Daily Endocrinology Research Analysis

BACKGROUND: Perirenal adipose tissue (PRAT) consists of white and brown adipocytes with good vascularization and dense innervation, which could influence the blood pressure. We aim to investigate the association of PRAT thickness with risks of overall and specific forms of hypertension. METHODS: We measured PRAT thickness in the UK Biobank and CONPASS (Chongqing Primary Aldosteronism Study). We prospectively examined the correlation between PRAT thickness and incident hypertension in the UK Biobank. We cross-sectionally explored associations between PRAT thickness and common forms of hypertension in CONPASS. Integrating data from GWAS (Genome-Wide Association Study), we investigated the potential causal relationship between PRAT and hypertension forms by 2-sample Mendelian randomization analyses. RESULTS: In the prospective analysis of the UK Biobank, participants whose PRAT thickness was ≥46.1 mm showed a higher risk of developing hypertension than participants whose PRAT thickness was <16.4 mm (hazard ratio, 2.91 [95% CI, 1.97-4.32]). In the cross-sectional analysis of CONPASS, a 1 SD increment in PRAT thickness was associated with a 2.77-fold higher adjusted odds of low-renin essential hypertension and a 3.89-fold higher adjusted odds of idiopathic hyperaldosteronism. PRAT thickness was not significantly associated with other forms of hypertension, such as aldosterone-producing adenoma and obstructive sleep apnea. In 2-sample Mendelian randomization analyses, PRAT thickness was only significantly associated with a higher risk of idiopathic hyperaldosteronism (inverse variance weighted odds ratio, 1.33 [95% CI, 1.09-1.62]), with no evidence of significant heterogeneity or substantial directional pleiotropy. CONCLUSIONS: PRAT is causally associated with idiopathic hyperaldosteronism rather than essential hypertension and other forms of secondary hypertension.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with an elevated risk of adverse maternal and neonatal outcomes. Dietary management is a cornerstone of GDM treatment due to its beneficial effects on metabolic control. However, suboptimal adherence to dietary recommendations has diminished its potential benefits in achieving optimal glycemic outcomes. Cognitive behavioral therapy (CBT)-based interventions have emerged as a promising approach to enhance dietary compliance and glycemic control in patients with GDM. OBJECTIVE: This study aims to investigate the effects of a CBT-based digital dietary intervention on glycemic control and pregnancy outcomes in patients with GDM. METHODS: The intervention group received standard care plus a digital dietary intervention based on CBT principles, delivered via a customized WeChat (Tencent Inc) mini program. This intervention included structured dietary education and behavioral strategies focused on appropriate food selection and meal sequencing. The control group received standard care alone. The primary outcome was the glycemic qualification rate, and secondary outcomes included fasting blood glucose, postprandial blood glucose (PBG), General Self-Efficacy Scale scores, and incidence of macrosomia. Self-monitored blood glucose data were collected and analyzed at biweekly follow-up visits from enrollment until delivery. RESULTS: Of the 200 participants, 171 completed the study. The average age was 31.2 (SD 4) years, and the average gestational age at enrollment was 26.3 (SD 1.6) weeks. Baseline HbA1c levels were similar between groups (5.2% vs 5.1%; P=.97). The glycemic qualification rate was significantly higher in the intervention group than in the control group at follow-up 3 (mean 87.9%, SD 14.9% vs 81.9%, SD 17.8%; P=.02), follow-up 4 (mean 91.0%, SD 9.9% vs 87.2%, SD 14.4 %; P=.04), follow-up 5 (mean 94.0%, SD 7.4% vs 91.5%, SD 9.5%; P=.04), and follow-up 6 (mean 94.3%, SD 6.7% vs 91.8%, SD 8.9%). PBG levels were significantly lower in the intervention group after lunch (1 h: mean 5.9, SD 0.7 vs 6.0, SD 0.7 mmol/L; P=.0 2 h2h: 5.1, SD 0.7 vs 5.3, SD 0.8 mmol/L; P=.03) and dinner (1 h: mean 6.0, SD 0.5 vs 6.2, SD 0.6; 2 h: 5.5, SD 0.7 vs 5.7, SD 0.8 mmol/L). However, no significant differences were observed in fasting blood glucose or PBG after breakfast between the groups. The intervention group showed significantly higher General Self-Efficacy Scale scores than the control group (mean 195.4, SD 6.9 vs 192.9, SD 5.8). The incidence of macrosomia was significantly lower in the intervention group than in the control group (5% vs 15%; P=.04). CONCLUSIONS: The findings of this randomized controlled trial suggest that a CBT-based digital dietary intervention can significantly enhance glycemic control, particularly PBG levels, and may contribute to improved pregnancy outcomes with a reduced incidence of macrosomia in women with GDM.

BACKGROUND: Primary aldosteronism (PA) is the leading cause of secondary hypertension. The 2022 WHO classification introduced the HISTALDO system, separating solitary aldosterone-producing adenomas/nodules (APA/APN; classical histology) from multiple nodules/micronodules (MAPN/MAPM; non-classical histology). Surgery often cures classical cases, while non-classical cases frequently recur. HISTALDO uses CYP11B2 immunohistochemistry, but interpretation is challenged by background nodules. A "B2 ratio" (size ratio of the largest to second-largest CYP11B2-positive nodule) has been proposed to aid diagnosis. OBJECTIVE: To assess whether standardized tissue sampling and the B2 ratio improve PA diagnosis and correlate with outcomes. METHODS: A prospective study of 75 unilateral PA patients undergoing adrenalectomy (2017-2022) at Karolinska University Hospital. CYP11B2 immunohistochemistry was performed using a standardized protocol, and the B2 ratio was calculated in cases with multiple CYP11B2-positive nodules (HISTALDO B2R). Outcomes were assessed using Primary Aldosteronism Surgical Outcome criteria. RESULTS: HISTALDO classified 20 cases as classical and 55 as non-classical (median B2 ratio 9). Using a B2 ratio cut-off ≥8.1, 29/55 non-classical cases were reclassified, yielding 49 classical and 26 non-classical cases under HISTALDO B2R. Higher B2 ratios correlated with complete clinical response (P = .0038) and fewer antihypertensive medications postoperatively (R = -0.4, P = .0022). A trend for B2 ratio as an independent predictor of complete response was observed (OR = 1.07, P = .058). CONCLUSIONS: HISTALDO may over-report non-classical histology. Adding the B2 ratio improves diagnostic accuracy, distinguishing APA with background zona glomerulosa activity from true multinodular disease, facilitating patient management and follow-up.