Nieuwe formulering Euthyrox

Er komen nieuwe tabletten van het middel Euthyrox. Deze zijn vanaf juni in Nederland op de markt. Apotheken maken echter eerst hun oude voorraad op, dus mogelijk krijgt men na 1 juni toch nog een keer de oude formulering mee. Per september zullen alle patienten de nieuwe formulering gebruiken.

Voor meer informatie en achtergronden, zie het bericht op de website van SON:

https://www.schildklier.nl/nieuws/43-nieuws/559-startdatum-invoering-nieuwe-formulering-euthyrox-per-1-juni-gestart

 

 

Het meten van endocrine-disruptors

People are constantly exposed to a wide variety of chemicals. Some of these compounds, such as parabens, bisphenols and phthalates, are known to have endocrine disrupting potencies. Over the years, these endocrine disrupting chemicals (EDCs) have been a rising cause for concern. In this study, we describe setup and validation of two methods to measure EDCs in human urine, using ultra-performance liquid chromatography tandem mass spectrometry. The phenol method determines methyl-, ethyl-, propyl-, n-butyl- and benzylparaben and bisphenol A, F and S. The phthalate method determines in total 13 metabolites of dimethyl, diethyl, diisobutyl, di-n-butyl, di(2-ethylhexyl), butylbenzyl, diiso-nonyl and diisodecyl phthalate. Runtime was 7 and 8 min per sample for phenols and phthalates, respectively. The methods were validated by the National Institute of Standards & Technology (NIST) for 13 compounds. In addition, EDCs were measured in forty 24-h urine samples, of which 12 EDCs were compared with the same samples measured in an established facility (Rigshospitalet, Copenhagen, Denmark). The intra-assay coefficient of variability (CV) was highest at 10% and inter-assay CV was highest at 12%. Recoveries ranged from 86 to 115%. The limit of detection ranged from 0.06 to 0.43 ng/mL. Of 21 compounds, 10 were detected above limit of detection in ≥93% of the samples. Eight compounds were in accordance to NIST reference concentrations. Differences in intercept were found for two compounds whereas slope differed for six compounds between our method and that used in the Danish facility. In conclusion, we set up and validated two high-throughput methods with very short runtime capable of measuring 5 parabens, 3 bisphenols and 13 different metabolites of 8 phthalates. Sensitivity of the phenol method was increased by using ammonium fluoride in the mobile phase.

Voor het complete artikel: https://academic.oup.com/jat/advance-article/doi/10.1093/jat/bkz027/5482460

 

 

Feochromocytoom en paraganglioom

INTRODUCTION: Recent years have seen major changes in clinical practice which may have affected the incidence rates of pheochromocytoma(PCC)/sympathetic paraganglioma(sPGL). There is, however, a lack of up-to-date information describing trends in these incidence rates.

METHODS: We searched the Dutch pathology registry to identify all histopathologically confirmed cases of PCC/sPGL diagnosed between 1995 and 2015. We calculated incidence rates according to age category as well as age-standardized incidence rates (ASR). We also searched Medline and Embase to find data on nationwide incidence rates of PCC/sPGL.

RESULTS: The nationwide pathology study revealed a total of 1493 patients with either PCC or sPGL. The ASR for PCC increased from 0.29 (95% CI: 0.24-0.33) to 0.46 (95% CI: 0.39-0.53) per 100,000 person-years in the periods 1995-1999 and 2011-2015, respectively. For sPGL the ASR in these same periods were 0.08 (95% CI: 0.06-0.10) and 0.11 (95% CI: 0.09-0.13) per 100,000 person-years, respectively. Concomitantly, PCC size decreased (β -0.17; P < .001) and age at diagnosis increased (β 0.13; P = .001). Our systematic search yielded 3 papers reporting on a total of 530 PCC/sPGL cases, showing a combined annual incidence rate varying from 0.04 to 0.21 per 100,000 person-years.

CONCLUSION: Incidence rates of PCC/sPGL have increased significantly over the past two decades. This trend coincides with a higher age and a smaller tumor size at diagnosis. Most likely these observations are at least in part the result of changes in clinical practice during the study period, with a more intensified use of both imaging studies and biochemical tests for detecting PCC/sPGL.

