Endocrinological Diseases Research Articles

Effect of rhGH treatment on lipidome and brown fat activity in prepuberal small for gestational age children: a pilot study

Recombinant human growth hormone (rhGH) therapy is the primary treatment for children born small for gestational age (SGA) who fail to show spontaneous catch-up growth by two or four years. While its effects on white adipose tissue are well-documented, this pilot study aimed to investigate its impact on the lipidome and the thermogenic and endocrine activities of brown adipose tissue (BAT) in SGA children following rhGH treatment. The study involved 11 SGA children divided into two groups: (a) SGA children who were not treated with rhGH (n = 4) and (b) SGA children who received rhGH treatment with Saizen® (n = 7). This second group of seven SGA children was followed for 12 months after initiating rhGH treatment. Interventions included 12-hour fasting blood extraction and infrared thermography at baseline and 3 and 12 months post-treatment. Five appropriate-for-gestational-age (AGA) children served as controls. Exclusion criteria included endocrinological, genetic, or chronic diseases. Untargeted lipidomics analysis was performed using liquid chromatography-mass spectrometry (LC-MS), and serum biomarker levels were measured using ELISA assays. Serum lipidomic analysis revealed that free fatty acids (FFAs) increased to levels close to those of the AGA group after three months of rhGH administration, including polyunsaturated fatty acids, correlating with reduced leptin levels. Elevated levels of 1a,1b-dihomo-PGJ2 and adrenic acid suggested potential aging markers. rhGH treatment also significantly reduced meteorin-like (METRNL) and monocyte chemoattractant protein-1 (MCP1) serum levels to control levels. rhGH influences the serum lipidome, promoting changes in maturation and metabolism. Further research is required to clarify the direct effects of rhGH on specific lipid species and batokines, potentially addressing metabolic disturbances linked to obesity and aging.

Transportation-Associated Carbon Dioxide Emissions Avoided by Use of Telehealth Through COVID-19 Pandemic.

Background: Increasing carbon dioxide (CO2) in the atmosphere contributes to Earth's warming, which has negative impacts on human health. The health care system is a major contributor to CO2 emissions. Telehealth has the capacity to reduce health-care-related emissions by eliminating patient travel to in-person appointments. Methods: Data were obtained from Nebraska Medicine's (NM) electronic medical record. Parameters included patient zip code, provider location, calendar year of visit, and provider specialty. Euclidean distance from centroid zip code to clinic location was calculated. Environmental Protection Agency estimates were used to convert mileage to CO2 saved. Results: During the period January 1, 2019, to January 31, 2022, the NM health care system completed 214,241 telemedicine visits for patients whose home zip code is within Nebraska, resulting in greater than 2,600 metric tons of CO2 avoided. Telehealth appointments increased by more than 22,000% from 2019 to 2020. An average of 12.38 kg of CO2 was avoided with each telehealth visit. Medical specialties that avoided the most CO2 included family medicine, endocrinology, and infectious disease. Conclusion: This study demonstrates the capability of the NM health care system to rapidly adjust to an emergency pandemic by drastically increasing the use of telehealth, which also avoided thousands of tons of transportation-associated CO2 emissions. Telehealth appointments increased during the height of the pandemic by more than 22,000%. Telehealth is an effective CO2 emission-reducing strategy and a worthy avenue to further explore reduced health-care-related emissions.

Trilostane: Beyond Cushing’s Syndrome

Trilostane is a drug able to block the synthesis of progesterone from pregnenolone, dependent on the enzyme 3β-hydroxysteroid dehydrogenase/Δ5−4 isomerase. As a consequence of this effect, it is used to treat endocrinological diseases such as Cushing’s syndrome, especially in dogs. Because of the modulatory effects of trilostane on the hypothalamic–pituitary–adrenal axis, trilostane administration causes an increase in brain levels of neurosteroids with anticonvulsant properties, as in the case of allopregnanolone. Allopregnanolone is also of interest in curing depression, suggesting that trilostane might represent a tool to address neurological and psychiatric disorders. In this review, we investigated the historical development of this drug and its current use, mechanisms, and possible developments. By searching the literature from 1978 to 2025, we identified 101 papers describing studies with trilostane. Precisely, 55 were about dogs and trilostane, 3 were on cats, and 23 were with other animals. Some studies (15) were also designed with human patients. The main disease treatment with trilostane was hyperadrenocorticism. However, we also found two preclinical papers on trilostane’s potential use in psychiatric diseases and three on trilostane’s potential use in neurological disorders. Moreover, few clinical and preclinical studies suggested the involvement of neurosteroids modulated by trilostane in different neurological disorders, thus opening a possible new perspective for the use of this drug.

