Endocrine Conditions Research Articles

Research Progress of Risk Factors Associated with Gestational Diabetes Mellitus.

Gestational Diabetes Mellitus (GDM) is a common endocrine condition associated with adverse pregnancy outcomes. In recent years, a growing number of risk factors associated with gestational diabetes mellitus have been defined. GDM poses a serious threat to maternal health. The etiology is complex and multifactorial and can be divided into inherent and modifiable factors. The inherent factors have been described in other literature, while the modifiable factors are mainly the risk of lifestyle habits. In this study, we performed a narrative review of the progress of risk factors associated with gestational diabetes mellitus.

FEATURES OF CLINICAL AND LABORATORY PRESENTATIONS OF PURULENT SURGICAL DISORDERS AFFECTING SOFT TISSUES IN THE CONTEXT OF DIABETES MELLITUS AND DIFFUSE TOXIC GOITER

In the context of concurrent endocrine conditions such as diabetes mellitus and diffuse toxic goiter, managing patients with purulent surgical soft tissue diseases presents notable challenges. This study aimed to explore the clinical characteristics of purulent surgical soft tissue diseases in the presence of diabetes mellitus and the combination of diffuse toxic goiter. Patients were divided into two groups: Group I comprised individuals with purulent surgical soft tissue diseases and diabetes mellitus, while Group II included patients with purulent surgical soft tissue diseases alongside a combination of diabetes mellitus and diffuse toxic goiter. The examination of patients with purulent-necrotic soft tissue diseases alongside comorbidities like diabetes mellitus and diffuse toxic goiter revealed distinct features in the wound healing process: parameters related to organism intoxication, wound cleansing, and healing duration tended to normalize at a slower pace in Group II compared to Group I, with a lag of approximately 2 days. Theaverage duration of bed rest for Group II was 10 ± 1.4 days, whereas in Group I, it was 8 ± 1.5 days.

IGF2BP2 and IGFBP3 Genotypes, Haplotypes, and Genetic Models Studies in Polycystic Ovary Syndrome.

Insulin resistance has been correlated with the genetic diversity within the insulin-like binding proteins genes. Moreover, insulin resistance is one of the key characteristics of the widespread reproductive endocrine condition known as polycystic ovarian syndrome (PCOS). Hence, this study is aimed to determine the association between IGFBP3 and IGF2BP2 gene variants and PCOS risk. A total of 300 subjects (150 PCOS cases diagnosed based on Rotterdam ESHRE/ASRM consensus criteria and 150 healthy subjects) were recruited in this case-control cross-sectional study. Tetra-primer amplification refractory mutation system polymerase chain reaction (ARMS-PCR) was used for genotyping rs11705701, whereas genotyping of rs1470579 and rs2854744 was done employing PCR-restriction fragment length polymorphism (PCR-RFLP) technique. The CC and AA+AC genotypes of rs1470579 conferred an increased risk of PCOS in our population. Regarding the rs2854744, an increased risk of PCOS was observed under the codominant homozygous (TT vs. GG) model by 2.54 fold. The C allele of rs1470579 and T allele of rs2854744 enhanced PCOS risk by 1.97 and 1.46 folds, respectively. Haplotype analysis showed that the Ars1470579Ars11705701 haplotype conferred a decreased risk of PCOS (odds ratio = 0.53, 95% confidence interval = 0.34-0.83, p = 0.006). The AC/GG/GT, AA/GA/GT, AC/GA/GG, and AC/GA/GT genotype combinations of rs1470579/rs11705701/rs2854744 were associated with a decreased risk of the disease. IGF2BP2 rs1470579 and IGFBP3 rs2854744 enhanced PCOS susceptibility in a Southeastern Iranian population. Further investigation involving larger cohorts representing diverse ethnic backgrounds is needed to confirm the current findings.

Clinical Features and Outcomes of Myxedema Coma in Patients Hospitalized for Hypothyroidism: Analysis of the United States National Inpatient Sample.

