Endokrynologia Polska最新文献

Introduction: Patients with type 2 diabetes mellitus (T2DM) have a higher risk of fracture, higher visceral fat, and lower muscle mass. The combined effect of skeletal muscle mass and visceral fat area [skeletal muscle mass to visceral fat area ratio (SVR)] on bone mineral density (BMD) and fracture risk in T2DM patients is still unknown.

Materials and methods: A cross-sectional study was performed on 422 patients. The associations between SVR with BMD and the 10-year probability of fractures [included major osteoporotic fracture (MOF), and hip fracture (HF)] were analyzed using R studio 4.2.3. Generalized additive models (GAMs) were used to identify the associations between SVR and BMD and fracture risk.

Results: There was a lower SVR in patients with osteoporosis/osteopenia than in controls. SVR was an independent determinant for BMD and MOF and HF, and SVR was positively associated with BMD and negatively associated with 10-year fracture risk in non-elderly men or elderly women with T2DM. SVR had an approximately positive linear association with BMD in elderly males and females, and it had an N-shaped curve association with BMD in non-elderly males. In addition, the associations between SVR and MOF/HF were negative linear in females and elderly men, and non-linear in non-elderly men.

Conclusion: Our study provided a novel viewpoint on the relationship between SVR and BMD/fracture risk. Relatively high SVR is a protective factor for bone in T2DM patients, but the osteoprotective effect of SVR was mediated by age and gender, and it persisted only in non-elderly men and elderly women with T2DM.

Introduction: Current studies have identified a close connection between the gut microbiota (GM) and autoimmune thyroid disease (AITD), indicating that the dysregulation of the GM could play a crucial bridging role in AITD. However, the causality between them has not been definitively defined.

Material and methods: We utilized the summary statistics of GM from the largest available meta-analysis of genome-wide association studies conducted by the MiBioGen consortium. The data on AITD were derived from the Genome-Wide Association Study (GWAS) database. We investigated the causality between GM and AITD through various analytical methods in a bidirectional Mendelian randomization (MR) analysis. This encompassed methods like inverse variance weighted, MR-Egger, weighted median, weighted mode, and simple mode.

Results: Our findings revealed a protective effect of genus Methanobrevibacter [odds ratio (OR) = 0.791, p = 0.044], order Rhodospirillales(OR = 0.775, p = 0.019) on Graves' disease (GD). However, the family Clostridiales vadin BB60 group (OR = 1.222, p = 0.038), genus Anaerofilum (OR = 1.243, p = 0.038), genus Barnesiella (OR = 1.405, p = 0.021), genus Intestinibacter (OR = 1.777, p = 0.000), and order NB1n (OR = 1.270, p = 0.003) were identified as risk factors for GD. In addition, family Alcaligenaceae (OR = 0.691, p= 0.004), family Rhodospirillaceae (OR = 0.813, p = 0.013), genus Butyrivibrio (OR = 0.877, p = 0.019), genus Prevotella 7 (OR = 0.835, p = 0.026), genus Ruminococcaceae UCG011 (OR = 0.883, p = 0.032), genus Ruminococcaceae UCG013 (OR = 0.797, p = 0.048), and order Lactobacillales (OR = 0.759, p = 0.009) had a protective effect on Hashimoto's thyroiditis (HT). Genus Intestinimonas (OR = 1.247, p = 0.010) was a risk factor for HT. Based on the findings from the reverse MR analysis, AITD did not exert a significant causal influence on the GM. There waere no observed remarkable instrumental variables of heterogeneity or horizontal pleiotropy.

Conclusion: Our study offered evidence of causal relationship between certain GM and AITD using two-sample MR analysis. This may provide novel perspectives on diagnosis and latent therapeutic targets for AITD.

Bone mineral density is the primary basis for the diagnosis of osteoporosis. Bone mineral density measurement methods include dual-energy X-ray (DXA) and quantitative computed tomography (QCT). Based on traditional bone density detection equipment, the newly developed imaging detection technology can further detect the microstructures and geometric features of bones, providing important reference for exploring the pathophysiological changes, sensitive clinical diagnosis, and disease monitoring of osteoporosis.

