Diagnosis and Management of Central Diabetes Insipidus in Adults

Human social behavior and oxytocin: Molecular and neuronal mechanisms

Oxytocin (OT) is a hormone that is crucial for regulating various human social behaviors, such as maternal instinct, empathy, and trust. Its secretion in the brain is triggered by social stimuli. Recent research demonstrated impaired regulation of OT secretion and reduced social behaviors in patients with arginine vasopressin deficiency (central diabetes insipidus). OT interacts with other hormones to regulate human trust. Moreover, it has been shown to generate feelings of attachment and trust toward other and familiar consumer brands, thereby, potentially impacting personal consumption, which is a significant aspect of economic activity. This review provided insights into the molecular and neural mechanisms of OT in regulating human social behavior, including both social and economic activities.

Capsiate Improves Glucose Metabolism by Improving Insulin Sensitivity in Diabetic Retinopathy Mice

PURPOSE

Capsiate (cap) is a metabolite that affects a number of biological processes, and diabetic retinopathy (DR) is now known to be the primary cause of end-stage eye illness.

METHODS

In order to examine the effects of the cap intervention on body weight, nutritional intake, changes in body weight composition, glucose metabolism levels, retinopathy, and oxidative stress levels, we proposed using a mouse model of diabetic retinopathy caused by STZ.

RESULTS

Our findings demonstrated that, in addition to increasing lean body mass and lowering fat body mass content, cap intervention significantly improved body weight and dietary consumption in STZ mice. Additionally, our results on glucose metabolism revealed that cap had a significant impact on insulin resistance and the stabilization of OGTT levels. In conclusion, we examined the levels of oxidative stress and retinopathy. We discovered that the cap intervention greatly reduced the levels of MDA and significantly improved the levels of VEGF and retinopathy. In contrast, the STZ group's levels of SOD, CAT, and GSH were significantly higher.

CONCLUSIONS

According to our research, the Cap intervention improved the damage caused by diabetic retinopathy by reversing the levels of oxidative stress and the disrupted state of glucose metabolism, which in turn decreased the levels of VEGF.

Redefining Diagnostic Cut-Offs for the Indirect Water Deprivation Test

OBJECTIVE

An incorrect diagnosis of arginine vasopressin deficiency and resistance (AVP-D and AVP-R) results in the potentially dangerous use of desmopressin in healthy individuals. The water deprivation test is a central diagnostic test in patients with polydipsia polyuria syndrome (PPS). This study aims to determine the effectiveness of the current interpretation of reference ranges.

METHODS

This is a retrospective analysis of 135 patients who underwent a water deprivation test between August 2014 and August 2023. All patient diagnoses were reviewed, and variability and receiver operating characteristic (ROC) curves were determined for serum osmolality, serum sodium and urine osmolality.

RESULTS

Serum sodium demonstrated reduced variability compared with serum osmolality (0.72% vs. 1.16%, respectively, 37.5% reduction; p < 0.001). The standard serum osmolality cut-off value of ≥ 300 mOsm/kg in diagnosing AVP-D, AVP-R, and primary polydipsia (PP) achieved a sensitivity of 76.19% and specificity of 76.92%. A serum sodium cut-off value of ≥ 148 mmol/L demonstrated 100% specificity in excluding PP. This cut-off was used alongside urine osmolality cut-off values of > 630 mOsm/kg (for PP) and < 383 mOsm/kg (for AVP-D/AVP-R). Review of post-desmopressin urine osmolality and clinical monitoring was performed in equivocal diagnostic cases (n = 6), achieving 100% sensitivity and 100% specificity within the study sample.

CONCLUSIONS

This study demonstrates that a serum sodium cut-off of ≥ 148 mmol/L in tandem with urine osmolality yields the best diagnostic accuracy to differentiate between AVP-D, AVP-R, and PP. Serum sodium may be more reliable than serum osmolality in the investigation of patients with PPS, demonstrating lower biological and analytical variability.

Fluid and Electrolyte Disorders in Traumatic Brain Injury: Clinical Implications and Management Strategies

Traumatic brain injuries (TBIs) cause direct central nervous system injury. The presentation depends on the location, the type, and the severity of the injury. Additional injury may develop secondary to compression, the disruption of cerebral perfusion, and changes in sodium levels, resulting in either cellular edema or dehydration. Plasma osmolality (Posm) is a critical parameter influenced by solute concentrations, including sodium, glucose, and urea, and is a relevant concern when considering sodium levels in these patients. While Posm can be calculated using a standard formula, direct measurements via osmometry offer better accuracy. It is essential to differentiate between osmolality and tonicity; the latter refers specifically to effective solutes that drive water movement in the extracellular fluid. Sodium and its anions are effective solutes, whereas urea and glucose have variable effects due to their permeability and insulin dependence. Following TBI, the dysregulation of osmoregulation may occur and affect neurological outcomes. Osmoreceptors in the brain regulate arginine vasopressin secretion in response to changes in effective solute concentrations, with sodium chloride and mannitol being potent stimuli. The regulation of plasma osmolality, typically maintained within ±5% of the 280-295 mOsm/kg H2O range, is crucial for homeostasis and relies on antidiuresis and thirst mechanisms. This review narrative underscores the complexities of osmoregulation in the context of TBIs and their clinical implications, particularly concerning the development of conditions such as diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and abnormal thirst.

Retinoic Acid Improves Vascular Endothelial Dysfunction by Inhibiting PI3K/AKT/YAP-mediated Ferroptosis in Diabetes Mellitus

BACKGROUND

Vascular endothelial dysfunction is the initial factor involved in cardiovascular injury in patients with diabetes. Retinoic acid is involved in improving vascular complications with diabetes, but its protective mechanism is still unclear. This study aimed to evaluate the effect and mechanism of All-trans Retinoic Acid (ATRA) on endothelial dysfunction induced by diabetes.

METHODS

In the present study, streptozotocin (STZ)-induced diabetic rats and high glucose (HG)-induced human umbilical vein endothelial cells (HUVECs) were observed, and the effects of ATRA on HG-induced endothelial dysfunction and ferroptosis were evaluated.

RESULTS

ATRA treatment improved impaired vasorelaxation in diabetic aortas in an endothelium-dependent manner, and this effect was accompanied by an increase in the NO concentration and eNOS expression. Ferroptosis, characterized by lipid peroxidation and iron overload induced by HG, was improved by ATRA administration, and a ferroptosis inhibitor (ferrostatin-1, Fer-1) improved endothelial function to a similar extent as ATRA. In addition, the inactivation of phosphoinositol-3-kinase (PI3K)/protein kinases B (AKT) and Yes-associated Protein (YAP) nuclear localization induced by HG were reversed by ATRA administration. Vascular ring relaxation experiments showed that PI3K/AKT activation and YAP inhibition had similar effects on ferroptosis and endothelial function. However, the vasodilative effect of retinoic acid was affected by PI3K/AKT inhibition, and the inhibitory effects of ATRA on ferroptosis and the improvement of endothelial function were dependent on the retinoic acid receptor.

CONCLUSION

ATRA could improve vascular endothelial dysfunction by inhibiting PI3K/AKT/YAP-mediated ferroptosis induced by HG, which provides a new idea for the treatment of vascular lesions in diabetes.

