Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Background Atherosclerosis risk is increased in hypothyroidism, largely due to early endothelial dysfunction. Noninvasive markers such as carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and pulse wave velocity (PWV) are useful for detecting subclinical vascular changes. Endocan, a proteoglycan secreted by endothelial cells, has emerged as a potential biomarker of endothelial dysfunction. This study aimed to assess endothelial function and arterial stiffness in clinical and subclinical hypothyroidism using CIMT, PWV, and FMD, and to explore their correlation with circulating endocan levels. Methods The study comprised ninety-six Egyptian adult females ranging from 18 to 60 years of age, enrolled from the endocrinology department at Kasralainy hospital between March 2023 and July 2024. Participants were stratified into three distinct groups: Group (I) consisted of 32 individuals with clinical hypothyroidism, Group (II) included 32 patients presenting subclinical hypothyroidism (SCH), and Group (III) encompassed 32 euthyroid healthy controls matched for age and gender. Anthropometric parameters encompassing weight, height, and body mass index were documented, along with systolic and diastolic blood pressure measurements, fasting glucose concentrations, lipid profiles, TSH levels, and serum Endocan values. Furthermore, carotid intima-media thickness (CIMT) assessment was conducted using high-resolution color-coded Doppler ultrasonography, endothelial function evaluation was performed via flow-mediated dilatation (FMD) testing, and arterial stiffness assessment was accomplished through carotid-femoral pulse wave velocity (cfPWV) determinations. Results Carotid intima-media thickness (CIMT) demonstrated significantly elevated values in both clinical hypothyroid and SCH group relative to the control population (P< 0.001). Carotid-femoral pulse wave velocity (cf-PWV) measurements revealed statistically significant elevation in the clinical hypothyroid group when compared with control subjects (P= 0.037). Circulating endocan concentrations showed no statistically significant variations across clinical hypothyroid (34.43±42.76), SCH (31.88±28.55), and healthy control groups (33.85±34.39), P= 0.442. Furthermore, endocan levels exhibited no correlations with age, BMI, fasting plasma glucose, HbA1C, lipid parameters, thyroid function markers, CIMT, FMD, or cf-PWV measurements. Summary: Endothelial dysfunction, arterial stiffness, and vascular wall thickening manifest in hypothyroid patients. Additionally, endothelial dysfunction and arterial wall thickening emerge during the subclinical phase. Flow-mediated dilatation (FMD), cf-PWV, and CIMT represent non-invasive diagnostic modalities suitable for early identification of vascular impairment in hypothyroid individuals. Endocan does not constitute an appropriate biomarker for endothelial dysfunction assessment within the context of hypothyroidism among Egyptian female populations....
Background/Objectives: The objective of this study is to determine the extent to which obesity alters the diagnostic reliability of the clonidine stimulation test (CST) for growth hormone deficiency (GHD) and whether incorporating insulin-like growth factor 1 (IGF-1) and the annual growth velocity standard deviation score (GV SDS) improves diagnostic precision. Methods: This retrospective study included 101 children evaluated for short stature using the clonidine stimulation test, with serum GH concentrations determined by a two-site, solid-phase, enzyme-labeled chemiluminescent immunometric assay (Immulite 2000 XPi, Siemens Healthcare Diagnostics, USA). Diagnostic performance was compared between overweight/obese (n = 47) and normal-weight (n = 54) groups. A two-step algorithm was evaluated: Step 1 applied a GH peak threshold of <5 ng/mL; Step 2 integrated IGF-1 SDS < −1.5 and annual GV SDS < −2.0 among children with subthreshold GH responses. Results: The median GH peak was significantly lower in overweight/obese children (4.5 [IQR 2.0–7.4] vs. 8.2 [5.1–11.5] ng/mL; p = 0.043). Although sensitivity remained comparable (82.6% vs. 90.5%; p = 0.666), elevated BMI markedly reduced specificity (50.0% vs. 84.8%; p = 0.008) and overall accuracy (66.0% vs. 87.0%; p = 0.017). Overweight/obese children demonstrated a higher proportion of false-positive CST results than non-obese children (25.5% vs. 9.3%). Among obese children with a GH peak of <5 ng/mL (n = 31), Step 2, which integrates IGF-1 and GV, improved specificity from 50% to 75% and the positive predictive value from 61.3% to 84.2%, correctly reclassifying 9 of 12 children without GHD who would otherwise have been misdiagnosed based on CST alone. Conclusions: Fixed GH cutoffs may lead to the misclassification of GHD in children with elevated BMI. Obesity significantly reduces the specificity and diagnostic accuracy of CST, increasing false-positive results. A two-step approach integrating IGF-1 and GV improves diagnostic precision and helps to differentiate true GHD from obesity-related GH suppression....
