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CONTEXT: Androstenedione (A4) and testosterone (T) are produced by both the adrenal glands and the gonads. The adrenal enzyme 11ß-hydroxylase (CYP11B1) executes the final step in cortisol synthesis; CYP11B1 also uses A4 and T as substrates, generating 11-hydroxyandrostenedione and 11-hydroxytestosterone, respectively. It has been suggested that CYP11B1 is expressed in the gonads, yet the circulating levels of all 11-oxygenated androgens (11-oxyandrogens) are similar in males and females of reproductive ages, despite enormous differences in T. OBJECTIVE: To assess the gonadal contribution to the circulating pool of 11-oxyandrogens. METHODS: We used liquid chromatography-tandem mass spectrometry to measure 13 steroids, including traditional and 11-oxyandrogens in: (I) paired gonadal and peripheral vein blood samples obtained during gonadal venograms from 11 patients (7 women), median age 37 (range 31-51 years); and (II) 17 women, median age 57 (range 41-81 years) before and after bilateral salpingo-oophorectomy (BSO). We also compared CYP11B1, 17α-hydroxylase/17,20-lyase (CYP17A1), and 3ß-hydroxysteroid dehydrogenase type 2 (HSD3B2) mRNA expression in adrenal, ovarian, and testicular tissue. RESULTS: A4, T, estradiol, estrone, progesterone, 17α- and 16α-hydroxyprogesterone were all higher in gonadal veins vs. periphery (p < 0.05 for all), while four 11-oxyandrogens were similar between matched gonadal and peripheral vein samples. Equally, in women who underwent BSO, A4 (median [interquartile range]: 59.7 [47.7-67.6] ng/dL vs. 32.7 [27.4-47.8] ng/dL, p < 0.001) and T (24.1 [16.4-32.3] vs.15.5 [13.7-19.0] ng/dL, p < 0.001) declined, while 11-oxyandrogens remained stable. Gonadal tissue displayed negligible CYP11B1 mRNA. CONCLUSION: Despite producing substantial amounts of A4 and T, human gonads are not relevant sources of 11-oxyandrogens.
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Adrenal insufficiency (AI) can be classified into three distinct categories based on its underlying causes: primary adrenal disorders, secondary deficiencies in adrenocorticotropin, or hypothalamic suppression from external factors, most commonly glucocorticoid medications used for anti-inflammatory therapy. The hallmark clinical features of AI include fatigue, appetite loss, unintentional weight loss, low blood pressure, and hyponatremia. Individuals with primary AI additionally manifest skin hyperpigmentation, hyperkalemia, and salt craving. The diagnosis of AI is frequently delayed due to the non-specific symptoms and signs early in the disease course, which poses a significant challenge to its early detection prior to an adrenal crisis. Despite the widespread availability of lifesaving glucocorticoid medications for decades, notable challenges persist, particularly in the domains of timely diagnosis while simultaneously avoiding misdiagnosis, patient education for averting adrenal crises, and the determination of optimal replacement therapies. This article reviews recent advancements in the contemporary diagnostic strategy and approaches to optimal treatment for AI.
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Insuficiência Adrenal , Glucocorticoides , Humanos , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/tratamento farmacológico , Progressão da Doença , Terapia de Reposição Hormonal , Hormônio Adrenocorticotrópico/uso terapêuticoRESUMO
Background: Bone mineral density (BMD) might not be a sensitive tool for predicting osteoporotic fracture risk among patients with rheumatoid arthritis (RA), especially when receiving glucocorticoids. Trabecular bone score (TBS), which has emerged as a new assessment technique representing bone microarchitecture and strength, may be considered an alternative approach. Materials and Methods: In this cross-sectional analytical study, postmenopausal RA patients receiving glucocorticoids were identified from the postmenopause BMD database. The database included clinical data of postmenopausal outpatients who had at least one BMD measurement between January 2014 and December 2017. TBS was calculated from lumbar spine BMD with the microarchitecture assessment software. The presence of osteoporotic fractures, either vertebral or non-vertebral, was identified at the time of BMD measurement. Results: A total of 64 postmenopausal RA patients receiving glucocorticoids were included. The TBS values were inversely associated with osteoporotic fractures, with a TBS cut-off of less than 1.24, showing the best accuracy with a sensitivity of 79% and a specificity of 84% in discriminating fractures. This newly proposed TBS threshold combined with a BMD T-score of -2.5 or less demonstrated a greater area under receiver operating characteristic curve in identifying patients with osteoporotic fractures than the BMD threshold alone (p value = 0.003). Conclusion: The reduction in TBS was associated with an osteoporotic fracture in postmenopausal RA patients receiving glucocorticoids. Combining TBS and BMD in these patients incrementally improves fracture risk discrimination and may serve as a supplementary tool in identifying patients at greatest risk of osteoporotic fracture.
