Endocrinological Disorders Research Articles

Correlation between parathyroid adenoma volume and perioperative outcomes inprimary hyperparathyroidism: Does the size matter?

Primary hyperparathyroidism (PHPT) due to a parathyroid adenoma stands as one of the most prevalent endocrinological disorders, with focused parathyroidectomy being the established therapeutic strategy. This study aims to investigate whether the volume of the pathological gland influences perioperative outcomes and postoperative morbidity. A retrospective analysis was conducted on data from 141 patients who underwent focused parathyroidectomy for PHPT at the University Hospital of Basel between 2007 and 2022. A total of 141 patients underwent surgery, with a mean age of 57.2years and prevalence of women (64.5%).The volume of the lesion was divided into three groups (low < 1ml, middle 1-1.99ml, large > 2ml) based on pathological specimen analysis. Preoperative calcium and parathyroid hormone (PTH) values were significantly higher in the large volume group compared to the low volume group (p < 0.05), while phosphate and vitamin D values were significantly lower (p < 0.05). A comparison of adenoma volume in symptomatic patients with asymptomatic patients revealed no statistically significant difference (p = 0.845) and the volume of the gland of any group did not influence the length of the operation (p = 0.173) and the perioperative morbidity (p = 0.108). Compared to a volume of less than 1ml, a parathyroid gland volume greater than 2ml was associated with higher preoperative PTH and calcium levels and lower phosphate and vitamin D levels. The volume of the parathyroid gland does not seem to impact the clinical manifestations, or the incidence of perioperative complications.

ROLE OF METFORMIN AND VITAMIN D3 IN OBESE PCOS PATIENTS

Polycystic ovarian syndrome (PCOS) is a common metabolic and endocrinological disorder affecting women of reproductive age, with a prevalence of 4-20%. It is characterized by symptoms such as oligoamenorrhea/amenorrhea, hyperandrogenism, hyperinsulinemia, and ultrasound (USG) features of polycystic ovaries. Risk factors include excessive weight gain, high BMI, dyslipidemia, stress, and chronic illness. Symptoms such as menstrual irregularity, infertility, male-pattern hair loss, facial hair, and acne are common due to anovulation and androgen excess. The exact cause of PCOS is unknown, but it is believed to be multifactorial, involving environmental and genetic factors. Studies suggest overexpression of LH receptors on theca cells as a potential mechanism. Metformin is recommended in addition to lifestyle interventions (LSI) for women with PCOS and BMI ?25 kg/m², irrespective of glucose disturbances or menstrual irregularity. It is effective for glucose intolerance and may be beneficial for long-term use, though the optimal duration is unclear. Vitamin D deficiency has been associated with insulin resistance and PCOS. Vitamin D enhances insulin synthesis, release, receptor expression, and reduces pro-inflammatory cytokines, improving insulin sensitivity. In conclusion, both metformin and vitamin D play significant roles in managing PCOS by addressing insulin resistance and hormonal imbalances.

Impact of Laboratory-Measured Euthyroid Hashimoto's Thyroiditis on Reproductive Hormone Profile in Women with Obesity.

Introduction: Hashimoto's thyroiditis is a common endocrinological disorder that often coexists with obesity. Thyroid hormones interact with the regulation of sex steroids, and thyroid autoimmunity has a negative impact on female fertility. There are studies showing when euthyroid state is achieved with hormone replacement therapy (HRT), the reproductive hormone profile is improved but they usually compare the reproductive hormones before and after HRT in the same individuals. Studies comparing patients with Hashimoto's thyroiditis in an euthyroid state receiving HRT with individuals having normal thyroid function are limited. Here, it was aimed to search the impact of euthyroid Hashimoto's thyroiditis on reproductive hormone profile in women living with obesity. Materials and Methods: Sixty-one randomly selected female patients with Hashimoto's thyroiditis were included as the case group and 60 patients without Hashimoto's thyroiditis were included as the control group, from our obesity center. The case group included patients who had menstrual cycles and were euthyroid under l-thyroxine treatment for at least 6 months. Data on weight, height, body mass index (BMI), waist circumference (WC), free thyroxine (fT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO), cortisol, insulin, prolactin (PRL), follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone (prog), testosterone (T), and dehydroepiandrosterone sulfate (DHEAS) levels, l-thyroxine treatment dosage (for case group), and accompanying diseases were recorded. The results were evaluated using SPSS. Results: A total of 121 patients were included in the study. Mean age was 41.8 ± 8.5 years in case and 38.6 ± 8.9 years in control group. There was no significant difference in weight, height, BMI, WC, or accompanying diseases between Hashimoto's thyroiditis and control group. fT4, anti-TPO, cortisol levels were higher in Hashimoto's thyroiditis group when compared with control group, but there was no significant difference for TSH, insulin, FSH, LH, E2, prog, T, DHEAS, or PRL. Conclusion: In women living with obesity, it is important to screen for Hashimoto's thyroiditis and achieve euthyroidism through effective LT4 treatment to promote a healthy reproductive system and improve fertility rates.

