The Journal of clinical endocrinology and metabolism
-
J. Clin. Endocrinol. Metab. · Aug 2011
Randomized Controlled TrialEffect of intensive insulin therapy on the somatotropic axis of critically ill children.
Intensive insulin therapy (IIT) improved outcome in the adult and pediatric intensive care unit (PICU) compared with conventional insulin therapy (CIT). IIT did not increase the anabolic hormone IGF-I in critically ill adults, but feeding in critically ill children and pediatric hormonal responses may differ. Twenty-five percent of the children with IIT experienced hypoglycemia, which may have evoked counterregulatory responses. ⋯ Despite improved PICU outcome, IIT did not counteract the catabolic state of critical illness. Suppression of portal insulin may have resulted in lower bioavailable IGF-I.
-
J. Clin. Endocrinol. Metab. · Aug 2011
Randomized Controlled Trial Comparative StudyThe effects of ronacaleret, a calcium-sensing receptor antagonist, on bone mineral density and biochemical markers of bone turnover in postmenopausal women with low bone mineral density.
Ronacaleret, a calcium-sensing receptor antagonist that stimulates PTH release from the parathyroid glands, was evaluated as an oral osteoanabolic agent for the treatment of osteoporosis. ⋯ The densitometric findings in the context of prolonged PTH elevation and increased bone turnover suggest ronacaleret induces mild hyperparathyroidism. Ronacaleret only modestly increased lumbar spine BMD and decreased BMD at hip sites.
-
J. Clin. Endocrinol. Metab. · Jul 2011
Surrogate estimates of insulin sensitivity in obese youth along the spectrum of glucose tolerance from normal to prediabetes to diabetes.
In epidemiological studies of childhood obesity, simple and reliable surrogate estimates of insulin sensitivity are needed because the gold standard, the hyperinsulinemic-euglycemic clamp, is not feasible on a large scale. ⋯ In obese adolescents with normal or impaired glucose tolerance or diabetes, OGTT-derived surrogates do not offer any advantage over the simpler fasting indices, which correlate strongly with clamp insulin sensitivity. Surrogate indices of insulin sensitivity could be used in epidemiological studies but not to define insulin resistance in individual patients or research subjects.
-
J. Clin. Endocrinol. Metab. · May 2011
Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture.
Previously undetected contributors to secondary osteoporosis and metabolic bone diseases (SECOB) are frequently found in patients with osteoporosis, but the prevalence in patients at the time they present with a clinical fracture is unknown. ⋯ At presentation with a fracture, 26.5% of patients have previously unknown contributors to SECOB, which are treatable or need follow-up, and more than 90% of patients have an inadequate vitamin D status and/or calcium intake. Systematic screening of patients with a recent fracture identifies those in whom potentially reversible contributors to SECOB and calcium and vitamin D deficiency are present.
-
J. Clin. Endocrinol. Metab. · May 2011
ReviewClinical review: Incidentally discovered medullary thyroid cancer: diagnostic strategies and treatment.
Medullary thyroid carcinoma (MTC) is diagnosed only after thyroidectomy in approximately 10-15% of cases. This delay in diagnosis can have adverse consequences such as missing underlying pheochromocytoma or hyperparathyroidism in unrecognized multiple endocrine neoplasia type 2 and choosing a suboptimal extent of surgery. Barriers to accurate preoperative diagnosis and management strategies after the discovery of occult MTC are reviewed. ⋯ Occult MTC is an uncommon, but clinically significant entity. If calcium stimulation testing cutoff data become well-validated, calcitonin screening would likely become more widely accepted in the diagnostic work-up for thyroid nodules in the United States. Among patients with incidental MTC, those with persistently elevated serum calcitonin levels, positive RET test, or nodal disease are good candidates for completion thyroidectomy and lymph node dissection in selected cases, whereas patients with undetectable calcitonin, negative RET testing, and no sonographic abnormalities often may be watched conservatively.