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DOI: 10.11855/j.issn.0577-7402.2019.12.15

Objective To analyze and compare the clinical features of fulminant type 1 diabetes mellitus (FT1DM). Methods The clinical data of 135 cases of FT1DM in recent 10 years were collected. The 135 patients included those admitted in the First Medical Center of Chinese PLA General Hospital and those reported in published papers with sample number ≥10 cases. Of which the clinical data of 20 adult patients admitted in Chinese PLA General Hospital were compared with that of 87 adult patients in non-special population diagnosed by other 6 domestic hospitals. All the patients were divided into youth group with age

Objective To investigate the correlations of plasma methoxyadrenaline (MN) and methoxynorepinephrine (NMN) (collectively called MNs) to blood lipid, blood glucose and blood pressure in patients with pheochromocytoma (PCC) and paraganglioma (PGL) (collectively called PPGL). Methods The clinical data were retrospectively analyzed of 64 patients with pathologically confirmed PPGL in Chinese PLA General Hospital during Jan. 2017 to Jun. 2018. According to the tertiles plasma MN before operation, the 64 cases were divided into T1 (n=21), T2 (n=21) and T3 (n=22) group, and then were divided into T'1 (n=21), T'2 (n=21) and T'3 (n=22) group according to the tertiles plasma NMN before operation. The correlations were analyzed of plasma level of MNs to the blood lipid, blood glucose and blood pressure. Results The body mass index (BMI) value decreased significantly with the increase of plasma MNs level in patients with PPGL. With the increase of plasma NMN level, high density lipoprotein cholesterol (HDL-C) and systolic blood pressure (SBP) increased significantly (P

Objective To evaluate the diagnostic significance of ACTH-cortisol rhythm for subclinical Cushing's syndrome (SCS) in patients with adrenal incidentaloma (AI), and explore the best diagnostic cut-off value. Methods The clinical data were collected of patients with AI admitted in Chinese PLA General Hospital from Jan. 2008 to Dec. 2016, and retrospectively analyzed based on the current CS guidelines and confirmed CS by postoperative histopathology. Patients with SCS were set as test group, and with non-functional adrenal adenoma (NFA) as control group. Receiver operating characteristic (ROC) curve was used to evaluate the diagnosis value of ACTH-cortisol rhythm for SCS in patients with AI, and search for the best cut-off value and its corresponding sensitivity and specificity. Results A total of 161 patients with NFA (84 males and 77 females with average age 51.74 years) and 88 patients with SCS (26 males and 62 females with average age 51.02 years) were recruited in present study. ROC analysis showed that the optimal cut-off value for F0:00am/F8:00am was 0.3 (AUC=0.807(95%CI 0.751-0.862, SE=0.029), sensitivity 76.1%, specificity 78.3%, Youden index 0.544, positive predictive value 77.8%, negative predictive value 75.9%); the optimal cut-off value for F0:00am was 113.35nmol/L (AUC=0.841(95%CI 0.792-0.890, SE=0.025), sensitivity 78.4%, specificity 79.5%, positive predictive value 79.3%, negative predictive value 78.6%); the optimal cut-off for ACTH8:00am was 3.0pmol/L (AUC=0.833(95%CI 0.781-0.885), SE=0.027, sensitivity 79.5%, specificity 72.7%, Youden index 0.522, accuracy 76.1%, positive predictive value 74.4%, negative predictive value 78.0%). Conclusion The serum cortisol level at med night 0:00am (F0:00am) is the best parameter in diagnosis of SCS, 113.35nmol/L is recommended as the cut-off point. DOI: 10.11855/j.issn.0577-7402.2018.07.06

Objective To analyze the clinical data [tumor size and adrenal vein sampling (AVS)] of patients with Cushing syndrome (CS) caused by bilateral adrenocortical adenoma (BAA), and explore their role in determining the predominant side before operation. Methods The clinical data were retrospectively analyzed of 11 cases of CS caused by BAA admitted in the General Hospital of Chinese PLA from Jan. 2008 to Nov. 2017. Of the 11 cases, 7 and 4 presented clinical CS and subclinical CS (SCS), respectively. Operation was performed on the determined predominant side in patients with successful AVS, while the rest of patients were operated on the larger side of the tumor. Results Six patients underwent AVS and 3 cases got success, for whom the larger side of tumor was the predominant side in 2 patients and the smaller side of tumor was the predominant side in 1 case; The clinical manifestation after operation was better than before in 1 CS case, and no obvious change was observed in postoperative clinical manifestation in 2 SCS cases. All the patients were long-term followed up, during the period their endocrine indicators were better than those before the operation. Blood pressure and blood glucose in patients with hypertension and diabetes were easier to control than before. Eight cases were operated on the larger side of tumor. The typical symptoms and physical signs of 6 CS patients improved after operation, and the clinical manifestations of 2 SCS patients hadn't changed. Five patients were long-term followed up, and their endocrine indicators were better than those before operation. Conclusions Successful AVS may be acted as an important indicator in preoperative preparation and evaluation in patients with CS caused by BAA, but it has high technical requirements and low success rate. If AVS is unconditional, a long term following-up will be needed after resecting the larger side of tumor. DOI: 10.11855/j.issn.0577-7402.2018.07.04

