Endocrine Connections最新文献

{"title":"Long-term outcomes and survival predictors in patients with ectopic ACTH syndrome: data from a retrospective cohort study.","authors":"Zhanna Belaya, Liudmila Rozhinskaya, Olga Golounina, Alexander Solodovnikov, Evgeniya Marova, Svetlana Arapova, Michail Pikunov, Alla Markovich, Elizaveta Mamedova, Elena Przhialkovskaya, Ekaterina Pigarova, Valentin Fadeev, Nikolay Kuznetsov, Ivan Sitkin, Larisa Dzeranova, Alexander Lutsenko, Natalia Mokrysheva, Ivan Dedov, Galina Melnichenko","doi":"10.1530/EC-25-0411","DOIUrl":"10.1530/EC-25-0411","url":null,"abstract":"<p><strong>Background: </strong>Ectopic ACTH syndrome (EAS) is caused by non-pituitary neuroendocrine tumor (NET) that produces adrenocorticotropic hormone (ACTH).</p><p><strong>Objective: </strong>To identify survival predictors and to analyze long-term outcomes in patients with EAS.</p><p><strong>Methods: </strong>Medical records of patients with verified EAS between 1990 and 2024 were analyzed to obtain the initial clinical and biochemical data along with subsequent interventions and survival outcomes.</p><p><strong>Results: </strong>The study included 173 patients (107 women and 66 men), with a median (Q25-Q75) age of 42 years (29; 55). The median follow-up period was 54 months (16; 99) with a maximum of 402 months. Over the observation period, death was registered in 50 (28.9%) cases. The overall 3- and 5-year survival rates were 77 and 70%, respectively. Multivariable analysis revealed the following negative predictive factors for survival: age at diagnosis ≥51 years (hazard ratio (HR) 3.53; 95% confidence interval (CI): 1.67-7.5; P = 0.001), presence of metastases (HR 2.93; 95% CI: 1.35-6.32; P = 0.006), and active hypercortisolism (HR 5.58; 95% CI 1.62-19.24; P = 0.006) along with late night salivary cortisol levels (LNSC) above 130 nmol/L (HR 2.81; 95% CI: 1.30-6.07; P = 0.009).</p><p><strong>Conclusion: </strong>Active hypercortisolism, high LNSC, distant metastases and older age at diagnosis are factors associated with mortality in EAS. As severity of hypercortisolism is the main targetable factors, it should be the focus of intervention and further studies aimed at improving outcomes.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014173","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":"Point-of-care ionised calcium testing: lab validation and clinical feasibility study.","authors":"Virginia Rozalen Garcia, Tarek Ezzat Abdel-Aziz, Mechteld C de Jong, Francis Lam, Christina Soromani, John Honour, Tom R Kurzawinski","doi":"10.1530/EC-25-0337","DOIUrl":"10.1530/EC-25-0337","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing thyroid and parathyroid surgery require frequent assessment of blood calcium levels to guide their management, and currently such measurements are performed mostly in hospital environments on main laboratory platforms. The aim of this study was to explore the potential use of a non-medical LAQUA device designed to measure ionised calcium in environmental samples as a pocket-size point-of-care device able to measure blood calcium concentration in patients after thyroid and parathyroid surgery.</p><p><strong>Methods: </strong>The protocol of the study consisted of three distinctive phases: surveying the technological landscape and identifying currently available devices and technologies able to measure calcium in a small volume of whole blood easily, quickly, and accurately (Phase 1); testing the potential candidate device in a laboratory (Phase 2); and performing a prospective, single-arm study (IRAS ID 236079, Protocol number 18/0058, REC ref 19/LO/1740), during which simultaneous calcium measurements were performed on venous and capillary blood on LAQUA and 'gold standard' platforms Roche Cobas-Calcium-Gen.2 and Blood Gas Analyser ABL90 (Phase 3).</p><p><strong>Results: </strong>In Phase 1, LAQUA (HORIBA Inc. Japan) was identified as the most promising potential POC device in terms of size, simplicity of use, and cost effectiveness. In Phase 2, LAQUA showed good accuracy (Δmean = 0.09; P = 0.33) and precision (CV 3.41%) in measuring ionised calcium in standardised solutions. In Phase 3, 30 patients were recruited and had 67 sets of measurements. 