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35 "Renal insufficiency"
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Review Article
Adrenal gland
A Contemporary Approach to the Diagnosis and Management of Adrenal Insufficiency
Suranut Charoensri, Richard J. Auchus
Endocrinol Metab. 2024;39(1):73-82.   Published online January 22, 2024
DOI: https://doi.org/10.3803/EnM.2024.1894
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  • 246 Download
AbstractAbstract PDFPubReader   ePub   
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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Original Article
Miscellaneous
Incidence of Endocrine-Related Dysfunction in Patients Treated with New Immune Checkpoint Inhibitors: A Meta-Analysis and Comprehensive Review
Won Sang Yoo, Eu Jeong Ku, Eun Kyung Lee, Hwa Young Ahn
Endocrinol Metab. 2023;38(6):750-759.   Published online November 13, 2023
DOI: https://doi.org/10.3803/EnM.2023.1785
  • 1,446 View
  • 122 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the incidence of endocrine immune-related adverse events (irAEs) for recently developed immune checkpoint inhibitor (ICI) drugs.
Methods
We collected studies on newly developed ICI drugs using PubMed/Medline, Embase, and Cochrane Library from inception through January 31, 2023. Among ICI drugs, nivolumab, pembrolizumab, and ipilimumab were excluded from the new ICI drugs because many papers on endocrine-related side effects have already been published.
Results
A total of 44,595 patients from 177 studies were included in this analysis. The incidence of hypothyroidism was 10.1% (95% confidence interval [CI], 8.9% to 11.4%), thyrotoxicosis was 4.6% (95% CI, 3.8% to 5.7%), hypophysitis was 0.8% (95% CI, 0.5% to 1.1%), adrenal insufficiency was 0.9% (95% CI, 0.7% to 1.1%), and hyperglycemia was 2.3% (95% CI, 1.6% to 3.4%). Hypothyroidism and thyrotoxicosis occurred most frequently with programmed cell death protein-1 (PD-1) inhibitors (13.7% and 7.5%, respectively). The rate of endocrine side effects for the combination of a programmed death-ligand 1 inhibitor (durvalumab) and cytotoxic T lymphocyte-associated antigen 4 inhibitor (tremelimumab) was higher than that of monotherapy. In a meta-analysis, the combination of tremelimumab and durvalumab had a 9- to 10-fold higher risk of pituitary and adrenal-related side effects than durvalumab alone.
Conclusion
Newly developed PD-1 inhibitors had a high incidence of thyroid-related irAEs, and combined treatment with durvalumab and tremelimumab increased the risk of pituitary- and adrenal-related irAEs. Based on these facts, it is necessary to predict the endocrine side effects corresponding to each ICI drug, diagnose and treat them appropriately, and try to reduce the morbidity and mortality of patients.
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Review Articles
Diabetes, Obesity and Metabolism
Renal Protection of Mineralocorticoid Receptor Antagonist, Finerenone, in Diabetic Kidney Disease
Dong-Lim Kim, Seung-Eun Lee, Nan Hee Kim
Endocrinol Metab. 2023;38(1):43-55.   Published online February 27, 2023
DOI: https://doi.org/10.3803/EnM.2022.1629
  • 5,642 View
  • 766 Download
  • 5 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   ePub   
Chronic kidney disease (CKD) is the most common cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). CKD increases the risk of cardiovascular diseases; therefore, its prevention and treatment are important. The prevention of diabetic kidney disease (DKD) can be achieved through intensive glycemic control and blood pressure management. Additionally, DKD treatment aims to reduce albuminuria and improve kidney function. In patients with T2DM, renin-angiotensin-aldosterone system inhibitors, sodium glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can delay the progression of DKD. Hence, there is a need for novel treatments that can effectively suppress DKD progression. Finerenone is a first-in-class nonsteroidal mineralocorticoid receptor antagonist with clinically proven efficacy in improving albuminuria, estimated glomerular filtration rate, and risk of cardiovascular events in early and advanced DKD. Therefore, finerenone is a promising treatment option to delay DKD progression. This article reviews the mechanism of renal effects and major clinical outcomes of finerenone in DKD.

