1
|
Channaiah CY, Memon SS, Lila AR, Sarathi V, Karlekar M, Barnabas R, Patil VA, Sharma A, Phadte A, Malhotra G, Shah N, Bandgar T. Diagnostic performance of various imaging modalities in localizing ectopic ACTH syndrome: A systematic review. ANNALES D'ENDOCRINOLOGIE 2024:S0003-4266(24)00109-4. [PMID: 39002895 DOI: 10.1016/j.ando.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/06/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND To elucidate the role of various imaging modalities for tumor localization in ectopic ACTH Cushing's syndrome (EAS). DESIGN AND METHOD Systematic review of the literature published between January 2015-2024 was performed. Patients (290 EAS patients, 23.8% Occult) who underwent contrast enhanced CT (CECT) and at least one PET/CT-scan (68Ga-SSTR, FDG and/or F-DOPA) were included. RESULTS The sensitivity for identifying EAS tumor was comparable across CECT (63.1%, n=290), SSTR-PET/CT (58.2%, n=187), and FDG-PET/CT (57.6%, n=191), but was poor for DOPA-PET/CT (30.8%, n=26). Sensitivity for detecting metastasis was also comparable across CECT (78%, n=73), SSTR-PET/CT (85.3%, n=41), and FDG-PET (73.7%, n=38). For localised lesions, sensitivity as per etiology and grade of NET were similar for three scans, with exception of Thymic NET and grade 1 NET where CECT was better than FDG PET/CT. In patients not localised on CECT, sensitivity of SSTR PET/CT was 33.3% (vs. 18.9% FDG-PET/CT) whereas for patients negative on CECT and FDG-PET, sensitivity of SSTR-PET/CT was 15%. In cases where CECT and SSTR-PET/CT failed to localize, the sensitivities of FDG-PET/CT and DOPA-PET/CT were only 5.7% (2/35) and 0% (0/9), respectively. SSTR-PET/CT has a distinct advantage with significantly lesser false positive (FP) lesions (2.6%, mostly in thyroid/or pancreas). In comparison, CECT and FDG-PET/CT had FP ∼11% (mostly in lung and/or mediastinum), most of which were negative on SSTR-PET/CT. CONCLUSIONS As per the current evidence, SSTR-PET/CT can be considered as the scan of choice in EAS evaluation, and further research is needed as one-fourth of the lesions remain occult.
Collapse
Affiliation(s)
- Chethan Yami Channaiah
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Saba Samad Memon
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Anurag Ranjan Lila
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, 560066 Bengaluru, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Rohit Barnabas
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Virendra Ashokrao Patil
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Anima Sharma
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Aditya Phadte
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Gaurav Malhotra
- Radiation medical Centre, Bhabha Atomic Research Centre, 400012 Mumbai, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College, KEM Hospital, 400012 Parel, Mumbai, India.
| |
Collapse
|
2
|
Caretta N, Scafa R, Graziani A, Crepaldi MC, Vedovato M, Avogaro A, Ferlin A. Noninvasive Indices of MASLD Are Associated With Hypogonadism in Male Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:e522-e530. [PMID: 37795977 DOI: 10.1210/clinem/dgad586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023]
Abstract
CONTEXT Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease, affecting one-fourth of the adult population worldwide. Recent data found an association between MASLD and hypogonadism, but this relation in patients with type 2 diabetes mellitus (T2DM) is still unclear. OBJECTIVE To evaluate in men with T2DM the association between total testosterone (TT) and noninvasive indices of hepatic steatosis (Fatty Liver Index [FLI], Hepatic Steatosis Index [HSI], Dallas Steatosis Index [DSI]) and fibrosis (AST to Platelet Ratio Index [APRI], Fibrosis-4 Index [FIB-4]), and their predictive cutoff values in identifying hypogonadism. METHODS Cross-sectional study on 189 men with T2DM, without history of liver diseases and alcoholism, recruited on an outpatient basis. Interventions were andrological evaluation, metabolic parameters, TT, and liver indices. The main outcome measures were comparison of steatosis and fibrosis indices with testosterone levels and presence of hypogonadism. Receiver operating characteristic curves were used to identify cutoff values of liver indices in predicting low testosterone (<12 nmol/L). RESULTS FLI, HSI, and DSI were negatively related with TT and were higher in the low-testosterone group than in the normal-testosterone group (FLI: 74.1 [61.4-93.5] vs 56.5 [32.1-78.2], P < .001; HSI: 41.5 [39.2-45.9] vs 40.1 [36.6-43.2], P = .005; DSI: 0.45 [-0.08-+1.04] vs -0.07 [-1.02-+0.58], P < .001). FLI and DSI also correlated with clinical symptoms of hypogonadism. No differences between groups were observed for APRI and FIB-4. FLI ≥63 was the best parameter as predictive index of low TT (sensitivity 73%, specificity 64%). CONCLUSION We found an association between noninvasive indices of steatosis and hypogonadism in patients with T2DM. These indices could be used to direct the patients to andrological evaluation.
Collapse
Affiliation(s)
- Nicola Caretta
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Raffaele Scafa
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Graziani
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Cristina Crepaldi
- Department of Medicine, Division of Metabolic Diseases, University of Padova, 35128 Padova, Italy
| | - Monica Vedovato
- Department of Medicine, Division of Metabolic Diseases, University of Padova, 35128 Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, Division of Metabolic Diseases, University of Padova, 35128 Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| |
Collapse
|
3
|
Singh SK, Singh R, Singh SK, Iquebal MA, Jaiswal S, Rai PK. Uric acid and diabetes mellitus: an update. Postgrad Med J 2023; 99:1220-1225. [PMID: 37777188 DOI: 10.1093/postmj/qgad081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
The relationship between diabetes mellitus (DM) and high serum uric acid is complex and controversial. Many epidemiological studies have reported a positive association, whereas others have reported an inverse association or none. In the pathogenesis of DM it is the intracellular urate that is more important than the extracellular and dissociation between the two is possible. Evidence suggests that high serum uric acid induces insulin resistance and beta cell failure in animal models. Reduction of intracellular uric acid can be achieved by dietary measures such as reducing fructose and salt intake, and uric acid-lowering drugs. We suggest that in the Western diet, these elements play a crucial role in pathogenesis of DM. To determine the precise and exact interrelationship between intracellular and extracellular uric acid, well-designed studies are required. Besides this, clinical trials are needed to determine whether intracellular and extracellular urate reduction will provide benefit in prevention and treatment of DM and complications associated with it.
Collapse
Affiliation(s)
- Shailendra K Singh
- Department of Endocrine, Endocrine Clinic, Varanasi, Uttar Pradesh 221002, India
| | - Rina Singh
- Department of Endocrine, Endocrine Clinic, Varanasi, Uttar Pradesh 221002, India
| | - Santosh K Singh
- Department of Endocrinology, Endocrine Center, Patna, Bihar 800001, India
| | - Mir A Iquebal
- Division of Agricultural Bioinformatics, ICAR-Indian Agricultural Statistics Research Institute, New Delhi 110012, India
| | - Sarika Jaiswal
- Division of Agricultural Bioinformatics, ICAR-Indian Agricultural Statistics Research Institute, New Delhi 110012, India
| | - Pradeep K Rai
- Department of Nephrology, Opal Hospital, Varanasi, Uttar Pradesh 221006, India
| |
Collapse
|