Prevalence of neoplasms in acromegaly: a Turkish single-center retrospective study

Aims: This study aimed to investigate the prevalence of benign and malignant neoplasms and to assess associated clinical conditions in patients with acromegaly. Methods: In this single center, retrospective and observational study, data from 71 patients with acromegaly followed at an endocrinology and metabolism diseases outpatient clinic between January 2010 and December 2023 were reviewed through the hospital's electronic database. Patients' medical histories, demographic data, blood examinations, medications, pituitary MRI scans, thyroid ultrasound, mammography, colonoscopy, endoscopy, and pathology reports were evaluated. Acromegaly diagnosis was based on elevated insulin-like growth factor-1 (IGF-1) levels and unsuppressed growth hormone (GH) levels after oral glucose tolerance testing. The chi-square test and Mann-Whitney U test were used to compare patients with malignancy to other patients in terms of demographic and clinical characteristics. Results: The study included predominantly female patients (60.6%) with an average age of 55.6 years. The mean age at diagnosis was 44.3±11.3 years, and the mean disease duration was 11.3±8.4 years. Malignancies, including breast, thyroid, and colorectal cancers, were detected in 9.9% of patients. Additionally, thyroid nodules were present in 62% of patients, and colon polyps in 14.1%. No significant differences were observed in clinical features including age, gender, disease duration, GH levels, IGF-1 levels, adenoma size, or remission frequency between patients with and without malignancy (p>0.05 for all). Conclusion: This study reveals an increased prevalence of breast, colon, and thyroid cancers in patients with acromegaly. Performing cancer screenings in patients with acromegaly more comprehensively and at an earlier stage compared to the normal population may be beneficial.

The effect of a stress ball on pain and anxiety during sharp debridement in patients with diabetic foot ulcers: A randomized controlled, single-blind study.

The aim of this study was to investigate the effect of using a stress ball during sharp debridement on the pain and anxiety in patients with diabetic foot ulcers. This study with a randomized, controlled and single-blind design was conducted at a single-center on patients diagnosed with diabetic foot ulcers who were being treated at the endocrinology and metabolic diseases clinic of a university hospital. Patients in the intervention group started using a stress ball before the debridement procedure and continued to use it until the procedure ended. No intervention was made to the patients in the control group. Data were collected by using the Descriptive Information Form, Diabetic Foot Meggit-Wagner Classification, Visual Analogue Scale (VAS), and State Anxiety Inventory (STAI). The study was completed with a total of 76 patients, 38 each in the intervention and control groups. The use of stress balls led to a reduction in anxiety and pain symptoms in the intervention group. The anxiety score of the patients in the intervention group was also found to be statistically significantly lower than those in the control group after the procedure (p=0.008; η2=0,091). The VAS scores of the patients in the intervention group were found to be statistically significantly lower than those in the control group both during (p<0.001; η2=0.348) and after (p<0.001; η2=0.438) the procedure. The use of a stress ball was found to be an effective method of reducing the level of pain and anxiety that occurs during the sharp debridement procedure. Stress ball application is a practical, easy, and cost-effective non-pharmacological method. The study was recorded in the ClinicalTrials.gov website with the number NCT06316115.