Background While much of medical resident trainee exposure to pediatric endocrinology is geared towards hospital-based management of hyperglycemic urgencies and emergencies, the American Board of Pediatrics certification exam and trends within pediatric endocrinology referrals require an understanding of more nuanced aspects of the endocrine system that include abnormalities of growth, puberty, sexual differentiation, and the thyroid gland, which are less often encountered in emergency, inpatient, and critical care settings. Challenges in medical education include increased direct faculty supervision requirements and heightened demand for clinical productivity among faculty at the expense of time for teaching. In response, online case-based learning (CBL), which utilizes real or simulated clinical scenarios with high rates of flexibility and learner satisfaction, offers a viable learning option. This study sought to determine whether an online CBL tool would contribute to resident learning during an outpatient pediatric endocrinology elective rotation. Methods Clinical cases reflecting different scenarios within pediatric endocrinology, including growth, puberty, thyroid disorders, sexual differentiation, and calcium metabolism, were created in Microsoft PowerPoint with an audiovisual recording created using TechSmith Camtasia Studio and were made available online. Each case posed several questions, each followed by a discussion and rationale for the correct answer. Trainees were encouraged to complete the CBL modules prior to or early during their pediatric endocrinology rotation. After completion of the elective rotation, residents were sent a questionnaire via SurveyMonkey to evaluate the CBL modules based on the Kirkpatrick model. Results A total of 29 residents participated in the evaluation. Resident rating of satisfaction of cases was 76% ‘a lot’ and 24% ‘some’. Resident rating of knowledge acquisition was 79% ‘a lot’ and 21% ‘some’. Resident rating of application of learning was 79% ‘a lot’ and 21% ‘some’. Finally, resident rating of impact on clinical practice was 62% ‘a lot’ and 38% ‘some’. No categories included responses in the “a little” or “none” options and free-text comments were overwhelmingly positive. Conclusion This evaluation supports that an online CBL model of pediatric endocrinology education can be an effective adjunct to the current state of medical education. Overall, utilization of CBL education bolstered resident education in critical areas of endocrinology during their outpatient rotation as measured by self-reported metrics. Similar online CBL models can promote competence, confidence, and interest in pediatric endocrinology and other domains of medical education both for expansion of interest in the field of pediatric endocrinology itself and confidence of general pediatricians in approaching it....
Background/Objectives: Seasonal variation in hemoglobin A1c (HbA1c) values has been previously documented, with physical activity (PA) and macronutrient intake (MNI) suggested as potential drivers. This study combines seasonal mean HbA1c values from the Dutch (pre)diabetes population with national survey data on PA and MNI from 2018 to 2021 to identify key associations. Methods: HbA1c data were collected from 24 laboratory organizations in the Netherlands and Dutch Caribbean. MNI and total energy intake data were extracted from the Dutch National Food Consumption Survey, while PA data came from the Dutch National Sports Participation Index Survey. Weighting factors were applied to align PA and MNI data with HbA1c data. Seasonal averages were analyzed for significant differences, and a prediction model compared PA and MNI with actual HbA1c values. Results: Among 5,635,920 HbA1c results, the average HbA1c increased by 0.71 mmol/mol (NGSP 0.06%) over four years, with an overall mean of 52.4 mmol/mol (NGSP 7.0%). Seasonal HbA1c variation showed a dip in summer–autumn and a peak in winter–spring (1.2 mmol/mol; NGSP 0.11%; p < 0.0001). MNI, except for total energy intake (which peaked in summer; p < 0.001), showed no significant trends or association with HbA1c (p = 0.157). PA decreased by 7.2% over the study period, with seasonal peaks in summer–autumn, showing an inverse relationship with HbA1c (p < 0.0001). During the COVID-19 lockdowns, PA significantly decreased, and mean HbA1c values increased more markedly than in previous years. The prediction model confirmed PA as a significant driver of seasonal HbA1c variation (p = 0.004). Conclusions: These findings suggest that PA is the strongest driver of seasonal variation in HbA1c. Public health initiatives and support programs promoting physical activity are essential for improving HbA1c regulation....
Background: Survivors of childhood brain cancer survivors (CBCS) have a higher risk of endothelial dysfunction and cardiovascular mortality. Recombinant human growth hormone (rhGH) replacement therapy may help reduce endothelial damage and the development of cardiovascular diseases (CVD). This study aimed to assess biochemical and biophysical endothelial function in CBCS with GH deficiency (GHD). Methods: CBCS who were at least two years post-treatment underwent clinical evaluation, including anthropometric measurements and metabolic assessments (adiponectin, blood clotting, and lipid profile). Endothelial function was evaluated using the estimation of the reactive hyperemia index (RHI) measured by the EndoPAT 2000. A value < 1.5 was considered pathologic. CBCS without GHD served as the control group. Results: The study included 60 participants: 12 controls (mean age 14 ± 4.7 years) and 48 CBCS with GHD (mean age 16.6 ± 4.9 years), 8 of whom were not receiving rhGH therapy. The cohort showed a high prevalence of abnormal RHI values. Although there were no significant differences in weight or body mass index between groups, those with GHD, especially those not on rhGH therapy, had a higher prevalence of an RHI < 1.5, lower pathological adiponectin levels and a disrupted lipid profile. Conclusions: CBCS exhibited altered RHI values consistent with early endothelial biophysical dysfunction. Among patients with GHD, this impairment was further associated with an adverse lipid profile and signs of adipose tissue dysfunction. Recombinant growth hormone replacement therapy may contribute to a partial improvement in biochemical indicators of endothelial function....
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