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Background: Hypothyroidism and Type 2 Diabetes Mellitus (T2DM) are prevalent endocrine disorders, and their interplay has garnered significant attention due to potential bidirectional relationships. This study investigates the association of hypothyroidism in T2DM patients, focusing on prevalence, clinical correlations, and implications for management. Materials & Methods: A cross-sectional study was conducted at Hind Institute of Medical Sciences, Uttar Pradesh, involving 50 T2DM patients. Clinical assessments, thyroid function tests, and diabetes parameters were collected. Statistical analyses, including descriptive statistics, odds ratios, and correlation coefficients, were employed to explore associations. Results: Among T2DM patients, 20% exhibited hypothyroidism, emphasizing a noteworthy prevalence. Alterations in thyroid function parameters, including elevated TSH and decreased FT4 and FT3, indicated subclinical hypothyroidism. Glycemic control analyses revealed significant differences in FBG and HbA1c levels between euthyroid and hypothyroid individuals. Odds ratios demonstrated associations between hypothyroidism and age, BMI, and T2DM duration. Medication usage patterns highlighted the necessity of thyroid-specific interventions. Conclusion: This study uncovers a substantial prevalence of hypothyroidism in T2DM patients, emphasizing the intricate relationship between these endocrine disorders. Clinical correlations with age, BMI, and T2DM duration suggest the need for tailored therapeutic approaches. Recognizing the impact on glycemic control, screening strategies, and public health measures may enhance patient outcomes in this complex interplay. [ABSTRACT FROM AUTHOR]

Hormonal disorders like PCOS (Polycystic Ovary Syndrome), autoimmune thyroid disease (AITD) including Hashimoto's thyroiditis, male hypogonadism are commonly encountered in clinical practice in the US and worldwide, with rising frequency. These typically affect patients during young or middle age, compared with other common chronic illnesses like type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, where onset may usually be in middle or older age. Multiple studies point to the role of disordered lifestyle health behaviors as contributory to these endocrinopathies, and conversely therapeutic lifestyle changes leading to improvement in signs, symptoms, biochemical markers, and sequelae of these conditions. This article presents 3 different real life case studies of the conditions enlisted above and documents the positive impact of lifestyle improvements on their disease condition. Therapeutic lifestyle behaviors are an extremely useful and important component of management of these familiar endocrinologic disorders, and clinicians need to routinely counsel their patients about healthy lifestyle interventions when treating these common syndromes. [ABSTRACT FROM AUTHOR]

Yan Yan, Hanqing Cai, Maoguang Yang Department of Endocrinology, The Second Hospital of Jilin University, Changchun, 13000, People’s Republic of ChinaCorrespondence: Maoguang Yang, Department of Endocrinology, The Second Hospital of Jilin University, Changchun, 13000, People’s Republic of China, Email yangmaoguang@jlu.edu.cnAbstract: The endocrine system regulates many biological systems, and disruptions may result in disorders, such as diabetes, thyroid dysfunction, Cushing’s syndrome, and obesity. The total incidence of endocrine illnesses was found to be 47.4%, excluding type 2 diabetes mellitus, with a significant frequency of newly diagnosed endocrine disorders. Nanotechnology manipulates particles at the atomic and molecular levels, opening up new paths for studying disease etiology and therapeutic alternatives. The goal of using nanomaterials in the treatment of endocrine illnesses is to create endogenous nano-biosensors that can detect even modest changes in hormone levels and react spontaneously to restore normal function. The size and surface characteristics of nanoparticles enhances the sensitivity in nano-sensors and are functionalized for targeted drug delivery. Nano-sized carriers composed of lipids, polymers, carbon, or metals have been shown to work much better than standard drug delivery methods. Nanoparticles (NPs) offer various advantages over current methods for diagnosing and treating endocrine disorders, acting as hydrogels for insulin delivery and wound healing. Incorporating selenium NPs into inorganic nanoparticles enhances their bioactivity and targeted delivery. Gold NPs show a promising precise insulin delivery. Mesoporous silica NPs maintain glycemic level effectively and lipid and polymeric NPs protect drugs from degradation in the gastrointestinal tract. Carbon nanotubes (CNTs) have become popular in thyroid surgeries. These characteristics make nanoparticles valuable for developing effective diagnostic and therapeutic systems. NP-based medicines have been thoroughly researched in order to identify the beginning point for the creation of theranostics, which may function in two ways: as imaging agents or therapeutics. The study posits that nanotechnology bridges diagnostics and therapies, potentially revolutionizing endocrine disorder treatments. This review delves into nanotechnology techniques, emphasizing their applications in diagnosing and treating diabetes mellitus.Keywords: nanomedicines, theranostics, endocrine disorders, diabetes, thyroid dysfunction

Background: In most developing countries, data on the prevalence and distribution of paediatric endocrine disorders is lacking. Objective: To describe the pattern of endocrine disorders seen in the Department of Child Health, University of Benin Teaching Hospital (UBTH), Benin City, Nigeria between 2004 to 2013. Methods: In this retrospective study, the case files of children seen in the paediatric endocrinemetabolic clinic and those admitted into the wards at the UBTH, Benin City from January, 2004 to December, 2013 were audited. Information obtained included age at presentation, gender, principal complaints, and final diagnosis. For those who were admitted, the outcome was noted. The hospital’s paediatric clinic register was examined to obtain the total number of new cases seen during the period under review. Results: A total of 13,735 new cases were seen in the Department of Child Health, UBTH during the ten-year period under review and 99 (0.72%) of these had endocrine disorders. The frequencies of the four leading groups of endocrine disorders seen were as follows: diabetes mellitus 17.2%; disorders of sex development 13.8%; disorders of the thyroid gland 12.1%; and disorders of energy balance 11.2%. Short stature was a rare presenting complaint. Conclusion: Diabetes mellitus and disorders involving sex development, thyroid gland, energy balance and pubertal development were the five leading groups of childhood endocrine disorders encountered in our clinical practice in UBTH.