THE ROLE OF INTRACELLULAR SIGNALING PATHWAYS IN THE DEVELOPMENT OF LOWER EXTREMITY TROPHIC PATHOLOGY AND PECULIARITIES OF ITS REGENERATION IN TYPE 2 DIABETES (PART 2)

Introduction. In endocrinological science, the pathogenesis of trophic ulcers in soft tissues, which frequently occur and progress in patients with type 2 diabetes, remains a significant yet underexplored issue. Gaining a deeper understanding of the etiology and development of chronic trophic ulcers in the context of type 2 diabetes is crucial for advancing innovative and highly effective therapeutic approaches in the near future. The aim of this study is to investigate the role of certain “minor” signaling pathways, including hypoxia-inducible factor (HIF), Notch, and nuclear factor E2-related factor 2 (Nrf2), in the regeneration of cellular elements in soft tissue trophic ulcers observed in experimental animals and patients with type 2 diabetes. Material and methods. Based on data from modern professional literature, a study was conducted to elucidate the participation of the НIF-1, Notch and Nrf2 signaling pathways in the development of acute wounds, type 2 diabetes and, finally, the occurrence, progression, and healing of trophic ulcers during this endocrine disease. Results. It has been established that under hypoxic conditions at the initial stage of the inflammatory process during the regeneration of damaged soft tissues, an increase in the НIF-1α content is observed. The involvement of this molecular factor in the development of type 2 diabetes and the suppression of its expression level in chronic trophic ulcers against the background of type 2 diabetes were revealed. It has been demonstrated that another messenger cascade, Notch, is involved in all stages of healing of wound defects of the skin in acute wounds. At the same time, with the progression of type 2 diabetes, as well as the occurrence of chronic trophic ulcers in this endocrinological disease, the activation of this intracellular cascade was recorded. The process of regeneration and healing of damaged soft tissues of the skin was also accompanied by an increase in the content of the Nrf2. However, the development of type 2 diabetes was characterized by a decrease in the level of expression of this molecule. It is important to stress that the role of Nrf2 in the healing of trophic ulcers during type 2 diabetes remains not fully studied. Conclusion. The pathogenesis of chronic trophic ulcers in type 2 diabetes is based on disturbances in the activity of individual intracellular “minor” signaling pathways. Further study of the role of messenger cascades such as НIF-1, Notch and Nrf2 will contribute to the development of new approaches to improving the effectiveness of treatment of patients with chronic trophic ulcers of the lower extremities under type 2 diabetes.

Pesticides and human health.

to review scientific evidence on the impacts of pesticides on child health, addressing prenatal and postnatal exposures, acute and chronic effects. narrative literature review, using databases such as PubMed, SciELO and Google Scholar. The inclusion criteria involved studies published between 2000 and 2023 that analyzed the relationship between pesticides and child health, including systematic reviews, cohort studies, case-control studies and clinical trials. The descriptors used were "pesticides," "child health," "prenatal exposure," "environmental health," and "developmental toxicity." In this review, an association was observed between exposure to pesticides and the development of neurological and endocrinological diseases, childhood cancer and immunological diseases. Pesticides represent a significant risk to children's health, with impacts ranging from neurological alterations to chronic diseases. It is essential to promote regulatory changes and encourage agricultural practices that are less dependent on chemical substances, in addition to investing in research that explores long-term impacts and mitigation strategies.

Bone Health in Patients with Rheumatoid Arthritis in Bahrain.

Background and Objectives: Compared to the general population, rheumatoid arthritis (RA) patients have additional disease-specific risk factors for osteoporosis that include chronic exposure to systemic inflammation. The current study aimed to investigate the prevalence of osteoporosis and its associated risk factors, such as age, sex, body mass index (BMI), uric acid (UA), and vitamin D status, but also the coexistence of type 2 diabetes mellitus (DMT2) and breast cancer (Ca breast) in patients with RA in Bahrain. Material and Methods: Data from DEXA scans were collected retrospectively from the patient's electronic health records. All patients who had BMD data and at least one single comorbidity, including RA, were included in the current study. The collected data were analyzed by using SPSS, version 28. Results: A total of 4396 patients were included in the current study. The comorbidities among this cohort were as follows: 3434 patients had endocrinological diseases, among them 63.6% had DMT2; 1870 patients had rheumatological diseases, among them 15.1% had rheumatoid arthritis; and 941 patients had malignancies, among them 75.6% had breast cancer. Our results indicated that patients with RA had a high prevalence of low BMD (72.30%, p < 0.001) and low vitamin D levels (63.10%, p < 0.001) but high serum UA (20.85%). Comparing RA with non-RA patients, our results showed a statistically significant association between RA and each of BMD and UA (p = 0.017 and p = 0.004, respectively), but also between RA and each of age (p = 0.001) and Ca breast (p < 0.001). However, no association was found between RA and BMI, DMT2, or vitamin D status. Conclusions: RA patients had a high prevalence of low BMD (72.3%) and low vitamin D (63.10%) but high serum UA (20.85%). The risk of osteoporosis, hypovitaminosis, and gout must be kept in mind during the evaluation of any case with RA.

