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Aberle J, Schulze Zur Wiesch C, Flitsch J, Veigel J, Schön G, Jung R, Reining F, Lautenbach A, Rotermund R, Riedel N. Specificity of late-night salivary cortisol measured by automated electrochemiluminescence immunoassay for Cushing's disease in an obese population. J Endocrinol Invest 2018; 41:1325-1331. [PMID: 29550934 DOI: 10.1007/s40618-018-0870-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Data about the specificity of late-night salivary cortisol (LNSC) in obese subjects are still conflicting. Therefore, with this study, we aimed to evaluate the specificity of LNSC measurement in an obese cohort with or without type 2 diabetes mellitus (T2DM) using an automated electrochemiluminescence immunoassay (ECLIA). METHODS A total number of 157 patients involving 40 healthy subjects (HS) with BMI < 25 kg/m2, 83 obese subjects (OS) with BMI ≥ 35 kg/m2, and 34 histopathologically proven Cushing's disease (CD) were included. All patients underwent LNSC testing. Salivary cortisol was measured at 11 p.m. for all groups using an ECLIA. Reference range was established using values of LNSCs of HS and ROC curves were used to determine diagnostic cutoffs. RESULTS In the HS group, mean LNSC was 4.7 nmol/l (SD ± 3.1), while the OS group had a mean value of 10.9 nmol/l (SD ± 7.5) and the CD group of 19.9 nmol/l (SD ± 15.4). All groups differed significantly (p < 0.001). The ROC analysis of CD against HS alone showed a sensitivity of 85.3% and a specificity of 87.5% with a cut-off value of 8.3 nmol/l. The ROC analysis between OS and CD showed a maximum sensitivity of 67.6% and specificity of 78.3% for a cut-off value of 12.3 nmol/l. Taken both (HS and OS) groups together against the CD group, ROC analysis showed a maximum sensitivity of 67.6% and specificity of 85.4% for a cut-off value of 12.3 nmol/l. No correlation was found between BMI, T2DM, and LNSC for all groups. CONCLUSIONS In our obese cohort, we found that LNSC assayed by ECLIA had a low specificity in the diagnosis of CD.
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Affiliation(s)
- J Aberle
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - C Schulze Zur Wiesch
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - J Flitsch
- Department for Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - J Veigel
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - G Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Jung
- Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - F Reining
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - A Lautenbach
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - R Rotermund
- Department for Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - N Riedel
- Department for Endocrinology and Diabetology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Meyer D, Reining F, Aberle J. [Non surgical treatment of benign thyroid nodules: are there alternatives to thyroidectomy?]. Dtsch Med Wochenschr 2016; 141:1325-9. [PMID: 27519008 DOI: 10.1055/s-0041-107933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nodular disease of the thyroid is a very common disorder with which colleagues from all disciplines are frequently confronted. Particularly for patients with benign thyroid nodules or cystic lesions the expenditure and risks of standardly performed thyroidectomy stands in discrepancy with the clinical harmlessness of the disease. For this reason we would like to give an overview of possible non-surgical alternatives in the therapy of benign thyroid nodules and cysts, if they cause unpleasant symptoms.
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Sauer N, Reining F, Schulze Zur Wiesch C, Burkhardt T, Aberle J. Off-label antiobesity treatment in patients without diabetes with GLP-1 agonists in clinical practice. Horm Metab Res 2015; 47:560-4. [PMID: 25230325 DOI: 10.1055/s-0034-1387793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the work was to investigate whether continuation of treatment, side effects, and effect on weight loss of GLP-1 agonists in obese patients without diabetes are equally promising in daily clinical-practice-settings compared to controlled clinical trials. Obese patients without diabetes of our interdisciplinary obesity centre were treated off-label with GLP-1-agonists for different time periods. Application was started with low-dose and increased if side effects were tolerable. Monthly costs were € 125 for daily applications of 1.2 mg liraglutide or 10 μg exenatide twice daily. Data were obtained by telephone interviews about baseline characteristics, weight loss, sensation of satiation, duration of therapy, side effects, and reasons for discontinuation. Of 43 included cases (5 males, mean age 43±11 years, mean weight 107±24 kg, mean excess weight 35±21 kg) 7 were treated with exenatide and 36 with liraglutide. Excess weight loss in linear regression models was 6.7% per month (p <0.05) under control of age, sex, initial weight, and type of GLP-1 analogue treatment and did not significantly differ between liraglutide and exenatide. Overall, 58% of patients reported side effects mostly concerning the gastrointestinal tract. Surprisingly no patient reported vomiting. One patient developed a severe pancreatitis. At time of telephone interview only 30.2% were continuing treatment. Mean treatment duration was 2.98±2.71 months. Common reasons for discontinuation of treatment were no/little effect on weight loss (27.9%), intolerable side effects (20.9%), or financial reasons (14%). GLP-1 agonist treatment in obese patients without diabetes also correlates with significant weight loss in clinical practice. However, side effects and discontinuation of treatment are common. Therefore, long-term effect on weight loss might not be as promising as suggested by data from clinical trials.