Background: Hypothyroidism is a common endocrine condition and chronic thyroid hormone deficiency is associated with adverse effects across multiple organ systems. In compensated hypothyroidism, however, patients remain clinically stable due to gradual physiological adaptation. In contrast, the clinical syndrome of decompensated hypothyroidism referred to as myxedema coma (MC) is an endocrine emergency with high risk of mortality. Because of its rarity, there are currently limited data regarding MC. This study analyzes the clinical features and hospital outcomes of MC compared with hypothyroid patients without MC (nonMChypo) in national United States hospital data. Methods: A retrospective analysis of the National Inpatient Sample, a public database of inpatient admissions to nonfederal hospitals in the United States, 2016-2018, including adult patients with primary diagnosis of MC (International Classification of Diseases 10th Revision [ICD-10]: E03.5) or nonMChypo (E03.0-E03.9, E89.0). Patient demographics, relevant clinical features, mortality, length of stay (LOS), and hospital costs were compared. Results: Of 18,635 patients hospitalized for hypothyroidism, 2495 (13.4%) had a diagnosis of MC. Sex distribution and race/ethnicity were similar between patients with MC and nonMChypo, whereas MC was associated with older patient age (p = 0.02), public insurance (p = 0.01), and unhoused status (p = 0.04). More admissions with MC occurred in winter compared with other seasons (p = 0.01). The overall mortality rate for MC was 6.8% versus 0.7% for nonMChypo (p < 0.001), and MC was independently associated with in-hospital mortality after adjusted regression analysis (adjusted odds ratio = 9.92 [CI 5.69-17.28], p < 0.001). Mean LOS ± standard error was 9.64 ± 0.73 days for MC versus 4.62 ± 0.12 days for nonMChypo (p < 0.001), and total hospital cost for MC was $21,768 ± $1759 versus $8941 ± $276 for nonMChypo (p = 0.07). In linear regression analyses, MC was an independent predictor of both increased LOS and total hospital cost. Conclusions: In summary, MC remains a clinically significant diagnosis in the modern era, independently associated with high mortality and health care costs. This continued burden demonstrates a need for further efforts to prevent, identify, and optimize treatment for patients with MC.

Prolame produces anxiolytic- and antidepressant-like effects in middle-aged female rats with less uterotrophic effects than 17β-estradiol

Estrogen hormone replacement therapy (EHRT), improving women's life quality at menopause, reduces anxiety and depression symptoms associated with ovarian hormonal decline. However, its potential adverse effects, like thromboembolism and cancer risk, limit its use. Prolame is a synthetic 17β-amino estrogen with antithrombotic actions that exerts anxiolytic- and antidepressant-like effects on young adult ovariectomized female rats. It is unknown if prolame's effects may be observed in age and endocrine conditions emulating menopause. This study aimed to identify the antidepressant- and anxiolytic-like effects of prolame and E2 (used as a reference estrogen treatment) in middle-aged female rats coursing with irregular cycles, in two different conditions: ovariectomized or gonadally intact. Results were compared with those from young adult ovariectomized rats. Prolame (60 or 120 μg/kg), 17β-estradiol (E2, 40 or 80 μg/kg), or vehicle were chronically administered, and their effects were evaluated in the elevated plus-maze, defensive burying behavior test, open field test, and forced swimming test. Uterotrophic actions were estimated by uterine weight related to body weight. Prolame and E2 produced robust anxiolytic- and antidepressant-like effects in young adult ovariectomized rats, but these effects were absent in gonadally intact middle-aged rats. Interestingly, only prolame induced anxiolytic- and antidepressant-like effects in middle-aged ovariectomized rats. Uterotrophic effects of prolame were weaker than E2 effects, notably in middle-aged females. Altogether, present data support the notion that prolame has the potential to be considered an EHRT with relevant psychoactive actions and with apparently lower adverse-side effects, especially in middle-aged populations.

A Dual Therapeutic Approach to Diabetes Mellitus via Bioactive Phytochemicals Found in a Poly Herbal Extract by Restoration of Favorable Gut Flora and Related Short-Chain Fatty Acids.

