Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

Trabecular bone score (TBS) index has recently been obtained as a result of textural greyscale analysis of DXA images. Because it enables the assessment of bone microarchitectural texture, TBS may be useful in evaluating bone quality. This study explores the current knowledge of the use of TBS in patients with endocrine disorders with co-occurring bone structure changes. Currently, the clinical importance TBS was verified in terms of disorders of the growth hormone/insulin-like growth factor 1 (GH/IGF-I) axis, glucocorticoid excess, thyroid and parathyroid disease, as well as in diabetes mellitus type 1 and 2.It has been clarified that patients suffering from various endocrinopathies are a group in which TBS should be used routinely because it correlates with clinical factors and may improve patient management in various endocrine disorders.

Rozpuszczalne białko α-Klotho — nowy marker aktywności akromegalii?

  Introduction: Klotho is a transmembrane protein that attenuates insulin/insulin-like growth factor-1 (IGF-1) signalling and appears to be involved in ageing. Recent data suggest that soluble a-Klotho (sKlotho) is also elevated in acromegaly. The aim of this study was to assess serum levels of sKlotho in patients in relation to the activity of the disease and to compare with the control group. Material and methods: We studied 55 patients with acromegaly and 29 healthy controls (CG). Patients were divided into three subgroups according to minimal GH (growth hormone) concentration during the oral glucose tolerance test (OGTT) and the IGF-1 concentration: a surgically cured acromegalic group (SCA), well-controlled acromegalic group (WCA), and active acromegaly group (AA). In all subjects, blood samples were taken to assess the concentration of sKlotho, GH, IGF-1, and biochemical markers. Results: Soluble a-Klotho was highest in the AA group and lowest in the SCA group. The differences in sKlotho levels were statistically significant when the AA group was compared to the SCA, WCA, and CG groups (p = 0.000, p = 0.002, p = 0.001, respectively). There were no significant differences in sKlotho levels among the SCA, WCA, and CG groups. sKlotho positively correlated with GH levels in the WCA and WCA + SCA groups (r = 0.666, p = 0.009; r = 0.366, p = 0.047, respectively) and with the IGF-1 level in the AA group (r = 0.589, p = 0.021). Conclusions: sKlotho is increased in active acromegaly and normalises after successful treatment. It could be a new biomarker of acromegaly activity. (Endokrynol Pol 2016; 67 (4): 390–396)    Wstęp: Klotho to białko transbłonowe, osłabiające sygnał na szlaku insulina/insulinopodobny czynnik wzrostu-1 (IGF-1), biorące prawdopodobnie udział w procesie starzenia się organzimu. Najnowsze dane wskazują, że stężenie rozpuszczalnego białka Klotho (sKlotho) jest również podwyższone w akromegalii. Celem badania była ocena stężenia rozpuszczalnej formy białka Klotho w surowicy pacjentów chorujących na akromegalię w zależności od aktywności choroby w porównaniu z grupą kontrolną. Materiał i metody: W badaniu wzięło udział 55 pacjentów z akromegalią i 29 zdrowych pacjentów tworzących grupę kontrolną (CG). Pacjentów z akromegalią podzielono na trzy podgrupy na podstawie minimalnego stężenia hormonu wzrostu (GH) podczas testu doustnego obciążenia glukozą (OGTT), oraz stężenia IGF-1: grupa wyleczonej operacyjnie akromegalii (SCA), grupa dobrze kontrolowanej akromegalii (WCA) i grupa aktywnej akromegalii (AA). U wszystkich osób biorących udział w badaniu pobrano krew celem oznaczenia stężenia sKlotho, GH, IGF-1 i parametrów biochemicznych. Wyniki: Średnie stężenie rozpuszczalnego białka a-Klotho było największe w grupie AA, a najmniejsze w grupie SCA. Różnice stężeń sKlotho były istotne statystycznie, gdy grupę AA porównano z grupą SCA, WCA i CG (p = 0,000, p = 0,002, p = 0,001, odpowiednio). Nie stwierdzono istotnych różnic stężenia sKlotho pomiędzy pozostałymi grupami, tj. SCA, WCA i CG. sKlotho korelowało dodatnio ze stężeniem GH w grupie WCA i WCA + SCA (r = 0,666, p = 0,009; r = 0,366, p = 0,047, odpowiednio) i stężeniem IGF-1 w grupie AA (r = 0,589, p = 0,021). Wnioski: Stężenie sKlotho jest podwyższone w aktywnej akromegalii i ulega normalizacji po skutecznym leczeniu. Białko Klotho może być nowym markerem aktywności akromegalii. (Endokrynol Pol 2016; 67 (4): 390–396)

