Resumo em Inglês:

ABSTRACT Substantial evidence highlights the pervasive nature of weight stigma, reported by people of all ages and backgrounds. Weight stigma is experienced across the life course and in many settings across society. These harmful experiences may include verbal and physical behaviours, with long-lasting effects on mental and physical health. They may also impact the patient-practitioner when weight stigma is experienced in a healthcare setting, as well as reducing health seeking behaviour and avoidance of healthcare. It is therefore essential that weight stigma in healthcare is addressed given the important implications of these experiences in this setting, Interventions need to be longer term and given the widespread nature of weight stigma, change is needed throughout society from policy to practice. Thus, a whole system approach to weight stigma is needed to address the entrenched and often robust nature of weight stigma attitudes.

Resumo em Inglês:

ABSTRACT Primary aldosteronism (PA) is a major contributor to hypertension and cardiovascular disease. Subclinical PA, a preclinical or early manifestation of PA, has been identified in individuals with normal blood pressure and in those with mild hypertension without signs or symptoms of overt PA, using evidence from histopathology, hormonal biochemistry, proteomic, and genetic studies. Longitudinal studies have shown that subclinical PA increases the risk for developing incident hypertension, adverse cardiovascular remodeling, major adverse cardiovascular events, and chronic kidney disease. Given the clinical relevance of subclinical PA on the pathogenesis of cardiorenal disease, future studies should focus on methods to enhance early detection and assessment of the impact of early aldosterone-directed interventions for preventing adverse clinical outcomes.

Resumo em Inglês:

ABSTRACT The recently proposed cardio-kidney-metabolic (CKM) framework underscores the interconnected nature of cardiovascular, renal, and metabolic diseases and represents an important step toward preventive, integrated care. However, its application in kidney care remains limited and dependent on additional supportive evidence. Chronic kidney disease (CKD) is often underrecognized in cardiovascular risk models and receives delayed attention within the CKM pathway. Nephrologists face unique challenges - including workforce shortages, late referrals, and fragmented care systems - particularly in lowand middleincome countries. Early detection is further hindered by the lack of CKD-specific risk assessment tools and limited access to essential diagnostics and therapies. Real-world data from global and national studies highlight substantial implementation gaps, suboptimal outcomes, and the heavy economic burden of delayed CKD management. Importantly, as emphasized by the American Heart Association, implementation of the CKM approach is still under construction and must remain data-driven, ensuring that strategies are grounded in robust evidence. This review offers a nephrology-oriented perspective on the CKM framework, emphasizing the bidirectional relationship between CKD and other CKM components, the prognostic implications of delayed diagnosis, and the need for improved multidisciplinary coordination.

Resumo em Inglês:

ABSTRACT Disorders of pubertal onset and progression are a common cause for referral to paediatric endocrinologists, with delayed puberty in males being particularly frequent. Pubertal development depends on the hypothalamic-pituitary-testicular (HPT) axis, which is established during fetal life and undergoes distinct phases: fetal androgen production, postnatal “minipuberty”, and reactivation during adolescence. Key regulators include GnRH neurons, Sertoli and Leydig cells, and biomarkers such as AMH, inhibin B, testosterone and INSL3. Puberty is marked clinically by testicular enlargement beyond 4 mL, usually at a median age of 11.5 years. Delayed puberty is defined as absence of testicular enlargement by age 14. The most common cause is self-limited delayed puberty (SLDP), often familial and benign. Functional hypogonadotropic hypogonadism due to chronic illness, and permanent central hypogonadism (congenital or acquired), account for additional cases. Congenital hypogonadotropic hypogonadism (CHH), including Kallmann syndrome, is frequently genetic, with variants in genes such as FGFR1, ANOS1 and GNRHR. Clinical assessment includes family history, growth patterns, and red flags such as micropenis, cryptorchidism or anosmia.

Resumo em Inglês:

ABSTRACT The separation of the interior from the exterior environment through the skin was fundamental for the evolutionary progression from prevertebrates into vertebrates. The development of the skin also established an internal environment controlled by hormones. The skin is influenced by different hormones; it is also the largest endocrine organ, producing several hormones. Skin inspections often save lives from skin cancer but can also diagnose potentially deadly endocrine diseases. The objectives of this review were to describe the emergence and definition of dermatoendocrinology and to focus on the clinical diagnosis of cutaneous manifestations of endocrine disorders, some of which are potentially fatal. This narrative review was based on a comprehensive search using the term “dermatoendocrinology” since its creation in 2001 in the PubMed® database. Subsequently, a complementary search was performed with combinations of the keywords “skin”, “insulin”, “diabetes”, “thyroid”, “adrenal”, “sex hormones”, “parathyroid hormone”, and “growth hormone.” A total of 111 articles were included. The cutaneous manifestations of Itabaianinha syndrome (isolated growth hormone deficiency) and five anecdotal cases that enabled life-saving therapeutic measures are reported. The dermatoendocrine conditions described include acanthosis nigricans and androgenetic alopecia (insulin resistance), necrobiosis lipoidica diabeticorum and granuloma annulare (diabetes), pretibial myxedema (hyperthyroidism), xerosis cutis (hypothyroidism), purple striae and facial plethora (hypercortisolism), hyperpigmentation (primary adrenal insufficiency), dryness and urogenital atrophy (hypoestrogenism), hirsutism and virilization (hyperandrogenism), pruritus and calcium deposition (hyperparathyroidism), thinness, wrinkling, and reduced sweating (growth hormone deficiency), and thick oily skin with excessive sweating (acromegaly). Skin inspection allows the diagnosis of serious endocrinopathies.

