Diabetic Ketoacidosis Associated with Sodium-Glucose Cotransporter 2 Inhibitors: Clinical and Biochemical Characteristics of 29 CasesRead the full article
International Journal of Endocrinology publishes original research articles and review articles that provide insights into the endocrine system and its associated diseases at a genomic, molecular, biochemical and cellular level.
Chief Editor, Dr. Zhongjian Xie, is based at the Second Xiangya Hospital of Central South University, China. He is mainly engaged in research on the skeletal and extraskeletal function of vitamin D and calcium.
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Association of IGF-1 Level with Low Bone Mass in Young Patients with Cushing’s Disease
Purpose. Few related factors of low bone mass in Cushing’s disease (CD) have been identified so far, and relevant sufficient powered studies in CD patients are rare. On account of the scarcity of data, we performed a well-powered study to identify related factors associated with low bone mass in young CD patients. Methods. This retrospective study included 153 CD patients (33 males and 120 females, under the age of 50 for men and premenopausal women). Bone mineral density (BMD) of the left hip and lumbar spine was measured by dual energy X-ray absorptiometry (DEXA). In this study, low bone mass was defined when the Z score was −2.0 or lower. Results. Among those CD patients, low bone mass occurred in 74 patients (48.37%). Compared to patients with normal BMD, those patients with low bone mass had a higher level of serum cortisol at midnight (22.31 (17.95-29.62) vs. 17.80 (13.75-22.77), ), testosterone in women (2.10 (1.33–2.89) vs. 1.54 (0.97–2.05), ), higher portion of male (32.43% vs. 11.54%, ) as well as hypertension (76.12% vs. 51.67%, ), and lower IGF-1 index (0.59 (0.43–0.76) vs. 0.79 (0.60–1.02), ). The Z score was positively associated with the IGF-1 index in both the lumbar spine (r = 0.35153, ) and the femoral neck (r = 0.24418, ). The Z score in the femoral neck was negatively associated with osteocalcin (r = −0.22744, ). Compared to the lowest tertile of the IGF-1 index (<0.5563), the patients with the highest tertile of the IGF-1 index (≥0.7993) had a lower prevalence of low bone mass (95% CI 0.02 (0.001–0.50), ), even after adjusting for confounders such as age, gender, duration, BMI, hypertension, serum cortisol at midnight, PTH, and osteocalcin. Conclusions. The higher IGF-1 index was independently associated with lower prevalence of low bone mass in young CD patients, and IGF-1 might play an important role in the pathogenesis of CD-caused low bone mass.
DHA Supplementation during Pregnancy in Women with Obesity Normalizes IGF2R Levels in the Placenta of Male Newborns
Introduction. Insulin-like growth factor receptor 2 (IGF2R) regulates placental nutrient transport, and its soluble form is related to obesity in adults. If the placental expression of IGF2R is altered in women with obesity is unknown. Whether maternal supplementation with docosahexaenoic acid (DHA), a polyunsaturated fatty acid with anti-inflammatory properties, has a modulatory role in IGF2R’s function has not been elucidated. We hypothesized that maternal obesity (Ob) would be associated with alterations in placental IGF2R expression, which may be prevented with DHA supplementation during pregnancy. Methods. At delivery, we obtained placentas from women with Ob (BMI ≥ 30 kg/m2, n = 17), Ob supplemented with 800 mg/day of DHA during pregnancy (Ob + DHA, n = 13), and normal-weight women (Nw, BMI ≥ 18.5 ≤ 24.9 kg/m2, n = 14). The IGF2R mRNA and protein were determined by RT-PCR and western blotting, respectively. Moreover, we quantified the gene expression of molecules that modulate the IGF2R function in the extracellular domain, such as TACE/ADAM17, PLAU, and IGF2. Mann–Whitney and Kruskal–Wallis nonparametric tests were used to compare results between two or three groups accordingly. Results. The IGF2R levels in the Ob placentas of the male offspring were higher than in the Nw group. The DHA supplementation prevented this effect, suggesting an unknown relationship between IGF2R-Ob-DHA in placental tissues. Conclusion. We report, for the first time, that DHA supplementation during pregnancy in women with obesity normalizes the increased IGF2R levels in male placentas, reducing the risk of adverse outcomes related to the IGF2/IGF2R system in male newborns.