Glucose Oxidase Coupling with Pistol-Like DNAzyme Based Colorimetric Assay for Sensitive Glucose Detection in Tears and Saliva

Non-invasive monitoring of glucose levels in tears and saliva is crucial for diagnosing and predicting various illnesses, such as diabetic nephropathy. However, the capability of the current glucose detection methods to identify small amounts of glucose with a high sensitivity remains a significant obstacle. This study proposes a simple, visual technique for sensitively detecting glucose levels from tears and saliva using glucose oxidase (GOx) to catalyze glucose and pistol-like DNAzyme (PLDz) to enhance the signal. In particular, the β-D-glucose present in the samples serves as the initial molecule that GOx identifies and catalyzes to generate gluconic acid and hydrogen peroxide (H2O2). The H2O2 induces the self-cleavage of PLDz, activating the "part b" sequence. This activation initiates catalytic hairpin assembly (CHA) and releases the DNAzyme section in the H1 probe. The DNAzyme acts as a peroxidase analog, facilitating the catalysis of the 3,3',5,5'-tetramethylbenzidine (TMB)-hydrogen peroxide (H2O2) system and resulting in color changes. The proposed method exhibits a broad detection range of six orders of magnitude and a low limit of 0.32 μM for glucose detection. Furthermore, the proposed method was highly effective in detecting glucose in saliva and tears, suggesting that it could potentially diagnose hyperglycemia-related disorders in clinical environments.

Role of Early Postoperative Measurement of Copeptin in Prediction of Diabetes Insipidus Following Pituitary Surgery in Adults: A Systematic Review Plus Meta-analysis

BACKGROUND

Early diagnosis of diabetes insipidus (DI), a complication following pituitary surgery, can avoid catastrophic results such as lethargy or even death. Measurement of arginine vasopressin (AVP) may help the early diagnosis, but its direct assaying is challenging. Copeptin, which is co-secreted in equimolar quantities to AVP, is suggested to be a reliable marker in prediction of postoperative DI. Therefore, this systematic review plus meta-analysis aims to discover this possible role.

METHODS

Google Scholar, PubMed, Scopus, Web of Science, Embase, and Cochrane library were systematically searched up to August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Two authors independently reviewed the eligible articles and assessed the quality of them. A meta-analysis was conducted to assess the discriminative performance of copeptin.

RESULTS

In total, 8 cohort studies including 1255 participants met the inclusion criteria. The median copeptin levels were significantly lower in DI groups compared with non-DI groups in all included studies (P < 0.005). Meta-analysis of areas under the curve demonstrated that early measurement of copeptin level had an accuracy of 0.791 (standard error: 0.0198, 95% CI: 0.752 to 0.830), which was statistically significant (P < 0.001).

CONCLUSIONS

Copeptin level was significantly lower in DI patients than in non-DI patients who underwent pituitary surgery. Early measurement, as soon as possible (from the first hour to 48 hours after the operation) of copeptin after pituitary surgeries has good, but not excellent, accuracy to exclude postoperative DI.

Inhibition of Th17 cell differentiation by aerobic exercise improves vasodilatation in diabetic mice

BACKGROUND

Aortic endothelial diastolic dysfunction is an early complication of diabetes and the abnormal differentiation of Th17 cells is involved in the development of diabetes. However, the exact role of exercise on regulating the Th17 cells differentiation and the underlying molecular mechanisms remain to be elucidated in diabetic mice.

METHODS

db/db and db/m+ mice were randomly divided into exercise and sedentary groups. Mice in exercise group were exercised daily, 6 days/week, for 6 weeks and mice in sedentary groups were placed on a nonmoving treadmill for 6 weeks. Vascular endothelial function was measured via wire myograph and the frequencies of Th17 from peripheral blood in mice were assessed via flow cytometry.

RESULTS

Our data showed that exercise improved insulin resistance and aortic endothelial diastolic function in db/db mice. In addition, the proportion of Th17 cells and IL-17A level in peripheral blood of db/db mice were significantly increased, and exercise could promote Th17 cell differentiation and reduce IL-17A level. More importantly, STAT3 or ROR-γt inhibitors could promote Th17 cell differentiation in db/db mice, while exercise significantly down-regulated p-STAT3/ROR-γt signaling in db/db mice, suggesting that exercise regulated Th17 differentiation through STAT3/ROR-γt signaling.

CONCLUSIONS

This study demonstrated that exercise improved vascular endothelial function in diabetic mice via reducing Th17 cell differentiation through p-STAT3/ROR-γt pathway, suggesting exercise may be an important non-pharmacological intervention strategy for the treatment of diabetes-related vascular complications.

Urinary oxytocin secretion after pituitary surgery, early arginine vasopressin deficiency and syndrome of inappropriate antidiuresis

PURPOSE

Transient arginine vasopressin deficiency (AVP-D), previously called diabetes insipidus, is a well-known complication of transsphenoidal pituitary surgery (TPS) with no definite predictive biomarker to date making it difficult to anticipate. While oxytocin (OXT) was previously suggested as a possible biomarker to predict syndrome of inappropriate diuresis (SIAD)-related hyponatraemia after TPS, its secretion in patients presenting with AVP-D remains poorly understood. We therefore hypothesized that OXT might present a different secretion in the case of AVP-D which would support its potential as an early biomarker of AVP-D. Moreover, we hypothesized that abnormal secretion of OXT might occur later on, notably with SIAD.

METHODS

We measured the urinary output of OXT in 67 consecutive patients subjected to TPS and compared the values of oxytocin between time-points and OXT ratio between groups. The primary endpoint of our study was to identify a difference in urinary OXT excretion in patients suffering from AVP-D compared to patients remaining normonatraemic. As a secondary endpoint, we compared the evolution of OXT secretion after the diagnosis of AVP-D in both groups, comparing the patients that later developed SIAD with the ones that did not.

RESULTS

Patients developing AVP-D showed a delay in the increase of OXT secretion after TPS as shown by a significantly lower ratio of OXT between the first postoperative day and the day of surgery (0.88 VS 1.68, p = 0.0162, IC:0.2979-0.2642) but a significantly higher ratio of OXT between the fourth and the first postoperative days (1.17 VS 0.53, p = 0.0006, IC:-2.109-0.6092). Moreover, normonatraemic patients that did not show normalization of OXT levels at day 4 after surgery tended to develop SIAD later on.

CONCLUSION

Taken together, these results show for the first time that OXT release might help predict AVP-D after TPS and differentiate it from other pathologies of water-sodium balance.

Hypophysitis in COVID-19: a systematic review

PURPOSE

This systematic review aims to collect and examine recent research findings regarding hypophysitis in COVID-19 patients.

METHOD

We conducted a comprehensive literature review in English on the topic "Hypophysitis in COVID-19," using the MEDLINE (PubMed) database in July 2024. The selected articles were systematically tabulated and we have assessed in this review patient demographics, symptom presentation, imaging results, diagnosis, clinical management, and outcomes.

RESULTS

Seven reported cases of post-COVID-19 hypophysitis were identified, comprising 4 (57%) females and 3 (43%) males, with a median age of 37 years. The interval between COVID-19 infection symptoms and the onset of hypophysitis ranged from 2 to 3 weeks. Initial symptoms included frontal headache in 4 (57%) cases and polyuria and polydipsia in 3 (43%) cases. Anterior or posterior hypopituitarism was observed in 6 (85%) patients. Radiological findings varied: 2 (28.5%) cases showed panhypophysitis, 3 (43%) cases exhibited gland enlargement with homogeneous contrast enhancement on magnetic resonance imaging (MRI), 1 case involved the loss of the posterior pituitary bright spot, and 1 case involved pituitary apoplexy/enlargement of the gland and infundibulum. No pituitary biopsies were performed. Four (57%) patients received glucocorticoid (GC) treatment. Long-term follow-up was documented in only one case, a 16-year-old female followed for 2 years reporting complete clinical and radiological resolution.

CONCLUSION

Although rare, hypophysitis related to COVID-19 is documented in the literature exhibiting distinct characteristics such as a homogeneous gender prevalence, an average age of onset around 35 years, and primary symptoms of headache, polyuria, and polydipsia which are indicative of angiotensin-vasopressin deficiency. This is in contrast with primary autoimmune hypophysitis characterized by a female prevalence and typical symptoms with headache and visual impairment. Longer-term follow-up of these patients is needed to better understand the potential lasting impact on pituitary function and radiological improvement. Future research should also explore the presence of anti-pituitary antibodies and the other possible pathophysiological mechanisms potentially involved in these cases.

