美国内分泌协会垂体意外瘤临床实践指南

本指南采用GRADE (Grading of Recommendations,Assessment,Development,and Evaluation)系统来描述推荐等级和证据质量.就推荐等级而言,强烈推荐用词语“推荐”和数字“1”表示,较弱推荐用“建议”和数字“2”表示.“+”代表证据质量,“+”表示证据极不充分;“++”表示证据不充分;“+++”表示证据充分;“++++”表示证据相当充分.     

2015年美国胃肠病学会临床实践指南:原发性硬化性胆管炎

<正>原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)是一种慢性胆汁淤积性肝病,可缩短生存期,并可能需要进行肝移植治疗。迄今为止,虽然通常认为该病与结肠炎有关,但其病因仍然未知;治疗方面,熊去氧胆酸(UDCA)作为经验性用药已使用多年,但目前尚无被批准的药物或较为成熟的治疗方案;并发症主要包括门静脉高压、脂溶性维生素缺乏症、骨代谢疾病以及日后可能发展的胆管癌或结肠癌。     

美国内分泌学会的临床指南:库欣综合征的诊断

凡例 专家组用统一的短语和符号来表示建议的力度和证据的确凿程度,即用数字1表示强烈推荐,用数字2表示一般推荐;用●○○○、●●○○、●●●○和●●●●,分别表看示极低、低、中等和高度可靠的证据.     

最新欧洲和美国肝病学会肝硬化腹水临床实践指南比较

肝硬化腹水是临床常见的肝病晚期综合征,相关学科临床医师对于国内外关于肝硬化腹水诊疗指南的更新与进展颇为关注。继2009年美国肝病学会更新肝硬化腹水临床实践指南后,欧洲肝病学会也于今年5月发表了同一类指南,现将两指南作比较分析。     

美国内分泌学会临床指南:代谢风险患者心血管疾病和2型糖尿病的早期预防

从发达国家到发展中国家,有可能罹患心血管疾病(CVD)和2型糖尿病的人数急剧增加,这就要求医务人员认识有关的危险因素,能够识别高危者并进行预防.     

2016年欧洲肝病学会临床实践指南:肝脏良性肿瘤的管理

根据1994年世界胃肠病学大会国际专家小组的总结,肝脏良性肿瘤是一类包括各种不同细胞起源的多样化病变.这些病变通常在影像学检查中被偶然发现.2016年该推荐意见的目的是为临床比较常见的肝脏良性肿瘤的诊断和治疗提供帮助.这些病变包括肝血管瘤、局灶性结节性增生(focal nodular hyperplasia,FNH)和肝细胞腺瘤(hepatocellular adenoma,HCA).     

成人低血糖症的诊断和治疗——美国内分泌学会临床指南

专家组按照GRADE系统推荐的方法,用统一的短语和符号来表示建议的力度和证据的确凿程度,即"推荐"和数字l表示强烈推荐,"建议"和数字2表示一般推荐.专家组确信根据"推荐"的方案进行检查和治疗对患者将是利大于弊;而对"建议"的方案则需仔细考虑患者的临床情况、化验数据和个人意愿.     

高甘油三酯血症的评估和治疗美国内分泌学会临床指南

1 诊断和定义 1.1 重度(11.2 ～ 22.4 mmol/L)和极重度高甘油三酯血症(≥22.4 mmol/L)可增加胰腺炎的发生风险,而轻度(1.7 ～ 2.3 mmol/L)或中度高甘油三酯血症(2.3 ～ 11.2 mmol/L)可能是心血管疾病的危险因子.因此,推荐成人至少每5年筛查1次高甘油三酯血症. 1.2 推荐根据空腹甘油三酯水平,而不是非空腹甘油三酯水平来确诊高甘油三酯血症. 1.3不推荐高甘油三酯血症患者常规检查脂蛋白颗粒异质性.检查载脂蛋白B或脂蛋白(a)具有一定的临床参考价值,而其他载脂蛋白水平的临床参考价值不大.     

维生素D缺乏的评价、预防及治疗——内分泌学会临床实践指南

由国际著名维生素D研究专家HolickMF教授牵头的专家组为美国内分泌学会临床学术期刊JCEM撰写的“维生素D缺乏的评价、预防及治疗”（指南）一文,于2011年6月6日首先以电子版发表,本文做了重点节译,供读者参考。这是一篇基于循证医学和流行病学研究资料基础上所成之文,对内分泌临床及其他有关涉及骨矿盐代谢疾病领域的专业人员都有重要的实际指导意义。但也应看到,该文所依据的资料大都来自对西方人群的研究,文内提出的对维生素D缺乏诊断依据、标准,以及对预防及治疗时所设定的剂量范围,是否完全适合东方人群,特别是我国人群,尚需我们自己的工作进一步阐明。又如,作者认为维生素D2和D3的实际应用效果是一样的,但有研究资料显示,在调控人类骨钙代谢效能方面,D3较D2强2～4倍。对此如何看待？似值得考虑。     