Citations

Citations to this article as recorded by  
  • Neue Antihypertensiva im Renin-Angiotensin-Aldosteron-System
    Markus van der Giet
    CardioVasc.2024; 24(1): 33.     CrossRef
  • Chicoric acid advanced PAQR3 ubiquitination to ameliorate ferroptosis in diabetes nephropathy through the relieving of the interaction between PAQR3 and P110α pathway
    Weiwei Zhang, Yong Liu, Jiajun Zhou, Teng Qiu, Haitang Xie, Zhichen Pu
    Clinical and Experimental Hypertension.2024;[Epub]     CrossRef
  • Endothelial CXCR2 deficiency attenuates renal inflammation and glycocalyx shedding through NF-κB signaling in diabetic kidney disease
    Siyuan Cui, Xin Chen, Jiayu Li, Wei Wang, Deqi Meng, Shenglong Zhu, Shiwei Shen
    Cell Communication and Signaling.2024;[Epub]     CrossRef
  • Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection
    Alessio Mazzieri, Francesca Porcellati, Francesca Timio, Gianpaolo Reboldi
    International Journal of Molecular Sciences.2024; 25(7): 3969.     CrossRef
  • Epigenetic modification in diabetic kidney disease
    Zhe Liu, Jiahui Liu, Wanning Wang, Xingna An, Ling Luo, Dehai Yu, Weixia Sun
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Novel Approaches in Chronic Renal Failure without Renal Replacement Therapy: A Review
    Sandra Martínez-Hernández, Martín Muñoz-Ortega, Manuel Ávila-Blanco, Mariana Medina-Pizaño, Javier Ventura-Juárez
    Biomedicines.2023; 11(10): 2828.     CrossRef
  • Finerenone and other future therapeutic options for Alport syndrome
    Helen Pearce, Holly Mabillard
    Journal of Rare Diseases.2023;[Epub]     CrossRef
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Diabetes, Obesity and Metabolism
Glucagon-Like Peptide 1 Therapy: From Discovery to Type 2 Diabetes and Beyond
Adie Viljoen, Stephen C. Bain
Endocrinol Metab. 2023;38(1):25-33.   Published online February 6, 2023
DOI: https://doi.org/10.3803/EnM.2022.1642
  • 2,787 View
  • 307 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   ePub   
The therapeutic benefits of the incretin hormone, glucagon-like peptide 1 (GLP1), for people with type 2 diabetes and/or obesity, are now firmly established. The evidence-base arising from head-to-head comparative effectiveness studies in people with type 2 diabetes, as well as the recommendations by professional guidelines suggest that GLP1 receptor agonists should replace more traditional treatment options such as sulfonylureas and dipeptidyl-peptidase 4 (DPP4) inhibitors. Furthermore, their benefits in reducing cardiovascular events in people with type 2 diabetes beyond improvements in glycaemic control has led to numerous clinical trials seeking to translate this benefit beyond type 2 diabetes. Following early trial results their therapeutic benefit is currently being tested in other conditions including fatty liver disease, kidney disease, and Alzheimer’s disease.