Introduction: Osteoporosis is one of the most common diseases in elderly subjects. Accurate assessment of fracture risk is essential in the management of osteoporotic patients. The aim of the study was to present the optimal manner of using a method designed for fracture risk prediction, e.g. POL-RISK, in daily practice.

Material and methods: Methods for fracture prediction were presented, especially those which allow easy and quick online assessment. In addition to true medical aspect, e.g. the ability to accurately detect high fracture risk patients who need therapy, the economic aspects were also presented. Due to the enormous number of osteoporotic patients the therapy should be indicated mainly in patients with high fracture risk. The optimal threshold of fracture risk for the initiation of reimbursed therapy should be established as a compromise of prior established medical threshold and economic aspects. The expected endpoint is the reduction of new fractures noted in longitudinal observation.

Conclusion: Implementation of the described scenario should enable the development of the optimal model of care in osteoporotic subjects. Broad use of fracture risk thresholds to initiate reimbursed therapy, encompassing both true medical and economic aspects, should result in the reduction of osteoporotic fractures and decrease overall osteoporosis-related costs to the healthcare system.

Not required for Clinical Vignette.

Background: Primary hyperparathyroidism (PHPT) is a relatively common disease with considerable heterogeneity. We aimed to assess the impact of age, gender, and body mass index (BMI) on the presentation of PHPT.

Material and methods: We retrospectively analyzed the baseline biochemical status, symptoms, renal manifestations, and bone mineral density (BMD) of patients diagnosed with PHPT at the national tertiary endocrine referral clinic from January 2004 to December 2016.

Results: We included 415 patients (333 women [41 premenopausal, 292 postmenopausal] and 82 men) with PHPT, aged 64 years on average [standard deviation (SD)13, range 19-89 years], with an average BMI of 28.4 (SD 6.0, range 11.2-51.1 kg/m²). Older age was statisticallysignificantly associated with milder biochemical presentation - lower total and corrected calcium (standardized regression coefficient β = -0.17, p < 0.001 and β = -0.12, p = 0.018). In comparison with premenopausal women, postmenopausal women [estimated odds ratio (OR) = 8.6, 95% confidence interval (CI): 3.9-20.8; p < 0.001] and men (OR = 5.9, 95% CI: 2.5-15.6; p < 0.001) were more likely to suffer from skeletal manifestations of PHPT. Renal manifestations were less likely among postmenopausal than premenopausal women (OR = 0.4, 95% CI: 0.2-0.8; p = 0.014). BMI was negatively associated with skeletal and renal manifestations (OR = 0.94 per unit change, p = 0.002) and symptomatic presentation (OR = 0.96 per unit change, p = 0.012).

Conclusion: Older patients with PHPT presented with a biochemically less florid disease. Postmenopausal women and men with PHPT were more likely to suffer from skeletal manifestations of PHPT than premenopausal women. Patients with higher BMI had fewer skeletal and renal manifestations of PHPT and were less likely to be symptomatic.

Introduction: No study has specifically investigated the correlation between stress hyperglycemia ratio (SHR) and mortality in critically ill patients across different glucose metabolic status and diabetes mellitus (DM) subtypes.

Material and methods: Analysis was conducted using the Medical Information Mart for Intensive Care-IV 2.2 database.

Result: In this study, a total of 73,181 intensive care unit (ICU) patients were included, among whom 33,683 critically ill patients were included in the final analysis. Logistic model analysis revealed that the SHR was associated with elevated mortality rates in the ICU and in-hospital among patients with type 2 diabetes mellitus (T2DM) and those in the ICU with different glucose metabolism status, particularly in individuals with prediabetes mellitus (Pre-DM) and normal glucose regulation (NGR). In the Cox proportional hazards model, SHR was linked to an increased risk of one-year mortality, particularly among critically ill patients with Pre-DM. Mediation analysis revealed that the high SHR could account for 14.0% and 11.3% of the increased risk of ICU death and in-hospital mortality associated with DM, respectively.