Relationship between neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio and osteoporosis in postmenopausal type 2 diabetic patients: A retrospective study.

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) are newly discovered inflammatory markers in recent years. To explore the relationship between NLR, MLR, PLR, and bone mineral density (BMD), as well as osteoporosis (OP), in postmenopausal patients with type 2 diabetes mellitus (T2DM). 320 postmenopausal patients with T2DM who were admitted to the Department of Endocrinology and Metabolic Diseases of our hospital from January 2022 to January 2024 for treatment were included in this retrospective study. The patients were divided into 3 groups according to the BMD: normal bone mass group (n = 109), osteopenia group (n = 99), and OP group (n = 112). Clinical data and blood laboratory parameters were collected from the patients. The NLR, MLR, and PLR were calculated. Statistically significant differences were found in the comparison of NLR, MLR, and PLR among the 3 groups of patients (P < .001). The OP group had higher NLR, MLR, and PLR than the normal bone mass group and the osteopenia group. NLR, MLR, and PLR were negatively correlated with BMD at the lumbar spine (L1-L4), left femoral neck, and left hip, respectively. Analysis revealed that elevated levels of NLR and PLR were independent risk factors for OP in postmenopausal patients. The results of the receiver operating characteristic curve analysis indicated that the area under the curve (AUC) for NLR was higher than that of PLR. Combined use of NLR and PLR resulting in an improved AUC of 0.904. Neutrophils produce mediators such as interferon-gamma (IFN-γ), interleukin-6 (IL-6), interleukin-1 (IL-1), and receptor activator of nuclear factor kappa-B ligand (RANKL), which increase the number and activity of osteoclasts. Peripheral blood monocytes play a vital role in osteoclastogenesis as osteoclast precursors. The BMD of postmenopausal T2DM patients is negatively correlated with NLR, MLR, and PLR. NLR and PLR can both serve as predictive indicators for the occurrence of OP in postmenopausal T2DM patients.

Unlocking the potential: SLU-PP-332 and the future of exercise Enhancement and Metabolic health

The synthetic oestrogen receptor-related orphan receptor (ERR) agonist SLU-PP-332 exhibits promising potential in revolutionizing fitness and weight loss strategies. Through its activation of ERRs, SLU-PP-332 enhances energy expenditure, increases fatty acid oxidation, and reduces fat mass buildup. Studies indicate its ability to mimic exercise-induced metabolic pathways, resulting in improved endurance and weight loss in mice. While long-term implications are yet to be fully understood, initial trials show no significant adverse effects. SLU-PP-332 targets ERRs found in various human organs, influencing vital metabolic processes. With implications for treating metabolic disorders like obesity, type 2 diabetes, and heart failure, SLU-PP-332 emerges as a novel therapeutic agent. Its biological activity, structure, and solubility data support its potential as a small molecule drug in endocrinology and metabolic diseases. Further research is warranted to elucidate its long-term effects and refine its structure for future clinical applications