Significance of pyroptosis-related genes in the diagnosis and classification of diabetic kidney disease

OBJECTIVE

This study aimed to identify the potential biomarkers associated with pyroptosis in diabetic kidney disease (DKD).

METHODS

Three datasets from the Gene Expression Omnibus (GEO) were downloaded and merged into an integrated dataset. Differentially expressed genes (DEGs) were filtered and intersected with pyroptosis-related genes (PRGs). Pyroptosis-related DEGs (PRDEGs) were obtained and analyzed using functional enrichment analysis. Random forest, Least Absolute Shrinkage and Selection Operator, and logistic regression analyses were used to select the features of PRDEGs. These feature genes were used to build a diagnostic prediction model, identify the subtypes of the disease, and analyze their interactions with transcription factors (TFs)/miRNAs/drugs and small molecules. We conducted a comparative analysis of immune cell infiltration at different risk levels of pyroptosis. qRT-PCR was used to validate the expression of the feature genes.

RESULTS

A total of 25 PRDEGs were obtained. These genes were coenriched in biological processes and pathways, such as the regulation of inflammatory responses. Five key genes (CASP1, CITED2, HTRA1, PTGS2, S100A12) were identified and verified using qRT-PCR. The diagnostic model based on key genes has a good diagnostic prediction ability. Five key genes interacted with TFs and miRNAs in 67 and 80 pairs, respectively, and interacted with 113 types of drugs or molecules. Immune infiltration of samples with different pyroptosis risk levels showed significant differences. Thus, CASP1, CITED2, HTRA1, PTGS2 and S100A12 are potential DKD biomarkers.

CONCLUSION

Genes that regulate pyroptosis can be used as predictors of DKD. Early diagnosis of DKD can aid in its effective treatment.

Extraction, purification, structural characterization, and bioactivities of Ginkgo biloba leave polysaccharides: A review

Ginkgo biloba, a deciduous tree from the Ginkgoaceae family, is widely cultivated globally. In China, it predominantly grows in the eastern and southern regions. The leaves can be harvested multiple times throughout the growing season, presenting a significant resource potential. Ginkgo biloba leaves are considered as a living fossil with both medicinal and edible properties in traditional Chinese medicine. Polysaccharides, the primary bioactive compounds in these leaves, exhibit numerous biological activities, including antioxidant, antitumor, anti-inflammatory, immunoregulatory activity, antidepressant effects, hepatoprotective, hypoglycemic activity and hair-growth promoting effect. This review highlights the advancements in the extraction separation purification, structural elucidation, and functional analysis of polysaccharides derived from Ginkgo biloba leaves over the past decade, aiming to provide valuable insights for future development and commercialization of Ginkgo biloba leave polysaccharides.

Desmopressin dosing in children using real-world data and pharmacokinetic/pharmacodynamic model simulations

BACKGROUND

Variability in pediatric dosing of desmopressin (ddAVP) in AVP-deficiency (AVP-D) is well-documented but dosing recommendations are limited. This study evaluates and optimizes ddAVP dosing regimens in children with AVP-D using pharmacokinetic and pharmacodynamic (PK/PD) simulations.

METHODS

Retrospective electronic health record review was done to identify children (<18 years) with AVP-D on ddAVP evaluated in the outpatient setting using ICD 9 and 10 codes. A previously developed PK/PD model from Michelet et al was used to simulate ddAVP concentrations and urine rates based on a child's age and ddAVP dose. The effects of demographic characteristics (age, weight, etc.) on dose and urine rate were investigated through simulations to optimize doses of ddAVP for children who were wet overnight.

RESULT

A total of 276 dosing records were identified among 53 children with AVP-D. Simulations indicated that in children under 5 years of age who were wet overnight, increasing the outpatient dose to 50 mcg was predicted to decrease urine rate to a pattern similar to those who remained dry.

CONCLUSION

An initial outpatient dose of at least 50 mcg for children between 1 and 5 years of age would improve efficacy of ddAVP.

IMPACT

50 mcg is likely a safe initial outpatient dose of oral desmopressin tablet for young children 1-5 yrs of age with central Diabetes Insipidus/AVP-Deficiency. We confirmed that desmopressin doses vary greatly in children with central Diabetes Insipidus/AVP-deficiency. Real-world clinical data can be leveraged to improve medication dosing in rare diseases.

An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. The various etiologies are reviewed, including pituitary neuroendocrine tumors (PitNETs), hypothalamic lesions, genetic mutations, and acquired factors such as head trauma, medications, neoplasms, and infiltrative diseases. It is noted that PitNETs are responsible for approximately half of the cases in adults, whereas in children the causes are predominantly congenital. Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. Laboratory tests present challenges and limitations that must be understood and addressed. Hormone replacement therapy is the mainstay of treatment, significantly improving patients' quality of life. It is important to know the possible interactions between hormone replacement therapies in HP. Recent advances in understanding the pathophysiology of HP and the importance of a multidisciplinary approach to the management of associated complications are discussed. This article emphasizes the need for comprehensive evaluation and continuous follow-up to optimize outcomes in patients with HP and highlights the importance of ongoing research to improve diagnostic and treatment strategies.

A sensitive fluorescence assay of serum dipeptidyl peptidase IV activity to predict the suitability of its inhibitors in patients with type 2 diabetes mellitus

DPP-IV inhibitors, which are close to the natural hypoglycemic pathway of human physiology and have few side effects, have been extensively employed in the management of type 2 diabetes mellitus (T2DM). However, there are currently no specific blood indicators that can indicate or predict a patient's suitability for DPP-IV inhibitors. In this study, based on the self-developed high-specificity fluorescent substrate glycyl-prolyl-N-butyl-4-amino-1, 8-naphthimide (GP-BAN), a detection method of human serum DPP-IV activity was established and optimized. The method demonstrates a favorable lower limit of detection (LOD) at 0.32 ng/mL and a satisfactory lower limit of quantification (LOQ) of 1.12 ng/mL, and can be used for the detection of DPP-IV activity in trace serum (2 μL). In addition, Vitalliptin and Sitagliptin showed similar IC50 values when human recombinant DPP-IV and human serum were used as enzyme sources, and the intra-day and inter-day precision obtained by the microplate analyzer were less than 15 %. These results indicate that the microplate reader based detection technique has good accuracy, repeatability and reproducibility. A total of 700 volunteers were recruited, and 646 serum samples were tested for DPP-IV activity. The results showed that serum DPP-IV activity was higher in patients with T2DM than in controls (P < 0.01). However, the statistical data of family history of diabetes, gender and age of diabetic patients showed no statistical significance, and there was no contrast difference. The DPP-IV activity of serum in T2DM patients ranged from 2.4 μmol/min/L to 78.6 μmol/min/L, with a huge difference of up to 32-fold. These results suggest that it is necessary to test DPP-IV activity in patients with T2DM when taking DPP-IV inhibitors to determine the applicability of DPP-IV inhibitors in T2DM patients. These results suggest that it is necessary to detect the activity of DPP-IV in blood before taking DPP-IV inhibitors in patients with T2DM to judge the applicability of DPP-IV inhibitors in patients with T2DM.

Utility of copeptin in predicting non-pathological postoperative polyuria in patients affected by acromegaly undergoing pituitary neurosurgery

PURPOSE

Copeptin efficiently predicts post-neurosurgical central diabetes insipidus (CDI) in patients with hypothalamic-pituitary lesions, but its role in characterizing changes in diuresis in individuals with acromegaly undergoing neurosurgery remains unexplored. Our study aimed to assess changes in postoperative fluid balance in acromegaly patients and correlate them with both copeptin and growth hormone (GH) levels.

