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Clinical and Biochemical Profiles of Hospitalized Patients with Hypercalcaemia from a Tertiary Care Centre in North India. 北印度一家三级医疗中心高钙血症住院患者的临床和生化特征
Pub Date : 2024-10-01 Epub Date: 2024-10-04 DOI: 10.17925/EE.2024.20.2.15
Aman Kumar, Deepak Khandelwal, Lovely Gupta, Upasana Agrawal, Suresh Mittal, Vivek Aggarwal, Nishikant Avinash Damle, Monika Garg, Deep Dutta, Sanjay Kalra

Background and aims: The profile of hypercalcaemia in hospitalized patients in India seems to be changing. However, studies evaluating the profile of hypercalcaemia in hospitalized settings in India are extremely limited. This prospective study aims to evaluate the clinical and biochemical profile of hospitalized patients with hypercalcaemia from a tertiary care centre in north India. Materials and methods: Clinical and biochemical profiles of subjects with hypercalcaemia detected during hospitalization/hospitalized with hypercalcaemia were assessed. A total of 91 subjects with sustained hypercalcaemia, who were eligible, underwent further investigation as per the institutional protocol and the data collected were analyzed. Results: The mean age of participants was 57.88 ± 14.23 years, with 62.64% of participants being females. The most common symptoms were nausea and anorexia, which were observed in all patients. The most common clinical sign was dehydration, which was observed in 32.97% of subjects. Primary hyperparathyroidism was the most common cause (41.76%), followed by suspected or confirmed malignancy/solid tumours in 15.38% of subjects. Other causes were advanced chronic liver disease (10.99%), multiple myeloma (9.89%), vitamin D toxicity (8.79%), granulomatous disorders (2.20%) and drug-i nduced disorders (1.10%). Forty-one subjects (45.05%) developed acute kidney injury and 14 subjects (15.38%) developed acute pancreatitis as a complication. Six subjects (6.59%) died during the course of hospitalization because of either primary disease or other secondary complications. Conclusions: Clinicians should be aware of changing patterns of hypercalcaemia in a hospital setting. Hypercalcaemia in hospitalized patients is associated with significant complications and mortality. Further large-scale prospective studies are needed to understand the changing pattern of hypercalcaemia in hospitalized patients from India.

背景和目的:印度住院患者的高钙血症特征似乎正在发生变化。然而,评估印度住院患者高钙血症概况的研究极为有限。本前瞻性研究旨在评估印度北部一家三级医疗中心的高钙血症住院患者的临床和生化概况。材料和方法:对住院期间发现的高钙血症患者/高钙血症住院患者的临床和生化概况进行评估。共有 91 名符合条件的持续性高钙血症患者按照机构规定接受了进一步检查,并对收集到的数据进行了分析。结果参与者的平均年龄为(57.88 ± 14.23)岁,女性占 62.64%。所有患者最常见的症状是恶心和厌食。最常见的临床表现是脱水,有 32.97% 的受试者出现这种情况。原发性甲状旁腺功能亢进症是最常见的病因(41.76%),其次是疑似或确诊的恶性肿瘤/实体瘤(15.38%)。其他原因包括晚期慢性肝病(10.99%)、多发性骨髓瘤(9.89%)、维生素 D 中毒(8.79%)、肉芽肿性疾病(2.20%)和药物性疾病(1.10%)。41名受试者(45.05%)出现急性肾损伤,14名受试者(15.38%)出现急性胰腺炎并发症。在住院期间,有 6 名受试者(6.59%)因原发病或其他继发性并发症而死亡。结论:临床医生应注意医院环境中高钙血症的变化规律。住院患者的高钙血症与严重的并发症和死亡率有关。需要进一步开展大规模前瞻性研究,以了解印度住院患者高钙血症的变化模式。
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引用次数: 0
Metformin Use and Vitamin B12 Deficiency in People with Type 2 Diabetes. What Are the Risk Factors? A Mini-systematic Review. 2 型糖尿病患者服用二甲双胍与维生素 B12 缺乏症。风险因素有哪些?小型系统综述。
Pub Date : 2024-10-01 Epub Date: 2024-07-12 DOI: 10.17925/EE.2024.20.2.7
Michael Atkinson, Prashamsa Gharti, Thinzar Min