'Gold standard' venous adjusted calcium (Roche) and ionised calcium (BGA) were equivalent, R = 0.95, (P < 0.001). Strong positive correlation R = 0.75 (P = <0.001) was observed between venous ionised calcium measured on BGA and LAQUA. Positive but weaker correlation was found between venous (BGA) and capillary (LAQUA) ionised calcium R = 0.68, (P = <0.001), and between venous and capillary ionised calcium (LAQUA), R = 0.56 (P = <0.001).</p><p><strong>Conclusions: </strong>LAQUA is a promising device, which can measure ionised calcium accurately in small venous but not yet capillary blood samples. Further device development is needed before it can be recommended as a potential POC device to measure calcium in blood.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947166","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":"Gestational diabetes mellitus and its association with newborn thyroid screening: a population-based study.","authors":"Dor Shoshan, Avivit Brener, Eyal Cohen-Sela, Orian Raviv, Michal Yackobovitch-Gavan, Shlomo Almashanu, Ronella Marom, Liran Hiersch, Yael Lebenthal","doi":"10.1530/EC-25-0280","DOIUrl":"10.1530/EC-25-0280","url":null,"abstract":"<p><strong>Objective: </strong>Gestational diabetes mellitus (GDM) affects maternal-fetal metabolism, but its impact on neonatal thyroid function remains unclear. This study aimed to evaluate the association between maternal GDM and total thyroxine (TT4) levels in newborn screening (NBS) and to identify contributing maternal and neonatal factors.</p><p><strong>Methods: </strong>This observational cohort study linked national NBS thyroid data with hospital medical records. The cohort included 101,450 mother-infant dyads, comprising 4,643 GDM and 96,807 non-GDM singleton pregnancies with term liveborn offspring. Maternal GDM status was the primary exposure variable, and neonatal TT4 levels were assessed as the main outcome measure.</p><p><strong>Results: </strong>The GDM prevalence was 4.6%. The median NBS TT4 levels (mg/dL) were 14.9 (12.7-17.3) in the GDM newborns compared to 14.6 (12.4-17.2) in the non-GDM newborns, with similar proportions of newborns requiring reflex-TSH testing. GDM mothers were older than non-GDM mothers (34.2 ± 4.8 vs 32.5 ± 4.8 years), had higher prepregnancy body mass indices (25.6 ± 5.5 vs 22.5 ± 4.0 kg/m2), and increased odds of hypertension (OR 3.39) and proteinuria (OR 2.40). GDM pregnancies had higher odds of Cesarean delivery (OR 2.21), large-for-gestational-age infants (OR 1.51), and neonatal intensive care admissions (OR 1.52). Multivariable analysis identified parity, neuraxial anesthesia, oxytocin use, Cesarean delivery, maternal fever, newborn sex, gestational age, and birth weight percentiles as factors associated with TT4 levels (P < 0.001 for all).</p><p><strong>Conclusion: </strong>GDM was not associated with clinically significant differences in NBS TT4 levels. While GDM pregnancies showed increased risks of adverse maternal-neonatal outcomes, the modest thyroid differences observed in this large cohort of term singleton pregnancies suggest that thyroid alterations in the newborns may not be a matter of concern in GDM pregnancies.</p><p><strong>Significance statement: </strong>This study examines the relationship between GDM and newborn thyroid function using a large, population-based dataset. By focusing exclusively on term singleton pregnancies, we eliminated confounding factors such as prematurity and multiple gestations. While previous research raised concerns about potential thyroid dysfunction in neonates of mothers with GDM, our findings show only minimal differences in thyroxine levels, providing reassurance that GDM has little impact on neonatal thyroid function. GDM remains strongly linked to adverse maternal and neonatal outcomes, including higher rates of Cesarean deliveries and neonatal intensive care admissions. These findings provide reassurance about neonatal thyroid function in GDM pregnancies while emphasizing the importance of monitoring other perinatal risks.