Muscle fat infiltration: a narrative review of the magnetic resonance (MR)-based evaluation methods and their clinical applications.

Muscle fat infiltration (MFI) can be seen in several pathologies of various origin including neuromuscular, endocrinological, or musculoskeletal etiologies. Its evaluation is possible through medical imaging, especially MRI, using qualitative or quantitative methods. This paper is an overview of the techniques used to evaluate MFI in different pathologies. The literature search was performed on the PubMed database for articles published in English between 2010 and end of January 2023. The keywords used were: (Fat infiltration of the muscle) AND magnetic resonance imaging (MRI). In total, 159 articles were included. Qualitative methods of MFI evaluation represented 20% of the studies, with the Goutallier classification being the most used, especially in the setting of rotator cuff tears. Quantitative methods were used in most studies (80%), with the Dixon technique being the most adopted. The evaluation of MFI was used for the assessment of endocrinological, neuromuscular and musculoskeletal disorders. Spinal pathologies, including low back pain and spinal deformities, were the most represented (44% of the studies). This review shows the importance of automated MFI calculation using MRI to monitor the progression of diseases, assess the effect of treatments, or predict post-surgical complications such as in the setting of adult spinal deformity. This review also showed the importance of automation of MFI assessment, particularly using the Dixon technique, to make its use easier in clinical settings and open MFI assessment applications to other diseases.

Emerging treatment strategies in dry eye disease: Potential of blood-derived approaches and natural plant-based products.

Dry eye disease (DED) is a common ocular condition characterized by chronic inflammation and tear film disruption. It affects millions of people worldwide, causing significant eye discomfort and vision disturbances. Despite its prevalence, DED remains a complex condition that is not yet fully understood. It can arise from various ocular pathologies, including endocrinological disorders such as diabetes and Graves' orbitopathy. Natural products, including plant- and blood-based therapies, have shown promise in alleviating DED symptoms and may represent effective therapeutic approaches. In this study, we review recent research on natural product treatments for DED, focusing on blood-derived therapies (e.g., autologous serum, albumin serum, and allogeneic serum) and plant-based compounds such as omega-3 fatty acids (O3FA), omega-6 fatty acids (O6FA), antioxidants, polyphenols, and flavonoids. Additionally, we examine the efficacy, mechanisms of action, and delivery systems of these treatments, highlighting the potential of blood-derived therapies, polyphenols, and flavonoids to improve or treat DED through multiple mechanisms. However, the use of these natural products as instilled drugs is limited by challenges such as solubility, stability, and biological barriers. Finally, we discuss drug delivery systems and structural modifications designed to enhance the therapeutic effects of these treatments, emphasizing their potential in managing DED.

Promises and challenges of genomic newborn screening (NBS) - lessons from public health NBS programs.