Objective To explore the clinical value of 24h urinary aldosterone-to-active renin ratio (UARR) in different postures for screening primary aldosteronism (PA). Methods The clinical data were retrospectively analyzed of 123 PA and 155 essential hypertension (EH) patients admitted in Chinese PLA general hospital from Jan. 2012 to Dec. 2014. The UARR and plasma aldosterone-to-active renin ratio (ARR) in different postures were calculated, and the receiver operating characteristic (ROC) curve was applied to obtain the area under ROC curve (AUC) and the optimal cut-off point of UARR in different postures for PA screening, and all the results were compared with recognized screening parameters. Results The optimal cut-off point of erect UARR was 14.20nmol/[μg/(L·h)], the AUC, sensitivity and specificity were 0.954, 91.87% and 88.64%, respectively; the AUC, sensitivity and specificity of clinostatasm UARR were 0.918, 78.05% and 87.12%, respectively; the AUC of UARR was larger in erect position than in clinostatic (Z=2.572, P=0.01). The AUC, sensitivity and specificity of erect ARR were 0.929, 85.88% and 90.91%, respectively; and of clinostatic ARR were 0.913, 84.55% and 81.82%, respectively; the AUC of erect UARR was larger than the AUC of both erect and clinostatic ARR (Z=2.094, P=0.036; Z=2.675, P=0.008). Conclusion Both erect position UARR and ARR are the effective parameters for screening PA. DOI: 10.11855/j.issn.0577-7402.2018.07.05

Objective To discuss the clinical features of preoperative undiagnosed pheochromocytoma in patients with adrenal incidentaloma (AI). Methods The clinical data were retrospectively analyzed of 103 cases of pathologically diagnosed adrenal pheochromocytoma in patients with AI admitted in the General Hospital of Chinese PLA during Mar. 2012 to Dec. 2016. The cases were divided into two groups: patients preoperatively diagnosed as non-function adrenal tumor were assigned as group A (n=16), and preoperatively diagnosed as pheochromocytoma were assigned as group B (n=87). The clinical features, endocrine hormone levels and imaging features of the two groups were analyzed. Results The age when diagnosed as hypertension was higher in group A (55.5±9.1 years) than in group B (43.6±12.3 years, P

Objective To investigate the diagnostic value of different evaluation indexes of captopril challenge test (CCT) on primary aldosteronism. Methods The biochemical parameters were collected of patients with aldosterone producing adenoma (APA, 90 cases), with idiopathic hyperaldosteronism (IHA, 44 cases) and with essential hypertension (EH, 88 cases) who were diagnosed and undergone CCT in the General Hospital of PLA from Jan. 2014 to Mar. 2016. The clinical characteristics were compared, the receiver operating characteristic curve (ROC) was conducted to evaluate the diagnostic value of different evaluation indexes including the absolute value and suppression percentage of aldosterone, the increasing percentage of plasma renin activity (PRA) and the ratio of aldosterone/renin (ARR), and then the optimal diagnostic criteria and its sensitivity and specificity were determined. Results After CCT the suppression percentage of aldosterone in APA, IHA and EH groups were 0.3%, 0.7% and 4.0%, respectively. The increasing percentage of renin in APA, IHA and EH groups was 0(0, 1), 0.25(0, 1) and 0.97(0.23, 2.27), respectively. The increasing percentage of renin in primary aldosterone group was significantly lower than that in EH group (P