Background and Aim: Metformin is recommended as the first-line agent for the management of type 2 diabetes following lifestyle and dietary changes. The long-term use of metformin has been associated with vitamin B12 deficiency. The aim of this review is to investigate the effect of metformin on vitamin B12 levels and identify any risk factors. Method: A literature search was conducted using MEDLINE, PubMed and ProQuest Central. Selected articles were peer-reviewed articles, written in English and published from 2015 and onwards. Excluded articles were case reports, reviews or meta-analyses, as well as those with no access to full text. Results: In total, 21 articles were included. There was a significant association between metformin use and vitamin B12 levels in 17 studies, while 4 studies found no such association. The risk factors examined were metformin dose, treatment duration, patient age and patient ethnicity. Conclusion: In summary, metformin use was associated with lower vitamin B12 concentrations, and higher doses and longer durations of treatment increase the risk of vitamin B12 deficiency. Routine vitamin B12 screening is recommended, prioritizing higher-risk patients. Further research is needed to identify when to initiate monitoring.

背景和目的:二甲双胍被推荐为改变生活方式和饮食习惯后治疗 2 型糖尿病的一线药物。长期服用二甲双胍与维生素 B12 缺乏有关。本综述旨在研究二甲双胍对维生素 B12 水平的影响,并确定任何风险因素。研究方法使用 MEDLINE、PubMed 和 ProQuest Central 进行文献检索。所选文章均为同行评议文章,以英语撰写,发表于 2015 年及以后。排除了病例报告、综述或荟萃分析以及无法获取全文的文章。结果:共纳入 21 篇文章。在 17 项研究中,二甲双胍的使用与维生素 B12 水平之间存在明显关联,而 4 项研究则未发现这种关联。研究的风险因素包括二甲双胍剂量、治疗时间、患者年龄和患者种族。最后得出结论:总之,二甲双胍的使用与维生素 B12 浓度较低有关,而较高的剂量和较长的治疗时间会增加维生素 B12 缺乏的风险。建议对高风险患者优先进行常规维生素 B12 筛查。需要进一步研究以确定何时开始监测。
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引用次数: 0
The International Evidence-based Guidelines for the Assessment and Management of Polycystic Ovary Syndrome: An Exemplar of Person-centred Care. 多囊卵巢综合症评估与管理国际循证指南》:以人为本的护理典范。
Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.17925/EE.2024.20.2.1
Bharti Kalra, Nitin Kapoor, Atul Dhingra, Sanjay Kalra

In this opinion piece, we appraise the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023 from a person-centric perspective. We discuss how the authors balance evidence with empathy and offer excellence in clinical decision-making while ensuring the empowerment of the affected individual. We note how they skilfully use powerful words and phrases to capture the essence of person-centred care. Finally, we suggest how these guidelines can be strengthened and how they can be used to create a template for guidance on the management of other chronic disorders.

在这篇评论文章中,我们从以人为本的角度对《2023 年多囊卵巢综合征评估与管理国际循证指南》进行了评价。我们讨论了作者如何平衡证据与同理心,在临床决策中提供卓越建议,同时确保增强患者的能力。我们注意到他们如何巧妙地使用有力的词汇和短语来捕捉以人为本的护理精髓。最后,我们建议如何加强这些指南,以及如何将其用于创建其他慢性疾病管理指南的模板。
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引用次数: 0
Setmelanotide: A Melanocortin-4 Receptor Agonist for the Treatment of Severe Obesity Due to Hypothalamic Dysfunction. 塞美拉诺肽:治疗因下丘脑功能障碍导致的严重肥胖症的黑色素皮质素-4 受体激动剂。
Pub Date : 2024-10-01 Epub Date: 2024-02-09 DOI: 10.17925/EE.2024.20.2.9
Sulmaaz Qamar, Ritwika Mallik, Janine Makaronidis

Obesity is a silent global pandemic. It is a condition associated with multiple risk factors and adverse outcomes that arise from the intertwined relationship between environmental factors and genetics. The genetic factors that cause phenotypic expression are variable. Monogenic obesity is a severe early-onset and rarer form of obesity, which presents with co-morbidities such as abnormal feeding behaviour. Monogenic obesity causes impaired weight regulation in the hypothalamus due to defects in the leptin-melanocortin signalling pathway. The emergence of a new therapeutic treatment, the melanocortin-4 receptor agonist setmelanotide (originally RM-493), has represented a breakthrough in the management of monogenic obesity and has raised hope in managing complex obesity. This review provides an overview of the setmelanotide trials that have taken place, as well as its mechanism of action, side effects and weight loss outcomes that led to its approval in the treatment of pro-opiomelanocortin (POMC) deficiency and proprotein convertase subtilisin/kexin type 1 (PCSK1) deficiency. It also explores setmelanotide's role in other genetic forms of obesity, such as hypothalamic obesity, Prader-Willi syndrome, Alström syndrome and other rare genetic conditions that are being investigated. This review aims to help to understand the pathophysiology of genetic obesity and aid in future treatment options for people with severe, complex genetic obesity.