Newborn screening (NBS) in the United States began in the 1960s to detect inborn errors of metabolism that benefited from presymptomatic treatment compared with treatment after the development of symptoms and diagnosis. Over time, it expanded to include endocrinological disorders, hematological disorders, immunodeficiencies, and other treatable diseases such as lysosomal storage diseases (LSD), cystic fibrosis, X-linked adrenoleukodystrophy, and spinal muscular dystrophy. This expansion has been driven by new technologies (e.g., tandem mass spectrometry) and novel treatments (e.g., enzyme replacement therapy and stem cell transplant for LSDs). Advances in next-generation gene sequencing (NGS) enable rapid identification of many additional conditions that might benefit from early presymptomatic intervention. We review the NGS technologies that evolved as diagnostic testing and suggest issues to be resolved before their potential application to screening the asymptomatic population. We illustrate the importance of selecting diseases to be screened and propose recommendations to follow when variants of uncertain significance are found. We address ethical issues around achieving equity in the sensitivity of genomic NBS, access to follow-up and management, especially for people from diverse backgrounds, and other considerations. Finally, we discuss the potential benefits and harms of genomic NBS to the overall health of children with monogenic diseases. IMPACT: Genomic newborn screening programs are ongoing worldwide. Public discussion is needed as to whether genomic newborn screening should be offered as a public health program and, if so, what conditions should be screened for. Providers should understand that the sensitivity of genomic newborn screening is especially low for newborns from non-European populations. Methylation, large structural variants and repeat expansion variants are not amenable to next-generation sequencing-based genomic newborn screening. The article serves as a comprehensive guide to understanding issues that need to be solved before genomic newborn screening is implemented as a public health program.

A strategic brand development framework for expanding cardiovascular and endocrinology treatments in emerging markets

This paper introduces a conceptual framework for strategic brand development in the pharmaceutical industry, specifically targeting the cardiovascular and endocrinology treatment sectors in emerging markets. The framework explores how stakeholder engagement, market segmentation, and brand positioning can enhance access to critical treatments, addressing growing public health challenges in these regions. Cardiovascular and endocrinological disorders, such as heart disease and diabetes, are rising rapidly in emerging markets due to lifestyle changes, urbanization, and increased life expectancy. Pharmaceutical companies face unique challenges in expanding their market presence in these regions, including varying healthcare infrastructure, economic disparities, and regulatory environments. The proposed framework emphasizes the importance of engaging key stakeholders—such as healthcare professionals, policymakers, and patients—through targeted educational campaigns, partnerships, and advocacy. Effective stakeholder engagement fosters trust and collaboration, which is essential for expanding access to life-saving treatments. In addition, market segmentation is a critical component of this strategy, allowing companies to tailor their marketing efforts to specific demographic groups, economic conditions, and healthcare needs in each region. By identifying the most relevant segments and understanding their unique needs, companies can ensure that their treatments reach the populations most at risk for cardiovascular and endocrinological diseases. Brand positioning is another cornerstone of this framework. By clearly defining and communicating the value of their treatments in terms of efficacy, affordability, and accessibility, pharmaceutical companies can differentiate themselves in increasingly competitive markets. Strategic positioning not only enhances brand visibility but also builds long-term customer loyalty, which is crucial for sustaining market growth in emerging economies. Overall, this conceptual framework provides a roadmap for pharmaceutical companies to strategically develop their brands in the cardiovascular and endocrinology sectors, ultimately contributing to improved public health outcomes in emerging markets.

The CT-derived fat-free muscle fraction is associated with inflammation and predicts outcome in patients with aortic stenosis undergoing TAVR

