Clinical Endocrinology Journal Impact Factor & Information

Publisher: Wiley

Journal 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.

Current impact factor: 3.46

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 3.457
2013 Impact Factor 3.353
2012 Impact Factor 3.396
2011 Impact Factor 3.168
2010 Impact Factor 3.323
2009 Impact Factor 3.201
2008 Impact Factor 3.398
2007 Impact Factor 3.37
2006 Impact Factor 3.358
2005 Impact Factor 3.412
2004 Impact Factor 3.023
2003 Impact Factor 2.767
2002 Impact Factor 2.674
2001 Impact Factor 2.465
2000 Impact Factor 2.922
1999 Impact Factor 2.833
1998 Impact Factor 3.101
1997 Impact Factor 2.447
1996 Impact Factor 2.414
1995 Impact Factor 2.279
1994 Impact Factor 2.657
1993 Impact Factor 2.642
1992 Impact Factor 2.211

Impact factor over time

Impact factor

Additional details

5-year impact 3.41
Cited half-life 8.00
Immediacy index 0.92
Eigenfactor 0.02
Article influence 1.07
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


  • Pre-print
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  • Post-print
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    • 12 months embargo
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    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
    • Author's pre-print may not be updated with Publisher's Version/PDF
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    • Non-Commercial
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    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Structural traumatic brain injury (TBI) can result in late-occurring health sequelae, consisting mainly of neuroendocrine dysfunctions. Studies have suggested that hypopituitarism is relatively common following TBI in childhood, but recent evidence suggests that the incidence appears to be frequently over-estimated. We recently showed that permanent hypopituitarism is rare after both inflicted and accidental structural TBI in early childhood. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 10/2015; DOI:10.1111/cen.12961
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    ABSTRACT: Objective Precocious pubarche (PP) has been linked to higher prevalence of metabolic disturbances and polycystic ovary syndrome (PCOS). The aim of the study was to assess echocardiographic parameters in PP girls and to analyze their relationship with androgens and insulin resistance (IR).DesignCase-control study.Patients35 PP girls and 35 healthy age-matched controls.MeasurementsClinical, hormonal and metabolic profiles, echocardiography, body composition, and oral glucose tolerance test.ResultsChronological age (10.04 ± 2.6 years in PP vs. 10.13 ± 2.56 years in controls, p=0.227), and pubertal stage at the time of the study were similar between the groups. PP girls had higher free androgen index (FAI) [1.39 (0.48 – 3.64) vs. 1.06 (0.39 – 1.7), p = 0.005] and QUICKI (0.58 ± 0.08 vs. 0.63 ± 0.12, p = 0.021). However, HOMA-IR was not significantly different between the groups [2.79 (1.84 – 4.05) vs. 2.15 (1.09 – 3.23), p = 0.085]. After adjusting for total body fat, left ventricular mass (LVM) was higher in the PP group (97.31 ± 33.37 vs. 81.25 ± 19.06 g, p = 0.017) as well as A’ wave (5.66 ± 1.34 vs. 5.09 ± 0.98 cm/s, p=0.025), a measurement of diastolic function. FAI and total body fat were independent predictors of higher LVM, and together with HOMA-IR contributed 72% of LVM variability in the PP group.Conclusion In this study with PP girls, greater LVM, associated with higher androgen levels, IR, and total body fat, occurred early in pubertal development.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 10/2015; DOI:10.1111/cen.12957
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    ABSTRACT: Objective: The results of few studies conducted to date suggest an increased prevalence of sexual dysfunction in patients with thyroid disorders. Design: The aim of this study was to compare female sexual function and depressive symptoms between women with autoimmune thyroid disease and with mild thyroid failure. Patients: The study included four groups of young women: euthyroid women with Hashimoto's thyroiditis (Group 1), women with non-autoimmune subclinical hypothyroiditism (Group 2), women with autoimmune subclinical hypothyroidism (Group 3) and healthy euthyroid females without thyroid autoimmunity (Group 4). Measurements: Beyond measuring serum hormone levels and thyroid antibody titers, all enrolled women completed questionnaires evaluating female sexual function (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II). Results: The mean total FSFI score was lower in women with autoimmune hypothyroidism than in the remaining groups of women, as well as lower in Groups 1 and 2 than in Group 4. Compared to Group 4, three domains (sexual desire, lubrication and sexual satisfaction) were lower in Group 1, four domains (desire, arousal, lubrication and dyspareunia) in Group 2, and all FSFI domain scores in Group 3. The total BDI-II score was higher in Groups 1 and 2 than in Group 4, as well as higher in Group 3 than in the other groups of women. Conclusions: The obtained results suggest that both thyroid autoimmunity and mild thyroid failure, particularly if they occur together, may negatively affect female sexual function and depressive symptoms. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 10/2015; DOI:10.1111/cen.12956
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    ABSTRACT: Objective: Rodent models have found that osteocalcin crosses the blood-brain barrier and regulates behavior. No data are available on osteocalcin's effects on brain microstructure and cognitive performance in humans. We evaluated the association between serum osteocalcin concentrations and a) brain microstructural changes on magnetic resonance imaging (MRI) and b) neuropsychological performance. Design, patients and measurements: We studied 24 consecutive obese subjects (13 women; age,49.8±8.1 years; body mass index [BMI],43.9±4.54 kg/m(2) ) and 20 healthy volunteers (10 women; age, 48.8±9.5 years; BMI, 24.3±3.54 kg/m(2) ) in a cross-sectional study within the multicenter FLORINASH Project. FLAIR signal intensity and DTI-metrics (primary (λ1 ), secondary (λ2 ), and tertiary (λ3 ) eigenvalues; fractional anisotropy (FA); and mean diffusivity) in the caudate, hypothalamus, thalamus, and putamen, and in subcortical white matter were assessed. Cognitive performance evaluated by neuropsychological test-battery. Results: Lower osteocalcin concentrations were associated with BMI, higher λ1, λ2, and λ3 values at the caudate and lower FLAIR signal intensity at the caudate and putamen. Obese patients with lower osteocalcin concentrations had higher FA at putamen and thalamus. Lower osteocalcin concentrations were associated with higher Iowa Gambling Task (IGT) scores. FLAIR signal intensity at the caudate<601.832 yielded 85.7% sensitivity, 64.3% specificity, 70.6% negative predictive value, and 81.8% positive predictive value for IGT score. Lower osteocalcin was an independent predictor of worse cognitive performance on multivariate analysis (F=3.551, p=0.01343; R(2) =0.103). Bayesian information criterion demonstrated that osteocalcin had the predominant role in predicting IGT score. Conclusions: Lower serum osteocalcin concentrations are associated with brain microstructural changes and worse cognitive performance. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12954
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    ABSTRACT: Pseudohypoparathyroidism type 1a (PHP1a) (OMIM #103580) is characterised by hypocalcaemia and hyperphosphataemia due to parathyroid hormone (PTH) resistance, associated with features of Albright's Hereditary Osteodystrophy (AHO) which include short stature, obesity, subcutaneous calcifications and brachydactyly (1) . PHP1a is caused by heterozygous germline mutations of the alpha subunit of the stimulatory form of the GTP-binding protein (Gs-alpha), which is a downstream signalling protein of the PTH receptor and of other G protein-coupled hormone receptors (1) . Gs-alpha is encoded by the GNAS gene (chromosome 20q13.3), which is a complex imprinted locus that also produces additional coding and non-coding transcripts through the use of alternative promoters and alternative splicing, in a tissue-specific manner (2) . This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12953
