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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Secondary and Tertiary Hyperparathyroidism in Chronic Kidney Disease: An Endocrine and Renal Perspective.

Indian Journal of Endocrinology and

Secondary Hyperparathyroidism (SHP) seen as a frequent complication in Chronic Kidney Disease (CKD) has many pathogenetic peculiarities that are st...

Biosimilar Insulins - What a Clinician Needs to Know?

Indian Journal of Endocrinology and

As the first biologics produced by recombinant deoxyribonucleic acid (DNA) technology were approved in the late 1980s and consequently the exclusiv...

Health-related Quality of Life of Patients with Type 2 Diabetes Mellitus at A Tertiary Care Hospital in India Using EQ 5D 5L.

Indian Journal of Endocrinology and

To assess the health-related quality of life of Type 2 Diabetes mellitus patients attending outpatient departments of a tertiary hospital using EQ-5D-5L.

The study was conducted at a tertiary care hospital in India. The quality of life of patients with type 2 Diabetes mellitus, age 18 years and older, attending outpatient departments of Medicine and Endocrinology was assessed with the help of EQ-5D-5L, a measure of self-reported health related quality of life. Data was analyzed to obtain EQ-5D-5L scores for the five dimensions and EQ VAS score. Correlation of EQ VAS score with different variables was analyzed.

Out of total 358 participants, 208 had comorbidities, hypertension being the most common. Mean age was 60.71 ± 11.41 years and 216 (58.9%) were female participants. Out of five dimensions, Mobility, Self-care, Usual activities, and Pain/discomfort were most affected in age group 71 years and above while anxiety/depression affected age group 18-30 years the most. Mean EQ VAS score was 78.83 ± 15.02. Female participants had significantly higher EQ VAS score (P = 0.00) than male participants. EQ VAS score showed significant negative correlation with uncontrolled state of diabetes (P = 0.000). There was significant difference in EQ VAS score between patients with and without comorbidities. (P =0.004) Cronbach alpha for EQ-5D-5L was 0.76.

The results suggest that EQ-5D-5L is a reliable measure for assessing health related quality of life of patients with Type 2 Diabetes mellitus. Type 2 Diabetes adversely affects the quality of life of patients. Uncontrolled disease and comorbidities can further compromise the quality of life.

A Cross-sectional Study of Stretched Penile Length in Boys from West Bengal, India.

Indian Journal of Endocrinology and

Short penile length is a commonly encountered problem in clinical practice. Detection of abnormal stretched penile length (SPL) warrants appropriate endocrine evaluation. Ethnicity-specific SPL data are required to detect these abnormalities. There is a dearth of such data in India. This study aims to establish normative values of SPL in boys from West Bengal.

This is a cross-sectional study. SPL, testicular volume (TV), height/length, and weight were measured in 460 boys aged 1 to 13 years from the schools located at urban, suburban, and rural areas in the state of West Bengal, India. Similar data were collected from 36 healthy neonates within 1-3 days of full-term delivery at IPGME and R and SSKM Hospital, Kolkata, West Bengal, India.

The 5th percentile, median, and 95th percentile of SPL were 1.7, 2.0, and 2.7 cm for neonates; 3.5, 4.4, and 6.4 cm for the children aged 1 Y-2 Y 11 M; 4.0, 5.5, and 7.0 cm for the age group 3 Y-4 Y 11 M; 4.2, 6.0, and 7.2 cm for the age group 5 Y-6 Y 11 M; 4.3, 6.0, and 7.6 cm for the age group 7 Y-8 Y 11 M; 4.4, 6.5, and 9.0 cm for the age group 9 Y-10 Y 11 M; and 4.8, 7.0, and 11.0 cm for the age group 11 Y-12 Y 11 M, respectively. SPL showed significant positive correlation with TV [r = 0.365, P < 0.0005] and height of the children [r = 0.516, P < 0.0005], but not with BMI.

Our study provides normative data of SPL in neonate and children aged 1 to 13 years from the eastern part of India. SPL value correlated positively with TV and height of children.

Continuation of Metformin Till Night Before Surgery and Lactate Levels in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Indian Journal of Endocrinology and

Lactic acidosis is a rare but serious complication associated with metformin therapy in certain high-risk patients. NICE guidelines and the British National Formulary advise the discontinuation of metformin before surgery. The drug manufacturer's datasheet advises the withdrawal of metformin 48 h before surgery. However, the data regarding perioperative use of metformin is scarce.