METHODS

This was a secondary analysis of a prospective study involving 15 acromegaly patients undergoing endoscopic endonasal resection at our University Hospital. Fluid balance was assessed daily, and copeptin and GH levels were evaluated preoperatively (T0), and serially on the morning of the first (T2) and second (T3) postoperative day, with an additional measurement of copeptin one hour post-extubation (T1). Patients with pre-existing or post-neurosurgical CDI were excluded from the analysis.

RESULTS

Most patients (11/15) exhibited a negative fluid balance on the second postoperative day, with 4 developing polyuria. Postoperative GH levels did not differ significantly between polyuric and non-polyuric patients, but GH measured at T2 correlated significantly with negative total balance (r = -0.519, p = 0.048). Copeptin levels at T1 were significantly higher in those who developed polyuria (p = 0.013), and a copeptin value > 39.9 pmol/L at T1 showed excellent ability (Sensitivity 100%, Specificity 90.9%, p < 0.001) in predicting postoperative polyuria. Additionally, polyuric patients exhibited a higher T1 / T3 copeptin ratio (p = 0.013) and a negative fluid balance was associated with the remission of acromegaly at 12 months (p = 0.046).

CONCLUSION

The early assessment of copeptin, in addition to facilitating the rapid identification of individuals at increased risk of developing CDI, could also allow the recognition of subjects with a tendency towards non-pathological polyuria in the postoperative setting, at least in individuals affected by acromegaly.

Experience in the Treatment of Male Prolactinomas: A Single-Center, 10-Year Retrospective Study

INTRODUCTION

Male prolactinomas are uncommon and typically macroadenomas with difficult treatment and management. The purpose of this study was to summarize the treatment and management experiences of 254 male prolactinoma patients at a single center.

METHODS

This was a 10-year retrospective study conducted at a single center. A total of 254 male prolactinoma patients were included. Clinical data for all subjects were collected using an electronic medical record system.

RESULTS

A total of 254 male patients with prolactinoma were studied. Their median age at onset was 28.8 years, and median disease duration was 28.5 months. The median PRL levels were 582.0 ng/mL at diagnosis. Their median maximum tumor diameter was 23.0 mm, with macroadenoma accounting for the majority (76.7%). After treatment, the biochemical remission rate with monotherapy was 36.6%, but significantly increased to 60.6% with multidisciplinary treatment (p < 0.001). Knosp 0-2 patients had significantly higher rates of biochemical remission compared to Knosp 3-4 (all p < 0.05). In addition, the maximum diameter of adenoma (B = -0.110, p = 0.008) and cavernous sinus invasion (B = -1.741, p = 0.023) were negatively correlated with postoperative biochemical remission. The maximum diameter of the adenoma (B = - 0.131, p < 0.001) was a negative correlation factor, while treatment duration (B = 0.034, p = 0.002) was a positive correlation factor for biochemical response to medication.

CONCLUSION

Male prolactinoma has a low biochemical remission rate when treated alone, but multitherapy can improve it even more. Surgery may also be considered for male prolactinoma with a micro, and noninvasive tumor after a thorough evaluation.

INTRODUCTION

Male prolactinomas are uncommon and typically macroadenomas with difficult treatment and management. The purpose of this study was to summarize the treatment and management experiences of 254 male prolactinoma patients at a single center.

METHODS

This was a 10-year retrospective study conducted at a single center. A total of 254 male prolactinoma patients were included. Clinical data for all subjects were collected using an electronic medical record system.

RESULTS

A total of 254 male patients with prolactinoma were studied. Their median age at onset was 28.8 years, and median disease duration was 28.5 months. The median PRL levels were 582.0 ng/mL at diagnosis. Their median maximum tumor diameter was 23.0 mm, with macroadenoma accounting for the majority (76.7%). After treatment, the biochemical remission rate with monotherapy was 36.6%, but significantly increased to 60.6% with multidisciplinary treatment (p < 0.001). Knosp 0-2 patients had significantly higher rates of biochemical remission compared to Knosp 3-4 (all p < 0.05). In addition, the maximum diameter of adenoma (B = -0.110, p = 0.008) and cavernous sinus invasion (B = -1.741, p = 0.023) were negatively correlated with postoperative biochemical remission. The maximum diameter of the adenoma (B = - 0.131, p < 0.001) was a negative correlation factor, while treatment duration (B = 0.034, p = 0.002) was a positive correlation factor for biochemical response to medication.

CONCLUSION

Male prolactinoma has a low biochemical remission rate when treated alone, but multitherapy can improve it even more. Surgery may also be considered for male prolactinoma with a micro, and noninvasive tumor after a thorough evaluation.

Advancing the Diagnosis of Diabetic Neuropathies: Electrodiagnostic and Skin Autofluorescence Methods

INTRODUCTION

Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening value. This article highlights the diagnostic challenges and raises awareness of the often underdiagnosed neuropathic conditions in diabetes patients.

MATERIAL AND METHODS

We present common entrapment neuropathy cases from our diabetes clinic's electrodiagnosis laboratory in Iași, Romania. We selected seven type 2 diabetes patients with sensory or sensory-motor distal polyneuropathy and atypical DN presentations investigated through electroneurography (ENG) and electromyography (EMG) with the Neurosoft® EMG instrument and SAF measured by standard procedures. Subsequently, a narrative literature review was conducted.

RESULTS

Entrapment neuropathies were diagnosed in all the patients: three carpal tunnel syndromes, two ulnar neuropathies (one proximal, one distal), one peroneal neuropathy, and one case of meralgia paresthetica. The lower-limb cases showed radiculoplexopathy, and there was one case of superficial radial nerve neuropathy. The SAF values ranged from 2.5 AU to 3.4 AU.

CONCLUSIONS

Electrodiagnosis is essential for detecting focal neuropathies in patients with sensory-motor distal polyneuropathy. Elevated SAF levels may correlate with symptom severity, although further research, including large cohorts, is needed.

Arginine vasopressin deficiency onset after COVID-19 vaccination with positive anti-rabphilin-3A antibodies: a case report and literature review

BACKGROUND

Arginine vasopressin deficiency (AVP-D) can occur due to various conditions, so clarifying its cause is important for deciding treatment strategy. Although several cases of AVP-D following coronavirus disease 2019(COVID-19) infection or COVID-19 vaccination have been reported, the diagnosis of the underlying disease has not been reported in most cases.

CASE PRESENTATION

A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.

CONCLUSION

We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.

Arginine vasopressin deficiency: diagnosis, management and the relevance of oxytocin deficiency

Polyuria-polydipsia syndrome can be caused by central diabetes insipidus, nephrogenic diabetes insipidus or primary polydipsia. To avoid confusion with diabetes mellitus, the name 'central diabetes insipidus' was changed in 2022 to arginine vasopressin (AVP) deficiency and 'nephrogenic diabetes insipidus' was renamed as AVP resistance. To differentiate the three entities, various osmotic and non-osmotic copeptin-based stimulation tests have been introduced in the past decade. The hypertonic saline test plus plasma copeptin measurement emerged as the test with highest diagnostic accuracy, replacing the water deprivation test as the gold standard in differential diagnosis of the polyuria-polydipsia syndrome. The mainstay of treatment for AVP deficiency is AVP replacement with desmopressin, a synthetic analogue of AVP specific for AVP receptor 2 (AVPR2), which usually leads to rapid improvements in polyuria and polydipsia. The main adverse effect of desmopressin is dilutional hyponatraemia, which can be reduced by regularly performing the so-called desmopressin escape method. Evidence from the past few years suggests an additional oxytocin deficiency in patients with AVP deficiency. This potential deficiency should be further evaluated in future studies, including feasible provocation tests for clinical practice and interventional trials with oxytocin substitution.