Conclusion: SHR is correlated with both short-term and long-term mortality in critically ill patients across various glucose metabolism status, particularly evident in those with NGR and Pre-DM. Moreover, SHR demonstrates an elevated risk of short-term and long-term mortality in critically ill patients with T2DM. Additionally, SHR plays a mediating role in the association between DM and mortality.

Introduction: Hashimoto's thyroiditis (HT) is the most common organ-specific autoimmune disorder. It is a chronic lymphocytic infiltration into the thyroid gland and is characterized by the production of anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb). HT is a polygenic disease with an incompletely defined etiopathogenesis. It affects 0.3-1.5/1000 subjects/year and is 4-10 times more frequent in women than in men (3.5-5/1000 subjects/year in women versus 0.6-1.0/1000 subjects in men).

Material and methods: The study group included 482 females of childbearing age (18-45 years). The group was divided into 3 subgroups: (147 - healthy individuals, 152 - hypothyreosis, 183 - HT). All patients were recruited in a 24-months period from the Cardiometabolic Center Gierach-Med in Bydgoszcz, Poland, and the Department of Endocrinology and Diabetology Collegium Medicum University of Nicolaus Copernicus in Bydgoszcz, Poland, and provided verbal consent to participate in the study.

Results: We noticed that a lower level of ferritin was connected with a higher level of thyroid-stimulating hormone (TSH) in each of the subgroups. Additionally, we marked the correlation between ferritin and TSH and anti-thyroid antibodies (TPOAb and TgAb). There was a strong, negative correlation between TSH and ferritin level in all the study groups. Moreover, there was a weak, negative correlation between anti-TPO, anti-TG, and ferritin level in females with HT.

Conclusions: To sum up, we believe that hypothyroidism, especially in the course of Hashimoto's disease, leads to an increased risk of iron and ferritin deficiency and requires monitoring of these parameters.

Not required for Clinical Vignette.

Introduction: Primary hyperparathyroidism (PHPT) is caused by excessive hormone secretion from one or more parathyroid glands. Based on their morphological and immunophenotypic characteristics, parathyroid glands can be considered as neuroendocrine organs, and their neoplasms as neuroendocrine tumors. The 2022 World Health Organization (WHO) Classification of Endocrine and Neuroendocrine Tumors introduced updated diagnostic criteria, advancing the understanding of parathyroid neoplasms. This study aimed to analyze the clinicopathological features of PHPT, emphasizing tumor localization and histopathological findings.

Material and methods: The retrospective study analyzed 39 surgically treated patients for PHPT at a single tertiary referral center between 2022 and 2024. Localization methods included neck ultrasonography (US), technetium-99m methoxyisobutylisonitrile single photon emission computed tomography/computed tomography ([99mTc]Tc-MIBI SPECT/CT), and ¹⁸F-fluorocholine positron emission tomography/computed tomography (¹⁸F-FCH PET/CT). Postoperative histopathological evaluation of specimens was conducted according to the 2022 WHO criteria.

Results: The cohort comprised 85% female patients with a mean age of 57.8 years. Lower parathyroid glands were more frequently affected, reflecting their distinct embryological origins. Pathological analysis identified 77.5% parathyroid adenomas (PA), 12.5% atypical parathyroid tumors (APT), and 7.5% parathyroid carcinomas (PC), with the incidence of APT and PC exceeding reported ranges. PET/CT showed superior diagnostic accuracy (100% detection) compared to neck US (65.8%) and [99mTc]Tc-MIBI SPECT/CT (65.7%). Maximum standardized uptake value (SUVmax) from PET/CT significantly correlated with serum calcium, PTH concentration, and lesion volume, suggesting their utility as markers of metabolic activity. Surgery achieved a 92.3% cure rate, with successful reoperations in all recurrent cases.

Conclusions: The study underscores the neuroendocrine nature of parathyroid glands, highlights the diagnostic value of the updated WHO classification, and demonstrates the superior accuracy of 18F-FCH PET/CT in localizing parathyroid lesions. A deeper understanding of the neuroendocrine characteristics of parathyroid glands and their embryological migration patterns could further improve diagnostic and therapeutic strategies. Early diagnosis and precise localization of affected parathyroid glands remain critical for achieving curative outcomes in PHPT.