To evaluate the effect of continuation of metformin till night before surgery on lactate levels in patients undergoing coronary artery bypass graft (CABG) surgery.

In this prospective cohort study, 1,800 consecutive patients who underwent CABG between 1st November 2015 and 31st October 2016 were enrolled. Following exclusion criteria, a total of 790 subjects were included for final analysis. Three-hundred and eight seven (48.9%) patients with diabetes received metformin till night before surgery (Met group), 239 (30.3%) patients with diabetes were non-metformin users (Non-Met group), and 164 (20.8%) patients were having no diabetes (Non-Diab group). Lactate levels and arterial pH were measured using arterial blood gas machine. Postoperative morbidity outcome data were obtained by collecting clinical data, routine biochemistry, and chest imaging.

The mean metformin dose was 1,124.6 mg/day (SD: 509.3; range: 500-2,500 mg/day). Mean postoperative lactate levels were 1.91 ± 0.7 in Met group, 2.04 ± 0.79 in Non-Met group, and 2.07 ± 0.78 in Non-Diab group. Lactic acidosis occurred in 41 patients and there was no difference among the groups [Met group = 18 (4.7%); Non-Met group = 14 (5.9%)]. Among secondary outcome measures, acute renal failure occurred more frequently in diabetic patients [Met group = 46 (11.9%) and Non-Met group = 32 (13.4%)] as compared with non-diabetic patients. There were no differences with regard to pneumonia, length of ICU stay, and duration of ventilatory support among the three groups.

Continuation of metformin till night before surgery is not associated with significant changes in lactate levels in patients undergoing CABG.

Inverse Relationship Between 25 Hydroxy Vitamin D and Parathormone: Are there Two Inflection Points?

Indian Journal of Endocrinology and

There is no consensus about the inflection point for 25 hydroxy vitamin D below which the intact PTH level increases.

Determine the relationship/inflection point between 25 hydroxy vitamin D and parathormone levels.

We performed a population-based analysis on a nonobese cohort (n = 405).

Prevalence of vitamin D deficiency was 58.76% (n = 228). Vitamin D insufficiency was found in 34.56% (n = 140). An inverse relationship between 25 hydroxy vitamin D (25(OH)D) and intact PTH exist, but strength of such relationship is weak (r = -0.16, P = 0.018). With respect to the 25(OH)D cut-off of 16 ng/mL by IOM (EAR linked), proportion of persons with high intact PTH was higher in the group with lower 25(OH)D compared with higher 25(OH)D group (P = 0.005) and it was similar for RDA linked cut-off of 20 ng/mL also (P = 0.017). LOWESS method revealed two inflection points at which PTH levels change. A less conspicuous inflection point was found at 32 ng/mL (95% CI, 27-36), which reasonably corroborates with the current cutoff of definition of vitamin D sufficiency, and the second, steeper inflection point was found at 16.5 ng/ml (95% CI, 14.9-18.8) which corroborates with the IOM supported EAR linked value of 25(OH)D level in general population and possible definition of vitamin D deficiency.

There are possibly two inflection points at which PTH levels change in relation to 25(OH)D levels.

Prevalence of Childhood Obesity in an Affluent School in Telangana Using the Recent IAP Growth Chart: A Pilot Study.

Indian Journal of Endocrinology and

To study the prevalence of obesity in children in an affluent school in Hyderabad, Telangana, using the recent Indian Academy of Paediatrics (IAP) growth charts and to compare the same with the Centre for Disease Control and Prevention (CDC) charts.

A cross-sectional study was conducted in an affluent school of Hyderabad in January 2018. After getting appropriate permission, anthropometry measurements of the school children were done. The data were collected from students of Classes 4-10. Each class had three sections. Each section had around 25-30 students. Body mass index (BMI), calculated as weight (kg)/height2 (m2) was used to classify the participants using age- and gender-specific cut-points as per CDC growth charts and the recent IAP charts.

A total of 544 students were studied. About 52% were boys (n = 288) and 48% were girls (n = 256). Using the IAP charts, 24.6% were obese and 35.8% were overweight. Using the CDC criteria, the prevalence of obesity and overweight was 15.4% and 26.1%, respectively. The mean BMI in the obese group was 25.6 ± 3.5 kg/m2 and in the overweight group was 21.1 ± 1.9 kg/m2. The prevalence of obesity and overweight was more in girls (obesity 32.8% versus 17.3% and overweight 44.5% versus 28.1%, respectively). The highest prevalence of childhood obesity was seen in the 8-10 years age group.

