Hasil untuk "Diseases of the endocrine glands. Clinical endocrinology"

Hearty C. Yao, Elaine C. Cunanan, Bien J. Matawaran et al.

Introduction: Ipswich touch test (ITT) is a simple, non-invasive test for screening risk of foot ulceration among patients with diabetes which shows similar agreement with monofilament test, however, this has not yet been verified in the local setting. Objectives: The primary objective of this study is to determine the diagnostic accuracy and agreement of face-to-face and online Ipswich touch test compared to 10-g monofilament test as reference standard. Methods: This was a cross-sectional, observational, analytical, prospective study which screened patients with diabetes for diabetic neuropathy using face-to-face, online Ipswich touch test compared to 10-g monofilament test. The primary endpoints were to determine the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and computed agreement to the 10-g monofilament test of both face-to-face and online ITT. Result: Two hundred twenty-one patients were included in the study. The sensitivity, specificity, positive and negative likelihood ratio of the online ITT, were 53.21%, 80.36%, 2.71 (95% CI: 1.79 to 4.10) and 0.58 (95% CI: 0.47 to 0.73), respectively. While the sensitivity, specificity, positive and negative likelihood ratio of the face-to face ITT, 74.31%, 73.21%, 2.77 (95% CI: 2.00 to 3.84) and 0.35 (95% CI: 0.25 to 0.49), respectively. The agreement between the 10-gram monofilament test and the face-to-face ITT was higher, with an observed agreement of 73.76% compared to the observed agreement for the 10-gram monofilament Test and the online ITT which was 66.97%. The overall accuracy of the online ITT in diagnosing peripheral neuropathy was calculated to be 66.97% (95% CI: 60.34% to 73.13%) while the overall accuracy of the F2F ITT was 73.76% (95% CI: 67.43% to 79.43%). Conclusion: The face-to-face ITT exhibited higher sensitivity and specificity, indicating a stronger diagnostic performance in detecting peripheral neuropathy among the study population. Diagnostic accuracy assessment showed that the face-to-face ITT demonstrated a moderate level of agreement with the 10-gram Monofilament Test, surpassing the online ITT, which only achieved a fair agreement level.

Vali Musazadeh, Maryam Falahatzadeh, Mahsa Mahmoudinezhad et al.

ABSTRACT Background Several meta‐analyses suggest that Coenzyme Q10 (CoQ10) supplementation is associated with glycemic control; however, findings about fasting blood glucose (FBG) and haemoglobin A1c (HbA1c) remain inconsistent across studies. Accordingly, this study aimed to synthesise the results to present a firm conclusion in relation to the efficacy of CoQ10 on glycemic control. Methods A systematic search was conducted to find meta‐analyses of randomised controlled trials using PubMed, Scopus, Web of Science and the Cochrane Database of Systematic Reviews from inception to March 6, 2025. Also, the methodological quality of included studies was evaluated using the AMSTAR2 tool. Results In total, eight meta‐analyses were included in this umbrella systematic review and meta‐analysis. Pooled analysis using standardized mean difference analysis demonstrated that CoQ10 is associated with decreased FBG. While it didn't exert any significant changes on the HbA1c, HOMA‐IR, and insulin levels. In addition, the combined effect of CoQ10 using weighted mean difference analysis revealed that CoQ10 is able to decrease the FBG (5.04 mg/dL), HbA1c (0.17%), HOMA‐IR (0.72), and insulin (1.32 μIU/mL) levels significantly. Conclusion The present study suggests that CoQ10 supplementation may have a moderate beneficial effect on glycemic control in diabetic patients, though findings differ depending on analytic approach.

Yejuan Li, Jiajia Hu, Hui Lu et al.

ObjectiveTo investigate the impact of smooth endoplasmic reticulum aggregates (SERa) in oocytes on embryological outcomes and clinical and neonatal outcomes during split IVF-ICSI cycles.MethodsA retrospective analysis was conducted using clinical data from January 2020 to December 2023 at the Reproductive Medicine Center of Hainan Women and Children’s Medical Center. Patients were divided into SERa+ and SERa- cycles based on the visibility of SERa after the removal of cumulus cells. Basic patient characteristics, embryological outcomes, clinical and neonatal outcomes were compared between the two groups.ResultsCompared to the SERa- cycles, the SERa+ cycles showed significantly higher levels of E2 on the day of hCG administration (P<0.01) and a significantly increased number of retrieved oocytes (P<0.01). In terms of embryological outcomes, the total D3 high-quality embryo rate was significantly higher in the SERa+ cycles (P<0.01). There was a significant increase in the D3 high-quality embryo rate for ICSI, but no difference in the D3 high-quality embryo rate for IVF. No significant differences were observed between the SERa+ and SERa- cycles in terms of βhCG positivity rate, clinical pregnancy rate, implantation rate, early miscarriage rate, live birth rate, preterm birth rate, newborn height, and weight (P>0.05). No congenital birth defects were found in either group.ConclusionThe occurrence of SERa in split IVF-ICSI cycles may be associated with increased E2 levels on hCG day, and the presence of SERa does not appear to affect in vitro fertilization, embryological, clinical, or neonatal outcomes.