Citations

Citations to this article as recorded by  
  • The Road towards Triple Agonists: Glucagon-Like Peptide 1, Glucose-Dependent Insulinotropic Polypeptide and Glucagon Receptor - An Update
    Agnieszka Jakubowska, Carel W. le Roux, Adie Viljoen
    Endocrinology and Metabolism.2024; 39(1): 12.     CrossRef
  • Glucagon-like peptide 1 receptor agonists: cardiovascular benefits and mechanisms of action
    John R. Ussher, Daniel J. Drucker
    Nature Reviews Cardiology.2023; 20(7): 463.     CrossRef
  • A new class of glucose-lowering therapy for type 2 diabetes: the latest development in the incretin arena
    Stephen C Bain, Thinzar Min
    The Lancet.2023; 402(10401): 504.     CrossRef
  • Flattening the biological age curve by improving metabolic health: to taurine or not to taurine, that’ s the question
    Kwok M. Ho, Anna Lee, William Wu, Matthew T.V. Chan, Lowell Ling, Jeffrey Lipman, Jason Roberts, Edward Litton, Gavin M. Joynt, Martin Wong
    Journal of Geriatric Cardiology.2023; 20(11): 813.     CrossRef
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Adrenal Gland
Clinical and Technical Aspects in Free Cortisol Measurement
Man Ho Choi
Endocrinol Metab. 2022;37(4):599-607.   Published online August 19, 2022
DOI: https://doi.org/10.3803/EnM.2022.1549
  • 4,699 View
  • 290 Download
  • 9 Web of Science
  • 12 Crossref
AbstractAbstract PDFPubReader   ePub   
Accurate measurement of cortisol is critical in adrenal insufficiency as it reduces the risk associated with misdiagnosis and supports the optimization of stress dose. Comprehensive assays have been developed to determine the levels of bioactive free cortisol and their clinical and analytical efficacies have been extensively discussed because the level of total cortisol is affected by changes in the structure or circulating levels of corticoid-binding globulin and albumin, which are the main reservoirs of cortisol in the human body. Antibody-based immunoassays are routinely used in clinical laboratories; however, the lack of molecular specificity in cortisol assessment limits their applicability to characterize adrenocortical function. Improved specificity and sensitivity can be achieved by mass spectrometry coupled with chromatographic separation methods, which is a cutting-edge technology to measure individual as well as a panel of steroids in a single analytical run. The purpose of this review is to introduce recent advances in free cortisol measurement from the perspectives of clinical specimens and issues associated with prospective analytical technologies.