肥胖症是一种无声的全球性流行病。它是一种与多种风险因素和不良后果相关的疾病,这些风险因素和不良后果源于环境因素和遗传学之间的交织关系。导致表型表现的遗传因素多种多样。单基因肥胖症是一种严重的早发性肥胖症,也是一种较罕见的肥胖症,表现为喂养行为异常等并发症。由于瘦素-黑皮素信号通路的缺陷,单基因肥胖症导致下丘脑的体重调节功能受损。黑色素皮质素-4受体激动剂setmelanotide(原名RM-493)这一新疗法的出现,标志着在治疗单基因肥胖症方面取得了突破性进展,也为治疗复杂性肥胖症带来了希望。本综述概述了已进行的塞美拉诺肽试验、其作用机制、副作用和减肥效果,这些因素促使该药被批准用于治疗原绒毛膜促皮质素(POMC)缺乏症和丙蛋白转化酶亚基酶/kexin 1 型(PCSK1)缺乏症。本综述还探讨了塞美拉诺肽在其他遗传性肥胖症中的作用,如下丘脑性肥胖症、普拉德-威利综合征、阿尔斯特伦综合征和其他正在研究的罕见遗传病。本综述旨在帮助了解遗传性肥胖症的病理生理学,并为严重、复杂的遗传性肥胖症患者的未来治疗方案提供帮助。
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引用次数: 0
Metabolic Dysfunction-associated Steatotic Liver Disease and Type 2 Diabetes: A Deadly Synergy. 代谢功能障碍相关性脂肪肝和 2 型糖尿病:致命的协同作用
Pub Date : 2024-10-01 Epub Date: 2024-04-23 DOI: 10.17925/EE.2024.20.2.2
Damien Leith, Yeun Yi Lin, Paul Brennan

Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) are both facets of the metabolic syndrome, associated with obesity and insulin resistance. MASLD, a term that replaces non-alcoholic fatty liver disease (NAFLD), occurs in up to 70% of people with T2D. Not only do T2D and MASLD commonly co-occur, but there is a synergistic, bidirectional relationship between these conditions, meaning that each affects the natural disease course of the other. As such, it is important for those caring for people with T2D to recognize the importance of this co-diagnosis. In this summary, we detail the synergistic relationship between T2D and MASLD, explain the current challenges in recognizing this common co-diagnosis and suggest practical approaches for those caring for people with T2D to improve the diagnosis and treatment of MASLD.

二型糖尿病(T2D)和代谢功能障碍相关性脂肪肝(MASLD)都是代谢综合征的一个方面,与肥胖和胰岛素抵抗有关。MASLD是取代非酒精性脂肪肝(NAFLD)的一个术语,多达70%的T2D患者会患上MASLD。T2D 和 MASLD 不仅经常同时发生,而且这两种疾病之间还存在协同、双向的关系,也就是说,每一种疾病都会影响另一种疾病的自然病程。因此,对于护理 T2D 患者的人来说,认识到这种联合诊断的重要性非常重要。在本摘要中,我们将详细介绍 T2D 和 MASLD 之间的协同关系,解释目前在识别这种常见的联合诊断方面所面临的挑战,并为 T2D 患者的护理人员提出改善 MASLD 诊断和治疗的实用方法。
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引用次数: 0
Use of Automated Insulin Delivery in Pregnancies Complicated by Type 1 Diabetes. 在 1 型糖尿病并发妊娠中使用胰岛素自动输送系统。
Pub Date : 2024-10-01 Epub Date: 2024-10-09 DOI: 10.17925/EE.2024.20.2.14
Mahima Chillakanti, Elaine Young, April Hopcroft, Natalie Bellini, Jennifer Smith, Diana Isaacs