Bing Zhao, Miaomiao Zhang, Zhiyu Zhang et al.

Objective: The aim of this study was to determine serum I-309 levels in type 2 diabetes mellitus (T2DM) patients, as well as the association with clinical/laboratory phenotypes and disease complications. Methods: A total of 155 T2DM patients and 30 healthy controls (HC) were enrolled. The concentrations of serum I-309, interleukin-4 (IL-4), IL-6, IL-10, IL-12, IL-17, IL-23, tumor necrosis factor-α (TNF-α), and interferon (IFN)-γ were measured. The relationships between I-309 and various clinical and laboratory variables were analyzed. Results: The serum concentrations of I-309 were significantly higher in T2DM patients than in HC (P < 0.001). The serum I-309 levels were significantly elevated in T2DM patients with diabetic kidney disease (DKD), hypertension, coronary artery disease, peripheral neuropathy, peripheral artery disease, and diabetic ketosis (all P < 0.05), but reduced in drinkers (P = 0.018). The Spearman analysis showed that serum I-309 correlated positively with age, disease duration, CKD stages, urea, creatinine, urinary albumin-to-creatinine ratio, C-reactive protein, red blood cell distribution width, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, IL-6, IL-12, and IFN-γ, but negatively with estimated glomerular filtration rate (eGFR), fasting blood glucose, total bilirubin, albumin, lymphocyte count, red blood cell count, and hemoglobin. The multiple linear regression analysis indicated that serum I-309 was independently correlated only with eGFR and IFN-γ. The multivariate logistic regression analysis demonstrated that serum I-30 and IL-17A remained independently associated with DKD. Conclusion: Serum I-309 is markedly elevated in T2DM patients and is associated with increased DKD risk, suggesting its potential role as both a promising biomarker and a pathogenic mediator in the progression of T2DM, particularly DKD.

Mahsa Maghalian, Mojgan Mirghafourvand

Abstract Background Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap. Methods This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis. Results The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD − 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD − 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD − 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD − 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function. Conclusion Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

Yunfeng Yu, Xinyu Yang, Gang Hu et al.

ObjectiveThe effect of tea on gout and uric acid is still controversial. This study aims to analyze the effect of tea intake on genetic predisposition to gout, idiopathic gout, gout due to impairment of renal function as well as uric acid by Mendelian randomization (MR).MethodsForty independent single nucleotide polymorphisms (SNPs) associated with tea intake were selected from UK Biobank. SNPs for uric acid were obtained from BioBank Japan, SNPs for gout were obtained from UK Biobank, and SNPs for gout due to impairment of renal function and idiopathic gout were derived from FinnGen. The causal relationship of exposure-outcome was tested using inverse variance weighted, MR-Egger and weighted median. MR-Egger intercept was employed to assess horizontal pleiotropy, Cochran’s Q test was used to assess heterogeneity, and leave-one-out sensitivity analysis was utilized to analyze the stability of the results.ResultsThe results of MR analysis showed that tea intake was negatively associated with gout due to impairment of renal function (OR 0.997, 95% CI 0.994 to 0.999, P = 0.017), whereas there was no causal association with gout, idiopathic gout, and uric acid (P &gt; 0.05), for which sensitivity analysis suggested that these results were robust.ConclusionsThere was a genetic predisposition effect of increased tea intake on the reduced risk of gout due to impairment of renal function, whereas there was no such effect on gout, idiopathic gout, and uric acid. Tea intake may become an important option in the dietary treatment of gout due to impairment of renal function.

Daniel Cuevas-Ramos, Alfredo A. Reza-Albarrán, José M. Hinojosa-Amaya et al.

