Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association最新文献

Currently, no data are available using standardized instruments for evaluating the postpartum mental health of women with previous bariatric surgery. The aim of this pilot study was to assess postpartum mental health in women following bariatric surgery and to establish appropriate tools for a prospective registry study in the future. In this survey, the mental health of 22 women during the first weeks postpartum was examined (T1) and their status at least 6 months after childbirth was prospectively assessed (T2). Symptoms of depression and anxiety were evaluated with standardized questionnaires and depression was diagnosed with structured diagnostic interviews (SCID-5). At T1, 3/22 women (14%) reported depressive or anxiety symptoms, and in these women, the diagnosis of depression was established. In comparison with T1, at T2, symptomatology for depression or anxiety increased to 32% and 27% of patients, respectively, but only one woman was diagnosed with depression. In comparison to patients without symptoms, patients with signs of depression or anxiety or both had lower total body weight loss and, more often, a personal or family history of depressive disorders. Our pilot study suggests that the rate of postpartum depression in women after BS might be higher than in the general population. High symptom levels of depression and anxiety emphasize the necessity of long-term bariatric follow-up care. Further research is needed to evaluate if prevalence of depression or anxiety disorder or both is higher in this patient group as compared to other patients after bariatric surgery.

The impact of different drinking solutions used for an oral glucose tolerance test (oGTT) on 2-h glucose values and gastrointestinal side effects are not clear. This study compared a commercially produced solution (Accu-Chek Roche solution) and a standardized pharmacy solution (NRF 13.8. oGTT solution) within the German National Cohort (NAKO), including the assessment of gastrointestinal symptoms.The Accu-Chek Roche solution comprises mono- and oligosaccharides with blackcurrant juice for enhanced flavor. The NRF 13.8. oGTT solution contained glucose monohydrates only, with citric acid to maintain the pH for preservation, and did not include flavor enhancers. Within a subgroup of the NAKO participants obtaining a standardized 75g oGTT, 818 participants each received the Accu-Chek Roche solution and the NRF 13.8. oGTT solution matched by study center, sex, age, body mass index, and fasting glucose values. Intra-class correlations for 2-h glucose values were calculated and agreement evaluated with Bland-Altman plots; additionally, coefficients of variation and their difference were estimated for the two solutions.The mean difference of the 2-h glucose concentrations between the Accu-Chek Roche and NRF 13.8. oGTT solution was - 3.4 [95% CI - 6.1; - 0.9] mg/dL. The Bland-Altman plot showed increasing variability of differences with increasing 2-h glucose concentrations without a systematic pattern. The intra-class correlations of 2-h glucose values within matched pairs were 22% [95%CI: 16%; 29%]. The coefficients of variation for 2-h glucose observed with the Accu-Chek Roche and NRF 13.8. oGTT solutions were 25% [24%; 27%] and 25% [23%; 26%], respectively, with a difference of 1% [- 1%; 3%]. Nausea or vomiting were observed in<0.1% of matched participants with no differences between the solutions.The differences in 2-h glucose values and frequency of acute gastrointestinal side effects were not clinically different in participants following the consumption of the Accu-Chek Roche or the NRF 13.8. oGTT solutions.

Ocular motor mononeuropathies affect cranial nerves III, IV and VI and are more frequent in diabetes mellitus, with oculomotor nerve involvement being predominant. This narrative brief review discusses the clinical manifestations, diagnosis and management of ocular motor mononeuropathies in subjects with diabetes. Clinical manifestations often include ptosis, diplopia, and periorbital pain. Pupillary sparing is a characteristic of third nerve palsy. Differential diagnosis may be challenging due to overlapping symptoms with nerve palsies of other aetiologies. Treatment includes optimised glycaemic control and management of vascular risk factors. Neuroprotective agents, mainly alpha-lipoic acid and botulinum toxin A have been occasionally used, as well. Spontaneous recovery is seen in many cases.

Diabetes mellitus (DM) is one of the fastest growing diseases in terms of global incidence and seriously affects cognitive function. The incidence rate of cognitive dysfunction is up to 13% in diabetes patients aged 65-74 years and reaches 24% in those aged >75 years. The mechanisms and treatments of cognitive dysfunction associated with diabetes mellitus are complicated and varied. Previous studies suggest that hyperglycemia mainly contributes to cognitive dysfunction through mechanisms involving inflammation, autophagy, the microbial-gut-brain axis, brain-derived neurotrophic factors, and insulin resistance. Antidiabetic drugs such as metformin, liraglutide, and empagliflozin and other drugs such as fingolimod and melatonin can alleviate diabetes-induced cognitive dysfunction. Self-management, intermittent fasting, and repetitive transverse magnetic stimulation can also ameliorate cognitive impairment. In this review, we discuss the mechanisms linking diabetes mellitus with cognitive dysfunction and propose a potential treatment for cognitive decline associated with diabetes mellitus.