Intraoperative Transient Central Diabetes Insipidus Status Post-Cerebellopontine Meningioma Resection: A Case Report

Central diabetes insipidus (CDI) is a neurological pathological condition in which vasopressin synthesis has been compromised. A 52-year-old male presented with a cerebellopontine angle mass not involving the hypothalamic-pituitary axis. Despite vasopressin therapy, the patient produced a total of 8650 mL of urine, with the urine-specific gravity measured at 1.002 near hour 8. A literature review found associations with certain anesthetic drugs that have an increased incidence of CDI, including alpha-2 agonists and sevoflurane. Reports have recommended administering desmopressin over vasopressin, especially for neurosurgery cases that warrant a more extended operative period, given that desmopressin has a longer context-sensitive half-life.

Rebuilding strength: surgical intervention and rehabilitation for bilateral spontaneous quadriceps tendon rupture-a case report

The quadriceps tendon, crucial for body movement, is among the body's strongest tendons. Factors like diabetes or hormone use can weaken it, making even minor trauma potentially causing rupture. Bilateral spontaneous quadriceps tendon rupture, where both tendons tear simultaneously, is rare. Prompt diagnosis and treatment are crucial. We present a case of a 44-year-old woman who experienced bilateral rupture after falling while doing chores. She had immediate pain and limited knee movement. Diagnosis via physical examination and CT/MRI scans confirmed the rupture. Surgical repair followed by rehabilitation led to significant pain reduction and improved function within two months. Overall, her postoperative outcome was satisfactory. This study underscores the importance of clear diagnosis, timely surgery, and thorough rehabilitation for optimal patient recovery from bilateral quadriceps tendon rupture.

Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis

OBJECTIVE

Central diabetes insipidus or vasopressin deficiency (AVP-D) is the most frequent water balance disorder after transsphenoidal surgery (TSS) with variable prevalence amongst studies. We aimed to determine rates of newly developed transient or permanent AVP-D in patients with pituitary tumours treated with TSS.

DESIGN AND METHODS

We performed systematic review of Medline, Embase, and Cochrane Library between January 1, 2000 and January 31, 2021 for studies reporting on outcomes for pituitary adenoma, craniopharyngioma, and Rathke's cleft cyst (RCC) after TSS and providing definition of post-operative AVP-D. We pooled the results as proportions with 95% confidence intervals (CIs) using Freeman-Tukey transformation random effects meta-analysis.

RESULTS

From 11 694 studies, 51 were included. Rates of transient or permanent AVP-D were: 17% (95% CI, 13-21) and 3% (95% CI, 2-5) in total group, 16% (95% CI, 12-21) and 2% (95% CI, 2-3) in pituitary adenomas, 31% (95% CI, 24-39) and 30% (95% CI, 22-39) in craniopharyngiomas, and 35% (95% CI, 16-57) and 14% (95% CI, 6-23) in RCCs, respectively. Based on diagnostic criteria, rates of transient or permanent AVP-D were: For hypotonic polyuria, 14% (95% CI, 8-22) and 3% (95% CI, 1-4), for hypotonic polyuria and hypernatraemia, 21% (95% CI, 13-29) and 5% (95% CI, 2-11), and for desmopressin administration, 22% (95% CI, 15-29) and 9% (95% CI, 0-30), respectively.

CONCLUSIONS

Following TSS, a small proportion of patients with pituitary adenoma have permanent AVP-D (2%), but prevalence reaches 30% in ones with craniopharyngioma and 14% in those with RCC. Diagnostic criteria for post-operative AVP-D remain variable affecting reported rates of this condition.

The diagnostic performance of copeptin in clinical practice: A prospective study

OBJECTIVE

Plasma copeptin is a relatively new biomarker for evaluation of arginine vasopressin (AVP) secretion. The aim of this study was to test the diagnostic performance of copeptin in patients with polyuria-polydipsia syndrome.

DESIGN, PATIENTS AND MEASUREMENTS

This was a prospective study where 88 patients with polyuria-polydipsia syndrome were evaluated with a water deprivation test (WDT). Weight, urine osmolality, urine specific gravity, and plasma copeptin were collected at baseline, after 8 h, and at termination of the WDT when one of the following had been reached: (i) >3% weight reduction, (ii) urine specific gravity >1.017 or urine osmolality >600 mOsm/kg, or (iii) intolerable adverse symptoms.

RESULTS

Of 88 patients (57 women), 21 (24%) were diagnosed with central diabetes insipidus (cDI), 5 (6%) with nephrogenic DI (nDI), and 62 (71%) with primary polydipsia (PP). Median (interquartile range) copeptin at baseline was 1.7 (1.4-2.5) pmol/L in cDI, 22 (18-65) pmol/L in nDI, and 2.7 (2-4) pmol/L in PP. After 8 h of WDT, the highest copeptin in patients with cDI was 4.0 pmol/L. In patients with PP: (i) 41 had urine osmolality <600 mOsm/kg, 7 (17%) of these had copeptin >4.0 pmol/L, (ii) 21 had urine osmolality ≥600 mOsm/kg, 14 (67%) of these had copeptin >4.0 pmol/L.

CONCLUSIONS

Copeptin >4.0 pmol/L after an overnight WDT can be used to rule out cDI and copeptin ≥21 pmol/L at baseline to diagnose nDI. The diagnostic performance of copeptin in the context of the WDT is otherwise limited in the diagnostic work-up of patients with polyuria-polydipsia syndrome.

New insights on diagnosis and treatment of AVP deficiency

Arginine vasopressin deficiency (AVP-D) is one of the main entities of the polyuria-polydipsia syndrome. Its correct diagnosis and differentiation from the other two causes - AVP resistance and primary polydipsia - is crucial as this determines the further management of these patients.Over the last years, several new diagnostic tests using copeptin, the stable surrogate marker of AVP, have been introduced. Among them, hypertonic saline stimulated copeptin was confirmed to reliably and safely improve the diagnostic accuracy to diagnose AVP-D. Due to its simplicity, arginine stimulated copeptin was put forward as alternative test procedure. Glucagon-stimulated copeptin also showed promising results, while the oral growth hormone secretagogue Macimorelin failed to provide a sufficient stimulus. Interestingly, an approach using machine learning techniques also showed promising results concerning diagnostic accuracy.Once AVP-D is diagnosed, further workup is needed to evaluate its etiology. This will partly define the further treatment and management. In general, treatment of AVP-D focuses on desmopressin substitution, with oral formulations currently showing the best tolerance and safety profile. However, in addition to desmopressin substitution, recent data also showed that psychopathological factors play an important role in managing AVP-D patients.

Diagnosing and treating the elderly individual with hypopituitarism

Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.

Naturally Occurring Atherosclerosis Progression and In-stent Restenosis: Exploring Histomorphologic Associations Using Optical Coherence Tomography

ABSTRACT

The mechanism of in-stent restenosis (ISR) remains elusive, and in-stent neoatherosclerosis (ISNA) may hold significant pathophysiologic implications. Nevertheless, the correlation between ISNA and the progression of untreated coronary segments affected by native atherosclerosis remains incompletely investigated. This study enrolled 225 patients diagnosed with coronary heart disease and multivessel disease. These patients underwent successful percutaneous coronary intervention and intraoperative placement of the drug-eluting stent, followed by optical coherence tomography assessment of the culprit stent. The mechanism of ISR was examined through qualitative and quantitative analysis of optical coherence tomography imaging. A significantly higher proportion of patients in the ISR with nontarget lesion progression (N-TLP) group exhibited lipid plaque formation compared with the ISR without N-TLP group (69.0% vs. 39.8%, P < 0.001). The incidence of thin-cap fibroatheroma (33.3% vs. 11.4%, P = 0.001) and ISNA (60.7% vs. 38.6%, P < 0.001) was markedly elevated in the ISR with N-TLP group compared with the ISR without N-TLP group. Regarding manifestations, heterogeneous hyperplasia was predominantly observed in the ISR with N-TLP group (76.2% vs. 38.6%, P < 0.001), whereas homogeneous hyperplasia was primarily presented in the ISR without N-TLP group (61.4% vs. 23.8%, P < 0.001). Patients displaying notable progression of naturally occurring atherosclerosis manifest histomorphologic features of ISR, primarily characterized by heterogeneous intimal hyperplasia and a higher prevalence of ISNA. In contrast, patients without substantial progression of naturally occurring atherosclerosis exhibit histomorphologic features of ISR primarily characterized by homogeneous intimal hyperplasia.