Resumo em Inglês:

ABSTRACT Cushing’s syndrome is a chronic disorder characterized by prolonged glucocorticoid exposure, leading to significant multisystem complications. Multiple epidemiological studies have demonstrated a substantially elevated risk of venous thromboembolism in patients with Cushing’s syndrome, including deep vein thrombosis and pulmonary embolism, particularly during active disease, the perioperative period, but more importantly also after biochemical remission. Hypercortisolism promotes a hypercoagulable state through multiple mechanisms, including persistent endothelial dysfunction, increased procoagulant factors such as von Willebrand factor and factor VIII, impaired fibrinolysis, and venous stasis. Additionally, common comorbidities in Cushing’s syndrome, such as obesity, hypertension, and diabetes, further amplify thrombotic risk. Given these findings, recent consensus recommends thromboprophylaxis for most patients with Cushing’s syndrome, with anticoagulation therapy initiated at diagnosis, continued perioperatively, and extended post-remission when appropriate in patients both after surgery and also in patients on medical therapy. Low molecular weight heparin is the preferred anticoagulant, while direct oral anticoagulants require further investigation in patients with Cushing’s syndrome. Despite these recommendations, clinical practice varies significantly across centers and countries, highlighting the need for standardized thromboprophylaxis protocols. Future research should focus on refining risk stratification models, optimizing prophylaxis duration, and evaluating the long-term thrombotic risk in Cushing’s syndrome remission. Additionally, studies exploring the safety and efficacy of direct oral anticoagulants and personalized medicine approaches through biomarker-driven strategies may further improve patient outcomes. Addressing these gaps will enhance thromboembolism prevention strategies in Cushing’s syndrome and ultimately may reduce morbidity and mortality in this high-risk population.

Resumo em Inglês:

ABSTRACT Oxytocin (OXT) is a neuropeptide hormone that plays a central role in numerous physiological and socio-emotional processes. Similar to arginine vasopressin (AVP), it is synthesized in the supraoptic and paraventricular hypothalamic nuclei and released both centrally and peripherally. Peripherally, OXT regulates uterine contractions during childbirth and milk ejection during lactation, metabolism, bone health, and cardiovascular functions. Centrally, it modulates social behavior, influencing trust, empathy, stress regulation, and emotional processing. Despite its close connection to AVP, the clinical significance of OXTDeficiency has only recently gained attention, particularly in patients with hypothalamic or pituitary damage with concomitant AVP-Deficiency. OXT-Deficiency may contribute to various neuropsychological symptoms seen in these patients, including social dysfunction, anxiety disorders, and reduced quality of life. However, a major challenge lies in accurately measuring OXT and thereby diagnosing a potential OXT-Deficiency. Basal plasma levels are unreliable, and most studied provocation tests only stimulate to a limited degree; hence, stronger provocation tests (e.g., using MDMA) and new surrogate parameters such as neurophysin I (NP-I) are gaining traction. Preliminary evidence from case reports and one small study suggests that intranasal OXT administration in patients with hypothalamic disorders may have beneficial effects on social behavior and emotion recognition. However, there is a clear need for larger, well-designed clinical trials, and several trials are currently underway to investigate the therapeutic potential of OXT in patients with AVP-Deficiency. OXT is also being explored as a possible treatment option in psychiatric conditions such as autism spectrum disorder, borderline personality disorder, and social anxiety disorder, with controversial results so far.

Resumo em Inglês:

ABSTRACT Diabetic autonomic neuropathy (DAN) is a serious and often under-recognized complication of diabetes that can affect any division of the autonomic nervous system (ANS), presenting with a wide range of signs and symptoms. The pathophysiology of DAN involves a complex interplay of hyperglycemia-driven metabolic and vascular pathways, oxidative stress, inflammation, and autonomic imbalance, ultimately leading to progressive nerve dysfunction. Cardiovascular autonomic neuropathy (CAN) has emerged as a particularly severe condition, associated with heightened risk of arrhythmia, silent myocardial ischemia, heart failure, and mortality. DAN, however, extends beyond the cardiovascular system, encompassing gastrointestinal (GI), genitourinary (GU), and sudomotor dysfunctions, that strongly impair quality of life. Despite its impact, DAN remains largely overlooked in clinical practice due to its subclinical onset, non-specific symptoms, and limited routine screening. This review integrates basic, epidemiological, and clinical data to provide a practical understanding of DAN with the aim of helping clinicians to suspect, investigate and manage DAN, with particular attention to its cardiovascular (CV), GI, and GU manifestations.