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Importance: Primary aldosteronism (PA) is a common cause of secondary hypertension and an independent risk factor for cardiovascular morbidity and mortality. Fewer than 2% to 4% of patients at risk are evaluated for PA. Objective: To develop and evaluate an electronic health record best-practice advisory (BPA) that assists with PA screening. Design, Setting, and Participants: This prospective quality improvement study was conducted at academic center outpatient clinics. Data analysis was performed between February and June 2023 and included adults with hypertension and at least 1 of the following: 4 or more current antihypertensive medications; hypokalemia; age younger than 35 years; or adrenal nodule(s). Patients previously tested for PA were excluded. Exposure: A noninterruptive BPA was developed to trigger for PA screening candidates seen in outpatient setting by clinicians who treat hypertension. The BPA included an order set for PA screening and a link to results interpretation guidance. Main Outcomes and Measures: (1) The number of PA screening candidates identified by the BPA between October 1, 2021, and December 31, 2022; (2) the rates of PA screening; and (3) the BPA use patterns, stratified by physician specialty were assessed. Results: Over 15 months, the BPA identified 14â¯603 unique candidates (mean [SD] age, 65.5 [16.9] years; 7300 women [49.9%]; 371 [2.5%] Asian, 2383 [16.3%] Black, and 11â¯225 [76.9%] White individuals) for PA screening, including 7028 (48.1%) with treatment-resistant hypertension, 6351 (43.5%) with hypokalemia, 1537 (10.5%) younger than 35 years, and 445 (3.1%) with adrenal nodule(s). In total, 2040 patients (14.0%) received orders for PA screening. Of these, 1439 patients (70.5%) completed the recommended screening within the system, and 250 (17.4%) had positive screening results. Most screening orders were placed by internists (40.0%) and family medicine physicians (28.1%). Family practitioners (80.3%) and internists (68.9%) placed most orders via the embedded order set, while specialists placed most orders (83.0%-95.4%) outside the BPA. Patients who received screening were younger and included more women and Black patients than those not screened. The likelihood of screening was higher among patients with obesity and dyslipidemia and lower in those with chronic kidney disease and established cardiovascular complications. Conclusions and Relevance: The study results suggest that noninterruptive BPAs are potentially promising PA screening-assistance tools, particularly among primary care physicians. Combined with artificial intelligence algorithms that optimize the detection yield, refined BPAs may contribute to personalized hypertension care.
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Hiperaldosteronismo , Hipertensão , Hipopotassemia , Adulto , Humanos , Feminino , Idoso , Hipopotassemia/complicações , Estudos Prospectivos , Inteligência Artificial , Hipertensão/tratamento farmacológico , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnósticoRESUMO
CONTEXT: The prevalence of cardiovascular and metabolic complications among adults with 21-hydroxylase deficiency (21OHD) is unknown. OBJECTIVE: We sought to determine the prevalence of cardiovascular and metabolic morbidities among adults with 21OHD and to identify clinical factors and biomarkers associated with cardiovascular outcomes. METHODS: A 10-year retrospective cross-sectional analysis was conducted on adult patients with confirmed 21OHD, aged 18 to 70 years, who had at least one clinical visit for assessment at the University of Michigan. The presence of cardiovascular diseases (CVDs) and other metabolic comorbidities was extracted from medical records based on International Classification of Diseases (ICD) codes. Medical treatments, glucocorticoid (GC) and mineralocorticoid doses, as well as specific biomarkers of disease control since age 18, were collected for analysis. RESULTS: A total of 254 patients with 21OHD, median age of 35 years (interquartile range, 28.25-46 y), were included in the analysis. The prevalence of CVDs in the entire cohort was 7.5%. An increase in prevalence was seen from early adulthood, reaching 25% in patients older than 60 years. Increasing age (adjusted odds ratio [OR], 1.05; 95% CI, 1.01-1.09), hypertension (OR, 4.27; 95% CI, 1.41-12.92), and higher GC doses (OR, 1.51; 95% CI, 1.11-2.06) were significantly associated with prevalent CVDs. Higher plasma renin activity was significantly associated with CVDs (OR, 1.07; 95% CI, 1.01-1.15) but not other biochemical markers of disease. CONCLUSION: Cardiometabolic morbidities are prevalent among adults with 21OHD. Hypertension, age, and GC exposure are the main predictive factors of established CVDs in our cohort.
