TouchREVIEWS in endocrinology最新文献

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.

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.

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.

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.

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.

Objectives: Hyperthyroidism has a significant impact on the cardiovascular system, causing thyrotoxic cardiomyopathy, which is characterized by atrial fibrillation, left ventricular hypertrophy and diastolic dysfunction, and may lead to heart failure. This study aimed to investigate the prevalence and associated risk factors for heart failure in patients with hyperthyroidism. Methods: A systematic literature search was conducted on PubMed, SCOPUS and Ovid SP up until April 2023. Pooled prevalence and pooled odds ratio for risk factors were calculated using the generic inverse variance method. Results: Studies involving 30,889 patients were included in this meta-analysis. The overall prevalence of heart failure in patients with hyperthyroidism was 8% (95% confidence interval [CI]: 6-11%). Further analyses revealed that the prevalence of heart failure in patients who underwent treatment with radioactive iodine ablation, antithyroid medication and thyroidectomy was 8% (95% CI: -1 to 16%), 6% (95% CI: 2 to 11%) and 4% (95% CI: -2 to 10%), respectively. The risk factors of heart failure in hyperthyroidism include atrial fibrillation, chronic kidney disease, anaemia, hypertension, history of stroke or transient ischaemic attack, history of coronary artery disease and diabetes mellitus. Conclusion: Heart failure occurs in 8% of patients with hyperthyroidism, with the most common risk factor being atrial fibrillation.

Background. Obeticholic acid (OCA) has emerged as a promising drug in the management of nonalcoholic fatty liver disease (NAFLD). This meta-analysis aimed to analyse the therapeutic effect of OCA on NAFLD. Methods. Randomized controlled trials (RCTs) involving patients with NAFLD receiving OCA in the intervention arm and placebo in the control arm were searched throughout the electronic databases. The primary outcomes were changes in non-invasive markers of hepatic fibrosis and liver histology. The secondary outcomes included changes in liver enzymes, metabolic parameters from baseline and adverse events (AEs). Results. Four RCTs involving 1,278 subjects met the inclusion criteria. Over 6 weeks to 18 months of clinical use, OCA outperformed placebo in resolving definite nonalcoholic steatohepatitis (odds ratio [OR] 1.60, 95% confidence interval [CI] [1.04-2.48], p=0.03) and improving fibrosis (OR 2.23, 95% CI [1.56-3.20], p<0.0001), hepatocellular ballooning (OR 1.83, 95% CI [1.35-2.47], p<0.0001) and lobular inflammation (OR 1.62, 95% CI [1.13-2.32], p=0.009). OCA did not improve the enhanced liver fibrosis score and steatosis better than placebo, and demonstrated superior efficacy compared with the placebo in reducing serum alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase levels. Although a favourable effect of OCA over placebo was seen in body-weight reduction, the OCA use was associated with adverse changes in lipid parameters. Except for the greater risk of pruritus and constipation, the AE profile was comparable between the OCA and placebo groups. Conclusions. OCA has a favourable efficacy in improving liver histology and liver enzymes. However, the worsening of lipid parameters and other AEs with the OCA use warrants further investigation.

Background: Long-duration thyroid eye disease (TED) may present with persistent proptosis despite the absence of inflammatory symptoms, and treatment options have been limited to surgical intervention. Recently, teprotumumab, a monoclonal antibody, has garnered interest as a non-surgical option to reduce proptosis in such cases. This systematic review investigates the impact of teprotumumab on reducing proptosis in long-duration TED. Methods: A search was conducted across major online databases, and data were aggregated from observational studies, clinical trials and case series. Nine studies met the inclusion criteria. Cumulative and weighted effect measures were synthesized. The biases and limitations of each study were assessed. Results: Existing evidence shows teprotumumab to be highly efficacious in reducing proptosis in chronic TED; however, there are significant limitations in the quality of existing evidence. The cumulative meta-analysis reveals a mean proptosis reduction of 3.05 ± 0.54 mm across 182 orbits from nine studies, and the weighted meta-analysis shows a mean reduction of 2.69 ± 0.53 mm across 172 orbits from eight studies. Discussion: While existing clinical studies are open to bias and intrinsically limited, the meta-analysis dilutes the risk of bias by weighting more precise evidence, providing the highest quality evidence to date. Further research is essential to understand teprotumumab's long-term efficacy and comparative advantages over surgical options. These findings have significant implications for treating persistent proptosis in patients with long-duration TED, potentially offering a non-surgical alternative where options were previously limited.

The term "DSD" was coined for "disorders of sex development", referring to conditions where the chromosomal, gonadal and/or genital sex is discordant or ambiguous, to replace terms considered imprecise and stigmatizing. Recently, the term "disorder" has been questioned and the term "differences" has been proposed as not stigmatizing, reflecting that the term DSD should be depathologized. In this opinion article, I discuss the importance of using precise technical terminologies amongst healthcare professionals, in the era of "precision medicine", to avoid misleading diagnoses or classifications while being extremely careful to use sensitive terminologies when interacting with patients and their families. On the other hand, I challenge the concept that DSD are not disorders.

Dry eye disease (DED) is an inadequately addressed condition in the diabetes management process and can significantly impact the quality of life and self-care. Therefore, it was imperative to review DED in the diabetic population. The aim of this article was to obtain insights into the correlation between dry eye and diabetes, with a focus on data published in the Indian population. A comprehensive literature review was performed using MEDLINE and Google Scholar, along with an internet-based search of publicly available information and peer-reviewed publications that may not have been indexed in these databases. The recommendations from several important societies for patients with DED have also been reviewed. Major aspects commonly associated with DED and diabetes have been addressed, and specific suggestions for screening, diagnosis and treatment have been described. Therefore, this review could be an invaluable resource for doctors managing patients with both conditions.