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A 38-year-old female presented with irregular menstruation and hirsutism that started at age of 16 and diagnosed with polycystic ovary syndrome at age of 29 with elevated testosterone. When treated with ethinestradiol cyproterone tablets, her menstruation returned to normal and androgen levels was not changed. At age of 38 she was referred to the hospital with infertility, a diagnosis of nonclassical 21-hydroxylase deficiency was confirmed using 17-hydroxyprogesterone, dehydroepiandrosterone-sulfate, a cosyntropin-stimulation test and genetic test. This case suggested that nonclassical congenital adrenal hyperplasia should be considered when a patient is presented with oligomenorrhea, hirsutism with hyperandrogenemia and infertility.

Objective To investigate whether umbilical cord mesenchymal stem cells (UC-MSCs) can exert kidney protection in diabetes rats through regulating autophagy. Methods Type 2 diabetes rats model was induced by a high-fat diet combined with a low dosage of streptozotocin (STZ) intraperitoneal injection. After successful modeling, those rats were fed with a high-fat diet for another eight weeks, and the control group (10) was given a normal chow diet. The treatment group (MSCs group, 10) was infused UC-MSCs (3x106 suspended in 0.5 ml PBS) via tail vein once every two weeks, for a total of eight weeks of treatment. The diabetes control group (T2DM group, 10) was infused 0.5 ml PBS solution via tail vein and the control group did not receive any treatment at the same time. Random blood glucose and body weight were monitored every two weeks. One week after the fourth treatment, intraperitoneal glucose tolerance test (IPGTT) was performed in all rats, and later on they were sacrificed and their kidneys were collected for histopathological examinations and autophagy-related protein examinations. Data was measured using two independent sample mean t tests, one-way ANOVA and repeated measures analysis of variance. Results Compared to T2DM group, random blood glucose decreased [(23.9±3.7) vs (28.7±2.1) mmol/L, t=3.568, P<0.01], and glucose tolerance improved (t=3.07-6.64, P<0.01) in MSCs group. The pathological results showed that in the MSCs group the degree of glomerular sclerosis was reduced (P<0.01, t=17.28), the glomerular basement membrane thickening was relieved (P<0.01, t=12.00),and the degree of renal interstitial fibrosis was improved (P<0.01, t=2.83-17.28). Examinations of autophagy-related proteins showed that the MSCs group exhibited increased expression of LC3[(78.3±5.3)% vs(33.4±8.3)%,t=10.22, P<0.01] and reduced expression of P62[(24.1±4.2)% vs (93.3±4.9)%, t=24.13, P<0.01],which indicated that the level of autophagy in rat kidneys were significantly increased after MSCs infusion. Conclusion UC-MSCs therapy has the function of kidney protection and delay the development of diabetic nephropathy, which may be related to the enhancement of autophagy in renal tissues. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic value of adrenocorticotropic hormone (ACTH) stimulation test (AST) with different doses of ACTH combined with midnight administration of 1 mg dexamethasone for the determination of the subtypes of primary hyperaldosteronism (PA)., Methods: This is a prospective observational study. Patients diagnosed with PA in the Department of Endocrinology, the First Medical Center of of Chinese PLA General Hospital from January 1, 2020 to September 30, 2022 underwent AST with different doses of ACTH. All patients received 1 mg dexamethasone at midnight for inhibition. Then, the patients were randomly assigned to 25-unit and 50-unit ACTH treatment groups by a ratio of 1:2. Subtype classification and diagnosis of aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) was made on the basis of adrenal venous blood samples and/or postoperative pathology and clinical follow-up findings. Receiver operating characteristics (ROC) curves were plotted to examine the diagnostic efficacy and the difference of AST by varying doses of ACTH in distinguishing APA and IHA., Results: A total of 82 patients, including 49 patients with APA (59.8%) and 33 patients with IHA (40.2%), were enrolled. There were 29 patients in the 25-unit ACTH group (35.4%) and 53 patients in the 50-unit ACTH group (64.6%). There were no significant differences in age, sex, blood pressure, minimum serum potassium, and biochemical parameters between the 25-unit and 50-unit groups. After ACTH stimulation, plasma aldosterone concentration (PAC), cortisol (F), and PAC/F at different points of time showed no statistical difference between the two groups ( P >0.05). The area under the curve ( AUC ) of PAC in the 25-unit group was higher than that of PAC/F. The AUC of PAC reached the maximum at 90 minutes (0.948, 95% confidence interval [ CI ]: 0870-1.000) and the optimal cutoff was 38.0 ng/dL, which had a sensitivity of 92.9% and a specificity of 86.7% for differentiating APA and IHA. Similar to the 25-unit group, the maximum AUC of PAC in the 50-unit group was greater than that of PAC/F. The AUC of PAC reached the maximum 90 minutes (0.930, 95% CI : 0.840-0.994) and the optimal cutoff was 39.6 ng/dL, which had a sensitivity of 91.2% and a specificity of 83.3%. The AUC of PAC at different points of time in the 25-unit ACTH group (0.862-0.948) was greater than that of 50-unit ACTH group (0.823-0.930), but the difference was not statistical significance., Conclusion: AST with 25-unit or 50-unit ACTH combined with small-dose dexamethasone can be used in PA subtype determination, ie, differentiation between APA and IHA. The optimal PAC cut-off values for 25-unit or 50-unit ACTH are similar, being 38.0 ng/dL and 39.6 ng/dL, respectively, and both cutoff values show higher sensitivity and specificity at 90 min. The AST with 25-unit ACTH has the smaller dose and the better safety. Therefore, it is recommended for the diagnosis of PA subtypes., Competing Interests: 利益冲突　所有作者均声明不存在利益冲突, (© 2024《四川大学学报（医学版）》编辑部 版权所有Copyright ©2024 Editorial Board of Journal of Sichuan University (Medical Sciences).)