REMEMBER: 30 YEARS SINCE CONSTANTIN ARSENI PASSED AWAY - THE FONDATOR OF ROMANIAN NEUROSURGERY

Introduction The authors will present one of the great personalities of Romanian neurosurgery, Dr Constantin Arseni, who created it in Bucharest, creating the largest university centre of neurosurgery in Europe at that time. Material After the tragic loss of his mentor Prof. Dr Dumitru Bagdasar in 1946, Dr Constantin Arseni, took over the management of the neurosurgery service at the Central Hospital for Mental, Nervous and Endocrinologic Diseases, the only department of this kind in this country; He was able to have the first Clinic of Neurosurgery from Romania. For his merits, Dr Constantin Arseni, became an Associate Professor in 1952 and University Professor in 1963. His neurosurgical activity was complex, but mainly focused on tumoral pathology, cerebral and spinal, and also on spinal degenerative disease. Under Professor C. Arseni, the Neurosurgical Clinic of Bucharest is transformed in 1975 into the “Prof. Dr D. Bagdasar” Clinical Hospital of Neurosurgery, the largest hospital of Neurosurgery in the Europe, with 550 beds and, subsequently, 650 beds. Also, he developed the departments of neurosurgery in each of the biggest university centres in the country; while being the first President of the Romanian Society of Neurosurgery. Scientific Activity Scientific activity of Prof. Dr Constantin Arseni includes the numerous publications (54 treaties and monographies), together with all his collaborators, encompassing all domains of neurosurgery: Tumoral, Neuropathological, Vascular, Paediatric, Spinal Degenerative Pathology, Central Nervous System Malformations, History, etc. with high international visibility. An editorial board under C. Arseni published, with the substantial contribution of the Bucharest Medical Publishing House of the Clinic, the “Treatise of Neurology” in 8 volumes (1979-1981). Conclusions Professor Constantin Arseni was a dedicated surgeon, he practiced his job asking from those around him as much as he offered - the maximum. He was a schoolmaster and a teacher in the true sense of word. Professor Constantin Arseni, Member of the Romanian Academy, was an exemplary professional, a model of conduct, which will forever remain in our memory, of the neurosurgeons, and of the Romanian neurosurgery, leaving behind a legacy hard to match for those who followed him.

Testosterone mediates life-history trade-offs in female mammals.

Hormones mediate life-history trade-offs. In female mammals, such trade-offs have been studied predominantly in the contexts of oestrogen, progesterone and prolactin. We evaluate the hypothesis that prenatal and postnatal testosterone levels structure and regulate trade-offs in females involving components of reproduction and survival. This hypothesis is predicated on the observation that testosterone confers competition-related and survival-related benefits, but also reproduction-related costs, to female mammals. The hypothesis is supported by field and laboratory data from diverse non-human animals, and data from healthy women. Most broadly, relatively low testosterone level in females has been associated with earlier, faster and higher offspring production, greater attractiveness to males, and reduced dominance or competitiveness, whereas higher testosterone level is associated with delayed and reduced reproduction but increased dominance, status, aggression, and resource accrual. The magnitude of testosterone-mediated trade-offs is expected to depend upon the strength of female-female competition, which represents some function of species-specific ecology, behaviour and mating system. Testosterone-associated trade-offs have, until now, been virtually ignored in studies of female life history, reproductive physiology, evolutionary endocrinology, and female-limited disease, probably due to researcher biases towards conceptualizing androgens as hormones with effects mainly restricted to males.

Inventorization of ethnobotanical use of some medicinal halophytes plants in the Algerian arid zone (Biskra)

Context: The population's use of halophyte plants in traditional medicine is a fundamental component of the exploration of natural remedies. Aims: To analyze a list of halophyte plants and their ethnobotanical characteristics, with a focus on those most commonly used in traditional medicine in the southeast of Algeria (Biskra). Methods: The ethnobotanical surveys were conducted between 2017 and 2019 by interviewing 120 informants using a questionnaire and applying a semi-structured interview methodology. The data was analyzed using ethnobotanical statistical tools, including the informant consensus factor (ICF), citation frequency (CF), use value (UV), family importance value (FIV), relative frequency of citation (RFC), plant part value (PPV), and relative importance (RI), as well as statistics analysis (ANOVA) to compare the use of medicinal plants according to age, gender, and education level. Results: The results of the survey enabled us to identify 12 species distributed across eight different families. The most common family was that of the Amaranthaceae (four species), while the most frequently utilized parts of plants were leaves (PPV = 0.4). Furthermore, decoctions were the most commonly prepared form (33.39%). The highest ICF values were observed for the endocrinological and digestive disease groups (ICF = 0.97). The statistical analysis (ANOVA) revealed a significant difference in the knowledge of the use of halophyte plants in traditional medicine according to age and level of education. Conclusions: The findings of this research suggest that the halophyte flora in our arid study area may offer a promising source for the discovery of new drugs, a prospect that requires further investigation and exploration.

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.