Citations

Citations to this article as recorded by  
  • Highly Responsive Bioassay for Quantification of Glucocorticoids
    Mathias Flensted Poulsen, Martin Overgaard, Christian Brix Folsted Andersen, Andreas Lodberg
    Analytical Chemistry.2024; 96(5): 2000.     CrossRef
  • An LC-MS/MS Method for the Simultaneous Quantification of Insulin, Cortisol, Glucagon-like Peptide 1, Ghrelin, and Osteocalcin
    Zhichao Zhang, Hareem Siddiqi, Yu-Ping Huang, Shannon McClorry, Peng Ji, Daniela Barile, Carolyn M. Slupsky
    Separations.2024; 11(2): 41.     CrossRef
  • Determination of cortisol cut-off limits and steroid dynamics in the ACTH stimulation test: a comparative analysis using Roche Elecsys Cortisol II immunoassay and LC-MS/MS
    Sema Okutan, Nanna Thurmann Jørgensen, Lars Engers Pedersen, Stina Willemoes Borresen, Linda Hilsted, Lennart Friis Hansen, Ulla Feldt-Rasmussen, Marianne Klose
    Endocrine.2024;[Epub]     CrossRef
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    Visesh Vignesh, Bernardo Castro-Dominguez, Tony D. James, Julie M. Gamble-Turner, Stafford Lightman, Nuno M. Reis
    ACS Sensors.2024; 9(4): 1666.     CrossRef
  • Comparative analysis of salivary cortisol measurements using different assay methods in relation to serum-free cortisol measurement
    Anna Lee, Sooah Jang, Sanghoo Lee, Hyun-Kyung Park, In-Young Kim, Ryunsup Ahn, Jeong-Ho Seok, Kyoung-Ryul Lee
    Practical Laboratory Medicine.2024; 40: e00393.     CrossRef
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    Ying Shen, Xia Luo, Qing Guan, Liming Cheng
    Journal of Chromatography B.2024; 1239: 124127.     CrossRef
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    Kade C. Flowers, Kate E. Shipman
    Diagnostics.2023; 13(8): 1415.     CrossRef
  • Electrochemical sensors for cortisol detection: Principles, designs, fabrication, and characterisation
    Gopi Karuppaiah, Min-Ho Lee, Shekhar Bhansali, Pandiaraj Manickam
    Biosensors and Bioelectronics.2023; 239: 115600.     CrossRef
  • The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions
    Liisa Hantsoo, Kathleen M. Jagodnik, Andrew M. Novick, Ritika Baweja, Teresa Lanza di Scalea, Aysegul Ozerdem, Erin C. McGlade, Diana I. Simeonova, Sharon Dekel, Sara L. Kornfield, Michelle Nazareth, Sandra J. Weiss
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • РІВЕНЬ СТРЕСУ В ДІТЕЙ ШКІЛЬНОГО ВІКУ З COVID-19
    Г. А. Павлишин, О. І. Панченко
    Здобутки клінічної і експериментальної медицини.2023; (4): 119.     CrossRef
  • Corticotropin-stimulated steroid profiles to predict shock development and mortality in sepsis: From the HYPRESS study
    Josef Briegel, Patrick Möhnle, Didier Keh, Johanna M. Lindner, Anna C. Vetter, Holger Bogatsch, Dorothea Lange, Sandra Frank, Ludwig C. Hinske, Djillali Annane, Michael Vogeser, Michael Bauer, Thorsten Brenner, Patrick Meybohm, Markus Weigand, Matthias Gr
    Critical Care.2022;[Epub]     CrossRef
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Original Article
Miscellaneous
Clinical Value of Serum Mitochondria-Inhibiting Substances in Assessing Renal Hazards: A Community-Based Prospective Study in Korea
Hoon Sung Choi, Jin Taek Kim, Hong Kyu Lee, Wook Ha Park, Youngmi Kim Pak, Sung Woo Lee
Endocrinol Metab. 2021;36(6):1298-1306.   Published online November 26, 2021
DOI: https://doi.org/10.3803/EnM.2021.1226
  • 3,279 View
  • 95 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
Mitochondrial dysfunction is strongly associated with several kidney diseases. However, no studies have evaluated the potential renal hazards of serum mitochondria-inhibiting substance (MIS) and aryl hydrocarbon receptor ligand (AhRL) levels.
Methods
We used serum level of MIS and AhRL and clinical renal outcomes from 1,511 participants of a prospective community-based cohort in Ansung. MIS was evaluated based on intracellular adenosine triphosphate (MIS-ATP) or reactive oxygen species (MIS-ROS) generation measured using cell-based assays.
Results
During a mean 6.9-year follow-up, 84 participants (5.6%) developed a rapid decline in kidney function. In the lowest quartile group of MIS-ATP, patients were older and had metabolically deleterious parameters. In multivariate logistic regression analysis, higher MIS-ATP was associated with decreased odds for rapid decline: the odds ratio (OR) of 1% increase was 0.977 (95% confidence interval [CI], 0.957 to 0.998; P=0.031), while higher MIS-ROS was marginally associated with increased odds for rapid decline (OR, 1.014; 95% CI, 0.999 to 1.028; P=0.055). However, serum AhRL was not associated with the rapid decline in kidney function. In subgroup analysis, the renal hazard of MIS was particularly evident in people with hypertension and low baseline kidney function.
Conclusion
Serum MIS was independently associated with a rapid decline in kidney function, while serum AhRL was not. The clinical implication of renal hazard on serum MIS requires further evaluation in future studies.

Citations

Citations to this article as recorded by  
  • An Interactive Online App for Predicting Diabetes via Machine Learning from Environment-Polluting Chemical Exposure Data
    Rosy Oh, Hong Kyu Lee, Youngmi Kim Pak, Man-Suk Oh
    International Journal of Environmental Research and Public Health.2022; 19(10): 5800.     CrossRef
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Special Article
Miscellaneous
COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society
Cheol Ryong Ku, Kyong Yeun Jung, Chang Ho Ahn, Jun Sung Moon, Ju Hee Lee, Eun Heui Kim, Hyemi Kwon, Hee Kyung Kim, Sunghwan Suh, Sangmo Hong, Jeonghoon Ha, Eun Roh, Jin Hwa Kim, Mi-kyung Kim, the Committee of Clinical Practice Guideline of the Korean Endocrine Society
Endocrinol Metab. 2021;36(4):757-765.   Published online August 17, 2021
DOI: https://doi.org/10.3803/EnM.2021.404
  • 10,369 View
  • 419 Download
  • 19 Web of Science
  • 21 Crossref
AbstractAbstract PDFPubReader   ePub   
Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