Objective: To investigate the influence of hemoglobin glycation index (HGI) on the risk of incident chronic kidney disease (CDK) among nondiabetic patients. Methods: Prospective cohort study. At baseline, a total of 7 407 nondiabetic patients without a history of CKD from Pingguoyuan Community of the Shijingshan District in Beijing were included from December 2011 to August 2012, who were then divided into three groups according to the tertiles of their baseline HGI levels. The CKD incidence rate was compared among the different HGI groups at last follow-up. Cox multivariable regression was applied to evaluate whether HGI measures predicted CKD risk. Test for trend across tertiles were examined using ordinal values in separate models. Results: The mean age of the subjects was (56.4±7.5) years, and 4 933 (66.6%) were female. At mean follow-up of 3.23 years, 107 (1.4%) individuals developed CKD. The incidence of CKD was gradually increasing from the low to high HGI groups [1.1% (28/2 473) vs. 1.2% (31/2 564) vs. 2.0% (48/2 370), P =0.016]. In the multivariate Cox regression analysis, after adjustment for potential confounders, the high HGI group had a 68.5% increased risk of CKD compared with the low HGI group ( HR =1.685, 95% CI 1.023 to 2.774). CKD risk increased with increasing HGI tertiles ( P for trend=0.028). Conclusion: High HGI is associated with an increased risk for CKD in the nondiabetic population, indicating that HGI may help identify individuals at high risk for CKD.

