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Risk of Hepatocellular Carcinoma with Glucagon-like Peptide-1 receptor agonist treatment in patients: a systematic review and meta-analysis. 胰高血糖素样肽-1 受体激动剂治疗患者罹患肝细胞癌的风险:系统回顾和荟萃分析。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1186/s12902-024-01775-2
Muhammed Shabil, Mahalaqua Nazli Khatib, Suhas Ballal, Pooja Bansal, Balvir S Tomar, Ayash Ashraf, M Ravi Kumar, Aashna Sinha, Pramod Rawat, Abhay M Gaidhane, Sanjit Sah, Afukonyo Shidoiku Daniel, Ambanna Yappalparvi, Ganesh Bushi

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with increased prevalence in individuals with chronic liver conditions and type 2 diabetes mellitus (T2DM). Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) have shown promise in diabetes management and may influence liver disease progression. This systematic review and meta-analysis aimed to assess the efficacy of GLP-1 RAs in reducing the risk of HCC in patients with T2DM.

Methods: We conducted a literature search of PubMed, EMBASE, and Web of Science up to August 1, 2024. Studies that evaluated the incidence of HCC in T2DM patients treated with GLP-1 RAs compared to other therapies were included. Meta-analyses were performed using a random-effects model to compute pooled hazard ratios (HRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I² statistic. All statistical analyses were performed in R software version 4.3.

Results: Eight studies met the inclusion criteria. The pooled analysis demonstrated that GLP-1 RA treatment was associated with a significant reduction in HCC risk compared to insulin or no GLP-1 RA treatment (pooled HR = 0.41, 95% CI: 0.28 to 0.55), with considerable heterogeneity (I² = 74%). Compared to metformin and DPP-4 inhibitors, GLP-1 RAs did not significantly alter HCC risk (HR = 0.99, 95% CI: 0.79 to 1.27 for metformin; HR = 1.05, 95% CI: 0.80 to 1.39 for DPP-4 inhibitors). However, GLP-1 RAs were associated with a reduced risk compared to sulfonylureas (HR = 0.78, 95% CI: 0.65 to 0.93).

Conclusion: GLP-1 RAs may offer protective benefits against HCC in T2DM patients compared to insulin or no GLP-1 RAs, but not significantly over other antidiabetic medications. This review indicates the need for further randomized controlled trials to clarify the role of GLP-1 RAs in HCC risk mitigation and to explore their mechanistic pathways in liver disease management.

背景:肝细胞癌(HCC)是全球癌症相关死亡的主要原因,在患有慢性肝病和 2 型糖尿病(T2DM)的人中发病率更高。胰高血糖素样肽-1受体激动剂(GLP-1 RAs)在糖尿病治疗中显示出良好的前景,并可能影响肝病的进展。本系统综述和荟萃分析旨在评估 GLP-1 RAs 在降低 T2DM 患者 HCC 风险方面的疗效:我们对截至 2024 年 8 月 1 日的 PubMed、EMBASE 和 Web of Science 进行了文献检索。方法:我们检索了截至 2024 年 8 月 1 日的 PubMed、EMBASE 和 Web Science 文献,纳入了评估 T2DM 患者接受 GLP-1 RAs 治疗后与其他疗法相比 HCC 发生率的研究。采用随机效应模型进行 Meta 分析,计算汇总的危险比 (HR) 和 95% 置信区间 (CI),并使用 I² 统计量评估异质性。所有统计分析均在 R 软件 4.3 版本中进行:八项研究符合纳入标准。汇总分析表明,与胰岛素或无 GLP-1 RA 治疗相比,GLP-1 RA 治疗可显著降低 HCC 风险(汇总 HR = 0.41,95% CI:0.28 至 0.55),但存在相当大的异质性(I² = 74%)。与二甲双胍和 DPP-4 抑制剂相比,GLP-1 RAs 并未显著改变 HCC 风险(二甲双胍的 HR = 0.99,95% CI:0.79 至 1.27;DPP-4 抑制剂的 HR = 1.05,95% CI:0.80 至 1.39)。然而,与磺脲类药物相比,GLP-1 RAs 可降低风险(HR = 0.78,95% CI:0.65 至 0.93):结论:与胰岛素或无 GLP-1 RAs 相比,GLP-1 RAs 可为 T2DM 患者提供预防 HCC 的保护性益处,但与其他抗糖尿病药物相比效果并不明显。本综述表明,有必要进一步开展随机对照试验,以明确 GLP-1 RAs 在降低 HCC 风险中的作用,并探索其在肝病管理中的机制途径。
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引用次数: 0
Mediating effect of fasting blood glucose and peripheral arterial disease on the relationship between sexual functioning and health-related quality of life among Nigerians with type 2 diabetes. 空腹血糖和外周动脉疾病对尼日利亚 2 型糖尿病患者性功能与健康相关生活质量之间关系的中介效应。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1186/s12902-024-01784-1
Olufemi O Oyewole, Ayotunde O Ale, Ayanbola I Adepoju, Grace M Emmanuel, Michael O Ogunlana, Olufunmilayo O Oyewole, Olatunde Odusan

Background: Poor glycemic control and sexual dysfunction have been shown to impair health-related quality of life (HRQoL) of individuals with diabetes. However, mediators underlying this relationship have not been evaluated. This study aimed/sought to assess the effect of fasting blood glucose (FBG) and peripheral arterial disease (PAD) on the relationship between sexual functioning (SeF) and HRQoL among Nigerians with type 2 diabetes mellitus (T2DM).