Diabetes mellitus (DM), a metabolic and endocrine condition, poses a serious threat to human health and longevity. The emerging role of gut microbiome associated with bioactive compounds has recently created a new hope for DM treatment. UHPLC-HRMS methods were used to identify these compounds in a poly herbal ethanolic extract (PHE). The effects of PHE on body weight (BW), fasting blood glucose (FBG) level, gut microbiota, fecal short-chain fatty acids (SCFAs) production, and the correlation between DM-related indices and gut microbes, in rats were investigated. Chebulic acid (0.368%), gallic acid (0.469%), andrographolide (1.304%), berberine (6.442%), and numerous polysaccharides were the most representative constituents in PHE. A more significant BW gain and a reduction in FBG level towards normal of PHE 600mg/kg treated rats group were resulted at the end of 28th days of the study. Moreover, the composition of the gut microbiota corroborated the study's hypothesis, as evidenced by an increased ratio of Bacteroidetes to Firmicutes and some beneficial microbial species, including Prevotella copri and Lactobacillus hamster. The relative abundance of Bifidobacterium pseudolongum, Ruminococcus bromii, and Blautia producta was found to decline in PHE treatment groups as compared to diabetic group. The abundance of beneficial bacteria in PHE 600mg/kg treatment group was concurrently associated with increased SCFAs concentrations of acetate and propionate (7.26nmol/g and 4.13nmol/g). The findings of this study suggest a promising approach to prevent DM by demonstrating that these naturally occurring compounds decreased FBG levels by increasing SCFAs content and SCFAs producing gut microbiota.

Role of Proprotein Convertase Subtilisin Kexin Type 9 Inhibitor Therapy in treatment of Patients with Polycystic Ovary Syndrome: A systemic Review of Metabolic and Cardiovascular Outcomes

Polycystic Ovary Syndrome (PCOS) is a common endocrine condition that affects both obese and nonobese women of reproductive age group. Its clinical presentation is dysmenorrhea, hirsutism, acne, metabolic complications, infertility, and polycystic ovaries. The study is aimed to assess the efficacy of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors to lower dyslipidemia in women with PCOS to prevent long term cardio-metabolic complications. PCSK 9 Inhibitors ( Alirocumab, Evolocumab, and Inclisiran) bind to LDL receptors in liver and lower LDLC levels, preventing long term adverse side effects. This review aims at showing that these drugs can be effective when prescribed to women with PCOS earlyon to prevent some serious cardiovascular and metabolic complications in the long run. In terms of medical therapy, most physicians prescribe Metformin and Statins as first line agents to control risk factors. But much of the research supported the use of PCSK 9 Inhibitors early in the disease process or as an add-on to statins for controlling the lipid profile. When compared to Statins, the control rates of PCSK 9 Inhibitors were equal or superior and they showed additive effect when given along with other lipid lowering agents. Studies showed these drugs have only minor side effects and have good tolerability profile. They do not have severe side effects as compared to statins or fibrates.

Chronic health conditions after childhood Langerhans cell histiocytosis: Results from the Swiss Childhood Cancer Survivor Study.

Langerhans cell histiocytosis (LCH) is a rare disease characterized by dysregulated proliferation of myeloid marrow progenitors and subsequent organ infiltration. While LCH is associated with a favorable prognosis, some survivors may develop chronic health conditions (CHC) because of the disease. In this study, we aimed to assess the spectrum and prevalence of CHC among LCH survivors compared with siblings and identify factors associated with the development of CHC. The Swiss Childhood Cancer Survivor Study sent questionnaires to all ≥ 5-year LCH survivors registered in the Swiss Childhood Cancer Registry and diagnosed between 1976 and 2015. Siblings also received similar questionnaires. We compared CHC prevalence between LCH survivors and siblings and used logistic regression to identify determinants of CHC. A total of 123 LCH survivors participated in the study, with a response rate of 69%. Median time since diagnosis was 13years (interquartile range 9-20). Among LCH survivors, 59% had at least one CHC. Cardiovascular (13% vs. 6%), endocrine (15% vs. 2%), musculoskeletal (22% vs. 13%), and digestive (15% vs. 8%) CHC were more common among LCH survivors compared to siblings (all p < 0.05). Factors most strongly associated with the occurrence of CHC were multisystem LCH, multifocal bone involvement, and involvement of the pituitary gland. More than half of long-term LCH survivors suffered from one or more CHC and were affected considerably more than siblings. LCH survivors in follow-up care should be screened especially for cardiovascular, endocrine, musculoskeletal, and digestive conditions.