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    ABSTRACT: Objective: Although an International Workshop has suggested that cardiovascular assessment in asymptomatic primary hyperparathyroidism (PHPT) patients is not necessary, improvements in risk factors of subclinical atherosclerosis have been shown following parathyroidectomy. The objectives of this study were to determine whether parathyroidectomy in asymptomatic PHPT patients causes any change in carotid intima-media thickness (CIMT), arterial stiffness (PWV) and soluble CD40 ligand (sCD40L) levels. Design: Prospective study evaluating female patients diagnosed with asymptomatic PHPT in a single centre over a 6 month period. Patients: A total of 48 subjects were included: 17 hypercalcaemic (HC, mean age: 51±8 years, Ca: 2.73±0.17 mmol/l), and 16 normocalcaemic (NC, mean age: 58±7 years, Ca: 2.30±0.10 mmol/l) PHPT patients and 15 healthy controls (mean age: 52±4 years, Ca: 2.27±0.07 mmol/l). Measurements: Biochemical tests, CIMT, PWV and sCD40L levels were compared at in baseline and six months of after parathyroidectomy (PTx). Results: At baseline, CIMT and PWV values in the HC and NC patients were higher than in the control group. While there was a significant reduction in CIMT (601±91 μm vs 541±65 μm, p=0.006) and PWV (9.6±1.8 vs 8.4±1.5 m/s, p=0.000) in the hypercalcaemic group at the end of the 6th month after PTx, no change was observed in normocalcaemic group (p=0.686 and p=0.196 respectively). No differences were observed in sCD40L levels between patient and control groups or between baseline and 6 month in patients undergoing parathyroidectomy.. Conclusion: Parathyroidectomy leads to an improvement in the structural and functional impairment associated with atherosclerosis in the vascular wall in asymptomatic hypercalcaemic PHPT patients. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12952
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    ABSTRACT: Objective: The objective of this study was to determine levels of thrombospondin-1 (TSP-1), transforming growth factor-β1 (TGF-β1), and nuclear factor kappaβ (NF-κβ) in polycystic ovarian syndrome (PCOS) patients with and without insulin resistance and after treatment with cyproterone acetate/ethinylestradiol with or without concomitant metformin. Design: Prospective. Patients: PCOS patients and healthy women were recruited. Patients were subdivided into obese and non-obese based on body mass index. PCOS patients were also grouped according to homeostasis model assessment-insulin resistance (HOMA-IR) ≥ 2.69 or < 2.69, and by PCOS phenotype. PCOS-IR patients were treated with a 6 month course of cyproterone acetate/ethinylestradiol with or without concomitant metformin. Measurements: Inflammatory markers were examined at baseline, and after 6 months of treatment. Results: A total of 445 women with PCOS (mean age 25.9 ± 2.7 years; 298 obese, 147 non-obese) and 213 normal controls (mean age 24.9 ± 3.0 years) were included. Regardless of obesity status, testosterone, free androgen index (FAI), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio, HOMA-IR, TSP-1, and NF-κB in the PCOS groups were significantly higher than in the control group, whereas TSP-1 was lower in the PCOS groups (all, P < 0.05). PCOS patients without IR had lower TSP-1 levels than control patients (P < 0.05). Treatment with cyproterone acetate/ethinylestradiol with addition of metformin reduced the level of NF-κB, TGF-β1 and HOMA-IR and increased the level of TSP-1. Conclusions: These results support the association between PCOS and chronic inflammation. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12951
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    ABSTRACT: Objective: Male patients with the X-linked IGSF1 deficiency syndrome are characterized by central hypothyroidism, delayed pubertal testosterone rise, adult macroorchidism, variable prolactin deficiency and occasionally transient partial growth hormone deficiency. Thyroid hormone plays a vital role in brain development and functioning, and while most patients receive adequate replacement therapy starting shortly after birth, it is unknown whether this syndrome is accompanied by long-term impaired cognitive functioning. We therefore assessed cognitive functioning in male patients with IGSF1 deficiency. Methods: Fifteen adult male patients with IGSF1 deficiency participated in neuropsychological assessment of executive functioning and memory, and completed validated questionnaires on health related quality of life (HRQoL), mood, and fatigue. Results were compared to data from previous studies by our department; 54 healthy controls (76 for the attention task) for the test battery and 191 healthy controls for the questionnaires. Results: All patients had central hypothyroidism and twelve were treated with levothyroxine. Patients performed worse than controls in tasks that required attentional control (Trail Making Test, Letter-Digit Substitution Test, and Sustained Attention to Response Task) (all P<0.001). Memory was unaffected. In addition, patients reported more mental fatigue and reduction of activity (Multidimensional Fatigue Inventory) (both P<0.01), while HRQoL and mood reports were not different from controls. Age at start of replacement therapy and current thyroxine levels were not related to outcome. Conclusions: Adult male patients with IGSF1 deficiency exhibit mild deficits in attentional control on formal testing. This finding was not related to the age at start of, or current levothyroxine treatment. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12947
