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

Ploypun Narindrarangkura, Siroj Dejhansathit, Uzma Khan et al.

Abstract BackgroundOlder adults with diabetes frequently access their electronic health record (EHR) notes but often report difficulty understanding medical jargon and nonspecific self-care instructions. To address this communication gap, we developed Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered, EHR-integrated diabetes self-management support tool designed to embed tailored educational statements within the assessment and plan section of clinical notes. ObjectiveThis study aimed to validate the clarity, relevance, and alignment of SEE-Diabetes content with the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework from the perspectives of older adults and clinicians. MethodsAn interdisciplinary team conducted expert reviews and qualitative interviews with 11 older adults with diabetes and 8 clinicians practicing in primary care (family medicine) and specialty diabetes care settings at a Midwestern academic health center. Patients evaluated the readability and relevance of the content, while clinicians assessed clarity, sufficiency, and potential clinical utility. Interview data were analyzed using inductive thematic analysis, and descriptive statistics were used to summarize participant characteristics. ResultsPatients (mean age 72, SD 4.9 y; mean diabetes duration 26, SD 15 y) reported that the SEE-Diabetes statements were clear, relevant, and written in plain language that supported understanding of self-care recommendations. Clinicians (mean 13, SD 9.5 y of diabetes care experience) viewed the content as concise, clinically appropriate, and well aligned with patient self-management goals and the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework. Both groups identified the tool’s potential to enhance patient engagement and patient-clinician communication, while noting opportunities to improve the specificity of language, particularly within medication-related content. ConclusionsSEE-Diabetes demonstrated content validity as a practical, patient-centered digital health tool for supporting diabetes self-management communication within EHR clinical notes. The findings support its use as a complementary approach to reinforce self-care communication in routine clinical practice and highlight areas for refinement to enhance personalization.

Erik Bényei, Federica Begalli, Márta Korbonits

Serin Hong, Byung Soo Kong, Hyunsuk Lee et al.

Background The prevalence of type 2 diabetes mellitus (T2DM) increases with age, and cellular senescence of pancreatic β-cells plays a key role in T2DM pathogenesis. As canagliflozin and acarbose have been shown to increase lifespan in mice, we investigated the effect of sodium-glucose cotransporter 2 (SGLT2) inhibitor, α-glucosidase inhibitor or both on the cellular senescence of β-cells in a T2DM mouse model. Methods Enavogliflozin (0.3 mg/kg), acarbose (10 mg/kg), or vehicle was orally administered daily to db/db mice for 6 weeks. The levels of senescence markers (p16, p21, and p53) in the pancreas and kidney were measured through real-time polymerase chain reaction (PCR), immunofluorescence staining, and Western blot. In an in vitro analysis, isolated pancreatic islets were exposed to H2O2 to induce cellular senescence, then treated with β-hydroxybutyrate (β-HB), and subsequently assessed for levels of senescent markers. Results Enavogliflozin alone or combined with acarbose effectively lowered blood glucose levels in db/db mice. The combined treatment resulted in the greatest increase in β-cell function calculated using insulinogenic index and homeostasis model assessment of β-cell function compared to the vehicle. Additionally, the combined treatment significantly reversed the increase in p16, with a similar trend observed in p21 and p53 in the islets. Treatment increased circulating β-HB and in vitro analysis suggested the activation of nuclear factor erythroid 2-related factor 2 (Nrf2) by β-HB in reducing senescence in the islets. Conclusion The combined administration of enavogliflozin and acarbose significantly reduced blood glucose, improved β-cell function, and reduced senescent β-cells in db/db mice. This combination therapy holds potential as a senotherapeutic strategy for managing T2DM.

Muhadasi Tuerxunyiming, Muhadasi Tuerxunyiming, Qing Zhao et al.

