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.     

减肥手术后患者的内分泌和营养管理:美国内分泌学会临床实践指南

循证建议的制定方法 利用所得到的最佳研究证据进行推荐,以一致的语言和图表描述推荐的强度和证据的质量.为了标明推荐的强度,强烈推荐使用"推荐"和数字1,弱的推荐使用"建议"和数字2.     

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.     

亚临床库欣综合征

典型的库欣综合征是少见疾病 ,而亚临床库欣综合征则较为多见。后者缺乏皮质醇增多症的典型特征 ,而肥胖病、高血压、2型糖尿病的发病率较高。患有亚临床库欣综合征的患者是否实施肾上腺切除术 ,应根据大剂量地塞米松抑制试验的结果 ,对年龄小于 5 0岁的病人、血浆促肾上腺皮质激素较低的病人、近期体重增加、肥胖、高血压、糖尿病和骨质减少症的病人需考虑手术     

亚临床库欣综合征

典型的库欣综合下是少见疾病，而亚临床库欣综合征则较为多见。后者缺乏皮质醇增多症的典型特征，而肥胖病，高血压，2型糖尿病的发病率较高。患有亚临床库欣综合征的患者是否实施肾上腺切除术，应根据大剂量地塞米松抑制试验的结果，对年龄小于50岁的病人，血浆促肾上腺皮质激素较低的病人，近期体重增加，肥胖，高血压，糖尿病和骨质减少症的病人需考虑手术。     

高催乳素血症的诊治——介绍美国内分泌学会临床应用指南

美国内分泌学会的临床指南小组遵循国际GRADE组织(Grading of Recommendations,Assessment,Development,and Evaluation goup)的分级推荐标准,结合近期相关领域的研究成果,编写了该指南(以符号(+)○○○、(+)(+)○ ○、(+)(+)(+)○和(+)(+)(+)(+)分别表示从低到高的证据质量).指南建议的内容又分为“推荐”和“建议”,分别用“1”和“2”表示,根据推荐施行,通常对患者利多于弊,而如按建议执行时则需要更多考虑患者的个体化情况.     

库欣综合征可疑患者的诊断

库欣综合征(CS)疑似患者的临床诊断十分复杂;因其大多数临床特点和一些常见疾病重叠,有些患者则表现不典型,仅有一些孤寺症状:因而至今仍是最难诊断的内分泌疾病之一.近期有研究提出CS的发病率比过去估计的要高;因而需要建立有效的筛选试验,从可能与皮质醇分泌过多有关的门诊患者中寻找并确定未获诊断的CS患者.目前推荐的诊断试验包括24 h尿游离皮质醇、1 mg过夜地塞米松抑制试验和午夜唾液皮质醇.如果确诊为CS,下一步则应测定血浆ACTH.动态试验与影像检查是最有用的无创性鉴别诊断方法.库欣病患者对CRH试验和大剂量糖皮质激素反馈通常呈阳性反应.     

库欣综合征的病因和诊断

库欣综合征病因复杂,提法不断更新。在ACTH依赖型中,有垂体性(库欣病)及异位ACTH综合征两种,过去都只认为是肾上腺皮质增生、垂体性的也不是单一品种,包括占库欣病80％的具有相对自主分泌功能的垂体ACTH腺瘤、很少见的垂体ACTH细胞癌,另有10％左右表现为垂体ACTH增生,或在增生的基础上的腺瘤。关于Nelson综合征,认为是一     

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%.     

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.     

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.     

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.     

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.