The influence of insulin-induced hypoglycemia on copeptin concentrations

Plasma copeptin is a biomarker that reflects arginine vasopressin (AVP) secretion. In this study we measured copeptin during insulin tolerance test (ITT) in 65 patients referred to our department for evaluation of anterior pituitary function. Plasma for measurements of copeptin were collected at the start of the test and regurarly up to 120 minutes thereafter. Of 60 patients who developed significant hypoglycemia and were included in the analyses, 13 (22%) had corticotropic deficiency, 11 (18%) had thyreotropic deficiency, 33 (55%) had growth hormone deficiency and 4 (6%) had AVP deficieny (AVPD). Thirty-seven (62%) patients had at least one anterior pituitary deficiency. In patients without AVPD, median (range) copeptin increased from 4.5 pmol/L (1.3-33.0) to a maximum of 6.2 pmol/L (2.0-34.4; p<0.001). Baseline copeptin was similar in men and women, but maximal copeptin during ITT was higher in men. Copeptin concentrations were not affected by age, BMI, somatotropic, or corticotropic function. Copeptin concentrations were lower in patients with AVPD than patiets without AVPD, and in patients with thyrotropic deficiency, compared to patients with intact thyrotropic function, both at baseline and during ITT. In conclusion, copeptin increases significantly during insulin induced hypoglycemia but is of limited value in predicting anterior pituitary hormonal function.

A cAMP-biosensor-based assay for measuring plasma arginine-vasopressin levels

Arginine-vasopressin (AVP), a cyclic peptide hormone composed of nine amino acids, regulates water reabsorption by increasing intracellular cyclic adenosine monophosphate (cAMP) concentrations via the vasopressin V2 receptor (V2R). Plasma AVP is a valuable biomarker for the diagnosis of central diabetes insipidus (CDI) and is commonly measured using radioimmunoassay (RIA). However, RIA has several drawbacks, including a long hands-on time, complex procedures, and handling of radioisotopes with special equipment and facilities. In this study, we developed a bioassay to measure plasma AVP levels using HEK293 cells expressing an engineered V2R and a cAMP biosensor. To achieve high sensitivity, we screened V2R orthologs from 11 various mammalian species and found that the platypus V2R (pV2R) responded to AVP with approximately six-fold higher sensitivity than that observed by the human V2R. Furthermore, to reduce cross-reactivity with desmopressin (DDAVP), a V2R agonist used for CDI treatment, we introduced a previously described point mutation into pV2R, yielding an approximately 20-fold reduction of responsiveness to DDAVP while maintaining responsiveness to AVP. Finally, a comparison of plasma samples from 12 healthy individuals demonstrated a strong correlation (Pearson's correlation value: 0.90) between our bioassay and RIA. Overall, our assay offers a more rapid and convenient method for quantifying plasma AVP concentrations than existing techniques.

[Max Reger and his early death: could it have been avoided? : Would he have lived longer with adequate intensive care?]

BACKGROUND

Max Reger was an organist, university teacher and composer whose life, illnesses, death and dying are not or hardly known to many.

OBJECTIVES

Which illnesses determined Reger's life and did his lifestyle and illnesses influence his compositional work? Could his early death have been avoided? From today's point of view, could modern intensive care medicine have helped him?

MATERIAL AND METHODS

A detailed analysis of Reger's diseases was performed using scientific databases (medline, pubmed). All published articles were evaluated and examined in detail.

RESULTS

Max Reger was born in Brand in 1873 and received early lessons in violin, piano and organ playing. From 1890 he studied at the conservatory in Sondershausen, later at the conservatory in Wiesbaden. In 1901 he moved to Munich, and in 1907 to Leipzig, where he became university director and professor at the conservatory. Four years later he took over the court chapel in Meiningen, but ended this activity again in 1914. A year later he moved to Jena and wrote his late works in the "Jenaish style". Reger suffered from many illnesses, especially bipolar disorder with manic and depressive phases. He had metabolic syndrome with arterial hypertension, was overweight and smoked incredibly heavily. Overeating ("binge eating" syndrome) and polydipsia were other prominent findings. Reger's life was characterized by alcohol abuse, often aggravated by professional and/or human crises. In 1916 Reger died suddenly and unexpectedly in Leipzig of cardiovascular failure.

DISCUSSION

Reger was an outstanding personality who left behind an extensive oeuvre. Among the highlights of Max Reger's oeuvre are his chorale fantasies such as on "Ein' feste Burg ist unser Gott" (op. 27) or also the "Fantasia and Fugue on B A C H" (op. 46), but other compositions such as the Mozart Variations (op. 132) and the Clarinet Quintet (op. 146) are also world-famous. His lifestyle certainly favored coronary heart disease, the consequences of which caused Reger's sudden, unexpected and much too early death. Today's modern intensive care medicine could probably have prolonged his life.

Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND

Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus (DM). Therefore, early detection of left ventricular systolic function (LVSF) damage in DM is essential.

AIM

To explore the use of the three-dimensional speckle tracking technique (3D-STI) for measuring LVSF in DM patients via meta-analysis.

METHODS

The electronic databases were retrieved from the initial accessible time to 29 April 2023. The current study involved 9 studies, including 970 subjects. We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.

RESULTS

Night articles including 970 subjects were included. No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group (P > 0.05), while differences in global longitudinal strain, global circumferential strain, global radial strain, and global area strain were markedly different between the controls and DM patients (all P < 0.05).

CONCLUSION

The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors

Purpose  This article aims to identify patient- and surgery-related factors that could predict the development of postoperative central diabetes insipidus (DI). Methods  This is a retrospective case-control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay. Results  A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with postop DI (chi-square (1) = 18.35, p  < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37-5.28). The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17, p  = 0.001) with a RR of 1.8 (CI = 1.15-2.87). Defects requiring a two or more layers for reconstruction also correlated with postop DI compared to single layer repairs (chi-square (1) = 12.15, p  < 0.001) irrelevant of the materials used. Development of DI postop correlated with an increased hospital length of stay ( t (64) = -3.35, p  = 0.001). Conclusion  The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect.

Epidemiological and transcriptome data identify shared gene signatures and immune cell infiltration in type 2 diabetes and non-small cell lung cancer

BACKGROUND

Numerous previous studies have reported an association between type 2 diabetes mellitus (T2DM) and lung cancer risk, but the underlying mechanism of the interaction remains unclear. This study aimed to investigate the shared genetic features and immune infiltration processes between lung cancer and T2DM.

METHODS

Epidemiological data from the National Health and Nutrition Examination Survey (NHANES) 2000-2018 was used to explore the relationship between lung cancer and diabetes systematically. In addition, we also used bioinformatics methods to analyze the transcriptome data from the Gene Expression Omnibus (GEO) to explore the potential functional mechanisms from the perspective of genes and immune infiltration.

RESULTS

Logistic regression analysis showed that prediabetes (OR = 3.289,95%CI 1.231, 8.788, p = 0.01760, model 3)and type 2 diabetes (OR = 3.032 95%CI,1.015, 9.054, p = 0.04689) were significantly associated with an increased risk of lung cancer after adjusting for multiple covariates. Data from NHANES showed an inverted U-shaped relationship between fasting blood glucose and glycosylated haemoglobin and the risk of lung cancer (P for non-linear < 0.001). Transcriptome data showed that we screened 57 co-DEGs, of which 25 were up-regulated co-DEGs and 32 were down-regulated. Ten core DEGs were identified by bioinformatics analysis, which were SMC6, CDC27, CDC7, RACGAP1, SMC4, NCF4, NCF1, NCF2, SELPLG and CFP. Correlation analysis showed that some core DEGs were significantly associated with simultaneous dysregulation of immune cells.