Bone densitometry by Radiofrequency Echographic Multi-Spectrometry (REMS) in acromegaly patients

Introduction: Radiofrequency echographic multi-spectrometry (REMS) is a recently introduced non-ionising technology employed in the evaluation of osteoporosis. The aim of our study was to compare bone mineral density (BMD) in acromegaly patients and healthy controls by performing novel REMS densitometry. The second objective was to analyse the correlation between results of REMS and classical dual-energy X-ray absorptiometry (DXA) in acromegaly patients. Material and methods: We enrolled 33 patients with acromegaly (AG) and 24 controls (CG). The acromegaly patients were divided into two subgroups: well-controlled acromegaly (WCA) and surgery-cured acromegaly (SCA). REMS was performed in all participants, while DXA was performed only in the acromegaly group. IGF-I and GH levels were measured in acromegaly patients. Results: Bone mineral density of the lumbar spine (LS) and the femoral neck (FN) obtained from REMS did not reveal significant differences between AG, CG, WCA, and SCA. Similarly, there were no significant differences in BMD measured by DXA at the LS and at the FN between WCA and SCA. Significant positive correlations between IGF-I concentrations and BMD obtained from both REMS and DXA were detected in the AG and WCA. In the AG and WCA, there were positive correlations between T-scores and LS BMD obtained from both methods. Conclusions: Radiofrequency echographic multi-spectrometry is a potential method in assessment of bone status in acromegaly. Further studies with participation of active disease patients are needed. Introduction: REMS (Radiofrequency Echographic Multi-Spectrometry) is a recently introduced non-ionizing technology employed in evaluation of osteoporosis. The aim of our study was to compare BMD (bone mineral density) in acromegaly patients and healthy controls by performing novel REMS densitometry. Second objective was to analyze the correlation between results of REMS and classical DXA (dual-energy X-ray absorptiometry) in acromegaly patients. Material and Methods: We enrolled 33 patients with acromegaly (AG) and 24 controls (CG). The acromegaly patients were divided into 2 subgroups: well-controlled acromegaly (WCA) and surgery-cured acromegaly (SCA). REMS was performed in all participants, while DXA only in the acromegaly group. IGF-I and GH levels were measured in acromegaly patients. Results: BMD of the lumbar spine (LS) and the femoral neck (FN) obtained from REMS did not reveal significant differences between AG, CG, WCA and SCA. Similarly, there were no significant differences in BMD measured by DXA at the LS and at the FN between WCA and SCA. Significant positive correlations between IGF-I concentrations and BMD obtained from both REMS and DXA were detected in the AG and WCA. In the AG and WCA, there were positive correlations between T-scores and LS BMD obtained from both methods. Conclusions: REMS could be a potential method in assessment of bone status in acromegaly. Further studies with participation of active disease patients are needed

Three-Dimensional Cephalometric Analysis of Skeletal and Dental Effects in Patients Undergoing Transpalatal Distraction

The present study aimed to assess dental and skeletal effects after transpalatal distraction using 3D cephalometry methodology. The study group comprised 34 patients (mean age 27.7 years) who were diagnosed with transverse skeletal maxillary deficiency of at least 7 mm. Computed tomography scans were obtained before surgical procedure (T1), after completion of expansion (T2) and at 6-month follow-up (T3). Computed tomography scans were imported into Dolphin Imaging software version 11.7 (Chatsworth, CA, USA). Three-dimensional skull models were oriented according to the Frankfurt horizontal plane, midsagittal plane (passing through the skeletal nasion) and frontal plane (passing through the right and left porion). Cephalometric landmarks related to skeletal, and dental structures were traced and linear and angular measurements were calculated. Following transpalatal distraction N-ANS and S-PNS distances increased by 1.27 mm and 0.54 mm, respectively. Skeletal expansion at the canine region (ARCR-ARCL) was 8.43 mm at T2 and 6.39 mm at T3. Expansion at the distal part of the maxilla (ARMR-ARML) was 5.95 mm at T2 and 4.81 mm after retention. The highest increase in maxillary arch width at T2 was observed at canines (8.74 mm), lower at premolars (8.33 mm) and the lowest at molars (6.76 mm). There is no anteroposterior movement of maxilla following transpalatal distraction; however, the maxilla shifts downward which is particularly marked anteriorly. Skeletal and dental expansion in the transversal plane occurs in a V-shaped manner, with more expansion at the anterior part of the maxilla

Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts

Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. Material and Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients’ baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group—levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. Conclusions: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects