fracture risk. The selection of individualized treatment is based on fracture risk as well as contraindications to therapy. In those at a moderate fracture risk with a major osteoporotic fracture (MOF) risk of 10–20% over the next 10 years a bisphosphonate can be offered for 5 years followed by a possible drug holiday. If the MOF is high (≥20%) or hip fracture risk is ≥3% then denosumab can be offered. If the MOF is very high (MOF>30% or hip fracture risk >4.5%) or in the presence of fragility fracture then an anabolic agent can be considered as first line therapy).

骨质疏松症是一种骨骼疾病，其特征是骨骼强度降低，易使个体骨折风险增加。绝经后女性和50岁以上男性骨质疏松症的诊断在骨密度（BMD）双能x线吸收测定（DXA）研究中证实存在低骨密度。骨密度以g/cm2进行评估，并以高于或低于年轻成年女性高加索人群平均骨密度的标准偏差（t评分）表示。腰椎、股骨颈、全髋关节或桡骨三分之一部位的t评分为- 2.5或更低，DXA技术可确诊骨质疏松症。在任何年龄的绝经后女性和50岁以上的男性中，骨质疏松症也可以在临床上诊断为低创伤性骨折。压裂风险评估，包括压裂风险评估工具（FRAX），对于指导治疗决策至关重要。临床评估应包括详细的病史、体格检查和调查，以排除骨质疏松症的继发性原因，包括内分泌疾病、胃肠道疾病、炎症、恶性肿瘤以及药物相关的骨质流失。管理策略包括确保充足的钙、磷酸盐和维生素补充。在骨折风险增加的情况下提供药物干预。抗吸收疗法包括双膦酸盐、地诺单抗和选择性雌激素受体调节剂。它们可以减少骨转换和骨折风险。合成代谢药物包括特立帕肽、阿巴帕肽和罗莫索单抗。这些分子促进骨形成，改善骨微观结构，显著提高骨密度，同时显著降低骨折风险。个体化治疗的选择是基于骨折风险和治疗禁忌症。对于中度骨折风险且在未来10年内发生严重骨质疏松性骨折（MOF）风险为10 - 20%的患者，可以连续5年服用双膦酸盐，然后可能暂停用药。如果MOF高（≥20%）或髋部骨折风险≥3%，则可以提供denosumab。如果MOF非常高（MOF>；30%或髋部骨折风险>；4.5%）或存在脆性骨折，则可考虑使用合成代谢剂作为一线治疗。

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引用次数: 0

Pituitary hormone replacement 垂体激素替代

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.002

Maria Michaelidou, Shaishav S Dhage

Hypopituitarism is associated with increased morbidity and mortality. Hormone replacement therapies are available for the effective treatment of anterior pituitary deficiencies of growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone and follicle-stimulating hormone secretion. The posterior pituitary antidiuretic hormone can also be replaced. The aim of replacement therapy is to mimic as far as possible the normal physiology of the hormone and to avoid over-treatment. Currently available hormone preparations and their advantages and disadvantages are discussed.

垂体功能减退与发病率和死亡率增加有关。激素替代疗法可有效治疗垂体前叶生长激素、促肾上腺皮质激素、促甲状腺激素、促黄体生成素和促卵泡激素分泌不足。垂体后叶抗利尿激素也可以替代。替代疗法的目的是尽可能模仿激素的正常生理，避免过度治疗。讨论了目前可用的激素制剂及其优缺点。

引用次数: 0

Diabetes insipidus (arginine vasopressin deficiency and resistance) 尿崩症（精氨酸抗利尿素缺乏和抵抗）

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.010

Merah Al Busaidy, Mark Sherlock

Arginine vasopressin (AVP) is a critical hormone in the regulation of water balance and vascular tone. Synthesized in the hypothalamus and released from the posterior pituitary, AVP acts primarily on V2 receptors in the renal collecting ducts to promote water reabsorption via aquaporin-2 (AQP-2) channels, and on V1 receptors to mediate vasoconstriction. Disorders of AVP production or action manifest clinically as diabetes insipidus (DI), more recently termed AVP deficiency (AVP-D) and AVP resistance (AVP-R). These conditions are characterized by hypotonic polyuria and compensatory polydipsia.