Objective To analyze the relationship between the brain functional alterations of patients with Cushing's disease (CD) and patients' mental symptom by applying the Evaluating Emotional Scales and task functional magnetic resonance imaging (Task fMRI). Methods Task fMRI was performed on 8 patients with diagnosed CD admitted in the Department of Endocrinology of Chinese PLA General Hospital from Nov. 2015 to Nov. 2016 and 21 healthy people with matched age, gender and education level as control. Meanwhile, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Positive and Negative Affective Scale (PANAS) and Cushing Quality of Life Scale (Cushing QOL) were obtained to assess the brain functions. Results Significant depression and anxiety were observed in patients with CD, and their positive affective score was substantially lower while the negative affective score was relatively higher compared with that in the controls. Task fMRI revealed that, when watching the positive pictures, the activation degree of left cerebellum and right postcentral gyrus weakened in CD patients than in the controls, and the positive correlations existed between the activation degree of left cerebellum and the 16 o'clock adrenocorticotrophic hormone (ACTH) level, and between the activation degree of right postcentral gyrus and the urinary free cortisol (UFC) level in CD patients. In contrast, when watching the negative pictures, the activation degree of left cerebellum, bilateral parahippocampal gyrus and left inferior frontal gyrus was weakened in CD patients than in the controls, and the activation degree of left cerebellum was negatively correlated to the 0 o'clock cortisol level and SAS score, but is positively correlated to the UFC level. When watching the neutral pictures, the activation degree of left cerebellum and left parahippocampal gyrus was weakened in CD patients than in the controls. Conclusions CD patients may have impaired brain function with depression and anxiety mental symptoms. By Task fMRI, it can be found that the weakened activation degree of left inferior frontal gyrus, right postcentral gyrus, bilateral parahippocampal gyrus and left cerebellum may be related to CD patients' mental symptoms. DOI: 10.11855/j.issn.0577-7402.2017.07.02

Objective To evaluate the clinical characteristics of patients with growth-hormone adenoma (GHA) and summarize the diagnosis and treatment experience. Methods The clinical data of 338 GHA cases at the General Hospital of PLA from Jan. 1990 to Dec. 2016 were collected, of which 252 cases with more complete clinical data were retrospectively analyzed including their general situation, medical history, laboratory tests and auxiliary examinations, and treatment modalities and outcomes. Parts of the patients were followed up. Results The cases of hospitalized GHA patients have increased year by year since 1990, and the number of patients admitted in the last 3 years accounted for 56.2% of the total number of cases. The sex ratio for GHA patients was nearly 1:1. Age of visiting followed Gaussian distribution while the 41-50 age group occupied the largest part. The most typical sign is hand and foot enlargement (60.7%), followed by the hypertrophy of nasal ala. The most common symptoms are headache (42.5%), hypopsia, visual field defect and diplopia. More than half of GHA patients were complicated with prediabetes and diabetes (72.6%), sleep apnea (69.5%), goiter or thyroid nodularity (56.4%), cardiac insufficiency (57.0%) and colon polyp (54.1%); while the percentages of cases undergone the relevant examination in the total number of cases were as follows: 75g OGTT test (42.1%), polysomnography (23.4%), thyroid ultrasound (37.3%), echocardiogram (47.6%) and colonoscopy (14.7%); GHA was 23.37±1.42μg/L and IGF-1 was 804.28±273.93ng/ml on average; 85.0% of somatotroph tumors are macroadenoma. Surgery remains the mainstay of therapy to GHA, while medical therapy was selected by less patients. During the follow-up, only 38.0% of GHA patients can be contacted, among them the remission rate decreased to 40.5%. The positive rate of long-term remission evaluated by early postoperative GHA level was consistent with that confirmed by the long-term follow-up (χ2=3.368, P>0.05). Conclusions The number of hospitalized GHA patients have increased recent years. The common clinical signs and symptoms are somatic enlargement and nonspecific headache. Due to uncompleted screening, GHA associated complications are always misdiagnosed; It is essential to establish a sound model of follow-up to improve patients' quality of life. The early postoperative GHA levels may predict the prognosis of surgery. DOI: 10.11855/j.issn.0577-7402.2017.07.04