Citations

Citations to this article as recorded by  
  • COVID-19 mRNA vaccine may trigger subacute thyroiditis
    Mehmet Sözen, Ömercan Topaloğlu, Berrin Çetinarslan, Alev Selek, Zeynep Cantürk, Emre Gezer, Damla Köksalan, Taner Bayraktaroğlu
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    Expert Opinion on Drug Safety.2024; 23(3): 323.     CrossRef
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    David Tak Wai Lui, Chi Ho Lee, Yu Cho Woo, Ivan Fan Ngai Hung, Karen Siu Ling Lam
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    Hyeyeon Moon, Sunghwan Suh, Mi Kyoung Park
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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    Javaria Aslam, Faisal Shahzad Khan, Muhammad Talha Haris, Hewad Hewadmal, Maryam Khalid, Mohammad Y. Alshahrani, Qurrat-ul-ain Aslam, Irrum Aneela, Urooj Zafar
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    Yukako Kurematsu, Takako Mohri, Sadanori Okada, Yutaka Takahashi
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    İbrahim Mert Erbaş, İrem Ceren Erbaş, Gözde Akın Kağızmanlı, Kübra Yüksek Acinikli, Özge Besci, Korcan Demir, Ece Böber, Nurşen Belet, Ayhan Abacı
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    Tina Kienitz, Gesine Meyer
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    Ach Taieb, El Euch Mounira
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    Jong Chul Won, Ki-Hyun Baek
    Endocrinology and Metabolism.2022; 37(6): 851.     CrossRef
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    Tania Pilli, Cristina Dalmiglio, Gilda Dalmazio, Alfonso Sagnella, Raffaella Forleo, Lucia Brilli, Fabio Maino, Cristina Ciuoli, Maria Grazia Castagna
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    Hae Dong Choi, Jun Sung Moon
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Review Articles
Miscellaneous
Clinical Characteristics, Management, and Potential Biomarkers of Endocrine Dysfunction Induced by Immune Checkpoint Inhibitors
Shintaro Iwama, Tomoko Kobayashi, Hiroshi Arima
Endocrinol Metab. 2021;36(2):312-321.   Published online April 27, 2021
DOI: https://doi.org/10.3803/EnM.2021.1007
  • 5,492 View
  • 267 Download
  • 15 Web of Science
  • 14 Crossref
AbstractAbstract PDFPubReader   ePub   
Immune-related adverse events (irAEs) affecting the endocrine glands are among the most frequent irAEs induced by immune checkpoint inhibitors (ICIs) and include hypopituitarism, primary adrenal insufficiency, thyrotoxicosis, hypothyroidism, hypoparathyroidism, and type 1 diabetes mellitus. Since the incidence and clinical features of endocrine irAEs vary according to the ICI used, it is important to understand the characteristics of these irAEs and to manage each one appropriately. Since some endocrine irAEs, including adrenal crisis and diabetic ketoacidosis, are potentially life-threatening, predicting the risk of endocrine irAEs before their onset is critical. Several autoantibodies have been detected in patients who develop endocrine irAEs, among which anti-thyroid antibodies may be predictive biomarkers of thyroid dysfunction. In this review, we describe the clinical features of each endocrine irAE induced by ICIs and discuss their potential biomarkers, including autoantibodies.

Citations

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    Tomoko Kobayashi, Shintaro Iwama, Hiroshi Arima
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    Charity Tan, Sarah Hendricks, Kristina Hernandez, Martha Benavides, Rupinderjit Samra
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  • Risk of Thyroid Dysfunction in PD-1 Blockade Is Stratified by the Pattern of TgAb and TPOAb Positivity at Baseline
    Xin Zhou, Shintaro Iwama, Tomoko Kobayashi, Masahiko Ando, Hiroshi Arima
    The Journal of Clinical Endocrinology & Metabolism.2023; 108(10): e1056.     CrossRef
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    Liman Huo, Chao Wang, Haixia Ding, Xuelian Shi, Bin Shan, Ruoying Zhou, Ping Liang, Juan Hou
    Frontiers in Oncology.2023;[Epub]     CrossRef
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    Aleksandra Basek, Grzegorz K. Jakubiak, Grzegorz Cieślar, Agata Stanek
    Cancers.2023; 15(24): 5786.     CrossRef
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    Shintaro Iwama, Tomoko Kobayashi, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Masahiko Ando, Xin Zhou, Ayana Yamagami, Takeshi Onoue, Yohei Kawaguchi, Takashi Miyata, Mariko Sugiyama, Hiroshi Takagi, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tets
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    Ying Zhang, Xiaoling Zhang, Weiling Li, Yunyi Du, Wenqing Hu, Jun Zhao
    Human Vaccines & Immunotherapeutics.2022;[Epub]     CrossRef
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Close layer
Diabetes
Cardiorenal Protection in Diabetic Kidney Disease
Jason F. Lee, Ecaterina Berzan, Vikas S. Sridhar, Ayodele Odutayo, David Z.I. Cherney
Endocrinol Metab. 2021;36(2):256-269.   Published online April 19, 2021
DOI: https://doi.org/10.3803/EnM.2021.987
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AbstractAbstract PDFPubReader   ePub   
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.