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946932","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":"Modified stress hyperglycemia ratio identifies the risk of early cardiovascular complications in patients with acute myocardial infarction.","authors":"Yi Zhang, Jiahao Duan, Fan Huang, Kai Huang, Ruting Wang, Wei Liu, Xiaoyu Yang, Bin Zhu, Chun Yang, Ling Yang","doi":"10.1530/EC-25-0377","DOIUrl":"10.1530/EC-25-0377","url":null,"abstract":"<p><strong>Background: </strong>Stress hyperglycemia ratio (SHR) has been associated with poor outcomes in patients with acute myocardial infarction (AMI). Modified SHR (mSHR) is defined as the highest SHR observed within the first 24 h of admission. However, the association between mSHR and early cardiovascular complications (ECC) following AMI is unclear.</p><p><strong>Methods: </strong>This multicenter observational study incorporated retrospective and prospective analyses across two independent cohorts. The discovery and validation cohorts each included consecutive AMI patients admitted to intensive care units. The blood glucose and hemoglobin A1c levels were used to calculate mSHR. The primary outcome was the occurrence of ECC during the hospital stay.</p><p><strong>Results: </strong>In the discovery cohort, ECC occurred in 322 (23.9%) of 1,349 patients, and mSHR was independently associated with ECC (adjusted odds ratio: 1.164; 95% confidence interval (CI): 1.124-1.206; P < 0.001). Machine learning approaches identified mSHR as the most important feature. In the validation cohort, 303 patients were divided into three groups according to mSHR tertiles. Modified Poisson regression analysis showed that patients with mSHR ≥ 1.202 (tertile 3) had a significantly higher risk of ECC compared to those in tertiles 1-2 (adjusted risk ratio: 2.337; 95% CI: 1.479-3.693; P < 0.001). The results of multivariate analysis were consistent before and after applying inverse probability of treatment weighting.</p><p><strong>Conclusion: </strong>In AMI patients, mSHR is an accurate risk-stratification tool for identifying ECC. It may provide exploratory evidence to optimize current glycemic control strategies and early discharge pathways.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947081","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":"Disease-Specific Mortality in Patients With Acromegaly Treated With Pegvisomant: An ACROSTUDY Analysis.","authors":"Nicholas A Tritos, Martin O Carlsson, Greisa Vila, Camilo Jimenez, Daria La Torre, Michael P Wajnrajch, Beverly Mk Biller, Lissette Cespedes, Karen K Miller","doi":"10.1530/EC-25-0247","DOIUrl":"10.1530/EC-25-0247","url":null,"abstract":"<p><strong>Objective: </strong>Characterize disease-specific mortality rates in patients with acromegaly on pegvisomant and identify pertinent risk factors, including on-therapy insulin-like growth factor I (IGF-I) levels.</p><p><strong>Design: </strong>Retrospective cohort analysis of ACROSTUDY, a global surveillance study of patients with acromegaly receiving pegvisomant.</p><p><strong>Methods: </strong>Cumulative incidence function to estimate disease-specific mortality and regression analyses to characterize risk factors. Disease-specific standardized mortality rates (SMR) were calculated; Poisson regression models characterized the association between disease-specific SMR, IGF-I, and other risk factors.</p><p><strong>Results: </strong>2077 patients were followed (median: 4.1 years). Mortality (HR,95% CI) secondary to cardiovascular/cerebrovascular causes increased with higher on-treatment IGF-I (1.97 [1.45-2.67], P<.0001) and older age at enrollment (1.10 [1.07-1.13], P<.0001). Mortality secondary to malignant (1.57 [1.17-2.09), P=.0024) or respiratory (1.64 [1.23-2.19], P=.0008) causes increased with higher on-treatment IGF-I. Younger attained age (0.93 [0.91-0.96], P<.0001), younger age (<35 vs >50 years) at diagnosis (3.64 [1.33-9.93], P=.0117), higher on-treatment IGF-I (1.69 [1.12-2.55], P=.0127), and pituitary radiotherapy (2.25 [1.09-4.63], P=.0280) were associated with higher SMR (95% CI) for cardiovascular/cerebrovascular causes. Younger attained age (0.93 [0.89-0.96], P<.0001], higher IGF-I at enrollment (>2x vs <1x upper limit of normal: 4.89 [1.09-21.8], P=.0378), and malignancy at enrollment (7.05 [2.36-21.03], P=.0005) were associated with higher SMR (95% CI) for malignant causes. Younger age (35-50 vs >50 years) at diagnosis (4.50 [1.08-18.83], P=.0394) and sleep apnea (4.98 [1.34-18.53], P=.0168) were associated with higher SMR ratios for respiratory causes.