Why you should read this article: • To understand the long-term negative physical and psychosocial consequences of precocious puberty • To learn about central precocious puberty (CPP), the more prevalent form of precocious puberty • To familiarise yourself with the factors to consider when deciding whether to treat CPP. Precocious puberty is defined as the onset of puberty before the age of eight years in girls and before the age of nine years in boys. It is associated with negative physical health consequences in the long term and can also have negative psychosocial effects, particularly in adolescence. Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis, is the more prevalent form of precocious puberty. This article explains CPP and its signs, assessment, diagnosis and treatment. It also discusses the factors to consider when deciding whether or not to treat it, stressing the importance of a shared decision-making process that children and parents should be involved in. Precocious puberty must be diagnosed and managed by specialists, but all children’s nurses need a broad understanding of the condition so that they can refer children as early as possible and reassure and advise families. [ABSTRACT FROM AUTHOR]

Introduction: Craniopharyngiomas (CPs) are benign brain tumors accounting for 5 - 11% of intracranial tumors in children. These tumors often recur and can cause severe morbidity. Postoperative radiotherapy efficiently controls and prevents progression and recurrence. Despite advancements in neurosurgery, endocrinological, visual, and neuropsychological complications are common and significantly lower the quality of life of patients. Methods: We performed a retrospective study, including all patients younger than sixteen diagnosed with CP between July 1989 and August 2022 and followed up in Hôpital Universitaire de Bruxelles. Results: Nineteen children with CP were included, with median age of 7 years at first symptoms and 7.5 at diagnosis. Common symptoms at diagnosis were increased intracranial pressure (63%), visual impairment (47%), growth failure (26%), polyuria/polydipsia (16%), and weight gain (10.5%). As clinical signs at diagnosis, growth failure was observed in 11/18 patients, starting with a median lag of 1 year and 4 months before diagnosis. On ophthalmological examination, 27% of patients had papillary edema and 79% had visual impairment. When visual disturbances were found, the average preoperative volume was higher (p=0.039). Only 6/19 patients had gross total surgical resection. After the first neurosurgery, 83% experienced tumor recurrence or progression at a median time of 22 months. Eleven patients (73%) underwent postsurgical radiotherapy. At diagnosis, growth hormone deficiency (GHD) was the most frequent endocrine deficit (8/17) and one year post surgery, AVP deficiency was the most frequent deficit (14/17). Obesity was present in 13% of patients at diagnosis, and in 40% six months after surgery. There was no significant change in body mass index over time (p=0.273) after the first six months post-surgery. Conclusion: CP is a challenging brain tumor that requires multimodal therapy and lifelong multidisciplinary follow-up including hormonal substitution therapy. Early recognition of symptoms is crucial for prompt surgical management. The management of long-term sequelae and morbidity are crucial parts of the clinical path of the patients. The results of this study highlight the fundamental importance of carrying out a complete assessment (ophthalmological, endocrinological, neurocognitive) at the time of diagnosis and during follow-up so that patients can benefit from the best possible care. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Autoimmune polyglandular syndrome type 1 (APS‐1) is a rare disorder defined by the presence of at least two of the following conditions: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism, and Addison's syndrome. Despite the lack of CMC and autoimmune history, APS‐1 can be diagnosed using genetic testing. We present the case of a 28‐year‐old female patient with a history of hypocalcemia due to hypoparathyroidism since the age of 2 years. She presented to the endocrine clinic with hypogonadism, primary amenorrhea, and primary ovarian insufficiency. Addison's disease was eventually diagnosed, despite a negative Synacthen test. The adrenal crisis required intravenous hydrocortisone therapy. No CMC was documented, and there was no family history of such conditions. The diagnosis of APS‐1 was confirmed by genetic testing, revealing homozygous pathogenic variants of the autoimmune regulator gene. Management included oral calcium and calcitriol and oral hydrocortisone and fludrocortisone for Addison's disease. Hormonal induction of secondary sexual characteristics was initiated. The patient received combined oral estrogen and progesterone pills. This case highlights the critical significance of early recognition, thorough evaluation, and tailored treatment for patients with APS‐1 to enhance their quality of life and mitigate potentially life‐threatening complications. This underscores the importance of screening for associated minor autoimmune diseases as part of a holistic approach to care. [ABSTRACT FROM AUTHOR]

Abstract The report covers the current and past activities of the department Molecular Genetics-Function and Therapy (MGFT) at the Cyprus Institute of Neurology and Genetics (CING), an affiliated Reference Center for the European Reference Network on Rare Endocrine Conditions (Endo-ERN). The presented data is the outcome of > 15 years long standing collaboration between MGFT and endocrine specialists from the local government hospitals and the private sector. Up-to-date > 2000 genetic tests have been performed for the diagnosis of inherited rare endocrine disorders. The major clinical entities included Congenital Adrenal Hyperplasia (CAH) due to pathogenic variants in CYP21A2 gene and Multiple Endocrine Neoplasia (MEN) type 2 due to pathogenic variants in the RET proto-oncogene. Other rare and novel pathogenic variants in ANOS1, WDR11, FGFR1, RNF216, and CHD7 genes were also found in patients with Congenital Hypogonadotropic Hypogonadism. Interestingly, a few patients with Disorders of Sexual Differentiation (DSD) shared rare pathogenic variants in the SRD5A2, HSD17B3 and HSD3B2 while patients with Glucose and Insulin Homeostasis carried theirs in GCK and HNF1A genes. Lastly, MGFT over the last few years has established an esteemed diagnostic and research program on premature puberty with emphasis on the implication of MKRN3 gene on the onset of the disease and the identification of other prognosis biomarkers. As an Endo-ERN member MGFT department belongs to this large European network and holds the same humanistic ideals which aim toward the improvements of health care for patients with rare endocrine conditions in respect to improved and faster diagnosis.