Objective: To explore the value of serum parathyroid hormone (PTH) in the diagnosis of primary aldosteronism (PA) and to investigate an optimal cut-off of serum PTH to distinguish PA from nonfunctional adrenal tumor (NFA). Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from January 1, 2017 to December 31, 2019 were collected. The data of PA and NFA by clinical characteristics and evaluation on endocrine function were retrospectively analyzed. The logistic regression model was used to find the potential risk factors of elevated PTH. The receiver operating characteristic(ROC) curve was used to evaluate the efficacy of PTH in diagnosis of PA and to explore the best cut-off value. Results: A total of 773 patients were included. There were 356 PA patients (203 males, 57.0%), aged (50±11) years and 417 NFA patients (219 males, 52.5%), aged (51±12) years. The serum PTH level in patients with PA was significantly higher than that in patients with NFA [63.1 (48.4, 80.3) ng/L vs 41.7 (34.1, 51.7) ng/L, P <0.05], as well as the proportion of patients with elevated PTH level (47.8% vs 7.2%, P <0.05). Logistic regression analysis showed that having PA and deficiency of Vitamin D were risk factors for PTH elevation (both P <0.05). The ROC curve showed that the best cut-off value of PTH for the diagnosis of PA in patients with vitamin D deficiency was 56.44 ng/L, with a sensitivity of 66.5% and a specificity of 83.0%, and that in patients with normal vitamin D was 48.81 ng/L, with a sensitivity of 70.5% and a specificity of 72.6%. Conclusions: Patients with PA tend to show increased levels of serum PTH compared with NFA patients. The level of serum PTH can be used as one of the valuable indexes in screening of PA.

Objective: To investigate the distinct effects of intermittent and continuous administration of parathyroid hormone (PTH) on bone and mesenchymal stem cell (MSC). Methods: Six weeks old mice with C57/BL6J background and SOX9-creERT/Td-tomato/Osteocalcin-GFP genotype were divided into 6 groups: intermittent administration and withdraw group (subcutaneous injection with PTH 500 μg·kg -1 ·d -1 ), continuous administration and withdraw group (subcutaneous implantation of PTH pump, 80 μg·kg -1 ·d -1, with a rate of 0.25 μl/h), control administration and withdraw group, with 8 mice in each group. Serum calcium level and bone mineral density (BMD) were measured after two weeks' treatment and two weeks after drug withdraw. Histopathology and immunofluorescence analyses were performed to assess the effects of PTH on bone and mesenchymal stem cell. Results: Serum calcium level increased transiently in intermittent group[(1.36±0.03) mmol/L]and increased gradually in continuous group[up to (2.33±0.03) mmol/L], but reduced to normal level (1.12-1.27 mmol/L) 14 days after drug withdraw. BMD of both intermittent[(0.047±0.002) g/cm 2 ]and continuous[(0.046±0.001) g/cm 2 ]PTH administration groups increased compared with control group[(0.044±0.001) g/cm 2 ], but there was no significant difference among three groups 2 weeks after drug withdraw. Femoral histopathology showed that bone mass, trabecular number and little fibrous tissue hyperplasia in intermittent PTH group increased. Osteoblasts number increased, but lining cells decreased. There was no significant difference in osteocyte and osteoclast numbers. After withdrawing of intermittent PTH, osteocyte and osteoblast number declined significantly, but there was an increased number of lining cells. Continuous PTH caused very high amount of fibrosis, and osteoclast number increased significantly, while osteoblast and osteocyte number increased slightly. After withdrawing of continuous PTH, fibrosis disappeared significantly, and lining cell number increased. Immunofluorescence staining in the epiphyseal-metaphyseal regions in fibula showed intermittent PTH increased undifferentiated Td-Tomato MSC, but declined significantly after withdrawing. Undifferentiated Td-Tomato MSC in continuous PTH increased slightly and decreased after drug withdraw. Conclusions: Intermittent PTH increased undifferentiated Td-Tomato MSC and osteoblast number, and might transform lining cell into osteocytes and osteoblasts, and thus lead to bone formation. Continuous PTH increased undifferentiated Td/Tomato MSC, osteoblast and osteocyte number slightly, but high amount of fibrosis and osteoclasts can be seen, leading to metabolic bone disease. However, lining cell ascended after drug withdraw, which may be beneficial to bone remodeling.

