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Clinical Endocrinology

Catherine M Jankowski, Pamela Wolfe, Sarah J Schmiege, K Sreekumaran Nair, Sundeep Khosla, Michael Jensen, Denise von Muhlen, Gail A Laughlin, Donna Kritz-Silverstein, Jaclyn Bergstrom, Richele Bettencourt, Edward P Weiss, Dennis T Villareal, Wendy M Kohrt
OBJECTIVE: Studies of dehydroepiandrosterone (DHEA) therapy in older adults suggest sex-specific effects on bone mineral density (BMD) and body composition, but the ability of a single study to reach this conclusion was limited. We evaluated the effects of DHEA on sex hormones, BMD, fat mass, and fat-free mass in older women and men enrolled in four similar clinical trials. DESIGN: Pooled analyses of data from four double-blinded, randomized controlled trials. PARTICIPANTS: Women (n=295) and men (n=290) aged 55 years or older who took DHEA or placebo tablet daily for 12 months...
November 12, 2018: Clinical Endocrinology
Stephen Franks
Polycystic ovary syndrome remains an enigmatic disorder. Its aetiology is uncertain (although we have compelling evidence for an important genetic component 1-3 ) and the approach to diagnosis and management remains controversial. This article is protected by copyright. All rights reserved.
November 10, 2018: Clinical Endocrinology
A Guenego, S Mesrine, L Dartois, L Leenhardt, F Clavel-Chapelon, M Kvaskoff, M C Boutron-Ruault, F Bonnet
BACKGROUND: Thyroid cancers are threefold more frequent in women than in men. A role of reproductive or hormonal factors has been suggested but with contradictory results. We investigated potential associations between history of hysterectomy, with or without oophorectomy, and history of benign gynecological disease (uterine fibroids, endometriosis) and the incidence of differentiated thyroid cancer, in a large French prospective cohort. METHODS: 89,340 women from the E3N cohort were followed up between 1990 and 2012...
November 3, 2018: Clinical Endocrinology
Ling Chen, Jianxing Zhang, Lingcui Meng, Yunsi Lai, Wenyuan Huang
OBJECTIVE: The Thyroid Imaging Reporting and Data System (TI-RADS) is commonly used for risk stratification of thyroid nodules. However, this system has a pooled sensitivity and specificity. The aim of this study was to build a new model based on TI-RADS for evaluating ultrasound image patterns that offers improved efficacy for differentiating benign and malignant thyroid nodules. DESIGN AND PATIENTS: The study population consisted of 1092 participants with thyroid nodules...
November 3, 2018: Clinical Endocrinology
Christopher W Rowe, Sam Arthurs, Christine J O'Neill, Jacqueline Hawthorne, Rosemary Carroll, Katie Wynne, Cino Bendinelli
OBJECTIVE: Post-thyroidectomy hypocalcaemia is a significant cause of morbidity and prolonged hospitalization, usually due to transient parathyroid gland damage, treated with calcium and vitamin D supplementation. We present a randomized, double-blind placebo-controlled trial of preoperative loading with high-dose cholecalciferol (300,000 units) to reduce post-thyroidectomy hypocalcaemia. PATIENTS AND MEASUREMENTS: Patients (n=160) presenting for thyroidectomy at tertiary hospitals were randomized 1:1 to cholecalciferol (300,000 IU) or placebo 7 days prior to thyroidectomy...
November 1, 2018: Clinical Endocrinology
Ying Li, HongQun Wang, AiChun Wang, YingXue Li, ShanShan Ding, XiaoJing An, HuaiYin Shi
OBJECTIVE: FOXQ1, a member of the forkhead transcription factor family, plays important parts in cell cycle, apoptosis, metabolism, immunology and tumour genesis. Its expression has been associated with poor clinical prognosis in various tumours. However, the clinical significance of FOXQ1 in papillary thyroid carcinoma (PTC) has not been fully studied. The purpose of this study was to investigate if FOXQ1 is correlated with poor prognosis in PTC. DESIGN/METHODS: We performed a retrospective study of 136 PTCs...
October 31, 2018: Clinical Endocrinology
Thenmalar Vadiveloo, Peter T Donnan, Callum J Leese, Kirstin J Abraham, Graham P Leese
OBJECTIVES: A population based study was undertaken to determine the mortality and morbidity for people with hypoparathyroidism compared to the general population. METHODS: In this study, patients identified with chronic hypoparathyroidism using data-linkage from regional datasets were compared to five age and gender matched controls from the general population. Data from biochemistry, hospital admissions, prescribing and the demographic dataset were linked. Outcomes for mortality and specified conditions were examined for all patients and sub-divided into post-surgical and non-surgical cases of hypoparathyroidism...
