Clinical Endocrinology (Clin Endocrinol )

Publisher: Blackwell Publishing

Description

Clinical Endocrinology publishes papers and reviews which focus on the practical aspects of clinical endocrinology, such as protocols for investigation of endocrine disorders, imaging in endocrinology and the clinical application of molecular endocrinology. It also features reviews, current therapy papers and cases of the month. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.

  • Impact factor
    3.40
  • 5-year impact
    3.26
  • Cited half-life
    7.40
  • Immediacy index
    0.87
  • Eigenfactor
    0.02
  • Article influence
    0.99
  • Website
    Clinical Endocrinology website
  • Other titles
    Clinical endocrinology (Oxford, England: Online)
  • ISSN
    1365-2265
  • OCLC
    46569692
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

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    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review is to examine the evidence base underlying the corticotropin test in the management of the critically ill patient. The principle behind the corticotropin test is the demonstration of an inappropriately low cortisol production in response to exogenous ACTH, a situation analogous to physiological stress The corticotropin test was originally described in non stressed subjects, and its applicability and interpretation in the setting of critical illness continues to generate controversy. Attempting to determine the prevalence of an abnormal corticotropin test in critical illness is complicated by the use of different end points and different populations. Moreover, the test result is also influenced by the assay used for measurement of plasma cortisol. Trials assessing the relationship between corticotropin response and severity of stress and organ dysfunction have produced divergent results, which may reflect differences in the methodology and the association being measured. Moreover controversy exists with respect to the methodology and the interpretation with respect to the following variables: dose of corticotropin, end points for assessment- total or free cortisol, effect of plasma cortisol variability, adrenal blood flow and its equivalence with other tests of adrenocortical function. The corticotropin test is used widely in the evaluation of adrenocortical function in the endocrine clinics. Its role in the critically ill patient is less well established. Several confounding variables exist and to have a "one size fits all" approach with a single endpoint in the face of several methodological and pathophysiological confounders may be flawed and may result in the institution of inappropriate therapy. The current evidence does not support the use of the corticotrophin test in critical illness to assess adrenocortical function and guiding steroid therapy in critical illness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disease that results from defective secretion or insensitivity to gonadotropin-releasing hormone (GnRH), or both, and presents with absent or partial puberty due to sex steroid deficiency.(1) Little is known about the impact of CHH on perceived general well-being, as evaluated by health-related quality of life (HRQoL). Three previous studies have evaluated HRQoL in males with HH, and all reported decreased scores, whereas only one work has reported on HRQoL specifically in patients with CHH. (2) We analyzed HRQoL in a well-characterized population of CHH males, and paid special attention to the relationship between early clinical signs of profound GnRH deficiency (i.e. history of microphallus and/or cryptorchidism) and HRQoL later in life. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: A physiological increase in androgen levels occurs during adolescence. Measuring androgen concentrations is the best method to distinguish normal evolution processes from hyperandrogenic disorders. The increase in circulating androgens during puberty is inversely associated with insulin sensitivity in normal weight girls. To assess circulating levels of ovarian androgens and anti-Müllerian hormone (AMH) at baseline and after GnRH analogue (GnRH-a) stimulation in normal pubertal girls across different Tanner stages. We also studied the association between this response and insulin sensitivity. Prospective study of healthy girls (6-12 years) from the local community (n=63). Tanner I (n=23) subjects were assessed cross-sectionally, and Tanner II girls (n=40) were evaluated every six months until they reached Tanner V. Early morning dehydroepiandrosterone sulphate (DHEA-S), AMH, sex hormone-binding globulin (SHBG), androstenedione, glucose and insulin levels were measured. A GnRH-a test (500 μg/m(2) ; sc) and oral glucose intolerance test (OGTT) were performed. Differences throughout puberty were evaluated. Basal and stimulated testosterone, DHEA-S, and stimulated 17-hydroxyprogesterone (17OHP) were inversely associated with insulin sensitivity (WIBSI) from the beginning of puberty, whereas androstenedione was directly associated with gonadotrophins. AMH was inversely associated with basal and stimulated gonadotrophins and directly with insulin area under the curve (AUC) only in the early stages of puberty. 