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Congenital Adrenal Hyperplasia Due to 17-α-hydroxylase Deficiency: A Case Report. 17-α-羟化酶缺乏所致先天性肾上腺增生1例。
Pub Date : 2021-11-01 Epub Date: 2021-09-08 DOI: 10.17925/EE.2021.17.2.138
Lucas Ribeiro Dos Santos, Erico Paulo Heilbrun, Charles Simões Félix, Márcio Luis Duarte

Congenital adrenal hyperplasia, an innate error in adrenal steroid biosynthesis, triggers a wide range of consequences based on the level of enzyme blockade. Due to the various forms of enzyme deficiency and degree of penetration, the clinical features are very variable. In this case report, we present a form of congenital adrenal hyperplasia due to an enzymatic defect of CYP17A1, with a late diagnosis. The recognition of this pathology should occur as early as possible to avoid sequelae, both metabolic and psychological.

先天性肾上腺增生是肾上腺类固醇生物合成的先天错误,根据酶阻断的水平会引发广泛的后果。由于各种形式的酶缺乏和渗透程度,临床特征是非常不同的。在这个病例报告中,我们提出了一种由于CYP17A1酶缺陷导致的先天性肾上腺增生,诊断较晚。对这种病理的认识应尽早发生,以避免代谢和心理上的后遗症。
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引用次数: 0
Diagnosis and Clinical Management of Long-chain Fatty-acid Oxidation Disorders: A Review. 长链脂肪酸氧化障碍的诊断和临床治疗综述。
Pub Date : 2021-11-01 Epub Date: 2021-09-10 DOI: 10.17925/EE.2021.17.2.108
Joshua J Baker, Barbara K Burton

Long-chain fatty-acid oxidation disorders (LC-FAODs) are autosomal recessive inherited metabolic conditions that occur due to a disruption in the body's ability to perform mitochondrial beta oxidation. Expanded newborn screening is widening phenotypic understanding of these disorders, as well improving our knowledge of disease incidence. Management of these disorders is focused on avoidance of fasting, dietary changes and supplementation with energy sources that bypass the metabolic block. Recent US Food and Drug Administration approval of triheptanoin has improved the outcome for affected individuals. New research into dietary modifications and novel pharmacologic therapies continues for these disorders. In this article, we review the major LC-FAODs and their clinical presentation.

长链脂肪酸氧化障碍(LC-FAODs)是一种常染色体隐性遗传代谢疾病,是由于机体线粒体氧化能力的破坏而发生的。扩大新生儿筛查扩大了对这些疾病的表型理解,也提高了我们对疾病发病率的认识。这些疾病的管理重点是避免禁食、改变饮食和补充绕过代谢障碍的能量来源。最近美国食品和药物管理局批准了三庚烷酸,改善了受影响个体的预后。对这些疾病的饮食调整和新的药物治疗的新研究仍在继续。在本文中,我们回顾了主要的LC-FAODs及其临床表现。
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引用次数: 3
Diabetes Mellitus of Pituitary Origin: A Case Report. 垂体源性糖尿病1例报告。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.68
Mandeep Singla, Jaspreet Kaur Saini

We describe the case report of 36-year-old female who presented to the emergency department with diabetic ketoacidosis. On detailed clinical examination, coarse facial features in the form of large fleshy nose, thick lips, prognathism, and thickening of hands and feet were noticed, suggestive of acromegaly. Subsequently, she was diagnosed with acromegaly due to somatotropinoma. Impaired glucose tolerance and diabetes mellitus are frequently associated with acromegaly. Persistent growth hormone excess impairs insulin sensitivity, increases gluconeogenesis, reduces glucose uptake in adipose tissue and muscle, and alters pancreatic β-cell function. Rarely, diabetic ketoacidosis can be the presenting manifestation, as seen in this case.

我们描述了一例36岁女性因糖尿病酮症酸中毒到急诊科就诊的病例报告。在详细的临床检查中,发现了粗糙的面部特征,如大而多肉的鼻子、厚嘴唇、前突和手脚增厚,提示肢端肥大症。随后,她被诊断为生长激素瘤引起的肢端肥大症。糖耐量受损和糖尿病经常与肢端肥大症有关。持续过量的生长激素会损害胰岛素敏感性,增加糖异生,减少脂肪组织和肌肉中的葡萄糖摄取,并改变胰腺β细胞的功能。如本例所示,糖尿病酮症酸中毒可能是罕见的表现。
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引用次数: 1
Case Report of a Rare Adrenocortical Oncocytoma Suspected to be an Adrenal Carcinoma. 怀疑为肾上腺癌的罕见肾上腺皮质瘤1例报告。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.71
Inês Isabel Ferreira Barros, Fernando Manso, Margarida Teixeira, Maria Ramires Silva Lopes Pereira

