BMC Endocrine Disorders最新文献

Background: Polycystic ovary syndrome (PCOS) affects both obese and normal-weight women, with limited treatment options available for the nonobese population. Metformin (MET), an insulin sensitizer, is used to ameliorate insulin resistance and associated reproductive endocrine metabolic dysfunctions in PCOS patients. The efficacy of chiglitazar, a peroxisome proliferator-activated receptor (PPAR) pan-agonist used for type 2 diabetes treatment, is undefined in PCOS patients. In this randomized controlled trial, the effects of metformin versus chiglitazar on insulin resistance and reproductive endocrine metabolism are assessed in normal-weight women with PCOS.

Methods: Fifty-five normal-weight women with PCOS aged 18 to 45 years were included. Patients were randomly assigned to receive either chiglitazar (32 mg once daily) or MET (500 mg twice daily). Anthropometric measurements, menstrual cycle changes, sex hormone characteristics, and an oral glucose-insulin release test (OGIRT) were performed after three months of continuous use.

Results: Following 12 weeks of treatment with chiglitazar, there were notable improvements in insulin and blood glucose levels at the 120-minute mark of the OGIRT, and the peak insulin levels were significantly earlier than those at baseline, indicating a more pronounced effect than that in the MET group. Moreover, both the chiglitazar and MET treatments led to significant improvements in menstrual cyclicity, and luteinizing hormone (LH) and testosterone (Testo) levels, with no significant differences detected between the two groups. Prolactin (PRL) levels were significantly elevated in the Chiglitazar group compared with the MET group. There was also no significant difference in the efficacy of the two treatments for PCOS in subgroups with different baseline IR0 values.

Conclusion: In normal-weight PCOS patients, chiglitazar is similar to MET with regard to improving menstrual frequency and total testosterone (TT) and LH levels. Compared with MET, chiglitazar significantly improves fasting insulin levels, insulin and blood glucose levels at 120 min of the OGIRT and advances the insulin peak.

Trial registration: This single-center, open-label, 1:1 randomized controlled trial is registered with ClinicalTrials (NCT06125587, ClinicalTrials.gov) on 2023-11-05.

Background: Silent corticotroph adenomas (SCAs), a subtype of non-functioning pituitary adenomas (NFPAs), exhibit aggressive biological behaviour despite the absence of clinical hormone hypersecretion. This study aimed to identify preoperative predictors of SCAs and evaluate prognostic factors for postoperative recurrence in both NFPAs and SCAs.

Methods: We retrospectively analysed 192 patients with NFPAs who underwent transsphenoidal surgery between 2014 and 2019. Clinical presentation, imaging findings, pathological characteristics, surgical outcomes, and recurrence data were compared. Logistic regression and receiver operating characteristic analyses were used to identify predictors of SCAs. Recurrence-free survival was assessed using Kaplan-Meier analysis, and Cox regression was applied to determine independent prognostic factors.

Results: SCAs were more frequent in female patients and were associated with visual impairment, multiple microcysts, and sellar floor invasion (all p < 0.01). Logistic regression identified these factors as independent predictors, with an area under the curve (AUC) of 0.802. During a median follow-up of 53.5 months, the recurrence rate was significantly higher in the SCA group than in the non-SCA group (40.9% vs. 19.6%; p = 0.004). In NFPAs, Knosp grade ≥ 3, Ki-67 ≥ 3%, and subtotal resection (STR) were independent risk factors for recurrence. In SCAs, only Ki-67 ≥ 3% (hazard ratio [HR] = 5.122; p = 0.004) and STR (HR = 3.273; p = 0.018) remained significant.

Conclusion: SCAs are a biologically aggressive subtype of NFPA with distinct clinicopathological features. Reliable preoperative indicators and recognition of recurrence risk factors is essential to guide early diagnosis, close surveillance, and individualised treatment to improve long-term outcomes.

Clinical trial number: Not applicable.

Context: Bilateral inferior petrosal sinus sampling (BIPSS) is widely used to differentially diagnose ectopic ACTH syndrome (EAS) and Cushing's disease (CD) with pituitary lesions less than 6 mm detected on MRI.

Purpose: This study aimed to investigate the diagnostic accuracy of BIPSS and prognosis of low-lateralization [lateralization ratio of bilateral inferior petrosal sampling (IPS) ≤ 1.4] CD with microadenoma (≤ 6 mm).

Methods: This single-centre retrospective study (2011-2019) included 25 EAS and 179 CD (microadenoma ≤ 6 mm) patients whose diagnoses were confirmed by pathology. All CD patients received two to ten years of follow-up.

Results: According to the multivariable regression results, a false-negative diagnosis at baseline might be associated with a lateralization ratio ≤ 1.4 (adjusted OR = 12.69, 95% CI 4.14-38.86; P < 0.001). CD patients were divided into a low-lateralization group (lateralization ratio ≤ 1.4) and a high-lateralization group (> 1.4). An inferior petrosal sinus-to-peripheral ACTH ratio (IPS: P-ACTH) ≥ 2.0 had a sensitivity of 55.0% (95% CI 39.8%-69.3%) for the low-lateralization group (n = 40), which was lower than the sensitivity of 93.5% (95% CI 88.2%-96.6%) for the high-lateralization group (n = 139) (P < 0.001).

Conclusion: Lower diagnostic accuracy and poorer surgical outcomes were found for the low-lateralization group, with a lesser likelihood of remission and more impaired pituitary function after pituitary surgery.

Clinical trial number: Not applicable.