Abstract Background The ESC guidelines underscore the importance of objective risk stratification in making patient-centered decision for valve interventions. However, they primarily rely on surgical risk scores, not considering essential factors such as frailty. Computed tomography (CT) is a routine part of the pre-interventional workup in patients undergoing TAVR and allows for body composition analysis, including the assessment of fat-free muscle fraction (FFMF) as an indicator of muscle quality. Purpose This study aimed to assess the correlation between FFMF and both inflammation and endocrine disorders, and to investigate the predictive value of FFMF in patients with aortic stenosis undergoing TAVR. Methods The study included 789 patients undergoing TAVR between 2017 and 2019. Evaluations involved CT scans to assess body composition. Using densitometric thresholds, the skeletal muscle area at L3/L4 level was separated into fatty and lean muscle to calculate the FFMF. The cohort was divided into tertiles of high, medium, and low FFMF, Figure 1. Results The study population was 45.5% female with a mean age of 81.2±6.0 years. Overall, 261 (33.1%) patients had a high FFMF, 293 (37.1%) had a medium FFMF, and 235 (29.8%) had a low FFMF. Patients with a low FFMF were older (82.3±5.9 vs 81.6±5.6 vs 79.8±6.2 years, p&amp;lt;0.01) and had higher rates of atrial fibrillation (52 vs 43 vs 37%, p&amp;lt;0.01), compared to those with a medium and high FFMF. Regarding body composition, low FFMF patients had a higher percentage of body fat (28.7±11.2 vs 26.8±9.1 vs 24.2±9.6%, p=0.01) and a lower percentage of body muscle (30.9±5.3 vs 31.3±4.2 vs 32.7±4.4%, p=0.03). Moreover, a low FFMF was associated with inflammation, as indicated by increased levels of C-reactive protein (6.3 vs 4.2 vs 3.1 mg/l, p&amp;lt;0.01) and procalcitonin (0.06 vs 0.05 vs 0.05 µg/l, p=0.01). Endocrinological assessment revealed lower levels of estradiol (6.8 vs 14.7 vs 15.0 pg/ml, p=0.02) and testosterone (0.18 vs 0.48 vs 2.35 ng/ml, p&amp;lt;0.01) as well as higher levels of cortisol (8.9 vs 7.7 vs 7.6μg/dl, p=0.05) in low FFMF patients. Regarding clinical outcomes, low FFMF was associated with increased one-year mortality (23.4%) compared to medium (11.6%) or low FFMF (3.8%, p&amp;lt;0.01), Figure 2A. This difference persisted over five years (p&amp;lt;0.01), Figure 2B. ROC curve analysis showed that FFMF had the strongest association with one-year mortality (AUC 0.75, p&amp;lt;0.01) and was superior to the STS-PROM (AUC 0.65) and EuroSCORE II (AUC 0.64). Multivariate analysis revealed that low FFMF was independently associated with mortality following TAVR (OR: 3.19 [CI: 1.64 – 6.22], p&amp;lt;0.01). Conclusion The CT-derived FFMF is associated with inflammation and endocrinological disorder in patients undergoing TAVR. Importantly, a low FFMF is a strong and independent predictor of dismal outcomes. FFMF assessment can seamlessly integrate into routine pre-interventional CTs, offering a promising objective parameter for outcome prediction.

Beneficial Effects of Curcumin in Polycystic Ovary Syndrome: A Review of Recent Literature and Underlying Mechanisms.

Polycystic Ovary Syndrome (PCOS) is a common endocrinological disorder that affects women of reproductive age and can lead to infertility. The prevalence of PCOS ranges from 5-21% depending on the diagnostic criteria and study population. Clinical manifestations include irregular or absent menstrual periods, obesity, and signs of hyperandrogenism. PCOS can also lead to long-term consequences such as metabolic syndrome, increased risk of cardiovascular diseases, endometrial cancer, diabetes mellitus, and hypertension. Metformin and oral contraceptive pills are the most commonly used drugs for PCOS management, but their efficiency is limited and they have some considerable side effects. Researchers are looking into alternative therapeutic options such as phytochemicals. Curcumin (CUR) is a polyphenolic compound found in the rhizome of Curcuma longa and has shown promising effects for females with PCOS. CUR exerts its anti-PCOS effects through different mechanisms such as reducing oxidative stress and inflammation, balancing hormone levels, and controlling the blood sugar and lipid profile. It can also reduce insulin resistance, regulate menstruation, and improve ovarian morphology and function. Despite its beneficial effects, CUR faces several challenges and limitations in clinical use, such as low bioavailability, instability, and rapid elimination. Therefore, researchers are investigating the potential of CUR nanoformulations and new drug delivery systems to overcome these barriers. With growing evidence regarding the potential role of CUR in PCOS treatment, we decided to provide an updated summary of the recent literature from clinical and preclinical studies on this topic.

Oncostatin M: friend or foe in PCOS pathogenesis.

Polycystic ovary syndrome (PCOS) is a primary endocrinological disorder in women of reproductive age that is characterized by androgen excess and ovulatory irregularities. This syndrome is associated with adipose tissue dysfunction, an elevated risk of insulin resistance, hyperinsulinemia, obesity, and type 2 diabetes. Adipocyte dysfunction affects the secretion of adipokines and pro-inflammatory cytokines. Nevertheless, adipose tissue is not an exclusive source of adipokines as it can also be produced locally by reproductive tissues. Although adipokines have been recognized in the development of PCOS, the role of oncostatin M (OSM), a multifaceted adipokine, remains unclear. Current evidence suggests that this cytokine is associated with key aspects of the syndrome, including obesity, insulin resistance, hyperandrogenism, and inflammation. However, the data are often contradictory, likely due to variations in study designs, methodologies, and species differences. By investigating the link between OSM and PCOS-associated issues, this review identified the potential role of this adipokine in PCOS pathogenesis. This underscores the need for further research to clarify its predominant effects and assess its relevance as a therapeutic target.