An adrenal oncocytic neoplasm is an extremely rare tumour arising from the adrenal gland and it should be considered in the differential diagnosis of an adrenal incidentaloma, since it is frequently non-functioning. The suspicion for malignancy is high when an adrenal incidentaloma is >4 cm in size; however, adrenal oncocytomas are large, measuring an average of 8 cm, are round and encapsulated, and normally have a benign behaviour. We present a case of a 55-year-old male patient with dyslipidaemia, medicated with simvastatin. Upon complaints of abdominal pain, the general physician asked for an abdominal ultrasound that revealed an adrenal lesion, further characterized with a computed tomography scan, which showed an adrenal lesion measuring 49 × 64 × 56 mm and a calcification focus. The patient was referred to the general surgery and endocrinology department. The analytical study was negative for pheochromocytoma or Cushing's syndrome, which allowed surgery to be conducted, as is recommended. The aim of this case report is to contribute to the knowledge on adrenal oncocytomas, since there is scarce information based on singular experiences.

肾上腺嗜酸细胞肿瘤是一种极为罕见的由肾上腺引起的肿瘤,在肾上腺偶发瘤的鉴别诊断中应考虑它,因为它经常不起作用。当肾上腺偶发瘤的大小>4cm时,恶性肿瘤的怀疑度很高;然而,肾上腺嗜酸细胞瘤体积大,平均8厘米,呈圆形和包膜,通常具有良性行为。我们报告一例55岁男性患者,患有血脂异常,服用辛伐他汀。在抱怨腹痛后,普通医生要求进行腹部超声检查,发现肾上腺病变,并通过计算机断层扫描进行进一步表征,显示肾上腺病变尺寸为49×64×56 mm,并有钙化灶。病人被转诊到普通外科和内分泌科。分析研究对嗜铬细胞瘤或库欣综合征呈阴性,因此可以按照建议进行手术。本病例报告的目的是增加对肾上腺嗜酸细胞瘤的了解,因为基于单一经验的信息很少。
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引用次数: 2
Dapagliflozin as an Adjunct Therapy to Insulin in Patients with Type 1 Diabetes Mellitus: Efficacy and Safety of this Combination. 达格列净作为1型糖尿病患者胰岛素辅助治疗的疗效和安全性
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.12
Johan H Jendle, Francisco J Ampudia-Blasco, Martin Füchtenbusch, Paolo Pozzilli

The prevalence of type 1 diabetes (T1D) is increasing worldwide. T1D reduces life expectancy due to complications including cardiovascular disease. Sodium-glucose co-transporter (SGLT) inhibitors are a new class of drugs developed to treat type 2 diabetes (T2D), and now they can be used as an adjunct to insulin in T1D. In clinical trials, they have been shown to improve glycaemic control and decrease body weight without the risk of increased hypoglycaemia and with a reduction in insulin dose. Four SGLT2 inhibitors have been approved in Europe for the treatment of T2D, while only dapagliflozin and sotagliflozin, a dual SGLT1 and SGLT2 inhibitor approved in 2019, have been approved for the treatment of T1D. Both can be used as an adjunct therapy in combination with insulin in adults with a body mass index (BMI) of ≥27 kg/m2, inadequately controlled with insulin. In Europe, dapagliflozin is the only currently available SGLT2 inhibitor indcated as adjunct therapy for patients with T1D. The subgroup of patients with a BMI of ≥27 kg/m2 from the DEPICT-1 and -2 trials (Dapagliflozin Evaluation in Patients with Inadequately Controlled Type 1 diabetes) showed similar reduction in hyperglycaemia and body weight but no significant increased risk of diabetic ketoacidosis (DKA) than the overall trial population. The risk of DKA has been shown to increase in patients with T1D treated with adjunct therapy with SGLT2 inhibitors, and studies on sotagliflozin and empagliflozin have suggested a dose response. Thus, it is important to educate patients and doctors how to recognize symptoms of upcoming DKA and mitigate it. An independent DKA education programme has recently been developed to instruct patients with T1D being treated with SGLT inhibitor therapies with and without insulin pumps to prevent, identify and treat DKA. Despite these considerations, clinical trials support the use of SGLT2 inhibitors in the management of T1D. The benefits and potential risks of dapagliflozin as an adjunct therapy to insulin in adults with T1D should be considered in each individual case. Here we discuss the efficacy and safety of dapagliflozin as adjunct therapy in patients with T1D.

