[Abnormal thyroid markers in critically ill patients-harmless irritation or a real problem?] / Auffällige Schilddrüsenwerte bei kritisch Kranken ­ harmlose Irritation oder echtes Problem?

BACKGROUND: Abnormal thyroid markers are a frequent occurrence in emergency and intensive care medicine. Correct interpretation of their clinical relevance and distinction from a primary thyroid disease, particularly prior to potential administration of iodine-containing antiarrhythmic drugs such as amiodaron or radiocontrast agents, are both essential and challenging. OBJECTIVE: This article aims to present the pathophysiology of abnormal thyroid markers in acute or protracted critical disease. Their relevance for administration of amiodaron or iodine-containing radiocontrast agents is discussed, and concrete practical recommendations are presented. MATERIALS AND METHODS: The current work comprises a discussion of expert recommendations, guidelines, and basic research. RESULTS AND CONCLUSION: Approximately one third of intensive care patients develop non-thyroidal illness syndrome (NTIS) during the course of their critical disease. NTIS is characterized by a reduction in the serum concentration of fT3 and, during the course, also in those of thyroid-stimulating hormone (TSH) and fT4, despite an organically intact thyroid gland. A greater extent of the deviations correlates with a worse overall prognosis. The mechanisms involved are manifold and influence different levels of hormonal signaling axes. They are mediated by interaction with acute stress signals such as inflammatory factors and elevated cortisol levels and are influenced by medication. The components vary depending on disease severity and the protracted course. NTIS does not require any specific treatment; the focus is on treating the underlying disease. Latent hyperthyroidism in particular must be distinguished from NTIS. In unclear situations and high-risk constellations, perchlorate is indicated before (and after) iodine exposure.

Reduced threat avoidance but increased stress induced approach bias in women taking oral contraceptives.

Recent research has increasingly acknowledged the impact of oral contraceptives on affective behavior and stress responses; however, the underlying mechanisms are still not well understood. Studies have previously shown that steroid hormones modulate automatic approach and avoidance behavior. Here, we thus investigated the effects of oral contraceptives on approach and avoidance behavior and whether these effects are modulated by stress. The study comprised 130 female participants, half of whom were using oral contraceptives, while the other half were not using any hormonal contraception (NC). The participants completed the Approach Avoidance Task (AAT), which measures automatic approach and avoidance behavior to socio-affective signals. The AAT was run once before and once after a stress manipulation using the Socially Evaluated Cold Pressor Test. OC users showed absent avoidance behavior to social threat signals and a stress-induced increase in approach behavior to positive social signals. The latter was found in particular in women taking androgenic acting OC, demonstrating that different OC preparations need to be taken into account in research on OC effects. However, OC and NC group did not differ in their cortisol stress response. Overall, the results suggest that OC usage impacts on approach and avoidance behavior to social signals, which might also contribute to the development of affective side effects.

[Obesity - a chronic disease requiring treatment]. / Adipositas ­ eine behandlungsbedürftige chronische Erkrankung.

The globally increasing prevalence of obesity represents a key medical and socioeconomic challenge. Due to related comorbidities and complications such as arterial hypertension, diabetes mellitus, fatty liver disease, and arteriosclerosis, obesity leads to a significant statistical reduction in lifespan. Currently, bariatric surgery is the most effective approach to manage body weight and comorbidities while lifestyle intervention as basic obesity therapy and medical treatment often do not lead to sufficient and sustainable weight loss. However, recent medical approaches show now promising effects on weight control and might close the gap towards bariatric surgical procedures. For instance, semaglutide has been approved by EMA in January 2022 for medical treatment of obesity concomitant to basic lifestyle therapy in adults with a BMI of ≥ 30 kg/m2 or ≥ 27 kg/m2 and weight-related comorbidity. Apart from weight control, improvement in cardiometabolic risk factors can be achieved with this treatment. Moreover, other drugs, mostly based on incretin mono- or multiagonism, are currently developed and may open further effective treatment options for obesity and its complications in the near future.On a health political level, first steps for the development of a structured treatment program (DMP) for obesity are in progress to enable early guideline-based and structured treatment of obesity, and to prevent the obesity associated complications.

[New technologies in diabetes treatment]. / Neue Technologien in der Diabetestherapie.

