Clinical Endocrinology最新文献

{"title":"Association of Radioactive Iodine Administration With Outcome Among Patients With Low-Risk Differentiated Thyroid Cancer: A Real-World Data Analysis","authors":"Yang Xu,&nbsp;Peiyin Huang,&nbsp;Liying Wang,&nbsp;Najun Ke,&nbsp;Fangting Guo,&nbsp;Lijia Su,&nbsp;Qingbao Shen,&nbsp;Tintin Lin,&nbsp;Kunzhai Huang,&nbsp;Yi Zhang,&nbsp;Fangsen Xiao","doi":"10.1111/cen.15152","DOIUrl":"10.1111/cen.15152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite the generally favourable long-term prognosis of low-risk differentiated thyroid cancer (DTC), questions remain about disease-free survival (DFS) after initial treatment, particularly regarding the use of radioactive iodine (RAI). Although there are RCT trial confirming that RAI ablation therapy is not superior to follow-up in terms of the 3-year DFS rate in low-risk thyroid cancer, its longer-term prognosis remains to be established. The objective of this study was to assess the impact of RAI ablation on the presence of structural persistent/recurrent disease in patients with low-risk DTC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively identified 720 low-risk DTC patients who had undergone total or near-total thyroidectomy (TT) at a tertiary medical centre between January 2008 and July 2018. Propensity scores were calculated using a multivariable logistic regression model that accounted for age, sex, tumour size, neck dissection, multifocality, capsular invasion and lymph node (LN) metastasis. We compared DFS between patients who received RAI and those who did not using log-rank tests and multivariate Cox analyses. Subgroup analyses were also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total cohort, 180 (25.0%) patients received RAI, while 540 (75.0%) did not before matching. The median follow-up duration was 59.5 months. After matching, the RAI group comprised 135 (39.8%) patients and the non-RAI group comprised 204 (60.2%) patients. In the entire cohort, the 5-year DFS rate was 97.6% for patients receiving RAI compared to 96.8% for those not receiving RAI (<i>p</i> = 0.704). In the matched cohort, the rates were 98.5% and 95.6%, respectively (<i>p</i> = 0.090). Matched multivariate Cox analysis demonstrated that RAI was neither significantly nor independently associated with DFS (hazard ratio [HR] = 0.29; 95% CI 0.06–1.37; <i>p</i> = 0.118). Further subgroup analyses reaffirmed that RAI ablation did not significantly reduce the risk of developing structural persistent/recurrent disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Administering RAI ablation following TT did not result in improved DFS for low-risk DTC patients. Our findings suggest that decisions regarding RAI should be made judiciously to avoid overtreatment in this clinical scenario.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 2","pages":"205-213"},"PeriodicalIF":3.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Subclinical Hyperthyroidism and Incident Atrial Fibrillation","authors":"Mohammad Jay,&nbsp;Peter Huan,&nbsp;Nikki Cliffe,&nbsp;Jonah Rakoff,&nbsp;Emily Morris,&nbsp;Peter Kavsak,&nbsp;Meera Luthra,&nbsp;Zubin Punthakee","doi":"10.1111/cen.15150","DOIUrl":"10.1111/cen.15150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Treating overt hyperthyroidism prevents atrial fibrillation (AF). Though subclinical hyperthyroidism (SH) has been associated with AF, it is unknown whether treating SH prevents AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to identify the association between treating SH and incident AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>In a pharmacoepidemiologic retrospective cohort study, patients diagnosed with SH between 2000 and 2021 were followed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>Outpatients ≥ 18 years with biochemical SH and without prior AF, hypothyroidism, thyroid cancer, pituitary disease, or pregnancy were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>The primary outcome was incident AF. Secondary outcomes were ECG and echocardiographic features associated with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 2169 patients screened, 360 (131 treated and 229 untreated) were followed up for a mean of 4.27 years. In the treated and untreated groups, AF occurred in 4 (3.1%) and 15 (6.6%) patients (<i>p</i> = 0.15), and AF incidence was 0.8% and 1.4%/year (<i>p</i> = 0.31), respectively. The hazard ratio (HR) for treatment as a time-dependent variable was 0.60 (95% CI 0.19–1.92; <i>p</i> = 0.39). As some cases of AF were documented nearly simultaneously with SH treatment, a sensitivity analysis was performed reassigning two patients diagnosed with AF &lt; 30 days after starting SH treatment to the untreated group. Here, in the treated and untreated groups, AF occurred in 1.6% and 7.4% (<i>p</i> = 0.02), and AF incidence was 0.4% and 1.8%/year (<i>p</i> = 0.02), respectively. The HR was 0.25 (0.06–1.13; <i>p</i> = 0.07). There were no differences in ECG or echocardiographic features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was an overall trend towards lower incidence and prevalence of AF following treatment of SH, supporting the need for larger scale studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 