Endocrine dysfunction induced by immune checkpoint inhibitors / Disfunción endocrina inducida por inhibidores de los puntos de control inmune

Abstract Since their approval in 2011, immune checkpoint inhibitors (ICPis) are increasingly used to treat several advanced cancers. ICPis target certain cellular molecules that regulate immune response resulting in antitumor activity. The use of these new agents needs careful monitoring since they brought a whole new spectrum of adverse events. In this review, we aim to describe different endocrine dysfunctions induced by ICPis and to underline the importance of diagnosing and managing these adverse effects. Immune-related endocrine toxicities include thyroid dysfunction, hypophysitis and, less frequently, type 1 diabetes, primary ad renal insufficiency and hypoparathyroidism. Diagnosis of endocrine adverse events related to ICPis therapy can be challenging due to nonspecific manifestations in an oncological scenario and difficulties in the biochemical evaluation. Despite the fact that these endocrine adverse events could lead to life-threatening consequences, the availability of effective replacement treatment enables continuing therapy and together with an interdisciplinary approach will impact positively on survival.

Resumen Desde su aprobación en 2011, el uso de los inhibidores de los puntos de control inmunes (ICPis) se ha ex tendido para el tratamiento de diversas neoplasias en estadios avanzados. Los ICPis tienen como blanco ciertas moléculas de las células que regulan la respuesta inmune favoreciendo una actividad antitumoral. El uso de estos nuevos agentes requiere un monitoreo específico, ya que se han vinculado con un amplio y nuevo espectro de efectos adversos. El objetivo de esta revisión es describir las diferentes disfunciones endocrinas inducidas por los ICPis y destacar la importancia del diagnóstico y manejo oportuno de estos efectos adversos. Los efectos adversos inmunes endocrinos incluyen disfunción tiroidea, hipofisitis y con menor frecuencia, diabetes tipo 1, insuficiencia suprarrenal primaria e hipoparatiroidismo. El diagnóstico de eventos adversos endocrinos relacionados con la terapia ICPis es un desafío debido a su presentación clínica inespecífica en un escenario oncológico y a las dificultades en la evaluación bioquímica. Estos eventos adversos endocrinos podrían tener consecuencias potencialmente letales, pero la disponibilidad de un tratamiento de reemplazo eficaz permite continuar la terapia y, junto con un enfoque interdisciplinario, generar un impacto positivo en la supervivencia.

Hypothyroidism in type 2 diabetics – a hospital-based prevalence study

Introduction: Thyroid hormones and insulin are the antagonists and both are involved in cellular metabolism. With this, the study was planned to find the prevalence of thyroid dysfunction in type 2 diabetes mellitus (DM). Materials and Methods: Study was conducted in the department of General Medicine, GSL Medical College. The study protocol was approved by the institutional ethical committee. All type 2 diabetics aged >30yrs, irrespective of treatment were included in the study. Individuals on metformin therapy, smokers, thyroid hormone users, who underwent thyroid surgery, individuals on radioiodine therapy, pregnant women and individuals on steroids were excluded. Venous blood samples were taken from for fasting blood glucose and 2-hour post glucose blood sugar, glycosylated hemoglobin, lipid profile, and thyroid function estimated measured by using the autoanalyzer. Chi-square test was used to compare differences in categorical variables and p<0.05 was considered statistically significant. Results: Among 104 participants, 82.7% were euthyroid, 12.5% had subclinical and 4.8% had clinical hypothyroidism; statistically the difference not significant when age/gender was correlated. But there was a significant association with dyslipidemia. Conclusion: Hypothyroidism is very common among type 2 DM individuals and both complement others' metabolism.

