Antigen-specific immunotherapy to restore antigen-specific tolerance in Type 1 diabetes and Graves' disease.

Type 1 diabetes and Graves' disease are chronic autoimmune conditions, characterized by a dysregulated immune response. In Type 1 diabetes, there is beta cell destruction and subsequent insulin deficiency whereas in Graves' disease, there is unregulated excessive thyroid hormone production. Both diseases result in significant psychosocial, physiological, and emotional burden. There are associated risks of diabetic ketoacidosis and hypoglycaemia in Type 1 diabetes and risks of thyrotoxicosis and orbitopathy in Graves' disease. Advances in the understanding of the immunopathogenesis and response to immunotherapy in Type 1 diabetes and Graves' disease have facilitated the introduction of targeted therapies to induce self-tolerance, and subsequently, the potential to induce long-term remission if effective. We explore current research surrounding the use of antigen-specific immunotherapies, with a focus on human studies, in Type 1 diabetes and Graves' disease including protein-based, peptide-based, dendritic-cell-based, and nanoparticle-based immunotherapies, including discussion of factors to be considered when translating immunotherapies to clinical practice.

Current evidence and practical guidance for the use of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes.

BACKGROUND: The burden of type 2 diabetes (T2D) and its associated complications continues to grow in Australia. In recent years, sodium-glucose co-transporter-2 (SGLT2) inhibitors have become a key component of diabetes care with rapid uptake into routine clinical practice. There is growing evidence of their clinical efficacy, but also potential adverse effects. OBJECTIVE: The aim of this article is to review the use of SGLT2 inhibitors in T2D by exploring data surrounding clinical efficacy and safety as well as providing practical advice for prescribing clinicians. DISCUSSION: SGLT2 inhibitors have multiple metabolic benefits including reducing glycated haemoglobin, weight and blood pressure. Additionally, there are strong cardiovascular benefits and renoprotective effects in selected populations. Current evidence suggests that SGLT2 inhibitors should be considered for the secondary prevention of cardiovascular disease and to delay progression of early chronic kidney disease in people with T2D. Clinicians should also be aware of common side effects and potential rare severe complications.

Riedel Thyroiditis.

CONTEXT: Riedel thyroiditis (RT) is a rare inflammatory autoimmune disease that is often a clinically diagnostic dilemma because of its insidious presentation and nonspecific symptoms. OBJECTIVE: The aim of the present systematic review and meta-analysis is to clarify the presentation, management, and outcomes of RT. STUDY SELECTION: A systematic search of PubMed/MEDLINE and Web of Science was conducted to identify relevant reports published up to September 2019. DATA EXTRACTION: First author, country, patient sex, ethnicity, presentation, biochemical status, duration of symptoms, histology, treatment, follow-up duration, and short- and long-term outcomes. DATA SYNTHESIS: Data from 212 RT patients were retrieved. The mean age was 47 years with a predominantly female population (81%). Neck swelling (89%), dyspnea (50%), and neck pain (41%) were the most common presenting symptoms. Inflammatory markers were elevated in 70% to 97% and thyroid antibody positivity was present in less than 50%. Up to 82% underwent surgical intervention, with the most common being total thyroidectomy in 34% of individuals. Glucocorticoids were used in 70% of individuals with median duration 3 months. Prognosis was reasonable with 90% having resolution or improvement of symptoms. CONCLUSIONS: This analysis is the largest and most comprehensive to date of RT and provides clinicians with vital information on the common presentation features that may alert to the diagnosis and highlight management options.

Macrogonadotropinoma, a venous thromboembolic event and asymptomatic extensive periventricular white matter changes in a patient with Klinefelter syndrome.

Gonadotropinoma in Klinefelter syndrome (KS) is uncommon and may be a result of protracted stimulation of gonadotrophs from lack of androgen feedback. Associations of white matter changes and increased venous thromboembolic risk have been reported and need to be considered in patients with KS.