Эндокринология

[yananshs]

Subclinical Thyroid Disease
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Management of postpartum thyrotoxicosis.
Current Opinion in Endocrinology & Diabetes. 12(6):471-476, December 2005.
Azizi, Fereidoun a; Braverman, Lewis E b
Abstract:
Purpose of review: In the months following delivery, thyrotoxicosis occurs frequently. The timely recognition of the etiology and proper clinical management is important and improves the quality of life of both mother and her child. This article reviews recent literature defining the proper diagnosis and management of postpartum thyrotoxicosis.

Recent findings: During pregnancy, a variety of immune changes in systemic immune responses and localized mechanisms for protection of the placenta occur. Following delivery, there is exacerbation of immune reactivity, and during this period, autoimmune thyroid disorders may begin, recur, or exacerbate. Graves' disease and postpartum thyroiditis are two major causes of thyrotoxicosis during the postpartum period. Increased thyroidal uptake, high thyroxine/triiodothyronine ratio, and positive thyrotropin receptor-stimulating antibody results could differentiate Graves' disease from postpartum thyroiditis. The patient's thyrotoxic phase of postpartum thyroiditis lasts a few weeks and does not require treatment. Antithyroid drugs are the mainstay of treatment for postpartum Graves' disease. Many investigations have concluded that both methimazole and propylthiouracil do not cause any alterations in thyroid function and the physical and mental development of infants breast-fed by lactating hyperthyroid mothers.

Summary: Both methimazole and propylthiouracil could be safely administered in moderately high doses during lactation. It is now clear that treatment of breastfeeding thyrotoxic mothers using antithyroid medication has no detrimental effects on the thyroid function and physical and intellectual development of their children.

[Наталья П.]

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Endotext.org is the web-based source of information on endocrine disease directed to physicians around the world caring for patients with these problems.

[Наталья П.]

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American Association of Clinical Endocrinologists

[Наталья П.]

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Endocrine Surgical Procedures

[Alevgen]

Обновленные рекомендации American Diabetes Association (январь 2006 года).
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[Melnichenko]

Web site The Hormone Foundation - [Ссылки доступны только зарегистрированным пользователям ]

[Наталья П.]

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American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules.

[Melnichenko]

ENEA (The European Neuroendocrinology Association) весьма активизировала свою деятельность (это я как уже многолетний член этой асоциации напоминаю).
Вот информация о будущих конгрессах и новых ассоциациях (из письма нашего президента, самого A.Grossman - пользуюсь случаем подчеркнуть его необыкновенную человеческую милоту и простоту.

Итак, что у нас в этом году -19-22 июня Питтсбург, США - международный конгресс по нейроэндокринологии

Annual Meeting (ENDO) - ежегодный анонс конференций
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архив абстрактов прошлых конференций

[Light]

Интересно и заманчиво! Аж облизываюсь!

[Наталья П.]

The European Neuroendocrine Association was founded in the early 1980's to promote, assist and integrate neuroendocrinology in all its aspects, both basic and clinical, throughout the European continent. Visit the Society online at [Ссылки доступны только зарегистрированным пользователям ]




The British Society for Neuroendrocrinology aims to promote research into the interplay between the endocrine and nervous systems that control so many important body processes. The Society's homepage is at [Ссылки доступны только зарегистрированным пользователям ]




The International Neuroendocrine Federation aims to promote the development of research and education in basic and clinical neuroendocrinology, to disseminate scientific information in this and related fields, to arrange for publication of information aimed at the advance of the field, to facilitate the exchange of ideas among scientists of all nations and to attract young investigators to the field. Visit the Society online at [Ссылки доступны только зарегистрированным пользователям ]

[Наталья П.]

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Журнал European Thyroid Association
доступны полнотекстовые лекции

[Наталья П.]

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Androgen therapy in women: an Endocrine Society clinical practice guideline.


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Menopause and hormone therapy (HT): collaborative decision-making and management.

[Наталья П.]

Журнал "Оценка медицинских технологий"
Health Technol Assess. 2007 Mar;11(7):1-256.

Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis.

Kanis JA, Stevenson M, McCloskey EV, Davis S, Lloyd-Jones M.

WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UK.