Current diagnostic approaches include the water deprivation test (WDT) and hypertonic saline infusion with copeptin assessment, with increasing emphasis on the utility of copeptin as a stable and reliable biomarker for distinguishing between AVP deficiency (AVP-D), AVP resistance (AVP-R), and primary polydipsia (PP). Management of AVP-D relies on desmopressin (dDAVP), with careful titration to avoid hyponatraemia. AVP-R requires fluid management and pharmacologic interventions including thiazide diuretics and non-steroidal anti-inflammatory drugs. Additional subtypes of DI, such as gestational DI and adipsic hypernatraemia, present specific diagnostic and treatment complexities.

精氨酸加压素（AVP）是调节水分平衡和血管张力的关键激素。AVP在下丘脑合成，从垂体后叶释放，主要作用于肾集管中的V2受体，通过水通道蛋白-2 （AQP-2）通道促进水的重吸收，并作用于V1受体，介导血管收缩。AVP产生或作用障碍在临床上表现为尿囊症（DI），最近被称为AVP缺乏症（AVP- d）和AVP抵抗症（AVP- r）。这些疾病的特点是低渗性多尿和代偿性多饮。目前的诊断方法包括水剥夺试验（WDT）和高渗盐水输注与copeptin评估，越来越重视copeptin作为区分AVP缺乏症（AVP- d）、AVP抵抗（AVP- r）和原发性多饮症（PP）的稳定可靠的生物标志物的作用。AVP-D的治疗依赖于去氨加压素（dDAVP），并小心滴定以避免低钠血症。AVP-R需要液体管理和药物干预，包括噻嗪类利尿剂和非甾体抗炎药。其他DI亚型，如妊娠期DI和脂肪性高钠血症，具有特定的诊断和治疗复杂性。

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引用次数: 0

Addison's disease 阿狄森氏病

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.011

Vincent Simpson, Antonia M Brooke

Addison's disease, or primary adrenocortical failure, is rare, most commonly caused in the UK by autoimmune destruction of the adrenal glands. The insidious onset of symptoms over many months means there is often a delay in diagnosis and patients can first present in adrenal crisis, which is life-threatening if not appropriately treated. The diagnosis is made by finding a low serum cortisol at 09:00 hours in the presence of an elevated adrenocorticotropic hormone (ACTH) concentration, or by a suboptimal cortisol response to exogenous ACTH on provocation testing. Replacement with hydrocortisone and fludrocortisone should approximate physiological concentrations as closely as possible. Patients and families should have a good understanding of the condition and how to adjust the corticosteroid dosing in times of illness.

阿狄森氏病，或原发性肾上腺皮质衰竭，是罕见的，最常见的原因是在英国的自身免疫性破坏肾上腺。症状的潜伏发作会持续数月，这意味着诊断往往会延迟，患者可能首先表现为肾上腺危机，如果治疗不当，可能会危及生命。诊断是通过在09:00时发现促肾上腺皮质激素（ACTH）浓度升高的情况下血清皮质醇水平低，或在激发试验中发现皮质醇对外源性ACTH的反应不理想。用氢化可的松和氟化可的松替代应尽可能接近生理浓度。患者和家属应该很好地了解病情以及如何在患病时调整皮质类固醇的剂量。

引用次数: 0

Endocrine hypertension 内分泌高血压

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.001

Mark Sherlock, Merah Al Busaidy

Up to 10% of patients have a secondary cause for their hypertension. Endocrine conditions associated with hypertension include diseases associated with mineralocorticoid excess, glucocorticoid excess, phaeochromocytomas/paragangliomas, acromegaly and primary hyperparathyroidism. Primary aldosteronism is the most common endocrine cause of hypertension. If not appropriately managed, primary aldosteronism has an unfavourable cardiovascular morbidity and mortality profile. It is treatable by medical or surgical approaches. Phaeochromocytomas and paragangliomas are rare neuroendocrine tumours frequently associated with genetic abnormalities.