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Hiperplasia Suprarrenal Congênita , Doenças Cardiovasculares , Hipertensão , Adulto , Humanos , Hiperplasia Suprarrenal Congênita/complicações , Hiperplasia Suprarrenal Congênita/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Glucocorticoides , Hipertensão/complicações , Biomarcadores , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/complicações , Esteroide 21-HidroxilaseRESUMO
Congenital forms of endocrine hypertension are rare and potentially life-threatening disorders, primarily caused by genetic defects affecting adrenal steroid synthesis and activation pathways. These conditions exhibit diverse clinical manifestations, which can be distinguished by their unique molecular mechanisms and steroid profiles. Timely diagnosis and customized management approach are crucial to mitigate unfavorable outcomes associated with uncontrolled hypertension and other related conditions. Treatment options for these disorders depend on the distinct underlying pathophysiology, which involves specific pharmacological therapies or surgical adrenalectomy in some instances. This review article summarizes the current state of knowledge on the therapeutic management of congenital forms of endocrine hypertension, focusing on familial hyperaldosteronism (FH), congenital adrenal hyperplasia, apparent mineralocorticoid excess, and Liddle syndrome. We provide an overview of the genetic and molecular pathogenesis underlying each disorder, describe the clinical features, and discuss the various therapeutic approaches available and their risk of adverse effects, aiming to improve outcomes in patients with these rare and complex conditions.
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Hiperplasia Suprarrenal Congênita , Hiperaldosteronismo , Hipertensão , Síndrome de Excesso Aparente de Minerolocorticoides , Humanos , Hipertensão/genética , Hipertensão/terapia , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/genética , Hiperaldosteronismo/terapia , Síndrome de Excesso Aparente de Minerolocorticoides/diagnóstico , Síndrome de Excesso Aparente de Minerolocorticoides/genética , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/genética , Hiperplasia Suprarrenal Congênita/terapia , Esteroides , AldosteronaRESUMO
Primary aldosteronism (PA) is characterized by dysregulated, renin-independent aldosterone excess. Long perceived as rare, PA has emerged as one of the most common causes of secondary hypertension. Failure to recognize and treat PA results in cardiovascular and renal complications, through processes mediated by both direct target tissue insults and indirectly, by hypertension. PA spans a continuum of dysregulated aldosterone secretion, which is typically recognized in late stages after treatment-resistant hypertension and cardiovascular and/or renal complications develop. Determining the precise disease burden remains challenging due to heterogeneity in testing, arbitrary thresholds, and populations studied. This review summarizes the reports on PA prevalence among the general population and in specific high-risk subgroups, highlighting the impact of rigid versus permissive criteria on PA prevalence perception.
