BMC Endocrine Disorders最新文献

Background: Diabetes mellitus (DM) is a complex metabolic disease with numerous consequences that are especially linked to it. Because microRNAs (miRNAs) are produced specifically in the pancreas and remain stable in various bodily fluids, they can be used for early diagnosis as well as tracking the course and severity of the disease. This study examined the serum expression of miR-410, miR-133, and miR-582 in Egyptian patients with Type 1 Diabetes Mellitus.

Methods: There were two groups of 120 participants in this study: 40 healthy children and 80 diabetic children. Samples of venous blood were obtained from every participant. The quantitative real-time PCR (qRT-PCR) method was used to determine the serum expressions of miR-410, miR-133, and miR-582.

Results: Our findings showed a statistically significant difference in the median relative expression levels of miR-410, miR-133, and miR-582 between the T1DM group and the control group. T1DM patients had higher levels of miR-410 (P < .0001), miR- 133 (P = .006), and miR-582 (P < .0001) compared to controls. ROC curve analysis indicated that miR-410, miR-133, and miR-582 can distinguish T1DM patients from healthy subjects. For miR-410, at a cutoff point of 0.0009, sensitivity was 62%, specificity was 80%, and the area under the curve (AUC) was 0.713. For miR-133, the cutoff was 0.0016, with AUC 0.628, sensitivity 63%, and specificity 60%. For miR-582, the cutoff was 0.00028, with AUC 0.668, sensitivity 71.0%, and specificity 50%.

The periprocedural period represents a critical time for children and adolescents with diabetes, during which they are at increased risk of complications. The management of diabetes in this context has become increasingly complex due to the wide range of available insulin regimens and glucose monitoring technologies. The Australasian Periprocedural Guideline for Children and Adolescents with Diabetes Mellitus has been co-developed by New Zealand Paediatric Endocrine Society, Australia and New Zealand Society for Paediatric Endocrinology and Diabetes, Society for Paediatric Anaesthesia in New Zealand and Australia, and consumer representatives. The guideline emphasises the importance of involving individuals with diabetes and their caregivers in the development of management plans, adopting a multidisciplinary approach when appropriate. It provides detailed guidance on procedure classifications, the perioperative use of existing continuous glucose monitors and insulin pumps, fasting protocols, perioperative intravenous fluid and insulin administration, and hypoglycaemia management strategies. By adhering to this guideline, healthcare providers can deliver safe, comprehensive, and patient-centred care throughout the periprocedural period.

Background: Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder characterized by the interrelated dysfunction of metabolic abnormalities, chronic kidney disease, and cardiovascular injury, significantly increasing the risk of cardiovascular events and all-cause mortality. Insulin resistance (IR) plays an important role in the development and progression of CKM syndrome, but the relationship between estimated glucose disposal rate (eGDR) and mortality risk in CKM syndrome patients remains unclear, particularly across different glucose metabolic states.

Methods: This cohort study used data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) for CKM syndrome patients. We employed Cox regression and restricted cubic spline (RCS) analysis to assess the relationship between eGDR and mortality. Stratified analyses by glucose metabolism status and ROC curves compared the predictive performance of eGDR with TyG and HOMA-IR.

Results: eGDR was significantly associated with all-cause and cause-specific mortality (P < 0.05). RCS analysis revealed a nonlinear relationship between eGDR and all-cause (P for non-linear = 0.041) and diabetes-specific mortality (P for non-linear = 0.003), while a linear relationship was found with cardiovascular mortality P for non-linear = 0.278). Stratified analysis showed eGDR's strongest predictive value for all-cause mortality in diabetes, cardiovascular mortality in prediabetes, and multiple mortality outcomes in normal glucose regulation (all P < 0.05). ROC analysis demonstrated superior predictive performance of eGDR compared to TyG and HOMA-IR, especially in the CKM syndrome and normal glucose regulation groups.

Conclusion: Lower eGDR levels were independently associated with increased risks of all-cause, cardiovascular-specific, and diabetes-specific mortality in CKM syndrome patients. The relationship between eGDR and mortality was nonlinear for some outcomes. eGDR showed superior predictive performance, especially in individuals with normal glucose regulation and prediabetes, suggesting its potential as a biomarker for risk re-stratification and early intervention in CKM syndrome.

Clinical trial number: Not applicable.

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.