Lysosomal Acid Lipase Deficiency Investigation In Patients Diagnosed With Primary Hyperlipidemia

Objective: Cholesteryl ester storage disease (CESD) is a disease where a considerable decrease in the activity of lysosomal acid lipase (LAL) enzyme resulting from the mutation in lipa (lysosomal acid lipase) gene is observed, which goes along with dyslipidemia and involves a wide clinical condition ranging from hepatosteatosiz to liver fibrozis; and whose diagnosis is usually skipped. LAL deficiency should be taken into consideraiton for patients who are suffering from hepatosplenomegaly and/or high transaminase level, high ldl and/or low hdl without having problems of obesity or metabolic syndrome. Methods: Our study included 75 patients who applied to Gaziantep University Faculty of Medicine Pediatric Endocrinology and Metabolic Diseases Clinic, 35 patients were excluded out of study because of having secondary hyperlipidemia, 15 patients were diagnosed with non-familial hyperlipidemia, and 25 patients were diagnosed with familial hyperlipidemia. Patients were divided into three groups according to phenotypes; type 2, type 3 and type 5, at the same time patients were divided into three groups according to the treatment as applying lipid aferesis, lipid lowering treatment and dieting, and only dieting group. Gender, age, height, weight, height standard deviation score, weight standard deviation score, follow-up period, complaints, relative body weight were recorded. Lipid profiles, transaminase levels, complete blood count, hormone profiles, bone densitometry (DEXA), echocardiography and LAL enzyme profiles of patients were evaluated. Blood samples were taken to filter paper from totally 40 patients; 15 patients with non-familial hyperlipidemia to eveluate LAL activity and also the same samples were taken from 15 patients with primary hyperlipidemia and 25 patients with familial hyperlipidemia to eveluate LAL levels. Results: We determined the LAL enzyme levels at the normal reference ranges in all of 40 patients with primary hyperlipidemia. Conclussion: In our study there was no relationship between familial hyperlipidemia and lal levels but we think results must be eveluated with the larger number of patients.

Comparing Myo-Inositol and Folic Acid with and without D-Chiro-Inositol for The Management of Polycystic Ovary Syndrome

Background: Polycystic ovarian syndrome (PCOS) is an endocrinological disease of women of the reproductive age group. The study aimed to compare the efficacy of Myo-inositol and folic acid with and without D-chiro-inositol in the improvement of symptoms of PCOS within 4 months for the evaluation of the most effective therapeutic regimen. Methods: This Quasi-experimental study was conducted at Gynecology &amp; Obstetrics OPD of two Private Healthcare Hospitals in Sialkot from February 2024-June 2024. The Rotterdam criteria (2003) was used for diagnosis of PCOS in non-pregnant women aged between 18-35 years. A total of 90 PCOS patients (45 in each group) were enrolled using a purposive sampling technique and distributed into two treatment groups. Group A received MI 2000 mg + DCI 50 mg + FA 200 mcg while Group B received MI 2000 mg + FA 200 mcg BD, after meal, for 17-18 weeks. Patients’ menstrual cycle history, BMI, transabdominal-ultrasonographic picture, and serum total testosterone levels were evaluated at Day 0, 60, and 120 to compare these measurements before and after initiation of treatment. SPSS was used to analyze the data. Independent samples t-test and Repeated measures ANOVA were used to analyze the data. P-value ≤ 0.05 was considered statistically significant. Results: After the intervention, body mass index (kg/m²), serum total testosterone levels (ng/dl), and follicular number per ovary decreased, with Group A demonstrating better performance with p-values 0.03, 0.04 and &lt; 0.001 respectively. Both groups exhibited increased follicular size in both ovaries and decreased ovarian volumes. By Day 120, menstrual cycle regularity was more pronounced in Group A than in Group B (1.00 ± 0.00 and 1.13 ± 0.34 respectively, p-value &lt;0.001. Conclusion: Myo-inositol + D-chiro Inositol + Folic acid and Myo-Inositol + Folic acid showed a change in the studied variables, however, Myo-inositol + D-chiro Inositol + Folic acid demonstrated more efficacy in alleviating PCOS symptoms compared to Myo-Inositol + Folic acid.

Inborn errors of immunity-related immunological mechanisms and pharmacological therapy alternatives in periodontitis.