Objective: To understand type B insulin resistance syndrome (B-IRS) by reviewing 3 cases from our center and cases from literatures., Methods: The clinical characteristics, diagnosis, treatment and follow-up data of the 3 patients with B-IRS were evaluated., Results: All the 3 patients were middle-aged women with severe hyperglycemia or paradoxical hypoglycemia. The clinical findings were as follows. (1)B-IRS was associated with several autoimmune diseases such as systemic lupus erythematosus (SLE) and sclerosis. (2) The metabolic abnormalities of B-IRS include weight loss, severe hyperinsulinemia, high level of adiponectin, and low level of insulin-like growth factor type 1(IGF-1) and TG. (3)B-IRS was characterized with nonspecific serological disorders (such as leukopenia, thrombocytopenia and hypoalbuminemia) and changes (decreased complements and elevated IgG and/or IgA), and with specific immunological abnormalities[such as high titer of antinuclear antibody(ANA), positive in anti-SSA, anti-SSB and anti-dsDNA antibodies). Positive in anti-insulin receptor antibody was of diagnostic value but not necessary. (4) Treatments include insulin in combination with immunosuppressive therapy. Patients with H. pylori (Hp) infection may be benefit with eradication therapy., Conclusions: B-IRS is rare but not difficult to identify. Treatments include therapy of the underlying diseases and high dose of insulin.

Objective: To evaluate efficacy of the 1 mg overnight dexamethasone suppression test (1 mg overnight DST) in the diagnosis of subclinical Cushing's syndrome, and to explore the best diagnostic cut-off value., Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from 1995 to 2013 were gathered. The data of subclinical Cushing's syndrome (SCS) and non-functional adrenal adenoma (NFA) was retrospectively analyzed. The ROC curve was used to evaluate the efficacy of the 1 mg overnight DST and to explore the best cut-off value with high sensitivity and specificity., Results: There were 447 patients with NFA (224 male and 223 female), and the mean age was 53±11 years old.49 patients were with SCS (19 male and 30 female), and the mean age was 47±12 years old. The area under the ROC of serum cortisol level after 1 mg overnight DST was 0.967 (95%CI: 0.942-0.993). The best cut-off value of serum cortisol after 1 mg overnight DST was 63.65 nmol/L, with a sensitivity of 100.0% and a specificity of 88.8%. The best cut-off value of the suppression ratio of serum cortisol was 85.64%, with a sensitivity of 83.3% and a specificity of 84.6%., Conclusions: The best criterion for 1 mg overnight DST in the diagnosis of SCS was serum cortisol level , and the recommend cut-off point was 63.65 nmol/L, with both a higher sensitivity and specificity. The suppression ratio of serum cortisol after 1 mg overnight DST was also considered as a suitable criterion in the diagnosis of SCS.

Objective: To investigate the impact of diabetes mellitus (DM) on survival in patients with lung cancer., Methods: This is a retrospective study of 1 096 patients died from lung cancer collected from clinical records in Chinese PLA General Hospital. Survival time of lung cancer with and without DM was compared using Log-rank analysis and Cox regression model., Results: One hundred and eighty-one patients (16.5%) had DM. The median survival time of the lung cancer patients with DM was 9 months, whereas, the median survival time of the patients without DM was 8 months. Log-rank analysis showed that this difference was significant (P<0.05). Moreover, the 1-, 2-, and 3-year survival rate in lung cancer patients with and without DM were 43% vs 35%, 27% vs 17%, and 16% vs 10%, respectively. After adjusting for age, gender, histology, stage of lung cancer and treatment, Cox regression analysis showed that the hazard ratio for survival in lung cancer patients with DM was 0.74 (95%CI 0.61-0.89, P<0.05) compared with those without DM. In non-small-cell lung cancer(NSCLC)patients, the hazard ratio for survival in lung cancer patients with DM was 0.69 (95%CI 0.56-0.85, P<0.05). However, this association disappeared in small-cell lung cancer (SCLC) patients. In advanced lung cancer patients (stage III-IV), diabetes was also a significant factor for survival (HR=0.74, 95%CI 0.61-0.91, P<0.05)., Conclusion: Patients with advanced NSCLC with DM have longer survival time compared with those without DM.

