The latest medical research on Endocrinology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about endocrinology gathered by our medical AI research bot.
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Effectiveness and Safety of Thermal Ablation in the Treatment of Primary Hyperparathyroidism: A Multicenter Study.Clinical Endocrinology
To evaluate the effectiveness and safety of thermal ablation for primary hyperparathyroidism (pHPT).
From January 2015 to March 2020, data pertaining to patients who received thermal ablation for pHPT at 4 centers were retrospectively analyzed. The median follow-up duration was 18.1months (IQR: 6.5-42.2 months). A cure referred to the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) throughout the entire follow-up period, at least more than 6 months. The technical success, effectiveness, and safety of treatment were analyzed.
119 patients (mean age, 57.2 ± 16.3 years; 81 female) with 134 parathyroid nodules were enrolled. The mean maximum diameter of the parathyroid glands was 1.6 ± 0.9 cm. Ninety-six patients underwent microwave ablation (MWA), and 23 patients underwent radiofrequency ablation (RFA). The technical success rate was 98.3% and the cure rate was 89.9%. Significant differences were found in the maximum diameter between the cured patients and the patients who did not undergo ablation of the target lesions. Except the cases with pHPT nodules<0.6cm in diameter, the cure rate was 95%. There were no difference in cure rates at 6 months between the MWA and RFA (MWA vs. RFA, 90.6% vs. 87.0%; χ2=0.275, p = 0.699). The volume reduction rate of the ablation zone was 94.6% at 12 months. The complication rate was 6.7% (8/119). Except one patient with persistent voice impairment, other symptoms were spontaneously resolved within six months.
Thermal ablation was effective and safe for pHPT.
Properly collected plasma metanephrines excludes PPGL after false positive screening tests.Clinical Endocrinology
False positive results are common for pheochromocytoma/paraganglioma(PPGL) real-world screening.
Determine the correlation between screening urine and seated plasma metanephrines in outpatients where PPGL was absent, compared to meticulously prepared and supine-collected plasma metanephrines with age-adjusted references.
The correlation between urine and seated plasma measures along with the total positivity rate. All cases of plasma metanephrines drawn in the endocrine unit were reviewed for test indication and test positivity rate.
There were 810 non-PPGL pairs of urine and plasma metanephrines in the laboratory database; 46.1% of urine metanephrines were reported high. Of seated outpatient plasma metanephrines drawn a median of 5.9 days later, 19.2% were also high (r=0.33 and 0.50 for normetanephrine and metanephrine, respectively). In contrast, the meticulously prepared and supine collected patients(n=139, 51% prior high urine metanephrines) had <3% rate of abnormal high results in patients without known PPGL/adrenal mass.
There was a poor-to-moderate correlation between urine and seated plasma metanephrines. Up to 20% of those with high urine measures also had high seated plasma metanephrines in the absence of PPGL. Properly prepared and collected supine plasma metanephrines had a false positive rate of <3% in the absence of known PPGL/adrenal mass.
Adolescent Tri-ponderal Mass Index Growth Trajectories and Incident Diabetes Mellitus in Early Adulthood.Clinical Endocrinology
Studies have reported the influence of adolescent obesity on development of adult diabetes, but the effect of the growth pattern during this period has rarely been explored. Also, the tri-ponderal mass index (TMI) was thought to be a better estimation of adolescent body fat levels than the body mass index (BMI), so we sought to investigate whether growth trajectories derived by these two indices could predict incident diabetes.
We conducted a study by using the Taipei City Hospital Radiation Building Database, a longitudinal cohort established from 1996 until now. Physical exam results including blood test results were collected annually and the BMI z-score/TMI growth trajectory groups during 13-18 years of age were identified using growth mixture modeling. A Cox proportional hazard model for incident diabetes was used to examine the risk of baseline obese status and different BMI/TMI growth trajectories.
Five growth trajectory groups were identified for the BMI z-score and the TMI. During approximately 20,400 person-years follow-up, 33 of 1,387 participants developed diabetes. Baseline obesity defined by the BMI z-score and the TMI were both related to adult diabetes. The persistent increase TMI growth trajectory exhibited a significantly increased risk of diabetes after adjusting for baseline obese status and other correlated covariates (hazard ratio: 2.85, 95% confidence interval (CI): 1.01-8.09). There was no association between BMI growth trajectory groups and incident diabetes.
A specific TMI growth trajectory pattern during adolescence might be critical for diabetes prevention efforts.
Preoperative amlodipine is efficacious in preventing intraoperative HDI in pheochromocytoma- pilot RCT.Clinical Endocrinology
Preoperative blockade with α-blockers is recommended in patients with pheochromocytoma/paraganglioma (PPGL). The data on calcium channel blockade (CCB) in PPGL is scarce. We aimed to compare the efficacy of CCB and α-blockers on intraoperative haemodynamic instability (HDI) in PPGL.