Association between the Triglyceride Glucose Index and Hyperuricemia in Patients with Primary Hypertension: A Cross-Sectional Study
Objective. The aim of this study was to investigate the association between the triglyceride glucose (TyG) index and hyperuricemia (HUA) in patients with grades 1–3 hypertension. Study Design. This is a cross-sectional study. A total of 1,707 patients from the cardiovascular department of Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were studied. In this study, 899 patients with grades 1-2 hypertension were included, of which 151 had HUA; additionally, 808 patients with grade 3 hypertension were included, of which 162 patients had HUA. This study obtained all patient data from the electronic medical record system of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine. The TyG index was calculated as Ln (triglycerides × fasting glucose/2). Hyperuricemia was defined as uric acid ≥420 μmol/L (7 mg/dL). Multivariate logistic regression, penalized spline regression, and generalized additive models were used to evaluate the association between the TyG index and HUA. Stratified analyses were performed to assess the association in populations with different grades of hypertension. Results. The average TyG index was 8.71 ± 0.58. After adjusting for correlated variables, the logistic regression analysis revealed a positive correlation between the TyG index and HUA (OR = 1.83; 95% CI: 1.40–2.39). Smooth curve fitting showed that this correlation was linear in the whole range of the TyG index. In the subgroup analysis, the TyG index more strongly associated with HUA in the grades 1-2 hypertension group (OR = 2.22; 95% CI: 1.44–3.42) compared to that in the grade 3 hypertension group (OR = 1.58; 95% CI: 1.11–2.24; for interaction = 0.03). In addition, this association was consistent in all models. Conclusion. The TyG index was positively associated with HUA in patients with hypertension, and the association was more strongly confirmed in those with grades 1-2 hypertension rather than in those with grade 3 hypertension.
Clinical and Functional Characterization of Novel AGL Variants in Two Families with Glycogen Storage Disease Type III
Purpose. Glycogen storage disease type III (GSDIII) is a uncommon autosomal recessive inherited metabolic disorder, which is caused by variants in the AGL gene. The purpose of this study was to elucidate the clinical and functional features of two novel variants in two families with GSDIIIa. Methods. We collected the clinical and laboratory data of the two patients. Genetic testing was performed using GSDs gene panel sequencing, and the identified variants were classified according to the American College of Medical Genetics (ACMG) criteria. The pathogenicity of the novel variants was furthermore assessed through bioinformatics analysis and cellular functional validation experiments. Results. The two patients were hospitalized with abnormal liver function or hepatomegaly, which was characterized by remarkably elevated liver enzyme and muscle enzyme levels, as well as hepatomegaly, and were eventually diagnosed with GSDIIIa. Genetic analysis detected two novel variants of AGL gene in the two patients: c.1484A > G (p.Y495C), c.1981G > T (p.D661Y). Bioinformatics analysis indicated that the two novel missense mutations most likely altered the protein’s conformation and therefore made the enzyme it encodes less active. Based on the ACMG criteria, both variants were considered likely pathogenic, in accordance with the functional analysis results, which demonstrated that the mutated protein was still localized in the cytoplasm and that the glycogen content of cells transfected with the mutated AGL was increased compared to cells transfected with the wild-type one. Conclusion. These findings indicated that the two newly identified variants in the AGL gene (c.1484A > G; c.1981G > T) were undoubtedly pathogenic mutations, inducing a slight reduction in glycogen debranching enzyme activity and a mild increase in intracellular glycogen content. Two patients who visited us with abnormal liver function, or hepatomegaly, improved dramatically after treatment with oral uncooked cornstarch, but the effects on skeletal muscle and myocardium required further observation.