</p><p><strong>Conclusions: </strong>Younger age, higher on-therapy IGF-I and radiotherapy were associated with higher SMR for cardiovascular/cerebrovascular causes, highlighting the importance of achieving IGF-I normalization.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023053","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":"Optimising diagnosis in children with short stature: an integrated clinical and NGS approach.","authors":"Laura Guazzarotti, Chiara Mozzato, Silvia Zoletto, Francesca Boaretto, Chiara Rigon, Matteo Cassina","doi":"10.1530/EC-25-0229","DOIUrl":"10.1530/EC-25-0229","url":null,"abstract":"<p><p>Short stature (SS) is one of the most frequent reasons for referral to paediatric endocrinologists. Linear growth is a multifactorial process, with genetic variation representing the principal determinant of height differences. Between 2018 and 2022, 102 children referred to our clinic for growth failure were identified as having SS of unknown aetiology. The cohort comprised 57 children with idiopathic GH deficiency (GHD-SS) and 45 with idiopathic short stature (ISS). Children born small for gestational age and those with known genetic conditions were excluded. All patients underwent a single next-generation sequencing (NGS) analysis using a custom-designed targeted gene panel for SS. When variants were detected, segregation analysis was performed through parental testing. The overall diagnostic yield of NGS was 14.9%, with variants considered causative of the SS phenotype detected in 14.3% of GHD-SS patients and 15.6% of ISS patients. Detection rates were comparable between isolated GHD and combined pituitary hormone deficiency. Among ISS patients, a genetic diagnosis was achieved in 23.8% of familial cases and in 8.7% of sporadic cases. Variants of uncertain significance were identified in approximately half of the cohort. In conclusion, a first-line targeted NGS approach, applied in routine clinical practice to a carefully selected cohort of children with SS of unknown aetiology, demonstrated a competitive diagnostic yield. Accurate phenotypic assessment remains critical to improving the diagnostic performance of molecular testing and refining the aetiological evaluation of SS. Moreover, identification of the underlying genetic cause provides valuable insights for predicting clinical evolution and guiding therapeutic strategies.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12424039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947168","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":"Coffee intake and the vasopressin system: an epidemiological and experimental study.","authors":"Fredrika Schill, Simon Timpka, Sophie Hellstrand, Olle Melander, Sofia Enhörning","doi":"10.1530/EC-25-0100","DOIUrl":"10.1530/EC-25-0100","url":null,"abstract":"<p><p>Coffee is epidemiologically linked to health benefits and risks. Coffee is thought to be a diuretic. However, it can still contribute to daily fluid intake. Vasopressin is the most important physiological regulator of body fluid balance and diuresis. This study aimed to map the effects of coffee intake on vasopressin concentration. In the population-based cross-sectional Malmö Offspring Study (n = 3,270, age 18-75 years, 47% males) we performed linear regression analyses to investigate the association between coffee intake and plasma concentration of copeptin (a vasopressin surrogate marker). Coffee intake was assessed using a 4-day food record. Moreover, we compared plasma copeptin concentrations after intake of 4 dL of coffee and 10 mL of water (control) in an experimental study (n = 26, age 35-70 years, 15% males). Results showed that higher coffee intake was associated with lower copeptin concentration after adjusting for