BackgroundChanges in certain metabolites are linked to an increased risk of type I diabetes (T1D), making metabolite analysis a valuable tool for T1D diagnosis and treatment. This study aimed to identify a metabolic signature linked with T1D.MethodsUntargeted metabolomic profiling was performed using liquid chromatography–mass spectrometry (LC-MS) on peripheral blood samples from T1D patients (n = 45) and healthy controls (n = 40). Data preprocessing and quality control were conducted using MetaboAnalyst 4.0. Differential metabolites (DMs) were identified via Wilcoxon rank-sum test (P< 0.05), and key diagnostic markers were selected using least absolute shrinkage and selection operator (LASSO) regression. A streptozotocin (STZ)-induced diabetic rat model was used for in vivo validation.ResultsA total of 157 annotated metabolites were detected (58 in ESI− and 99 in ESI+ mode). Twenty-six DMs were identified, including 25 upregulated and 1 downregulated in the T1D group, mainly involving Acylcarnitines and xanthine metabolites. LASSO regression selected Hydroxyhexadecanoyl carnitine, Propionylcarnitine, and Valerylcarnitine as candidate markers. In the rat model, Hydroxyhexadecanoyl carnitine and Valerylcarnitine demonstrated strong diagnostic performance, with AUCs of 0.9383 (95% CI: 0.8786–0.9980) and 0.8395 (95% CI: 0.7451–0.9338), respectively (P< 0.01).ConclusionHydroxyhexadecanoyl carnitine and Valerylcarnitine are closely linked to altered lipid oxidation in T1D and show strong potential as diagnostic biomarkers. These findings provide new insights into the metabolic basis of T1D and offer promising targets for early detection.

N.M. Gromnatska, Yu.V. Marushko, T.V. Hyshchak et al.

Background. The prevalence of obesity in children has a trend of constant growth. A third of the pediatric population suffers from excess body weight and obesity, which are associated with such pathological conditions as hypertension, insulin resistance, hyperglycemia, type 2 diabetes, dyslipidemia, metabolic syndrome (MS) and early cardiovascular dysfunction. Waist circumference (WC) measurement is a simple noninvasive screening tool to identify children with abdominal obesity, MS, and increased cardiovascular risk. The purpose of the study was to develop age- and gender-specific WC percentiles for Ukrainian children aged 10–17 years and to determine possible WC cut-offs for detecting abdominal obesity. Materials and methods. 1566 children aged 10–17 were examined, 759 boys and 807 girls. According to the WHO protocol, WC was measured using a flexible centimeter tape in a standing position midway between the lower rib and the upper front edge of the ilium. The threshold point for detecting abdominal obesity was WC ≥ 90th percentile of the distribution according to age and sex (IDF Consensus, 2007). Results. Age and gender percentiles of WC and cut-off at the level of the 90th percentile in Ukrainian children and adolescents are presented. The importance of gender assessment of WC lies in the reliable difference of indicators in children aged 10–12 and 15–17 years and growth of parameters with age in both boys and girls. The need for age assessment of WC is due to increasing the 90th percentile indicators in girls aged 10–17 from 76 to 90.5 cm and in boys from 75.9 to 94 cm. The data obtained can serve as a source for screening and identifying children with abdominal obesity, increased metabolic risk and a better understanding of current trends in childhood obesity. It has been suggested that new WC reference values should be added to clinical examinations to help pediatricians and family physicians reduce cardiovascular risk in children. Conclusions. In the diagnosis of MS in children, it is recommended to use the proposed specific percentiles of WC for sex and age, the values of which ≥ 90th percentile of the distribution should be utilized for detection of abdominal obesity and further diagnosis of MS. Measuring and evaluating WC in routine pediatric examinations is important.

Othmar Moser, Othmar Moser, Othmar Moser et al.

Divya Rana, Rajesh Kumar, Ravi Kant

Background and Aims: Patients with type 2 diabetes mellitus (T2DM) need a high degree of self-care behavior, treatment adherence, and good psychological health. Psychological health play a vital role in adherence to treatment regimen and self-management of diabetes. This study aims to identify the psychological predictors of self-care behaviors among patients with T2DM. Methods: A descriptive cross-sectional survey was conducted at a diabetic clinic at a tertiary care hospital in North India. Structured pre-tested personal and clinical profile and self-efficacy, diabetes distress, depression and anxiety, and complications and fear of developing hypoglycaemia due to diabetes mellitus in the future are measured through standardized questionnaires. Results: The mean age of the participants was 53.5 (±3.68) years, and 41.4% were in the overweight (BMI: 25.0–29.9) and obese (16.7%, BMI > 30) category. Self-care behaviours found significant association with self-efficacy (r = 0.34, P < 0.001), anxiety (r = −0.28, P < 0.001), depression (r = −0.28, P < 0.001) and diabetes-related distress (r = −0.30, P < 0.001). Further, self-efficacy (P = 0.001), diabetes distress (P < 0.001) and fear of developing hypoglycaemia (P < 0.001) were reported independent predictors of self-care behaviour in patients with T2DM. Conclusions: The current study suggests that self-efficacy, fear of hypoglycaemia and emotional state played an important role in adherence to self-care behaviour in T2DM management. Patients with diabetes mellitus should be routinely screened for psychological factors at diabetes clinics. Thus, developing tailored interventions to raise belief and self-efficacy might be a useful way to increase the involvement of patients in treatment.