Methods: This cross-sectional study consecutively recruited 210 participants diagnosed with T2DM. The recent FBG and lipid profiles were gleaned from the medical records of the participants. We assessed the ankle-brachial index by 8 MHz handheld vascular Doppler. Participants completed the Changes in Sexual Functioning Questionnaire and Short Form 12 (SF-12) questionnaire to assess SeF and HRQoL, respectively.

Results: Significant differences exist in HRQoL of participants with good and poor glycemic control (mean rank = 111.02 vs. 93.64, p = 0.035) but none between participants with and without PAD (mean rank = 101.39 vs. 107.60, p = 0.483). There was a significant correlation between SeF and HRQoL (r = 0.181, CI = 0.043-0.313, p = 0.008), and a significant negative correlation between HRQoL and FBG (r = -0.149, CI = -0.284 - -0.008, p = 0.033). There is a significant indirect effect of impact of SeF on HRQoL through FBG (b = -0.027, t = -0.899) and PAD (b = 0.034, t = 1.246). Furthermore, the direct effect of SeF on HRQoL in the presence of the mediators was also significant (b = 0.483, p = 0.001). This shows that PAD and FBG mediates the relationship between SeF and HRQoL.

Conclusion: Good glycemic control and the absence of PAD mediate the relationship between SeF and HRQoL in Nigerians with T2DM.

Clinical trial number: Not applicable.

背景:血糖控制不佳和性功能障碍已被证明会损害糖尿病患者的健康相关生活质量(HRQoL)。然而,这种关系的中介因素尚未得到评估。本研究旨在评估空腹血糖(FBG)和外周动脉疾病(PAD)对尼日利亚 2 型糖尿病(T2DM)患者性功能(SeF)和 HRQoL 之间关系的影响:这项横断面研究连续招募了 210 名确诊为 T2DM 患者。我们从参与者的医疗记录中收集了他们近期的血糖和血脂情况。我们用 8 兆赫手持血管多普勒仪评估了踝肱指数。参与者填写了性功能变化问卷和简表 12 (SF-12) 问卷,以分别评估 SeF 和 HRQoL:结果:血糖控制良好和血糖控制不佳的参与者在 HRQoL 方面存在显著差异(平均等级 = 111.02 vs. 93.64,p = 0.035),但有 PAD 和没有 PAD 的参与者之间没有差异(平均等级 = 101.39 vs. 107.60,p = 0.483)。SeF 与 HRQoL 之间存在明显的相关性(r = 0.181,CI = 0.043-0.313,p = 0.008),HRQoL 与 FBG 之间存在明显的负相关(r = -0.149,CI = -0.284 -0.008,p = 0.033)。SeF 通过 FBG(b = -0.027,t = -0.899)和 PAD(b = 0.034,t = 1.246)对 HRQoL 有明显的间接影响。此外,在存在中介因子的情况下,SeF 对 HRQoL 的直接影响也是显著的(b = 0.483,p = 0.001)。这表明,PAD 和 FBG 是 SeF 与 HRQoL 之间关系的中介:结论:良好的血糖控制和无 PAD 可调节尼日利亚 T2DM 患者 SeF 与 HRQoL 之间的关系:临床试验编号:不适用。
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引用次数: 0
Thyroid hormone levels in patients with bipolar disorder: a systematic review and meta-analysis. 双相情感障碍患者的甲状腺激素水平:系统综述和荟萃分析。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1186/s12902-024-01776-1
Shanshan Liu, Xiaoai Chen, Xiaotao Li, Limin Tian

Purpose: To investigate the difference in blood (serum/plasma) thyroid hormone (TH) levels, including thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3), in bipolar disorder (BD) during different mood episodes (depression and mania) compared with healthy control (HC) and between manic episodes (BD-M) and depressive episodes (BD-D).

Methods: As of September 1, 2024, the electronic databases PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials. Gov were systematically searched with no language limitations. Standardized mean differences (SMD) with 95% confidence interval (CI) were summarized using a random effects model. The chi-squared-based Q test and the I2 test assessed the size of heterogeneity.