Clinical Endocrinology-Time for a Reset?

Measurement of blood levels of circulating hormones has always been the cornerstone of the biochemical diagnosis of endocrine diseases, with the objective of detecting hormone excess or insufficiency. Unfortunately, the dynamic nature of hormone secretion means single-point measurements of many hormones often lack diagnostic validity. Endocrinologists have devised complex dynamic tests as indirect assessments of the functioning of the hormone system under investigation. Recent advances in the measurement of dynamic hormone changes across the day now offer an opportunity to reconsider whether there might be better ways both to diagnose and to monitor the therapy of endocrine conditions.

Preclinical Rodent Models for Human Bone Disease, Including a Focus on Cortical Bone.

Preclinical models (typically ovariectomized rats and genetically altered mice) have underpinned much of what we know about skeletal biology. They have been pivotal for developing therapies for osteoporosis and monogenic skeletal conditions, including osteogenesis imperfecta, achondroplasia, hypophosphatasia, and craniodysplasias. Further therapeutic advances, particularly to improve cortical strength, require improved understanding and more rigorous use and reporting. We describe here how trabecular and cortical bone structure develop, are maintained, and degenerate with aging in mice, rats, and humans, and how cortical bone structure is changed in some preclinical models of endocrine conditions (eg, postmenopausal osteoporosis, chronic kidney disease, hyperparathyroidism, diabetes). We provide examples of preclinical models used to identify and test current therapies for osteoporosis, and discuss common concerns raised when comparing rodent preclinical models to the human skeleton. We focus especially on cortical bone, because it differs between small and larger mammals in its organizational structure. We discuss mechanisms common to mouse and human controlling cortical bone strength and structure, including recent examples revealing genetic contributors to cortical porosity and osteocyte network configurations during growth, maturity, and aging. We conclude with guidelines for clear reporting on mouse models with a goal for better consistency in the use and interpretation of these models.

The impact of oral isotretinoin on ovarian functions of acne patients complaining of polycystic ovarian syndrome: a prospective study

BackgroundWomen have polycystic ovarian syndrome (PCOS) at higher rates than any other endocrine condition with an average incidence rate of 6 to 8%. Acne is an immune mediate common condition frequently affecting adolescents and adults and is often associated with PCOS. The objective of the study was to assess the impact of oral isotretinoin on ovarian functions of acne patients suffering from PCOS. Forty women with a clinical diagnosis of acne as well as PCOS participated in this prospective clinical trial. Participants were given oral doses of isotretinoin ranging from 0.5 to 1 milligram per kilogram (mg/kg), for a total of 120 to 150 mg/kg. To establish baseline values of hormone levels, on days 2–5 of the menstrual cycle, venous blood samples were obtained. Moreover, global acne grading system (GAGS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment.ResultsA significant reduction in global acne score from pre-treatment levels to post-treatment levels was observed (11.58 ± 5.857 vs. 1.65 ± 1.369). Ovarian volume was significantly reduced from 10.26 ± 1.539 before treatment to 8.74 ± 1.436 after treatment on the right side (P < 0.001) and from 11.08 ± 1.564 before treatment to 9.36 ± 1.479 after treatment on the left side (P < 0.001). A significant reduction in free testosterone level and hirsutism scores were observed after treatment (P < 0.001; P < 0.01 respectively.ConclusionIsotretinoin may exert beneficial effects in hyperandrogenic women with PCOS and needs to be further evaluated by large multicentre controlled trials.