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Affiliation(s)
- N Sauer
- Department for Endocrinology and Diabetology, University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany
| | - F Reining
- Department for Endocrinology and Diabetology, University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany
| | - C Schulze Zur Wiesch
- Department for Endocrinology and Diabetology, University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany
| | - T Burkhardt
- Department for Neurosurgery, University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany
| | - J Aberle
- Department for Endocrinology and Diabetology, University Hospital Hamburg Eppendorf (UKE), Hamburg, Germany
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Reining F, Sauer N, Aberle J. Therapy of thyroid nodules by ultrasound-guided microwave thermoablation. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Reining F, Schulze zur Wiesch C, Sauer N, Jung R, Petersenn S, Flitsch J, Aberle J. Specifity of late night salivary cortisol in obese patients. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sauer N, Rösch T, Pezold J, Reining F, Anders M, Groth S, Schachschal G, Mann O, Aberle J. A new endoscopically implantable device (SatiSphere) for treatment of obesity--efficacy, safety, and metabolic effects on glucose, insulin, and GLP-1 levels. Obes Surg 2014; 23:1727-33. [PMID: 23780702 DOI: 10.1007/s11695-013-1005-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The endoluminal mechanical device SatiSphere is a new endoscopically implantable device designed to delay transit time of nutrients through the duodenum. It consists of a 1-mm nitinol wire with pigtail ends and several mesh spheres mounted along its course, released in the duodenum and gastric antrum to conform to the duodenal C loop configuration and thereby self-anchor. METHODS The objective is to test the safety, efficacy, and effect on body weight in a 2:1 randomized study, as well as incretin secretion in a subgroup. RESULTS Of 31 included cases (11 men, mean age 42.9 years, mean BMI 41.3 kg/m2), 21 patients treated with endoscopic device insertion with scheduled device removal after 3 months were compared with 10 controls. In 10 of 21 patients, device migration occurred, in two cases necessitating emergency surgery, which led to termination of the trial. Weight loss after 3 months was 6.7, 4.6, and 2.2 kg in the groups completing therapy, all treatment cases using intention to treat (ITT) analysis and controls. Excess weight loss was significantly increased by endoluminal mechanical device insertion (18.4, 12.2, and 4.4% in completers, ITT analysis group and controls; p = 0.02 for completers vs. controls). Measuring glucose, insulin, and glucagon-like peptide 1 (GLP-1) following a mixed-meal test with the device in place and after removal (n = 7), the device delayed glucose absorption and insulin secretion and altered kinetics in GLP-1 levels. CONCLUSIONS The device might be short-term effective in reducing body weight, which might be mediated through alterations in incretin metabolism. However, frequent device migration necessitates device modifications.
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Affiliation(s)
- Nina Sauer
- Departments of Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Sauer N, Pohl K, Schulze zur Wiesch C, Reining F, Burkhardt T, Flitsch J, Aberle J. Screening and Management of postoperative Hypoparathyreoidism induced Hypocalcemia in thyreoidectomiced patients on endocrine compared to surgical wards. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bouras I, Fochler O, Greif M, Reining F, Senzel F, Uphoff J, Wesp C, Xu Z, Greiner C. From microscopic interactions to the dynamics of the fireball. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146604010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sauer N, Schulze zur Wiesch C, Reining F, Rohani Z, Aberle J. Off-label GLP-1 agonist treatment in 43 non-diabetic patients: Are weight loss and treatment tolerance equally promising outside of clinical trials? DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1347764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sauer N, Aberle J, Reining F, Pezold J, Anders M, Groth S, Schachschal G, Mann O, Rösch T. A new endoscopically implantable device (SatiSphere) for treatment of obesity. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reining F, Bouras I, El A, Wesp C, Xu Z, Greiner C. Extraction of shear viscosity in stationary states of relativistic particle systems. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 85:026302. [PMID: 22463312 DOI: 10.1103/physreve.85.026302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Indexed: 05/31/2023]
Abstract
Starting from a classical picture of shear viscosity we construct a stationary velocity gradient in a microscopic parton cascade. Employing the Navier-Stokes ansatz we extract the shear viscosity coefficient η. For elastic isotropic scatterings we find an excellent agreement with the analytic values. This confirms the applicability of this method. Furthermore, for both elastic and inelastic scatterings with pQCD based cross sections we extract the shear viscosity coefficient η for a pure gluonic system and find a good agreement with already published calculations.
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Affiliation(s)
- F Reining
- Institut für Theoretische Physik, Johann Wolfgang Goethe-Universität, Max-von-Laue-Strasse 1, DE-60438 Frankfurt am Main, Germany
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Abstract
Metformin is the oral drug of first choice in type 2 diabetes. Therefore a large number of patients undergoing bariatric surgery will be on Metformin treatment. However, use of Metformin has been associated with lactate acidosis. Weight loss following bariatric surgery is most pronounced during the first weeks after the operation and this creates a phase of negative energy balance with ketone body formation. To shed more light on this situation we measured ketone bodies in 90 patients 5 days-18 months after bariatric surgery. Ketone bodies were markedly elevated during the first 3-4 months. Metformin use should therefore be critically reconsidered after bariatric operations.
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Affiliation(s)
- J Aberle
- Universitätsklinikum Hamburg-Eppendorf, Sektion Endokrinologie und Diabetologie, Interdisziplinäres Adipositaszentrum, Hamburg.
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Bouras I, El A, Fochler O, Reining F, Uphoff J, Wesp C, Xu Z, Greiner C. Collective Flow and Mach Cones with transport. EPJ Web of Conferences 2011. [DOI: 10.1051/epjconf/20111307001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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