3","pages":"315-323"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal and Pregnancy Management of Congenital Adrenal Hyperplasia","authors":"Hanna Franziska Nowotny,&nbsp;Lea Tschaidse,&nbsp;Matthias K. Auer,&nbsp;Nicole Reisch","doi":"10.1111/cen.15131","DOIUrl":"https://doi.org/10.1111/cen.15131","url":null,"abstract":"<p>Management of patients with congenital adrenal hyperplasia (CAH) poses challenges during pregnancy and prenatal stages, impacting fertility differently in men and women. Women with CAH experience menstrual irregularities due to androgen and glucocorticoid precursor interference with endometrial development and ovulation. Genital surgeries for virilization and urogenital anomalies further impact fertility and sexual function, leading to reduced heterosexual relationships among affected women. Fertility rates vary, with a lower prevalence of motherhood, primarily among those with classic CAH, necessitating optimized hormonal therapy for conception. Monitoring optimal disease control during pregnancy poses challenges due to hormonal fluctuations. Men with CAH often experience hypogonadotrophic hypogonadism and complications like testicular adrenal rest tissue, impacting fertility. Regular monitoring and intensified glucocorticoid therapy may restore spermatogenesis. Genetic counselling is vital to comprehend transmission risks and prenatal implications. Prenatal dexamethasone treatment in affected female fetuses prevents virilization but raises ethical and safety concerns, necessitating careful consideration and further research. The international “PREDICT” study aims to establish safer and more effective prenatal therapy in CAH, evaluating dosage, safety, and long-term effects.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 4","pages":"359-370"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142404705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial for Clinical Endocrinology Special Issue on Congenital Adrenal Hyperplasia","authors":"Michael W. O'Reilly,&nbsp;D. Aled Rees","doi":"10.1111/cen.15148","DOIUrl":"10.1111/cen.15148","url":null,"abstract":"","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 4","pages":"299"},"PeriodicalIF":3.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Difference in Paediatric Growth Hormone Deficiency: Fact or Fiction?","authors":"Rohan K. Henry,&nbsp;Leena Mamilly,&nbsp;Monika Chaudhari,&nbsp;Amy L. Pyle-Eilola","doi":"10.1111/cen.15149","DOIUrl":"10.1111/cen.15149","url":null,"abstract":"&lt;p&gt;Short stature, defined as a height of less than the 2.3rd percentile or 2 standard deviations below the mean for age and sex, is a common indication for referral to paediatric endocrinology clinics [&lt;span&gt;1&lt;/span&gt;]. In addition to the social implications of height, short stature with poor growth may be an indication of underlying systemic illness [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Though the estimated prevalence of growth hormone deficiency (GHD) is approximately 1:4000–10,000, the ultimate aim of a short stature evaluation in children who are growing below their genetic potential is to exclude this rare entity [&lt;span&gt;3&lt;/span&gt;]. An integral part of patient evaluation, growth hormone provocative tests are widely used in clinical practice worldwide during short stature workup to diagnose GHD [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The medical literature is replete with publications that address the male predominance of growth hormone use both in non-GHD and GHD cases [&lt;span&gt;5&lt;/span&gt;]. Various biases which contribute to this historically published male predominance are well documented. These include &lt;i&gt;societal&lt;/i&gt; factors, since short stature in males is perceived as more concerning than in females; &lt;i&gt;familial&lt;/i&gt; factors, as parents are often more concerned about the height of their sons than that of their daughters; and &lt;i&gt;provider&lt;/i&gt; factors, as more boys than girls are referred for concerns about short stature [&lt;span&gt;6, 7&lt;/span&gt;]. Given these biases, more boys than girls receive growth hormone provocative testing and are ultimately diagnosed with GHD [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The aforementioned biases undoubtedly prevent accurate assessment of the relative frequencies of paediatric GHD in males and females. If these biases are minimized, it is possible that the true frequencies of paediatric GHD are equal in males and females. This is also taking into account that although there may be certain rare pathologic conditions such as X-linked hypopituitarism, which could result in males with GHD when this and similar conditions are taken collectively, there still should not be a significant sex difference in GHD cases [&lt;span&gt;9&lt;/span&gt;]. A closer look into sub-classifications of GHD utilized in clinical practice may offer an opportunity for evaluation of the true sex frequencies. These sub-classification frameworks may include (i) GHD severity based on peak growth hormone levels, (ii) the presence or absence of abnormal pituitary gland magnetic resonance imaging findings traditionally associated with a diagnosis of severe GHD such as the hypoplastic pituitary gland and (iii) the presence of GHD in the context of multiple pituitary hormonal deficiencies [&lt;span&gt;10&lt;/span&gt;]. It should also be noted that although peak growth hormone levels are used as a surrogate for GHD severity, there is no association between this and with abnormalities such as the ectopic pituitary gland on pituitary magnetic resonance imaging [&lt;span&gt;11&lt;/span&gt;]. Under another sub-classification framework, GHD ","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 1","pages":"28-30"},"PeriodicalIF":3.