Our study reflects the increased prevalence of obesity and overweight in the adolescent age group, using the recent IAP criteria.

Presentation, Morbidity and Treatment Outcome of Acromegaly Patients at a Single Centre.

Indian Journal of Endocrinology and

The management of acromegaly, a rare and potentially curable disease, has undergone a paradigm shift in the past few decades. Many of the treatment modalities recommended for acromegaly are either too expensive or not available in many parts of India. There is a dearth of treatment and outcome data in Indian patients.

Our aim was to study the clinical presentation, hormonal profile, radiology, management, and outcome of the disease at our center.

Fifty one patients with acromegaly who attended the Department of Endocrinology, SKIMS, Srinagar, between October 2015 and April 2017, were included in the study. Clinical and hormonal profiles, comorbidities, treatment modalities, and outcome were evaluated.

The gender distribution was equal with the mean age of 42.3 ± 10.9 years at diagnosis. The majority (41) of the patients had macroadenoma. The most common presenting manifestations were acral enlargement and headache. Hypertension was present in 23, musculoskeletal manifestations in 19, and diabetes mellitus in 11 patients. Surgery was the most common method of treatment. Preoperatively only one patient with micro-adenoma had hypocortisolism, which was persistent in postoperative period, while no patient had preoperative or postoperative hypothyroidism or hypogonadism. As per the present consensus criteria, 23.7% patients achieved disease control (40% with microadenoma and only 19.5% with macroadenoma). The surgical complications occurred in 5 patients-CSF leak in 3 meningitis in 2 patients all except one having macroadenoma.

The presentation of disease was generally comparable to that reported in literature. Cure rates were significantly lower than those reported from many large centers.

Prevalence of End-Organ Damage, Beta Cell Reserve, and Exocrine Pancreas Defect in Fibrocalculous Pancreatic Diabetes: An Eastern India Perspective.

Indian Journal of Endocrinology and

Data on prevalence and burden of end-organ damage in fibrocalculous pancreatic diabetes (FCPD) from eastern India is scant. This study investigated the burden of end-organ damage and exocrine pancreatic defect in FCPD patients in Eastern India.

Consecutive FCPD patients underwent evaluation of glycemic control, C-peptide, fecal elastase, body fat percent, tests for cardiac autonomic neuropathy (CAN), neuropathy, nephropathy, and retinopathy which were compared with data from type-1 diabetes (T1DM) and type-2 diabetes (T2DM).

Data from 101 FCPD, 41 T1DM, 40 T2DM, and 40 controls were analyzed. Body fat percent was lowest in FCPD and T1DM. Similarly, fasting and stimulated C-peptide was significantly lowest in T1DM, followed by FCPD. Significant elevations in stimulated C-peptide were observed in FCPD. Fecal elastase was lowest in FCPD. Exocrine pancreas defect in FCPD, T1DM, and T2DM was 100%, 53.66%, 27.5%, respectively. HbA1c was worst in FCPD. About 40% of FCPD patients had CAN while 13.33% had borderline CAN. Isolated parasympathetic dysfunction was the commonest (66.67%) among them. FCPD patients with CAN had lower fecal elastase, higher HbA1c, microalbuminuria, steatorrhea, neuropathy, retinopathy, and nephropathy, compared to those without CAN. On binary logistic regression, diabetes duration was a significant predictor of end-organ damage in FCPD. Fecal elastase and body fat percent were independent predictors for insulin therapy in FCPD.

CAN is common in FCPD while exocrine pancreas defect is most severe in FCPD followed by T1DM and T2DM. Fecal elastase has an important prognostic role for insulinization in FCPD. Role of pancreatic enzyme replacement on glycemic control in diabetes with exocrine pancreas defect needs investigation.

Long-term Response to Recombinant Human Growth Hormone Therapy in Indian Children with Growth Hormone Deficiency.

Indian Journal of Endocrinology and

Growth hormone deficiency (GHD) remains the most common indication for use of recombinant human growth hormone (rhGH) therapy in clinical practice. However, there is a paucity of studies focusing on long-term response to rhGH therapy in the Indian context.

To determine the response to rhGH therapy and its predictors in children with GHD followed up at a tertiary care center in North India.

We performed a retrospective review of the records of children with GHD who received rhGH therapy for at least 1 year. The relevant anthropometric, biochemical and radiological data at baseline and follow-up were recorded.