CONCLUSION

The identified core genes of NSCLC and T2DM are associated with dysregulated immune cells, which provides a potential research avenue for diagnosing and treating lung cancer combined with diabetes.

Persistent hypernatremia secondary to adipsic central diabetes insipidus in a patient with herpes-induced meningoencephalitis and COVID-19 infection: a case report

Central diabetes insipidus (CDI) typically manifests as a polyuria-polydipsia syndrome, in which normonatremia is generally maintained through the polydipsia. A 53-year-old woman presented with diabetic ketosis and hyperosmolar hyperglycemic syndrome. Her medical history included herpes meningoencephalitis, which was associated with confusion and amnesia. On physical examination, she was apyretic, confused, and had signs of extracellular dehydration. Her capillary glucose concentration was high and her urine was positive for ketones. Laboratory investigations revealed severe hyperglycemia, hypernatremia (plasma hyperosmolarity of 393.6 mOsm/L), and mild acute renal failure. In addition, she had a paucisymptomatic COVID-19 infection. Intravenous rehydration with isotonic saline solution and insulin therapy were effective at controlling the ketosis and ameliorating the hyperglycemia, but failed to normalize the hypernatremia and hyperosmolarity. She was not thirsty and had a urine output of 1 L/day, with urinary hypotonicity. Desmopressin administration reduced the hypernatremia and hyperosmolarity to within their normal ranges, and the patient's urinary osmolarity increased to 743 mOsm/L. Therefore, adipsic CDI was diagnosed. Endocrine investigations revealed isolated central hypothyroidism. The results of pituitary magnetic resonance imaging were normal. Thus, patients with impaired thirst may have an atypical presentation of CDI. In addition, the diagnosis of adipsic CDI is particularly challenging.

Multiomics analysis revealed the mechanism of the anti-diabetic effect of Salecan

Salecan, a natural β-glucan compromising nine residues connected by β-(1 → 3)/α-(1 → 3) glycosidic bonds, is one of the newly approved food ingredients. Salecan has multiple health-improving effects, yet its mechanism against Type 2 diabetes mellitus (T2DM) remains poorly understood. In this study, the hypoglycemic effect and underlying mechanism of Salecan intervention on STZ-induced diabetic model mice were investigated. After 8 weeks of gavage, Salecan attenuated insulin resistance and repaired pancreatic β cells in a dose-dependent manner. In addition, Salecan supplement remodel the structure of the gut microbiota and altered the level of intestinal metabolites. Serum metabolites, especially unsaturated fatty acids, were also affected significantly. In addition, tight junction proteins in the colon and autophagy-related proteins in the pancreas were upregulated. Multiomics analysis indicated that Lactobacillus johnsonii, Muribaculaceae, and Lachnoclostridium were highly associated with fatty acid esters of hydroxy fatty acids (FAHFA) levels in the colon, accordingly enhancing arachidonic acid and linoleic acid in serum, and promoting GLP-1 release in the intestine and insulin secretion in the pancreas, thus relieving insulin resistance and exhibiting hypoglycemic effects. These findings provide a novel understanding of the anti-diabetic effect of Salecan in mice from a molecular perspective, paving the way for the wide use of Salecan.

Status of waste disposal of sharps outside medical institutions for patients with diabetes: A systematic review

OBJECTIVES

As the number of people with diabetes increases, so does the amount of household-generated sharp waste, and incorrect sharp disposal methods can expose the public to needle stick injuries This systematic study assesses the relevant factors and current situation of the disposal of sharp waste in diabetes patients.

METHODS

In this review, our study comprehensively searched PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and China Biomedical, Wanfang, and CNKI for the concepts of "sharps waste disposal" and "diabetes".

RESULT

In 12 identified articles, there are 4155 patients with diabetes. The findings highlight that diabetic patients have a positive attitude towards sharps waste disposal, but lack knowledge and practice of sharps waste disposal, and need to take appropriate measures to improve the rate of proper waste disposal before and during use. Patients with longer duration of diabetes are more likely to engage in inappropriate sharps disposal behaviors.

CONCLUSIONS

The findings emphasize that the majority of diabetic patients are unable to handle sharps safely, so more research is needed to find factors associated with sharps waste disposal in diabetic patients and to focus on sharps waste disposal behaviors in patients with longer duration of disease in future clinical practice.

TRIAL REGISTRATION

PROSPERO ID. The review was registered on PROSPERO (registration number: CRD42023427592) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023427592.

Construction and clinical validation of a nomogram-based predictive model for diabetic retinopathy in type 2 diabetes

OBJECTIVE

This study aimed to identify risk factors for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) and construct a nomogram prediction model for DR.

METHODS

T2DM patients (n = 520) who underwent funduscopic examinations from June 2020 to June 2022 were included. Of these patients, 220 had DR, yielding a disease rate of 40.38%. Patients were divided into a training set (n = 364) and a validation set (n = 156) at a 7:3 ratio. Feature variables were selected using LASSO regression, random forests, and decision trees. Venn diagrams identified common DR feature variables. The prediction model's validity was assessed using the C-index, decision curve analysis (DCA), receiver operating characteristic (ROC) curves, and calibration curves.

RESULTS

Factors influencing DR were age, Diabetic Peripheral Neuropathy (DPN), Hemoglobin A1C (HbA1C) levels, High-Density Lipoprotein (HDL) cholesterol, Low-Density Lipoprotein (LDL) cholesterol, Neutrophil-to-Lymphocyte Ratio (NLR), Triglycerides (TG), Blood Urea Nitrogen (BUN), and disease duration. Univariate analysis excluded LDL as being unrelated to DR. The DR prediction model, constructed using the remaining eight variables, showed internal validation metrics with a C-index of 0.937, area under the ROC curve (AUC) of 0.773, and DCA net benefit of 11%-95%. The external validation metrics demonstrated a C-index of 0.916, AUC of 0.735, and DCA net benefit of 17%-93%. Calibration curves indicated high consistency.

CONCLUSION

This study developed a nomogram prediction model to assess the risk of DR in patients with T2DM. The model demonstrated high precision through internal validation.

Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease featured by insulin resistance (IR) and decreased insulin secretion. Currently, vitamin D deficiency is found in most patients with T2DM, but the relationship between vitamin D and IR in T2DM patients requires further investigation.

AIM

To explore the risk factors of IR and the effects of vitamin D supplementation on glucose and lipid metabolism in patients with T2DM.

METHODS

Clinical data of 162 T2DM patients treated in First Affiliated Hospital of Harbin Medical University between January 2019 and February 2022 were retrospectively analyzed. Based on the diagnostic criteria of IR, the patients were divided into a resistance group (n = 100) and a non-resistance group (n = 62). Subsequently, patients in the resistance group were subdivided to a conventional group (n = 44) or a joint group (n = 56) according to the treatment regimens. Logistic regression was carried out to analyze the risk factors of IR in T2DM patients. The changes in glucose and lipid metabolism indexes in T2DM patients with vitamin D deficiency were evaluated after the treatment.

RESULTS

Notable differences were observed in age and body mass index (BMI) between the resistance group and the non-resistance group (both P < 0.05). The resistance group exhibited a lower 25-hydroxyvitamin D3 (25(OH)D3) level, as well as notably higher levels of 2-h postprandial blood glucose (2hPG), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) than the non-resistance group (all P < 0.0001). Additionally, the resistance group demonstrated a higher triglyceride (TG) level but a lower high-density lipoprotein-cholesterol (HDL-C) level than the non-resistance group (all P < 0.0001). The BMI, TG, HDL-C, 25(OH)D3, 2hPG, and HbA1c were found to be risk factors of IR. Moreover, the post-treatment changes in levels of 25(OH)D3, 2hPG, FBG and HbA1c, as well as TG, total cholesterol, and HDL-C in the joint group were more significant than those in the conventional group (all P < 0.05).