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Close layer
Original Article
Clinical Study
Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency
Yoon Ji Kim, Jung Hee Kim, A Ram Hong, Kyeong Seon Park, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim
Endocrinol Metab. 2020;35(3):628-635.   Published online September 22, 2020
DOI: https://doi.org/10.3803/EnM.2020.707
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AbstractAbstract PDFPubReader   ePub   
Background
Salivary cortisol is routinely used as a diagnostic test for Cushing syndrome. The diagnostic use of salivary cortisol for adrenal insufficiency (AI), however, is less established. We aimed to investigate the utility of morning basal and adrenocorticotropic hormone-stimulated salivary cortisol in diagnosing AI in Korean adults.
Methods
We prospectively included 120 subjects (female, n=70) from Seoul National University Hospital. AI was defined as a stimulated serum cortisol level of <496.8 nmol/L during the short Synacthen test (SST). Serum and saliva samples were drawn between 8:00 AM and 10:00 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit.
Results
Thirty-four patients were diagnosed with AI according to the SST results. Age, sex, body mass index, serum albumin levels, and serum creatinine levels did not significantly differ between the normal and AI groups. Basal and stimulated salivary cortisol levels were positively correlated with basal (r=0.538) and stimulated serum cortisol levels (r=0.750), respectively (all P<0.001). Receiver operating characteristic curve analysis yielded a cutoff level of morning basal salivary cortisol of 3.2 nmol/L (sensitivity, 84.9%; specificity, 73.5%; area under the curve [AUC]=0.822). The optimal cutoff value of stimulated salivary cortisol was 13.2 nmol/L (sensitivity, 90.7%; specificity, 94.1%; AUC=0.959). Subjects with a stimulated salivary cortisol level above 13.2 nmol/L but a stimulated serum cortisol level below 496.8 nmol/L (n=2) had lower serum albumin levels than those showing a concordant response.
Conclusion
The diagnostic performance of stimulated salivary cortisol measurements after the SST was comparable to serum cortisol measurements for diagnosing AI.

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Close layer
Review Article
Miscellaneous
Encountering COVID-19 as Endocrinologists
Eun-Jung Rhee, Jung Hee Kim, Sun Joon Moon, Won-Young Lee
Endocrinol Metab. 2020;35(2):197-205.   Published online June 23, 2020
DOI: https://doi.org/10.3803/EnM.2020.35.2.197
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AbstractAbstract PDFPubReader   ePub   
The world is entering an era of disaster and chaos due to coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. Since its first emergence in December 2019 in Wuhan, China, COVID-19 has swept through Asia and propagated throughout the world to Europe and North America. As of April 13, 1,773,084 people were infected and 111,652 people had died from COVID-19 globally, and new record levels of infection are being reported every day. Based on the data that have been amassed so far, the primary risk factors for a severe disease course or even mortality from COVID-19 are underlying diseases such as diabetes and hypertension. As the global prevalence of diabetes continues to increase, patients with endocrine diseases such as diabetes mellitus and those who are on long-term corticosteroid therapy due to adrenal insufficiency or hypopituitarism are at risk for a poor prognosis of COVID-19. As endocrinologists, we would like to briefly review the current knowledge about the relationship between COVID-19 and endocrine diseases and to discuss what we can do for the safety and health of our patients with endocrine diseases in this globally threatening situation.

