Reposted by SPINA Team
Die #thyreotoxische_Krise ist ein endokriner Notfall, der unbehandelt fast immer tödlich ist. Wenn sie rechtzeitig erkannt und richtig behandelt wird, ist die Prognose aber gut.
In einem Podcast diskutieren Dr. Kai Gruhn und ich Aspekte der Diagnostik & Therapie:
open.spotify.com/episode/3bnY...
open.spotify.com
Thyreotoxische Krise: wichtige Differentialdiagnose der Sepsis - mit Prof. Johannes Dietrich
Klinisch Relevant Podcast · Episode
![Abstract
Aims: The widely used dynamic disposition index, derived from oral glucose tolerance testing, is an integrative measure of the homeostatic performance of the insulin-glucose feedback control. Its collection is, however, time consuming and expensive. We, therefore, pursued the question if such a measure can be calculated at baseline/fasting conditions using plasma concentrations of insulin and glucose.
Methods: A new fasting-based disposition index (structure parameter inference approach-disposition index [SPINA-DI]) was calculated as the product of the reconstructed insulin receptor gain (SPINA-GR) times the secretory capacity of pancreatic beta cells (SPINA-GBeta). The novel index was evaluated in computer simulations and in three independent, multiethnic cohorts. The objectives were distribution in various populations, diagnostic performance, reliability and correlation to established physiological biomarkers of carbohydrate metabolism.
Results: Mathematical and in-silico analysis demonstrated SPINA-DI to mirror the hyperbolic relationship between insulin sensitivity and beta-cell function and to represent an optimum of the homeostatic control. It significantly correlates to the oral glucose tolerance test based disposition index and other important physiological parameters. Furthermore, it revealed higher discriminatory power for the diagnosis of (pre)diabetes and superior retest reliability than other static and dynamic function tests of glucose homeostasis.
Conclusions: SPINA-DI is a novel simple reliable and inexpensive marker of insulin-glucose homeostasis suitable for screening purposes and a wider clinical application.](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:yxkip4xxf4mlialvuuoisc2w/bafkreidjchyquyfdzhiisypyqhskslenupf3d7wgc7ffwaryfvjeibdysy)
: glucose concentration; S(t): insulin secretion rate; [I](t): insulin concentration; M(t): proximal insulin signalling; N(t) distal insulin signalling; P(t): constitutive glucose production rate; Q(t): regulated glucose production rate; W(t): intestinal glucose absorption rate; R(t): glucose arrival rate. G1 and G3 represent gains of ASIA elements. Units of measurement are displayed in the small, rounded boxes with red margins.](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:xaqslchhhuackby4i46m33e2/bafkreihh46ymprtcws7a6xj55tmyccuu4sfa7rpg7ltqwflbfxxnickqwu)
![Positive and negative biomarkers for thyroid hormone action in tissues. Positive biomarkers for TR-alpha signalling include bone-specific alkaline phosphatase (ostase) and heart rate, negative biomarkers for TR-alpha signalling comprise QT interval, JT interval and TP-e interval in the ECG. Positive biomarkers for TR-beta signalling are 3-methylhistidine, coeruloplasmin, copper and sex-hormone binding globulin (SHBG), negative biomarkers for TR-beta signalling include lipids (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], lipoprotein a [Lp(a)] and triglycerides) and creatine kinase (CK).](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:yxkip4xxf4mlialvuuoisc2w/bafkreiftssqzh5jy3lkfo334ixulw5v5hnla37m6x7zjapbdqsqovtm3ze)
