Endokrynologia Polska最新文献

Introduction: Nephrolithiasis is a common complication of primary hyperparathyroidism (PHPT), but the mechanisms underlying stone formation remain incompletely understood. Calcium-sensing receptor (CaSR) activity, indirectly assessed by serum calcitriol levels and urinary excretion of calcium and magnesium, may influence the risk of nephrolithiasis. Current diagnostic methods are cumbersome, prompting the need for more practical biomarkers. This study aimed to evaluate a novel parameter - calcium and magnesium fractional excretion (CAMFE) - as a predictor of nephrolithiasis risk in patients with PHPT.

Material and methods: A retrospective analysis was conducted on 109 patients with PHPT. CAMFE was calculated from 24-hour urine collection under a standard diet. Associations with nephrolithiasis were analyzed using logistic regression and receiver operating characteristic (ROC) curve analysis.

Results: Nephrolithiasis was present in 40% of patients. The CAMFE index was correlated significantly with kidney stone formation. Calcitriol levels were higher in stone formers, supporting its role in enhanced intestinal calcium absorption. CAMFE showed good predictive power with an optimal cut-off value of 6.18, offering a simpler alternative to dual urine collection protocols.

Conclusions: Low CAMFE (< 6.18) may be connected with a higher risk of nephrolithiasis, potentially serving as a useful marker for assessing the risk of renal complications in patients with PHPT.

Introduction: Type 2 diabetes mellitus (T2DM) is a frequent comorbidity in differentiated thyroid cancer (DTC). This study evaluated the impact of glycemic control, particularly glycated hemoglobin (HbA1c) levels, on tumor characteristics and treatment outcomes.

Material and methods: We retrospectively analyzed 302 DTC patients, including 58 (19.2%) with T2DM. Baseline demographic, clinical, and pathological data were collected. Treatment response was assessed as per American Thyroid Association (ATA) guidelines. Logistic regression identified predictors of non-excellent response, and a subgroup analysis was performed among diabetic patients stratified by HbA1c (< 7% vs. ≥ 7%).

Results: T2DM patients were older (p < 0.001), with more bilateral tumors (p = 0.047) and higher tumor foci (p = 0.039). Other tumor features were similar between groups. In multivariate analysis, both HbA1c[odds ratio (OR): 1.307, 95% confidence interval (CI): 1.014-1.683, p = 0.038) and lymph node metastasis (OR: 3.932, 95% CI: 1.000-15.464, p = 0.050] independently predicted non-excellent response. Among diabetics, HbA1c ≥ 7% was associated with higher non-excellent response rates (p = 0.030).

Conclusion: Poor glycemic control, rather than T2DM itself, was linked to suboptimal treatment response. HbA1c may serve as a simple prognostic marker in diabetic patients with DTC.

Introduction: Neuroendocrine neoplasms of the breast (Br-NENs) constitute a heterogeneous group of rare tumors, whose number may be underestimated. Our study aims to evaluate and compare the analysis of the radiological features of Br-NEN and carcinomas with neuroendocrine differentiation (NEDBC), which were visualized in contrast-enhanced mammography (CEM) images.

Material and methods: The histories of patients who, between 2015 and 2023, underwent CEM and core needle biopsy/postoperative histopathological examination confirming the nature of the lesion were retrospectively analyzed. All CEM images were acquired on two digital mammograms designed for dual-energy CEM acquisition (SenoBright et al., 3000 N. Grandview Blvd., Waukesha, WI, USA and Giotto Class, IMS Giotto, Sagittario, 5, 40037 Sasso Marconi BO, Italy). Two radiologists with at least eight years of experience describing CEM analyzed the studies and classified them into appropriate morphological categories.

Results: Ten patients with histopathologically diagnosed Br-NEN and 14 with NEDBC were retrospectively assessed. The mean age of patients at the time of diagnosis of Br-NEN was 56.5 years, and for NEDBC it was 67.4 years. All Br-NEN lesions and 93% of NEDBC lesions were observed as masses on low-energy CEM images. In the Br-NEN group, lesions most often had an oval shape (40%), while NEDBC lesions were irregular (43%) and obscure (43%). Multifocality and multicentricity of the tumor process were observed much more often in the Br-NEN group than in the NEDBC group. In the recombinant images, all lesions from the two groups were enhanced after intravenous administration of the iodinated contrast agent.

Conclusion: Br-NEN and NEDBC show similar radiological features on CEM images, differing only in a few aspects.

Introduction: To investigate the relationship between thyroglobulin (Tg) levels obtained from thyroid fine-needle aspiration (FNA) and cytopathological results.

Material and methods: This cross-sectional study included patients who underwent FNA between January 2023 and August 2024 in accordance with the American College of Radiology Thyroid Imaging Reporting and Data System risk scoring. Patients with pure cystic nodules, non-thyroid malignancy, and major psychiatric disorders that could interfere with compliance during the procedure were excluded from the study. FNA-Tg samples were obtained from the nodules using a 22-gauge needle on the first attempt. FNA-Tg levels were then measured by electrochemiluminescence immunoassay. These levels were compared among different patient groups and classified according to the cytopathological examination results based on the Bethesda System for Reporting Thyroid Cytopathology. Statistical analyses were performed using the Statistical Package for the Social Sciences, version 20.

