TouchREVIEWS in endocrinology最新文献

The recent coronavirus disease 2019 (COVID-19) pandemic has induced many challenges in the clinical environment worldwide. In a bid to reduce the exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 and the utilization of personal protective equipment (PPE), while maintaining optimal patient care, in April 2020, the US Food and Drug Administration issued a new policy, allowing the use of continuous glucose monitoring (CGM) systems in the intensive care unit (ICU) setting. This article aimed to explore the role of real-time continuous glucose monitoring systems in patients in the ICU with COVID-19. The hybrid protocols integrating real-time CGM and point of care seem to be a feasible and safe alternative for the glycaemic management of critically ill patients with COVID-1 9, including the reduction of healthcare providers' exposure and the preservation of PPE, whilst achieving and maintaining optimal glycaemic control.

Background: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common electrolyte disorder among elderly patients. Chronic urinary retention has also been implicated in the development of SIADH. The mechanism by which urinary retention leads to SIADH remains unclear. Increased responsiveness of the collecting ducts to arginine vasopressin has been observed in elderly patients with urinary retention. This study aims to evaluate whether SIADH in elderly patients with urinary retention is associated with increased urinary aquaporin 2 (U-AQP2) levels and whether the insertion of an indwelling catheter with fluid restriction, without the administration of 3% saline, can lower the U-AQP2 level, leading to the resolution of SIADH.

Method: This hospital-based clinical intervention study was conducted from January 2022 to January 2023. Eighteen elderly patients who met the selection criteria for euvolaemic SIADH (identified by Bartter and Schwartz criteria) associated with urinary retention, after excluding other causes, were selected. Serum sodium (Nas), serum osmolality (Osms), U-AQP2 levels, urinary osmolality (Osmu) and 24-hour urine volume on days 1 and 4 post-catheterization were assessed and compared. Clinical responses, including neurological signs and symptoms (Glasgow Coma Scale [GCS]), were also recorded.

Results: All 18 cases had comorbidities and were in a range of severe hyponatraemia, defined as Nas<125 mmol/L. Nas levels significantly increased (p<0.05) on days 2 and 4 after the drainage of residual urine, with mean (± standard deviation) changes of 8.39 (± 5.7) and 15.67 (± 5.6) mmol/L, respectively, from a baseline of 110.7 mmol/L. Osms significantly increased (p<0.05) from 240.01 (± 15.68) mOsm/kg on day 1 to 272.74 (± 13.41) mOsm/kg on day 4 post-catheterization. The mean urinary aquaporin:creatinine ratio significantly decreased (p<0.05) from 3,348.01 (± 2,127.82) fmol/mg Cr on day 1 to 1,135.27 (± 1,194.42) fmol/mg Cr on day 4. The mean Osmu significantly decreased (p=0.00) from 450.67 (± 187.3) mOsm/kg on day 1 to 229.33 (± 123.56) mOsm/kg on day 4. The mean urine volume significantly increased (p<0.05) from 1,610.00 (± 530.15) mL on day 1 to 2,725.56 (± 898.29) mL on day 4. All patients showed neurological improvement, with the mean GCS increasing from 11 to 14, without complications of osmotic demyelination syndrome.

Conclusion: U-AQP2 levels are elevated in elderly patients with SIADH with urinary retention. After catheterization, these levels decrease, leading to the spontaneous resolution of hyponatraemia without complications.

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are the preferred agents for managing type 2 diabetes in patients with established atherosclerotic cardiovascular disease and for reducing hospitalization for heart failure (HHF) in patients with heart failure with reduced and preserved ejection fraction. We undertook this meta-analysis, as, to date, no meta-analysis has holistically analysed the potential benefits and safety of SGLT2i in patients with acute myocardial infarction (MI).

Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving patients with MI who received SGLT2i in the intervention arm (initiated within 2 weeks of the index event) and placebo/active comparator in the control arm. The primary outcome was to evaluate the impact on cardiovascular death, all-cause death and HHF. The secondary outcomes were to evaluate the impact on echocardiographic parameters, N-terminal pro-b-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, MI, stroke, all-cause hospitalization and safety issues.

Results: From initially screened 8,922 articles, data from 6 RCTs were analysed (7,409 patients). Early initiation of SGLT2i following MI was associated with significantly lower future HHF (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.62-0.90; p=0.002; I ²=0%) and significantly higher left-ventricular ejection fraction (mean difference [MD]: 1.65%; 95% CI: 0.34-2.96; p=0.01; I ²=0%) compared with placebo. Compared with placebo, SGLT2i following MI had no beneficial impact on cardiovascular deaths (OR: 1.04; 95% CI: 0.83-1.30; p=0.76; I ²=0%), all-cause mortality (OR: 1.00; 95% CI: 0.82-1.21; p=0.98; I ²=0%), stroke (OR: 0.58; 95% CI: 0.26-1.27; p=0.17), all-cause hospitalization (OR: 1.13; 95% CI: 0.97-1.32; p=0.11; I ²=0%) and percentage change in NT-proBNP (MD: 1.18%; 95% CI: -9.78 to 12.14; p=0.83; I ²=52%). SGLT2i were well tolerated without increased ketoacidosis, acute renal failure or hepatic injury.

Conclusion: Early initiation of SGLT2i in acute MI is safe, well tolerated and associated with a reduction in HHF.

The results of the third phase of the UK Prospective Diabetes Study, recently published in The Lancet, reinforce the crucial role of early intensive glycaemic control in protection against micro- and macrovascular complications of diabetes. The benefits persist into the third decade after the completion of the trial, long after the difference in glycated haemoglobin between the intensive and standard arms has disappeared. This 'legacy effect' emphasizes the need for early diagnosis and aggressive management of diabetes from the time of its identification. It also validates the long-term safety and efficacy of conventional agents such as metformin and sulfonylureas. Understanding the mechanisms behind the 'legacy effect' could help target pathways that lead to the development of complications.

Background: Non-alcoholic fatty liver disease (NAFLD) and related health issues are increasing in Indian women with morbid obesity, but the standard diagnostic tool - abdominal ultrasound sonography (USG) - is costly and less accessible. This study aims to identify an affordable and effective biomarker panel to improve early detection and screening of NAFLD in resource-l imited settings.

Methods: This cross-sectional study included 106 consecutive patients aged between 18 and 70 years with morbid obesity defined by body mass index (BMI) ≥32.5 kg/m² who underwent an abdominal USG for a non-hepatic indication. The serum biomarker indices used were hepatic steatosis index, lipid accumulation product (LAP), Framingham steatosis index, triglyceride-glucose (TyG) index, TyG weight-to-height ratio composite index, TyG-BMI and TyG waist circumference composite index.

Results: The mean age was 40.2 ± 10.9 years, and the mean BMI was 41.5 ± 5.8 kg/m². NAFLD was diagnosed in 71.7% of the participants. The TyG index showed the highest diagnostic accuracy with an area under the receiver operating characteristic curve (AUROC) of 0.835 (confidence interval [CI]: 0.713-0.957, p<0.001), with a sensitivity of 95.1% and a specificity of 70.8% at a cut-off of 9.0994. LAP showed an AUROC of 0.711 (CI: 0.584-0.838, p-value: 0.002). Using a cut-off score of 76.2, the sensitivity and specificity were 71.2 and 70.8%, respectively.

Conclusion: Simple screening tools can be used to detect fatty liver disease in clinical practice. In our cohort, TyG index was found to be the best tool for identifying NAFLD, with LAP showing potential as a secondary option.

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.

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.

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.

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.

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.