Background: Diabetes during pregnancy is associated with significant maternal and foetal health risks. Insulin requirements also change during pregnancy. This necessitates careful and effective management of diabetes. Although commonly used in clinical practice, the US Food and Drug Administration (FDA)-approved algorithms for automated insulin delivery (AID) systems do not have pregnancy-specific glycaemic targets. This review aims to evaluate the safety and efficacy of AID systems in reaching glycaemic targets in pregnant women with type 1 diabetes (T1D). Methods: In this retrospective case review, six pregnant women with T1D used three types of AID systems. Two patients used Omnipod 5, two patients used Control-I Q and two patients used Do-I t-Yourself (DIY) Loop. Results: Across trimesters, the two patients using Omnipod 5 had an average time in range (TIR) of 68 and 82%. Patients using Control-I Q had an average TIR of 77 and 69%. Both the patients using DIY Loop had an average TIR of 85%. Hypoglycaemia occurrence was minimal. Additionally, four of the six patients had uncomplicated vaginal deliveries in their third trimester, and four of the six patients achieved guideline-r ecommended TIR targets. Birth complications for the other two patients were resolved shortly after birth. Throughout the pregnancies, insulin needs approximately doubled. Conclusions: AID systems can achieve near-desired glycaemic targets with minimal hypoglycaemia in pregnant women with T1D. Randomized controlled trials are needed to confirm these findings and to win FDA indications in pregnancy.

背景:妊娠期糖尿病对母体和胎儿的健康具有重大风险。孕期对胰岛素的需求也会发生变化。因此,有必要对糖尿病进行谨慎而有效的管理。美国食品药品管理局(FDA)批准的胰岛素自动给药(AID)系统算法虽然常用于临床实践,但并没有针对妊娠的血糖目标。本综述旨在评估自动胰岛素给药系统在实现 1 型糖尿病(T1D)孕妇血糖目标方面的安全性和有效性。方法:在这项回顾性病例研究中,六名患有 T1D 的孕妇使用了三种类型的 AID 系统。两名患者使用了 Omnipod 5,两名患者使用了 Control-I Q,两名患者使用了 Do-I t-Yourself (DIY) Loop。结果:在三个月中,使用 Omnipod 5 的两名患者的平均有效时间(TIR)分别为 68% 和 82%。使用 Control-I Q 的患者的平均射程时间分别为 77% 和 69%。使用 DIY Loop 的两名患者的平均 TIR 均为 85%。低血糖发生率极低。此外,六名患者中有四名在怀孕三个月时经阴道顺利分娩,其中四名达到了指南推荐的 TIR 指标。另外两名患者的分娩并发症在产后不久就得到了解决。在整个孕期,胰岛素需求量大约增加了一倍。结论:AID 系统可使 T1D 孕妇达到接近预期的血糖目标,同时将低血糖症降至最低。需要进行随机对照试验来证实这些研究结果,并赢得美国食品药品管理局在妊娠期的适应症。
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引用次数: 0
New Insights into the Pleiotropic Actions of Dipeptidyl Peptidase-4 Inhibitors Beyond Glycaemic Control. 二肽基肽酶-4 抑制剂在控制血糖之外的多效应新见解。
Pub Date : 2024-10-01 Epub Date: 2024-09-06 DOI: 10.17925/EE.2024.20.2.5
Safwat A Mangoura, Marwa A Ahmed, Andrew Z Zaka

Dipeptidyl peptidase-4 (DPP-4) is a multifunctional serine ectopeptidase that cleaves and modifies a plethora of substrates, including regulatory peptides, cytokines and chemokines. DPP-4 is implicated in the regulation of immune response, viral entry, cellular adhesion, metastasis and chemotaxis. Regarding its numerous substrates and extensive expression inside the body, multitasking DPP-4 has been assumed to participate in different pathophysiological mechanisms. DPP-4 inhibitors or gliptins are increasingly used for the treatment of type 2 diabetes mellitus. Several reports from experimental and clinical studies have clarified that DPP-4 inhibitors exert many beneficial pleiotropic effects beyond glycaemic control, which are mediated by anti-inflammatory, anti-oxidant, anti-fibrotic and anti-apoptotic actions. The present review will highlight the most recent findings in the literature about these pleiotropic effects and the potential mechanisms underlying these benefits, with a specific focus on the potential effectiveness of DPP-4 inhibitors in coronavirus disease-19 and diabetic kidney disease.