Lingning Huang, Peiwen Wu, Yongze Zhang et al.

Abstract Aims/Introduction To assess the relationship between type 2 diabetes mellitus onset age and vascular complications in China. Materials and Methods A retrospective review of 3,568 patients with type 2 diabetes mellitus using a propensity score‐matched (PSM) cohort analysis was carried out in two different age of onset groups (age 40 and 60 years). These groups were then subdivided into two groups, early‐onset diabetes (EOD40 and EOD60; the onset age before 40 and 60 years, respectively) and late‐onset diabetes (LOD40 and LOD60: the onset age after 40 and 60 years, respectively). Macrovascular and microvascular complications were analyzed before and after PSM. Results Patients categorized in both the early‐onset disease (EOD) groups had a higher risk of developing macro‐ and microvascular complications before PSM. After PSM, no differences existed between the EOD and late‐onset disease groups in the risk of macrovascular complications. Compared with the late‐onset disease group, the odds ratio of having a microvascular complication of diabetic retinopathy, chronic kidney disease and diabetic peripheral neuropathy in the 40‐year‐old EOD group increased to 2.906, 1.967 and 1.672 (P < 0.05), respectively. The odds ratio of diabetic retinopathy and diabetic peripheral neuropathy in the 60‐year‐old EOD group was 1.763 and 1.675 (P < 0.05), respectively. Conclusions The earlier the onset of type 2 diabetes mellitus, the higher risk of microvascular, but not necessarily macrovascular, complications. It is not too late to prevent diabetes at any age. Pre‐emptive microvascular treatment or preventative measures in EOD patients who do not yet show symptoms, might be beneficial.

Lucas Sosa

Prediabetes is an intermediate stage between normal blood glucose and diabetes and has a high prevalence, especially in older age groups and obese people. Five different definitions are currently used, based on cut-off points for HbA 1C, fasting glucose, and 2-hour glucose. The risks attributable to prediabetes, including diabetes, are related to micro and macrovascular complications, neuropathic complications, cardiorenal diseases, cancer, and death (depending on the definition used). Data on the worldwide prevalence of prediabetes are incomplete. The International Diabetes Federation (2019) estimated the global prevalence of impaired glucose tolerance at 7.5%. Most people with prediabetes (72.2%) reside in low- and middle-income countries.

Yongsheng Mei, Bingzi Dong, Zhuang Geng et al.

Uric acid (UA) is the final product of purine metabolism in the human body, and impaired purine metabolism can increase the uric acid in serum, finally resulting in hyperuricemia (HUA). Current evidences suggest that urates might have antioxidant properties under certain circumstances, but most evidences suggest that urates promote inflammation. Hyperuricemia leads to the formation of urate crystals, which might be recognized as a red flag by the immune system. Such a response stimulates macrophage activation, leads to the activation of NOD-like receptor protein 3 (NLRP3) inflammasome vesicles, and ultimately the production and liberation of interleukin-1b (IL-1b) and interleukin-18 (IL-18), which can mediate inflammation, apoptosis and necroinflammation and cause an inflammatory cascade response. The kidney is one of the most commonly affected organs in HUA, which promotes the development of chronic kidney disease (CKD) by damaging endothelial cells, activating the renin-angiotensin system (RAS), and promoting inflammatory responses. Pharmacological interventions and lifestyle modifications are the primary means for controlling gout and lowering UA. The febuxostat is safe for CKD patients in the UA lowering therapy. Although dialysis can reduce UA levels, the application of drug is also necessary for dialysis patients. This article reviews the synthesis and metabolism of UA, etiology of HUA, the relationship between HUA and kidney disease, the treatment of gout and gouty nephropathy (GN).

Matteo Spaziani, Matteo Spaziani, Chiara Tarantino et al.