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remission of Acromegaly: The Sooner the Better","authors":"Thomas Cuny,&nbsp;Luigi Maione,&nbsp;Sylvère Störmann","doi":"10.1111/cen.15147","DOIUrl":"10.1111/cen.15147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Remission of acromegaly is defined by normalization of GH/IGF-1 values according to age and gender. While treatment strategies, biochemical cut-off to reach, and morbidities related to the persistence of the disease are well described in the literature, there is little data focusing on the delay to reach remission and its consequences. In this commentary, the authors discussed the results obtained from the UK acromegaly registry showing that the time to biochemical remission predicts the overall survival of patients in acromegaly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"101 6","pages":"602-604"},"PeriodicalIF":3.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Androgen Deficiency, Associations and Survival of Men With Stage 4 and 5 Chronic Kidney Disease: A Cohort Study","authors":"Neomal De Silva,&nbsp;Richard Quinton,&nbsp;Nipun Lakshitha De Silva,&nbsp;Channa N. Jayasena,&nbsp;Bruna Barbar,&nbsp;Chris Boot,&nbsp;Rohana J. Wright,&nbsp;Timothy W. Shipley,&nbsp;N. Suren Kanagasundaram","doi":"10.1111/cen.15146","DOIUrl":"10.1111/cen.15146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Anaemia is a key cause of morbidity in chronic kidney disease (CKD). Androgen deficiency (AD) in males can contribute to anaemia of all causes, including in CKD. We sought to examine the prevalence of AD in men with CKD, the extent to which it contributed to anaemia and whether it was independently associated with long-term survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional observational study was conducted among males aged 18 years and over with CKD stages 4 and 5. The study analysed morning blood samples with regard to their full blood count, urea and electrolytes, albumin, lipids, testosterone (T) and sex hormone binding globulin, with calculation of free testosterone by mass action equation. Mortality data were obtained 15 years later for survival analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 322 patients with a mean age of 63 years, the overall prevalence of AD was 68.9%. There was a statistically significant negative correlation between erythropoiesis stimulating agent (ESA) dose and testosterone concentrations (Pearson correlation −0.193, <i>p</i> = 0.05). There was a positive correlation between haemoglobin (Hb) and free testosterone level among patients not on ESA therapy (Pearson correlation 0.331, <i>p</i> &lt; 0.001). Kaplan-Meier plots showed <i>p</i> &lt; 0.001 on log-rank analysis, indicating that AD was significantly associated with worse survival. However, in Cox regression analysis, free testosterone was not associated with survival (95% CI for free testosterone 0.997–1.000).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AD is highly prevalent among this population, and increases further with older age and more severe CKD warranting haemodialysis. Association of lower Hb and higher ESA dose with lower T concentration might be causative, which has important pharmaco-economic as well as clinical implications. Lower survival in men with low T, more likely reflects overall poor health rather than causation. A properly constituted randomised controlled study evaluating the effect of native T replacement is warranted in men with CKD and AD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 2","pages":"190-195"},"PeriodicalIF":3.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Thyroid Function and Biochemical Markers of Placental Function in Early Pregnancy","authors":"Maja H. Lundgaard,&nbsp;Marianne M. Sinding,&nbsp;Anne N. Sørensen,&nbsp;Nanna M. U. Torp,&nbsp;Aase Handberg,&nbsp;Stig Andersen,&nbsp;Stine L. Andersen","doi":"10.1111/cen.15145","DOIUrl":"10.1111/cen.15145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A link between maternal thyroid function and the placental biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), has been brought forward. This study aimed to describe their association in early pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Eight hundred and fifty-eight pregnant women from the North Denmark Region, 2013, with blood samples drawn in early pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Thyroid-stimulating hormone (TSH), free thyroxine (fT4), thyroid-peroxidase antibodies (TPO-Ab), thyroglobulin antibodies (Tg-Ab) (ADVIA Centaur XPT, Siemens Healthineers), sFlt-1 and PlGF (Kryptor Compact, ThermoFisher Scientific) were measured. The association between maternal TSH and fT4 and percentile (pc) levels of sFlt-1 and PlGF (&lt; 25th pc, 25–75th pc, &gt; 75th pc) was evaluated using regression analysis and reported as adjusted beta coefficient (aβ). The frequency of maternal thyroid autoantibodies (TPO-Ab &gt; 60 U/mL or Tg-Ab &gt; 33 U/mL) by pc levels of sFlt-1 and PlGF was compared using chi-squared test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher levels (&gt; 75th pc) of sFlt-1 associated with lower TSH (aβ 0.62, 95% CI: 0.51–0.76) and higher fT4 (aβ 1.03, 95% CI: 1.01–1.05). Higher levels of PlGF associated with lower TSH (aβ 0.82, 95% CI: 0.69–0.98), but not with levels of fT4 (aβ 1.00, 95% CI: 0.97–1.02). No association with maternal thyroid autoantibodies was found (TPO-Ab: sFlt-1: <i>p</i>-value 0.5 and PlGF: <i>p</i>-value 0.1; Tg-Ab: sFlt-1: <i>p</i>-value 0.7 and PlGF: <i>p</i>-value 0.