Results: The study included 193 FNA samples in 193 patients. In 148 (76.7%) out of 193 samples the aspirate was diagnostic. Of these, 101 (68.2%) were benign (Bethesda II), 29 (19.6%) were indeterminate (Bethesda III-IV), and 18 (12.2%) were malignant (Bethesda V-VI). FNA-Tg levels were significantly higher in benign nodules compared to malignant ones (p < 0.001). There was no significant difference between concomitant serum Tg levels in patients with benign and malignant nodules (p = 0.614). An FNA-Tg value above 13,262 ng/mL predicted benign cytology with 71.3% sensitivity and 77.8% specificity.

Conclusions: FNA-Tg levels may provide valuable insights into FNA cytology and serve as an effective marker for distinguishing benign nodules from those with malignant characteristics.

Introduction: Medullary thyroid cancer (MTC) is characterized by overexpression of cholecystokinin-2/gastrin receptors (CCK2R). There are limitations of calcitonin as a tumor marker in MTC diagnosis and prognosis. Procalcitonin is gaining a role as a complementary tumor marker. This study aimed to assess the feasibility of procalcitonin measurements on top of the calcitonin measurements after CCK2R agonist stimulation in patients with MTC.

Material and methods: The assessment was part of the GRAN-T-MTC translational study conducted through a Phase I multicenter clinical trial in patients with locally advanced and/or disseminated MTC. Patients were administered intravenously the CCK2R agonist CP04 labelled with indium-111 ([¹¹¹In]In-CP04); the first four patients at a lower mass amount of 10 μg, and afterwards the whole group at a higher mass amount of 50 μg. Blood samples for calcitonin and procalcitonin measurements were obtained shortly before and 2, 5, 10, and 20 minutes after start of [¹¹¹In]In-CP04 administration.

Results: Sixteen patients were included in the study. After injection of the higher mass amount of [¹¹¹In]In-CP04, the median maximum ratio for stimulated calcitonin was 2.97 (interquartile range [IQR] 2.35) pg/mL and procalcitonin 2.01 (IQR 2.07) pg/mL. The maximum stimulated/baseline calcitonin ratio was 5.2 ± 4.0 and 4.1 ± 3.8 in the low and high mass amount groups, respectively, and the maximum stimulated/baseline procalcitonin ratio was 4.6 ± 5.1 and 2.9 ± 3.1 in the low and high mass amount groups, respectively. There was a significant linear correlation between calcitonin and procalcitonin concentrations (p < 0.001) at each test time point and between the maximum procalcitonin and maximum calcitonin increment ratio (r = 0.94, p < 0.0001). Mild, short-lasting side effects (transient tachycardia, flushing) were observed in one patient during the injection of low and in two patients during the injection of high mass amount of [¹¹¹In] In-CP04. The side effects were not related to the baseline calcitonin or procalcitonin concentrations.

Conclusion: Procalcitonin concentrations after CP04 stimulation were highly correlated with calcitonin concentrations. Unlabeled CP04, if available commercially, may be considered an alternative stimulating agent in MTC patients, even in lower mass amounts. Further studies, including healthy controls, are required to prove this concept and calculate the diagnostic thresholds.

Introduction: Steroid metabolomics in neonatal populations is challenged by considerable physiological heterogeneity and technical variability, which complicate the interpretation and comparability of metabolite profiles. Effective normalization strategies are essential to ensure accurate data analysis in this context.

Material and methods: We analyzed 24-hour urinary steroid profiles in a cohort of 50 neonates (including very preterm, late preterm, and full-term infants) using gas chromatography-mass spectrometry. Two normalization techniques were compared: probabilistic quotient normalization (PQN) and peer group normalization (PGN). Normalization performance was assessed via distribution metrics, correlation with anthropometric variables, and principal component analysis (PCA).

Results: PGN achieved superior distributional normalization, with 27 of 30 metabolites conforming to normality assumptions, compared to 21 using PQN. PGN also eliminated all significant correlations between steroid levels and anthropometric parameters, indicating effective reduction of physiological confounding. In contrast, PQN partially mitigated such associations but was less robust in handling high-abundance metabolites. PCA confirmed improved sample dispersion and group separation after normalization, with method-dependent differences in Scores Plot.

Conclusions: Peer group normalization is a sophisticated approach to reducing physiological variability in neonatal steroid profiling. These observations lend further credence to PGN as a promising strategy for standardizing steroid metabolomics in the field of neonatology. Nevertheless, further validation is necessary to substantiate these findings.

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Obesity, regardless of age, is associated with various metabolic disorders. Amino acids, as essential food ingredients, play a critical role in regulating glucose and energy metabolism. Thus, their plasma concentrations may reflect the metabolic state of the individual. This narrative review aims to find out similarities in plasma amino acid profiles across the selected obese individuals (children, adolescents, and adults). An analysis of 21 original studies revealed similar amino acid alterations regardless of the age group- in particular, elevated levels of branched-chain amino acids (BCAAs: isoleucine, leucine, valine), tyrosine, glutamic acid, alanine, and proline, as well as decreased concentrations of glutamine, serine, glycine, and asparagine. These findings suggest the presence of a common, age-independent metabolic signature of amino acids in obesity. Such changes may reflect impaired amino acid catabolism and have been linked to insulin resistance, increased risk of type 2 diabetes risk, and other metabolic complications. There is a need to establish age- and population-specific reference values for plasma amino acids to use amino acid profiling as a diagnostic and prognostic tool management of obesity. Accurate plasma amino acid profile measurements could support early detection of obesity-related metabolic disturbances and the implementation of targeted nutritional and therapeutic strategies.