The role of growth hormone (GH) during childhood and adulthood is well established. Once final stature is reached, GH continues to act during the transition, the period between adolescence and adulthood in which most somatic and psychological development is obtained. The achievement of peak bone mass represents the most relevant aspect of GH action during the transition period; however, equally clear is its influence on body composition and metabolic profile and, probably, in the achievement of a complete gonadal and sexual maturation. Despite this, there are still some aspects that often make clinical practice difficult and uncertain, in particular in evaluating a possible persistence of GH deficiency once final stature has been reached. It is also essential to identify which subjects should undergo re-testing and, possibly, replacement therapy, and the definition of unambiguous criteria for therapeutic success. Moreover, even during the transition phase, the relationship between GH substitution therapy and cancer survival is of considerable interest. In view of the above, the aim of this paper is to clarify these relevant issues through a detailed analysis of the literature, with particular attention to the clinical, diagnostic and therapeutic aspects.

Yuqi Guo, Sun Wook Cho, Deepak Saxena et al.

Since the identification of succinate's receptor in 2004, studies supporting the involvement of succinate signaling through its receptor in various diseases have accumulated and most of these investigations have highlighted succinate's pro-inflammatory role. Taken with the fact that succinate is an intermediate metabolite in the center of mitochondrial activity, and considering its potential regulation of protein succinylation through succinyl-coenzyme A, a review on the overall multifaceted actions of succinate to discuss whether and how these actions relate to the cellular locations of succinate is much warranted. Mechanistically, it is important to consider the sources of succinate, which include somatic cellular released succinate and those produced by the microbiome, especially the gut microbiota, which is an equivalent, if not greater contributor of succinate levels in the body. Continue learning the critical roles of succinate signaling, known and unknown, in many pathophysiological conditions is important. Furthermore, studies to delineate the regulation of succinate levels and to determine how succinate elicits various types of signaling in a temporal and spatial manner are also required.

Yao-Kai Ho, Yao-Kai Ho, Hsiu-Hui Chen et al.

The percentage of peripheral CD56+CD16+ NK cells in the early follicular phase on days 2–3 of the menstrual cycle in repeated implantation failure (RIF) patients was used to evaluate the impact of intravenous immunoglobulin (IVIG) on ART cycles. A total 283 patients with RIF consisting of at least 3 ART failures and at least 2 high quality embryo transfers were recruited. A logistic regression analysis for the peripheral immunological profile was completed to predict implantation success and compare the implantation and pregnancy rates between groups with ≤10.6 and &gt;10.6% of CD56+CD16+ NK cells in the early follicular phase. The logistic regression and receiving operating curve analyses showed that patients with ≤ 10.6% of peripheral CD56+CD16+ NK cells in the early follicular phase showed a lower pregnancy rate within the RIF group without IVIG. Patients with peripheral CD56+CD16+ NK cells ≤ 10.6% and without IVIG treatment showed significantly lower implantation and pregnancy rates (12.3 and 30.3%, respectively) when compared with the CD56+CD16+ NK cells &gt;10.6% group (24.9 and 48.0%, respectively, p &lt; 0.05). Furthermore, the patients with CD56+CD16+ NK cells ≤ 10.6% given IVIG starting before ET had significantly higher implantation, pregnancy, and live birth rates (27.5, 57.4, and 45.6%, respectively) when compared with the non-IVIG group (12.3, 30.3, and 22.7%, respectively, p &lt; 0.05). Our results showed that a low percentage of peripheral CD56+CD16+ NK cells (≤10.6%) in the early follicular phase is a potential indicator of reduced pregnancy and implantation success rates in RIF patients, and IVIG treatment will likely benefit this patient subgroup.

Biyu Hou, Ping He, Peng Ma et al.

Metabolic changes associated with diabetes are reported to lead to the onset of early-stage diabetic nephropathy (DN). Furthermore, lipotoxicity is implicated in renal dysfunction. Most studies of DN have focused on a single or limited number of lipids, and the lipidome of the kidney during early-stage DN remains to be elucidated. In the present study, we aimed to comprehensively identify lipid abnormalities during early-stage DN; to this end, we established an early-stage DN rat model by feeding a high-sucrose and high-fat diet combined with administration of low-dose streptozotocin. Using a high-coverage, targeted lipidomic approach, we established the lipid profile, comprising 437 lipid species and 25 lipid classes, of the kidney cortex in normal rats and the DN rat model. Our findings additionally confirmed that the DN rat model had been successfully established. We observed distinct lipidomic signatures in the DN kidney, with characteristic alterations in side chain composition and degree of unsaturation. Glyceride lipids, especially cholesteryl esters, showed a significant increase in the DN kidney cortex. The levels of most phospholipids exhibited a decline, except those of phospholipids with side chain of 36:1. Furthermore, the levels of lyso-phospholipids and sphingolipids, including ceramide and its derivatives, were dramatically elevated in the present DN rat model. Our findings, which provide a comprehensive lipidome of the kidney cortex in rats with DN, are expected to be useful for the identification of pathologically relevant lipid species in DN. Furthermore, the results represent novel insights into the mechanistic basis of DN.