二肽基肽酶-4(DPP-4)是一种多功能丝氨酸外肽酶,可裂解和修饰大量底物,包括调节肽、细胞因子和趋化因子。DPP-4 与免疫反应、病毒进入、细胞粘附、转移和趋化的调节有关。由于 DPP-4 底物众多,在体内广泛表达,因此人们认为 DPP-4 的多重任务参与了不同的病理生理机制。DPP-4 抑制剂或格列汀类药物越来越多地被用于治疗 2 型糖尿病。一些实验和临床研究报告表明,DPP-4 抑制剂在控制血糖之外还能产生许多有益的多效应,这些效应由抗炎、抗氧化、抗纤维化和抗细胞凋亡作用介导。本综述将重点介绍文献中有关这些多效应的最新发现以及这些益处的潜在机制,并特别关注 DPP-4 抑制剂对冠状病毒病-19 和糖尿病肾病的潜在疗效。
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引用次数: 0
New Trends in Treating Cushing's Disease. 治疗库欣病的新趋势。
Pub Date : 2024-10-01 Epub Date: 2024-04-08 DOI: 10.17925/EE.2024.20.2.3
Odysseas Violetis, Krystallenia I Alexandraki

Rates of recurrence and/or persistence of Cushing's disease after surgical treatment are high. Recently, advances in molecular insights and a better understanding of pathophysiology have enabled the development of potential therapeutic targets that could control adrenocorticotropic hormone (ACTH) and cortisol secretion or even reduce tumour cell proliferation. At the pituitary level, pasireotide is an approved somatostatin receptor ligand, and compounds targeting cell cycle regulation, cell signalling and epigenetics are now under investigation. Levoketoconazole and osilodrostat are novel steroid inhibitors, and relacorilant overcomes the adverse effects of mifepristone. Adrenal ACTH receptor blockage and immunotherapy could also play a role.

库欣病手术治疗后的复发率和/或持续率很高。最近,随着分子研究的进展和对病理生理学的深入了解,开发出了一些潜在的治疗靶点,可以控制促肾上腺皮质激素(ACTH)和皮质醇的分泌,甚至减少肿瘤细胞的增殖。在垂体一级,帕西洛肽是一种已获批准的体生长抑素受体配体,针对细胞周期调节、细胞信号和表观遗传学的化合物目前也在研究之中。左旋酮康唑(Levoketoconazole)和奥西洛前列素(osilodrostat)是新型的类固醇抑制剂,而relacorilant则能克服米非司酮的不良反应。肾上腺促肾上腺皮质激素受体阻断和免疫疗法也可以发挥作用。
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引用次数: 0
The Horizon of Thyroid Imaging Reporting and Data System in the Diagnostic Performance of Thyroid Nodules: Clinical Application and Future Perspectives. 甲状腺成像报告和数据系统在甲状腺结节诊断中的地平线:临床应用与未来展望
Pub Date : 2024-10-01 Epub Date: 2024-07-12 DOI: 10.17925/EE.2024.20.2.11
Seyedeh Niloofar Sharafi, Mohammad Moarefzadeh, Milad Tari Moradi

The widespread occurrence of thyroid nodules and the typically slow progression of thyroid cancer have led to the development of the thyroid imaging reporting and data system (TI-RADS). The primary objectives behind the development of TI-RADS were to minimize unnecessary biopsies of non-cancerous nodules, enhance the overall precision of diagnosis and establish a uniform risk-stratification framework based on the lexicon to notify healthcare professionals of nodules that require a biopsy. The identification and precise diagnosis of thyroid nodules have led to improved clinical practice examination reports within the general population. TI-RADS is a risk-stratification system related to thyroid lesions and based on ultrasound characteristics and is similar to the structure of the breast imaging reporting and data system. There are various versions of TI-RADS, with some being widely used and adequately validated, while others lacking thorough evaluation. TI-RADS uses a numerical scoring system for characteristics, and its categories are determined by the cumulative score of a thyroid nodule, indicating the likelihood of it being benign or malignant. In this article, the various TI-RADS systems were examined as a successful method for producing precise and comprehensive documentation, with a particular emphasis on their functionality, similarities, distinctions and potential future developments.