17OHP and testosterone-responsiveness increased significantly during puberty in all subjects, whereas testosterone levels changed less consistently. This pattern of ovarian-steroidogenic response was most evident during mid- and late puberty. Moreover, during late puberty only, basal 17OHP, testosterone and DHEA-S were positively associated with gonadotrophins. In normal non-obese girls born appropriate for gestational age, androgen synthesis was associated with insulin sensitivity in early puberty and with LH only in late puberty. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is an autosomal recessive disorder and represents one of the most common inborn disorders of metabolism.1 Based on recent outcome studies,2,3 awareness of long-term health problems in CAH has significantly increased amongst many different medical specialities caring for patients with CAH. One particular issue is the variability of frequency, onset and development of hypertension in patients with CAH.4This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective The aim of the study was to analyse the relationship between nutritional status, selected adipokines, and plasma anti-Müllerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS).Study design patients and measurementsA prospective, cross-sectional study, involving 87 PCOS (48 obese) women and 67 Non-PCOS women (36 obese). Anthropometric parameters were measured and body composition was determined by the bioimpedance method. Fasting serum glucose, androgens, FSH, LH, SHBG, insulin, AMH, apelin-36, adiponectin, leptin, and omentin-1 were measured.ResultsPlasma AMH levels were significantly higher in PCOS compared to the Non-PCOS group (7.8±4.3 ng/mL vs. 4.4±2.4 ng/mL; p<0.001). Furthermore, AMH levels were higher in both PCOS and Non-PCOS normal weight than in obese subgroups (8.9±4.4 ng/mL vs. 7.0±4.0 ng/mL; p<0.05 and 5.1±2.4 ng/mL vs. 3.9±2.3 ng/mL; p<0.05). There were negative correlations between AMH levels and anthropometric parameters (body mass, BMI, fat mass and percentage, as well as waist circumference) and plasma omentin-1 concentrations (R=-0.28, p<0.001; R=-0.30, p<0.001; R=-0.36, p<0.001; R=-0.34, p<0.001; R=-0.23, p<0.01 and R=-0.20, p<0.05, respectively) in all study groups. In multiple regression analysis, circulating AMH level variability was explained by omentin-1 levels and anthropometric parameters (excluding waist circumference).Conclusions In this observational study, nutritional status appears to be the main factor influencing circulating AMH levels independent of PCOS. The observed AMH association with omentin-1 levels suggests that this adipokine may be a link between hormonal dysfunction of adipose tissue related to obesity and decreased AMH secretion.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Background The cytological diagnosis of follicular neoplasm (Thy3F) remains a diagnostic challenge. The main aim of this study is to stratify the risk of malignancy in thyroid nodules diagnosed as Thy3F on cytology (Thy3F) using Thyroid Imaging Reporting and Data System (TIRADS).MethodsA database of thyroid nodules with Thy3F cytological results from ultrasound guided FNA (US-FNA) between January 2007 and March 2014 was studied retrospectively. Information on patient demographics, ultrasound characteristics and final histology of the nodules was collated. The number of suspicious US features of each thyroid nodule was counted based on TIRADS. The malignancy rate of each of the TIRADS category was also calculated based on the final histological outcomes of the nodules and compared to that calculated using a recently proposed thyroid malignancy risk prediction model.ResultsThe overall malignancy rate of Thy3F cytology was 24.3%. There were significantly higher percentages of malignant nodules with irregular margins (20.0% versus 0%, p=0.000), hypoechogenicity (74.3% versus 51.4%, p=0.013) and taller than wide morphology (17.1% versus 0.9%, p=0.001) when compared to benign nodules. The risk of malignancy increased with advancing TIRADS score: TIRADS 4A (14.3%), TIRADS 4B (23.1%), TIRADS 4C (87.5%) and TIRADS 5 (100%). The malignancy rate calculated using the prediction model similarly increased with advancing TIRADS score: TIRADS 4A (6.2%), TIRADS 4B (32.5%), TIRADS 4C (79.9%) and TIRADS 5 (90%).Conclusion Thyroid nodules with TIRADS scores 4C and 5 should be considered for single definitive surgery in view of the high malignant rate.