Technological progress has led to numerous innovations in diagnostic and therapeutic applications in diabetes and will also improve the treatment of patients with diabetes in the future. The first commercially available hybrid closed-loop system has been available in the USA since 2016 and the next developmental step toward a fully automated artificial pancreas has been made. The automated control of the basal insulin secretion provides a stabilization of blood glucose with a reduction of hypoglycemia and improvement of long-term control as indicated by improved hemoglobin A1c levels. Although closed-loop systems are not yet officially available in Germany, patients with type 1 diabetes mellitus already benefit from a new generation of continuous glucose monitoring (CGM) systems. Apart from the increased accuracy these new devices can be used for up to 180 days and do not require daily calibration. This article provides a short overview of the innovations in CGM systems and the current status in the development of the artificial pancreas.

The corticosteroid prednisolone increases amygdala and insula reactivity to food approach signals in healthy young men.

Short- and long-term treatment with glucocorticoids is widely used in clinical practice and frequently induces features of iatrogenic Cushing syndrome, such as abdominally centered weight gain. Despite decades of glucocorticoids usage, the mechanisms underlying these side effects are still only partly understood. One possibility is that glucocorticoids impact subcortical (hypothalamus, amygdala, insula) and cortical (orbitofrontal and cingulate cortex) brain regions involved in appetite regulation and reward processing. In the present study, we used functional magnetic resonance imaging (fMRI) to study the acute effects of a prednisolone infusion on reactivity of brain reward systems to food stimuli. Twenty healthy normal-weight men were tested in a randomized, double-blind, cross-over study. After an overnight fast and infusion of either 250 mg prednisolone or placebo (always administered between 8 and 9 A M), fMRI scans were taken while presenting food and object pictures in a Go/NoGo (GNG) task. At home, participants were asked to register what they had eaten. On the following morning they came back to the lab and had a supervised ad libitum breakfast at a standardized buffet. Food-Go in contrast to Object-Go pictures yielded increased blood oxygen level dependent (BOLD) activity in hippocampus, amygdala, orbitofrontal cortex, insula and anterior cingulate cortex. Prednisolone increased activation in the bilateral amygdala and right insula for approach-associated food pictures. The buffet test did not reveal significant differences in calorie consumption or preferences of different macronutrients. However, prednisolone-induced insula reactivity to Food-Go images was associated with greater caloric intake, both at home and in the standardized buffet. In sum, we observed a specific effect of prednisolone on the BOLD response of the amygdala and insula to approach-associated food stimuli. As these brain areas have previously been implicated in hedonic eating, the present pattern of results may reflect an increased anticipated reward value of food modulated by glucocorticoids. These effects might potentially drive increased food intake and weight gain under prolonged glucocorticoid treatment.

Clinical Scenario of the Metabolic Syndrome.

The term metabolic syndrome (MeS) refers to a cluster of associated symptoms composed of impaired fasting glucose, abdominal obesity, hypertension, and dyslipidemia. MeS is associated with an increased risk of cardiovascular and diabetes-associated morbidity and mortality. The increased amount of visceral fat together with a chronic inflammatory state predisposes to the development of arteriosclerosis. Furthermore, insulin resistance (IR) and dyslipidemia are associated with fatty liver disease. In addition, MeS is linked to non-cardiovascular diseases such as cancer as well as psychiatric or endocrine disorders. Here, we discuss the clinical impact of MeS in cardiovascular and non-cardiovascular diseases to highlight the importance of prevention, early diagnosis, and multifactorial treatment of high-risk individuals.

Prednisolone increases neural reactivity to negative socio-emotional stimuli in healthy young men.

Exogenous glucocorticoids are known to trigger affective changes, but these are highly variable across individuals. A better understanding of how synthetic glucocorticoids impact the processing of negative emotions in the human brain might help to predict such changes. In the present functional magnetic resonance imaging (fMRI) study, we sought to uncover the slow effects of a synthetic glucocorticoid infusion on the neural response to socio-emotional scenes using a within-participant, double-blind, placebo-controlled design. In two separate sessions, 20 young males were given either an intravenous prednisolone dose (250mg) or placebo in a cross-over, randomized order. Four hours later, they were scanned while viewing drawings of persons in a neutral or negative emotional situation. On the next morning participants provided a blood sample for serum cortisol measurement, which served as a manipulation check. Prednisolone strongly suppressed morning cortisol, and heightened brain reactivity to emotional stimuli in left amygdala, left caudate head, right inferior frontal gyrus, bilateral supplementary motor area, and right somatosensory cortex. Amygdala reactivity was related to lower self-reported fatigue and higher irritability in the prednisolone condition. Moreover, prednisolone blunted inferior frontal and amygdala connectivity with other regions of the emotion-processing neural circuitry. Our results suggest specific brain pathways through which exogenous glucocorticoids may labilize affect.