7067 A Pilot Study on Levothyroxine Administration- Understanding the Effects on Thyroid Hormone Levels and Patient Compliance Without Restrictions on Food or Time

Abstract Disclosure: R. Patel: None. K. Pandya: None. D. Olson: None. Background- Hypothyroidism is one of the most common treatable endocrinological disorders that can be managed by replacement therapy. In most cases, compliance is a major hindrance for maintenance medications to express the intended effect. Thus, prescribing medications in a more convenient way would make it easier for the patients to remember and hence amplify compliance. Traditional practice dictates thyroid replacement medication to be administered early in the morning on an empty stomach for optimum absorption. This mandates some patients to set an alarm clock for early morning to take their thyroid medication, which can not just be cumbersome but also increase the chances of having a fall and can alter sleep hygiene as well. We aimed to identify if allowing patients with a more lenient approach in medication timing can help increase compliance while still maintaining thyroid hormone levels with fewer side effects. Methods- As an initial single-arm pilot study, we retrospectively looked at thirteen patients from a single center, for whom patient preference was respected in allowing them to take thyroid replacement in conjunction with any other medication, food, coffee, or any combination of those, as long as it was consistently taken the same way and at the same time each day. In this study, the patient population ranged in age from 44 to 95, with a mean age of 77.38. Most of these patients had follow-ups for over a decade while their TSH levels were observed with minimum follow-up duration being 4 years. Results- On the serial measurement of TSH on this patient cohort, it was discovered that patients were still euthyroid, ranging from 0.36 to 5.28 with a mean of 2.654. This euthyroid state was achieved without requiring any frequent monitoring or extraordinarily high doses of thyroid supplement hormones compared to patients following traditional measures for the same. The highest dose required to achieve Euthyroid status was no more than 125 mcg once/day without any major hormonal fluctuations or adverse events during their treatment course. Thus, indicating that the proposed amendment to thyroid replacement instructions did not negatively impact thyroid function Conclusion- Hence, we propose a more lenient approach to taking Thyroids supplements allowing the patients to take them more conveniently and hence improving the compliance, improving overall outcomes. This can primarily be applied to the elderly population, minimising potential harm, i.e., falls, and other limitations in an attempt to take it consistently. However, this will be further investigated through a clinical trial to gather more comprehensive data on outcomes as well as identify any potential limitations of this concept. Presentation: 6/2/2024

Endocrinopathies in Adult Egyptian Thalassemia Patients, A Cross Section Study

Abstract background Endocrine abnormalities are the most common complications of transfusion dependent thalassemias (TDT). Although the prevalence of endocrinopathies is less in nontransfusion dependent thalassemias (NTDT), they are still encountered, especially with advancing age. This necessitates regular screening. Evaluation and treatment of endocrinological disorders are the same as that of transfusion dependent patients. Aim is to asses the common endocrinal disorders in patients with thalassemia; TDT and NTDT for early detection and replacement therapy. Subjects and Methods This study is across sectional study, it included 100 patients with thalassaemia; 50 patients who were (TDT) and 50 patients who were (NTDT). Patients who are ≥ 18 years old, with thalassemia major TM and thalassemia intermedia TI, Patients with or without splenectomy, Transfusion dependent and non-transfusion dependent patients, all were included in the study. Results Study showed that there is a statistically significant positive correlation between serum ferritin and thyroid stimulating hormone(TSH) and there is negative correlation with Sex Hormons, S.Cortisol, GH level. Also there is negative correlation between (Sex Hormons, S.Cortisol, Growth hormone GH) and frequency of transfusion. Study shows that Validity of serum ferritin at cutoff point more than 1100 for prediction of patients who are transfusion dependent.in terms of sensitivity was 100% and specificity was 90%. Conclusion thalassemia’s patients are still suffering from many endocrine disorders, and This necessitates early regular screening, as Early identification of endocrinal disorders and use of iron chelation reverse this disorders.