Het volledige artikel vindt u op: https://www.ejinme.com/article/S0953-6205(18)30015-3/fulltext

 

 

Cobalamine (vitamine B12) deficiëntie

Although cobalamin (vitamin B12) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B12 deficiency may present with the classic megaloblastic anemia.

In clinical practice, many cases of vitamin B12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B12 deficiency in whom the diagnosis was either based on low serum B12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B12 therapy. We discuss the possible clinical signs and symptoms of patients with B12 deficiency and the various pitfalls of diagnosis and treatment.

Het volledige artikel vindt u op: https://mcpiqojournal.org/article/S2542-4548(19)30033-5/fulltext

 

De Ziekte van Von Hippel-Lindau

Von Hippel-Lindau (VHL) disease is an autosomal dominant rare tumor syndrome characterized by high penetrance. VHL mutation carriers develop numerous manifestations in multiple organs during life. The natural course of development of new and growth of existing VHL-related manifestations is still unclear. In this study we aimed to gain insight into the development of subsequent manifestations in VHL disease. We retrospectively scored each new VHL-related manifestation as detected by standard follow-up (retina, central nervous system, kidneys and pancreas, excluding adrenal and endolymfatic sac manifestations) in 75 VHL mutation carriers. The Kaplan-Meier method was used to plot the cumulative proportions of all consecutive manifestations in each organ against age. The cumulative average number of manifestations in all organs during life was calculated by summating these cumulative proportions. Poisson model parameters were used to calculate average time to the detection of consecutive VHL manifestations in each organ. Consecutive VHL-related kidney and retina manifestations during life occur linearly according to Poisson distribution model. The total number of VHL manifestations rises linearly, with an average of seven VHL-related lesions at age 60 years. The incidence of consecutive VHL-related manifestations is constant during life in VHL mutation carriers. Our data is consistent with the notion that somatic inactivation of the remaining allele (Knudson’s “two-hit” hypothesis) is the determining factor in developing new VHL-related manifestations.

Voor meer informatie en het gehele artikel: https://link.springer.com/article/10.1007%2Fs10689-019-00131-x

 

 

Endocrinologie Groningen

Dit is de website van de afdeling Endocrinologie van het UMCG.
Deze website is bedoeld voor onze huidige patiënten en voor personenen die verwezen zijn naar onze afdeling, maar ook voor huisartsen. Hier vindt U informatie over verschillende endocriene ziekten, maar ook over onze afdeling, polikliniek, en lopend wetenschappelijk onderzoek.

 

Skin autofluorescence in the general population

This week, researchers from our department published a paper in the journal Diabetologia, on the measurement of skin autofluorescence to estimate the risk of developing type 2 diabetes, cardiovascular disease and mortality. The abstract of the paper is as follows:

Aims/hypothesis
Earlier studies have shown that skin autofluorescence measured with an AGE reader estimates the accumulation of AGEs in the skin, which increases with ageing and is associated with the metabolic syndrome and type 2 diabetes. In the present study, we examined whether the measurement of skin autofluorescence can predict 4 year risk of incident type 2 diabetes, cardiovascular disease (CVD) and mortality in the general population.
Methods
For this prospective analysis, we included 72,880 participants of the Dutch Lifelines Cohort Study, who underwent baseline investigations between 2007 and 2013, had validated baseline skin autofluorescence values available and were not known to have diabetes or CVD. Individuals were diagnosed with incident type 2 diabetes by self-report or by a fasting blood glucose ≥7.0 mmol/l or HbA1c ≥48 mmol/mol (≥6.5%) at follow-up. Participants were diagnosed as having incident CVD (myocardial infarction, coronary interventions, cerebrovascular accident, transient ischaemic attack, intermittent claudication or vascular surgery) by self-report. Mortality was ascertained using the Municipal Personal Records Database.
Results
After a median follow-up of 4 years (range 0.5–10 years), 1056 participants (1.4%) had developed type 2 diabetes, 1258 individuals (1.7%) were diagnosed with CVD, while 928 (1.3%) had died. Baseline skin autofluorescence was elevated in participants with incident type 2 diabetes and/or CVD and in those who had died (all p < 0.001), compared with individuals who survived and remained free of the two diseases. Skin autofluorescence predicted the development of type 2 diabetes, CVD and mortality, independent of several traditional risk factors, such as the metabolic syndrome, glucose and HbA1c.
Conclusions/interpretation
The non-invasive skin autofluorescence measurement is of clinical value for screening for future risk of type 2 diabetes, CVD and mortality, independent of glycaemic measures and the metabolic syndrome.