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: ObjectiveGH deficiency is a common feature of Prader-Willi-syndrome; however, biochemical deficiency is not uniformly demonstrated. Criteria for GH treatment in pediatric PWS vary, with some countries requiring documentation of biochemical GH deficiency. Data regarding the significance of age in the interpretation of GH stimulation test results, particularly in infants is lacking. We aimed to assess age related trends in the prevalence of biochemical GH deficiency in infants and children with PWS.DesignA retrospective chart review was conducted. Data from children with Prader-Willi-syndrome that had GH stimulation tests done at the Hospital for Sick Children in Toronto between the years 2000-2012 was collected.PatientsCharts of 47 children 0.4-15.5 years of age with PWS that had GH stimulation tests were reviewed.MeasurementsBiochemical GH status in relation to age and body-mass-index.Results32/47 patients (68%) were biochemically GH deficient. GH deficiency was significantly associated with older age (r=0.45, p=0.02) and higher body-mass-index z-score (r=0.45, p=0.02). Biochemical GH deficiency was less prevalent up to 18 months of age (3/11 27%) compared with older children (29/36 [81%]; p=0.001). A higher prevalence of GH deficiency was also detected in obese patients (14/16 [88%]) compared with non-obese patients (18/31 [58%]; p=0.04).Conclusions The utility of performing GH stimulation tests as an indication of GH status under 18 months of age in Prader-Willi-syndrome is questionable. If performed, results should be carefully interpreted in the context of age.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Management of Graves’ disease (GD) in Europe was published in 1987. Aim of this survey was to provide an update on clinical practice in Europe, and to compare it with a 2011 American survey.DesignMembers of the European Thyroid Association (ETA) were asked to participate in a survey on management of GD, using the same questionnaire of a recent American survey.ResultsA total of 147 ETA members participated. In addition to serum TSH and free T4 assays, most respondents would request TSH receptor autoantibody (TRAb) measurement (85.6%) and thyroid ultrasound (70.6%) to confirm etiology, while isotopic studies were selected by 37.7%. Antithyroid drug (ATD) therapy was the preferred first-line treatment (83.8%). Compared to the previous European survey, Europeans currently more frequently use TRAb measurement and thyroid ultrasound for diagnosis and evaluation, but first-line treatment remains ATDs in a similar percentage of respondents. Current clinical practice patterns differ from those in North America, where isotopic studies are more frequently used, and radioiodine (RAI) still is first-line treatment. When RAI treatment is selected in the presence of mild Graves’ orbitopathy and/or associated risk factors for its occurrence/exacerbation, steroid prophylaxis is frequently used. The preferred ATD in pregnancy is propylthiouracil in the first trimester and methimazole in the second and third trimesters, similar to North America.Conclusions Significant changes in clinical practice patterns in Europe were noted compared to the previous European survey, as well as persisting differences in diagnosis and therapy between Europe and North America.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Whether nonalcoholic fatty liver disease (NAFLD) can predict atherosclerosis in obese patients remains unclear. The aim of our study was to investigate the usefulness of NAFLD and other cardiometabolic parameters in predicting subclinical atherosclerosis in obese patients.Design, Patients and MeasurementsWe studied 314 consecutive obese subjects (223 women; mean age, 45.04±9.34 years; body mass index 44.3±5 Kg/m2) and 47 healthy lean individuals. Hepatic steatosis and atherosclerosis (carotid intima-media thickness [cIMT]>0.8 mm and/or presence of plaques) were evaluated ultrasonographically. Liver biopsies were obtained in 51 patients.ResultsIn obese patients, mean c-IMT was greater in those with NAFLD (P<0.001). Hepatic steatosis and age were independent predictors of atherosclerosis: the NAFLD-associated OR for atherosclerosis was 5.96 (95%CI, 1.60-22.25;p=0.008) in men and 8.26 (95%CI, 4.02-16.99;p<0.001) in women, and the age-associated OR for atherosclerosis was 1.14 (95%CI, 1.07-1.22; p<0.001) in men and 1.12 (95%CI, 1.08-1.17; p<0.001) in women. The sensitivity, specificity, and positive and negative predictive values of steatosis for atherosclerosis were 78.70%, 70.50%, 74.00%, and 75.60% (AUC=0.840) in men ≥43.5 years and 86.90%, 52.50%, 68.80%, and 76.80% (AUC=0.761) in women ≥47.5 years, respectively. Agreement between ultrasound-diagnosed steatosis and histology was good (ICC=0.79). Combined NAFLD and age was the strongest predictor of atherosclerosis in obesity.ConclusionsNAFLD and age may be independent risk factors for carotid atherosclerosis in obese individuals. Obese men and women with steatosis aged over 43.5 and 47.5 years, respectively, should be screened for carotid atherosclerosis. However, further evidence is necessary before suggesting an intervention based on current findings.