The Association Between Lifestyle and Symptoms of Polycystic Ovary Syndrome: A Study Conducted on Taif University Medical Students.

Introduction Polycystic ovary syndrome (PCOS) is a common endocrinological disorder affecting millions of women worldwide, often leading to significant physiological and psychological challenges among medical students because of unhealthy lifestyle behaviors. Methods A cross-sectional study was conducted among female medical students at Taif University in Saudi Arabia in January 2024 using an online questionnaire distributed via a Google form. Results Out of 243 participants, 23 students (9.5%) were diagnosed with PCOS. One hundred and fifty-six (64.9%) of females experienced skin symptoms, including acne and oily skin, mostly during exam periods. More than half (n=131, 54.4%) had generalized anxiety, and 42 students (17.4%) reported delays in the menstrual cycle. Significant associations were found between being diagnosed with PCOS and experiencing generalized anxiety(p=0.020), irregular menstrual cycles (p=0.004), having diabetes (p=0.006), family history of PCOS (p=0.001), and being aware of PCOS and lifestyle relation (p=0.022). Conclusion The study findings showed that Taif University medical students do not exhibit a noticeably increased prevalence of PCOS. Still, most students are at risk of developing PCOS due to thepositive family history of PCOS andexcessive generalized anxiety and females with irregularity in the menstrual cycle and those who have diabetes.

Satisfaction and results of the subareolar incision as treatment for gynecomastia in adolescents: experience of two centers.

Gynecomastia is a benign glandular proliferation that can affect adolescents causing significant psychological discomfort. Generally, it is idiopathic but underlying endocrinological conditions must be excluded. Different surgical techniques are available, the surgical correction with subareolar incision achieves the goal of satisfactory aesthetic result for patients. We studied all patients treated for gynecomastia in two centers of pediatric surgery. After collection of a detailed family history, we evaluated the presence of early onset of puberty, congenital abnormalities of the external genitalia, use of drugs, eating habits and the presence of genetic disorders. Laboratory tests and ultrasound were made to exclude endocrinological disorders. The surgical treatment was performed by a subareolar incision with gland and adipose tissue excision. A Body - Q chest module to evaluate patient satisfaction has been proposed to everyone before and after surgery. 47 adolescents with median age of 15 years were surgically treated. Three presented endocrinological disorders. Grade of gynecomastia for surgery was: III in 40 patients and IIb in 7 patients. Postoperative complications occurred in 5 patients. The Body - Q chest module was completed by 42 patients and showed good results for all points analyzed, except for social feelings. Gynecomastia in adolescents can be surgically treated with subareolar incision, reporting good aesthetic results and low incidence of complications. Specific tests are useful to assess patient satisfaction.

Transcription repression of estrogen receptor alpha by ghrelin/Gq/11/YAP signaling in granulosa cells promotes polycystic ovary syndrome.

Polycystic ovarian syndrome (PCOS) is a prevalent endocrinological disorder affected by ghrelin. This study aimed to investigate the molecular mechanisms underlying the effects of ghrelin on PCOS manifestations in mice and to assess the therapeutic potential of ghrelin. Female C57BL/6 mice were subcutaneously injected with 6 mg/100 g dehydroepiandrosterone (DHEA) for 20 days to induce PCOS. Alterations in reproductive cycles, ovarian morphology, serum sex hormone levels, and related signaling markers were examined. Furthermore, ghrelin-induced effects on granulosa cells and the role of ghrelin/Gq/11/ Yes-associated protein (YAP) signaling were studied by silencing Gαq/11 or YAP using si-RNAs. Finally, we evaluated the therapeutic potential of anti-ghrelin antibodies in DHEA-induced PCOS mice. DHEA administration led to significant PCOS-associated changes including weight gain, disrupted estrous cycles, ovarian morphological alterations, and hormonal imbalances in mice, with elevated Gαq/11 and acylated ghrelin expression, which was also noted in PCOS patients. However, treatment with anti-ghrelin antibodies effectively managed DHEA-induced damage in PCOS mice. In vitro, ghrelin exposure resulted in granulosa cell injury and modulated estrogen receptors alpha (ERα) and YAP protein levels, whereas silencing YAP and Gαq/11 reversed ghrelin-induced detrimental effects and up-regulated ERα expression. This study revealed that DHEA-induced PCOS traits in mice could be improved by anti-ghrelin antibodies, with the ghrelin/Gq/11/YAP signaling pathway identified as a crucial mediator in granulosa cells, affecting ERα transcription to regulate PCOS. These findings suggest a potential therapeutic strategy for the treatment of PCOS.