In the interim analysis of this monocentric, pilot, open-label, randomized controlled trial, patients with solitary, secretory, and nonmetastatic PPGL were randomized to oral prazosin GITS (maximum 30mg, n=9) or amlodipine (maximum 20mg, n=11). The primary outcomes were the episodes and duration of hypertension (SBP≥160mmHg) and hypotension (MAP<60mmHg) and duration of HDI (hypertension and/or hypotension) as a percentage of total surgical time (from induction of anaesthesia to skin closure).
The median (IQR) episodes (2 [1-3] vs. 0 [0-1], p 0·002) and duration of hypertension (19 [14-42] min vs. 0 [0-3] min, p 0·001) and intraoperative HDI duration (22·85±18.4% vs 2·44±2·4%, CI 8·68-32·14%, p 0·002) were significantly higher in the prazosin GITS arm than the amlodipine arm whereas episodes and duration of hypotension did not differ between the two groups. There was no perioperative mortality whereas one patient had intraoperative ST depression on the electrocardiogram. The drug-related adverse effects were pedal edema (1 in amlodipine), dizziness (1 in prazosin GITS), and tachycardia (6 in prazosin GITS and 3 in amlodipine).
Preoperative blockade with amlodipine is an efficacious alternative to prazosin GITS in preventing intraoperative HDI in PPGL. Larger studies that compare preoperative blockade by amlodipine with other α-blockers like phenoxybenzamine and/or doxazosin in PPGL patients are warranted.
Clinical practice guidelines on the diagnosis and management of polycystic ovary syndrome: A systematic review and quality assessment study.Clinical Endocrinology
Clinical practice guidelines (CPGs) are key instruments to implement the practice of evidence-based medicine. We aimed to evaluate the methodological quality and variations in CPGs recommendations on the diagnosis and management of polycystic ovary syndrome (PCOS).
We searched MEDLINE, EMBASE, and CENTRAL until December 2020 for all evidence-based CPGs and consensus statements on PCOS. We extracted data in duplicate to map clinical recommendations across pre-specified disease domains and assessed CPGs methodological quality of using the AGREE II tool.
We included thirteen PCOS CPGs were published between 2007-2018. CPGs recommendations were mostly focused on screening for and managing metabolic disease (12/13, 92%), followed by cardiovascular risk assessment (10/13, 77%). Mental health (8/13, 62%) and diagnosis in adolescents (7/13, 54%) were the least reported domains. Most CPGs had a high quality for scope and purpose description (12/13, 92%) while stakeholder's involvement and applicability of recommendations to clinical practice were appropriate in only two CPGs (2/13, 15%).We identified inconsistency in recommendations on PCOS diagnosis in adolescents, optimal lifestyle interventions, hirsutism and acne treatments, interventions to reduce the risk of ovarian hyperstimulation syndrome, the frequency and screening criteria for metabolic and cardiovascular disease, and on optimal screening tools for mental health illness in women with PCOS.
Current CPGs on the diagnosis and management of PCOS vary in their scope and methodological quality which may hinder evidence translation into clinical practice. We identified disease domains with existing evidence gap to guide future research and guideline updates.
HDL Containing Apolipoprotein C-III is Associated with Insulin Sensitivity: a Multi-Center Cohort Study.Clinical Endocrinology
HDL in humans is composed of a heterogeneous group of particles varying in protein composition as well as biological effects.
We investigated the prospective associations between HDL subspecies containing and lacking apoC-III at baseline and insulin sensitivity at year 3.
Insulin sensitivity was estimated from an oral glucose tolerance test (OGTT) at baseline and year 3, and by euglycemic-hyperinsulinemic clamp at baseline only. The apolipoprotein concentrations were measured at baseline by a sandwich ELISA-based method.
The two HDL subspecies demonstrated significantly opposite associations with insulin sensitivity at year 3 (p-heterogeneity=0.004). The highest quintile of HDL containing apoC-III was associated with a 1.2% reduction in insulin sensitivity (p-trend=0.02), while the highest quintile of HDL lacking apoC-III was associated with a 1.3% increase (p-trend=0.01), compared to the lowest quintile. No significant association was observed for total HDL, and VLDL and LDL containing apoC-III. ApoC-III contained in HDL was associated with a decrease in insulin sensitivity even more strongly than plasma total apoC-III.
Both HDL containing apoC-III and apoC-III in HDL adversely affect the beneficial properties of HDL on insulin response to glucose. Our results support the potential of HDL-associated apoC-III as a promising target for diabetes prevention and treatment.
Predictive value of serum lipid for intravenous immunoglobulin resistance and coronary artery lesion in Kawasaki disease.Clinical Endocrinology
Intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) prediction are pivotal topic of interests in Kawasaki disease (KD). However, data on the predictive value of lipid profile for both IVIG resistance and CALs are limited.