Periodontitis is a frequent local inflammatory disease. The microbiota and repeated exposure to bacterial endotoxins triggers excessive inflammation through oral mucosal immunity and sometimes leads to a destructive effect on the supportive mucosal tissues around the teeth. Elimination of the pathogens and increasing the tolerance of the cellular immune response is crucial in addition to standard dental therapies like mechanical debridement. Based on our experience with immune-mediated diseases, especially primary immunodeficiency diseases, we wrote this review to discuss the treatment alternatives for severe periodontal disease. Risk factors are malnutrition, vitamin deficiencies, smoking, systemic inherited and acquired immune-mediated diseases, infections, endocrinological diseases, and pharmacological agents that may accompany periodontitis. The diagnosis and treatment of dietary deficiencies, as well as the addition of nutritional supplements, may aid in epithelial regeneration and immune system function. Recently, modifications to the therapeutic option for severe periodontitis have been made depending on the fact that the immune response against bacteria may modify the severity of periodontal inflammation. The anti-inflammatory therapies support or inhibit the host's immune response. The clinical approach to severe periodontitis should extend beyond classical therapies. There is a need for a diverse therapeutic strategy that supports the epithelial barrier, which is the crucial component of innate immunity against microbiota. Leukocytes are the main cellular component in periodontal inflammation. Anti-inflammatory therapeutic options directed at leukocytes, such as IL-17 and IL-23-targeted therapies, could be the candidates for the treatment of severe periodontitis. Therapy against other inflammatory cytokines, IL-1, IL-6, IL-12, IL-23, TNF-alpha, PGE2, and cytokine receptors, could also be used in periodontal inflammation control.

A machine learning approach to predict foot care self-management in older adults with diabetes

BackgroundFoot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach.MethodThis cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score.ResultsXGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score.ConclusionThe study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group.

8131 A Rare Case of Autoimmune Polyendocrine Syndrome; a Menopause Despite Replacement Therapy

Abstract Disclosure: M.E. Chacon Cruz: None. M. Sanchez Cordero: None. R.M. Roman Torres: None. G. Guerra Velazquez: None. Polyendocrinopathy is a heterogeneous group of disorders leading to dysfunction of multiple endocrine glands and other tissues. The syndromes can occur in patients from early infancy to old age and new components of a given syndrome can appear throughout life. APS can be classified into APS type 1 and APS2-4. APS-1 is a rare monogenic autosomal recessive autoimmune disorder consisting of the triad of chronic mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. APS2 require presence of Addison disease, autoimmune thyroid disorder and type 1 diabetes. APS 3 requires presence of Thyroid autoimmune disease associated with other autoimmune diseases. APS4 is a combination of organ specific autoimmune disease non included in a previous group. Autoimmune oophoritis is found in approximately 4 percent of females who presented with spontaneous primary ovarian insufficiency and may occur in type I and II syndromes of polyglandular autoimmune failure. This is the case of 44 year old female patient with history of hypertension, hypoparathyroidism diagnose at the age of 9 year old, vitiligo and premature ovarian failure diagnose at the age of 16 year old. Patient reported that started with multiple episodes of watery non bloody diarrhea and arthralgia. Patient went to her Pediatrician and they found hypocalcemia hyperphospathemia. Patient mineral was replaced with medication and then followed by pediatric endocrinologist. Patient continues with normal life, but menstrual periods had not started even at age 16th. Laboratory work up was done and premature ovarian failure was diagnosed after that, patient started with progesterone and estrogen to induce menstrual periods. Menstrual periods began regularly and monthly. Patient continues taking medication regularly, phoslo, calcitriol, progestin and estradiol without problem until this year that despite regular medication, started with signs and symptoms of menopause with irregular menstrual periods, palpitations hot flashes, sweating, anxiety and sleep problems. Patient met criteria for APS4 due to combination of organ specific autoimmune disease such premature ovarian failure, vitiligo and hypoparathryroidism. This case is extremely important since despite the fact that there is no family history of either endocrinological or autoimmune diseases, our patient debuts throughout her life with several autoimmune diseases, such as premature ovarian failure and vitiligo. Patient had Schedule appointment with gynecologist who increased the dose of progestin and estradiol. This case highlights the importance of being vigilant about new components of a syndrome developing at different times though a patient's life. As described, autoimmune diseases commonly are related to other diseases, but without a good clinical history and physical examination could be misdiagnosed affecting the quality of life of those patients. Presentation: 6/2/2024