Adenoma paratiroideo mediastínico como causa de hiperparatiroidismo primario / Mediastinal parathyroid adenoma as a cause of primary hyperparathyroidism

Resumen Las glándulas paratiroides participan en la regulación de las concentraciones de calcio al producir parathormona como respuesta a la hipocalcemia. Los adenomas paratiroideos, que rara vez se encuentran en mediastino, son la causa más importante de hiperparatiroidismo primario, una enfermedad rara con manifestaciones clínicas graves y que se diagnostica por la com binación de concentraciones elevadas de calcio sérico y paratohormona. Se considera que el adenoma paratiroideo ectópico se deriva de la migra ción de las glándulas paratiroides al mediastino y se conoce como una causa importante del fracaso de la exploración primaria del hiperparatiroi dismo primario. Se presenta un caso de adenoma paratiroideo mediastíni co en una mujer de 48 años que llevó a la aparición de hiperparatiroidismo primario. El adenoma se extirpó mediante esternotomía media total.

Abstract Parathyroid glands participate in regulation of calcium concentrations by producing parathormone in response to hypocalcemia. Parathyroid adeno mas, which are rarely found in the mediastinum, are the most important cause of primary hyperparathyroidism, which is a rare disease with serious clinical manifestations and is diagnosed by combination of high concentrations of serum calcium and parathormone. It is considered that ectopic parathyroid adenoma is derived from the migration of the parathyroid glands to the mediastinum and is known as an important cause of the failure of primary exploration of primary hyperparathyroidism. We present a case of medias tinal parathyroid adenoma in a 48-year-old woman that led to appearance of primary hyperparathyroidism. Adenoma was removed by total median sternotomy.

An overview of the contribution of acupuncture to thyroid disorders / 中西医结合学报

Thyroid dysfunction, affecting people of all ages, not only damages human growth and energy metabolism but is also comorbid with other illnesses such as cardiovascular disease, kidney disease and gastrointestinal disorders. With the increasing acceptance of alternative and complementary therapies, acupuncture, a traditional Chinese medical practice, has also been employed to address this problem. Analysing 29 clinical projects that were retrieved from 29 major digital databases and include 1757 patients aged 7-79 years from China, Italy, Korea, Macedonia and Russia, this narrative review offers an overview of the efficacy, and evaluated the safe and cost-effective use of acupuncture against hyperthyroidism, hypothyroidism and thyroid-relevant illnesses. Findings indicated reductions in patient symptoms and improvements in biomarkers where acupuncture was used alone or in combination therapy. In addition to showing the role of acupuncture as an alternative and complementary medicine or as an adjunctive therapy for curative and rehabilitative purposes, more well-designed researches are needed to achieve reliable data.

Total thyroid resection on the quality of life in patients with nodular goiter / 中国生化药物杂志

Objective To investigate the analysis of low calcium intravenous calcium supplementation agent and active vitamin D3 on total thyroidectomy on quality of life in patients with nodular goiter. Methods 40 cases of nodular goiter with total thyroidectomy were performed in our hospital from March 2014 to September 2016. It was randomly divided into control group and experimental group, 20 cases in each group. The patients in the control group were nodular thyroidectomy and the experimental group underwent total thyroidectomy. The quality of life of two groups of patients was evaluated by using the European five-dimensional health-related living quality scale (eq-5d). Results Two groups of patients, relevant questionnaire survey of the patient's ability to act, self-care ability, daily activity ability, pain or discomfort, anxiety, or depression, and the comparison of VAS score, according to the results of difference was not statistically significant. In comparison with ordinary people, the questionnaire survey results showed that the proportion of patients with moderate or above differences was higher and the difference was significant (P< 0.01). There was no statistical significance compared to the average person. Conclusion All patients with nodular goiter are treated with total thyroidism, and the effect is good, and the quality of life of patients is relatively small.