由于甲状腺结节的广泛存在以及甲状腺癌通常进展缓慢,甲状腺成像报告和数据系统(TI-RADS)应运而生。开发 TI-RADS 系统的主要目的是尽量减少对非癌结节进行不必要的活检,提高诊断的整体精确度,并根据词典建立统一的风险分级框架,通知医护人员结节需要进行活检。甲状腺结节的识别和精确诊断改善了普通人群的临床实践检查报告。TI-RADS是与甲状腺病变相关的风险分级系统,以超声波特征为基础,与乳腺成像报告和数据系统的结构相似。TI-RADS有多种版本,其中一些版本得到了广泛应用和充分验证,而另一些版本则缺乏全面评估。TI-RADS采用数字评分系统对特征进行评分,其类别由甲状腺结节的累积分数决定,表示结节是良性还是恶性的可能性。本文对各种 TI-RADS 系统进行了研究,将其视为制作精确、全面文档的成功方法,并特别强调了这些系统的功能、相似之处、区别以及未来的潜在发展。
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引用次数: 0
Amyloid Goiter: A Peruvian Case Series. 淀粉样变性甲状腺肿:秘鲁病例系列
Pub Date : 2024-10-01 Epub Date: 2024-04-02 DOI: 10.17925/EE.2024.20.2.16
José Paz-Ibarra, Marcio Concepción-Zavaleta, Juan Eduardo Quiroz-Aldave, José Somocurcio-Peralta, María Belén Tite Haro, Paola Solis-Pazmino

Introduction: Amyloid goiter (AG) is a rare cause of thyroid swelling, characterized by deposits of amyloid protein in the thyroid tissue. It can be associated with primary or secondary amyloidosis. Its prevalence in multinodular goiter cases is 0.17%, with rare clinical detection before surgery. Case series: This Peruvian case series comprised three female patients and one male patient, with ages ranging from 28 to 65 years. All individuals had pre-existing inflammatory diseases and reported symptoms including dyspnoea, dysphagia and dysphonia. Upon physical examination, all patients exhibited a grade III goiter. Fine-needle aspiration reported colloid goiter. Three out of the four patients underwent total thyroidectomy and histochemistry revealed AG with positive Congo red staining. Discussion: AG is an uncommon clinical entity. It has been reported to occur more frequently in males, with an average age of diagnosis of 40 years. In our series, we observed a broad age range of patients receiving diagnoses, spanning from 28 to 65 years, with a predominance in females. The consideration of AG should be extended to every patient with an underlying chronic systemic inflammatory disease, especially end stage renal disease. In this context, AG should be included in the differential diagnosis for patients with multinodular goiter exhibiting progressive growth and causing compressive symptoms at the cervical level without affecting thyroid function, as demonstrated in our series. Conclusion: AG, a rare condition, warrants suspicion in the presence of a giant goiter with an underlying systemic inflammatory disease.

简介淀粉样变性甲状腺肿(AG)是甲状腺肿大的一种罕见病因,其特点是淀粉样蛋白在甲状腺组织中沉积。它可能与原发性或继发性淀粉样变性有关。它在多结节性甲状腺肿病例中的发病率为0.17%,在手术前很少被临床发现。病例系列:这组秘鲁病例包括三名女性患者和一名男性患者,年龄从28岁到65岁不等。所有患者之前都患有炎症性疾病,并报告了呼吸困难、吞咽困难和发音障碍等症状。体格检查显示,所有患者均患有三级甲状腺肿。细针穿刺检查报告为胶状甲状腺肿。四名患者中有三人接受了甲状腺全切除术,组织化学检查显示AG刚果红染色阳性。讨论:AG在临床上并不常见。据报道,它多发于男性,平均诊断年龄为40岁。在我们的系列研究中,我们观察到确诊患者的年龄跨度很大,从 28 岁到 65 岁不等,其中女性居多。对 AG 的考虑应扩展到每一位患有潜在慢性全身性炎症疾病的患者,尤其是终末期肾病患者。在这种情况下,对于多结节性甲状腺肿患者,如我们的系列病例所示,应将AG纳入鉴别诊断,因为AG表现为进行性生长,并在颈椎水平引起压迫症状,但不影响甲状腺功能。结论AG是一种罕见病,在出现巨型甲状腺肿并伴有潜在的全身炎症性疾病时值得怀疑。
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引用次数: 0
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TouchREVIEWS in endocrinology
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