Metformin and Omega 3 effect on Cholesterol and HDL level in Iraqi women with Poly Cystic Ovary Syndrome

PCOS is a prevalent endocrine condition affecting women in their reproductive years all over the world. Metabolic abnormalities in women with PCOS frequently include insulin resistance and dyslipidemia, which is characterized by low levels of HDL and increased cholesterol. Metformin, an insulin-sensitizing medication, is commonly used to treat PCOS. Omega-3 fatty acids, found in fish oil supplements, have been shown to have beneficial effects on lipid profiles and reduce inflammation, making them a potential complementary therapy for PCOS. This study aimed to evaluate the effect of a combination of metformin and omega-3 supplements on the lipid profiles of women with PCOS. This study aim to evaluate the effect of using metformin (1000mg/day) and omega 3(1000mg/day) for 3 consecutive months on cholesterol and HDL level (in prospective manner) of patient serum with PCOS. This study was performed at gynecology outpatient clinic and infertile center in AL-batol hospital during the period from December 2021 to march 2022. A total 59 women between (18-40years) with PCOS were randomly assigned into two group, the first group were taking metformin for 12 week and the second group were taking metformin and omega 3 for 12 week. There cholesterol and HDL were measure before and after the treatment .The result show that use of metformin and omega 3 is more significant (P value 0.281) in reducing the level of cholesterol and increase HDL(p value 0.627) than metformin alone (p value 0.525) and (p value 0.106) respectively.

A Cross-Sectional Study of Alzheimer-Related Proteins in Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women of reproductive age, and several risk factors found in PCOS are associated with an increased risk of Alzheimer's disease (AD). Proteins increased in AD have been reported to include fibronectin (FN) fragments 3 and 4 (FN1.3 and FN1.4, respectively) and ApoE. We hypothesized that Alzheimer-related proteins would be dysregulated in PCOS because of associated insulin resistance and obesity. In this comparative cross-sectional analysis, aptamer-based SomaScan proteomic analysis for the detection of plasma Alzheimer-related proteins was undertaken in a PCOS biobank of 143 women with PCOS and 97 control women. Amyloid precursor protein (APP) (p < 0.05) and amyloid P-component (APCS) (p < 0.001) were elevated in PCOS, while alpha-synuclein (SNCA) (p < 0.05) was reduced in PCOS. Associations with protective heat shock proteins (HSPs) showed that SNCA positively correlated with HSP90 (p < 0.0001) and HSP60 (p < 0.0001) in both the PCOS and control women. Correlations with markers of inflammation showed that APCS correlated with interleukin 6 (IL6) (p = 0.04), while Apolipoprotein (Apo) E3 correlated with TNF-alpha (p = 0.02). FN, FN1.3, FN1.4 and ApoE were all elevated significantly (p < 0.05). An AD-associated protein pattern with elevated FN, FN1.3, FN1.4 and ApoE was found in PCOS, in addition to elevated APP and reduced SNCA, which was the same as reported for type 2 diabetes (T2D) with, additionally, an elevation in APCS. With the AD biomarker pattern in PCOS being very similar to that in T2D, where there is an association between AD and T2D, this suggests that larger prospective cohort studies are needed in women with PCOS to determine if there is a causal association with AD.

Antimüllerian hormone levels and IVF outcomes in polycystic ovary syndrome women: a scoping review.

