BMC Endocrine Disorders最新文献

Background: This study was conducted to evaluate the association between the implementation of the WHO 2017 and 2022 classification updates for pituitary tumours and the validity of ICD-10 codes in identifying nonfunctioning and functioning subtypes of pituitary neuroendocrine tumours (PitNETs) in a real-world surgical cohort.

Methods: We analysed data from 1,096 surgically treated PitNET patients at a major Chinese medical centre between January 2020 and April 2024. The validity of the ICD-10 codes for identifying nonfunctioning and functioning PitNET subtypes was assessed using prepathological discharge diagnoses as the reference standard. The performance metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Youden index, F1 score, and kappa statistic, were calculated for each subtype. These validity measures were then compared between cases classified according to the 2017/2022 WHO criteria and those classified using the pre-2017 criteria in pathological reports.

Results: ICD-10 code sensitivity was lowest for nonfunctioning PitNETs (72.9%; 95% CI: 69.1-76.3), followed by functioning gonadotrophs (83.3%; 95% CI: 36.5-99.1) and corticotrophs (84.0%; 95% CI: 77.4-89.0), while other subtypes maintained high sensitivity (97.9%-100%). Most subtypes had low PPVs (6.3-75.0%), except for nonfunctioning and somatotroph PitNETs. The nonfunctioning PitNET code also had a low NPV (73.8%; 95% CI: 70.1-77.2). When cases were pathologically classified using the updated 2017/2022 WHO criteria, a substantial decrease in sensitivity for nonfunctioning PitNETs was observed (94.7% to 63.0%, p < 0.001), which coincided with a reduced NPV, F1 score, and kappa, despite increased specificity (95.8% vs. 86.8%, p < 0.01). Similarly, under the new classification, corticotroph PitNETs had decreased specificity (100.0% to 92.8%, p < 0.001), PPV (94.8% to 64.6%, p < 0.001), and composite metrics. Notably, low PPVs persisted for lactotroph (59.2%) and gonadotroph (5.1%) PitNETs. Coding discrepancies primarily involved confusion with new pathological terminology and misapplication of endocrine codes for pituitary stalk compression effects.

Conclusion: The updated WHO classifications enhance pathological detail but should not guide clinical ICD coding, as misapplication reduces coding accuracy in surgically managed PitNETs. Future frameworks must align pathological nomenclature with clinical endocrine function in the ICD, maintaining a clear distinction between these domains. Multidisciplinary collaboration and standardized coding protocols are essential for improving accuracy.

Clinical trial number: Not applicable.

Purpose: To test the non-inferiority of alternate-day alternating monotherapy (q48h) versus daily concomitant atorvastatin-fenofibrate for change in LDL-C in adults with T2DM and mixed dyslipidemia (margin δ = 13 mg/dL).

Methods: Single-center, randomized, parallel-group non-inferiority trial (12 weeks). Patients (N = 94) were allocated 1:1 to Daily concomitant therapy (atorvastatin 10 mg plus fenofibrate 100 mg once daily) or Alternating monotherapy (q48h), with fixed doses maintained throughout the 12-week study and no dose titration.

Primary outcome: ΔLDL-C with 90% CIs versus δ. Analyses were intention-to-treat; Analyses followed intention-to-treat with LOCF; multiplicity for secondary endpoints was controlled (Holm/FDR).

Results: Eighty-six completed follow-ups. Both regimens improved TG, total cholesterol, LDL-C, and HDL-C; between-group differences in change were not significant across lipid or metabolic/safety markers. For LDL-C, the 90% CI for (Alternating - Daily) lay entirely within δ, demonstrating non-inferiority. Renal function remained stable; no severe adverse events; ΔAST/ΔALT did not differ between groups.

Conclusions: Over 12 weeks, Alternating monotherapy (q48h) was non-inferior to Daily concomitant atorvastatin-fenofibrate for LDL-C lowering, with similar secondary outcomes and acceptable tolerability. Findings support clinical feasibility of a simplified alternate-day schedule; no formal economic analysis was performed. Longer studies with objective adherence assessment are warranted.

Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20250718066536N1. Registered retrospectively on 18 July 2025. Patient enrolment occurred from August 2024 to June 2025. The protocol and the primary/secondary endpoints were finalized prior to data analysis.

Background: Diabetes is a common chronic disease among the elderly, with significant complications if not managed through a healthy lifestyle. This study evaluated the impact of an educational intervention on lifestyle changes in elderly individuals with diabetes in Yasuj, Iran.

Methods: This quasi-interventional study included 80 elderly individuals with diabetes in Yasuj, Iran, selected via multi-stage cluster sampling from four health centers. Two centers were randomly assigned to the intervention group (n = 40) and two to the control group (n = 40). The intervention group participated in six weekly 60-minute educational sessions based on Walker's health-promoting lifestyle model, covering nutrition, physical activity, stress management, interpersonal relationships, and spirituality through lectures, group discussions, and visual aids. The control group received routine care. Lifestyle components were assessed using Walker's health style questionnaire before and three months after the intervention. Data were analyzed using independent t-tests and chi-square tests.

Results: Before the intervention, there were no significant differences between the intervention and control groups in the total lifestyle scores (p = 0.82) or any of its sub-scores, including nutrition (p = 0.75), physical activity (p = 0.76), responsibility (p = 0.74), stress management (p = 0.91), interpersonal relationships (p = 0.84), and spiritual growth (p = 0.92). After the intervention, the intervention group showed significantly higher total lifestyle scores (p = 0.001) compared to the control group. Significant improvements were also observed in all sub-scores, including nutrition (p = 0.001), physical activity (p = 0.001), responsibility (p = 0.001), stress management (p = 0.001), interpersonal relationships (p = 0.001), and spiritual growth (p = 0.001).

Conclusion: The lifestyle-based educational intervention significantly improved participants' ability to adopt healthier behaviors, including better nutrition, physical activity, and stress management, leading to an overall enhancement in their lifestyle. These improvements suggest that such interventions can play a key role in diabetes management and the prevention of related complications in elderly individuals. Future research should explore long-term impacts and the integration of similar educational programs into broader public health strategies.

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.