Background: The thyroid hormone is so essential that it is involved in the functioning of all the body systems, especially in the development of the brain in fetal life. The World Health Organization has estimated that around 2 billion individuals are suffering from thyroid disorders. Hence, it is essential to identify and diagnose hypothyroid patients so that the treatment strategy can be started at the earliest. Aims and Objectives: The present study aimed to find out the peripheral nerve conduction velocity, range, and degree of movement of joints in newly diagnosed hypothyroid women and compare them with those of normal euthyroid women. Materials and Methods: The present study was a case–control study conducted from July 2015 to March 2016. A total of 50 cases of newly diagnosed hypothyroid women and 50 age-matched euthyroid women were part of the study after obtaining written and informed consent. Thyroid estimation was performed in the Clinical Biochemistry Department by the ELISA method, and nerve conduction studies were performed in the Neurology Department. Results: The age and height of the participants were not statistically significant. Weight and body mass index were significantly higher in the cases when compared to the control group. Sensory and motor conduction velocities of the right median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the right ulnar nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left ulnar nerve are significantly less in these cases when compared to control group participants. The goniometric parameters (right and left sides) of the cases and control group participants were not significantly different. Conclusion: Hypothyroid women have a delay in peripheral nerve conduction velocities, including sensory and motor components, and the degree and range of movements of limb joints were not affected. A nerve conduction study may be utilized as a routine screening test for hypothyroid individuals so that hormone replacement therapy can be instituted at the earliest.

Abstract Determination of long COVID requires ruling out alternative diagnoses, but there has been no report on the features of alternative diagnoses. This study was a single-center retrospective study of outpatients who visited our clinic between February 2021 and June 2023 that was carried out to determine the characteristics of alternative diagnoses in patients with post-COVID-19 symptoms. In a total of 731 patients, 50 patients (6.8%) were newly diagnosed with 52 diseases requiring medical intervention, and 16 (32%) of those 50 patients (2.2% of the total) were considered to have priority for treatment of the newly diagnosed disorders over long COVID treatment. The proportion of patients with a new diagnosis increased with advance of age, with 15.7% of the patients aged 60 years or older having a new diagnosis. Endocrine and metabolic diseases and hematological and respiratory diseases were the most common, being detected in eight patients (16%) each. Although 35 of the 52 diseases (67%) were related to their symptoms, endocrine and metabolic diseases were the least associated with specific symptoms. Other disorders that require attention were found especially in elderly patients with symptomatic long COVID. Thus, appropriate assessment and differentiation from alternative diagnoses are necessary for managing long COVID.

Dyslipidemia is one of the most common disorders worldwide, which, if left untreated, results in a multitude of complications. Thus proper diagnostics, which includes identifying of secondary causes of dyslipidemia is crucial. Endocrine disorders are an important cause of secondary dyslipidemia. This paper aims to review the publications on lipoprotein alterations in endocrine disorders from the past two years and provide an overview of the recent discoveries in this dynamically developing and large field. Significant changes in lipoprotein serum concentrations are present in most endocrinological diseases and can be modified with proper treatment. Some lipoproteins have also been proposed as markers in some endocrine diseases, e.g., thyroid carcinoma. From the scope of endocrine disorders, the largest number of studies explored the lipoprotein changes in polycystic ovary syndrome and in women during the menopausal and peri-menopausal period. Even though the association of thyroid disorders with dyslipidemia is already well studied, new research has delivered some exciting findings about lipoprotein alterations in euthyroid patients with either positive antithyroid peroxidase antibodies or reduced sensitivity to thyroid hormones. The problem of the adverse metabolic profile, including dyslipidemia in hypoprolactinemia has been recognized. Moreover, this review describes other significant discoveries encompassing lipoprotein alterations in disorders of the adrenals, thyroid, parathyroid glands, pituitary, and gonads. The up-to-date knowledge of the influence of endocrine disorders and hormonal changes on serum lipoproteins is prudent as it can significantly impact therapeutic decisions. [ABSTRACT FROM AUTHOR]

Developmental abnormalities and malformations of the breast are uncommon and include a range of genetic, acquired, and sporadic conditions. These abnormalities can lead to irregularities in the nipple-areolar complex and/or the underlying glandular tissue, resulting in either underdevelopment or overdevelopment of the breasts. The age at which these abnormalities present and their clinical severity depend on the underlying biological cause. Such abnormalities can affect either one or both breasts, particularly in conjunction with syndromic conditions or endocrine disorders. Disordered development may also be localized, giving rise to tumor-like lesions such as hamartomas, pseudoangiomatous stromal hyperplasia, and gynecomastia. This review will explore the various disorders of breast development. [ABSTRACT FROM AUTHOR]

Hypothyroidism and Polycystic Ovary Syndrome (PCOS) constitute prevalent endocrine conditions that have serious effects on the health of women. Hormonal dysregulation, ovarian dysfunction, and polycystic ovarian morphology are hallmarks of PCOS, whereas insufficient thyroid hormone production causes hypothyroidism. This study explores the complex interactions between hypothyroidism and PCOS, highlighting the urgent need for a thorough understanding of their coexistence. It is crucial to understand that PCOS and hypothyroidism frequently co-occur since they both involve similar metabolic and hormonal dysregulations. The complex interrelationship between these illnesses is further highlighted by genetic predispositions and epigenetic changes. Clinical manifestations and reproductive issues in afflicted people are mostly influenced by hormonal imbalances, insulin resistance, and metabolic abnormalities. It is crucial to use a multidisciplinary approach to patient treatment, collaborating with endocrinologists, gynaecologists, primary care doctors, nutritionists, and mental health specialists. This comprehensive approach takes into account not only the hormonal and metabolic components of PCOS and hypothyroidism but also the psychological well-being of persons dealing with these conditions. The importance of understanding and treating the interaction between PCOS and hypothyroidism in clinical practice is emphasized in this study. Improved results and a higher quality of life for afflicted people can result from early diagnosis and suitable care techniques. Future research initiatives on genetic, epigenetic, and metabolic issues also show potential for improving therapeutic and diagnostic approaches, eventually improving patient care. This review provides a comprehensive understanding of the challenges linked to PCOS and hypothyroidism, emphasizing the importance of a comprehensive treatment plan for improved outcomes. [ABSTRACT FROM AUTHOR]