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    ABSTRACT: Objective: Thyroid storm (TS) is a life-threatening endocrine emergency. This study aimed to achieve a better understanding of the management of TS by analyzing therapeutic modalities and prognoses reported by nationwide surveys performed in Japan. Design, patients and measurements: Retrospective analyses were performed on clinical parameters, outcomes, and treatments in 356 TS patients. Results: Patient disease severities assessed via Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores significantly correlated with mortality. Free triiodothyronine (FT3) and the FT3/free thyroxine (FT4) ratio inversely correlated with disease severity. Methimazole (MMI) was used in the majority of patients (78.1%), and there were no significant differences in mortality or disease severity between those treated with MMI and those receiving propylthiouracil (PTU). Patients who received inorganic iodide (KI) demonstrated higher disease severity but no change in mortality compared to those who did not. Patients treated with corticosteroids (CSs) demonstrated significantly higher disease severity and mortality than those who were not. Disease severity in patients treated with intravenous administration of beta-adrenergic antagonists (AAs) was significantly higher than those treated with oral preparations, although no significant difference in mortality was observed between these groups. In addition, mortality was significantly higher in patients treated with non-selective beta-AAs as compared with other types of beta-AAs. Conclusion: In Japan, MMI was preferentially used in TS and showed no disadvantages compared to PTU. In severe TS, multimodal treatment, including administration of antithyroid drugs, KI, CSs and selective beta1 -AAs may be preferable to improve outcomes. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12949
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    ABSTRACT: Objective: Pseudohypoparathyroidism (PHP) is caused by a mutation within the GNAS gene or upstream of the GNAS complex locus. It is characterized by target organ resistance to PTH, resulting in hypocalcaemia and hyperphosphataemia. Studies in patients with PHP are limited. We sought to identify all patients in Denmark with PHP and access their mortality data and risk of complications. Design: Patients were identified through the Danish National Patient Registry and a prescription database, with subsequent validation by investigation of patient charts. Methods: For each case, three age- (± 2 years) and gender-matched controls were randomly selected from the general background population. We identified a total of 60 cases, equal to a prevalence of 1.1/100,000 inhabitants. The average age at diagnosis was 13 years (range 1-62 years), and 42 were women. Only 14 patients had an identified mutation in the GNAS1 gene. Results: Compared with controls, patients with PHP had an increased risk of neuropsychiatric disorders (P < 0.01), infections (P < 0.01), seizures (P < 0.01), cataract (P < 0.01), whereas their risk of renal, cardiovascular, malignant disorders and fractures was compatible with the general background population. The same tendencies were found in a subgroup analysis in cases with genetically verified PHP. Conclusion: Patients with PHP have an increased risk of neuropsychiatric disorders, infections, cataract and seizures, whereas mortality among PHP patients is compatible with that in the background population. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12948