The Endocrine Society's Clinical Practice Guideline on endocrine and nutritional management of the post-bariatric surgery patient: commentary from a European Perspective

Bariatric and metabolic surgery is experiencing a noteworthy increase worldwide in recent years, but protocols and consensus published in the past decade have not yet established clear evidence-based clinical recommendations. The Endocrine Society, with the participation of the European Society of Endocrinology, has promoted the creation of an expert panel to propose a clinical practice guideline for postoperative management of patients, candidates to bariatric surgery, that places a particular emphasis on evidence-based medical aspects. The main arguments reflected in those recommendations are set out in this article and are subject to analysis and discussion from the specific viewpoint of the current European experience.     

Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocrine Society, Asia and Oceania Thyroid Association, and the Latin American Thyroid Society. A second draft was reviewed and approved by The Endocrine Society Council. At each stage of review, the Task Force received written comments and incorporated substantive changes. Conclusions: Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval. These include evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism, hyperthyroidism, gestational hyperthyroidism, thyroid autoimmunity, thyroid tumors, iodine nutrition, postpartum thyroiditis, and screening for thyroid disease. Indications and side effects of therapeutic agents used in treatment are also presented.     

The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline

OBJECTIVE: The objective of the study was to develop clinical practice guidelines for the diagnosis of Cushing's syndrome. PARTICIPANTS: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, five additional experts, a methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. CONSENSUS PROCESS: Consensus was guided by systematic reviews of evidence and discussions. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage the Task Force incorporated needed changes in response to written comments. CONCLUSIONS: After excluding exogenous glucocorticoid use, we recommend testing for Cushing's syndrome in patients with multiple and progressive features compatible with the syndrome, particularly those with a high discriminatory value, and patients with adrenal incidentaloma. We recommend initial use of one test with high diagnostic accuracy (urine cortisol, late night salivary cortisol, 1 mg overnight or 2 mg 48-h dexamethasone suppression test). We recommend that patients with an abnormal result see an endocrinologist and undergo a second test, either one of the above or, in some cases, a serum midnight cortisol or dexamethasone-CRH test. Patients with concordant abnormal results should undergo testing for the cause of Cushing's syndrome. Patients with concordant normal results should not undergo further evaluation. We recommend additional testing in patients with discordant results, normal responses suspected of cyclic hypercortisolism, or initially normal responses who accumulate additional features over time.     

Medical and gastroenterologic management of the post-bariatric surgery patient

Morbid obesity is a serious disease resulting in considerable morbidity. Bariatric surgery is an important treatment modality of morbid obesity. It appears to be safe and effective in reduction of excess weight in carefully selected patients. However, it carries a risk of many short- and long-term complications, some of them unique to bariatric surgery. Knowledge of possible postoperative complications and their management will allow the achievement of the best results. Despite many types of bariatric procedures developed, only a few are currently performed. Since the number of bariatric procedures performed annually increases, primary care physicians and gastroenterologists will be increasingly challenged by post-bariatric surgery patients. Hence, better understanding of the anatomy and adaptive changes in bariatric patients allows for a more efficient evaluation and management of post-bariatric surgery problems. This article reviews common complications in post-bariatric surgery patients and provides guidelines for their evaluation and management.     

儿童肥胖的预防和治疗:美国内分泌学会根据专家共识制定的临床指南

与1963～1970年的调查相比,1999～2000年的肥胖患病率在6～11岁儿童中增加了4倍,在12～19岁青少年中增加了3倍.于1976～1980年间,婴幼儿(0～23个月)的肥胖患病率从7.2%增至11.6%,2～5岁儿童从5%增至13.9%.儿童肥胖的总患病率为17.1%.同期,6岁以上儿童中的超重发生率增加了 2.5倍,达37.2%.     

Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline

OBJECTIVE: The objective is to provide guidelines for the evaluation and treatment of adults with GH deficiency (GHD). PARTICIPANTS: The chair of the Task Force was selected by the Clinical Guidelines Subcommittee of The Endocrine Society (TES). The chair selected five other endocrinologists and a medical writer, who were approved by the Council. One closed meeting of the group was held. There was no corporate funding, and members of the group received no remuneration. EVIDENCE: Only fully published, peer-reviewed literature was reviewed. The Grades of Evidence used are outlined in the Appendix. CONSENSUS PROCESS: Consensus was achieved through one group meeting and e-mailing of drafts that were written by the group with grammatical/style help from the medical writer. Drafts were reviewed successively by the Clinical Guidelines Subcommittee, the Clinical Affairs Committee, and TES Council, and a version was placed on the TES web site for comments. At each level, the writing group incorporated needed changes. CONCLUSIONS: GHD can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. GH therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.