Background: ABO blood types are not known to cause diseases directly, but they can be vulnerable and surrender to diseases and health problems. This study aimed to evaluate the susceptibility to COVID-19 in individuals with different blood groups at different ages. Methods: An electronic health record was used in this retrospective cohort study at Shahid Beheshti Hospital. We studied 858 patients who were referred to Shahid Beheshti Hospital, we identified 434 of them as COVID-19 patients using RT-PCR. An analysis of the electronic record involved collecting retrospective laboratory data and demographic information, including age, sex, and blood type. Next, we examined the differences between the ABO blood groups of COVID-19 patients and the control group (1991 case). We used SPSS26 for statistical computations. Data were scrutinizeed with the χ2 test. P < 0.05 was considered statistically outstanding. Results: Based on the distribution of ABO blood groups in 434 COVID-19 patients, it was revealed that 288 of them were male and 146 were female, and the majority of them were in their third decade of life. A total of 159 patients (36.6%) had type B blood, 116 had type A (26.7%), 109 had type O (25.1%), and 50 had type AB (11.5%). COVID-19 patients had a higher percentage of type B and AB blood than the control group Conclusion: Our study found that the frequency ratio of blood group B was remarkably higher in patients than in the control group, which indicates that the blood group B may play a pivotal role in COVID-19 disease. [ABSTRACT FROM AUTHOR]

Background: The thyroid hormone is so essential that it is involved in the functioning of all the body systems, especially in the development of the brain in fetal life. The World Health Organization has estimated that around 2 billion individuals are suffering from thyroid disorders. Hence, it is essential to identify and diagnose hypothyroid patients so that the treatment strategy can be started at the earliest. Aims and Objectives: The present study aimed to find out the peripheral nerve conduction velocity, range, and degree of movement of joints in newly diagnosed hypothyroid women and compare them with those of normal euthyroid women. Materials and Methods: The present study was a case--control study conducted from July 2015 to March 2016. A total of 50 cases of newly diagnosed hypothyroid women and 50 age-matched euthyroid women were part of the study after obtaining written and informed consent. Thyroid estimation was performed in the Clinical Biochemistry Department by the ELISA method, and nerve conduction studies were performed in the Neurology Department. Results: The age and height of the participants were not statistically significant. Weight and body mass index were significantly higher in the cases when compared to the control group. Sensory and motor conduction velocities of the right median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the right ulnar nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left ulnar nerve are significantly less in these cases when compared to control group participants. The goniometric parameters (right and left sides) of the cases and control group participants were not significantly different. Conclusion: Hypothyroid women have a delay in peripheral nerve conduction velocities, including sensory and motor components, and the degree and range of movements of limb joints were not affected. A nerve conduction study may be utilized as a routine screening test for hypothyroid individuals so that hormone replacement therapy can be instituted at the earliest. [ABSTRACT FROM AUTHOR]

Probiotics has offered a new prospect to treat and manage a variety of endocrine disorders such as obesity, diabetes, non- alcoholic fatty liver disease and metabolic syndrome. The precise mechanisms by which probiotics exert their beneficial effects on endocrine disorders and its associated problems are still indecisive. It seems that regulating the immune system and suppressing pro-inflammatory pathways like tumor necrosis factor-α and interleukin-6 or triggering anti-inflammatory pathways like interleukin-4 and 10 may be one of the potential mechanisms in the managing of endocrine disorders. In this systematic review, we hypothesized that various probiotic strains (Lactobacillus, Biofidiobacteria, Streptococcus, Entrococcus, Clostridium, and Bacillus) alone or in combination with each other could manage endocrine disorders via modulating inflammatory pathways such as suppressing pro-inflammatory cytokines (IL-6, IL-12, TNF-α, TNF-β, NFκB, and MCP-1), stimulating anti-inflammatory cytokines (IL-4,IL-6, IL-22, IL-23, IL-33, and TGF-β) and maintaining other factors like C-reactive protein, Toll like receptors, LPS, and NK cells. Data source this search was performed in PubMed and Scopus. Both human and animal studies were included. Among more than 15,000 papers, 25 studies were identified as eligible for more assessments. Quality assessment of the studies was cheeked by two researchers independently by title and abstract screening, then article which have inclusion criteria were included, and data retrieved from the included full text studies as the authors had originally reported. Results specified that Lactobacillus has been the most widely used probiotic as well as which one exhibiting the extend of the therapeutic effects on endocrine disorders, especially obesity by modulating immune responses. Also, most studies have revealed that probiotics through suppressing pro-inflammatory pathways specially via reducing levels TNF-α cytokine exhibited protective or beneficial effects on endocrine diseases particularly obesity as well as through decreasing level of IL-6 induced therapeutic effects in diabetes. This systematic review suggests that probiotics could ameliorate endocrine disorders via their immunomodulatory effects. [ABSTRACT FROM AUTHOR]