高达10%的患者有高血压的继发原因。与高血压相关的内分泌疾病包括与矿皮质激素过量、糖皮质激素过量、嗜铬细胞瘤/副神经节瘤、肢端肥大症和原发性甲状旁腺功能亢进相关的疾病。原发性醛固酮增多症是高血压最常见的内分泌原因。如果管理不当，原发性醛固酮增多症有不利的心血管发病率和死亡率。它可以通过药物或手术治疗。嗜铬细胞瘤和副神经节瘤是罕见的神经内分泌肿瘤，通常与遗传异常有关。

引用次数: 0

Imaging in endocrinology 内分泌成像

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.008

Ines Harper, Ashley S Shaw, HK Cheow

Imaging plays a crucial role in the management of endocrine diseases, providing essential diagnostic and prognostic information. This article reviews the various imaging modalities used in endocrine practice, including anatomical imaging techniques such as ultrasonography, computed tomography and magnetic resonance imaging, as well as functional imaging methods like scintigraphy and positron emission tomography. Each modality offers unique insights into endocrine pathologies, and their corresponding indications for use are summarized. Emphasis is placed on the interpretation of radiological and nuclear medicine reports, highlighting the clinical significance of the findings. This overview aims to inform practitioners about the optimal use of imaging in endocrine disease management, enhancing their ability to deliver comprehensive and effective care.

成像在内分泌疾病的治疗中起着至关重要的作用，提供了必要的诊断和预后信息。本文综述了内分泌实践中使用的各种成像方法，包括超声成像、计算机断层扫描和磁共振成像等解剖成像技术，以及闪烁成像和正电子发射断层扫描等功能成像方法。每种模式提供了独特的见解内分泌病理，并总结了其相应的使用适应症。重点放在对放射学和核医学报告的解释上，强调发现的临床意义。本综述旨在告知从业人员关于内分泌疾病管理中成像的最佳使用，提高他们提供全面有效护理的能力。

引用次数: 0

Cushing's syndrome 库兴氏综合征

Medicine (Abingdon, England : UK ed.)

Pub Date : 2025-09-01 DOI: 10.1016/j.mpmed.2025.06.004

Alan Kelsall, John Newell-Price

Endogenous Cushing's syndrome results from prolonged, excessive concentrations of circulating cortisol. Cushing's syndrome should be considered in individuals with features unusual for their age, multiple and progressive features or adrenal incidentalomas, and children with decreasing height percentile and increasing weight. Endogenous Cushing's syndrome is more common in women than men. Adrenocorticotropic hormone (ACTH)-dependent causes account for around 80% of cases. Of the ACTH-dependent cases, 80% result from pituitary adenomas (Cushing's disease) and the remainder from ectopic ACTH secretion. Non-ACTH-dependent Cushing's syndrome is caused by benign adrenal adenomas in 60% and carcinomas in 40%. Specialist assessment and treatment warrants referral to major centres. Diagnostically, the most discriminating clinical features are thin skin, easy bruising and proximal myopathy. There should be a high index of clinical suspicion before instigating investigations. Biochemical diagnosis is by a combination of dexamethasone suppression tests, assessment for loss of circadian rhythm and measurement of urinary free cortisol. When differentiating pituitary and non-pituitary sources of ACTH, reliance should be placed on biochemical evaluation. Medical therapy is used to lower plasma cortisol, before surgery or after incomplete surgical treatment. Trans-sphenoidal surgery is the treatment of choice for Cushing's disease; laparoscopic bilateral adrenalectomy can be used in refractory cases.

内源性库欣综合征是由循环皮质醇长期过高浓度引起的。库欣综合征应考虑到年龄异常、多发性和进行性特征或肾上腺偶发瘤的个体，以及身高百分位数下降和体重增加的儿童。内源性库欣综合征在女性中比男性更常见。促肾上腺皮质激素（ACTH）依赖性病因约占80%的病例。在ACTH依赖病例中，80%来自垂体腺瘤（库欣病），其余来自异位ACTH分泌。非acth依赖性库欣综合征60%由良性肾上腺腺瘤引起，40%由癌引起。专家评估和治疗需要转介到主要中心。诊断上，最具鉴别性的临床特征是皮肤薄，易瘀伤和近端肌病。在进行调查之前，应该有很高的临床怀疑指数。生化诊断是通过地塞米松抑制试验、昼夜节律丧失评估和尿游离皮质醇测量的组合。当区分垂体和非垂体ACTH来源时，应依赖生化评价。药物治疗用于降低血浆皮质醇，在手术前或不完全手术治疗后。经蝶窦手术是库欣病的首选治疗方法；腹腔镜双侧肾上腺切除术可用于难治性病例。

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