Jayakumar S Ambigapathy, Sadishkumar Kamalanathan, Jayaprakash Sahoo et al.

Context: Thyroid hormones play an important role in reproductive and sexual function in both sexes. Comprehensive information on the ill-effects of hypothyroidism on Leydig cell, Sertoli cell and germ cell function is lacking in the existing literature. Aims: To investigate the effect of primary hypothyroidism and its treatment on testicular function – Sertoli cell, Leydig cells, seminal fluid and spermatozoa. Methods and Material: This study was carried out as a descriptive study with a before-after study design in the endocrine department of a tertiary care hospital in South India. Forty treatment naïve, overtly primary hypothyroid, consenting male patients were included. Hormones assessed were free T3, free T4, thyroid stimulating hormone, follicle stimulating hormone [FSH], luteinizing hormone [LH], prolactin, testosterone, inhibin B[INHB], and insulin like factor 3[INSL3]. Semen analysis was done according to WHO 2010 guidelines in 37 subjects. Sexual function questionnaires like Androgen Deficiency in Aging Male [ADAM], and Arizona Sexual Experience Scale [ASEX] were used. After ensuring euthyroid state for consecutive 6 months with adequate dose of thyroxine sodium, reassessment of all parameters was done. Results: At baseline, 72.5 % had a low serum testosterone value (&lt; 230 ng/dl), 67.56 % had low total sperm motility, 72.97% had low total progressive sperm motility, 80% had low ADAM score and 72.72% had low ASEX score. A raised prolactin level was seen in 32.5% of study subjects. Hypogonadotropic hypogonadism was more common than hypergonadotropic hypogonadism (89.66% vs. 10.34%). On restoration of euthyroidism, all these parameters improved. Serum INSL3 and LH increased significantly after thyroxine replacement, unlike FSH and INHB. Conclusions: Leydig cell function seemed more severely affected by hypothyroidism as compared to Sertoli cell function. Among sperm function parameters, motility was predominantly affected.

Kyu Yong Cho, Akinobu Nakamura, Chiho Oba-Yamamoto et al.

BackgroundTo explore the efficacy and safety of switching from once-daily basal insulin therapy to once-daily pre-meal injection insulin degludec/insulin aspart (IDegAsp) with respect to the glycemic control of participants with type 2 diabetes mellitus (T2DM).MethodsIn this multicenter, open-label, prospective, randomized, parallel-group comparison trial, participants on basal insulin therapy were switched to IDegAsp (IDegAsp group; n=30) or continued basal insulin (Basal group; n=29). The primary endpoint was the superiority of IDegAsp in causing changes in the daily blood glucose profile, especially post-prandial blood glucose concentration after 12 weeks.ResultsBlood glucose concentrations after dinner and before bedtime were lower in the IDegAsp group, and the improvement in blood glucose before bedtime was significantly greater in the IDegAsp group than in the Basal group at 12 weeks (−1.7±3.0 mmol/L vs. 0.3±2.1 mmol/L, P<0.05). Intriguingly, glycemic control after breakfast was not improved by IDegAsp injection before breakfast, in contrast to the favorable effect of injection before dinner on blood glucose after dinner. Glycosylated hemoglobin significantly decreased only in the IDegAsp group (58 to 55 mmol/mol, P<0.05). Changes in daily insulin dose, body mass, and recorded adverse effects, including hypoglycemia, were comparable between groups.ConclusionIDegAsp was more effective than basal insulin at reducing blood glucose after dinner and before bedtime, but did not increase the incidence of hypoglycemia. Switching from basal insulin to IDegAsp does not increase the burden on the patient and positively impacts glycemic control in patients with T2DM.

Silvia Matino, Francesco Pesce, Michele Rossini et al.