Results: The 21 studies included a total of 3696 participants, Of the 2942 BD patients, 1583 were in depressive episodes 1359 were in manic episodes. The status of measuring blood TH levels included 2 studies in plasma and 19 in serum. Combined with the results of the sensitivity analyses, we obtained the following relatively reliable results: serum T3 (SMD: -0.63, 95%CI: -1.09 to -0.17) and FT3 (SMD: -0.42, 95%CI: -0.83 to -0.00) levels decreased significantly in BD-D compared to HC; serum T3 (SMD: -0.91, 95%CI: -1.49 to -0.32) levels decreased significantly and serum FT4 (SMD: 0.37, 95%CI: 0.14 to 0.60) levels increased significantly in BD-M than in HC; serum T3 (SMD: 0.87, 95%CI: 0.24 to 1.49) and FT3 (SMD: 0.27, 95%CI: 0.13 to 0.42) levels demonstrated a significant elevation in BD-M compared to BD-D. In the group of euthyroidism, apart from serum FT4 (SMD: 0.21, 95%CI: -0.15 to 0.58) levels showed no significant difference between BD-M and HC, other results above remained consistent.

Conclusion: Serum T3 and FT3 levels decreased significantly in BD-D compared to HC. Serum T3 levels decreased significantly and serum FT4 levels increased significantly in BD-M compared to HC. Serum T3 and FT3 levels increased significantly in BD-M than in BD-D. The temporality of changes in TH levels and BD progression demands further longitudinal studies to illustrate.

Trial registration: Number and date of registration for prospectively registered trials No. CRD42022378530.

目的研究双相情感障碍患者在不同情绪发作期(抑郁和躁狂)的血液(血清/血浆)甲状腺激素(TH)水平,包括促甲状腺激素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、游离甲状腺素(FT4)和游离三碘甲状腺原氨酸(FT3)与健康对照组(HC)的差异、和游离三碘甲状腺原氨酸(FT3),与健康对照组(HC)相比,以及与躁狂发作(BD-M)和抑郁发作(BD-D)之间的比较。研究方法截至 2024 年 9 月 1 日,系统检索了 PubMed、Embase、Cochrane Library、Web of Science、中国国家知识基础设施、中国生物医学文献数据库、中国科技期刊数据库、万方数据库和 Clinical Trials.在没有语言限制的情况下,对所有文献进行了系统检索。采用随机效应模型总结了标准化平均差(SMD)及 95% 置信区间(CI)。基于卡方的Q检验和I2检验评估了异质性的大小:21 项研究共纳入 3696 名参与者,在 2942 名 BD 患者中,1583 人处于抑郁发作期,1359 人处于躁狂发作期。血液中 TH 水平的测量情况包括 2 项血浆研究和 19 项血清研究。结合敏感性分析的结果,我们得出了以下相对可靠的结果:与 HC 相比,BD-D 患者的血清 T3(SMD:-0.63,95%CI:-1.09 至 -0.17)和 FT3(SMD:-0.42,95%CI:-0.83 至 -0.00)水平显著下降;与 HC 相比,BD-D 患者的血清 T3(SMD:-0.91,95%CI:-1.49至-0.32)水平显著下降,血清FT4(SMD:0.37,95%CI:0.14至0.60)水平显著升高;与HC相比,BD-M的血清T3(SMD:0.87,95%CI:0.24至1.49)和FT3(SMD:0.27,95%CI:0.13至0.42)水平显著升高。在甲状腺功能正常组中,除了血清FT4(SMD:0.21,95%CI:-0.15至0.58)水平在BD-M和HC之间无明显差异外,上述其他结果保持一致:结论:与 HC 相比,BD-D 的血清 T3 和 FT3 水平明显下降。结论:与 HC 相比,BD-D 的血清 T3 和 FT3 水平明显下降;与 HC 相比,BD-M 的血清 T3 水平明显下降,血清 FT4 水平明显上升。与 BD-D 相比,BD-M 的血清 T3 和 FT3 水平明显升高。TH水平变化与BD进展的时间性需要进一步的纵向研究来说明:前瞻性注册试验的编号和注册日期 编号:CRD42022378530。
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引用次数: 0
Does higher serum 25-hydroxyvitamin D levels will harm bone mineral density?: a cross-sectional study. 较高的血清 25- 羟维生素 D 水平是否会损害骨矿物质密度:一项横断面研究。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-18 DOI: 10.1186/s12902-024-01760-9
Bingcheng Xu, Qiai Li, Bo Luo, Hao Liu

Objective: Vitamin D plays a critical role in the prevention and management of osteoporosis. However, there is an ongoing debate regarding the most effective vitamin D supplementation strategies for maintaining optimal bone mineral density (BMD) levels in adults. This study sought to establish the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and total BMD in a substantial population sample.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) for the 2011-2018 cycles, encompassing 11,375 adult participants, were analyzed. The primary variables of interest were serum 25(OH)D levels and BMD. A multivariable logistic regression model was utilized to account for relevant variables associated with these correlations.