Antecedentes: La deficiencia de arginina-vasopresina central, antes llamada diabetes insípida, se refiere a la deficiencia parcial o total de la síntesis y/o secreción de esta hormona por diferentes causas. Objetivo: Actualizar los cambios en el tratamiento médico para pacientes adultos. Método: Se realizó distribución de los temas entre los miembros del grupo y mediante reuniones virtuales para llevar a cabo la revisión sistemática de la literatura. Resultados: Se actualiza el abordaje terapéutico más adecuado para los pacientes con deficiencia de arginina-vasopresina central. Conclusiones: Este posicionamiento permite la actualización en el tratamiento médico de la deficiencia de arginina-vasopresina central.

Ying Hao, Ningning Yang, Mengying Sun et al.

Osteoporosis, a systemic skeletal disorder marked by diminished bone mass and compromised bone microarchitecture, is becoming increasingly prevalent due to an aging population. The underlying pathophysiology of osteoporosis is attributed to an imbalance between osteoclast-mediated bone resorption and osteoblast-mediated bone formation. Osteoclasts play a crucial role in the development of osteoporosis through various molecular pathways, including the RANK/RANKL/OPG signaling axis, cytokines, and integrins. Notably, the calcium signaling pathway is pivotal in regulating osteoclast activation and function, influencing bone resorption activity. Disruption in calcium signaling can lead to increased osteoclast-mediated bone resorption, contributing to the progression of osteoporosis. Emerging research indicates that calcium-permeable channels on the cellular membrane play a critical role in bone metabolism by modulating these intracellular calcium pathways. Here, we provide an overview of current literature on the regulation of plasma membrane calcium channels in relation to bone metabolism with particular emphasis on their dysregulation during the progression of osteoporosis. Targeting these calcium channels may represent a potential therapeutic strategy for treating osteoporosis.

Alfonso Lendínez‐Jurado, Ana Gómez‐Perea, Ana B. Ariza‐Jiménez et al.

Abstract Background In recent years, technological advances in the field of diabetes have revolutionized the management, prognosis, and quality of life of diabetes patients and their environment. The aim of our study was to evaluate the impact of implementing the MiniMed 780G closed‐loop system in a pediatric and adolescent population previously treated with a continuous subcutaneous insulin infusion pump and intermittent glucose monitoring. Methods Data were collected from 28 patients with type 1 diabetes aged 6 to 17 years, with a follow‐up of 6 months. We included both glucometric and quality of life variables, as well as quality of life in primary caregivers. Metabolic control variables were assessed at baseline (before system change) and at different cutoff points after initiation of the closed‐loop system (48 hours, 7 days, 14 days, 21 days, 1 month, 3 months, 6 months). Results Time in range 70–180 mg/dL increased from 59.44% at baseline to 74.29% in the first 48 hours after automation of the new system, and this improvement was maintained at the other cutoff points, as was time in hyperglycemia 180–250 mg/dL (24.44% at baseline to 18.96% at 48 hours) and >250 mg/dL (11.71% at baseline to 3.82% at 48 hours). Conclusions Our study showed an improvement in time in range and in all time spent in hyperglycemia from the first 48 hours after the automation of the system, which was maintained at 6 months.

Borros Arneth

<b>Specific</b> critical functions of endocrine and immune cells ensure that an individual remains healthy and free from infection. This study aimed to explore immune–endocrine associations involved in disease. <b>Methods:</b> The PsycINFO, PubMed, Web of Science, and CINAHL databases were searched for relevant articles using the following search terms and phrases: “hormones”, “hormonal responses”, “immune system”, “endocrine system”, “infection”, “immune cells”, “endocrine cells”, “infection”, “immune”, “endocrine”, and “interactions”. The search was limited to articles published between 2009 and 2023. <b>Results: A review of ninety-three studies</b> showed that metabolic activity levels in the body as well as energy consumption patterns are affected by feedback loops that connect the endocrine and immune systems. The associations between endocrine cells and immune cells are complex and involve a wide range of hormones, molecules, and receptors related to antipathogen responses and metabolic regulation. <b>Conclusions:</b> During infection, endocrine cells and immune cells interact via feedback loops to ensure optimal energy utilization and a timely response to pathogens. Therefore, the endocrine system helps to regulate systemic metabolism while controlling the outcomes of regulatory elements of the immune system.

Jordan S. Sherwood, Jagdeesh Ullal, Katherine Kutney et al.

Johanna K. Ihalainen, Ida Löfberg, Anna Kotkajuuri et al.

