Gonadotropin-Releasing Hormone (GnRH) stimulation test is a valuable tool used to diagnose and differentiate causes of early pubertal occurrences. However, its utility can be limited in the early phases of pubertal hypothalamic pituitary gonadal (HPG) axis activation, in girls where commonly overlapping pictures were observed, and in obese children due to excess circulating estrogen suppressing luteinizing hormone (LH) level. The lack of consistent baseline and stimulated gonadotropin cut offs observed in different studies also contribute to this limitation. Nevertheless, an early detection of a true pathological causes is still mandatory to allow prompt treatment and better prognosis. While basal LH can be beneficial as a good screening tool for detecting pubertal disorder, it does not preclude the need for GnRH test. This review is aiming to highlight the role of GnRH stimulation test and its varying cut off used to diagnose precocious puberty and classifying into its different types.

Hyperprolactinemia (hPRL) often poses a diagnostic dilemma due to the presence of macroprolactin. Understanding the prevalence of macroprolactinemia (mPRL) has an important implication in managing patients with hPRL. The primary aim of this study was to determine the prevalence of mPRL globally and to explore selected factors influencing the prevalence estimate. Studies with original data related to the prevalence of mPRL among patients with hPRL from inception to March 2020 were identified, and a random effects meta-analysis was performed. Of the 3770 records identified, 67 eligible studies from 27 countries were included. The overall global prevalence estimate was 18.9% (95% CI: 15.8%, 22.1%) with a substantial statistical heterogeneity (I² = 95.7%). The highest random effects pooled prevalence was observed in the African region (30.3%), followed by Region of the Americas (29.1%), European (17.5%), Eastern Mediterranean (13.9%), South-East Asian (12.7%), and Western Pacific Region (12.6%). Lower prevalence was observed in studies involving both sexes as compared to studies involving only female participants (17.1% vs. 25.4%) and in more recent studies (16.4%, 20.4%, and 26.5% in studies conducted after 2009, between 2000 and 2009, and before 2000, respectively). The prevalence estimate does not vary according to the age group of study participants, sample size, and types of polyethylene glycol (PEG) used for detection of macroprolactin (PEG 6000 or PEG 8000). With macroprolactin causing nearly one-fifth of hPRL cases, screening for mPRL should be made a routine before an investigation of other causes of hPRL.

Association of vitamin D and magnesium with insulin sensitivity and their influence on glycemic control

(1) Background: Several studies have suggested that the vitamin D receptor (VDR) gene plays a role in type 2 diabetes mellitus (T2DM) susceptibility. Nonetheless, the association between T2DM and VDR polymorphisms remains inconclusive. We determined the genotype of VDR rs1544410 (BsmI) and rs2228570 (FokI) polymorphisms among Malaysian patients with T2DM and their association with glycemic control factors (vitamin D levels, calcium, magnesium, and phosphate). (2) Methods: A total of 189 participants comprising 126 patients with T2DM (63 with good glycemic control and 63 with poor glycemic control) and 63 healthy controls were enrolled in this case–control study. All biochemical assays were measured using spectrophotometric analysis. VDR gene FokI and BsmI polymorphisms were analyzed using polymerase chain reaction and endonuclease digestion. (3) Results: Our findings revealed no significant differences in VDR FokI and BsmI genotypes between participants with T2DM and healthy controls. Moreover, no significant association was observed between both single nucleotide polymorphisms and glycemic control factors. Participants with poor glycemic control had significantly lower serum magnesium levels and significantly higher HOMA-IR compared to the other groups. (4) Conclusions: The present study revealed that VDR gene BsmI and FokI polymorphisms were not significantly associated with T2DM.

Chronic kidney disease (CKD) is a degenerative disorder that affects millions of people throughout the world, causing considerable morbidity and healthcare burden. Frequent blood sampling is the current gold standard for monitoring CKD to evaluate biochemical and mineral indicators. However, there are drawbacks to frequent blood draws, such as pain for patients, the possibility of infection, and higher medical expenses. Saliva-based diagnostics offer advantages such as ease of collection, reduced invasiveness, and improved patient compliance. A comprehensive literature review was conducted to analyze studies evaluating the diagnostic utility of salivary creatinine, urea, calcium, and parathyroid hormone (PTH) in patients with CKD. Various saliva collection methods, including stimulated and unstimulated approaches, were investigated for efficiency and reliability, and a correlation was shown between serum and salivary creatinine, urea, PTH, and calcium levels, indicating their potential as CKD biomarkers. Despite these promising findings, challenges such as standardization of collection methods, variability in salivary flow rates, and predictive value in association with blood parameters are addressed to ensure clinical applicability. This review explores the potential and challenges of saliva as a non-invasive alternative for CKD diagnostics.

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm²). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.