Objective: To investigate the clinical features, therapeutic regimens and follow-up information of patients with 45, X/46, XY mixed gonadal dysgenesis in order to improve the diagnosis and treatment of the disease., Methods: We performed a retrospective review of patients with 45, X/46, XY mosaicism hospitalized in Chinese PLA General Hospital between 2000 and 2014. The clinical features,sex hormones,treatment and follow-up information were summarized., Results: (1) Seven patients ranging 12-17 years old were diagnosed as having 45, X/46, XY mixed gonadal dysgenesis. Six of them had female sex of rearing and one had male. (2) All of them presented with short stature and growth retardation, and had similar specific somatic signs to Turner syndrome. (3) The external genitalia presented with a wide variety of phenotypes. One patient presented with male phenotype with hypospadia, one presented with clitoridauxe, and five presented with female phenotype. The masculinization scores for the external genitalia showed that five patients presented with female phenotype, one patient with mild undervirilization and one patient with ambiguous genitalia. (4) By surgical exploration and ultrasound, two patients were found with testes and one was with ovary-like gonads. No gonad could be detected in the other four patients. (5) Five patients were treated with recombinant human growth hormone (rhGH). Two patients received sex hormone replacement therapy with one patient taking testosterone, whose penis became enlarged and erect after treatment, and one taking artificial cycle., Conclusions: The patients with 45, X/46, XY mosaicism share similar specific somatic signs to Turner syndrome. The 45, X/46, XY mosaicism presents with a wide spectrum of phenotypes with the highest proportion of being genital ambiguity. RhGH, testosterone and artificial cycle can be used accordingly.

Objective: Cushing's syndrome is a clinical condition resulting from chronic exposure to excess glucocorticoid. As a consequence, long-term hypercortisolism contributes significantly to the development of systemic disorders by direct and/or indirect effects. The present study was to analyze the changes of renin-angiotensin-aldosterone-system in different subtypes of Cushing's syndrome on the standard posture test., Methods: We retrospectively reviewed 150 patients with histologically confirmed Cushing's syndrome treated at the PLA General Hospital between 2002 and 2014. Among them, 128 patients were diagnosed as adreno-cortico-tropic-hormone (ACTH)-independent Cushing's syndrome, and 22 were ACTH-dependent Cushing's syndrome. All patients were undertaken the posture test. Plasma renin activity (PRA), angiotensin II, plasma aldosterone concertration (PAC) levels were measured before and after the test., Results: Basal plasma PRA [0.5 (0.2,1.3)µg·L(-1)·h(-1), angiotensin II [(48.9±20.1) ng/L] and PAC [(285.0±128.1) pmol/L] levels were within the normal range in supine position. Compared with the subjects with ACTH-independent Cushing's syndrome, the basal PAC levels were higher in subjects with ACTH-dependent Cushing's syndrome [(348.0±130.4) pmol/L vs (274.2±125.0) pmol/L, P<0.05]. However, the PAC response in subjects with ACTH-dependent Cushing's syndrome [(49.7±26.4)%] was significantly lower than that in those with ACTH-independent Cushing's syndrome [(81.2±69.3)%] upon upright posture stimulation (P<0.05). There were no statistical significances in PRA and angiotensin II levels between the two groups. The basal PAC and PRA levels were positively correlated with ACTH, whereas PAC response was negatively correlated with ACTH., Conclusions: The renin-angiotensin-aldosterone-system activity in subjects with Cushing's syndrome was similar to that in normal control. The basal PAC level and its response to upright posture are differently associated with ACTH level in Cushing's syndrome.