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Hiperaldosteronismo , Hipertensão , Humanos , Aldosterona , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Prevalência , Renina , Hipertensão/etiologia , Hipertensão/complicaçõesRESUMO
Background: Systemic sclerosis may affect male and female fertility. Premature ovarian failure has been reported in female systemic sclerosis patients, but the effects on male fertility in systemic sclerosis have not been studied. Objectives: We aimed to determine the prevalence and clinical associations with primary hypogonadism among male systemic sclerosis patients. Methods: This was a cross-sectional pilot study, including 30 adult male systemic sclerosis patients attending the Scleroderma Clinic, Khon Kaen University. Testosterone deficiency symptoms were assessed using the Aging Males' Symptoms Rating Scale, urological examination, and blood testing (for total testosterone, free testosterone, follicle-stimulating hormone, and luteinizing hormone). We excluded patients with congenital hypogonadism and any acquired disorders of the testes and genitalia. The definition of primary hypogonadism was based on the International Society for the Study of the Aging Male 2015 diagnostic criteria for hypogonadism. Results: Seven patients met the definition of primary hypogonadism-a prevalence of 23.3% (95% confidence interval: 9.9-42.3). The respective mean age and mean systemic sclerosis duration was 59.4 ± 11.9 and 5.5 ± 4.7 years. Older age at onset, high triglyceride level, and older age starting corticosteroid treatment were significantly associated with primary hypogonadism (p = 0.02, 0.02, and 0.03, respectively). Systemic sclerosis subset, disease severity, and immunosuppressant use were not associated with primary hypogonadism among Thai male systemic sclerosis patients. Conclusion: Around one-quarter of male systemic sclerosis patients had primary hypogonadism. Elderly onset of systemic sclerosis, hypertriglyceridemia, and late corticosteroid treatment were risk factors for developing primary hypogonadism.
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This study was designed to determine a FRAX intervention threshold in postmenopausal Thais, based on a history of hip fracture. The optimal FRAX thresholds for hip fracture were 4.9% (without BMD) and 4% (with BMD), while the thresholds for major osteoporotic fracture were 9.8% (without BMD) and 8.9% (with BMD). INTRODUCTION: Fracture Risk Assessment Tool (FRAX) has been widely used as an intervention threshold for initiating osteoporosis treatment. However, there is a lack of data to validate the threshold in Thai population. METHODS: A cross-sectional study was conducted from January 2014 to February 2019. Postmenopausal women in the Northeast of Thailand whom has bone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DXA) in the study period were recruited. Participants who had previously received anti-osteoporotic treatment were not eligible. FRAX score, both with and without BMD, was calculated using a Thai reference. Prevalent hip fracture was identified by reviewing the ICD-10 diagnosis from the hospital database during the study period. The receiver operating characteristic (ROC) curve and Youden index were used to determine the FRAX threshold in predicting hip fracture, based on the rationale that women with a prevalent hip fracture would be eligible for treatment. RESULTS: A total of 2872 postmenopausal Thai women were recruited, with 45 sustained a recent hip fracture. In association with hip fracture, the optimal FRAX thresholds for hip fracture without and with BMD were 4.9% and 4%, respectively, with 71.1% sensitivity and 83.3% specificity, and 82.2% sensitivity and 78.6% specificity, while the optimal FRAX thresholds for major osteoporotic fracture (MOF) without and with BMD were 9.8% and 8.9%, respectively, with 75.6% sensitivity and 77.0% specificity, and 86.7% sensitivity and 70.9% specificity. CONCLUSION: An optimal intervention threshold based on FRAX of hip fracture and MOF in postmenopausal Thai women is slightly different from the standard recommendation, which confirmed the marked variations of thresholds across ethnicities. The proposed threshold should be considered as new cutoff for initiating osteoporosis treatment in postmenopausal Thais.
