BMC Endocrine Disorders最新文献

Background: Hyperparathyroidism includes conditions marked by excessive secretion of parathyroid hormone (PTH), resulting in disruptions in calcium-phosphate metabolism. In individuals with chronic kidney disease (CKD), differentiating secondary hyperparathyroidism from tertiary hyperparathyroidism is frequently challenging due to the overlapping biochemical and clinical characteristics. Ectopic mediastinal parathyroid adenomas are uncommon and complicate localisation and therapy further.

Case presentation: We present a 66-year-old female with chronic kidney disease, hypertension, and ischaemic heart disease, who had increasing dyspnoea initially attributed to heart failure. Laboratory assessment indicated PTH 238.8 pmol/L, corrected calcium 2.545 mmol/L, phosphorus 1.389 mmol/L, and vitamin D 39.8 nmol/L, suggesting advanced hyperparathyroidism. The primary diagnostic issue was distinguishing tertiary hyperparathyroidism from secondary hyperparathyroidism in the context of chronic kidney disease (CKD). Localisation was accomplished with Tc-99m sestamibi SPECT/CT, revealing a 3 × 2 cm anterior mediastinal lesion consistent with an ectopic parathyroid adenoma. Echocardiography demonstrated significant concentric left ventricular hypertrophy and a large pericardial effusion. Definitive surgical treatment consisting of bilateral neck exploration with thoracoscopic excision of the anterior mediastinal parathyroid gland was recommended following stabilization. However, after counseling, the patient declined surgical intervention and was managed conservatively with ongoing nephrology and endocrinology follow-up.

Discussion: This case highlights the diagnostic complexity of tertiary hyperparathyroidism in CKD and the crucial role of multimodal imaging in localising ectopic adenomas. Integrating biochemical, radiological, and clinical findings is essential for accurate diagnosis and timely surgical planning.

Conclusion: This case highlights how modest biochemical irregularities and unusual cardiopulmonary symptoms can obscure ectopic parathyroid disease, emphasising the importance of maintaining a high index of suspicion to guide optimal clinical decision-making.

Clinical trial number: Not applicable.

Background and objective: Diabetic foot (DF), a limb-threatening complication associated with high risk of amputation, currently lacks reliable early diagnostic biomarkers. This study aims to identify novel DF-specific metabolic biomarkers and develop predictive models for early diagnosis by integrating serum and urine metabolomic profiling.

Methods: Serum and urine samples were collected from patients with diabetic foot and those with diabetes mellitus without foot complications. Metabolomic and lipoprotein profiles were quantitatively analyzed using multivariate statistical methods to identify metabolic alterations associated with DF. Differential metabolites were used to construct a machine learning-based predictive model for early DF diagnosis.

Results: Distinct metabolic profiles differentiated DF from DM patients. Serum analysis revealed significantly lower hemoglobin, albumin, calcium, and apolipoprotein A1 levels in DF (P < 0.05). Urine metabolomics identified elevated N-isovaleroylglycine (OR = 12.89) and valine (OR = 2.23) as key DF-associated metabolites (P < 0.05). Lipidomics demonstrated increased triglyceride-rich LDL subtypes (L2TG, L4TG) and reduced high-density lipoprotein components (H4CH, H4PL) in DF. A predictive model integrating urinary metabolites (N-isovaleroylglycine, valine) and clinical profiles (albumin, apolipoprotein A1, calcium) achieved robust diagnostic accuracy (AUC = 0.91).

Conclusion: This study reveals distinct metabolic disturbances in DF through integrated metabolomic analysis. The combination of urinary metabolites and clinical biomarkers provides a non-invasive approach for early detection of DF, highlighting the potential utility of metabolomics in improving early diagnosis and management of diabetic foot.

Clinical trial number: Not applicable.

Background: In recent years, simpler and more practical indicators based on routine biochemical tests or anthropometric measurements have been widely utilized for the assessment of insulin sensitivity. However, limited research has been conducted to investigate the predictive value of these novel simplified measures in relation to subclinical left ventricular systolic dysfunction.

Methods: A total of 160 newly diagnosed patients with type 2 diabetes mellitus (T₂DM) and 70 healthy subjects matched by age and sex were included in the study. The systolic function of the left ventricle were assessed using AFI echocardiography( global longitudinal strain, GLS). Four indicators of insulin resistance (IR) were computed: Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-c), the product of fasting triglycerides and glucose levels(TyG), TyG multiplied by the body mass index(TyG-BMI)and the Insulin resistance metabolic score(METS-IR). The binary logistic regression analysis identified clinical and ultrasonic risk factors associated with abnormal left ventricular GLS in patients with T2DM. Develop a multiple-index-based log P model for integrated application. The diagnostic efficacy of the log P model in predicting left ventricular systolic function impairment was assessed using ROC analysis.

Results: Competing risk regression revealed that body mass index(BMI), interventricular septal diameter(IVSD), systolic blood pressure(SBP) and left atrium(LA) were significant risk factors for the reduction of GLS in individuals with T2DM. Additionally, two IR index models were found to be closely associated with abnormal GLS: TyG-BMI (6.227,p = 0.000); METS-IR(7.436,p = 0.000). ROC analysis results indicate that TyG-BMI, METS-IR, IVSD, SBP, LA and a combination of five other indexes have demonstrated certain efficacy in predicting and evaluating diabetic heart function reduction. Its ROC-AUC (0.95CI) are 0.750 (0.564 ~ 0.934), 0.774 (0.582 ~ 0.944), 0.702 (0.461 ~ 0.948), 0.737 (0.478 ~ 0.983), 0.726 (0.483 ~ 0.951), 0.878 (0.770 ~ 0.987) respectively.

Conclusion: Approximately 20% of newly diagnosed patients with T₂DM exhibit early-stage left ventricular systolic dysfunction.The Log P model exhibited the highest predictive efficiency when applied in combination, with significantly higher sensitivity, specificity and accuracy than each individual application.

Clinical trial number: Not applicable.

Background: This study aimed to compare the reduction in hospital admissions due to hypoglycemia and the decrease in HbA1c levels between empagliflozin and sulfonylurea, alongside the standard care provided to patients with type 2 diabetes during fasting.

Methodology: A single-center prospective observational cohort study was conducted from March to June 2022. Patients were treated with stable doses of empagliflozin, sulfonylureas, metformin, and DPP-4 inhibitors at least two months before fasting. Stability was defined as unchanged doses for at least one month. Participants' BMI distribution and treatment regimens were clarified. The eGFR cutoff of < 60 ml/min/1.73 m² was chosen based on international standards for renal function in diabetes.

Results: Females were in the majority (60.3%) in the intervention (case) group. Most had ages ranging from 41 to 60 years; the empagliflozin group reported slightly fewer hypoglycemic events (26.5%) compared to the sulfonylurea group (31%), and both groups demonstrated statistically significant reductions in HbA1c levels (p < 0.0001), with a similar mean decrease of approximately 0.5%, during fasting, without changes in baseline antidiabetic medications. An odds ratio of 0.387 indicated a trend toward further HbA1c reduction with increasing empagliflozin dose. However, differences in baseline weight between groups may have influenced outcomes. Separate data for modern versus conventional sulfonylureas were analyzed, showing consistency in hypoglycemic event rates across both types.

Conclusions: Empagliflozin is effective for type 2 diabetic patients during Ramadan fasting in modestly reducing the hypoglycemic events requiring hospital admissions. While both empagliflozin and sulfonylureas led to comparable reductions in HbA1c, larger, controlled studies are warranted to further evaluate clinical outcomes and control for baseline differences.

Clinical trial number: Not applicable.