To investigate the predictive validity of lipid profile for IVIG resistance and CALs in KD.
Validity of lipid profile in predicting IVIG resistance and CALs.
TG was significantly higher whereas TC, HDL-C, LDL-C as well as Apo A were significantly lower in initial IVIG-resistant subjects, with cut-off values of 1.625 mmol/L, 3.255 mmol/L, 0.475 mmol/L, and 1.965 mmol/L and 0.665 g/L, yielding sensitivities of 52%, 70%, 52%, 61%, 50%, and specificities of 68%, 53%, 78%, 71%, 81%, respectively. TC, LDL-C, and Apo A levels were significantly lower in repeated IVIG-resistant subjects, with cut-off values of 3.20 mmol/L, 1.78 mmol/L, 0.605 g/L, producing sensitivities of 91%, 70%, 57% and specificities of 55%, 67%, 70%, respectively. Apo-A level was significantly lower in the CAL group, with cut-off value of 0.805g/L, yielding sensitivity of 66% and specificity of 54%.
Lipid profiles were significantly dysregulated in KD patients suffering IVIG resistance and CALs. Some of them, such as LDL-c and Apo-A, could serve as complementary laboratory markers for predicting both IVIG resistance and CALs.
Serum inflammation-based scores in endocrine tumors.Clinical Endocrinology
Serum inflammation-based scores reflect systemic inflammatory response and/or patients' nutritional status, and may predict clinical outcomes in cancer. While these are well-described and increasingly used in different cancers, their clinical usefulness in the management of patients with endocrine tumors is less known.
A comprehensive PubMed search was performed using the terms "endocrine tumor", "inflammation", "serum inflammation-based score", "inflammatory-based score", "inflammatory response-related scoring", "systemic inflammatory response markers", "Neutrophil-to-lymphocyte ratio", "Neutrophil-to-platelet ratio", "Lymphocyte-to-monocyte ratio", "Glasgow Prognostic Score", "Neutrophil-Platelet Score", "Systemic Immune-Inflammation Index", and "Prognostic Nutrition Index" in clinical studies.
The Neutrophil-to-Lymphocyte Ratio and the Platelet-to-Lymphocyte Ratio are the ones most extensively investigated in patients with endocrine tumors. Other scores have also been considered in some studies. Several studies focused in finding whether serum inflammatory biomarkers may stratify the endocrine tumor patients' risk and detect those at risk for developing more aggressive and/or refractory disease, particularly after endocrine surgery.
In this review, we summarize the current knowledge on the different serum inflammation-based scores and their usefulness in predicting the phenotype, clinical aggressiveness, disease outcomes and prognosis in patients with endocrine tumors. The value of such serum inflammation-based scores in the management of patients with endocrine tumors has been emerging over the last decade. However, further research is necessary to establish useful markers and their cut-offs for routine clinical practice for individual diseases.
Successful delivery in 17,20-lyase Deficiency.Clinical Endocrinology
To study and describe the achievement of successful pregnancy and delivery in a patient with 17,20-lyase deficiency.
Clinical pregnancy, successful delivery.
Isolated 17,20-lyase deficiency is caused by mutations in the CYP17A1 gene (coding for cytochrome P450c17), POR (coding for cytochrome P450 oxidoreductase) and CYB5A (coding for microsomal cytochrome b5) genes. A 24 yo patient with 17,20-lyase deficiency had undergone IVF with gonadotropin releasing hormone agonist (GnRHa) protocol, prednisone, and gonadotropins. After human chorionic gonadotropin (hCG) trigger 37 oocytes were retrieved, 25 ova fertilized, and 17 embryos cryopreserved. After menstrual bleeding, the endometrium was stimulated with oral estradiol, under progesterone suppression with long acting GnRHa and prednisone. When endometrial width of 8.5 mm was reached, vaginal progesterone was added, while gradually decreasing prednisone. On the fourth day of progesterone supplement, two thawed embryos were transferred. After 11 days of human menopausal gonadotropin (hMG), estradiol concentration moderately increased, but progesterone levels remained high, therefore, no fresh ET was performed. Twelve days after thawed ET, hCG was positive, and seven days later, an intrauterine gestational sac was detected, but the pregnancy ended in missed abortion. After two months, another frozen-thawed embryo transfer (FET) was performed, generating a normal gestation, which ended in successful delivery.
Pregnancy can be achieved in patients with 17,20-lyase deficiency, by IVF, freezing all embrya, and ET in a subsequent cycle, while suppressing endogenous ovarian progesterone with a GnRHa and adrenal suppression with high dose glucocorticoids.