B-163 Development of a Multiplex Serum Steroid Profiling Assay Utilizing Liquid Chromatography-Mass Spectrometry

Abstract Background The accurate measurement of serum steroid hormone levels is important in many endocrinologic diseases, including but not limited to congenital adrenal hyperplasia (CAH). Screening for CAH with 17-OH-progesterone immunoassays is known to yield many false-positive results. Furthermore, the differentiation between classical CAH and other non-classical CAH subtypes requires complex steroid profiling. We developed and evaluated the analytical performance of a simultaneous multiplex LC-MS/MS assay for 20 steroid hormones, and also established preliminary pediatric reference intervals for the evaluated steroid hormones. Methods Briefly, sample preparation consists of serum sample mixing with internal standard and acetonitrile, followed by lipid extraction with methyl-tert-butyl ether. Derivatization is conducted using hydroxylamine. The LC-MS/MS system consists of an ACQUITY UPLC I-Class System (Waters Corporation, Milford, MA, USA) equipped with a Waters ACQUITY UPLC BEH C18 column (1.0×50 mm, 1.7 µm; Waters Corporation), and Xevo TQ-XS (Waters Corporation) MS/MS system. The linearity, within- and between-run precision, carryover, lower limits of detection (LOQ) and quantification (LOQ), and matrix effect/recovery were evaluated for aldosterone, cortisol, cortisone, 21-deoxycortisol, corticosterone, 11β-OH-testosterone, 11-ketotestosterone, 11-ketoandrostendione, 11β-OH-androstenedione, estrone, 11-deoxycortisol, 17-OH-pregnenolone, 11β-OH-progesterone, Dehydroepiandrosterone (DHEA), androstenedione, 11-deoxycorticosterone, testosterone, 17-OH-progesterone, 5α-dihydrotestosterone, pregnenolone, and progesterone. Depending on the analyte, approximately 40 residual pediatric samples (age &amp;lt;9 years) were used to calculate the 2.5 and 97.5 percentiles in order to establish reference intervals. Results Linearity evaluation showed correlation coefficients (R2) of &amp;gt;0.9900 for 19/20 hormones, and 0.9853 for corticosterone. Within-run precision (%CV) ranged from 2.24-13.04%, 3.30-12.27%, and 2.63-9.67% for low, medium, and high steroid hormone levels. Between-run precision (%CV) ranged from 3.91-23.86%, 2.97-27.35%, and 3.95-23.67% for low, medium, and high steroid hormone levels. Carryover (%) was &amp;lt;5% for 18/20 hormones, 6.61% for pregnenolone, and 8.24% for progesterone. LOD ranged from 0.005-0.25 ng/mL, and LOQ ranged from 0.01-0.5 ng/mL for all 20 hormones. Matrix effect ranged from 99.0-110.6% for all 20 hormones, and recovery was 69.4-88.1% for 19/20 hormones, and 59.7% for aldosterone. Preliminary reference intervals (2.5-97.5 percentile) were successfully established for 18/20 evaluated hormones (ng/mL): aldosterone (0.010-0.186), cortisol (23.4-80.8), cortisone (5.82-24.8), 21-deoxycortisol (0.130-0.226), corticosterone (0.088-1.501), 11β-OH-testosterone (0.001-0.021), 11-ketotestosterone (0.031-0.390), 11-ketoandrostendione (0.031-0.390), 11β-OH-androstenedione (0.024-0.279), 11-deoxycortisol (0.040-0.701), 17-OH-pregnenolone (0.112-1.994), 11β-OH-progesterone (0.001-0.316), DHEA (0.018-1.452), androstenedione (0.010-0.160), 11-deoxycorticosterone (0.016-0.175), testosterone (0.015-0.096), 17-OH-progesterone (0.020-0.251), pregnenolone (0.031-0.215), and progesterone (0.010-0.048). Conclusions The LC-MS/MS-based multiplex steroid hormone assay showed robust analytical performance for all evaluated parameters, and can be used to reliably measure 20 steroid hormones with good sensitivity and specificity. This assay can be utilized in the clinical laboratory for the accurate diagnosis of various endocrinologic diseases, including rare subtypes of CAH, which can ultimately lead to better clinical outcomes.