Hirsutism in postmenopausal women demands careful clinical evaluation; malignant causes are not infrequent and must be excluded, especially when virilization or a testosterone level of > 5nmol/L is present. Ovarian hyperthecosis (OH) is an uncommon, benign cause of marked hyperandrogenism. A 61-year-old post-menopausal woman presents with a year-long history of hirsutism, particularly on her face, chest, and abdomen. She had a BMI of 32kg/m2, an uncharacteristic phenotype, and slight clitoromegaly with no other virilization symptoms. Despite discrete symptoms, blood tests showed severe hyperandrogenism with total testosterone levels > 12nmol/L (~346 ng/dL). The abdominopelvic CT scan and transvaginal ultrasound were normal. A laparoscopic diagnostic salpingo-oophorectomy was performed, and histology revealed bilateral OH. Testosterone levels normalized one month after surgery. OH requires a high degree of suspicion and bilateral salpingo-oophorectomy is both diagnostic and therapeutic. Early diagnosis is crucial to optimize the treatment of comorbidities and prevent long-term complications.
Background: Resistance to thyroid hormone beta (RTHβ) is a rare genetic disorder characterized by impaired thyroid hormone receptor β (TRβ) function, leading to resistance to thyroid hormones (THs) in TRβ-dependent tissues. Although traditionally considered a benign condition, emerging evidence highlights increased cardiovascular morbidity. Summary: In RTHβ, impaired TRβ2 function, responsible for central regulation of TH, leads to increased TH levels. The heart is TRα1-dependent, being chronically overexposed to TH, often resulting in sinus tachycardia and increased arrhythmic risk. Other cardiac changes include enlarged left chambers, increased cardiac output and valvular abnormalities, predisposing to heart failure and/or increased cardiovascular and all-cause mortality. Free thyroxine, age at diagnosis, and comorbidity burden positively correlate with risk of major adverse cardiovascular events. RTHβ is also associated to dyslipidemia and hepatic steatosis, further compounding cardiovascular risk. β-blockers are considered first-line therapy for tachycardia and atrial fibrillation, although they do not correct the underlying imbalance. The TRβ-selective analogue 3,5,3′-triiodothyroacetic acid (TRIAC) represents a theoretically promising therapeutic option. Key Messages: Cardiovascular complications in RTHβ are often underestimated. Management should include routine cardiac monitoring, aggressive control of cardiovascular risk factors, and consideration of emerging therapies such as TRIAC, though more trials are needed to confirm their safety and efficacy.
Introduction: Hypothyroidism is a prevalent endocrine disorder that has been linked to adverse cardiovascular outcomes. However, national-level trends and disparities in cardiovascular disease (CVD)-related mortality among individuals with hypothyroidism remain incompletely characterized. This study aimed to evaluate long-term temporal trends and demographic disparities in CVD mortality among US adults with hypothyroidism. Methods: We conducted a retrospective population-based analysis using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2020. Adults aged >= 25 years with hypothyroidism were identified using ICD-10 codes E02-E03, with CVD-related deaths defined by ICD-10 codes I00-I99. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 US standard population. Temporal trends were analyzed using joinpoint regression to estimate annual percent change (APC), and subgroup analyses were performed by sex, race/ethnicity, age group, urban-rural status, and place of death. Results: Between 1999 and 2020, 382,906 CVD-related deaths were associated with hypothyroidism, corresponding to an overall AAMR of 8.00 per 100,000. Mortality rates increased steadily over the study period, peaking at 10.12 per 100,000 in 2020, with the most pronounced rise occurring between 2018 and 2020 (APC 14.01%). Women accounted for nearly three times as many deaths as men, although mortality rates increased more rapidly among men. Non-Hispanic white individuals exhibited the highest absolute mortality burden, while Hispanic populations experienced the fastest growth in mortality rates. The largest relative increases were observed among adults aged 35-44 and 45-54 years. Mortality rates were consistently higher in rural compared with urban areas, and the majority of deaths occurred in long-term care facilities. Conclusion: CVD-related mortality among US adults with hypothyroidism has risen substantially over the past two decades, with marked disparities across sex, age, race/ethnicity, and geographic location. These findings highlight the need for targeted cardiovascular risk assessment, early detection of hypothyroidism, and integrated management strategies, particularly in high-risk and underserved populations, to mitigate rising mortality and reduce health inequities.
Continuous glucose monitoring (CGM) has revolutionised diabetes management, transforming both clinical practice and the self-management of people with diabetes. By providing a more detailed understanding of individual glycaemic patterns, CGM supports more informed therapeutic decisions and sustained behavioural changes that promote improved clinical outcomes and quality of life. In light of new evidence and accumulated experience, it has become necessary to update the clinical indications and public health strategy for the use of CGM in Portugal. The recommendations focused on three priority areas: (1) the clear definition of target populations for CGM use, namely, all individuals with diabetes treated with any insulin regimen (including basal therapy), as well as those not treated with insulin but at increased risk of hypoglycemia and its consequences, based on eligibility criteria grounded in scientific evidence and clinical needs; (2) the strengthening of therapeutic education and health literacy, promoted by multidisciplinary teams trained to support self-management and the appropriate use of technology; and (3) ensuring the quality and integrated functioning of CGM systems with other medical devices, including insulin pumps and digital monitoring platforms, in order to guarantee interoperability, reliability, and data management security.
Introduction: Primary hyperparathyroidism (PHPT) is a relatively common endocrine disorder that is more frequently diagnosed in postmenopausal women; however, its association with vesicovaginal fistula (VVF) and severe urological complications is rare. We present a rare manifestation of PHPT in a 56-year-old woman with previously undiagnosed disease, resulting in severe genitourinary complications including VVF and retained encrusted ureteral stents. This constellation of findings can easily be misattributed to more common urological or gynaecological conditions. Case Presentation: Investigations revealed a recurrent VVF and completely encrusted, retained bilateral double J (DJ) ureteral stents. Serum parathyroid hormone (PTH) levels were measured following the detection of persistent hypercalcemia during evaluation for stent-related complications, prompting endocrine referral. The hypercalcemia induced by a parathyroid adenoma likely contributed to both severe stent encrustation and failure of previous VVF repair due to impaired tissue healing. Definitive management involved surgical excision of the left inferior parathyroid adenoma, followed by a staged, multimodal endourological procedure for stent retrieval. The recurrent VVF, being small, was successfully managed with laser fulguration. Conclusion: This case underscores the importance of early endocrine/metabolic evaluation in patients with recurrent stone disease or poor surgical wound healing to prevent complex urological complications arising from unrecognized PHPT.