Lara E. Graves, Kim C. Donaghue

Type 1 and type 2 diabetes are increasing in prevalence and diabetes complications are common. Diabetes complications are rarely studied in youth, despite the potential onset in childhood. Microvascular complications of diabetes include retinopathy, diabetic kidney disease or nephropathy, and neuropathy that may be somatic or autonomic. Macrovascular disease is the leading cause of death in patients with type 1 diabetes. Strict glycaemic control will reduce microvascular and macrovascular complications; however, they may still manifest in youth. This article discusses the diagnosis and treatment of complications that arise from type 1 and type 2 diabetes mellitus in youth. Screening for complications is paramount as early intervention improves outcome. Screening should commence from 11 years of age depending on the duration of type 1 diabetes or at diagnosis for patients with type 2 diabetes. Diabetic retinopathy may require invasive treatment such as laser therapy or intravitreal antivascular endothelial growth factor therapy to prevent future blindness. Hypertension and albuminuria may herald diabetic nephropathy and require management with angiotensin converting enzyme (ACE) inhibition. In addition to hypertension, dyslipidaemia must be treated to reduce macrovascular complications. Interventional trials aimed at examining the treatment of diabetes complications in youth are few. Statins, ACE inhibitors and metformin have been successfully trialled in adolescents with type 1 diabetes with positive effects on lipid profile, microalbuminuria and measures of vascular health. Although relatively rare, complications do occur in youth and further research into effective treatment for diabetes complications, particularly therapeutics in children in addition to prevention strategies is required.

Eric D. Buras, Emily Weatherup, Jennifer Wyckoff

Abstract Background Ectopic insulin-like growth factor (IGF)-2 production is a rare complication of an array of epithelial and mesenchymal tumors, and can clinically manifest as life-threatening hypoglycemia. Case presentation A 49-year-old woman with 13-year history of metastatic hemangiopericytoma, previously treated with multiple rounds of chemotherapy and palliative radiation, presented to the emergency department after a hypoglycemic seizure. On arrival, glucose was 18 mg/dL (1.0 mmol/L) and required continuous dextrose infusion for maintenance within normal limits. Insulin was <2.0 μU/mL, C-peptide 0.1 ng/mL, and beta-hydroxybutyrate <0.2 mmol/L. Random cortisol was 21 μg/dL; sulfonylurea screen, and insulin antibodies were negative. IGF-2 level was 1320 ng/mL; IGF-1 was within normal limits and IGF binding protein (BP)-3 suppressed. Dexamethasone, started at 6 mg twice daily, allowed discontinuation of the glucose infusion. Given concern for nocturnal hypoglycemia, and patient interest in steroid-sparing anti-hypoglycemic regimen, she was also started on overnight continuous subcutaneous glucagon infusion via insulin pump. She was discharged with instructions to maintain a diet high in complex carbohydrates during the day, while utilizing glucagon pump at night. She was also started on continuous glucose monitoring system (CGMS) with an alarm to warn of hypoglycemia. Glucagon infusion rate was later titrated based on CGMS readings. Abdominal CT revealed increasing size of a right upper quadrant mass not previously subjected to radiotherapy. After radiation to this area, hypoglycemia improved, allowing further glucagon titration. In parallel, IGF-2 level declined to 380 ng/mL. Conclusions Ectopic IGF-2 production is a rare but often fatal complication of many cancers, and should be considered on the differential diagnosis in patients with malignancy and unexplained hypoglycemia. Once hypoglycemia is diagnosed, patients often have end-stage disease. While treatment of the causative tumor is the only definitive intervention, anti-hypoglycemia therapy is a life-saving, temporizing measure. In this case, the patient attained euglycemia and survived 3 months after presentation before ultimately succumbing to other malignancy-related complications. Given efficacy in management of hypoglycemia while awaiting definitive tumor-directed therapy, we submit nighttime subcutaneous glucagon infusion and CGMS are valuable additions to the physician’s armamentarium in managing this condition.

Danilo Cimadomo, Gemma Fabozzi, Alberto Vaiarelli et al.

The overall success of human reproduction, either spontaneously or after IVF, is highly dependent upon maternal age. The main reasons for age-related infertility include reduced ovarian reserve and decreased oocyte/embryo competence due to aging insults, especially concerning an increased incidence of aneuploidies and possibly decreased mitochondrial activity. Age-related chromosomal abnormalities mainly arise because of meiotic impairments during oogenesis, following flawed chromosome segregation patterns such as non-disjunction, premature separation of sister chromatids, or the recent reverse segregation. In this review, we briefly discuss the main mechanisms putatively impaired by aging in the oocytes and the deriving embryos. We also report the main strategies proposed to improve the management of advanced maternal age women in IVF: fertility preservation through oocyte cryopreservation to prevent aging; optimization of the ovarian stimulation and enhancement of embryo selection to limit its effects; and oocyte donation to circumvent its consequences.