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    ABSTRACT: Objective: To determine serum vascular endothelial growth factor B levels in polycystic ovary syndrome, their association with insulin resistance and β-cell dysfunction, and the effect of metformin on serum vascular endothelial growth factor B levels. Design: A cross-sectional, interventional study. Patients: We recruited 103 women with polycystic ovary syndrome and 96 age-matched healthy controls. Serum vascular endothelial growth factor B levels were determined in all participants, and 44 polycystic ovary syndrome patients randomly received metformin. Measurements: We measured vascular endothelial growth factor B levels in healthy controls and women with polycystic ovary syndrome before and after metformin treatment. Results: Women with polycystic ovary syndrome had higher serum vascular endothelial growth factor B levels, which decreased with metformin treatment. In the lean and overweight/obese groups, patients with polycystic ovary syndrome had higher plasma vascular endothelial growth factor B levels than did healthy controls (P < 0.05). Vascular endothelial growth factor B levels were correlated with body mass index, body fat percentage, M values, homeostasis model assessment of insulin resistance, and β-cell function indices. A multiple linear regression analysis showed that vascular endothelial growth factor B level was associated with M values after adjusting for age, body mass index, serum sex hormones, and serum lipids in women with polycystic ovary syndrome. Conclusions: Serum vascular endothelial growth factor B is significantly higher in women with polycystic ovary syndrome and is closely and positively related to insulin resistance. Metformin treatment reduces vascular endothelial growth factor B levels and ameliorates insulin resistance. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12950
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    ABSTRACT: The accelerator hypothesis, which proposes a link between Type 1 (T1D) and Type 2 diabetes (T2D) through weight-related insulin resistance, remains untested in developing countries with increasing rates of childhood obesity and T1D, and different ethnicities. We aimed to test the accelerator hypothesis in the context of a significant increase in T1D at our centre. Medical records of children diagnosed with T1D between January 2005 and December 2014 were retrospectively reviewed. The body mass index (BMI) standard deviation scores (SDSs) were calculated using height and weight measurements recorded 1-2 months after diagnosis of T1D and compared with age-matched anthropometric data. The rate of change in BMI SDSs over time was calculated. Analysis of BMI data was undertaken for the 3 age categories: <5, 5 to <10 and >10 yrs. The mean age at diagnosis of 467 children with T1D was 7.27±0.32 yrs and showed no change over the study period. There was a yearly increase of 14.11% in patient numbers; this increase was similar in the 3 age categories (22.7%, 17.0%, 16.3% respectively, p=1.0). Comparison of patient numbers between the 2 time periods of 5 yr each showed a marked increase during 2010-2014 (148 versus 319, % increase 115.5%). The mean BMI SDSs at diagnosis in the 3 age categories were similar (p=1.0) and showed a yearly change of -0.36; the mean change in the 3 age categories was also similar (-0.35, -0.27, -0.46 respectively, p=1.0). No correlation was found between age at diagnosis and BMI SDSs (correlation coefficient 0.010, p=0.82). The mean BMI SDS in patients was significantly lower compared to controls (-0.54 versus -0.02, p=0.001). There was no association between BMI SDS and age at diagnosis in children with new onset T1D. Further studies are needed to test if the accelerator hypothesis is relevant in developing countries. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12941
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is a well-known contributor for the development of cardiovascular disease (CVD). We examined the influence of NAFLD and metabolic syndrome (MetS) on markers of subclinical atherosclerosis, including carotid intima-media thickness (CIMT), brachial-ankle pulse wave velocity (baPWV), and ankle-brachial pressure index (ABI), after adjusting for cardiometabolic risk factors. cross-sectional study. The association between NAFLD, MetS, and markers of subclinical atherosclerosis were assessed in 955 participants without CVD using multiple logistic regression analysis after adjusting for multiple cardiometabolic risk variables. After adjusting for age and sex, CIMT and baPWV were found to be significantly correlated with multiple cardiometabolic risk variables, whereas ABI was only associated with obesity parameters. The prevalence of NAFLD differed significantly according to the presence of subclinical atherosclerosis as defined by both CIMT and baPWV (P = 0.004 and P = 0.007, respectively). After adjusting for potential confounding factors, NAFLD or MetS was not associated with subclinical atherosclerosis as defined by CIMT and baPWV. However, individuals with both NAFLD and MetS had a significantly higher risk of subclinical atherosclerosis as defined by CIMT (OR = 2.06, 95% CI = 1.13-3.74) or baPWV (OR = 2.64, 95% CI = 1.46-4.76) compared to normal subjects, even after adjusting for potential confounders. The results show that NAFLD and MetS have a synergistic impact on the subclinical atherosclerosis, which suggests that individuals with both NAFLD and MetS should be strongly advised to engage in CVD prevention strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12940