1型糖尿病(T1D)的患病率在全球范围内呈上升趋势。由于包括心血管疾病在内的并发症,T1D降低了预期寿命。钠-葡萄糖共转运体(SGLT)抑制剂是一类用于治疗2型糖尿病(T2D)的新药物,现在它们可以作为T1D胰岛素的辅助药物。在临床试验中,它们已被证明可以改善血糖控制和降低体重,而不会增加低血糖的风险,也不会减少胰岛素剂量。欧洲已经批准了4种SGLT2抑制剂用于治疗T2D,而2019年批准的SGLT1和SGLT2双抑制剂达格列净和sotagliflozin被批准用于治疗T1D。对于体重指数(BMI)≥27 kg/m2且胰岛素控制不充分的成人,两者均可作为辅助治疗与胰岛素联合使用。在欧洲,达格列净是目前唯一可用的SGLT2抑制剂,可作为T1D患者的辅助治疗。BMI≥27kg /m2的患者亚组(Dapagliflozin在控制不充分的1型糖尿病患者中的评估)在高血糖和体重方面的降低与总体试验人群相似,但糖尿病酮症酸中毒(DKA)的风险没有显著增加。已有研究表明,在接受SGLT2抑制剂辅助治疗的T1D患者中,DKA的风险增加,并且对sotagliflozin和empagliflozin的研究表明存在剂量反应。因此,教育患者和医生如何识别即将到来的DKA的症状并减轻它是很重要的。最近开发了一个独立的DKA教育计划,指导接受SGLT抑制剂治疗的T1D患者使用或不使用胰岛素泵来预防、识别和治疗DKA。尽管有这些考虑,临床试验支持使用SGLT2抑制剂治疗T1D。达格列净作为成人T1D患者胰岛素辅助治疗的益处和潜在风险应在每个病例中考虑。在这里,我们讨论了达格列净作为T1D患者辅助治疗的有效性和安全性。
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引用次数: 2
Organ-specific Adverse Events of Immune Checkpoint Inhibitor Therapy, with Special Reference to Endocrinopathies. 免疫检查点抑制剂治疗的器官特异性不良事件,特别涉及内分泌疾病。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.21
Annu Susan George, Cornelius J Fernandez, Dilip Eapen, Joseph M Pappachan

Immune checkpoint inhibitors are potent and promising immunotherapeutic agents that are increasingly used for the management of various types of advanced cancers. The widespread approval of this group of drugs simultaneously revealed immune-related adverse events as unique side-effects. Endocrinopathies are one of the most common immune-related adverse events. The precise pathogenic mechanisms for these endocrinopathies are still unclear. Though few of the endocrinopathies are reversible, calling for only symptom control, most are irreversible, requiring multiple long-term hormone replacement therapies. However, in contrast to other organ-specific immune-related adverse events, patients with endocrinopathies can continue their immune checkpoint therapy, provided the hormone replacement therapy is adequate and the symptoms are controlled. Though patients who have developed immune-related adverse events demonstrate superior antitumor activity and overall survival, due to the high morbidity associated with the immune-related adverse events, researchers are trying to uncouple the antitumour activity associated with immune checkpoint inhibitor therapy from the immune-related adverse events, to preserve antitumour activity without adverse events.

免疫检查点抑制剂是一种有效且有前景的免疫治疗剂,越来越多地用于治疗各种类型的晚期癌症。这组药物的广泛批准同时揭示了免疫相关的不良事件是独特的副作用。内分泌疾病是最常见的免疫相关不良事件之一。这些内分泌疾病的确切致病机制尚不清楚。尽管很少有内分泌疾病是可逆的,只需要控制症状,但大多数是不可逆转的,需要多种长期激素替代疗法。然而,与其他器官特异性免疫相关不良事件相比,内分泌疾病患者可以继续进行免疫检查点治疗,前提是激素替代治疗足够且症状得到控制。尽管出现免疫相关不良事件的患者表现出优异的抗肿瘤活性和总生存率,但由于与免疫相关不良反应相关的高发病率,研究人员正试图将与免疫检查点抑制剂治疗相关的抗肿瘤活动与免疫相关的不良事件脱钩,以保持抗肿瘤活性而没有不良事件。
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引用次数: 7
The Role of Individualized Exercise Prescription in Type 2 Diabetes Mellitus Management. 个体化运动处方在2型糖尿病治疗中的作用
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.2
John Doupis, Konstantinos Karras, Konstantinos Avramidis

The adoption and the maintenance of a proper training routine are critical elements for optimal blood glucose management and overall health improvement in individuals with diabetes. Physical activity reduces cardiovascular risk, contributes to weight loss and improves overall wellbeing. A combination of aerobic and resistance exercise maximizes the benefit of daily training. The risk of exercise-induced complications varies depending on the activity type and the presence of diabetes-related complications. Prescribing a personalized exercise programme may reduce the risk and maximize the benefit of physical activity in patients with diabetes.