Resumo em Inglês:

ABSTRACT The thyroid-gut axis represents a dynamic interaction between the intestinal microbiota and thyroid function, with growing evidence linking gut dysbiosis to thyroid diseases. The gut microbiome, comprising over 100 trillion microorganisms, influences immune modulation, iodine metabolism, and thyroid hormone regulation. Short-chain fatty acids, produced by beneficial gut bacteria, support immune homeostasis and thyroid function, while pathogenic bacteria and lipopolysaccharides trigger inflammatory pathways that impair thyroid activity. Alterations in gut microbiota composition have been associated with autoimmune thyroid diseases, including Hashimoto’s thyroiditis and Graves’ disease. Dysbiosis increases intestinal permeability, antigen exposure, and immune activation, exacerbating thyroid autoimmunity. A reduction in short-chain fatty acids-producing bacteria weakens immune tolerance, promoting inflammatory cytokine release and autoantibody production. Recent studies highlight microbial metabolites such as tryptophan derivatives and their role in immune regulation. Gut dysbiosis is also implicated in thyroid nodules and cancer. Decreased butyrate-producing bacteria and increased inflammatory bacterial taxa have been observed in thyroid malignancies. Microbiota influence iodine and selenium bioavailability, essential for thyroid hormone synthesis, and modulate sodium-iodide symporter expression, affecting thyroid cancer response to radioactive iodine therapy. Microbiome-targeted interventions, including probiotics, prebiotics, dietary modifications, and fecal microbiota transplantation, may restore microbial balance, enhance immune regulation, and improve thyroid treatments. This review synthesizes our current understanding of the thyroid-gut axis, indicating that the intestinal microbiota and its metabolites may act directly or indirectly on the thyroid gland, highlighting potential clinical implications and paving the way for therapeutic strategies targeting the intestinal microbiota.

Resumo em Inglês:

ABSTRACT The pleiotropic role of vitamin D in human health has been implicated in modulating bone metabolism and other several extraskeletal areas, including muscle and adipose tissues regulation, and in influencing general and systemic outcomes. In the elderly, vitamin D deficiency is considered as an emerging public health issue affecting 40%-70% of older adults worldwide with higher rates occurring in institutionalized individuals or patients with multiple chronic comorbidities. The pathophysiology of vitamin D deficiency in the elderly is multifactorial and includes age-related reduced skin synthesis, limited sun exposure, declined renal and liver function, and long-term use of interfering medications. Given its pleiotropic effects, vitamin D deficiency in the elderly has been consistently associated with progressive bone deterioration and muscle and adipose dysfunctions, concurring to the occurrence of the osteosarcopenic obese phenotype. This multifaced deleterious scenario is strongly correlated with an increasing risk of fragility fractures, falls, functional and metabolic decline, all of which contribute to higher morbidity and mortality. Early diagnosis and screening with individualized criteria, targeted and personalized strategies for supplementation, and structured follow-up monitoring are required to reduce the clinically significant impact of vitamin D deficiency in this highly vulnerable population.

Resumo em Inglês:

ABSTRACT Over the past year, three new key guidelines have been published in the area of female hypogonadism, one from the Society for Endocrinology covering the full spectrum of causes of female hypogonadism in adult life, which will form the core of this review; another solely covering premature ovarian insufficiency from a consortium comprising the International Menopause Society (IMS), the European Society of Human Reproduction & Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) that updates the 2016 ESHRE guidance, and a third covering Turner syndrome across all stages of life from the International Turner Syndrome Consensus Group. In this review, we aim to synthesize the key elements from all of these documents, providing a timely update for clinicians managing affected women.

Resumo em Inglês:

Abstract Bonehealth is influenced by a dynamic interplay of genetic, hormonal, and environmental factors, with nutrition playing a vital role throughout life. This review consolidates the current evidence on the roles of essential micronutrients, specifically calcium, vitamin D, vitamin K, magnesium, and phosphorus, in skeletal metabolism and integrity. Calcium and vitamin D, the most extensively studied, have been shown to reduce bone loss and fracture risk, particularly in institutionalized individuals or those with deficiencies, while evidence is less consistent in the general population. Although vitamin K, magnesium, and phosphorus are important for bone physiology, the clinical evidence supporting their supplementation is either limited or context dependent. Additionally, this review explores the current status of micronutrient intake in Brazil and discusses potential risks associated with excessive or inappropriate supplementation, such as cardiovascular issues and mineral metabolism disturbances. An individualized, evidence-informed approach may be beneficial in optimizing bone health while minimizing adverse effects.