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Treatment of growth hormone (GH) – deficient adults with GH has been shown to improve a range of metabolic abnormalities and enhance quality of life. However, the results of access to nationally funded treatment have not been reported.DesignRetrospective case series auditing nationally funded treatment of defined GH-deficient adults in New Zealand, with carefully designed entry and exit criteria overseen by a panel of endocrinologists.PatientsApplications for 201 patients were assessed and 191 approved for funded treatment over the initial 3 years since inception. The majority had GH deficiency following treatment of pituitary adenomas or tumours adjacent to the pituitary.ResultsAfter an initial 9-month treatment period using serum IGF-I measurements to adjust GH dosing, all patients reported a significant improvement in quality of life (QoL) score on the QoL-AGHDA® instrument (baseline (95%CI) 19 (18-21), 9 months 6 (5-7.5)), and mean serum IGF-I SD scores rose from -3 to zero. Mean waist circumference decreased significantly by 2.8 ± 0.6 cm. The mean maintenance GH dose after 9 months treatment was 0.39mg/day. After 3 years 17% of patients had stopped treatment, and all of the remaining patients maintained the improvements seen at 9 months of treatment.Conclusion Carefully designed access to nationally-funded GH replacement in GH-deficient adults was associated with a significant improvement in quality of life over a 3-year period with mean daily GH doses lower than in the majority of previously reported studies.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Guran et al.1 recently published an article in Clinical Endocrinology reporting age-related reference values for serum dehydroepiandrosterone sulphate (DHEAS) in healthy children and adolescents. The mean gestational age of their cohort was 39±2 weeks, with a mean birth weight of 3237±615 g. Therefore, their study included children who were born prematurely or were small for their gestational age (SGA).This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Recent studies report high rates of thyroid disorders in pregnant women. However the need for universal thyroid screening remains controversial. Our aim was to estimate the prevalence of thyroid dysfunction (TD) during pregnancy and to analyze the association with maternal age.Design and methodsWe conducted a cross-sectional study in a referral centre in collaboration with the primary care units from April 2010 to March 2011. The study included 2509 consecutive pregnant women resident in an iodine-sufficient area, mean age 32 years (range 16-47) who were universally screened for TD in their first trimester (median gestation 8 weeks, range 4-13 weeks). Thyroid stimulating hormone (TSH) and free T4 (FT4) were analyzed during the first antenatal visit. We applied first trimester-specific population-based TSH and FT4 reference ranges.ResultsWe identified 416 women with positive TD screening [16.6%, 95% confidence interval (95% CI) 15.1-18.0. Of these, 47 had overt hypothyroidism (1.9%), 90 subclinical hypothyroidism (3.6%), 23 overt hyperthyroidism (0.9%), 20 subclinical hyperthyroidism (0.8%) and 236 had isolated hypothyroxinaemia (9.4%). Applying a logistic regression model, age ≥30 years was not associated with a higher risk of TD [Odds ratio (OR) 0.85, 95% CI 0.67-1.08] or hypothyroidism (OR 0.72, 95% CI 0.50-1.06).ConclusionsTD affects one in six pregnant women in an iodine-sufficient population. Maternal age ≥30 years does not increase the risk of TD.