co-variables, including total fluid intake. In the coffee experiment, the acute intake of 4 dL of coffee significantly decreased copeptin concentration at all time points (every 30 min for 4 h) compared with baseline concentration. A 27% maximum reduction on average was observed within 150 min. Intake of 10 mL of water also resulted in a slight reduction of copeptin concentration within 2 h. These findings suggest that copeptin concentration is lower among individuals with high coffee intake and can be acutely decreased by coffee intake. The mechanisms behind the coffee-induced reduction in copeptin concentration may involve oral and gut reflexes, volume load, and/or specific effects of coffee compounds.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872034","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":"Outcomes following hospitalization for diabetic ketoacidosis in patients with cardiovascular disease.","authors":"Yanrui Huang, Zijun Xu, Honghua Deng, Junxin Chen, Rong Huang, Hai Li, Juan Liu, Hongyu Guan","doi":"10.1530/EC-25-0276","DOIUrl":"10.1530/EC-25-0276","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic ketoacidosis (DKA) is a serious complication in patients with diabetes. This study compares the outcomes of hospitalized DKA patients with and without cardiovascular disease (CVD). In addition, we assess outcomes between DKA and hyperosmolar hyperglycemic syndrome (HHS) in diabetes patients with CVD, and between those who developed DKA and those who did not.</p><p><strong>Methods: </strong>We employed a population-based, retrospective observational design utilizing data sourced from the National Inpatient Sample database for the years 2016-2022. The primary outcome assessed was in-hospital mortality. In addition, various secondary outcomes were examined, including the incidence of acute respiratory failure, acute kidney failure, septic shock, sepsis, acute neurological failure, pulmonary embolism, deep vein thrombosis, acute liver failure, mechanical ventilation, noninvasive ventilation, and the length of hospital stay (LOS) and total hospital charges.</p><p><strong>Results: </strong>Multivariable regression analysis demonstrated that CVD independently increased mortality and complications, including acute respiratory failure and sepsis, in DKA patients, who also experienced longer LOS and higher medical costs compared to those without CVD. Similar findings were observed when comparing outcomes between DKA and HHS in diabetes patients with CVD, as well as between those who developed DKA and those who did not.</p><p><strong>Conclusions: </strong>This study demonstrates that CVD significantly affects the outcomes of patients admitted for DKA. Moreover, similar negative outcomes were observed when comparing DKA patients with HHS and those who developed DKA versus those who did not. These findings highlight the need for careful management of DKA in patients with CVD to optimize clinical outcomes.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947156","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":"Is evaluation of cortisol after dexamethasone suppression test enough? Analysis of steroid profile after dexamethasone suppression test using tandem mass spectrometry.","authors":"Tomas Brutvan, Marcela Kotasova, Adela Krausova, Jarmila Krizova, Otakar Psenicka, Jan Sevcik, Martin Sevcik, Hana Vitkova, Jana Jezkova","doi":"10.1530/EC-25-0281","DOIUrl":"10.1530/EC-25-0281","url":null,"abstract":"<p><strong>Introduction: </strong>The overnight dexamethasone suppression test (DST) is recommended for the initial testing of Cushing's syndrome. Simultaneous measurement of dexamethasone and cortisol is recommended. This study aimed to determine the cutoff value for dexamethasone measured in DST analyzed via liquid chromatography tandem mass spectrometry (2D-LC-MS/MS) and to assess whether analysis of adrenal steroids other than cortisol may improve diagnostic accuracy.</p><p><strong>Methods: </strong>A prospective study was conducted including patients with adrenal incidentalomas (n = 55), pituitary incidentalomas and symptoms of Cushing's disease (n = 18), and healthy controls (n = 100) undergoing DST. Plasma levels of ten steroids and dexamethasone were determined via 2D-LC-MS/MS, while cortisol levels were also determined via a chemiluminescence immunoassay.