Antimüllerian hormone (AMH) is a homodimeric glycoprotein secreted by granulosa cells from primary to large antral follicles, and it plays an important role in the regulation of early follicle growth. It is considered a reliable marker of ovarian reserve and a predictor of ovarian response to controlled stimulation. Polycystic ovary syndrome (PCOS) is an endocrine condition that affects women of reproductive age worldwide, and it is associated with high levels of AMH. PCOS patients may have worse maturation and fertilization rates compared to normo-ovulatory women. Some studies have demonstrated a positive correlation between AMH levels and qualitative aspects of assisted reproduction treatment; but it is not clear whether high levels of both serum and follicular fluid AMH in PCOS patients correlate with in vitro fertilization outcomes. We ran this scoping review of the literature to address this specific question. We comprehensively searched the databases PubMed and Cochrane Library until January 2023. We found that higher AMH levels are associated with higher oocyte yield, but PCOS patients tend to have fewer mature oocytes and impaired embryo quality and implantation rates. Pregnancy rates, however, are not affected by AMH levels or laboratorial outcomes. We also found that higher AMH levels are associated with worse PCOS features.

A Systematic Review of Telehealth Applications in Endocrinology.

The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care. This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting. This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations. In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.

Dietary Pattern, Physical, and Behavioral Trends in Women with Polycystic Ovary Syndrome

Abstract Context: Dietary intake and physical activity play a significant role in improving health parameters such as enhancing mood, strengthening visceral organ functions, and reducing the progression of chronic diseases. Polycystic ovary syndrome (PCOS) is a multifactorial endocrine and metabolic condition that concerns women of reproductive age presenting hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Aims: This study aimed to assess the quality of life and dietary patterns in women with and without PCOS, which may assist in identifying the possible factors linked to PCOS. Settings and Design: The cross-sectional study was conducted Central Research Laboratory, K. S. Hegde Medical Academy, KSHEMA-IVF Unit and Obstetrics and Gynaecology Department of Justice K. S. Hegde Charitable Hospital, Mangalore. Methods: With the sample size of 45 (23 women with PCOS diagnosed based on Rotterdam criteria and 20 women as healthy control aged between 18 and 40 years), we investigated the sociodemographic dietary intake, quality of life, sleep, and physical activity using a semi-validated questionnaire. Statistical Analysis: Obtained data were analyzed using Student’s t-test and Mann–Whitney U-test with P &lt; 0.05. Results: The results indicate that total energy, carbohydrate, protein, and total dietary fiber, including soluble dietary fiber intake, was significantly lower in women with PCOS than the healthy group. No clear relation was identified between lifestyle and PCOS indices. Conclusions: The present study suggests dietary intake and associated nutrient patterns may indeed play an imperative role in the management of PCOS symptoms, but physical activity and quality of life may need further investigation.

A Rare Case of Sheehan’s Syndrome Presenting as Depression and Dyselectrolytaemia in a Multiparous Woman

Sheehan’s Syndrome (SS) is a rare endocrine condition that presents with complex features in women with intrapartum or Postpartum Haemorrhage (PPH) seen in clinical practice. The spectrum of symptoms is diverse, and early detection with prompt treatment of this endocrinopathy is facilitated by a high index of suspicion, sound clinical acumen, and an appropriate diagnostic strategy by an astute physician. SS, which manifests as a major depressive disorder, but not accompanied with dyselectrolytaemia, is an interesting finding in the present case study. In fact, most of the time, it presents with non specific symptoms that delays the diagnosis and management. Hereby, the authors present the case of a 39-year-old multiparous woman who was diagnosed with depression for two months by the psychiatrist. Later, she developed symptoms including anorexia, for which she presented to the Medicine Department. On detailed examination, her vitals were poor. Again, she was evaluated in detail for her obstetric history presented as a history of agalactia and early amenorrhoea two years ago. Followed by the history, laboratory investigation and imaging techniques were done, and found to have thinned pituitary gland and flattened against the sella floor. With this prompt examination, diagnosed with SS due to PPH. Yet, her laboratory investigation resulted in abnormal electrolytes made the final diagnosis as SS with dyselectrolytaemia and depression as neuropsychiatric manifestations. She was treated with Hormone Replacement Therapy (HRT). Due to her financial constraints, her treatment switched to oral drugs and discharged Against Medical Advice (AMA) with follow-up advice.

Motilin fluctuations in healthy volunteers determined by liquid chromatography mass spectrometry.