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Close layer
Original Articles
Comparison between Atorvastatin and Rosuvastatin in Renal Function Decline among Patients with Diabetes
Eugene Han, Gyuri Kim, Ji-Yeon Lee, Yong-ho Lee, Beom Seok Kim, Byung-Wan Lee, Bong-Soo Cha, Eun Seok Kang
Endocrinol Metab. 2017;32(2):274-280.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.274
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AbstractAbstract PDFPubReader   
Background

Although the beneficial effects of statin treatment in dyslipidemia and atherosclerosis have been well studied, there is limited information regarding the renal effects of statins in diabetic nephropathy. We aimed to investigate whether, and which, statins affected renal function in Asian patients with diabetes.

Methods

We enrolled 484 patients with diabetes who received statin treatment for more than 12 months. We included patients treated with moderate-intensity dose statin treatment (atorvastatin 10 to 20 mg/day or rosuvastatin 5 to 10 mg/day). The primary outcome was a change in estimated glomerular filtration rate (eGFR) during the 12-month statin treatment, and rapid renal decline was defined as a >3% reduction in eGFR in a 1-year period.

Results

In both statin treatment groups, patients showed improved serum lipid levels and significantly reduced eGFRs (from 80.3 to 78.8 mL/min/1.73 m2 for atorvastatin [P=0.012], from 79.1 to 76.1 mL/min/1.73 m2 for rosuvastatin [P=0.001]). A more rapid eGFR decline was observed in the rosuvastatin group than in the atorvastatin group (48.7% vs. 38.6%, P=0.029). Multiple logistic regression analyses demonstrated more rapid renal function loss in the rosuvastatin group than in the atorvastatin group after adjustment for other confounding factors (odds ratio, 1.60; 95% confidence interval, 1.06 to 2.42).

Conclusion

These results suggest that a moderate-intensity dose of atorvastatin has fewer detrimental effects on renal function than that of rosuvastatin.

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Close layer
Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital
Ye Yeon Lee, Nan Hee Cho, Jong Won Lee, Nam Kyung Kim, Hye Soon Kim, Mi-Kyung Kim
Endocrinol Metab. 2017;32(1):83-89.   Published online February 28, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.1.83
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AbstractAbstract PDFPubReader   
Background

Adrenal insufficiency (AI) is a life-threatening disorder caused by the deficiency of adrenal steroid hormones. This retrospective cross-sectional study investigated the characteristics of patients with AI in Korea.

Methods

All consecutive patients with suspected AI who received care at a tertiary referral center in Korea in 2014 and underwent adrenocorticotropic hormone stimulation or insulin-tolerance testing were identified through a review of medical charts. Patients diagnosed with AI were enrolled. Their demographic, clinical, and treatment details were extracted.

Results

Of 771 patients with suspected AI, 183 (23.7%) received a definitive diagnosis. The most common reason for testing was the presence of suspicious AI-related symptoms (30.0%), followed by a history of steroid medications (23.5%). Their mean age was 66.7 years, and females predominated (67.8%). The most common symptoms were general weakness, anorexia, arthralgia, and fever. Approximately half (53.6%) had a history of steroid use. Hydrocortisone was the most common treatment (71.6%), with most patients taking a 30 mg dose (44.2%). The most common dose frequency was twice a day (78.6%). Fourteen patients were treated for adrenal crisis (n=10, 5.5%) or an intercurrent illness (n=4, 2.2%).

Conclusion

AI may have been caused by steroid medication use in many of the patients included in this study. The detection of AI can be improved by careful history-taking and being alert to the possibility that a patient has used steroids.

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Close layer
Clinical Study
Prevalent Rate of Nonalbuminuric Renal Insufficiency and Its Association with Cardiovascular Disease Event in Korean Type 2 Diabetes
Hye Won Lee, A Ra Jo, Dong Won Yi, Yang Ho Kang, Seok Man Son
Endocrinol Metab. 2016;31(4):577-585.   Published online December 20, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.4.577
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AbstractAbstract PDFPubReader   
Background

Nonalbuminuric renal insufficiency is a unique category of diabetic kidney diseases. The objectives of the study were to evaluate prevalent rate of nonalbuminuric renal insufficiency and to investigate its relationship with previous cardiovascular disease (CVD) event in Korean patients with type 2 diabetes mellitus (T2DM).