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Cadmium (Cd) has been shown to impair pubertal development in experimental animals. However, no data are available for male adolescents with increased urinary cadmium levels.DesignAim of this cross-sectional study was to evaluate pubertal onset and pituitary-gonadal axis hormones in male adolescents with increased urinary levels of Cd.SubjectsWe studied 111 males, aged 12-14 years living in the Milazzo-Valle del Mela area. A control age matched population (n=60) living 28-45 km far from the industrial site was also enrolled.MeasurementsPubertal stages were assessed by clinical examination according to Tanner's score. Mean testicular volume was also investigated by ultrasound examination. Urinary Cd concentration and blood levels of FSH, LH, testosterone, and inhibin-B were also investigated.ResultsCd levels were significantly higher in adolescents living in the Milazzo-Valle del Mela area, compared to both age-matched subjects living far from the industrial plants and the reference values. Our population showed also a delayed onset of puberty, a smaller testicular volume, and lower testosterone levels. An inverse correlation was found between urinary Cd and testicular volume (r=-0.25; p=0.0008), testosterone levels (Spearman's r=-0.0.37; two-tailed p<0.0001), and LH levels (Spearman's r=0.048; p<0.05). Testosterone levels were positively correlated with testicular volume (Spearman's r=0.48; p<0.0001).Conclusions This study, for the first time, suggests that increased Cd burden is associated with delayed onset of puberty in male adolescents and impaired testicular growth.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Objective Thyroid cancer is the most common endocrine malignancy and its incidence has been increasing over the last thirty years. Several studies have suggested that miRNAs may play a significant role in the differential diagnosis of indeterminate thyroid nodules. To systematically evaluate the utility of miRNAs in discriminating malignant thyroid nodules from benign ones on fine-needle aspiration biopsy (FNAB) samples, a systematic review and meta-analysis of the published literatures were carried out.Patients and Design361 samples, obtained from 341 patients, were included in the research and summary sensitivity (SEN), specificity (SPE), positive likelihood ratios (PLR), negative likelihood ratios (NLR), diagnostic odds ratio (DOR) were calculated. Then summary receiver operating characteristic curves (SROCs) and areas under the SROC curves (AUCs) were calculated to further estimate the overall diagnostic value of miRNAs in thyroid cancer.ResultsThe overall pooled SEN, SPE and AUC are 0.75, 0.81, 0.89, respectively. For multiple miRNAs assays, the pooled SEN, SPE and AUC are 0.87, 0.75, 0.68, respectively. For single miRNA assays, the corresponding results are 0.71, 0.84 ,0.87, respectively. The corresponding statistical results for differentiating indeterminate FNAB samples are 0.92, 0.68, 0.86, respectively.Conclusion Our current meta-analysis suggests that miRNAs may serve as a novel diagnostic tool in distinguishing malignant thyroid nodules from benign ones on FNAB specimens. In addition, subgroup analysis suggests that a panel of miRNAs may have a higher sensitivity but a relatively lower specificity than that of single miRNA in distinguishing thyroid nodules.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: We read with interest the relevant study by Dinas et al.1 where they showed, for the first time, an association between self-reported habitual physical activity and brown adipose tissue (BAT) activity in a sample of forty (14 females) patients with cancer. Their positive findings are of great importance and despite their study design does not allow to infer any causal relationship, the results are informative and support evidence from exercise-based intervention studies conducted in animal models. Although contribution by Dinas et al. 1 should be recognized, caution is needed when suggesting that habitual physical activity may have an effect on BAT activity.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Cardiovascular complications represent the biggest cause of mortality in acromegaly. It is therefore important to optimally stratify acromegalic patients according to disease activity and complication risk. GH is secreted in a pulsatile manner from the pituitary gland, but GH pulsatility is not routinely assessed clinically. The coefficient of variation of serum GH (GHCV) during OGTT quantifies the variation of GH secretion in patients with acromegaly, but has not been reported previously. Investigate whether GHCV during OGTT is associated with clinical parameters predicted to relate with hypothalamo-pituitary dysfunction during acromegaly, such as radiotherapy treatment, pituitary deficiency, and cardiac disease. GHCV was calculated during 584 OGTTs and compared with nadir serum GH and IGF-1 in 111 acromegalic patients treated at a single center. Acromegalic patients treated with radiotherapy had a 37% lower level of GHCV when compared with the non-radiotherapy group (mean GHCV: 0.298±0.015, no radiotherapy; 0.189±0.007, radiotherapy; P<0.001). Neither serum IGF-1 nor nadir GH was significantly altered in the radiotherapy group. Mean GHCV was 50% lower in the acromegalic patients with cardiac failure when compared with acromegalic patients with normal echocardiogram (0.161±0.034 vs. 0.297±0.055; P<0.05). Neither serum IGF-1 nor nadir GH were significantly altered during cardiac failure. Our preliminary data suggest that GHCV during OGTT may be reduced during acromegaly in patients with previous radiotherapy, pituitary deficiencies, and cardiac disease. Larger studies are required to determine if GHCV could provide help to assess the morbidity status of patients with treated acromegaly. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Background Since renin and aldosterone levels vary during the menstrual cycle, and are critical criteria for interpretation of aldosterone suppression tests to confirm or exclude primary aldosteronism, outcome of testing may vary depending on the menstrual cycle phase. We assessed the effect of timing within the menstrual cycle on levels of renin, aldosterone and female sex steroids during fludrocortisone suppression testing (FST).Methods In 22 women undergoing FST who experienced regular menstrual cycles, renin (measured as both plasma renin activity and direct renin concentration), aldosterone (mass spectrometry) and cortisol, progesterone, estradiol, LH and FSH (immunoassay) levels were compared, relative to phase of cycle. Aldosterone levels were compared to those in age-matched males undergoing FST.ResultsProgesterone (p<0.0001) and aldosterone (p=0.006) levels were higher in nine women (after one of 10 was excluded with anovulatory cycle) studied during the luteal phase than in 12 studied during the follicular phase. All studied during the luteal phase had positive FST and all three with negative FST were studied during the follicular phase. There were no significant differences in other parameters measured except FSH, which was higher (p=0.02) during the follicular phase. Aldosterone was higher (p=0.01) in women studied in the luteal (but not follicular) phase compared to men.Conclusion The menstrual cycle may affect the outcome of FST and other suppression testing used to diagnose primary aldosteronism. Larger patient numbers and preferably restudy of the same patient in both phases should clarify this, and determine the optimum time in the cycle for testing.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: We read with interest the recent paper by Vaidya et al.1, which deals with antithyroid drug therapy of Graves’ disease (GD). Among the three major treatment options for GD - radioiodine, surgery, and antithyroid drugs2 - the latter is that most preferred among clinicians worldwide3. In this respect, two different regimes are in play: either the block & replace (B&R) regime or the titration regime2. According to the first principle, a fixed high dose of an antithyroid drug (carbimazole, methimazole, or propylthiouracil) is used in order to shut down the endogenous thyroid hormone synthesis, while euthyroidism is maintained by levothyroxine supplementation.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
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    ABSTRACT: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity; however data on the reversibility of cardiovascular disease in mild primary hyperparathyroidism are conflicting. The aim of this study was to assess endothelial function in patients with mild PHPT before and after parathyroidectomy (Ptx) METHODS: We prospectively evaluated 53 patients with mild PHPT (Group 1; 45 women, 8 men; aged 52 ± 3.1 years) and 46 healthy control subjects (Group 2; 38 women, 8 men; aged 46 ± 9.5 years). Endothelial function was measured as flow-mediated dilation (FMD) and carotid intima media thickness (CIMT) using doppler ultrasonograpy. Patients with diabetes mellitus, coronary heart disease, impaired renal function, hyperthyroidism, hypothyroidism, and a history of smoking were excluded from the study. Patients were studied at baseline and 6-12 months after the first evaluation.
    Clinical Endocrinology 11/2014;
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    ABSTRACT: Obesity causes dysfunction of adipose tissue, with resultant chronic inflammation and adverse interplay of various adipokines, sex steroids and endocrine hormones. All these drive tumourigenesis and explain the epidemiological link between obesity and cancer. Over the past decade, the associations among obesity, adipokines and cancer have been increasingly recognized. Adipokines and their respective signaling pathways have drawn much research attention in the field of oncology and cancer therapeutics. This review will discuss the recent advances in the understanding of the association of several adipokines with common obesity-related cancers, and the clinical therapeutic implications. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 11/2014;