Determination of long COVID requires ruling out alternative diagnoses, but there has been no report on the features of alternative diagnoses. This study was a single-center retrospective study of outpatients who visited our clinic between February 2021 and June 2023 that was carried out to determine the characteristics of alternative diagnoses in patients with post-COVID-19 symptoms. In a total of 731 patients, 50 patients (6.8%) were newly diagnosed with 52 diseases requiring medical intervention, and 16 (32%) of those 50 patients (2.2% of the total) were considered to have priority for treatment of the newly diagnosed disorders over long COVID treatment. The proportion of patients with a new diagnosis increased with advance of age, with 15.7% of the patients aged 60 years or older having a new diagnosis. Endocrine and metabolic diseases and hematological and respiratory diseases were the most common, being detected in eight patients (16%) each. Although 35 of the 52 diseases (67%) were related to their symptoms, endocrine and metabolic diseases were the least associated with specific symptoms. Other disorders that require attention were found especially in elderly patients with symptomatic long COVID. Thus, appropriate assessment and differentiation from alternative diagnoses are necessary for managing long COVID. [ABSTRACT FROM AUTHOR]

Purpose: Polycystic ovary syndrome (PCOS) is the most common endocrine-reproductive disease linked not just to infertility but also to serious comorbidities. There is a reported association between low vitamin D levels and multiple health conditions including PCOS. This narrative review aims to analyze the role of vitamin D in PCOS development, use of the vitamin D in the treatment of PCOS, and the molecular basis of these observations. Methods: A Medline and PubMed research was performed, during the years 1990–2023, using a combination of keywords on such topic. According to the author's evaluation and target, papers were identified and included for a narrative review. Results: There are associations between lower levels of vitamin D and PCOS, as well as with insulin resistance, metabolic syndrome, hyperandrogenemia, metabolic and endocrine disorders as well as the onset of oxidative stress and pro-inflammatory milieu, in PCOS women. Conclusion: Vitamin D has a role in pathologic changes linked to PCOS. Molecular and clinical investigations which give new information about the role of vitamin D in the development of PCOS and related endocrine and metabolic disturbance are further needed. [ABSTRACT FROM AUTHOR]

Background: The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational hazards, on hormonal disruption and the initiation of endometriosis remains a major issue. Objectives: This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications. Discussion: Endocrine‐disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women's reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders. Conclusion: Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long‐term commitment. [ABSTRACT FROM AUTHOR]

People with endocrine disorders are at an increased risk of osteoporosis, yet their knowledge of osteoporosis prevention is rarely studied. This study aimed to assess the knowledge related to osteoporosis prevention and its associated factors among people with endocrine disorders in China. A cross-sectional study was conducted in a Chinese hospital's Department of Metabolism and Endocrinology. A total of 562 people with endocrine disorders completed the Chinese version of the Osteoporosis Prevention and Awareness Tool to assess their knowledge of osteoporosis prevention. Results showed that participants had a mean knowledge of 59.36 ± 23.90 out of 100, with only 52.1% scoring above 60 points. Being female, having higher education, with comorbidities, with a recent osteoporosis diagnosis, and having received health education related to osteoporosis prevention were associated with higher knowledge of osteoporosis prevention. Our study indicates that more efforts are needed to improve the knowledge related to osteoporosis prevention among people with endocrine disorders. This may be realized by strengthening and expanding diverse education, focusing on males and those with lower education and without comorbidities. [ABSTRACT FROM AUTHOR]

Sarcopenia is a disease mainly characterized by a decrease in skeletal muscle mass and muscle strength in the elderly population and chronic disease patients. Its main pathogenic factors include endocrine metabolic disorders, insufficient physical activity, chronic inflammation, etc. Recently, the impact of sleep disorders on sarcopenia has begun to receive attention, more studies have shown a correlation between sleep disorders and sarcopenia. Sleep disorders can lead to circadian disorders and thus affect the secretion of hormones such as insulin and sex hormones, as well as promote the secretion of pro-inflammatory inflammatory factors, all of which can lead to abnormal synthesis and breakdown of skeletal muscle proteins and may cause the development of sarcopenia. Therefore, exploring the relationship between the two and targeting sleep disorders may be effective in the prevention and treatment of sarcopenia and is a potential treatment strategy to intervene in the development of sarcopenia. [ABSTRACT FROM AUTHOR]

Key Clinical Message Autoimmune polyglandular syndrome type 1 (APS‐1) is a rare disorder defined by the presence of at least two of the following conditions: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism, and Addison's syndrome. Despite the lack of CMC and autoimmune history, APS‐1 can be diagnosed using genetic testing. We present the case of a 28‐year‐old female patient with a history of hypocalcemia due to hypoparathyroidism since the age of 2 years. She presented to the endocrine clinic with hypogonadism, primary amenorrhea, and primary ovarian insufficiency. Addison's disease was eventually diagnosed, despite a negative Synacthen test. The adrenal crisis required intravenous hydrocortisone therapy. No CMC was documented, and there was no family history of such conditions. The diagnosis of APS‐1 was confirmed by genetic testing, revealing homozygous pathogenic variants of the autoimmune regulator gene. Management included oral calcium and calcitriol and oral hydrocortisone and fludrocortisone for Addison's disease. Hormonal induction of secondary sexual characteristics was initiated. The patient received combined oral estrogen and progesterone pills. This case highlights the critical significance of early recognition, thorough evaluation, and tailored treatment for patients with APS‐1 to enhance their quality of life and mitigate potentially life‐threatening complications. This underscores the importance of screening for associated minor autoimmune diseases as part of a holistic approach to care.