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Osteoporose Pós-Menopausa , Fraturas por Osteoporose , Absorciometria de Fóton , Densidade Óssea , Estudos Transversais , Feminino , Humanos , Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/diagnóstico , Pós-Menopausa , Medição de Risco , Fatores de Risco , Tailândia/epidemiologiaRESUMO
INTRODUCTION: The comparative effect of new-onset diabetes mellitus (DM) and hypertension (HT) on long-term mortality is a matter of debate. MATERIALS AND METHODS: From 2007 to 2017, a 10-year longitudinal retrospective cohort study was conducted in Thailand's tertiary care setting. As baseline data, health check-up data from apparently healthy participants without underlying disease from 2007 were extracted. The vital status of all participants was determined in 2017, ten years after an initial examination. The impact of new-onset DM and HT at baseline on 10-year all-cause mortality was investigated using multivariable logistic regression analysis. RESULTS: The prevalence of new-onset DM and HT was 6.4% and 28.8%, respectively, at baseline. Newly diagnosed diabetes increased the risk of all-cause mortality over 10 years (adjusted OR 4.77 and 95% CI 2.23-9.99). HT, on the other hand, did not increase the risk of death (adjusted OR 1.24 and 95% CI 0.65-2.35). Different HT and DM status combinations were compared to a nondiabetic, nonhypertensive reference. Individuals who were diabetic and hypertensive had a greater risk of death (adjusted OR 6.22 and 95% CI 2.22-17.00). Having DM without HT also increased the risk of death (adjusted OR 4.36 and 95% CI 1.35-12.87). However, having HT without DM did not result in a significant increase in 10-year mortality risk (adjusted OR 1.21 and 95% CI 0.57-2.56). CONCLUSION: In an apparently healthy population, new-onset DM is more strongly associated with 10-year all-cause mortality than new-onset HT. Having both DM and HT was associated with a greater risk of death when compared to having DM or HT alone.
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Diabetes Mellitus/mortalidade , Hipertensão/mortalidade , Adulto , Glicemia/análise , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Tailândia/epidemiologiaRESUMO
BACKGROUND: Fasting hypertriglyceridemia commonly associates with insulin resistance and is frequently prevalent in type 2 diabetes mellitus (DM). However, hypertriglyceridemia has not been investigated as an independent predictor of incidence of DM, especially in Thais. METHODS: A 10-year hospital-based retrospective cohort study was conducted in a tertiary care setting in Thailand. Health check-up data in 2007 from healthy participants without underlying disease were extracted as baseline data. In 2017, 10 years following an initial examination, the diagnosis of DM and other laboratory data were identified. Hypertriglyceridemia was defined as fasting triglyceride level ≥ 150 mg/dL. A generalized additive model (GAM) was applied to demonstrate a relationship between fasting TG level and probability of incident DM in 10 years. An association between hypertriglyceridemia and 10-year incidence of DM was evaluated using univariable and multivariable logistic regression analysis. RESULTS: A total of 1342 non-diabetic adults with complete both baseline and 10-year follow-up data were included in the analysis. The incidence of DM in the study period was 10.3%. Baseline fasting triglyceride level is significantly higher in participants with incidence of DM, with a median difference of 45 mg/dL (P < 0.01). Univariable logistic regression showed that hypertriglyceridemia was associated with 10-year incidence of DM (odds ratio (OR) 3.03, 95% CI 2.12-4.35). After adjusting for potential confounders, hypertriglyceridemia remained significantly associated with incidence of DM (OR 2.33, 95% CI 1.61-3.39). CONCLUSION: Fasting triglyceride level is an independent risk factor for the development of new-onset DM. Testing for hypertriglyceridemia in people without diabetes may be an alternative screening tool to identify populations at risk of developing future DM, as well as providing triglyceride as a new target for DM risk reduction.
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Diabetes Mellitus Tipo 2/epidemiologia , Hiperlipidemias/etnologia , Hipertrigliceridemia/etnologia , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Hiperlipidemias/epidemiologia , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/epidemiologia , Incidência , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia , Triglicerídeos/sangueRESUMO
Thyroid disease, particularly hypothyroidism, has been reported in systemic sclerosis (SSc). Some clinical features of SSc can also present in hypothyroidism. Our aims were to determine the prevalence of, and describe clinical features associated with, hypothyroidism in SSc patients. We conducted a historical cohort study of adult SSc patients who underwent screening thyroid function tests at the Scleroderma Clinic, Khon Kaen University, Thailand, between 2009 and 2018. The patients who had any thyroid disorders before the onset of SSc and were diagnosed as an overlap syndrome were excluded. A total of 200 SSc were included according to sample size calculation, among whom the female to male ratio was 2:1. The majority of cases (137; 69.5%) were diffuse cutaneous SSc subset. The mean age was 55.8 ± 10.7 years and the median duration of disease 4.9 (IQR 1.6-9.9) years. Of the total, 9 had primary hypothyroidism (prevalence 4.5%; 95%CI 2.1-8.4) and 22 had subclinical hypothyroidism (prevalence 11%; 95%CI 7.0-16.2). Of the latter 22, 71% had dcSSc. Logistic regression analysis indicated that unexplained anemia was significantly associated with either subclinical hypothyroid or hypothyroidism (OR 2.74; 95% CI 1.17-6.47), whereas Raynaud's phenomenon had a negative association (OR 0.28; 95% CI 0.11-0.66). Neither severity of skin tightness nor internal organ involvement were associated with hypothyroidism among SSc patients. Clinical-subclinical hypothyroidism is uncommon among SSc patients, it is frequently associated with anemia, and less so Raynaud's phenomenon. Clinical-subclinical hypothyroidism should thus be considered in cases of unexplained anemia in SSc patients.