Sex hormones are suggested to influence energy intake (EI) and metabolic hormones. This study investigated the influence of menstrual cycle (MC) and hormonal contraceptive (HC) cycle phases on EI, energy availability (EA), and metabolic hormones in recreational athletes (eumenorrheic, NHC = 15 and monophasic HC-users, CHC = 9). In addition, 72-h dietary and training logs were collected in addition to blood samples, which were analyzed for 17β-estradiol (E2), progesterone (P4), leptin, total ghrelin, insulin, and tri-iodothyronine (T3). Measurements were completed at four time-points (phases): Bleeding, mid-follicular (FP)/active 1, ovulation (OVU)/active 2, mid-luteal (LP)/inactive in NHC/CHC, respectively. As expected, E2 and P4 fluctuated significantly in NHC (<i>p</i> < 0.05) and remained stable in CHC. In NHC, leptin increased significantly between bleeding and ovulation (<i>p</i> = 0.030) as well as between FP and OVU (<i>p</i> = 0.022). No group differences in other measured hormones were observed across the MC and HC cycle. The mean EI and EA were similar between phases, with no significant differences observed in macronutrient intake over either the MC or HC. While the MC phase might have a small, but statistically significant effect on leptin, the findings of the present study suggest that the MC or HC phase does not significantly alter ad libitum EI or EA in recreational athletes.

Tania Mayvel Espinosa Reyes, Teresa Collazo Mesa, Paulina Arasely Lantigua Cruz et al.

Background. There are several studies that show a good genotype-phenotype correlation in congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD). However, there is well-documented evidence of inconsistency in some cases. Objectives. To determine if there is a correlation between the identified mutations and the clinical manifestations of 21OHD in the Cuban population. Methods. A cross-sectional descriptive study of all patients referred for a molecular diagnosis of 21OHD in Cuba from January 2000 to December 2018. The clinical manifestations of each patient were identified and classified according to the phenotype. The CYP21A2 gene was analyzed for the presence of 5 point mutations involved in the pathogenesis of 21OHD (intron 2, deletion of 8bp, I172N, P30L, and Q318X); correlation was sought between the phenotypic characteristics and the frequencies of point mutations in the patients using the Spearman test. Results. A total of 55 patients underwent direct analysis of the CYP21A2 gene in order to determine the presence of the 5 point mutations. Point mutations were identified in 31 patients, which corresponded to 56%. A statistically significant genotype-phenotype correlation was found. Conclusions. The correlation between the detected molecular defect and the clinical expression of 21OHD was reasonable in the Cuban population, which could allow phenotypic predictions to be made from the genotype.

R. Gunda, X. Tyler, S. Rehman

Abstract Introduction: Thyroid swellings are one of the most common encountered endocrinological presentations however the prevalence of malignancy is about 4-6.5%. Hodgkin lymphomas usually present as neck swelling in form lymphadenopathy and Hodgkin disease affecting the thyroid gland is extremely rare (1-2.5% of all lymphomas). It usually occurs in middle age and has predilection for female gender. It can pose a diagnostic challenge with the histology of sclerosing fibrosis mimicking Riedel’s thyroiditis; another rare cause of stony hard goitre. Case History: A 39yr old female presented with rapidly enlarging painful thyroid mass. She complained of mild dysphagia but denied to have dyspnoea, dysphonia wheeze or stridor. There was no history of weight loss, B symptoms or any significant past illness. Clinically and biochemically she was euthyroid with normal TSH 0.73mU/l(0.35-3.50), Free thyroxine 13pmol/L (8-21), Free T3 3.9pmol/L (3.8-6.0). Blood count showed mild neutrophilia 8.21 (2-7x109/L). IGG subclasses 1-4 were all with normal limits. Initial Ultrasonography demonstrated 4.6 X 3.6cm U3 thyroid nodule extending retrosternally. FNA x2 was THY. Core biopsy demonstrated dense core of fibrous tissue with crushed aggregates of mature lymphoid cells and mixed neutrophils and histiocytes in keeping with fibro inflammatory process suggestive of Riedel’s thyroiditis. Patient was initiated on Prednisolone 100mg OD by the ENT surgeons after MDT discussion and patient had some symptomatic improvement in pain but no discernible reduction in size. Due to side effects from steroids she was referred to endocrinology department. Tamoxifen 20mg BD was started for symptom management. CTNCAP was organised to rule out lymphoproliferative disorder which was negative barring the known thyroid mass. She had no response to Tamoxifen either hence she underwent surgical resection. Surgical resection deemed very difficult due to mass infiltrating the strap muscles and neck vasculature hence wedge resection of the isthmus was done. Histology now revealed bands of dense fibrous tissue with admixed large lymphoid cells showing enlarged, red nucleoli. Immunohistochemistry of the large atypical lymphoid cells expressed CD30, CD15, MUM1, PAX5, CD20, CD79a and BCL6 and diagnosis was revised to Classic Hodgkin lymphoma, nodular sclerosis subtype. She was then referred to haematologist who initiated ABVD chemotherapy and her latest FDG PET scan shows complete metabolic response with significant reduction in the thyroid mass to 17mm X16 mm. Conclusion: Primary thyroid lymphoma can mimic Riedel’s and other forms of fibrosing thyroiditis. Most lymphomas arise from Hashimoto’s thyroiditis. Stony hard neck swellings are difficult to FNA and even core biopsy may not reveal the diagnosis, hence surgical resection and histological diagnosis should be sought earlier as most lymphomas respond well to chemotherapy.