Cushing’s Disease Complicated with Multiple Thrombotic Phenomena Following Inferior Petrosal Sinus Sampling

Cushing’s syndrome is an endocrinologic disorder that occurs due to an excessive secretion of adrenal cortex-stimulating hormones or an overproduction of cortisol in the adrenal glands. Patients present with a variety of clinical symptoms such as obesity, hypertension, impaired glucose tolerance, and cardiovascular complications have been known for major contributors to the mortality. The inferior petrosal sinus sampling (IPSS) test is a useful diagnostic tool for identifying the source of Cushing’s disease. This procedure involves process of collecting samples through venous access and is generally considered safe. Here, we present 44-year-old patient diagnosed with Cushing’s disease presenting pulmonary thromboembolism and multiple embolic infarctions following IPSS.

Wolfram Syndrome 1: A Neuropsychiatric Perspective on a Rare Disease.

Wolfram syndrome 1 (WS1) is an uncommon autosomal recessive neurological disorder that is characterized by diabetes insipidus, early-onset non-autoimmune diabetes mellitus, optic atrophy, and deafness (DIDMOAD). Other clinical manifestations are neuropsychiatric symptoms, urinary tract alterations, and endocrinological disorders. The rapid clinical course of WS1 results in death by the age of 30. Severe brain atrophy leads to central respiratory failure, which is the main cause of death in WS1 patients. Mutations in the WFS1 gene, located on chromosome 4p16, account for approximately 90% of WS1 cases. The gene produces wolframin, a transmembrane glycoprotein widely distributed and highly expressed in retinal, neural, and muscular tissues. Wolframin plays a crucial role in the regulation of apoptosis, insulin signaling, and ER calcium homeostasis, as well as the ER stress response. WS1 has been designated as a neurodegenerative and neurodevelopmental disorder due to the numerous abnormalities in the ER stress-mediated system. WS1 is a devastating neurodegenerative disease that affects patients and their families. Early diagnosis and recognition of the initial clinical signs may slow the disease's progression and improve symptomatology. Moreover, genetic counseling should be provided to the patient's relatives to extend multidisciplinary care to their first-degree family members. Regrettably, there are currently no specific drugs for the therapy of this fatal disease. A better understanding of the etiology of WS1 will make possible the development of new therapeutic approaches that may enhance the life expectancy of patients. This review will examine the pathogenetic mechanisms, development, and progression of neuropsychiatric symptoms commonly associated with WS1. A thorough understanding of WS1's neurophysiopathology is critical for achieving the goal of improving patients' quality of life and life expectancy.

O-316 Clinical application of PGT-A for recurrent pregnancy loss, what effects live birth after single euploid blastocyst transfer?