Results: A U-shaped relationship between serum 25(OH)D levels and BMD was observed. In males, a significant positive association was identified for 25(OH)D levels below 84.8 nmol/L (p < 0.0001), while levels above this threshold showed no significant correlation (p = 0.3377). In females, those with 25(OH)D levels below 31.4 nmol/L exhibited a significant positive association with BMD (p = 0.0010), but this association weakened and became marginally significant above this threshold (p = 0.0650).

Conclusions: For adult males, the optimal serum 25(OH)D level is 84.8 nmol/L, beyond which higher levels do not lead to increased BMD. A deficiency threshold for adult females should be above 31.4 nmol/L, as lower 25(OH)D levels are not conducive to BMD. These findings underscore the importance of maintaining appropriate vitamin D levels for bone health in both genders.

目的:维生素 D 在预防和治疗骨质疏松症方面发挥着至关重要的作用。然而,关于维持成人最佳骨矿物质密度(BMD)水平的最有效维生素 D 补充策略,目前仍存在争议。本研究试图在大量人口样本中建立血清 25- 羟维生素 D [25(OH)D] 水平与总 BMD 之间的相关性:本研究分析了美国国家健康与营养调查(NHANES)2011-2018 年期间的数据,其中包括 11,375 名成年参与者。主要研究变量为血清 25(OH)D 水平和 BMD。利用多变量逻辑回归模型来解释与这些相关性有关的相关变量:血清 25(OH)D 水平与 BMD 之间呈 U 型关系。在男性中,25(OH)D 水平低于 84.8 nmol/L(p 结论:血清 25(OH)D 水平与 BMD 呈显著正相关:对于成年男性来说,血清 25(OH)D 的最佳水平是 84.8 nmol/L,超过这一水平不会导致 BMD 增加。成年女性的缺乏阈值应高于 31.4 nmol/L,因为较低的 25(OH)D 水平不利于 BMD。这些发现强调了保持适当的维生素 D 水平对两性骨骼健康的重要性。
{"title":"Does higher serum 25-hydroxyvitamin D levels will harm bone mineral density?: a cross-sectional study.","authors":"Bingcheng Xu, Qiai Li, Bo Luo, Hao Liu","doi":"10.1186/s12902-024-01760-9","DOIUrl":"10.1186/s12902-024-01760-9","url":null,"abstract":"<p><strong>Objective: </strong>Vitamin D plays a critical role in the prevention and management of osteoporosis. However, there is an ongoing debate regarding the most effective vitamin D supplementation strategies for maintaining optimal bone mineral density (BMD) levels in adults. This study sought to establish the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and total BMD in a substantial population sample.</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey (NHANES) for the 2011-2018 cycles, encompassing 11,375 adult participants, were analyzed. The primary variables of interest were serum 25(OH)D levels and BMD. A multivariable logistic regression model was utilized to account for relevant variables associated with these correlations.</p><p><strong>Results: </strong>A U-shaped relationship between serum 25(OH)D levels and BMD was observed. In males, a significant positive association was identified for 25(OH)D levels below 84.8 nmol/L (p < 0.0001), while levels above this threshold showed no significant correlation (p = 0.3377). In females, those with 25(OH)D levels below 31.4 nmol/L exhibited a significant positive association with BMD (p = 0.0010), but this association weakened and became marginally significant above this threshold (p = 0.0650).</p><p><strong>Conclusions: </strong>For adult males, the optimal serum 25(OH)D level is 84.8 nmol/L, beyond which higher levels do not lead to increased BMD. A deficiency threshold for adult females should be above 31.4 nmol/L, as lower 25(OH)D levels are not conducive to BMD. These findings underscore the importance of maintaining appropriate vitamin D levels for bone health in both genders.</p>","PeriodicalId":9152,"journal":{"name":"BMC Endocrine Disorders","volume":"24 1","pages":"250"},"PeriodicalIF":2.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of gestational diabetes mellitus on women's sexual function: a systematic review and meta-analysis. 妊娠糖尿病对女性性功能的影响:系统回顾和荟萃分析。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-15 DOI: 10.1186/s12902-024-01781-4
Mahsa Maghalian, Mojgan Mirghafourvand

Background: Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap.

Methods: This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis.

Results: The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD - 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD - 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD - 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD - 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function.

