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Background: Although vaccination against coronavirus disease (COVID-19) has several side effects, hypopituitarism due to hypophysitis has rarely been reported. Case presentation: An 83-year-old healthy woman, who had received her fourth COVID-19 vaccine dose 2 days before admission, presented to the emergency department with difficulty moving. On examination, impaired consciousness (Glasgow Coma Scale: 14) and fever were observed. Computed tomography and magnetic resonance imaging of the head revealed swelling from the sella turcica to the suprasellar region. Her morning serum cortisol level was low (4.4 μg/dL) and adrenocorticotropic hormone level was normal (21.6 pg/mL). Central hypothyroidism was also suspected (thyroid stimulating hormone, 0.46 μIU/mL; free triiodothyronine, 1.86 pg/mL; free thyroxine, 0.48 ng/dL). Secondary adrenocortical insufficiency, growth hormone deficiency, delayed gonadotropin response, and elevated prolactin levels were also observed. After administration of prednisolone and levothyroxine, her consciousness recovered. On the 7th day of admission, the patient developed polyuria, and arginine vasopressin deficiency was diagnosed using a hypertonic saline test. On the 15th day, the posterior pituitary gland showed a loss of high signal intensity and the polyuria resolved spontaneously. On the 134th day, the corticotropin-releasing hormone loading test showed a normal response; however, the thyrotropin-releasing hormone stimulation test showed a low response. The patient's disease course was stable with continued thyroid and adrenal corticosteroid supplementation. Conclusions: Herein, we report a rare case of anterior hypopituitarism and arginine vasopressin deficiency secondary to hypophysitis following COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is a crucial health issue among older adults. Growth differentiation factor 15 (GDF15) is associated with inflammation, oxidative stress, insulin resistance, and mitochondrial dysfunction, which are possible pathogeneses of frailty. However, few longitudinal studies have investigated the association between GDF15 and the incidence of frailty. Therefore, we investigated whether high serum GDF15 levels are associated with the incidence of frailty. Methods: A total of 175 older adults (mean age: 77 ± 6 years; 63% women) with cardiometabolic diseases and no frailty out of the two criteria at baseline participated. Individuals with severe renal impairment or severe cognitive impairment were excluded. Serum GDF15 levels were measured at baseline. Patients were asked to assess frailty status at baseline and annually during follow-up using the modified version of the Cardiovascular Health Study (mCHS) and the Kihon Checklist (KCL). We examined the association between GDF15 tertiles and each frailty measure during follow-up (median 38–39 months). In the multivariate Cox regression analysis, with the GDF15 tertile groups as the explanatory variables, hazard ratios (HRs) and 95% confidence intervals (CIs) for incident frailty were calculated after adjusting for covariates and using the lowest tertile group as the reference. Results: During the follow-up period, 25.6% and 34.0% of patients developed frailty, as defined by the mCHS and KCL, respectively. The highest GDF15 tertile group had a significantly higher incidence of mCHS- or KCL-defined frailty than the lowest GDF15 tertile group. Multivariate Cox regression analysis revealed that the adjusted HRs for incident mCHS- and KCL-defined frailty in the highest GDF15 tertile group were 3.9 (95% CI: 1.3–12.0) and 2.7 (95% CI: 1.1–6.9), respectively. Conclusion: High serum GDF15 levels predicted the incidence of frailty among older adults with cardiometabolic diseases and could be an effective marker of the risk for frailty in interventions aimed at preventing frailty, such as exercise and nutrition. [ABSTRACT FROM AUTHOR]