采用和保持适当的日常训练是糖尿病患者血糖管理和整体健康改善的关键因素。体育活动可以降低心血管风险,有助于减肥,提高整体健康水平。有氧运动和阻力运动的结合使日常训练的益处最大化。运动引起的并发症的风险取决于运动类型和糖尿病相关并发症的存在。为糖尿病患者制定个性化的运动计划可能会降低风险,并使体育活动的益处最大化。
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引用次数: 2
The DFUC 2020 Dataset: Analysis Towards Diabetic Foot Ulcer Detection. DFUC 2020 数据集:糖尿病足溃疡检测分析
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.5
Bill Cassidy, Neil D Reeves, Joseph M Pappachan, David Gillespie, Claire O'Shea, Satyan Rajbhandari, Arun G Maiya, Eibe Frank, Andrew Jm Boulton, David G Armstrong, Bijan Najafi, Justina Wu, Rupinder Singh Kochhar, Moi Hoon Yap

Every 20 seconds a limb is amputated somewhere in the world due to diabetes. This is a global health problem that requires a global solution. The International Conference on Medical Image Computing and Computer Assisted Intervention challenge, which concerns the automated detection of diabetic foot ulcers (DFUs) using machine learning techniques, will accelerate the development of innovative healthcare technology to address this unmet medical need. In an effort to improve patient care and reduce the strain on healthcare systems, recent research has focused on the creation of cloud-based detection algorithms. These can be consumed as a service by a mobile app that patients (or a carer, partner or family member) could use themselves at home to monitor their condition and to detect the appearance of a DFU. Collaborative work between Manchester Metropolitan University, Lancashire Teaching Hospitals and the Manchester University NHS Foundation Trust has created a repository of 4,000 DFU images for the purpose of supporting research toward more advanced methods of DFU detection. This paper presents a dataset description and analysis, assessment methods, benchmark algorithms and initial evaluation results. It facilitates the challenge by providing useful insights into state-of-the-art and ongoing research.

每 20 秒钟,世界上就有一个地方因糖尿病而截肢。这是一个全球性的健康问题,需要全球性的解决方案。医学影像计算和计算机辅助干预国际会议的挑战是利用机器学习技术自动检测糖尿病足溃疡(DFUs),它将加速创新医疗保健技术的发展,以满足这一尚未得到满足的医疗需求。为了改善患者护理并减轻医疗系统的压力,最近的研究重点是创建基于云的检测算法。患者(或护理人员、伴侣或家人)可以在家中使用手机应用程序来监测自己的病情并检测是否出现 DFU。曼彻斯特都会大学、兰开夏教学医院和曼彻斯特大学 NHS 基金会信托基金会合作建立了一个包含 4000 张 DFU 图像的存储库,以支持对更先进的 DFU 检测方法的研究。本文介绍了数据集描述和分析、评估方法、基准算法和初步评估结果。通过对最新技术和正在进行的研究提供有用的见解,它有助于应对挑战。
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引用次数: 0
Renal Tubular Acidosis Manifesting as Severe Metabolic Bone Disease. 表现为严重代谢性骨病的肾小管酸中毒。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.59
Hiya Boro, Saurav Khatiwada, Sarah Alam, Suraj Kubihal, Vinay Dogra, Velmurugan Mannar, Rajesh Khadgawat

Renal tubular acidosis (RTA) is a condition characterized by normal anion gap metabolic acidosis. Type 1 and type 2 RTA are the most common, and are caused by defective secretion of hydrogen ions and impaired absorption of bicarbonate, respectively. Long-standing uncorrected acidosis can lead to metabolic bone disease (MBD). Rickets and osteomalacia remain the commonest manifestations of uncorrected RTA. In addition, there can be a myriad of other skeletal manifestations like fractures, pseudofractures, secondary osteoporosis and even sclerotic bone disease. The postulated mechanism for bone involvement includes acidosis-mediated exaggerated osteoclastic bone resorption. Other contributory factors include abnormal renal handling of phosphate leading to hypophosphataemia in proximal RTA, and impaired vitamin D metabolism and action. In distal RTA, hypercalciuria and secondary hyperparathyroidism may play a key role for bone involvement. Recognizing the disease in its early course is important to prevent permanent sequelae of skeletal involvement. Most of these patients may, in fact, undergo orthopaedic interventions without primary correction of acidosis. We describe five cases who presented with MBD in varied forms. While evaluating the aetiology of MBD, they were diagnosed with RTA. Subsequently, we attempted to analyse the causes of RTA. Although the common causes were ruled out, genetic aetiology could not be ascertained due to resource constraints. RTA remains an important differential diagnosis of MBD. More awareness is required to diagnose the disease early and to treat it adequately. Our case series is an attempt to provide the clinical, biochemical and skeletal spectrum of RTA. In addition, we have attempted to provide algorithms for the approach and evaluation of RTA along with their varied causes.