Conclusion: Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

背景:妊娠糖尿病(GDM)是一种常见的妊娠并发症,对母体和胎儿健康的不利影响已得到公认。然而,有关其对性健康影响的研究却并不一致。目前,还没有关于 GDM 孕妇性功能的全面综述。本研究的目的是系统地收集和综合现有证据,填补这一重要的研究空白:本系统综述和荟萃分析采用了全面的文献检索策略,并纳入了以下数据库:Cochrane Library、Scopus、PubMed、Web of Science、SID 和 Google Scholar。检索截止到 2024 年 2 月 21 日。本研究中纳入的横断面研究和病例对照研究的质量通过修改后的标准纽卡斯尔-渥太华量表进行评估。证据的确定性通过建议、评估、发展和评价分级(GRADE)框架进行评估。进行了元回归以研究影响总体性功能的变量。此外,还进行了序列分析,以确定荟萃分析所需的信息量:结果:系统性搜索过程共获得了 370 项研究。最终分析包括六项研究。与对照组妇女相比,确诊为 GDM 的孕妇性功能较低。鉴于证据的确定性较低,有必要进行样本量更大的进一步研究,以增强证据的稳健性。医疗保健提供者应关注 GDM 妇女的性健康,并针对她们的特殊需求制定有针对性的干预措施。
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引用次数: 0
Renovascular hypertension following by juxtaglomerular cell tumor: a challenging case with 12-year history of resistant hypertension and hypokalemia. 并肾小球细胞瘤引起的肾血管性高血压:一个具有 12 年抵抗性高血压和低钾血症病史的棘手病例。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-14 DOI: 10.1186/s12902-024-01770-7
Guangshu Chen, Yang Zhang, Xiaoqing Xiong, Zhengming Li, Xing Hua, Zhenhui Li, Meizheng Lai, Ping Zhu, Jianmin Ran

Background: Adolescents with secondary hyperaldosteronism often present with severe and treatment-resistant hypertension, along with hypokalemia. Renovascular hypertension is frequently caused by renal artery stenosis, primarily due to atherosclerosis and fibromuscular dysplasia (FMD). The presence of an accessory renal artery (ARA) is a common anatomical variation that can contribute to secondary renal vascular hypertension. However, FMD occurring in the ARA is a rare cause of renal vascular hypertension. Juxtaglomerular cell tumor (JGCT) represents a rare etiology of renal hypertension. The co-occurrence of the pathogenic ARA with JGCT is infrequently reported in the existing literature.

Case presentations: This case study presents a young individual with a 12-year history of resistant hypertension, initially diagnosed with pathogenic ARA but later confirmed as JGCT 4 years later. Following surgery for JGCT, the patient experienced only temporary stabilization of blood pressure without anti-hypertensive medication. Stenosis of the ARA was definitively diagnosed one and a half years post-surgery, with FMD occurring on the ARA strongly suspected. The patient underwent balloon dilatation angioplasty 3 years later, leading to sustained blood pressure stability with the use of two medications.

Conclusions: The case study discussed herein involves a patient with resistant hypertension initially diagnosed with ARA but later determined to have late-onset JGCT and renal artery stenosis. It is imperative to consider atypical JGCT in young patients exhibiting resistant hypertension, hypokalemia, and hyperreninemia. Adequate management of renal artery stenosis is crucial in the management of hyperreninemic hypertension.

背景:患有继发性高醛固酮血症的青少年通常会出现严重的耐药性高血压,并伴有低钾血症。肾血管性高血压常由肾动脉狭窄引起,主要是由于动脉粥样硬化和纤维肌发育不良(FMD)。肾动脉分支(ARA)的存在是一种常见的解剖变异,可导致继发性肾血管性高血压。然而,发生在 ARA 上的 FMD 是肾血管性高血压的罕见病因。并肾小球细胞瘤(JGCT)是肾血管性高血压的一种罕见病因。在现有文献中,同时出现致病性 ARA 和 JGCT 的报道并不多见:本病例研究介绍了一名有 12 年抵抗性高血压病史的年轻人,他最初被诊断为致病性 ARA,但 4 年后被确诊为 JGCT。在接受 JGCT 手术治疗后,患者在没有服用降压药的情况下血压仅暂时稳定。术后一年半,患者被明确诊断为 ARA 狭窄,并强烈怀疑 ARA 上发生了 FMD。3 年后,患者接受了球囊扩张血管成形术,使用两种药物后血压持续稳定:本文讨论的病例研究涉及一名最初被诊断为 ARA 的抵抗性高血压患者,但后来被确定为晚发性 JGCT 和肾动脉狭窄。对于表现出抵抗性高血压、低钾血症和高肾素血症的年轻患者,必须考虑非典型 JGCT。在高肾素血症高血压的治疗过程中,适当处理肾动脉狭窄至关重要。
{"title":"Renovascular hypertension following by juxtaglomerular cell tumor: a challenging case with 12-year history of resistant hypertension and hypokalemia.","authors":"Guangshu Chen, Yang Zhang, Xiaoqing Xiong, Zhengming Li, Xing Hua, Zhenhui Li, Meizheng Lai, Ping Zhu, Jianmin Ran","doi":"10.1186/s12902-024-01770-7","DOIUrl":"10.1186/s12902-024-01770-7","url":null,"abstract":"<p><strong>Background: </strong>Adolescents with secondary hyperaldosteronism often present with severe and treatment-resistant hypertension, along with hypokalemia. Renovascular hypertension is frequently caused by renal artery stenosis, primarily due to atherosclerosis and fibromuscular dysplasia (FMD). The presence of an accessory renal artery (ARA) is a common anatomical variation that can contribute to secondary renal vascular hypertension. However, FMD occurring in the ARA is a rare cause of renal vascular hypertension. Juxtaglomerular cell tumor (JGCT) represents a rare etiology of renal hypertension. The co-occurrence of the pathogenic ARA with JGCT is infrequently reported in the existing literature.</p><p><strong>Case presentations: </strong>This case study presents a young individual with a 12-year history of resistant hypertension, initially diagnosed with pathogenic ARA but later confirmed as JGCT 4 years later. Following surgery for JGCT, the patient experienced only temporary stabilization of blood pressure without anti-hypertensive medication. Stenosis of the ARA was definitively diagnosed one and a half years post-surgery, with FMD occurring on the ARA strongly suspected. The patient underwent balloon dilatation angioplasty 3 years later, leading to sustained blood pressure stability with the use of two medications.</p><p><strong>Conclusions: </strong>The case study discussed herein involves a patient with resistant hypertension initially diagnosed with ARA but later determined to have late-onset JGCT and renal artery stenosis. It is imperative to consider atypical JGCT in young patients exhibiting resistant hypertension, hypokalemia, and hyperreninemia. Adequate management of renal artery stenosis is crucial in the management of hyperreninemic hypertension.</p>","PeriodicalId":9152,"journal":{"name":"BMC Endocrine Disorders","volume":"24 1","pages":"244"},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ectopic adrenocorticotrophic hormone syndrome in a 10-year-old girl with a thymic neuroendocrine tumor: a case report. 一名患有胸腺神经内分泌肿瘤的 10 岁女孩的异位肾上腺皮质激素综合征:病例报告。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-13 DOI: 10.1186/s12902-024-01756-5
Irena Aldhoon-Hainerová, Mikuláš Kosák, Michal Kršek, David Zogala, Karel Pacak