Objective To comparatively analyze the clinical characteristics of thyrotropin-secreting pituitary adenomas (TSH-omas). Methods The clinical features, laboratory variables, imaging and pathological results were retrospectively compared and analyzed of 26 cases with TSH-omas admitted in Chinese PLA General Hospital from Feb. 2006 to Oct. 2016 and 20 cases with TSH-omas admitted in Shanghai Huashan Hospital from Apr. 2006 to Apr. 2013. Results The female ratio was slightly higher in patients of Chinese PLA General Hospital than in Huashan Hospital [(57.7%(15/26) vs. 45.0%(9/20)], while the mean age was similar [39.5±14.1(18-67 years) vs. 40.0±14.5(17-74 years)]. The most common chief complaint was thyrotoxicosis [73.1%(19/26) vs. 55.0%(11/20)], and mild-to-moderate goiter was the most common symptom. The mean serum TSH levels in Chinese PLA General Hospital and in Huashan Hospital were 5.06(2.97-6.27)mU/L and 6.16(3.76-10.91)mU/L respectively, and patients with normal serum TSH levels were more common in Chinese PLA General Hospital than in Huashan Hospital [57.7%(15/26) vs. 40.0%(8/20)]. Microadenoma was more common in Chinese PLA General Hospital than in Huashan Hospital [34.62%(9/26) vs. 20.0%(4/20)], while macroadenoma was more common in Huashan Hospital than in Chinese PLA General Hospital [20.0%(4/20) vs. 7.7%(2/26)]. Microadenoma was more common in female patients of the both groups [66.7%(6/9) vs. 75.0%(3/4)], while macroadenoma was all found in male patients. Tumor invasion of surrounding tissue and structure was often found in macroadenoma. In terms of octreotide inhibition test, the range of 24h TSH inhibition rate was roughly the same in the two groups (37.4%-91.8% and 46.5%-94.1%, respectively). Mixed adenoma was rare among all the pathologically confirmed cases. In Chinese PLA General Hospitals, TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases, and octreotide scanning showed negative in 2 of 12 cases. Conclusions Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features. Overall, the domestic patients with TSH-omas are diagnosed without gender difference according to the reports in China. The mean age at diagnosis is significantly younger than that in foreign data. Microadenoma is more common in females, while macroadenoma is more common in males. Serum TSH levels can be normal in patients with TSH-omas. Immunostaining and/or octreotide scanning for TSH can be negative. DOI: 10.11855/j.issn.0577-7402.2017.07.03

Objective To explore the potential influence of gender on screening value of aldosterone-renin ratio (ARR) for primary aldosteronism (PA). Methods The biochemical parameters were collected of 451 PA patients and 300 essential hypertension (EH) patients who were diagnosed in the General Hospital of PLA from 1992 to 2014. Each group was then divided into two groups by gender. The clinical characteristics were compared and then the receiver operating characteristic curve (ROC) was conducted to evaluate the best cut-off value. Results The plasma aldosterone concentration (PAC), serum sodium and ARR were much higher, but the plasma rennin activity (PRA), serum potassium and BMI were much lower in PA patients than in EH patients (P0.05). The best cut-off value of ARR in male PA patients was 19.11, the relevant area under the curve (AUC) was 0.968, the sensitivity and specificity was 92.44% and 93.08%, and the Youden index (YI) was 0.86. The best cut-off value of ARR in female PA patients was 27.26, with AUC 0.956, sensitivity 92.07%, specificity 90.00% and YI 0.82, respectively. If the cut-off value was set at 27.26 in males, the specificity would rise a little, but the sensitivity and YI would sharply decrease. Similarly, the sensitivity would increase a little but the specificity and YI would fall substantially if the cut-off value in females was set at 19.11. The best cut-off value of ARR in men was smaller than the official value recommended by guidelines. Conclusion Gender is an important factor should be considered while ARR is used in PA screening, and the cut-off value of ARR in screening female PA patients should be setting higher. DOI: 10.11855/j.issn.0577-7402.2017.01.10

Objective To deepen the understanding of 45,X/46,XY mixed gonadal dysgenesis (45,X/46,XY MGD) by summarizing the respective clinical features of patients gathered from China, Brazil, Norway and Denmark suffering from the disease. Methods Comparative analysis was done with the clinical data of 7 patients suffering from 45,X/46,XY MGD diagnosed in the PLA General Hospital of China, and that of other domestic and foreign (Brazil, Norway and Denmark) cases summarized by Peking Union Medical College Hospital. Results Most of the patients of 45,X/46,XY MGD presented the Turner's syndrome-like clinical manifestations such as short stature, multiple naevi on face and lower hair line, etc. Cardiovascular and renal malformation could be found in some patients with 45,X/46,XY MGD. Regarding to the external genitalia, 42.9% (n=27) of the patients were considered to be ambiguous, with a variety of gonadal expression. Laboratory tests demonstrated elevation of follicle-stimulating and/or luteinizing hormone levels with decreased sex hormone levels in most of the patients with 45,X/46,XY MGD. Recombinant human growth hormone (RhGH), testosterone, artificial menstrual cycle and prophylactic gonadectomy were used as primary treatment. There were differences between the domestic and foreign patients in the reason to visit the hospital, and in the age for diagnosis. Chinese patients were always hospitalized for growth retardation, while the foreign patients might go to a doctor for consultation due to various reasons, such as abnormal genitalia, infertility, and fetal chromosomal abnormalities, and many of them might also be diagnosed as 45,X/46,XY MGD in prenatal period or at birth. That was why the average diagnostic age was 4.7 years younger in foreign patients than in Chinese patients. Conclusions No significant difference was found in the clinical characteristics of patients with 45,X/46,XY MGD among different countries and races. But the diagnostic age in Chinese patients is older, and the main reason to consult a doctor is growth retardation. DOI: 10.11855/j.issn.0577-7402.2016.01.14