Research progress on correlation between subclinical hypothyroidism and cardiovascular diseases / 天津医药

Subclinical hypothyroidism is a metabolic disease, defined by increased thyroid-stimulating hormone (TSH) and accompanied by normal thyroid hormone levels. Recent years, many domestic and foreign studies have showed that sub?clinical hypothyroidism may be related with atherosclerosis and left ventricular diastolic dysfunction, which increasing the risk and mortality of cardiovascular diseases. Subclinical hypothyroidism may be associated with lipid metabolic disorders, hypertension, coagulation dysfunction, endothelial dysfunction, abnormal glucose metabolism, homocysteine, C-reactive pro?tein and lipoprotein. At present, controversy persists on the subclinical hypothyroidism. The aim of this study is to review the correlation between cardiovascular diseases and subclinical hypothyroidism.

Analysis on pathogenic factors in serum TPOAb positive patients with thyroid diseases / 中国免疫学杂志

Objective:To study the pathogenesis of thyroid autoantibodies determination in thyroidism disease.Methods:Autoantibody to thyroid-peroxidase(TPOAb) were measured in 352 sera of the cases suffering from thyroid diseases by electrochemiluminescence immunoassay(ECLIA),50 healthy volunteers were enrolled as control group.Results:The levels of TPOAb in patient group were higher than that in control group(P

The Incidence of Hyperparathyroidism in Renal Allograft Recipients with Stable Renal Function / 대한신장학회잡지

The hyperparathyroidism which causes renal osteodystrophy is a common complication in patients with end stage renal diseases. It is usually normalized after successful renal transplantation, but it remains in some renal transplant recipients. It is not well known whether hyperparathyroidism decreases bone mineral density in renal allograft recipients or not. To evaluate the incidence and predictive marker for hyperparathyroidism in renal allograft recipients and to describe the impact of hyperparathyroidism on the bone mineral density, we measured intact parathyroid hormone(iPTH) in 193 renal allograft recipients with stable renal and hepatic function. The mean age of patients was 42+/-12(13-76) years old and male female ratio was 1.9. The patients were on pre-transplant dialysis for 14.4+/-15.6(0-130) months and were followed up for 43.8+/-35.7(2-204) months after transplantation. Of the total 193 patients, 13 patients(6.7%) had high iPTH level. All patients showed normal serum calcium and phosphorous levels. iPTH levels were positively correlated to pre- and post-transplant serum alkaline phosphatase levels(vs. pre-transplant r=0.32, P<0.001, vs post- transplant r=0.63, P<0.001). There was no difference in pre- and post-transplant serum calcium, phosphorus, post-transplant serum creatinine and hemoglobin levels between the patients. There were no statistical differences in age, sex, duration of pre-transplant dialysis, duration of post-transplant follow-up, number of transplantation, donor type, primary renal disease and episodes of acute rejection. Of the total 193 patients, bone mineral density was studied in 37 patients. Bone mineral densities did not correlated to iPTH levels. In conclusion, the incidence of hyperparathyroidism in renal allograft recipients with stable renal function was 6.7%. Pre- and post-transplant serum alkaline phosphatase levels might be used as a useful marker for hyperparathyroidism. Serum iPTH level was not correlated to bone mineral density.

Analysis of the factors affecting the prognosis of surgical treatment of primary hyperparathyroidism / 中国普通外科杂志

Objective To study the pathologic fracture of primary hyperparathyroidism and the effect of the timing of operation of the prognosis of the surgical treatment for hyperparathyroidism. Methods Analysis of the postoperative follow-up data of 13 hyperparathyroidic cases were analyzed. Results The prognosis of ~hyperpathyroidic cases without pathologic fracture was better than cases with concurrent fracture; Orthomorphia of fracture during perioperative period of parathyroidectomy showed a good prognosis,but those who had delayed treatment of fracture owing to concern of malunion due to severe osteoporosis showed a poor prognosis.~Conclusions Resection of the parathyroid gland before the appearance of pathologic fracture has a good ~proguosis .For those who present with associated pathologic fracture,treatment of the fracture at the time of parathyroidectomy or during the perioperative period of the parathyroidectomy are important factors that can ~improve the prognosis of hyperparathyroid patients.