Several ultrasound-based risk stratification systems (RSSs) have been developed and introduced into clinical practice for managing thyroid nodules. However, there are essential differences among these systems. This study aimed to determine and compare the category-based diagnostic performance of four ultrasound-based risk stratification systems in the detection of thyroid cancer: ACR-TIRADS, ATA, K-TIRADS, and EU-TIRADS.This study included 4238 nodules sampled by fine-needle aspiration biopsy between January 2018 and December 2021. Nodules were classified according to ultrasound imaging features and correlated with biopsy results. The diagnostic success of the risk stratification systems was evaluated and compared.Of the 4238 nodules, 3861 (91.1%) were benign and 376 (8.9%) were malignant. Malignancy was significantly higher in hypoechoic and marked hypoechoic nodules (p=0.001), and solid nodules (p=0.002). For detection of malignancy, areas under the receiving operator characteristics curves were 0.862, 0.850, 0.842, and 0.835 for 2017 ACR-TIRADS, EU-TIRADS, for K-TIRADS, and 2015 American Thyroid Association guidelines, respectively. EU-TIRADS showed the highest sensitivity (91%), whereas ACR-TIRADS had the highest specificity (87%). Compared to other risk stratification systems, ACR-TIRADS resulted in significantly fewer unnecessary biopsies (p=0.009). All RSSs show high diagnostic accuracy and have their own advantages and disadvantages. When selecting an appropriate RSS, the population, the prevalence of the disease, and gender distribution should be considered.

Purpose:   Familial hypercholesterolemia (FH) is a genetic disorder associated with extremely high levels of low-density lipoprotein cholesterol (LDL-C) and increased incidence of cardiovascular disease. We aimed to evaluate the efficacy and long-term outcomes of lipoprotein apheresis (LA) in the treatment of FH.

Methods:   Cardiovascular events that occurred before and after LA treatment were evaluated by reviewing previous medical records of patients with FH.

Results:   Thirteen patients (female/male: 8/5) were included in this study. The mean Dutch score was 20±4. All patients were treated with a combination of statin and ezetimibe. Before the onset of LA, 8 patients had a history of coronary artery disease, and the median age at onset of cardiovascular disease (CVD) in these patients was 24 years. At the initiation of LA, the median age was 22 years and the mean LDL-C level was 410±130 mg/dL. The mean duration of LA treatment was 13.9±6.9 years. The mean LDL-C levels before and after the latest three LA treatments were 267±63.4 and 71.5±23.4 mg/dL, respectively. The mean reduction in LDL-C levels after LA was 73±8.2%. De novo cardiovascular events occurred in 10 patients during LA treatment; six of these patients had a known history of CVD before LA. Eight of these patients underwent invasive procedures for therapeutic purposes and the total number of procedures was 12.

Conclusion:   LA is an effective method of reducing LDL-C levels and an additional treatment option that may slow disease progression in patients with FH who are at high risk of cardiovascular events.

The issue of a possible association between Shwachman-Diamond Syndrome and diabetes has been debated for many years. This review updates the Italian Shwachman-Diamond registry, confirming our previous findings that suggest that these patients might be at higher risk of developing diabetes, particularly type 1. These data are of relevance in the clinical follow-up of patients in everyday life, emphasizing the need for early diagnosis and timely intervention.

Patients with a hepatic type of glycogen storage diseases (GSDs) can manifest endocrine features such as hypoglycemia, dyslipidemia, or osteoporosis. This study aimed to investigate the long-term endocrine consequences in patients with hepatic GSDs.This study included 64 patients from 52 families with hepatic GSDs including GSD type Ia (41 patients from 37 families), Ib (3 unrelated), III (8 from 6 families), IV (1 patient), and IX (11 from 5 families). All patients were genetically confirmed. Clinical and endocrine findings were retrospectively analyzed.The median age at diagnosis and current age were 2.4 years (range, 0.1-42.4 years) and 17.6 years (range, 1.0-47.8 years), respectively. The mean height SDS at diagnosis was -3.5±1.4, and short stature was observed in 35.6% of patients. Patients diagnosed after the age of 3.4 years exhibited a high risk of short stature (OR=36.1; P-value<0.001). Among 33 patients who reached the final height, 23 (69.7%) showed delayed puberty. Hypertriglyceridemia was observed in 46 patients (71.9%), whereas 25 patients (39%) had elevated low-density lipoprotein cholesterol levels during the follow-up period. Among 24 patients who underwent dual-energy X-ray absorptiometry, 22 showed a low bone mineral density Z-score of -3.0±1.3 at the L-spine.This study described the long-term endocrine consequences in patients with hepatic GSDs. Pediatric endocrinologists should be aware of the presenting features and long-term endocrine sequelae of GSDs to provide proper management and decrease its morbidities.

Introduction: The diagnosis of adrenal insufficiency (AI) related to traumatic brain injury (TBI) remains a challenge. We investigated the basal and low-dose adrenocorticotropic hormone (ACTH)-stimulated serum cortisol and salivary cortisol (SaC) levels and the diagnostic utility of SaC levels during 28 days following TBI.

Materials and methods: Blood samples were collected for basal levels [sequentially from day 1 (D1) to D7 and on D28)] and for peak serum cortisol and SaC responses to the low-dose ACTH stimulation test (on D1, D7, and D28). After the patient enrollment period was completed, patients were retrospectively categorized as AI or AS (adrenal sufficiency) for each day separately, based on a basal serum cortisol cut-off level of 11 µg/dL, and data analysis was performed between the groups.

Results: Thirty-seven patients and 40 healthy controls were included. Median basal serum cortisol levels were higher in patients on D1 but were similar on other days. Median basal SaC levels were higher in patients on D1 and D2 but were similar on other days. Median peak serum cortisol and SaC levels were similar on D1 but were lower in patients on D7 and D28. Median basal SaC levels were higher in the AS group than in the AI group on all days.

Discussion and conclusions: When evaluating AI during the course of TBI, the cut-off for basal SaC levels is 0.5-0.6 µg/dL throughout the first week, except for 1.38 µg/dL on D2. SaC levels may serve as a surrogate marker for accurately reflecting circulating glucocorticoid activity.