IntroductionCraniopharyngiomas (CPs) are benign brain tumors accounting for 5 - 11% of intracranial tumors in children. These tumors often recur and can cause severe morbidity. Postoperative radiotherapy efficiently controls and prevents progression and recurrence. Despite advancements in neurosurgery, endocrinological, visual, and neuropsychological complications are common and significantly lower the quality of life of patients.MethodsWe performed a retrospective study, including all patients younger than sixteen diagnosed with CP between July 1989 and August 2022 and followed up in Hôpital Universitaire de Bruxelles.ResultsNineteen children with CP were included, with median age of 7 years at first symptoms and 7.5 at diagnosis. Common symptoms at diagnosis were increased intracranial pressure (63%), visual impairment (47%), growth failure (26%), polyuria/polydipsia (16%), and weight gain (10.5%). As clinical signs at diagnosis, growth failure was observed in 11/18 patients, starting with a median lag of 1 year and 4 months before diagnosis. On ophthalmological examination, 27% of patients had papillary edema and 79% had visual impairment. When visual disturbances were found, the average preoperative volume was higher (p=0.039). Only 6/19 patients had gross total surgical resection. After the first neurosurgery, 83% experienced tumor recurrence or progression at a median time of 22 months. Eleven patients (73%) underwent postsurgical radiotherapy. At diagnosis, growth hormone deficiency (GHD) was the most frequent endocrine deficit (8/17) and one year post surgery, AVP deficiency was the most frequent deficit (14/17). Obesity was present in 13% of patients at diagnosis, and in 40% six months after surgery. There was no significant change in body mass index over time (p=0.273) after the first six months post-surgery.ConclusionCP is a challenging brain tumor that requires multimodal therapy and lifelong multidisciplinary follow-up including hormonal substitution therapy. Early recognition of symptoms is crucial for prompt surgical management. The management of long-term sequelae and morbidity are crucial parts of the clinical path of the patients. The results of this study highlight the fundamental importance of carrying out a complete assessment (ophthalmological, endocrinological, neurocognitive) at the time of diagnosis and during follow-up so that patients can benefit from the best possible care.

Abstract The human voice is commonly affected by hormonal changes, both in physiological and pathological conditions. Voice changes were reported in a number of endocrine disorders, and dysphonia may be the initial sign of these disorders. A number of studies documented endocrine-related voice changes utilizing both subjective and objective voice assessment tools. The objective of the present review is to draw the phoniatrician’s attention to the wide variety of typical changes, as well as the potential for hormonal imbalances that may affect the voice, in order to identify them promptly and generate proper treatment and referrals.

Abstract Male infertility is a physiological phenomenon in which a man is unable to impregnate a fertile woman during a 12-month period of continuous, unprotected sexual intercourse. A growing body of clinical and epidemiological evidence indicates that the increasing incidence of male reproductive problems, especially infertility, shows a very similar trend to the incidence of diabetes within the same age range. In addition, a large number of previous in vivo and in vitro experiments have also suggested that the complex pathophysiological changes caused by diabetes may induce male infertility in multiple aspects, including hypothalamic-pituitary–gonadal axis dysfunction, spermatogenesis and maturation disorders, testicular interstitial cell damage erectile dysfunction. Based on the above related mechanisms, a large number of studies have focused on the potential therapeutic association between diabetes progression and infertility in patients with diabetes and infertility, providing important clues for the treatment of this population. In this paper, we summarized the research results of the effects of diabetes on male reproductive function in recent 5 years, elaborated the potential pathophysiological mechanisms of male infertility induced by diabetes, and reviewed and prospected the therapeutic measures.

Introduction: Acromegaly is a slow-progressing disease caused by excessive secretion of growth hormone, typically by pituitary adenomas. Ectopic tumors, such as those in the lungs or pancreas, are a rare cause. Acromegaly associated with ectopic GHRH secretion is more common in women. Case Report: The 48-year-old man underwent head contrast computed tomography (CT) and pituitary magnetic resonance imaging (MRI) due to persistent headaches, but no lesions were found. Outpatient tests showed elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Physical examination revealed coarse facial features, enlarged hands and feet, hyperhidrosis, and snoring. During hospitalization, elevated levels of IGF-1 and serotonin were noted, along with paradoxical GH release during an oral glucose tolerance test and abnormal thyroid hormone levels. Chest X-ray showed opacity in the right lung. The patient, diagnosed with acromegaly, also had obesity, hypertension, left ventricular hypertrophy, impaired fasting glucose, and cholelithiasis. Treatment with liraglutide was initiated. Ectopic sites of GH secretion were investigated, revealing emphysematous bullae and nodules in the lungs, as well as suspicious findings in the anterior mediastinum. Subsequent hospitalization showed normal thyroid and gonadal function, and MRI showed no pituitary lesions. Conclusion: This case illustrates the difficulties in diagnosing acromegaly. Pituitary hyperplasia visualized on imaging studies does not always indicate pituitary acromegaly, as it could result from hypertrophy due to ectopic GHRH secretion. Although ectopic acromegaly is rare, it should always be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

The human voice is commonly affected by hormonal changes, both in physiological and pathological conditions. Voice changes were reported in a number of endocrine disorders, and dysphonia may be the initial sign of these disorders. A number of studies documented endocrine-related voice changes utilizing both subjective and objective voice assessment tools. The objective of the present review is to draw the phoniatrician's attention to the wide variety of typical changes, as well as the potential for hormonal imbalances that may affect the voice, in order to identify them promptly and generate proper treatment and referrals. [ABSTRACT FROM AUTHOR]