Objective: To evaluate the outcomes of intravenous glucocorticoid therapy with or without orbital radiotherapy for moderate-to-severe Graves' ophthalmopathy., Methods: A total of 83 patients with moderate-to-severe Graves' ophthalmopathy were retrospectively analyzed. Intravenous glucocorticoid was given to patients for 3 consecutive days every four weeks in 1-3 circles. The regimens included intravenous glucocorticoid alone (n = 36) and intravenous glucocorticoid plus orbital radiotherapy (n = 47). Photophobia, lacrimation, eye pain, soft tissue congestion, edema, exophthalmos and diplopia were compared before and after treatment. The symptoms and efficacies were compared between two groups., Results: During a 12-week follow-up, clinical activity score (CAS), exophthalmos and diplopia all improved after treatment (P < 0.05). However, the changes of CAS, exophthalmos or diplopia showed no inter-group differences (P > 0.05). The overall clinical response was 50% in glucocorticoid group and 63.8% in glucocorticoid plus orbital radiotherapy group. And there was no statistical difference (P > 0.05)., Conclusion: Moderate-to-severe Graves' ophthalmopathy may be relieved by pulsed intravenous glucocorticoid with or without orbital radiotherapy. There is no inter-group difference in short-term efficacies.

Objective: To study the effect of conditioned media for rat bone marrow mesenchymal stem cells (BMSCs-CM) on palmitic acid (PA)-induced insulin resistance (IR) in HepG2 cells and its underlying molecular mechanisms., Methods: HepG2 cells were treated with or without BMSCs-CM and L-DMEM in the presence or absence of PA.Glucose utilization in HepG2 cells were detected with PAS, glucose and glycogen measurements. Western blotting was used to assess the expression of phospho-insulin receptor substrate (p-IRS), phosphatidylinositol 3-kinase (PI3K) and p-AKT., Results: (1) Incubation of HepG2 cells with 0.25 mmol/L PA for 24 hours significantly increased the glucose concentration and decreased the glycogen content (P<0.05) in the media. (2) Treatment with BMSCs-CM significantly ameliorated the glucose and glycogen alteration in cells pretreated with PA (P<0.05), however, no obvious effect of BMSCs-CM on the cell glucose and glycogen production. (3) BMSCs-CM treatment also increased protein expression of p-IRS, PI3K and p-AKT in PA incubated HapG2 cells (P<0.05). The effect of BMSCs-CM on PI3K and p-AKT expression could be mimicked upon addition of 740Y-P, a PI3K agonist, but abolished by LY294002, a PI3K specific inhibitor., Conclusions: BMSCs-CM could improve the insulin sensitivity in HepG2 cells pretreated with PA through upregulation of insulin signaling component expression.

Objective: To summarize the disease distribution characteristics of adrenal lesions and analyze the changes of disease spectrum so as to further guide clinical practices., Methods: All clinical data of adrenal lesion patients hospitalized between 1993 and 2013 were collected. Their profiles of gender ratio, visiting age, final diagnosis and year of hospitalization were retrospectively analyzed., Results: A total of 4 049 patients with adrenal lesions were admitted. There were 2 004 males and 2 045 females with a mean age of 46.82 ± 13.36 years. The number of cases gradually increased year-on-year. And the visiting age was 30-60 years. The annual proportion of adrenal incidentaloma out of total adrenal lesions gradually increased with advancing age. Among them, 3 014 received endocrine function assessments. And there were non-functional lesions (n = 1 503, 49.88%) , adrenal Cushing's syndrome (n = 259, 8.60%), primary aldosteronism (n = 665, 22.04%) and pheochromocytoma (n = 235, 7.80%) . The proportion of non-functional lesions rose from 20.97% to 54.11% (P < 0.05). The proportion of primary aldsteronism declined from 29.84% to 20.43% (P < 0.05). And the proportion of adrenal Cushing syndrome changed slightly (P > 0.05). The proportion of pheochromocytoma declined from 18.55% to 6.99% (P < 0.05)., Conclusion: The number of patients gradually increased over the last two decades.So did the proportion of adrenal incidentaloma. The disease spectrum of adrenal lesions has changed. And the proportion of non-functional lesions increased while that of functional lesions declined.