Abstract Study question Which factors effect the likelihood of live birth after euploid frozen embryo transfer (FET) in recurrent pregnancy loss (RPL)? Summary answer Female age and number of previous pregnancy loss do not effect the live birth rates after euploid blastocyst FET. What is known already PGT-A is helpful to discard the aneuploid embryos and has been proven to improve pregnancy outcomes and reduce miscarriage rate per embryo transfer. As approximately 50% of clinical miscarriages have chromosomal abnormalities, PGT-A has been suggested as a treatment option for RPL. However it is questionable on the cost effectiveness, effect on prognosis and labor-intensive. In addition, currently PGT-A use is not recommended by any society guidelines in RPL patients. ESHRE guideline on RPL stated ‘All couples with results of an abnormal fetal or parental karyotype may be informed about the possible treatment options available including their advantages and disadvantages.’ Study design, size, duration This retrospective cohort study from January 2018 to January 2023 was conducted at Bahçeci Health Group included patients underwent PGT-A/ICSI cycles. Patients with RPL (2 or more clinical pregnancy loss) had a complete RPL workup recommended by ASRM and reported no etiology for RPL was included in the study. Patients with uterine synechia, hydrosalpinx, endocrinological disorders and thin endometrium (endometrial thickness &amp;lt;6mm) were excluded Participants/materials, setting, methods A total of 366 single euploid blastocyst FETs employing hormone replacement therapy for endometrial preparation were evaluated. Patients were categorized into 2 group regarding female age (female age&amp;lt; 35 years and female age≥35 years. Demographic, embryological and endocrinological parameters were analyzed. Live birth rate (LBR) was the primary outcome. Clinical pregnancy rate (CPR) and miscarriage rate (MR) were the secondary outcome. Main results and the role of chance The mean female age of the study population was 33.9±4.6 years, the number of previous pregnancy loss was 3.2±1.6 and BMI was 23.8 ±7.9 kg/m2. Overall CPR, MR and LBR were 61.7% (226/366), 24.8% (56/226) and 46.5% (170/366) respectively. Comparison of clinical characteristics of the 195 women &amp;lt;35 years and 171 women ≥35 years revealed no significant deference in BMI, number of previous live birth, and number of previous pregnancy loss. CPR, MR and LBR were similar among two groups [ 63.6% (124/195) vs 59.6% (102/171), p = 0.44; 27.4% (34/124) vs 21.6% (22/102), p = 0.31; 46.2% (90/195) vs 46.8% (80/171), p = 0.9; respectively]. Binary logistic regression evaluating the independent factors that effect live birth revealed that female age and number of previous pregnancy loss were not found to be statistically significant factors. The only independent factor for live birth was day of embryo biopsy, transferring the day 6 biopsied embriyo significantly decreased the live birth [p = 0.003, OR: 0.47, 95% CI (0.29-0.77)]. Limitations, reasons for caution The maim limitation of the study is its retrospective nature. Wider implications of the findings PGT-A has been suggested to be a treatment for RPL. However there is insufficient data to call PGT-A as an efficient treatment for RPL. Investigating the factors that effect live birth after PGT-A may be the first step for selecting the most favorable group Trial registration number Not applicable

The impact of regular yoga practice on the course of endocrinological and diabetological disorders - a literature review.

The impact of regular yoga practice on the course of endocrinological and diabetological disorders - a literature review.

Effectiveness of dual combination therapy of acarbose plus metformin and acarbose plus myo-inositol in ameliorating the metabolic and endocrinologic complications of polycystic ovary syndrome – A randomized controlled trial

IntroductionPCOS, beyond being characterized by reproductive disturbances, is a complicated rapid expanding metabolic and endocrinologic disorder of the recent times. Nearly 70% PCOS women show resistance to insulin. AIM: The aim of the study is to determine and compare the effectiveness of acarbose plus metformin and acarbose plus myo-inositol combination therapy in alleviating the metabolic and endocrinologic complications of PCOS. Materials and methodsAn open labelled RCT was conducted on 168 PCOS women attending the gynaecology clinic at SRM MCH & RC, Chengalpattu and the trial was registered in CTRI (No. CTRI/2022/04/041877). Group A (n = 56) received metformin 500 mg/TID alone; group B (n = 54) received (acarbose 25 mg/TID for 4 weeks then 50 mg/TID for other 20 weeks) along with metformin 500 mg/TID and group C (n = 54) received (acarbose 25 mg/TID for 4 weeks then 50 mg/TID for other 20 weeks) along with myoinositol 1000 mg/BD. All parameters were measured at baseline and at the end of 6 months. ResultsSignificant reduction of LH, LH: FSH, TT, HOMA-IR was observed in all the groups. FSH increased only in metformin group. Increase in serum progesterone and reduction in FI, TGL, LDL were significant only in acarbose plus myo-inositol group. SHBG and HDL increased significantly only in acarbose plus metformin group. No changes in BMI, TC and VLDL were observed in any group. ConclusionTherefore, decrease in FI, HOMA-IR, TGL, LDL seen in acarbose plus myo-inositol group indirectly contributes to cardio-metabolic safety in PCOS. Similarly, a significant increase in SHBG levels with acarbose plus metformin group shows correction of the excess androgen and restoration of ovulation.