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a large cohort of Danish pregnant women, higher levels of sFlt-1 and PlGF associated with maternal thyroid function in early pregnancy, while there was no association with maternal thyroid autoantibodies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 3","pages":"306-314"},"PeriodicalIF":3.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers and Diagnostic Thresholds for Congenital Hyperinsulinism","authors":"Grace Petkovic,&nbsp;Julie Park,&nbsp;Catherine Collingwood,&nbsp;Senthil Senniappan,&nbsp;Mohammed Didi","doi":"10.1111/cen.15137","DOIUrl":"10.1111/cen.15137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Congenital Hyperinsulinism (CHI) is associated with inappropriately high levels of C-peptide in the context of hypoglycemia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to better clarify a diagnostic threshold value of C-peptide for children presenting with CHI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This was a retrospective case-control analysis, examining all hypoglycemia screens, undertaken between 2009 and 2019 at a quaternary paediatrics unit. Plasma C-peptide, insulin, free fatty acid (FFA) and B-hydroxybutyrate (BHOB) concentrations in children diagnosed with CHI were compared with concentrations in children diagnosed with other conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>All patients requiring hypoglycaemic screens at the quaternary children's hospital were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median [C-peptide] were statistically significantly different between CHI (147) and non-CHI (72) patients, <i>p</i> &lt; 0.05. The Youden Index indicated that a [C-peptide] value of 291.5 pmol/L would give the greatest optimization of sensitivity (82%) and specificity (99%) for detecting CHI. Median [insulin] differed significantly between the cohorts with a level of 64 pmol/L for CHI patients compared with 0 pmol/L with non-CHI patients (<i>p</i> &lt; 0.01). Median [BOHB] was 0 μmol/L in CHI patients as compared with 2378 μmol/L for non-CHI patients (<i>p</i> &lt; 0.01). Median [FFA] levels were 1910 μmol/L in the non-CHI cohort, compared with 0 in the CHI cohort (<i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study suggests that a C-peptide concentration greater than 291.5 pmol/L is diagnostic of CHI in children. C-peptide appears to offer the greatest utility as a biochemical diagnostic test for CHI and could be prioritised for laboratory analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 2","pages":"129-135"},"PeriodicalIF":3.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Vein Sampling for Primary Aldosteronism: Recommendations From the Australian and New Zealand Working Group","authors":"Jun Yang,&nbsp;Damon A. Bell,&nbsp;Richard Carroll,&nbsp;Cherie Chiang,&nbsp;Diane Cowley,&nbsp;Emma Croker,&nbsp;James C. G. Doery,&nbsp;Marianne Elston,&nbsp;Paul Glendenning,&nbsp;Julie Hetherington,&nbsp;Andrea R. Horvath,&nbsp;Shanshan Lu-Shirzad,&nbsp;Elisabeth Ng,&nbsp;Amanda Mather,&nbsp;Nimalie Perera,&nbsp;Muddassir Rashid,&nbsp;Nirupa Sachithanandan,&nbsp;Jimmy Shen,&nbsp;Michael Stowasser,&nbsp;Michael J. Swarbrick,&nbsp;Hong Lin Evelyn Tan,&nbsp;Moe Thuzar,&nbsp;Simon Young,&nbsp;Winston Chong","doi":"10.1111/cen.15139","DOIUrl":"10.1111/cen.15139","url":null,"abstract":"<p>Adrenal vein sampling (AVS) is the current recommended procedure for identifying unilateral subtypes of primary aldosteronism (PA), which are amenable to surgery with the potential for cure. AVS is a technically challenging procedure usually undertaken by interventional radiologists at tertiary centres. However, there are numerous variations in AVS protocols relating to patient preparation, sampling techniques and interpretation which may impact the success of AVS and patient care. To reduce practice variations, improve the success rates of AVS and optimise patient outcomes, we established an Australian and New Zealand AVS Working Group and developed evidence-based expert consensus recommendations for the preparation, performance and interpretation of AVS. These recommendations can be used by all healthcare professionals in a multidisciplinary team who look after the diagnosis and management of PA.</p>","PeriodicalId":10346,"journal":{"name":"Clinical Endocrinology","volume":"102 1","pages":"31-43"},"PeriodicalIF":3.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cen.15139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}