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Hipotireoidismo/etiologia , Escleroderma Sistêmico/complicações , Idoso , Anemia/etiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Escleroderma Sistêmico/epidemiologia , Tailândia/epidemiologiaRESUMO
Obstructive sleep apnoea (OSA) is prevalent in obese women with gestational diabetes mellitus (GDM). The present pilot study explored associations between OSA severity and metabolites in women with GDM. A total of 81 obese women with diet-controlled GDM had OSA assessment (median gestational age [GA] 29 weeks). The metabolic profile was assayed from fasting serum samples via liquid chromatography-mass spectrometry (LC-MS) using an untargeted approach. Metabolites were extracted and subjected to an Agilent 1,290 UPLC coupled to an Agilent 6,545 quadrupole time-of-flight (Q-TOF) MS. Data were acquired using electrospray ionisation in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantify features, and these features were annotated using the Human Metabolite Database. The feature data were compared with OSA status, apnea-hypopnea index (AHI), body mass index (BMI) and GA using "limma" in R. Correlation analyses of the continuous covariates were performed using Kendall's Tau test. The p values were adjusted for multiple testing using the Benjamini-Hochberg false discovery rate correction. A total of 42 women (51.8%) had OSA, with a median AHI of 9.1 events/hr. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modelling in GA and BMI found 12 features that significantly associated with the AHI. These features could be annotated to oestradiols, lysophospholipids, and fatty acids, with higher levels related to higher AHI. Metabolites including oestradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. A targeted approach may help elucidate our understanding of their role in OSA in this population.
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Diabetes Gestacional , Apneia Obstrutiva do Sono , Glicemia , Índice de Massa Corporal , Feminino , Humanos , Lactente , Metabolômica , Obesidade/complicações , Projetos Piloto , Polissonografia , Gravidez , GestantesRESUMO
Ketogenic diet, a very low-carbohydrate diet and high-fat diet, has emerged as a popular approach for weight reduction, particularly in young adults. However, a serious but rare complication of the ketogenic diet is ketoacidosis associated with low carbohydrate intake, which should be cautiously monitored in people with a predisposition to the condition. We report a 22-year-old Thai woman with an unremarkable past medical history who presented with an acute onset of dyspnea of 2 days' duration. Diabetic ketoacidosis was diagnosed by elevated capillary blood glucose, significant metabolic acidosis, and a high serum beta-hydroxybutyrate level. Low C-peptide level and positive islet autoantibodies confirmed the new diagnosis of type 1 diabetes in this patient. After her conditions were stabilized, the patient revealed that she began a ketogenic diet for weight reduction 4 days before her illness. Other precipitating factors were not identified. This highlights that ketogenic diet may increase diabetic ketoacidosis risk at the presentation of previously unrecognized type 1 diabetes.