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    ABSTRACT: The risk of progression of subclinical hypothyroidism (SCH) to clinical dysfunction is one of the factors considered in the decision to treat this condition. This study evaluated the natural history of SCH in women with TSH ≤ 10 mIU/L. Prospective study. Two hundred and fifty-two women with SCH and TSH levels ranging from 4.5 to 10 mIU/L were followed up for a period of 5 years. Among the 241 patients followed up until completion of the study, 46 (19%) required levothyroxine (L-T4) therapy, 55 (22.8%) had spontaneous normalisation of serum TSH, and 140 (58.1%) continued to meet the criteria for mild SCH. In multivariate analysis, only initial TSH > 8 mIU/L was a predictor of the need for L-T4. In contrast, initial TSH ≤ 8 mIU/L and the absence of thyroiditis [negative anti-thyroid peroxidase antibodies (TPOAb) and ultrasonography (US)] were predictors of TSH normalisation. Of note, the natural history was similar in TPOAb-positive patients and patients with negative TPOAb but with positive US. Most women with mild elevation of serum TSH, ranging from 4.5 to 10 mIU/L, do not progress to overt hypothyroidism and even normalise their TSH. However, initial TSH seems to be a more important predictor of progression than the presence of antibodies or ultrasonographic appearance. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12939
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    ABSTRACT: For patient with a recurrent or residual acromegaly or Cushing's disease (CD) after resection, Gamma knife radiosurgery (GKRS) is often used. Hypopituitarism is the most common adverse effect after GKRS treatment. The paucity of studies with long-term follow up has hampered understanding of the latent risks of hypopituitarism in patients with a Acromegaly or CD. We report the long-term risks of hypopituitarism for patients treated with GKRS for Acromegaly or CD. From a prospectively created, IRB approved database, we identified all patients with a Acromegaly or CD treated with GKRS at the University of Virginia from 1989 to 2008. Only patients with a minimum endocrine follow up of 60 months were included. The median follow-up is 159.5 months (60.1-278). Thorough radiological and endocrine assessments were performed immediately before GKRS and at regular follow-up intervals. New onset of hypopituitarism was defined as pituitary hormone deficits after GKRS requiring corresponding hormone replacement. 60 patients with either Acromegaly or CD were included. Median tumor volume at time of GKRS was 1.3 cm(3) (0.3-13.4), median margin dose was 25 Gy (6-30). GKRS induced new pituitary deficiency occurred in 58.3% (n=35) of patients. Growth Hormone deficiency was most common (28.3%, n=17). The actuarial overall rates of hypopituitarism at 3, 5, and 10 years were 10%, 21.7%, and 53.3%, respectively. The median time to hypopituitarism was 61 months after GKRS (range, 12-160). Cavernous sinus invasion of the tumor was found to correlate with the occurrence of a new or progressive hypopituitarism after GKRS (p=0.018). Delayed hypopituitarism increases as a function of time after radiosurgery. Hormone axes appear to vary in terms of radiosensitivity. Patients with adenoma in the cavernous sinus are more prone to develop loss of pituitary function after GKRS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12938