Adiponectin Gene Polymorphisms and Possible Susceptibility to Metabolic Syndrome among the Sudanese Population: A Case-Control Study
Background and Aim. The adiponectin gene (ADIPQ) has been identified as a human adiposity marker of metabolic syndrome (MetS) in several ethnic cultures. This study aimed to determine the allelic genotypes and haplotypes distribution of the ADIPQ gene polymorphisms and its association with body mass index (BMI), waist circumference (WC), glycated hemoglobin (HbA1c), and lipid profile in MetS adult Sudanese patients. Methodology. Four hundred and twenty middle-aged adults participated in this community-based case-control research. BMI (kg/m2) and blood pressure (BP) were measured. HbA1c (%) and lipid profile evaluation was performed on fasting blood samples. The guanidine extraction procedure was used to extract genomic DNA from EDTA whole blood by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP); samples were genotyped for the polymorphisms (rs266729), (rs2241766), and (rs1501299). Results. There is a significant difference in genotypic frequencies of the rs266729, rs2241766, and rs1501299 SNPs and allele frequencies between the MetS patients and non-MetS group. MetS patients had a significantly higher serum triglycerides (TG), total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) in the GG genotype of rs2241766 . Additionally; the TT genotype of rs1501299 had higher SBP, serum TG, TC, and LDL-C . Multivariate logistic regression analysis showed hypertension, hyperglycemia, BMI, WC, serum TG, ADIPOQ rs2241766 (TG allele), and ADIPOQ rs1501299 (GT allele) had independently predicted the incidence of metabolic syndrome in the Sudanese population. The three investigated SNPs of ADIPOQ were in a moderate linkage disequilibrium (LD) connection according to the LD measures (D' = 0.54, 0.62, and 0.69, respectively). The CTT, CGG, and GTG haplotypes, which consist of three alleles of −11377C > G, +45T > G, and +276G > T, were shown to report 1.788-, 1.622,- and 1.641-fold risks toward MetS susceptibility in Sudanese’s population, respectively. Conclusion. Along with clinical and biochemical signs, the ADIPOQ gene’s genetic variants (rs266729, rs2241766, and rs1501299), CTT, CGG, and GTG haplotypes are connected to the MetS risk among the Sudanese population.
Surgical Management of Giant Prolactinomas: A Descriptive Study
Introduction. Giant prolactinoma (GP) is a rare pituitary lactotropic cell tumor larger than 4 cm in its widest dimension, and is less likely than a smaller prolactinoma to achieve prolactin normalization on dopamine agonist (DA) monotherapy. There is a paucity of data on the circumstances and outcomes of second-line management of GP with surgery. Herein, our institution’s experience with the surgical management of GPs is described. Methods. A single-center retrospective analysis was conducted of patients who underwent surgery for giant prolactinoma from 2003 to 2018. A chart review was conducted for demographic data, clinical features, laboratory and radiographic findings, operative and pathology reports, perioperative management, and clinical outcomes in follow-up. Descriptive statistics were used. Results. Of 79 prolactinoma cases, 8 patients had GP with a median age of 38 years (range 20–53), 75% (6/8) were male, with a median largest tumor dimension of 6 cm (range 4.6–7.7), and a median prolactin level of 2,500 μg/L (range 100–>13,000). Six patients had transsphenoidal surgery for dopamine agonist (DA) resistance or intolerance. Two patients had a craniotomy for a missed diagnosis; one was due to the hook effect. No tumor resections were complete by either surgical approach; all had persistent hyperprolactinemia requiring postoperative DA therapy, and two patients had an additional craniotomy procedure for further tumor debulking. There was no recovery of pituitary axes and postoperative deficits were common. Remission as defined by prolactin normalization occurred in 63% (5/8) at a median time of 36 months (range 14–63 months) on DA therapy after surgery with a follow-up of 3–13 years. Conclusions. GPs infrequently require surgical resection, which is generally incomplete and requires adjuvant therapy. Given the rarity of surgery for GPs, multi-institutional or registry studies would yield clearer guidance on optimal management.