October 30, 2018: Clinical Endocrinology
Ana Creo, Fares Alahdab, Alaa Al Nofal, Kristen Thomas, Amy Kolbe, Siobhan Pittock
We appreciate the careful review and proposed methodological suggestions by Dr. Fang et al. The authors suggest reporting extensive statistical measures including sensitivity, specificity, negative predictive value, positive predictive value, diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio. Reporting receiver operating curves was also suggested, but we feel this is beyond the scope of the project. This article is protected by copyright. All rights reserved.
October 29, 2018: Clinical Endocrinology
Kashyap A Patel, Bridget Knight, Aftab Aziz, Tarig Babiker, Tamar Avades, Joanna Findlay, Sue Cox, Ioannis Dimitropoulos, Carolyn Tysoe, Vijay Panicker, Bijay Vaidya
OBJECTIVE: Patients with hyperthyroidism lacking autoimmune features but showing diffuse uptake on thyroid scintigram can have either Graves' disease or germline activating TSHR mutation. It is important to identify patients with activating TSHR mutation due to treatment implication but the overlapping clinical features with Graves' disease make it difficult to discriminate these two conditions without genetic testing. Our study aimed to assess the potential of systematic TSHR mutation screening in adults with hyperthyroidism, showing diffuse uptake on thyroid scintigraphy but absence of TSH receptor antibodies (TRAb) and clinical signs of autoimmunity...
October 29, 2018: Clinical Endocrinology
Annika M A Berends, Edward Buitenwerf, Eke G Gruppen, Wim J Sluiter, Stephan J L Bakker, Margery A Connelly, Michiel N Kerstens, Robin P F Dullaart
BACKGROUND: Primary aldosteronism (PA) may confer increased cardiovascular risk beyond effects on systemic blood pressure, but contributing mechanisms remain incompletely understood. We compared plasma (apo)lipoproteins and lipoprotein particle characteristics, GlycA, a pro-inflammatory glycoprotein biomarker of enhanced chronic inflammation, and plasma total branched chain amino acids (BCAA), measured using nuclear magnetic resonance (NMR) spectroscopy, between patients with PA, control subjects without hypertension, subjects with untreated hypertension and subjects with treated hypertension...
October 29, 2018: Clinical Endocrinology
Michael Thompson, John Burgess
OBJECTIVE: Literature concerning the impact of Multiple Endocrine Neoplasia Type 1 (MEN 1) on fertility is limited to case reports despite the early onset of endocrinopathies, such as primary hyperparathyroidism and prolactinoma, that may impact fertility. This study describes the impact of unrecognised and untreated MEN 1 on fertility and pregnancy outcomes in a multigenerational cohort of the Tasman 1 MEN 1 kindred. METHODS: All MEN 1 positive (MEN 1+ , n=63) and MEN 1 negative (MEN 1- , n=75) descendants born between 1825 and 1951 of a common founder...
October 28, 2018: Clinical Endocrinology
Mina Chamberlin, E Helen Kemp, Anthony P Weetman, Bhupesh Khadka, Edward M Brown
CONTEXT: Activating antibodies directed at the extracellular calcium-sensing receptor (CaSR) have been described in autoimmune hypoparathyroidism in the setting of isolated hypoparathyroidism or autoimmune polyglandular syndrome type 1. MATERIALS AND METHODS: A 34-year-old female presented with hypocalcemia (6.0 mg/dL) and hypomagnesemia (1.1 mg/dL) accompanied by low serum PTH (2.4 pg/mL) as well as urinary calcium and magnesium wasting. She was diagnosed with hypoparathyroidism, which was refractory to standard therapy...
October 25, 2018: Clinical Endocrinology
Michael S Sagmeister, Angela E Taylor, Anthony Fenton, Nadezhda A Wall, Dimitrios Chanouzas, Peter G Nightingale, Charles J Ferro, Wiebke Arlt, Paul Cockwell, Rowan S Hardy, Lorraine Harper
OBJECTIVE: Patients with chronic kidney disease (CKD) have dysregulated cortisol metabolism secondary to changes in 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes. The determinants of this and its clinical implications are poorly defined. METHODS: We performed a cross-sectional study to characterise shifts in cortisol metabolism in relation to renal function, inflammation and glycaemic control. Systemic activation of cortisol by 11β-HSD was measured as the metabolite ratio [tetrahydrocortisol (THF) + 5α-tetrahydrocortisol (5αTHF)] / tetrahydrocortisone (THE) in urine...