A total of 99 children (64 boys, 35 girls; 61 isolated GHD, 38 multiple pituitary hormone deficiency) were studied. The mean (±SD) age and height SDS at treatment initiation were 12.4 (±3.0) years and -4.0 (±1.1) respectively, while median (IQR) serum insulin-like growth factor 1 (IGF-1) and peak growth hormone level on clonidine stimulation were 73 (25-167) ng/ml and 1.1 (0.4-3.6) ng/ml respectively. The height velocity was highest during the first year of treatment (10.6 ± 3.0 cm/year), declining to 8.7 ± 2.7 and 7.9 ± 2.2 cm/year during second and third year, respectively. Over the subsequent years, there was further graded fall in height velocity, declining to 4.8 ± 3.6 cm/year (n = 2) during the seventh year. The height gain during first year was negatively correlated with age at initiation of treatment, baseline height SDS, baseline serum IGF-1 and peak serum GH level on GH stimulation test, while it showed a positive correlation with bone age delay at baseline. Only baseline height SDS was found to have a significant negative correlation with height gain during the second year.

This study provides data on long-term response to rhGH therapy and its predictors in Indian children with GHD.

Is 3-4 Weeks Required for TSH to Rise Post Thyroidectomy? A prospective Study and Discussion of its Implications on Patient Care.

Indian Journal of Endocrinology and

In patients with differentiated thyroid cancer (DTC), for the purpose of radioiodine (131I) whole-body scan and treatment of remnant, or residual tumor, or metastatic disease, thyroid hormone withdrawal remains the standard approach for raising thyroid-stimulating hormone (TSH) levels to ensure adequate radioiodine uptake. Thyroid hormone is withdrawn 3-4 weeks prior radioiodine therapy (RAIT) to allow the serum-TSH concentration to rise to above 25-30 mU/L.

We studied the time taken for TSH to rise in 40 patients after total thyroidectomy operated for DTC.

Prospective observational study.

40 patients with proven differentiated thyroid cancer attending a tertiary care center were studied.

Data was analyzed by using SPPSS software for windows (version 15, SPSS Inc., Chicago, USA).

After performing preoperative TSH in all patients excluding preoperative TSH elevation, it was planned to collect weekly postoperative samples till TSH ≥30. The mean (standard deviation, SD) age of the cohort was 40 (13) years with 35 females (88%) and their mean (SD) preoperative TSH was 3.6 (1.35) mIU/L. At the end of the first week postoperatively, the mean TSH of the cohort was 24.25 (6) with 8 patients (20%) achieving the cut-off of TSH ≥30 mIU/L and 30 patients (75%) achieving TSH level ≥20 mIU/L. At the end of the second week, the mean TSH was 53 (17) with all patients (100%) achieving a TSH level >30 mIU/ml.

An iodine whole-body scan can be performed in 10-14 days after total thyroidectomy instead of the usual wait time of 4 weeks. This could improve patient QOL and avoid complications related to prolonged hypothyroidism.

Demystifying "Steroid Withdrawal" During Remission in Cushing's Disease: Is Mineralocorticoid Replacement the Answer?

Indian Journal of Endocrinology and

To study renin-angiotensin-aldosterone axis status (RAAS) in patients of Cushing's disease (CD) at baseline and 6 weeks after curative trans-sphenoidal surgery and evaluate the role of mineralocorticoid replacement in the resolution of "steroid withdrawal syndrome" (SWS). Postoperative RAAS status had not been evaluated in previous studies, although aldosterone levels have been shown to be suppressed during medical therapy with pasireotide and cabergoline.

This was a prospective, single-center study. Patients with CD, aged between 15-75 years, undergoing curative pituitary surgery were recruited. An 8 am and 11 pm cortisol and adrenocorticotropic hormone (ACTH) were measured at baseline. An 8 am cortisol was measured 6 weeks after surgery to demonstrate remission. Plasma-renin activity and plasma-aldosterone concentration were measured at baseline and 6 weeks after curative surgery.

A total of 14 patients (11 female, 3 male) were recruited initially, of these 8 patients completed the study. The plasma-renin activity was not suppressed at baseline and did not rise significantly after surgery (P = 0.717). However, plasma-aldosterone concentration was in the low-normal range at baseline and had risen significantly 6 weeks after surgery (P = 0.013). No difference was noted in subgroups with or without hypertension.

Curative pituitary surgery leads to normalization of plasma-aldosterone concentration in patients with CD just 6 weeks after surgery. Hence, mineralocorticoid replacement may not prove beneficial in alleviating the "SWS" in postsurgical CD patients who have achieved remission.