Objective To analyze the clinical characteristics and mutation of RET proto-oncogene in a pedigree with multiple endocrine neoplasia type 2A (MEN2A). Methods The clinical data of a proband and other 10 family members were collected, the genomic DNA of their peripheral blood were extracted, the overall exons of RET proto-oncogene were amplified by PCR , and the PCR products were then purified and direct DNA sequence analysis was performed. Results Different clinical features were found in three of the family members. Three missense mutations, C634R and G691S in exon 11 and R982C in exon 18, were detected in RET proto-oncogene. The three of family members had shown MEN2A related signs, and no such mutations were detected in the other family members. Conclusions Genetic screening set the diagnosis of MEN2A at the gene level, and help analyze the family members at risk. Patients in this case may show typical clinical manifestations of MEN2A, which indicates that C634R mutation combined with G691S and R982C polymorphisms lead to the increase of downstream signal activation of the RET protein as the single C634R mutation along does.

Objective To investigate the clinical significance of serum thyrotrophic receptor antibody(TRAb) in the diagnosis of Graves’ disease(GD).Methods Serum level of TRAb was measured with enzyme-linked immunosorbent assay(ELISA) in 298 untreated patients with GD,212 cases with hypothyroidism,47 cases with subacute thyroiditis,161 cases with thyroid nodule and 73 health controls.ROC curve with SPSS 13.0 was drawn according to the data from patients with GD and subacute thyroiditis.Results The mean value of serum TRAb was significantly higher in Graves’ patients than in patients with other thyroid diseases.The positive rates of TRAb was highest in GD patients(93.3%),followed by the patients with subacute thyroiditis and hypothyroidism(14.9% and 11.3%),and the lowest in the patients with thyoid nodule(1.2%).Serum levels of TRAb in untreated GD showed various titers,and TRAb>30U/L was more commonly found(38.3%).ROC analysis showed that diagnostic code on TRAb for subacute thyroiditis and GD patients was 1.495U/L(93.5% sensitivity and 85.1% specificity),and the doubtable value interval of 1.11U/L to 13.65U/L was determined.Finally,there was a positive correlation between the serum titer of TRAb and TPOAb(P < 0.01).Conclusion TRAb measured by ELISA is a stimulating antibody,and may be used in the differential diagnosis of GD and subacute thyroiditis.

Objective To analyze the clinical characteristics of the syndrome of inappropriate antidiuretic hormone secretion(SIADH).Methods The clinical and biochemical data of sixty cases of SIADH diagnosed in Chinese PLA General Hospital from Jan.1990 to Oct.2010 were analyzed retrospectively.They were classified into malignant tumor(group A),pulmonary infection(group B),and central nervous system diseases(group C) according to different etiology,and their data were compared.Results The number of patients with diagnosis of SIADH was increasing significantly in recent 5 years,and it was higher than the total number diagnosed in the past 15 years before 1990.The SIADH patients were often admitted to various clinical department to which the patient first visited.The mean age of 60 SIADH patients(41 males and 19 females) was 58.9±15.4 years.Etiology of SIADH was diversified,and it was predominantly malignant tumor,pulmonary infection and central nervous system diseases.The clinical manifestations were mainly that of the digestive system and nervous system.The incidence of mental disorders was higher in patients with serious hyponatremia(57.6%) than in those with mild hyponatremia(11.1%,P < 0.05).Age,serum urea and serum creatinine were higher,while the urine osmolality was lower in patients suffering from lung infection than in those with malignant tumor and central nervous system disease.Other clinical symptoms and laboratory findings were not statistically different among the 3 groups.Conclusion The SIADH is prone to misdiagnosis because of different primary etiology and diverse clinical presentation,so it is important to screen SIADH in elderly patients and those with hyponatremia.