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We investigate the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD. We found that predictions were concordant in 83.8% of patients. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. INTRODUCTION: The Fracture Risk Assessment Tool (FRAX) is used to calculate the 10-year probability of fracture using important clinical factors, with bone mineral density (BMD) as an optional input variable. We aimed to determine the rate of concordance between treatment recommendations of osteoporosis with 10-year probability of hip fracture calculated using FRAX scores with and without BMD and to identify relevant clinical risk factors associated with discordance. METHODS: This was a cross-sectional study conducted in patients between 40 and 90 years of age who were screened for osteoporosis by BMD measurement using dual energy X-ray absorptiometry (DXA) from 2010 to 2018 at a university hospital in Thailand. A FRAX questionnaire was administered to determine demographic data and osteoporotic risk factors. FRAX scores with and without BMD were calculated for each participant using the Thai reference, and patients were categorized into either the treatment or non-treatment group based on a cut-off of 3% 10-year probability of hip fracture. When FRAX scores with and without BMD results were consistent, they were considered concordant. Otherwise, they were deemed discordant. Clinical risk factors were compared between the concordant and discordant groups. RESULTS: A total of 3545 participants were included in the study. The majority (83.8%) were in the concordant group. However, older age, lower BMD, and FRAX without BMD around the intervention threshold were significantly associated with discordant results. In the discordant group, FRAX with BMD suggested treatment in more participants with lower age, higher BMI, and lower BMD when compared with FRAX without BMD. CONCLUSION: FRAX scores with and without BMD yielded concordant predictions regarding the 10-year probability of hip fracture suggesting pharmacological treatment. However, this concordance declined in elderly and osteoporotic participants and in those with FRAX without BMD around intervention threshold. BMD data may be required in these populations in order to facilitate accurate risk assessment.
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Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Estudos Transversais , Humanos , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Medição de Risco , Fatores de Risco , Tailândia/epidemiologiaRESUMO
PURPOSE: The long-term impact of changes in serum uric acid (SUA) concentration on the estimated glomerular filtration rate (eGFR) among the general population remains unclear. We investigated the longitudinal associations between changes in SUA and eGFR over 10 years in 1222 participants with baseline eGFR ≥60 mL/min/1.73 m2. METHODS: This was a 10-year retrospective cohort study conducted from 2007 to 2017. Rapid eGFR decline (defined as the highest quartile of change in eGFR between 2007 and 2017) and new-onset kidney disease (defined as an eGFR <60 mL/min/1.73 m2 at a 10-year follow-up) were examined using multiple logistic regression analysis, adjusted for sex, age, body mass index, systolic blood pressure, SUA, fasting plasma glucose, serum total cholesterol, and triglyceride at baseline. RESULTS: SUA was inversely correlated with eGFR, and the slopes of the SUA-eGFR regression lines were consistently steeper in females than males. A significant inverse correlation was also observed between 10-year changes in SUA and eGFR in both sexes. Multivariate analysis showed that every 1 mg/dL increase in SUA from baseline was associated with higher risk of rapid eGFR decline and new-onset kidney disease (OR 1.25; 95% CI 1.14-1.33 and OR 1.40; 95% CI 1.26-1.49, respectively). Furthermore, the subjects in the highest SUA quartile (>6.0 mg/dL) had a 2.45 times higher risk of rapid eGFR decline (95% CI 1.51-3.42) compared to those in the lowest SUA quartile (<3.9 mg/dL). CONCLUSION: Elevated baseline SUA is an independent risk factor for rapid eGFR decline and new-onset kidney disease in the general population.
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INTRODUCTION: Thalassemia bone disease is one of the disease-related complications in patients with thalassemia. Prevalence of fractures and the role of a trabecular bone score (TBS) as a predictive factor for fractures were evaluated in patients with thalassemia. METHODS: A cross-sectional study was conducted in patients with thalassemia aged ≥18 years at Srinagarind Hospital, Khon Kaen University, Thailand. A lateral thoracolumbar radiograph and bone mineral density (BMD) at the lumbar spine and hip, as well as the TBS measured by dual-energy X-ray absorptiometry (DXA), were evaluated in all patients. RESULTS: Among 86 patients, 14 patients were found to have radiographic vertebral fracture yielding a prevalence of 16.3%. All patients who had fractures were ß-thalassemia/Hb E. Combined low BMD and TBS at lumbar spines and a presence of endocrinopathies were significantly associated with vertebral fractures. CONCLUSIONS: The prevalence of vertebral fractures in patients with thalassemia was not uncommon. A combined low BMD and TBS and a presence of endocrinopathies were associated with vertebral fractures. These findings suggested that BMD testing and TBS measurement have a clinical implication as a screening tool for evaluating the risk of vertebral fractures in thalassemic patients, particularly in ß-thalassemia/Hb E who have endocrinopathies.