</p><p><strong>Results: </strong>The lower 2.5th percentile of plasma dexamethasone in the control group (cortisol level <50 nmol/L) was 3.48 nmol/L, which was set as the cutoff. In the subgroup of patients with adrenal incidentalomas, regardless of the results of DST, subjects exhibited identical changes in the basal adrenal steroid profile: increased 11-deoxycortisol and decreased DHEA and DHEAS levels. After 1 mg dexamethasone administration, cortisol and cortisone levels increased, while decreased androstenedione and 17-OHP levels were detected. Statistically significant changes were found in the subgroup of patients with pituitary incidentalomas: increased levels of 11-deoxycortisol, plasma cortisol, cortisone, and androstenedione were observed only in those with serum cortisol levels >50 nmol/L. Based on the ROC curves, none of the steroid hormones exhibited higher specificity than cortisol.</p><p><strong>Conclusion: </strong>Simultaneous measurement of cortisol and dexamethasone increases DST specificity. The cutoff value for dexamethasone was set at 3.48 nmol/L. None of the adrenal steroids in the DST demonstrated increased specificity; thus, a cortisol concentration <50 nmol/L remains the gold standard for ruling out Cushing's syndrome.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946946","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":"Long-term efficacy of dapagliflozin combined with Bifidobacterium triple viable tablets on metabolic syndrome and gut microbiota in overweight/obese patients with type 2 diabetes.","authors":"Kunyi Li, Zhi Li, Lifeng Liu","doi":"10.1530/EC-25-0219","DOIUrl":"10.1530/EC-25-0219","url":null,"abstract":"<p><strong>Background: </strong>The rising global prevalence of type 2 diabetes (T2D) necessitates innovative therapies targeting glycemic control and metabolic complications. SGLT2 inhibitors improve cardiorenal outcomes and may modulate gut microbiota, while specific probiotics demonstrate glycemic and lipid benefits. However, synergistic effects of combining SGLT2 inhibitors with probiotics remain unexplored.</p><p><strong>Methods: </strong>This 24-week randomized controlled trial enrolled 120 overweight/obese T2D patients (BMI ≥ 24 kg/m2, HbA1c ≥ 7.0%). Participants were randomized to dapagliflozin (10 mg/day) alone (control, n = 60) or dapagliflozin plus triple viable tablets, containing Bifidobacterium longum, Lactobacillus acidophilus and Enterococcus faecalis (six tablets/day, ≥1.0 × 107 CFU/g/strain; experimental, n = 60). The primary outcome was HbA1c change; secondary outcomes included weight, lipid profiles, blood pressure, gut microbiota (qPCR quantification), and safety. Analyses used mixed-effects models (completers: 57 control, 58 experimental) and Spearman correlations.</p><p><strong>Results: </strong>The experimental group showed superior improvements in weight (-5.2 kg vs -3.1 kg), HbA1c (-1.8% vs -0.8%), LDL-C (-0.5 vs -0.3 mmol/L), HDL-C (+0.17 vs +0.07 mmol/L), and HOMA-IR (-1.2 vs -0.6) compared to controls (all P < 0.05). Gut microbiota analysis revealed increased Bifidobacterium (7.3 vs 5.5 log CFU/g, P < 0.001), reduced Enterobacteriaceae (4.5 vs 6.5 log CFU/g, P = 0.003), and a higher gram-positive/negative ratio (1.12 vs 0.70, P = 0.001). Bifidobacterium abundance correlated with HbA1c reduction (r = -0.42, P = 0.008), while gram-positive/negative ratio was linked to improved HDL-C (r = 0.26, P = 0.041). Adverse events were comparable between groups (28.3 vs 25.0%, P = 0.672).</p><p><strong>Conclusions: </strong>Combining dapagliflozin with Bifidobacterium probiotics enhances metabolic outcomes and favorably modulates gut microbiota in T2D patients. These findings support microbiota-targeted adjunctive therapy to optimize SGLT2 inhibitor efficacy.</p>","PeriodicalId":11634,"journal":{"name":"Endocrine Connections","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872037","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}