Motilin is a hormone secreted by specialised enteroendocrine cells in the small intestine, and is known to modulate gastrointestinal motility in humans, regulating the migratory motor complex. It is understudied at least in part due to the lack of commercially available immunoassays. A multiplexed liquid chromatography mass spectrometry (LC-MS/MS) method was optimised to measure motilin, insulin, C-peptide, GIP (1-42) and GIP (3-42). Corresponding active ghrelin concentrations were determined by immunoassay. Ten healthy volunteers with no prior history of gastroenterological or endocrine condition attended after overnight fast and had blood samples taken every 15 minutes for 4 hours whilst continuing to fast, and then further sampling for 2 hours following a liquid mixed meal. Hunger scores were taken at each time point using a visual analogue scale. Normal bowel habit was confirmed by 1 week stool diary. Motilin levels fluctuated in the fasting state with an average period between peaks of 109.5 mins (SD:30.0), but with no evidence of a relationship with either ghrelin levels or hunger scores. The mixed meal interrupted cyclical motilin fluctuations, increased concentrations of motilin, insulin, C-peptide, GIP(1-42) and GIP(3-42), and suppressed ghrelin levels. This study highlights the utility of LC-MS/MS for parallel measurement of motilin alongside other peptide hormones, and supports previous reports of the cyclical nature of motilin levels in the fasting state and interruption with feeding. This analytical method has utility for further clinical studies into motilin and gut hormone physiology in human volunteers.

Depression in Polycystic Ovary Syndrome: Focusing on Pathogenesis and Treatment.

Polycystic ovary syndrome (PCOS) is one of the most prevalent gynecological endocrine conditions affecting reproductive women. It can feature a variety of symptoms, such as obesity, insulin resistance, skin conditions, and infertility. Women with PCOS are susceptible to illnesses including mood disorders, diabetes, hypertension, and dyslipidemia. Among them, depression is the most common in PCOS and has a detrimental effect on quality of life. Depression may occasionally develop due to the pathological traits of PCOS, but its exact pathogenesis in PCOS have eluded researchers to date. Therefore, there is an urgent need to explore the pathogenesis and treatments of depression in PCOS. The present review discusses the epidemiology of depression in PCOS, potential pathogenic mechanisms underlying PCOS and depression, as well as some potential factors causing depression in PCOS, including obesity, insulin resistance, hyperandrogenism, inflammation, and infertility. Meanwhile, some common treatment strategies for depression in PCOS, such as lifestyle intervention, acupuncture, oral contraceptive pills, psychological intervention, and insulin-sensitizer, are also reviewed. To fully understand the pathogenesis and treatment of depression in PCOS, a need remains for future large-scale multi-center randomized controlled trials and in-depth mechanism studies. Appeared originally in Front Psychiatry 2022; 13:1001484.

Recognizing the Diverse Clinical Presentations of Acromegaly: Insight from a Case Series

Purpose: Acromegaly is an endocrine disease due to growth hormone excess with slowly developing manifestations and diverse clinical presentations. There are chances that patients may present with common clinical problems and the underlying endocrine condition is overlooked and diagnosis is delayed. This case series will discuss the presentation, clinical features and investigations of four acromegaly cases to increase the clinical skills of physicians so that an early diagnosis is made and treatment is initiated early. Methods: This is an observational study, where a series of four acromegaly cases, who presented to medicine inpatients or outpatients of Sylhet Women’s Medical College, Bangladesh. They were analyzed through detailed clinical features and, investigation findings. MRI brain was used as the main tool for diagnosis. Serum levels of growth hormone, IGF-1, TSH, ACTH, and prolactin were assessed in all. Other anterior pituitary hormone assays were selectively done. Ocular examinations were performed on all patients. Conclusion: Though a case series has lower value as medical evidence than systematic reviews and randomized clinical trials, it can help in generating future protocols of studies. This series emphasizes that a keen clinical eye of the physician can help in early diagnosis of acromegaly and thus an early MRI of brain based on clinical suspicion can ensure early treatment and prevent cardiovascular complications.