Jahangir Moini, Craig Badolato, Raheleh Ahangari

Caroline Johns, Natalia Weare-Regales, C. P. Fernandez et al.

Abstract Unusual Presentation of Central Diabetes Insipidus in a Patient with Crohn’s disease Introduction Autoimmune hypophysitis is defined as an inflammatory condition of the pituitary gland of autoimmune etiology that leads to pituitary dysfunction. There are three different histopathological categories of inflammatory hypophysitis including lymphocytic, granulomatous, and xanthomatous hypophysitis. Although, an autoimmune link has been suggested for lymphocytic hypophysitis (LH), the pathogenesis of autoimmune hypophysitis is still incompletely defined. The co-existence of LH and Crohn’s is a rare combination with only a few case reports in the literature. Case presentation We present a 39-year-old female with history of Crohn’s disease who presented to the ED with abdominal pain, poor oral intake and headaches. Lab work showed hypernatremia. A neck CT incidentally noted a nodular density along the superior aspect of the pituitary gland. A focused MRI of the pituitary showed abnormal thickening of the pituitary stalk with a prominent and heterogeneous gland. Endocrinology was consulted and on interview patient reported chronic headaches, polyuria and polydipsia for the past year, worsening over the past month. She denied any visual disturbances. Labs showed Na 159, K+ 4.0, serum osmolality 307, urine osmolality 178, specific gravity urine 1.006, cortisol 18, FSH 1.26, LH 0.12, prolactin 55, TSH 1.45 and free T4 0.84. Patient diagnosed with Diabetes Insipidus (DI) from LH and was started on PO desmopressin. Unfortunately, patient continued to have hypernatremia and increased urine output despite increases in the dose and frequency of the oral desmopressin. Given no clinical improvement, decision was made to switch from PO to IV desmopressin considering malabsorption of PO medication in the setting of Crohn’s disease. DI labs including plasma sodium, plasma osmolality, urine osmolality, specific gravity of urine and urine output were closely monitored. Patient’s hypernatremia and increased urine output started to improve with the switch to IV and was ultimately discharged home with intranasal desmopressin. Discussion Lymphocytic hypophysitis is a rare disorder predominantly affecting females during the antepartum or postpartum period. This case illustrates the importance of considering its presence in the setting of other autoimmune conditions. It also serves to illustrate the complex management and decision making followed in adjusting the desmopressin formulation in the setting of a malabsorptive disease such as Crohn’s.

Kevin Fasing, Mark Weiner, Daniel J Rubin

Introduction Patients with diabetes are at greater risk of hospital readmission than patients without diabetes. There is a need to identify more modifiable risk factors for readmission as potential targets for intervention. Cardiorespiratory fitness is a predictor of morbidity and mortality. The purpose of this study was to examine whether there is an association between exercise capacity based on the maximal workload achieved during treadmill stress testing and readmission among patients with diabetes.Research design and methods This retrospective cohort study included adult patients with diabetes discharged from an academic medical center between July 1, 2012 and December 31, 2018 who had a stress test documented before the index discharge. Univariate analysis and multinomial multivariable logistic regressions were used to evaluate associations with readmission within 30 days, 6 months, and 1 year of discharge. Exercise capacity was measured as metabolic equivalents (METs).Results A total of 580 patients with 1598 hospitalizations were analyzed. Mean METs of readmitted patients were significantly lower than for non-readmitted patients (5.7 (2.6) vs 6.7 (2.6), p&lt;0.001). After adjustment for confounders, a low METs level (&lt;5) was associated with higher odds of readmission within 30 days (OR 5.46 (2.22–13.45), p&lt;0.001), 6 months (OR 2.78 (1.36–5.65), p=0.005), and 1 year (OR 2.16 (1.12–4.16), p=0.022) compared with medium (5–7) and high (&gt;7) METs level. During the 6.5-year study period, patients with low METs had a mean of 3.2±3.6 hospitalizations, while those with high METs had 2.5±2.4 hospitalizations (p=0.007).Conclusions Lower exercise capacity is associated with a higher risk of readmission within 30 days, 6 months, and 1 year, as well as a greater incidence of hospitalization, in patients with diabetes. Future studies are needed to explore whether exercise reduces readmission risk in this population.