Objective: To investigate the association between DBil with normal range and serum lipid in type 2 diabetic patients., Methods: A total of 979 subjects with type 2 diabetes admitted to the Department of Endocrinology of Chinese PLA General Hospital from June 2012 to June 2013 were included for the study. Serum DBil, TC, TG, HDL-C and LDL-C levels were collected for the analyses. Subjects were divided into four groups based on the DBil levels: Q1 group (<2.2 µmol/L), Q2 group (2.2-< 2.9 µmol/L), Q3 group (2.9-< 3.9 µmol/L) and Q4 group ( ≥ 3.9 µmol/L) ., Results: (1) TC, TG, LDL-C levels were significantly lower in Q4 group than those in the other three Q groups after adjustment of age, gender, duration of diabetes, BMI, smoking, drinking, glycosylated hemoglobin A1c (HbA1c) , fasting plasma glucose (FPG), medication, ALT, AST and fatty liver. No difference could be viewed in HDL-C level between each group (P = 0.65). (2) Pearson correlation analyses showed that DBil was inversely correlated with TC (r = -0.33, P < 0.01), TG (r = -0.23, P < 0.01), LDL-C (r = -0.18, P < 0.01), and positively correlated with HDL-C level in men (r = 0.14, P < 0.01), respectively. Multiple linear regression analyses showed DBil was an independent impact factor for TC, TG and LDL-C. (3) Compared with Q1 group, the odds ratio (OR) for dyslipidemia was 0.54 (95%CI 0.35-0.82, P < 0.01), 0.56 (95%CI 0.37-0.85, P < 0.01) and 0.44 (95%CI 0.29-0.69, P < 0.01) in Q2, Q3 and Q4 group, respectively, after age, gender, duration of diabetes, BMI, smoking, drinking, HbA1c, FPG, medication, ALT, AST and fatty liver were adjusted. Moreover, the OR for dyslipidemia was much lower in Q4 man subjects with age<55 years , HbA1c ≥ 6.5%, BMI<25 kg/m(2), and with no fatty liver., Conclusion: DBil in normal range was closely associated with lipid profile in type 2 diabetes. It might play a protective effect in dyslipidemia.

Objective: To evaluate the association between calcaneus bone mineral density (BMD) and metabolic syndrome (MS)., Methods: A cross-sectional study was carried out in 5 552 subjects with 1 987 men and 3 565 women (age:40-87 years old). MS was defined according to Chinese Diabetes Society criteria. BMD was assessed by quantitative ultrasound., Results: The proportion of MS was 29.0% in male and 24.4% in female. There were no differences in BMD between MS and non-MS subjects in both genders. Linear trend analysis displayed that BMD was positively associated with the increase of MS components in post-menopausal women after adjustment of age, ALT, creatinine and exercises (P < 0.05). Moreover, multiple regression analysis showed that BMD was inversely correlated with age (β = -0.034, P < 0.001) and positively correlated with BMI (β = 0.046, P = 0.001) , TG (β = 0.066, P = 0.034) and systolic blood pressure (SBP) (β = 0.007, P = 0.039) in post-menopausal women with MS., Conclusions: BMD tended to increase with the numbers of MS components in post-menopausal women. It was positively correlated with BMI, TG and SBP in postmenopausal women with MS.

