Using a thyroid-stimulating hormone (TSH) cutoff of 2.5 mIU/L or 4.5 mIU/L, no differences in the rates of clinical pregnancy, delivery, or miscarriage were observed in this large, retrospective ...cohort study of first-cycle IVF patients from 2005 through 2008, after controlling for age. Although lowering the TSH threshold to 2.5 mIU/L would result in a nearly fivefold increase in the number of women being classified as hypothyroid, the lack of differences in maternal clinical outcomes must be considered in the current controversy regarding the relative merits of lowering the upper limit of normal of TSH.
Female Physicians and the Future of Endocrinology Pelley, Elaine; Danoff, Ann; Cooper, David S ...
The journal of clinical endocrinology and metabolism,
1/2016, Letnik:
101, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Context:
Given that approximately 70% of current endocrinology fellows are women, female physicians will compose the majority of the future endocrinology workforce. This gender shift partly reflects ...an apparent waning of interest in endocrinology among male trainees. It also coincides with a projected shortage of endocrinologists overall. Female physicians face unique challenges in the workplace. To continue to attract trainees to the specialty and support their success, it is imperative that these challenges be recognized, understood, and addressed.
Evidence Acquisition:
A PubMed search using the terms “female physician” and “physician gender” covering the years 2000–2015 was performed. Additional references were identified through review of the citations of the retrieved articles. The following topics were identified as key to understanding the impact of this gender shift: professional satisfaction, work-life balance, income, parenthood, academic success, and patient satisfaction.
Evidence Synthesis:
Several changes can be predicted to occur as endocrinology becomes a female-predominant specialty. Although professional satisfaction should remain stable, increased burnout rates are likely. Work-life balance challenges will likely be magnified. The combined effects of occupational gender segregation and a gender pay gap are predicted to negatively impact salaries of endocrinologists of both genders. The underrepresentation of women in academic leadership may mean a lesser voice for endocrinology in this arena. Finally, gender biases evident in patient satisfaction measures—commonly used as proxies for quality of care—may disproportionately impact endocrinology.
Conclusions:
Endocrinology is predicted to become the most female-predominant subspecialty of internal medicine. The specialty of endocrinology should take a lead role in advocating for changes that support the success of female physicians. Strengthening and supporting the physician workforce can only serve to attract talented physicians of both genders to the specialty, which will be key to meeting the needs of the increasing numbers of patients with endocrine disorders.
Tumors of mesenchymal and epithelial origin produce IGF-2, which activates pathways in the tumors. In a minority of patients, the tumors (hepatomas, fibromas, and fibrosarcomas are the most common ...among many) release into the circulation enough IGF-2–related peptides to mimic the fasting hypoglycemia characteristic of patients with insulin-producing islet-cell tumors. Rarely, markedly elevated IGF-2 levels produce somatic changes suggestive of acromegaly. Typically, the elevated IGF-2 levels are associated with suppressed plasma levels of insulin, IGF-1, and GH. Complicating the pathophysiology are the IGF binding proteins (IGFBPs) that can bind IGF-2 and IGF-1, modifying hormone metabolism and action. IGFBP concentrations are often altered in the presence of these tumors. At the cellular level, the 3 hormone-related ligands, IGF-2, IGF-1, and insulin, all bind to 4 (or more) types of IGF-1 receptor (IGF-1R) and insulin receptor (IR). Each receptor has its own characteristic affinity for each ligand, a tyrosine kinase, and overlapping profiles of action in the target cells. The IGF-2R, in addition to binding mannose-6-phosphate–containing proteins, provides an IGF-2 degradation pathway. Recent evidence suggests IGF-2R involvement also in signal transduction. Surgery, the treatment of choice, can produce a cure. For patients not cured by surgery, multiple therapies exist, for the tumor and for hypoglycemia. Potential future therapeutic approaches are sketched. From 1910 to 1930, hypoglycemia, insulin, insulinomas, and non–islet-cell tumors were recognized. The latter third of the century witnessed the emergence of the immunoassay for insulin; the IGFs, their binding proteins, and assays to measure them; and receptors for the insulin-related peptides as well as the intracellular pathways beyond the receptor. In closing, we replace non–islet-cell tumor hypoglycemia, an outdated and misleading label, with IGF-2-oma, self-explanatory and consistent with names of other hormone-secreting tumors.
Obesity and the accompanying metabolic syndrome are strongly associated with heightened morbidity and mortality in older adults. In our review of more than 20 epidemiologic studies of major ...infectious diseases, including leaders such as tuberculosis, community-acquired pneumonia, and sepsis, obesity was associated with better outcomes. A cause-and-effect relationship between over-nutrition and survival with infection is suggested by results of two preliminary studies of infections in mice, where high fat feeding for 8-10 weeks provided much better outcomes. The better outcomes of infections with obesity are reminiscent of many recent studies of "sterile" non-infectious medical and surgical conditions where outcomes for obese patients are better than for their thinner counterparts --- and given the tag "obesity paradox". Turning to the history of medicine and biological evolution, we hypothesize that the metabolic syndrome has very ancient origins and is part of a lifelong metabolic program. While part of that program (the metabolic syndrome) promotes morbidity and mortality with aging, it helps infants and children as well as adults in their fight against infections and recovery from injuries, key roles in the hundreds of centuries before the public health advances of the 20th century. We conclude with speculation on how understanding the biological elements that protect obese patients with infections or injuries might be applied advantageously to thin patients with the same medical challenges.
We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes.
In 2013 and 2014, we performed hemoglobin ...A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired "gold-standard" HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients.
About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits.
Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients.
In recent years, a number of investigators have studied the
relationship between IGF-I and risk of developing cancer, diabetes or
cardiovascular disease. Upper tertile, quartile, and quintile IGF-Is
...were associated with higher risk of developing cancer, and lowest
quartile with cardiac disease and diabetes. As part of a study to
correlate serum IGF-Is and growth hormone dynamics in aging, we
measured fasting serum IGF-I at baseline and two weeks later in a group
of 84 normal volunteers between the ages of 50 and 90 years. Although
the correlation between the two IGF-Is was high (r = 0.922; p< 0.0001) there were substantial differences between the two IGF-I
values ranging from −36.25 to _38.24% between individual IGF-I values
at the two blood draws and a significant difference between the mean
IGF-Is at visits 1 and 2 (mean 120.28 ± 53.5 vs. 114.95 ±
50.03; p = 0.03). When considered in quartiles, IGF-I changed from
one quartile to another in 34/84 (40.5%) of the volunteers. When the
group was divided in halves, tertiles, quartiles, or quintiles there
was an increasing number of subjects who changed from one subdivision
to another as the number of gradations increased. These results suggest
that the predictive outcomes of earlier studies that used single IGF-I
samples for analysis of risk ratios according to tertiles, quartiles,
or qunitiles could have been different if a second IGF-I was used to
establish the risk ratio. The results also suggest that variability in
IGF-I should be taken into account when designing such studies.
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