OBJECTIVES: To determine whether strategies can be devised for the assessment and treatment of glucocorticoid-induced osteoporosis (GIO).
DATA SOURCES: Electronic databases were searched up to October 2002.
REVIEW METHODS: A systematic review of interventions was undertaken of all randomised controlled trials in which fracture was measured as an outcome. Effectiveness was compared with effectiveness in postmenopausal osteoporosis. The risk of osteoporotic fractures at any given T-score for bone mineral density (BMD) was determined from published meta-analyses of the relationship between BMD and fracture risk. The risk of an osteoporotic fracture in the presence of a prior osteoporotic fracture was computed from a published meta-analysis of the relationship between the prior occurrence of fracture of each type and the risk of a future fracture of each type. The additional risk due to exposure to glucocorticoids was determined by meta-analysis of prospectively studied population-based cohorts. The consequences of fracture on mortality were assessed for each fracture type. Costs and utilities were determined for osteoporosis in the UK by updating systematic reviews of the literature. A model was prepared that comprised an individual patient-based approach that simulated whether or not events occurred in each subsequent year for each patient. Effectiveness was populated from a systematic review of interventions in GIO and postmenopausal osteoporosis. Treatments were given for 5 years using a 5-year offset time (in this context, offset time is the duration for which an effect on fracture persists after the treatment stops). The analytic framework was set at 10 years. Because of the many uncertainties, extensive sensitivity analysis was undertaken.
RESULTS: Evidence of anti-fracture efficacy was confined to a minority of agents used in the management of GIO. Only risedronate (a bisphosphonate) and calcidiol (vitamin D) were shown to have significant effects on vertebral fracture risk, but neither had significant effects on non-vertebral fracture risk. In further meta-analyses, the effects of bisphosphonates in GIO were compared with effects combining all available data for bisphosphonates in GIO and in postmenopausal osteoporosis. Since calcidiol is not licensed for use in the UK, cost-effectiveness analysis was confined to risedronate and to a pooled bisphosphonate effect. Analysis of cost-effectiveness of risedronate using the empirical data in GIO showed better cost-effectiveness with increasing age, but at no age did cost-effectiveness ratios fall below the threshold value of pound30,000 per quality-adjusted life-year gained. When account was taken of BMD, cost-effectiveness was confined to less than 10% of patients with very low T-scores for BMD. Assuming that bisphosphonate efficacy on fracture risk was comparable to that observed with bisphosphonates in postmenopausal osteoporosis, cost-effectiveness was shown in patients with a prior fracture. In patients with no prior fracture, cost-effectiveness was observed in individuals aged 75 years or more. In younger patients without a prior fracture, cost-effective scenarios were found contingent upon a T-score for BMD that was 2.0 SD or less.
CONCLUSIONS: Cost-effective scenarios for risedronate in the management of GIO were identified, but only at the extremes of age and T-score, such that less than 10% of patients aged 50 years or more would be eligible for treatment. Greater cost-effectiveness was observed assuming that the effects of bisphosphonate in GIO were similar to those observed in postmenopausal osteoporosis, an assumption tested by meta-analysis. An assessment algorithm is proposed based on age, the presence of a prior fragility fracture and BMD tests in individuals aged 50 years or more with no fracture. The conclusions derived are conservative, mainly because of the assumptions that were made in the absence of sufficient data. Thus, conclusions that treatment scenarios are cost-effective are reasonably secure. By contrast, scenarios shown not to be cost-effective are less secure. As information in these areas becomes available, the implications for cost-effectiveness of interventions should be reappraised. Health economic assessment based on probability of fracture is an important area for further research. Other areas for further research arise from gaps in empirical knowledge on utilities and side-effects that are amenable to primary research. Further secondary research is recommended to evaluate more closely the impact of all vertebral fractures (rather than clinically overt vertebral fractures) on cost-effectiveness and methods of monitoring treatment.

[Наталья П.]

полный текст pdf
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Health Technol Assess. 2007 Feb;11(4):1-134.

The clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fragility fractures in postmenopausal women.

Stevenson M, Davis S, Lloyd-Jones M, Beverley C.

School of Health and Related Research (ScHARR), University of Sheffield, UK.