肾小管酸中毒(RTA)是一种以正常阴离子间隙代谢性酸中毒为特征的疾病。1型和2型RTA是最常见的,分别由氢离子分泌缺陷和碳酸氢盐吸收受损引起。长期未纠正的酸中毒可导致代谢性骨病(MBD)。佝偻病和骨软化仍然是未矫正RTA最常见的表现。此外,还可能有无数其他骨骼表现,如骨折、假性骨折、继发性骨质疏松症甚至硬化性骨病。假设的骨骼受累机制包括酸中毒介导的过度破骨细胞骨吸收。其他因素包括肾脏对磷酸盐的异常处理导致近端RTA低磷血症,以及维生素D代谢和作用受损。在RTA远端,高钙尿和继发性甲状旁腺功能亢进可能是骨受累的关键因素。在早期识别疾病对于预防骨骼受累的永久性后遗症是很重要的。事实上,这些患者中的大多数可能在没有酸中毒的初步矫正的情况下接受矫形外科干预。我们描述了5例不同形式的MBD。在评估MBD的病因时,他们被诊断为RTA。随后,我们试图分析RTA的原因。虽然排除了常见原因,但由于资源限制,无法确定遗传病因。RTA仍然是MBD的重要鉴别诊断。需要提高认识,以便及早诊断该病并对其进行适当治疗。我们的病例系列试图提供RTA的临床、生化和骨骼谱。此外,我们还试图为RTA及其各种原因的方法和评估提供算法。
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引用次数: 2
An Occult Leydig Cell Tumour in a Postmenopausal Woman Presenting with Alopecia and Hirsutism: A Case Report. 隐蔽性间质细胞肿瘤在绝经后妇女表现为脱发和多毛:1例报告。
Pub Date : 2021-04-01 Epub Date: 2021-04-28 DOI: 10.17925/EE.2021.17.1.75
Shuann Shwana, Natasha Shrikrishnapalasuriyar, Win Yin, Monica Vij, Atul Kalhan

Progressive hirsutism and moderate to severe male-pattern balding in women requires exclusion of an adrenal or ovarian tumour, especially in the presence of significantly elevated androgen levels. We present the case of a 68-year-old woman who was referred to an endocrinology clinic with insidious onset excessive facial hair growth and loss of scalp hair. Her testosterone levels were significantly elevated at 13 nmol/L (normal range: 0.1-1.4 nmol/L), although dehydroepiandrosterone sulphate and 17-hydroxyprogesterone levels were normal, suggestive of an ovarian source of androgens. Repeated radiologic investigations, including pelvic ultrasound, and abdominal and pelvic computed tomography, could not identify the obvious source of androgens. Based on strong clinical suspicion of an ovarian tumour, she underwent an elective salpingo-oophorectomy, which detected an occult Leydig cell tumour on histopathological analysis. Post-operatively, her hyperandrogenic features significantly improved and testosterone levels normalized.

进行性多毛症和中度至重度男性型秃顶的女性需要排除肾上腺或卵巢肿瘤,特别是在雄激素水平显著升高的情况下。我们提出的情况下,68岁的妇女谁被转介到内分泌诊所与潜伏发作过多的面部毛发生长和头皮头发的损失。她的睾酮水平显著升高至13 nmol/L(正常范围:0.1-1.4 nmol/L),尽管硫酸脱氢表雄酮和17-羟孕酮水平正常,提示卵巢雄激素来源。反复的放射学检查,包括盆腔超声、腹部和盆腔计算机断层扫描,都不能确定雄激素的明显来源。基于强烈的临床怀疑卵巢肿瘤,她接受了选择性输卵管卵巢切除术,在组织病理学分析中发现了隐匿的间质细胞肿瘤。术后高雄激素特征明显改善,睾酮水平恢复正常。
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引用次数: 1
期刊
TouchREVIEWS in endocrinology
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