Male infertility is a physiological phenomenon in which a man is unable to impregnate a fertile woman during a 12-month period of continuous, unprotected sexual intercourse. A growing body of clinical and epidemiological evidence indicates that the increasing incidence of male reproductive problems, especially infertility, shows a very similar trend to the incidence of diabetes within the same age range. In addition, a large number of previous in vivo and in vitro experiments have also suggested that the complex pathophysiological changes caused by diabetes may induce male infertility in multiple aspects, including hypothalamic-pituitary–gonadal axis dysfunction, spermatogenesis and maturation disorders, testicular interstitial cell damage erectile dysfunction. Based on the above related mechanisms, a large number of studies have focused on the potential therapeutic association between diabetes progression and infertility in patients with diabetes and infertility, providing important clues for the treatment of this population. In this paper, we summarized the research results of the effects of diabetes on male reproductive function in recent 5 years, elaborated the potential pathophysiological mechanisms of male infertility induced by diabetes, and reviewed and prospected the therapeutic measures. [ABSTRACT FROM AUTHOR]

This comprehensive review article delves into the critical role of the human microbiota in the development and management of endocrine-related diseases. We explore the complex interactions between the microbiota and the endocrine system, emphasizing the implications of microbiota dysbiosis for the onset and progression of various endocrine disorders. The review aims to synthesize current knowledge, highlighting recent advancements and the potential of novel therapeutic approaches targeting microbiota-endocrine interactions. Key topics include the impact of microbiota on hormone regulation, its role in endocrine pathologies, and the promising avenues of microbiota modulation through diet, probiotics, prebiotics, and fecal microbiota transplantation. We underscore the importance of this research in advancing personalized medicine, offering insights for more tailored and effective treatments for endocrine-related diseases. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of life (QOL) among type 2 diabetes patients aged 30–64 years belonging to middle and high income group and to find out the factors associated with it. Research design and methods: A cross-sectional study was done in a tertiary care hospital in Delhi, India. Using interview-based method, the investigator collected information from 150 type 2 diabetes patients. The tool used was QOLID, i.e., Quality of Life Questionnaire for Indian Diabetes patients with scores ranging from 34 to 170. Data was analyzed using software SPSS 23.0 version, and both descriptive and inferential statistics were calculated. Results: The mean QOL score in our study was 142 ± 12.2 with a median of 145 (IQR = 135–150.7). The most affected domains of QOL were general health, treatment satisfaction, and diet satisfaction. The factors which were significantly associated with QOL were age (p = 0.002), gender (p = 0.004), duration of diabetes (p < 0.001), current treatment of patient (p < 0.01), absence of complications (p = 0.002), co-morbidities (0.006), and regular exercise (p = 0.01). Patient's current on-going treatment and regular exercise were identified as determinants of QOL. Conclusion: The quality of life of diabetes patients in our study was fairly high. It was better in younger males, those taking single oral hypoglycemic drug, who were without any complications and co-morbidities, and who did regular physical exercise. The overall infrastructure, patient friendly environment and patient management system also played a big role towards good QOL of our participants. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the prevalence of depression, anxiety, and stress among in-patients diagnosed with various endocrine disorders. Quality of life (QoL) was also evaluated using the WHOQoL-BREF questionnaire. Material and Methods: The study included 110 patients. Participants were assessed for depression using the Hamilton Depression Rating Scale (HDRS), for anxiety using the Hamilton Anxiety Scale (HAM-A), and for stress using the Perceived Stress Scale (PSS). Results: The majority of patients had Type-2 Diabetes Mellitus (46.4%) or hypothyroidism (33.6%). The study showed that 22% of endocrine patients exhibited signs of depression, with the highest depression rate found among PCOD patients (58.3%). Anxiety was prevalent across all endocrine disorders, with the most severe cases found among hyperthyroid patients (66%). Regarding stress levels, most patients with Type-2 Diabetes and hypothyroidism reported moderate stress (70% and 86% respectively), while PCOD patients reported moderate (66%) and high stress (33.3%). Quality of life varied, with physical health ranging from 17.86 to 85.7 (mean 48.5), psychological health ranging from 20.83 to 70.8 (mean 50.9), social health ranging from 8.33 to 91.6 (mean 56.4), and environmental health ranging from 15.63 to 87.5 (mean 56.5). Conclusion: In conclusion, endocrine disorders can have far-reaching effects on mental health, causing depression, anxiety, and stress. Understanding these connections and integrating mental health care into treatment plans is crucial to improving patient outcomes. [ABSTRACT FROM AUTHOR]

Dyslipidemia is one of the most common disorders worldwide, which, if left untreated, results in a multitude of complications. Thus proper diagnostics, which includes identifying of secondary causes of dyslipidemia is crucial. Endocrine disorders are an important cause of secondary dyslipidemia. This paper aims to review the publications on lipoprotein alterations in endocrine disorders from the past two years and provide an overview of the recent discoveries in this dynamically developing and large field. Significant changes in lipoprotein serum concentrations are present in most endocrinological diseases and can be modified with proper treatment. Some lipoproteins have also been proposed as markers in some endocrine diseases, e.g., thyroid carcinoma. From the scope of endocrine disorders, the largest number of studies explored the lipoprotein changes in polycystic ovary syndrome and in women during the menopausal and peri-menopausal period. Even though the association of thyroid disorders with dyslipidemia is already well studied, new research has delivered some exciting findings about lipoprotein alterations in euthyroid patients with either positive antithyroid peroxidase antibodies or reduced sensitivity to thyroid hormones. The problem of the adverse metabolic profile, including dyslipidemia in hypoprolactinemia has been recognized. Moreover, this review describes other significant discoveries encompassing lipoprotein alterations in disorders of the adrenals, thyroid, parathyroid glands, pituitary, and gonads. The up-to-date knowledge of the influence of endocrine disorders and hormonal changes on serum lipoproteins is prudent as it can significantly impact therapeutic decisions.