OBJECTIVES: To estimate the clinical effectiveness and cost-effectiveness of strontium ranelate for the prevention of osteoporotic fractures in postmenopausal women, at different levels of absolute fracture risk. This considers secondary prevention in women who have sustained a previous fracture and primary prevention in those women without a previous fracture, as women with osteoporosis are asymptomatic until a fracture is sustained.
DATA SOURCES: Major electronic bibliographic databases were searched in September 2004 and updated in March 2005.
REVIEW METHODS: A systematic review was carried out to determine clinical effectiveness using the major electronic bibliographic databases and handsearching reference lists of relevant articles and sponsor submissions. Data from selected studies were assessed and included in the meta-analyses, if appropriate. The model used to calculate cost-effectiveness ratios was an updated version of Sheffield Health Economic Model for Osteoporosis that was populated with absolute risk of fractures using an algorithm being developed for the World Health Organization and supplied in confidence to the authors. The model calculated the number of fractures that occur and provided as output data the costs associated with osteoporotic fractures, and the quality adjusted life-years (QALYs) accrued by a cohort of 100 osteoporotic women, with each fracture being detrimental to health and incurring a cost. When the costs of the intervention were included, the incremental cost compared with no treatment was calculated and divided by the gain in QALYs to calculate cost-effectiveness measures. Treatment with strontium ranelate was calculated against a no-treatment option to evaluate whether it could be given cost-effectively. An incremental analysis against alendronate was also conducted to estimate the cost-effectiveness of strontium ranelate relative to a current standard treatment. The cost-effectiveness of strategies for identifying and treating women without a prior fracture used the risk of fracture as an input to the cost-effectiveness model.
RESULTS: Three trials were identified. Pooled data from two studies indicate that strontium ranelate therapy is associated with a reduction in the risk of vertebral fracture [relative risk (RR) compared with placebo 0.60, 95% confidence interval (CI) 0.53 to 0.69, p < 0.001] and non-vertebral fracture (RR 0.84, 95% CI 0.73 to 0.97, p = 0.01). In general, strontium ranelate therapy did not seem to be associated with an increased risk of adverse events. However, the risk of one rare but serious adverse event, venous thromboembolism (including pulmonary embolism), was found to be significantly higher in patients receiving strontium ranelate compared with placebo (RR 1.42, 95% CI 1.02 to 1.98, p = 0.036). Some nervous system disorders, including mental impairment, disturbed consciousness, memory loss and seizures, were also more common in patients randomised to strontium ranelate. Strontium ranelate provided gains in QALYs compared with no treatment in women with sufficient calcium and vitamin D intakes. The size of the QALY gain for each intervention was strongly related to the absolute risk of fracture. From the algorithm used, it is seen that strontium ranelate can be used cost-effectively in women at relatively high risk of osteoporotic fracture. However, the results of the probabilistic sensitivity analysis, using efficacy data from randomised controlled trials, suggest that it is not as cost-effective as alendronate, a comparator intervention from the bisphosphonate class. The use of strontium ranelate in women without a prior fracture will be dependent on identification algorithms being produced in conjunction with the National Institute for Health and Clinical Excellence Osteoporosis Guidelines Development Group.
CONCLUSIONS: Strontium ranelate was shown to be clinically effective in the prevention of osteoporotic fractures. Scenarios have been found where strontium ranelate can be used cost-effectively, however given the probabilistic sensitivity analyses conducted, this intervention appears to be less cost-effective than the bisphosphonate alendronate. The evidence base for the efficacy of fracture prevention for strontium ranelate needs to be strengthened, particularly for hip fractures, where there is currently a non-significant reduction. If it were believed that the efficacy of strontium ranelate is dependent on either age or absolute risk, this would need to be proven. The evidence base on the T-score by age of the general female population needs to be strengthened, particularly in women over the age of 80 years. The prevalence of risk factors associated with fracture rates, over and above that provided by bone mineral density, also needs to be significantly strengthened to ensure that the estimated number of women that could be cost-effectively treated is accurate.

[Наталья П.]

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a multidisciplinary consortium of clinicians (endocrinologists and ophthalmologists, clinical epidemiologists and radiologists) who have a special clinical and research interest in Graves' orbitopathy. Our aims are to develop standardised clinical assessment methods for evaluation of patients with Graves' orbitopathy