Methods

Laboratory and clinical data of 1,067 subjects with T2DM were obtained and reviewed. Study subjects were allocated into four subgroups according to the CKD classification. Major CVD events were included with coronary, cerebrovascular, and peripheral vascular events.

Results

Nonalbuminuric stage ≥3 CKD group, when compared with albuminuric stage ≥3 CKD group, had shorter diabetic duration, lower concentrations of glycated hemoglobin, high density lipoprotein cholesterol, and high-sensitivity C-reactive protein, lower prevalent rates of retinopathy and previous CVD, and higher rate of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Nonalbuminuric stage ≥3 CKD group showed a greater association with prior CVD events than no CKD group; however, albuminuric stage ≥3 CKD group made addition to increase prevalence of prior CVD events significantly when CKD categories were applied as covariates. Association of prior CVD events, when compared with normal estimated glomerular filtration rate (eGFR) and nonalbuminuria categories, became significant for declined eGFR, which was higher for eGFR of <30 mL/min/1.73 m2, and albuminuria.

Conclusion

The results show that subjects with nonalbuminuric stage ≥3 CKD is significantly interrelated with occurrence of prior CVD events than those with normal eGFR with or without albuminuria. Comparing with normal eGFR and nonalbuminuria categories, the combination of increased degree of albuminuria and declined eGFR is becoming significant for the association of prior CVD events.

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Clinical Study
Eligibility for Statin Treatment in Korean Subjects with Reduced Renal Function: An Observational Study
Byung Sub Moon, Jongho Kim, Ji Hyun Kim, Young Youl Hyun, Se Eun Park, Hyung-Geun Oh, Cheol-Young Park, Won-Young Lee, Ki-Won Oh, Kyu-Beck Lee, Hyang Kim, Sung-Woo Park, Eun-Jung Rhee
Endocrinol Metab. 2016;31(3):402-409.   Published online August 26, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.3.402
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AbstractAbstract PDFPubReader   
Background

The purpose of this study was to investigate the relationship between statin eligibility and the degree of renal dysfunction using the Adult Treatment Panel (ATP) III and the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines in Korean adults.

Methods

Renal function was assessed in 18,746 participants of the Kangbuk Samsung Health Study from January 2011 to December 2012. Subjects were divided into three groups according to estimated glomerular filtration rate (eGFR): stage 1, eGFR ≥90 mL/min/1.73 m2; stage 2, eGFR 60 to 89 mL/min/1.73 m2; and stages 3 to 5, eGFR <60 mL/min/1.73 m2. Statin eligibility in these groups was determined using the ATP III and ACC/AHA guidelines, and the risk for 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using the Framingham Risk Score (FRS) and Pooled Cohort Equation (PCE).

Results

There were 3,546 (18.9%) and 4,048 (21.5%) statin-eligible subjects according to ATP III and ACC/AHA guidelines, respectively. The proportion of statin-eligible subjects increased as renal function deteriorated. Statin eligibility by the ACC/AHA guidelines showed better agreement with the Kidney Disease Improving Global Outcomes (KDIGO) recommendations compared to the ATP III guidelines in subjects with stage 3 to 5 chronic kidney disease (CKD) (κ value, 0.689 vs. 0.531). When the 10-year ASCVD risk was assessed using the FRS and PCE, the mean risk calculated by both equations significantly increased as renal function declined.

Conclusions

The proportion of statin-eligible subjects significantly increased according to worsening renal function in this Korean cohort. ACC/AHA guideline showed better agreement for statin eligibility with that recommended by KDIGO guideline compared to ATP III in subjects with CKD.

Citations

Citations to this article as recorded by  
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    Journal of Clinical Pharmacy and Therapeutics.2017; 42(3): 292.     CrossRef
  • Comparison between Atorvastatin and Rosuvastatin in Renal Function Decline among Patients with Diabetes
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    Endocrinology and Metabolism.2017; 32(2): 274.     CrossRef
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