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    ABSTRACT: Levels of lipoprotein(a), Lp(a), an independent risk factor for cardiovascular disease (CVD), are affected by sex hormones. Women with polycystic ovary syndrome (PCOS) have elevated androgen levels and are at increased CVD risk. We investigated the impact of PCOS-related hormonal imbalance on Lp(a) levels in relation to apo(a) gene size polymorphism, a major regulator of Lp(a) level. Cross-sectional. Forty one Caucasian women with PCOS based on the NIH criteria. 1) Apo(a) gene size polymorphism measured as Kringle (K) 4 repeat number; 2) Total plasma Lp(a) level; 3) Allele-specific apo(a) level assessing the amount of Lp(a) carried by an individual apo(a) allele/isoform; 4) Sex hormone levels. The mean age was 32±6 years and the mean BMI was 35±8 with 66% of women classified as obese (BMI >30kg/m(2) ). LDL cholesterol was borderline high (3.37 mmol/l) and HDL cholesterol was low (1.06 mmol/l). The distribution of Lp(a) level was skewed towards lower levels with a median level of 22.1 nmol/l (IQR: 6.2-66.5 nmol/l). Lp(a) levels were not correlated with age, body weight or BMI. The median allele-specific apo(a) level was 10.6 nmol/l (IQR: 3.1-31.2 nmol/l) and the median apo(a) size was 27 (IQR: 23-30) K4 repeats. Allele-specific apo(a) levels were significantly and inversely correlated with K4 repeats (r=-0.298, p=0.007). Neither Lp(a) or allele-specific apo(a) levels were significantly associated with testosterone or dehydroepiandrosterone sulfate levels. The apo(a) genetic variability remains the major regulator of plasma Lp(a) levels in women with PCOS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12937
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    ABSTRACT: Objective Overt and subclinical hypothyroidism are risk factors for atherosclerosis and cardiovascular diseases. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC).ContextThis study aimed to examine the relationship between normal variations in thyroid function and changes in coronary artery calcium.MeasurementsWe conducted a 4-year retrospective study of 2,173 apparently healthy men and women with normal thyroid hormone levels. Their free thyroxin (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were measured by electrochemiluminescent immunoassay. The CAC score (CACS) of each subject was measured by multi-detector computed tomography in both 2010 and 2014. Progression of CAC was defined as a CACS change over four years greater than 0.ResultsThe mean CACS changes over four years by quartiles of baseline FT4 level (lowest to highest) were 12.9, 8.43, 7.82, and 7.81 (P=0.028). CAC progression was not significantly associated with either the baseline FT3 or TSH levels. The odds ratios (OR) for CAC progression over four years (highest versus lowest quartile for baseline FT4) were 0.647 (95% CI 0.472-0.886) after adjustment for confounding factor, which were attenuated with further adjustment for lipid profiles, HOMA-IR, hs-CRP and hypertension {0.747 (95% CI 0.537-1.038)}. Quartiles of baseline FT3 or TSH level did not show any increased OR for CAC progression after adjustment for confounding factors.Conclusions In this cohort of euthyroid men and women, a low baseline FT4 level was associated with a high risk of CACS progression over four years.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12946
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    ABSTRACT: Objective European guidelines do not recommend tolvaptan for treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH), principally owing to concerns about risk of overly rapid correction of hyponatraemia. This study evaluated the real-life effectiveness and safety of tolvaptan.DesignConsecutive case series.PatientsInpatients treated with tolvaptan for SIADH in 2 UK hospitals over a 3-year period.MeasurementsThe primary outcome measures were serum sodium (sNa) correction at 24 and 48 hours after tolvaptan therapy.ResultsThis case series included 61 patients aged 74.4 ± 15.3 years with (mean ± SD) sNa 119.9 ± 5.5 mmol/l. The mean sNa increase 24 hours after tolvaptan initiation was 9 ± 3.9 mmol/l. Excessive correction of hyponatraemia was observed in 23% of patients with all these patients having baseline sNa < 125 mmol/l, but no cases of osmotic demyelination syndrome were recorded. At the end of tolvaptan therapy, sNa increase was 13.5 ± 5.9 mmol/l with 96.7% of patients having sNa increase ≥ 5 mmol/l in 48 hours. There was a negative significant correlation (p = 0.012) between baseline sNa and 24-hour change; for every 1 mmol/l reduction in baseline value, sNa increased by an additional 0.23 mmol/l (95% CI 0.05 - 0.41).Conclusions Tolvaptan is effective in correcting hyponatraemia. Without rigorous electrolyte monitoring, tolvaptan carries a significant risk of overly rapid sodium correction, especially in patients with starting sNa < 125 mmol/l. Tolvaptan should be used with great caution under close electrolyte monitoring.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 09/2015; DOI:10.1111/cen.12943