Lipid disorders are common in several endocrine conditions. Diabetes mellitus, hypothyroidism and Cushing's syndrome are the common endocrine disorders with dyslipidemia. Dyslipidemia has a significant impact on endocrine and metabolic health and the risk of atherosclerotic cardiovascular disease. In most cases of dyslipidemia, the suspicion of endocrine diseases must be based on clinical symptoms and signs. Optimal management of the dyslipidemia requires treatment of the underlying endocrine condition. Lipid lowering therapy is a useful adjunct or a requirement in many cases. The Indian guidelines provide a pragmatic and practical approach to the management of lipid disorders in endocrine disease, as well as endocrine vigilance with lipid therapy.

Abstract Purpose Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management. Methods The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records. Results A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients’ ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases. Conclusions Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels.

Method-related variations in the measurement of hormones and the reference intervals used in the clinical laboratory can have a significant, but often under-appreciated, impact on the diagnosis and management of endocrine disorders. This variation in laboratory practice has the potential to lead to an errant approach to patient care and thus could cause harm. It may also be the source of confusion or result in excessive or inadequate investigation. It is important that laboratory professionals and clinicians know about these impacts, their sources, and how to detect and mitigate them when they do arise. In this review article, we describe the historical and scientific context from which inconsistency in the clinical laboratory arises. Examples from the published literature of the impact of the method, reference interval, and clinical decision threshold-related discordances on the assessment and monitoring of various endocrine disorders are discussed to illustrate the sources, causes, and effects of this variability. Its potential impact on the evaluation of growth hormone deficiency and excess, thyroid and parathyroid disorders, hyperandrogenism, hypogonadism, glucocorticoid excess and deficiency, and diabetes mellitus is elaborated. Strategies for assessment and mitigation of the discordance are discussed. The clinical laboratory has a responsibility to recognise and address these issues, and although a lot has been accomplished in this area already, there remains more to be done. [ABSTRACT FROM AUTHOR]

Childhood onset endocrine disorders need long-term medical, psychological and social management. Over time, many illnesses evolve, while others may witness onset of new complications. Thus, the components of the care change as the child grows into adolescence and then adulthood. The transition of children and adolescents with chronic endocrine disorders to adult care continues to be a major challenge. Pediatric and adult healthcare teams should together design a transitional care plan that is developmentally appropriate and responsive to the needs of young adults. The preparation for transition to adult care should begin early in adolescence and involve both the adolescent and his parents. A structured and planned transitional care bridges the gap between pediatric and adult care teams, promote ongoing engagement and build trust with the new healthcare teams. Combined pediatric-adult care transition model for endocrine conditions has yielded high adherence rates and patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management. Methods: The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records. Results: A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients' ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases. Conclusions: Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels. [ABSTRACT FROM AUTHOR]

Context: Endocrine complications are common in pediatric brain tumor patients. Objective: To describe hypothalamic--pituitary--gonadal axis (HPGA) function in patients treated in childhood for a primary brain tumor more than 5 years earlier, in order to identify risk factors for HPGA impairment. Methods: We retrospectively included 204 patients diagnosed with a primary brain tumor before 18 years of age and monitored at the pediatric endocrinology unit of the Necker Enfants-Malades University Hospital (Paris, France) between January 2010 and December 2015. Patients with pituitary adenoma or untreated glioma were excluded. Results: Among patients with suprasellar glioma not treated by radiotherapy, the prevalence of advanced puberty was 65% overall and 70% when the diagnosis occurred before 5 years of age. Medulloblastoma chemotherapy caused gonadal toxicity in 70% of all patients and in 87.5% of those younger than 5 years at diagnosis. In the group with craniopharyngioma, 70% of patients had hypogonadotropic hypogonadism, which was consistently accompanied by growth hormone deficiency. Conclusion: Tumor type, location, and treatment were the risk main factors for HPGA impairment. Awareness that onset can be delayed is essential to guide information of parents and patients, patient monitoring, and timely hormone replacement therapy. [ABSTRACT FROM AUTHOR]

Introduction: Ovariectomies rats were used to assess the preventive effects of almond and primrose oils on their lipid and neurochemical profiles. Methods: The experimental groups were as follows: Group 1: A negative control group. Group 2: Rats given an oral dose of almond oil (800 mg/kg/d) for 30 days. Group 3: Rats given an oral dose of primrose oil (500 mg/kg/d) for 30 days. Group 4: Untreated ovariectomized rats. Group 5: Ovariectomized rats given an oral dose of almond oil (800 mg/kg/d) for 30 days. Group 6: Ovariectomized rats given an oral dose (500 mg/kg/d) of primrose oil daily for 30 days. Results: Oral administration of almond and primrose oils significantly decreased mean (P < 0.05) serum total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C) concentrations and raised high-density lipoprotein cholesterol (HDL-C) in the ovariectomized groups compared to group 4 (P < 0.05). They also increased leptin and estradiol (E2) concentrations in groups 5 and 6. Administration of oils showed a marked increase in noradrenalin, dopamine, and 5-hydroxytyramin levels and a marked decrease in PGE2 and COX-2 levels (P < 0.05). Rats given almond and primrose oils revealed minor capillary congestion in the hippocampus in brain sections. Conclusion: Administration of almond or primrose oils may improve central nervous system functions and decrease the risk of cardiovascular illnesses. They also might be effective against atherosclerosis, inflammation, endocrine disorders, and cognitive impairments for women who undergo surgical menopause prior to their natural menopause.

This document is an editorial published in Frontiers in Endocrinology titled "Hormonal imbalance-associated oxidative stress and protective benefits of nutritional antioxidants." The editorial discusses the complex relationship between hormonal conditions, redox state, and oxidative stress (OS) in various biological processes. It highlights the potential of plant-based compounds and nutritional antioxidants in combating OS and addressing disorders associated with hormonal dysregulation. The editorial also explores the effects of antioxidants on thyroid pathologies, male fertility, and the reproductive tract following mating. The use of antioxidant supplements as adjunctive modalities in therapeutic interventions is also mentioned. [Extracted from the article]