CONCLUSION

Patients with IR exhibit significant abnormalities in glucose and lipid metabolism parameters compared to the non-insulin resistant group. Logistic regression analysis revealed that 25(OH)D3 is an independent risk factor influencing IR. Supplementation of vitamin D has been shown to improve glucose and lipid metabolism in patients with IR and T2DM.

Effect of the index of cardiac electrophysiological balance on major adverse cardiovascular events in patients with diabetes complicated with coronary heart disease

Purpose

To investigate the prognostic value of the index of cardio-electrophysiological balance (ICEB) and its association with major adverse cardiac events (MACE) and cardiovascular death in diabetic patients complicated with coronary heart disease.

Methods

A total of 920 diabetic patients were enrolled in this longitudinal study. Participants were categorized into three groups based on their ICEB levels: normal ICEB, low ICEB, and high ICEB. The primary outcome was the occurrence of MACE, and secondary outcomes included cardiovascular death, coronary heart disease (CHD), heart failure (HF), and sudden cardiac arrest (SCA). Patients were followed for a median period of 3.26 years, and the associations between ICEB levels and various outcomes were evaluated.

Results

Over the follow-up period, 46 (5.0%) MACE were observed in the normal ICEB group, 57 (6.2%) in the low ICEB group, and 62 (6.8%) in the high ICEB group. Elevated ICEB levels were found to be associated with a higher risk of MACE and cardiovascular death. A significant relationship between ICEB levels and the risk of MACE was observed for both genders. The risk of MACE increased with each unit increment in the ICEB index. However, the two-stage linear regression model did not outperform the single-line linear regression models in determining the threshold effect.

Conclusion

This study demonstrates the potential utility of ICEB, derived from a standard non-invasive ECG, as a prognostic tool for predicting MACE and cardiovascular death in diabetic patients complicated with CVD. The associations between ICEB levels and the risk of MACE highlight the importance of understanding cardiac electrophysiological imbalances and their implications in CVD.

Structure and dynamics of the course of chronic non-infectious somatic diseases in patients during war events on the territory of Ukraine

BACKGROUND

The work studied and compared the dynamics of changes in the course of hypertension, type 2 diabetes, and somatized disorders in Ukrainian population, in the 1st period before war (October 2021 - February 2022) and 2nd period during the war (March -July 2022). The choice of the study of the above-mentioned nosology is due, first of all, to the increase in cases of referrals to outpatient doctors regarding hypertensive crises, the increase in the frequency of patients' complaints about the lability of glycemic indicators during routine monitoring of glucose levels with ambulatory glucometers, the appearance of chronic pain syndrome of unspecified pathology with the beginning of war events.

METHODS

272 people were examined in Mykolaiv Region (Ukraine). The patients were divided into three clinical groups: 1st group - 90 people patients with arterial hypertension; 2nd group - 92 people with type 2 diabetes; the 3rd group - 90 people with somatiform disorders.

RESULTS

In the patients of the 1st group during the 2nd period, amount of people with hypertension of the 1st stage increased in 1.8 times (p = 0.0412), with 2nd stage hypertension increased in 2 times (p = 0.0491) and 3rd stage hypertension increased in 2.5 times (p = 0.0391); somatized disorders in 3rd group also increased in 4.1 times (p = 0.001 < 0.05); in 2nd group recorded an increase in HbA1c by 0.99 ± 0.57 mmol/l (p = 1.795e-07 < 0.05), in comparison with the indicators for the 1st observation period.

CONCLUSIONS

The war events in Ukraine not only changed the life of every Ukrainian, but also had a significant impact on the dynamics and structure of chronic somatic diseases, in particular due to an increase in patient referrals for hypertensive crises, exacerbations of type 2 diabetes, somatized disorders, and chronic pain syndrome of unknown etiology. Considering these results, it is important to increase the equipment of regional primary care centers with antihypertensive, hypoglycemic and sedative drugs.

Challenges of Pituitary Apoplexy in Pregnancy

Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012-December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP/PAPP = 43/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15/43) and terguride (1/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29/43 females received the conservative approach, and 22/43 women had trans-sphenoidal surgery (TSS) (and 10/22 had the initial approach). Furthermore, 18/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26/43), with the majority of them (N = 16/26) being larger than 1 cm. A maternal-fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5/6 had no underlying pituitary adenoma; 5/6 patients were managed conservatively and 1/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample-case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal-fetal outcomes from multidisciplinary insights.

Central diabetes insipidus: a late sequela of BNT162b2 SARS-CoV-2 mRNA vaccine?

BACKGROUND

The development of an effective vaccine is a powerful tool to contain the global spread of coronavirus disease 2019 (COVID-19). Still, it raises potential safety concerns about the subsequent enhancement of associated immunopathology. Increasing evidence shows that the endocrine system, including the hypophysis, may be involved in COVID-19. Moreover, occasional but increasing reports of endocrine disorders involving the thyroid have been reported after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Among them, a few cases encompass the pituitary. Here we report a rare case of central diabetes insipidus following SARS-CoV-2 vaccination.

CASE PRESENTATION

We report a 59-year-old female patient with a 25-year history of Crohn's disease in long-term remission, who presented with sudden onset of polyuria eight weeks after administration of an mRNA SARS-CoV-2 vaccination. Laboratory evaluation was consistent with isolated central diabetes insipidus. Magnetic resonance imaging displayed involvement of the infundibulum and the posterior hypophysis. Eighteen months after the vaccination, she is still under desmopressin treatment and had stable pituitary stalk thickening on magnetic resonance imaging. Although Crohn's disease-associated hypophysitis has been reported, it is scarce. In the absence of other recognizable causes of hypophysitis, we believe the involvement of the hypophysis in our patient may have been triggered by the SARS-CoV-2 vaccine.

CONCLUSIONS

We report a rare case of central diabetes insipidus potentially associated with SARS-CoV-2 mRNA vaccination. Further studies are needed to understand better the mechanisms underlying autoimmune endocrinopathies development in the context of COVID-19 infection and SARS-CoV-2 vaccination.

A 75-Year-Old Woman with a 5-Year History of Controlled Type 2 Diabetes Mellitus Presenting with Polydipsia and Polyuria and a Diagnosis of Central Diabetes Insipidus

BACKGROUND Central diabetes insipidus (CDI) is a rare disorder characterized by large volumes of dilute urine because of a lack of antidiuretic hormone. Co-existing CDI and diabetes mellitus without inherited disorders such as Wolfram syndrome are rare. It is both important and challenging to diagnose this combination because the 2 conditions present with thirst, polydipsia, and polyuria. A few cases of CDI developing in patients with type 2 diabetes mellitus (T2D) have been reported. We report an unusual case of CDI that developed in an older patient with T2D. The aims of this report are to share the clinical course and discuss clues to the early diagnosis of CDI in T2D. CASE REPORT A 70-year-old Japanese woman developed T2D with hyperglycemia symptoms, including thirst, polydipsia, and polyuria. After starting medical treatment, the hyperglycemia and its symptoms improved. The glycated hemoglobin level decreased from 9% to 6%. However, 5 years later (at 75 years of age), she re-exhibited thirst, polydipsia, and polyuria despite stable glycemic control. Her urine volume was large (6.3 L/day). A urine glucose test was negative. The plasma osmolality was high (321 mOsm/kg), while the urinary osmolality was low (125 mOsm/kg). A significant increase in urinary osmolality following vasopressin administration indicated a diagnosis of CDI. Desmopressin therapy effectively relieved the symptoms. CONCLUSIONS This case highlights the need to consider CDI as a rare but important comorbid disorder in patients with diabetes mellitus, including T2D, particularly those presenting with thirst, polydipsia, and polyuria despite well-controlled glycemia.