The full paper can be found online on the Diabetologia website:
https://link.springer.com/article/10.1007%2Fs00125-018-4769-x

HERE you can find a PowerPoint presentation explaining the concept of measuring skin autofluorescence and the results of the paper in more detail.

You may also find useful information on the website of the manufacturer of the AGe-reader:
www.diagnoptics.com

 

Publieke informatie over dit onderzoek vindt u o.a. op:

https://www.rtvnoord.nl/nieuws/201703/UMCG-apparaat-voorspelt-diabetes-en-overlijden

https://www.umcg.nl/NL/UMCG/Nieuws/Persberichten/Paginas/Slim-meetapparaatje-voorspelt-diabetes,-hart–en-vaatziekten-en-overlijden.aspx

https://www.dvhn.nl/groningen/Groningse-uitvinding-maakt-voorspellen-hartinfarct-nog-preciezer-23848890.html

https://www.telegraaf.nl/nieuws/2828789/apparaatje-voorspelt-diabetes-en-overlijden

https://www.newscientist.com/article/2186297-diabetes-can-be-diagnosed-by-simply-shining-a-light-on-your-skin/

http://pennstatehershey.adam.com/content.aspx?productId=35&gid=4300

 

Verhuizing Diabetescentrum 12 november 2018

Het Universitair DiabetesCentrum gaat binnenkort verhuizen. Vanaf 12 november vindt u in ons gebouw De Brug, op de begane grond. De gemakkelijkste ingang is nr. 47 aan de Oostersingel, zie de foto en de plattegrond. U loopt door de draaideur naar binnen, en vindt ons direct aan de linkerkant. Een bushalte is vlak in de buurt op de Oostersingel, of aan de hoofdingang van het UMCG.

Mensen die met de auto komen, parkeren het simpelst in garage Noord, en nemen dan trap of lift aan de noordelijke kant van de garage om pal naast het Diabetescentrum uit te komen. Ook uitermate comfortabel voor toegang voor mensen, die van een rolstoel afhankelijk zijn.

U vindt in de nieuwe locatie alle faciliteiten die belangrijk zijn voor uw zorg, en die u ook gewend was in het oude Triadegebouw: diabetesverpleegkundigen, diëtisten, podotherapeut, internisten, bloedafnamepunt, fundusfotografie, en de wetenschappelijk onderzoekers……

Gestational diabetes mellitus: diagnosis and outcome

Gestational diabetes mellitus: diagnosis and outcome.
Need for a revision of the Dutch perspective?
PhD ceremony: S.H. Koning, MSc
When: November 27, 2017
Start: 14:30
Promotors: prof. dr. B.H.R. (Bruce) Wolffenbuttel, P.P. van den Berg
Where: Academy building RUG, open to the public
Faculty: Medical Sciences / UMCG

 

Untreated gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and child. Many of these complications can be reduced by early diagnosis and treatment of GDM. However, worldwide there is a lack of agreement on the best way to diagnose and treat GDM.

In the Netherlands, the Dutch Society of Obstetrics and Gynaecology guideline “Diabetes and Pregnancy” for the screening and treatment of GDM was implemented in 2010. The diagnostic thresholds are based on the old WHO consensus originating from 1999 and have until now not been updated to the newest (more stringent) criteria, implemented in 2013. These new criteria have been adopted by many expert committees. However, evidence that applying the stricter criteria for GDM improves pregnancy outcomes is limited.

The research described in this thesis aimed to evaluate the current Dutch national guideline of GDM i.e. what is the outcome of GDM pregnancies using this guideline? And what are consequences when the current diagnostic criteria of GDM are to be revised?

In this thesis we have shown that the currently used national guideline for screening and treatment of GDM is successful in reducing the risk of short-term adverse outcomes, but not in reducing the likelihood of having a large-for-gestational-age neonate. We have also shown that the long-term care for GDM is far from optimal and requires further improvement. In order to further optimize GDM care and pregnancy outcomes we advise the use of more stringent blood glucose criteria for GDM diagnosis.

 

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