Maternal adiposity and energy balance after normotensive and preeclamptic pregnancies.Clinical Endocrinology
Preeclampsia is a major pregnancy complication associated with long-term maternal cardiometabolic disease. Research generally is focused on metabolic and pathophysiological changes during pregnancy, however, there is much less focus on the early postpartum period in subjects who suffered preeclampsia. The aim of this study was to (a) characterise energy intake and expenditure six months following normotensive and preeclamptic pregnancies, and (b) examine associations between energy balance, body composition, insulin resistance measures (HOMA-IR), and clinical characteristics.
A cross-sectional study six months following normotensive (n=75) and preeclamptic (n=22) pregnancies was performed. Metabolic measurements included: anthropometrics measures, body composition via bioelectrical impedance analysis, 24-hour energy expenditure via SenseWear Armbands, energy intake via a three-day food diary, and serum metabolic parameters.
Six months following preeclampsia, women had a significantly higher weight (77.3±20.9kg versus 64.5±11.4kg, p=0.01), fat mass percentage (FM%) (40.7±7.4% versus 34.9±8.1%, p=0.004), and insulin resistance (HOMA-IR 2.2±1.5 versus 1.0±0.7, p=0.003), as well as reduced HDL levels (1.5±0.4 mmol/L versus 1.8±0.4 mmol/L, p=0.01) compared to normotensive women. Women post-preeclampsia had lower activity-related energy expenditure (p=0.02) but a decreased total energy intake (p=0.02), leading to a more negative energy balance compared to their normotensive counterparts (-1,942 kJ/24-hours versus -480 kJ/24-hours; p=0.02).
Increases in insulin resistance and FM%, reduced HDL, and more sedentary lifestyles characterise the postpartum period following preeclamptic compared with normotensive pregnancies. Early post-preeclampsia interventions, such as lifestyle behaviour change, should be implemented and assessed to determine whether they reduce long-term cardiometabolic risk in women who experienced preeclampsia during pregnancy.
Clinical and hormonal profiles correlate with molecular characteristics in patients with 11β-hydroxylase deficiency.Clinical Endocrinology
Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and non-classic 11βOHD (NC-11βOHD).
To characterize a multicenter pediatric cohort with 11βOHD.
The clinical and biochemical characteristics were retrospectively retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls.
102 patients (C-11βOHD; n=92, NC-11βOHD; n=10) from 76 families (46,XX; n=53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female adult height was 152 cm (-1.85SDS) and male 160.4 cm (-2.56SDS).None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%) and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs. 6.9 years, p<0.0001), had higher bone age-to-chronological age (p=0.04) and lower adult height (-2.46 vs. -1.32SDS, p=0.05). The concentrations of 11-oxygenated androgens and 21-deoxycortisol were low in all patients. The baseline ACTH and stimulated cortisol were normal in NC-11βOHD. Baseline cortisol, cortisone, 11-deoxycortisol, 11-deoxycorticosterone and corticosterone concentrations, and 11-deoxycortisol/cortisol, 11-deoxycorticosterone/cortisol and androstenedione/cortisol ratios were higher in C-11βOHD than NC-11βOHD patients (p<0.05). The 11-deoxycortisol/cortisol ratio >2.2, <1.5 and <0.1 had 100% specificity to segregate C-11βOHD, NC-11βOHD and control groups.
NC-11βOHD can escape from clinical attention due to relatively mild clinical presentation. However, steroid profiles enable the diagnosis, differential diagnosis, and subtyping of 11βOHD.
Psychological distress and sleep disturbance throughout thyroid nodules screening, diagnosis and treatment.Clinical Endocrinology
Many controversies exist regarding screening and treatment of thyroid cancer (TC), especially papillary thyroid microcarcinoma (PTMC). The aim of this study was to evaluate patients' psychological distress and sleep disturbance throughout thyroid nodules (TNs) screening, diagnosis and treatment.
A total of 2834 participants (1153 participants with TNs) were enrolled during the screening phase, and 1105 individuals with TNs (87 individuals with TC) were enrolled during the diagnosis phase. Of the 87 TC patients, 66 underwent immediate operation (OP), and 21 patients with PTMC opted for active surveillance (AS). Four validated scales were applied to quantify the outcome indicators at prescreening, postscreening, postdiagnosis and posttreatment.
Higher psychological distress and sleep disturbance were found postscreening than prescreening in subjects with TNs, but no differences in those absence of nodules. Compared to postscreening, higher scores of psychological distress and sleep disturbance were identified in patients with suspicious TC treated with fine needle aspiration (FNA) or AS. Lower psychological distress and sleep disturbance were noted for benign nodule patients than for TC patients. OP for TC, especially PTMC, did not alleviate psychological distress or sleep disturbance compared with the same parameters in patients who underwent AS.
Based on the findings of impaired psychological health and sleep quality, screening for TNs in adults who show no symptoms should be performed with caution. Psychological distress and sleep disturbance should also be taken into consideration when FNA is performed for suspected TC or OP for PTC, especially PTMC.