Background: Thymic neuroendocrine tumor as a cause of Cushing syndrome is extremely rare in children.

Case presentation: We report a case of a 10-year-old girl who presented with typical symptoms and signs of hypercortisolemia, including bone fractures, growth retardation, and kidney stones. The patient was managed with oral ketoconazole, during which she experienced adrenal insufficiency, possibly due to either cyclic adrenocorticotropic hormone (ACTH) secretion or concurrent COVID-19 infection. The patient underwent a diagnostic work-up which indicated the possibility of an ACTH-secreting pituitary neuroendocrine tumor. However, after a transsphenoidal surgery, the diagnosis was not confirmed on histopathological examination. Subsequent bilateral inferior petrosal sinus sampling showed strong indications of the presence of ectopic ACTH syndrome. Detailed rereading of functional imaging studies, including 18F-FDG PET/MRI and 68Ga DOTATOC PET/CT, ultimately identified a small lesion in the thymus. The patient underwent videothoracoscopic thymectomy that confirmed a neuroendocrine tumor with ACTH positivity on histopathological examination.

Conclusion: This case presents some unique challenges related to the diagnosis, management, and treatment of thymic neuroendocrine tumor in a child. We can conclude that ketoconazole treatment was effective in managing hypercortisolemia in our patient. Further, a combination of functional imaging studies can be a useful tool in locating the source of ectopic ACTH secretion. Lastly, in cases of discrepancy in the results of stimulation tests, bilateral inferior petrosal sinus sampling is highly recommended to differentiate between Cushing disease and ectopic ACTH syndrome.

背景:作为库欣综合征病因的胸腺神经内分泌肿瘤极为罕见:胸腺神经内分泌肿瘤导致库欣综合征的病例在儿童中极为罕见:我们报告了一例 10 岁女孩的病例,她出现了高皮质醇血症的典型症状和体征,包括骨折、生长迟缓和肾结石。患者在口服酮康唑治疗期间出现肾上腺功能不全,这可能是由于促肾上腺皮质激素(ACTH)周期性分泌或同时感染 COVID-19。患者接受了诊断性检查,结果显示可能患有分泌促肾上腺皮质激素的垂体神经内分泌肿瘤。然而,经蝶窦手术后,组织病理学检查并未确诊。随后的双侧下蝶窦取样显示,存在异位 ACTH 综合征的强烈迹象。详细重读功能成像检查,包括 18F-FDG PET/MRI 和 68Ga DOTATOC PET/CT,最终确定胸腺有一个小病灶。患者接受了视频胸腔镜胸腺切除术,组织病理学检查证实为ACTH阳性的神经内分泌肿瘤:本病例为儿童胸腺神经内分泌肿瘤的诊断、管理和治疗提出了一些独特的挑战。我们可以得出结论,酮康唑治疗能有效控制患者的高皮质醇血症。此外,结合功能成像研究也是找到异位促肾上腺皮质激素分泌源的有效工具。最后,在刺激试验结果不一致的情况下,强烈建议进行双侧下额窦取样,以区分库欣病和异位 ACTH 综合征。
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引用次数: 0
Analysis of the efficacy of different amounts of parathyroid grafts in the treatment of secondary hyperparathyroidism. 分析不同数量的甲状旁腺移植物在治疗继发性甲状旁腺功能亢进症中的疗效。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-12 DOI: 10.1186/s12902-024-01777-0
Wentan Chen, Ge Zhou

Purpose: This study compares the efficacy of two different ranges of parathyroid transplantation weights with the aim of determining a preferable range for transplantation weight.