October 25, 2018: Clinical Endocrinology
Bu B Yeap, Frederick C W Wu
U.S. Endocrine Society (ES) published a clinical practice guideline on testosterone therapy in men with hypogonadism, and Endocrine Society of Australia (ESA) a position statement on management of male hypogonadism. Both emphasise the importance of diagnosing men who are androgen deficient due to organic (classical or pathological) hypogonadism arising from disorders of the hypothalamus, pituitary or testes, who assuredly benefit from testosterone therapy. Both recognise that men with an intact gonadal axis may have low testosterone concentrations, for instance older men or men with obesity or other medical comorbidities...
October 25, 2018: Clinical Endocrinology
Aleksander Kuś, Mikołaj Radziszewski, Aleksandra Glina, Konrad Szymański, Beata Jurecka-Lubieniecka, Edyta Pawlak-Adamska, Dorota Kula, Natalia Wawrusiewicz-Kurylonek, Joanna Kuś, Piotr Miśkiewicz, Rafał Płoski, Marek Bolanowski, Jacek Daroszewski, Barbara Jarząb, Artur Bossowski, Tomasz Bednarczuk
BACKGROUND: Graves' disease (GD) is an autoimmune thyroid disease (AITD) with a peak incidence between 30 and 50 years of age. Whereas children and adolescents may also develop the disease, the genetic background of paediatric-onset GD (POGD) remains largely unknown. Here we looked for similarities and differences in the genetic risk factors for POGD and adult-onset GD (AOGD) as well as for variants associated with age of GD onset. MATERIALS & METHODS: A total of 1267 GD patients and 1054 healthy controls were included in the study...
October 25, 2018: Clinical Endocrinology
Bu B Yeap, Matthew W Knuiman, David J Handelsman, Ken K Y Ho, Jennie Hui, Mark L Divitini, Gillian M Arscott, Brendan McQuillan, Joseph Hung, John P Beilby
CONTEXT: Pituitary luteinising hormone (LH) stimulates testicular production of testosterone (T) which is metabolised to dihydrotestosterone (DHT) by 5α-reductase and to estradiol (E2) by aromatase. How the activity of population variants in these enzymes impact on gonadal function is unclear. We examined whether polymorphisms in 5α-reductase (SRD5A2) and aromatase (CYP19A1) genes predict circulating sex hormone concentrations. DESIGN: Cross-sectional analysis of 1,865 community-dwelling men aged 50...
October 24, 2018: Clinical Endocrinology
Daniel Yuan, Ben J Wu, Amanda Henry, Kerry-Anne Rye, Kwok Leung Ong
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first diagnosis during pregnancy, but not to the level of being diagnostic for diabetes in a non-pregnant adult. In GDM whole-body insulin-dependent glucose disposal decreases by 40-60% which necessitates a 200-250% increase in insulin secretion to maintain normoglycemia. GDM develops when a pregnant woman does not produce sufficient insulin to compensate for the reduced glucose disposal. Fibroblast growth factor 21 (FGF21) is a hormone that is expressed predominantly in the liver, but also in other metabolically active tissues such as pancreas, skeletal muscle and adipose tissue...
October 22, 2018: Clinical Endocrinology
M Shawky, T Abdel Aziz, S Morley, T Beale, J Bomanji, C Soromani, F Lam, I Philips, M Matias, J Honour, J Smart, T R Kurzawinski
BACKGROUND/OBJECTIVE: Intraoperative Parathyroid Hormone (IOPTH) monitoring during surgery for Primary Hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and peri-operative strategy. DESIGN: This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by pre-operative US, MIBI, and IOPTH monitoring...
October 22, 2018: Clinical Endocrinology
Xiang Fang, Weili Kong, Zeping Yu, Jingqing Qiu, Hong Duan
With interest, we read the article by Creo et al. published in Clinical endocrinology in October 2018. Thyroid cancer is very common in adolescents. And there is currently no well-validated evaluation system for pediatric thyroid nodules. The objective of this study was to assess the diagnostic accuracy of Pediatric McGill Thyroid Nodule Score (PMTNS). They enrolled 99 patients with 131 thyroid nodules. This article is protected by copyright. All rights reserved.
October 22, 2018: Clinical Endocrinology
J Buxton, S H Vun, D van Dellen, R Wadsworth, T Augustine
OBJECTIVE: Adrenal surgery remains a distinct surgical challenge. Technical challenges associated with laparoscopic adrenalectomy are tumour size, haemorrhage control, and oncological compromise. Hand Assisted Laparoscopic (HAL) Adrenalectomy, utilising a hand-port device, offers minimally invasive surgery with the advantages and safety of tactile feedback. We aimed to assess the efficacy of HAL for patients requiring adrenalectomy for tumours over 5cm in size. CONTEXT: Hand assisted laparoscopic surgery is used in several surgical specialities over totally laparoscopic surgery to manage sizeable pathology, reduce operating time and conversion rates...
October 22, 2018: Clinical Endocrinology
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