Objective: To investigate the clinical characteristics of patients with different gender who diagnosed as differentiated thyroid cancers (DTC)., Methods: A cohort of patients with DTC underwent surgery in Chinese PLA General Hospital from October 2001 to may 2011 was retrospectively studied., Results: (1) A total of 1 756 patients with DTC were enrolled in the study and a marked female preponderance was found with the female/male ratio of 2.32: 1. The peak incidence was 35-45 years old in both genders.Higher prevalence of DTC was observed in the male patients with a single nodule than in the males with multinodulars (36.42% vs 28.90%, P < 0.01), while no statistical difference was found in the female patients (33.60% vs 31.77%, P > 0.05). (2) Ultrasound examination revealed that, the female DTC patients with microcalcification thyroid nodules were more than the male patients (69.26% vs 62.62%, P < 0.05), while less in female patients with undefined boundary thyroid nodules (57.79% vs 72.01%, P < 0.01). The tumor size was shown to be smaller in the women than in the men [(1.6 ± 1.3) cm vs (1.8 ± 1.5) cm, P < 0.01]. (3) Higher rates of III/IV TNM Stage, lymph node metastasis and extrathyroidal invasion were found in the men than in the women (21.74% vs 14.51%, P < 0.01, 33.27% vs 23.80%, P < 0.01 and 10.59% vs 7.17%, P < 0.01)., Conclusion: There is significant gender-related difference of clinical characteristics in the patients with DTC.

Objective: To summarize the characteristics of etiological distribution of adrenal incidentaloma during the past 20 years., Methods: All the relevant data of adrenal incidentaloma patients admitted into Chinese PLA General Hospital between January 1993 and January 2013 were collected. Their gender ratio, visiting ages and final diagnoses were retrospectively analyzed., Results: There were 1 173 patients were collected, of which, 629 (53.62%) males and 544 (46.38%) females with a mean age of (50.84 ± 12.13) years. There were 669 (57.03%) hypertensive cases and 622 cases undergone adrenalectomy. Routine medical checkup and abdominal discomfort led to the discovery of adrenal incidentalomas. As to the etiologies, there were non-functional tumors (n = 809, 68.97%), pheochromocytoma (n = 137, 11.68%), primary aldosteronism (n = 84, 7.16%) and adrenal Cushing syndrome (n = 65, 5.54%). The proportions of adrenal cortical carcinomas and metastases were 1.70% (n = 20) and 1.36% (n = 16) respectively. Compared with normotension group, the proportion of non-functional lesions in hypertension group was significant lower (73.81% vs 65.32%, P < 0.05) while the proportions of primary aldosteronism and adrenal Cushing syndrome were higher (11.96% vs 0.79%, 5.83% vs 5.18%, both P < 0.05)., Conclusion: Adrenal incidentaloma patients with concurrent hypertension is quite common. In respect of etiologies, non-functional tumor is the most common and followed by pheochromocytoma and primary aldosteronism Cushing syndrome.

Objective: To analyze the clinical characteristics, diagnosis and treatment of pseudohypoparathyroidism (PHP)., Methods: The clinical data of 15 patients with pseudohypoparathyroidism (including 9 male and 6 female patients) admitted in our hospital between January, 1990 and July, 2011 were reviewed., Results: The disease course of the patients ranged from 3 days to 21 years, and such symptoms of tetany and fatigue were found in all the patients. Most of the patients had a history of seizures. Laboratory tests suggested commonly low serum calcium, hyperphosphatemia, and parathyroid hormone (PTH) elevation. Head CT indicated multiple intracranial calcifications in 9 cases, and abnormal thyroid function was found in 4 cases. No specific treatment was available for this disease, and life-long calcium and vitamin D supplementation was advised to prevent acute attacks and disease progression., Conclusion: PHP is a rare genetic disease with a high rate of misdiagnosis in initial diagnosis. For repeated tetany and epileptic attacks and children with congenital developmental defects, examinations of blood calcium, phosphorus, and PTH and brain CT should be ordered as soon as possible. Long-term calcium and vitamin D supplementation is suggested for the treatment, and the presence of concomitant thyroid dysfunction or hypogonadism necessitates corresponding treatments.