Kristen Lavelle, K. Kirkeby

Abstract Introduction It is well-established that estrogen-containing oral contraceptives can raise serum cortisol levels and yield false-positive results on dexamethasone suppression testing, however it is less known that they can raise urinary free cortisol levels by an unknown mechanism. Case presentation A 47-year old woman taking microgestin 1/20 oral contraceptive (OC) was found incidentally to have osteopenia on chest X-ray. Subsequent DEXA scan demonstrated osteoporosis. During the work-up to determine the underlying etiology of her osteoporosis, she underwent a 24-hour urinary free cortisol, which was 207 ug/24 hours (0-50 ug/24 hours). Serum cortisol was 40.1 (6.2-19.4 ug/dL) and overnight 1mg dexamethasone suppression test yielded a cortisol of 2.7. After one week off her OC, serum cortisol was 24.6. After five weeks off her OC, urinary free cortisol was 19 and 1mg dexamethasone suppression test yielded a cortisol of 0.8. On exam, the patient did not have any cushingoid features. MRI of the brain showed a small hypoenhancing lesion, which was determined by neurosurgery to be insignificant. Ultimately, the cause of her osteoporosis was thought to be likely secondary to vitamin D deficiency and calcium malabsorption due to celiac disease. Discussion The biochemical diagnosis of hypercortisolism during treatment with estrogen-containing OCs remains a challenge. Prior studies have demonstrated that serum cortisol levels are typically elevated during OC use and that 1mg dexamethasone suppression testing may yield false-positive results in more than 50% of cases. This is thought to be due to an increase in the major binding protein for cortisol, corticosteroid-binding globulin. Although it is commonly thought that OCs do not affect urinary free cortisol measurements, a recent study showed that more than one-third of women taking OCs had a mild elevation of urinary free cortisol. There are a few hypotheses for the mechanism by which OC use leads to elevated urinary free cortisol, including direct effect on steroidogenesis in the adrenal glands. Our patient had a significantly elevated 24-hour urinary free cortisol and an equivocal 1mg dexamethasone suppression test while on OCs that normalized with OC discontinuation. Further, serum cortisol decreased with OC discontinuation. Conclusion The 24-hour urinary free cortisol level may be altered by oral contraceptive use and is therefore not a valid tool to evaluate for hypercortisolism in women on OCs. References Nickelsen T, et al. (1989). The dexamethasone suppression test and long-term contraceptive treatment. Experimental and Clinical Endocrinology, 94, 275–280. Paschali M, et al. (2013). False positives on both dexamethasone testing and urinary free cortisol in women on oral contraception. Clin Endocrinol, 79, 443-445. Trainer PJ. (2002). Corticosteroids and pregnancy. Seminars in Reproductive Medicine, 20, 375–280.

María José Pomares

Patients on hemodialysis often have more urinary tract infections (UTIs) due to immunosuppression, lack of germ removal, presence of lithiasis, neurogenic bladder, abnormalities in the urinary tract, use of intravenous catheters and urinary catheters. The antibiotics used in the treatment of UTIs in the general population can be used in hemodialysis patients with the corresponding adjustment of dose. UTI is the most common bacterial infection in kidney transplant recipients due to factors such as immunosuppressive therapy, UTIs prior to transplantation, vesicoureteral reflux, polycystic kidney disease, diabetes, prolonged use of urinary catheters, delay in graft function, episodes of acute rejection, recurrent asymptomatic bacteriuria and lack of antibiotic prophylaxis. They occur mainly in the immediate post-surgery period and the first months after transplant. The recurrence of UTIs or AB episodes can trigger acute rejection.