Methods: From May 2018 to June 2023, 79 patients underwent total parathyroidectomy with autotransplantation. Demographic data, symptoms, and pre- or postoperative biochemical indicators were compared between two different ranges of parathyroid transplantation weights.

Results: All 79 surgeries were successful, with a total of 316 parathyroid glands reported among the patients. The patients were diagnosed with parathyroid hyperplasia. Postoperatively, itching, bone pain, and muscle weakness disappeared, while serum parathyroid hormone and phosphate levels significantly decreased. With an average follow-up of 12 months, no transplant-dependent recurrence was observed.

Conclusion: Parathyroid transplantation with a weight of 30-50 mg is a feasible, safe, and effective surgical approach.

目的:本研究比较了两种不同范围的甲状旁腺移植重量的疗效,旨在确定移植重量的优选范围:2018年5月至2023年6月,79名患者接受了甲状旁腺全切除术并进行了自体移植。比较了两种不同范围的甲状旁腺移植重量的人口统计学数据、症状和术前或术后生化指标:79例手术全部成功,患者共报告了316个甲状旁腺。患者被诊断为甲状旁腺增生症。术后,瘙痒、骨痛和肌肉无力症状消失,血清甲状旁腺激素和磷酸盐水平显著下降。平均随访12个月,未发现移植依赖性复发:结论:重量为30-50毫克的甲状旁腺移植是一种可行、安全且有效的手术方法。
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引用次数: 0
Association of time in range with cognitive impairment in middle-aged type 2 diabetic patients. 中年 2 型糖尿病患者的认知障碍与在量程范围内的时间有关。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-08 DOI: 10.1186/s12902-024-01772-5
Yanting Liu, Yanlan Liu, Huina Qiu, Nahal Haghbin, Jingbo Li, Yaoshuang Li, Weiran Jiang, Longfei Xia, Fan Wu, Chenying Lin, Jingna Lin, Chunjun Li

Objective: This study investigated the association of Time In Range (TIR) obtained from Blood Glucose Monitoring (BGM) with Cognitive Impairment (CI) inpatients with middle-aged Type 2 Diabetes Mellitus (T2DM) and further explored whether a TIR goal for T2DM in adults with > 70% possess a protective effect on cognitive function.

Research design and methods: A total of 274 inpatients with T2DM aged 40-64 years, who underwent seven-point BGM ( pre meals and 120 min post meals and at bedtime) were recruited in this cross-sectional study. TIR was defined as the percentage of blood glucose within the target range of 3.9-10.0mmol/L. Subjects were divided into Normal Cognitive Function (NCF) (n = 160) and CI (n = 114) groups according to the results of the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). The association of TIR and other glycemic metrics, calculated from seven-point BGM data, with cognitive dysfunction was analyzed.

Results: The prevalence of CI was 41.6% in patients with middle-aged T2DM (median age 58 years). TIR was lower in CI group than in NCF group (28.6% vs. 42.9%, P = 0.004). The prevalence of CI decreased with ascending tertiles of TIR (p for trend < 0.05). Binary logistic regression analysis showed a significant association between TIR and CI (odds ratio [OR] = 0.84, p < 0.001) after adjusting for confounders (age, education, marital status, age at Diabetes Mellitus (DM) onset, cerebrovascular disease). Further adjustment of Standard Deviation (SD)(OR = 0.84, p = 0.001) or Coefficient of Variation (CV)(OR = 0.83, p < 0.001), TIR was still associated with CI. While a TIR goal of > 70% probably possessed independent protective effect on cognitive function (OR = 0.25, p = 0.001) after controlling for confounders above.

Conclusions: TIR obtained from BGM was related to CI in middle-aged T2DM individuals and a TIR goal of > 70% probably possessed a protective effect on cognitive function for middle-aged T2DM .

研究目的本研究调查了中年2型糖尿病(T2DM)患者通过血糖监测(BGM)获得的 "在量程内时间"(TIR)与认知功能障碍(CI)之间的关系,并进一步探讨了TIR>70%的T2DM患者是否对认知功能具有保护作用:这项横断面研究共招募了274名年龄在40-64岁之间的T2DM住院患者,他们均接受了七点血糖监测(餐前、餐后120分钟和睡前)。TIR定义为血糖在3.9-10.0mmol/L目标范围内的百分比。根据蒙特利尔认知评估(MoCA)和迷你精神状态检查(MMSE)的结果,受试者被分为认知功能正常组(NCF,n = 160)和认知功能障碍组(CI,n = 114)。根据七点血糖监测数据计算出的 TIR 和其他血糖指标与认知功能障碍的关联进行了分析:在中年 T2DM 患者(中位年龄 58 岁)中,CI 患病率为 41.6%。CI 组的 TIR 低于 NCF 组(28.6% 对 42.9%,P = 0.004)。在控制了上述混杂因素后,CI 的患病率随 TIR 值的递增而降低(P 为趋势的 70%),可能对认知功能具有独立的保护作用(OR = 0.25,P = 0.001):中年 T2DM 患者从血糖仪获得的 TIR 与 CI 有关,TIR > 70% 的目标可能对中年 T2DM 患者的认知功能具有保护作用。
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引用次数: 0
Relationship of serum iron and thyroid hormone in obesity and after laparoscopic sleeve gastrectomy. 肥胖症和腹腔镜袖带胃切除术后血清铁和甲状腺激素的关系。
IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-07 DOI: 10.1186/s12902-024-01753-8
Xingchun Wang, Yaling Fang, Xiu Huang, Lei Du, Hui Ren, Chunjun Sheng, Peng Yang, Yueye Huang, Shen Qu

Background: Iron is an essential element for thyroid function. However, no study focuses on the association between iron and thyroid in individuals with obesity. Our research aimed to investigate the iron status in relation to baseline thyroid hormone levels and after laparoscopic sleeve gastrectomy (LSG).

Methods: A total of 216 subjects with obesity were enrolled and divided into low and high iron groups depending on the median value. The association between iron and thyroid hormone was analyzed and compared before and after LSG at the 6-month follow-up in patients who underwent LSG.

Results: 1) In all, Total Triiodothyronine (TT3) was significantly higher in high iron than low iron group (P = 0.008). TT3 and thyroid stimulating hormone (TSH) were significantly higher in high iron than low iron group (1.92 ± 0.61 vs. 1.69 ± 0.28 nmol/l, P = 0.029; 2.93 ± 1.66 vs. 1.88 ± 1.03 mU/l, P = 0.002) in females while not in males (all P > 0.05). 2) Iron was significantly positively associated with free triiodothyronine (FT3), free thyroxine (FT4), TT3 and TSH (all P < 0.05). Adjusted for body mass index (BMI), total cholesterol (TCH), high-density lipoprotein cholesterol (HDL-C), fasting insulin (FINS) and homeostatic model assessment of insulin resistance (HOMA-IR), FT3, FT4 and TSH were still significantly associated with iron (all P < 0.05). 3). Regression analysis showed that iron was significantly associated with FT4 (β = 0.338, P = 0.038). 3) LSG led to decreased FT3, FT3, TT3, total thyroxine (TT4) and TSH at 6 months follow-up (all P < 0.05). Changed FT4 was significantly associated with changed iron (r = 0.520, P = 0.009). Subjects with iron decreased had more significant decreased TT4 than subjects without iron decreased (P = 0.021).

Conclusion: Serum iron overload is significantly associated with impaired thyroid function in subjects with obesity. LSG led to improved thyroid function which is associated with a change in iron.

Trial registration: NCT04548232 registration date is on October 9, 2022, registered in https://register.

Clinicaltrials: gov/ .

背景:铁是甲状腺功能所必需的元素。然而,还没有研究关注肥胖症患者体内铁与甲状腺之间的关系。我们的研究旨在调查铁的状态与基线甲状腺激素水平以及腹腔镜袖带胃切除术(LSG)后的关系:方法:我们共招募了 216 名肥胖症患者,并根据中位值将其分为低铁组和高铁组。方法:共招募了 216 名肥胖症患者,根据中位值将其分为低铁组和高铁组,并在 6 个月的随访中分析和比较了 LSG 前后铁与甲状腺激素之间的关系:1)总三碘甲状腺原氨酸(TT3)在高铁组明显高于低铁组(P = 0.008)。高铁组女性的总三碘甲状腺原氨酸(TT3)和促甲状腺激素(TSH)明显高于低铁组(1.92 ± 0.61 vs. 1.69 ± 0.28 nmol/l,P = 0.029;2.93 ± 1.66 vs. 1.88 ± 1.03 mU/l,P = 0.002),而男性则没有差异(均 P > 0.05)。2)铁与游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TT3 和促甲状腺激素呈明显正相关(均为 P 结论:血清铁超载与肥胖症患者甲状腺功能受损密切相关。LSG可改善甲状腺功能,而甲状腺功能的改善与铁的变化有关:NCT04548232注册日期为2022年10月9日,注册网址为https://register.Clinicaltrials: gov/ .
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引用次数: 0
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BMC Endocrine Disorders
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