Aim: This longitudinal study aimed to determine whether categorization by the Dementia Assessment Sheet for Community‐based Integrated Care System 8‐items (DASC‐8) is associated with risk of frailty onset, disability, and mortality. Methods: We analyzed longitudinal data from outpatients aged 65 years and older evaluated for the DASC‐8 at the Frailty Clinic. The outcomes during the 3‐year follow‐up period were (Study A) frailty onset (Kihon Checklist ≥8) and (Study B) disability (new certification of nursing care needs) or mortality. Multivariate Cox regression analyses were performed to examine independent associations between the DASC‐8 category and outcomes, and hazard ratios and 95% confidence intervals (CIs) were calculated after adjustment for age, sex, and the presence or absence of diabetes, hypertension, and dyslipidemia. Results: (Study A) Out of the 216 patients without frailty in Categories I or II at baseline, 40 (20.4%) and 11 (55.0%) developed frailty, respectively. The adjusted hazard ratio was 3.62 (95% CI: 1.69–7.76, P < 0.001). (Study B) Out of the 350 patients who did not require long‐term care at baseline, disability or death occurred for 20 (7.3%) in Category I, 14 (23.0%) in Category II, and 9 (56.3%) in Category III. The adjusted hazard ratios were 2.40 (Category I vs. II; 95% CI: 1.13–5.11, P = 0.023) and 5.43 (Category I vs. III; 95% CI: 2.23–13.3, P < 0.001). Conclusion: Categorization according to DASC‐8 is associated with the risk of frailty, disability, and mortality in older patients. Geriatr Gerontol Int 2024; 24: 150–155. [ABSTRACT FROM AUTHOR]

Aims: This study investigated risk factors of falls in elderly patients with type 2 diabetes mellitus.Methods: A total of 211 patients aged ≧60years (168 diabetic patients and 43 non-diabetic control subjects) were studied. Factors associated with falls in the past year were retrospectively examined using multiple logistic regression analysis.Results: The prevalence of patients who had a history of falls in the past year was twice as high as in diabetic patients compared in control subjects (36.9% vs. 18.6%, P<0.05). When diabetic patients were exclusively analyzed, the presence of any level of hypoglycemia and the Timed Up and Go test (TUG) scores correlated with patients' falls. The presence of hypoglycemia (OR 3.62, 95% CI: 1.242-10.534, P=0.018), cognitive impairment (OR 3.63, 95% CI: 1.227-10.727, P=0.020), and high Fall Risk Index scores (OR 1.2, 95% CI: 1.010-1.425, P=0.039) was independently correlated with the presence of multiple falls. When the diabetic patients were divided into three groups according to the frequency of hypoglycemia episodes, the prevalence of falls increased as the frequency of hypoglycemia increased.Conclusion: Hypoglycemia was a risk factor of falls in elderly type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

The article presents case study of 91-year-old man have type 1 diabetes patient receiving insulin pump treatment with positive myeloperoxidase-antineutrophil cytoplasmic antibody complication. It mentions that Without therapeutic intervention, the C-reactive protein levels decreased to the normal range, and hematuria has improved with no damage to other organs has been observed to date.

Aims/Introduction: Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood. Materials and Methods: The study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients' diabetes status. Results: We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto‐occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019‐defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation. Conclusions: White matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes. [ABSTRACT FROM AUTHOR]

Aim: We examined whether the Dementia Assessment Sheet for Community‐based Integrated Care System 8‐items (DASC‐8) is useful for screening frailty and as a comprehensive geriatric assessment (CGA). Methods: Outpatients (N = 431; 269 women; Mage = 78.9 ± 6.8 years) with cardiometabolic disease from a frailty clinic participated. Frailty status was assessed using modified Cardiovascular Health Study criteria, the Clinical Frailty Scale and the Kihon Checklist. Cognition, higher‐level activities of daily living, sarcopenia, physical activities, depression, nutrition, medication adherence, social network and quality of life were assessed as CGA components. We examined the association of DASC‐8 category with frailty or CGA components using multiple logistic regression analyses, adjusted for age and sex. Results: Most participants (n = 310, 71.9%) were in Category I, 90 (20.9%) were in Category II and 31 (7.1%) were in Category III. There were no significant differences in sex, body mass index, or past medical history, except regarding age or cerebral infarction. Logistic regression analyses showed that, for all definitions of frailty, the odds ratios of frailty significantly increased as category progressed. Cognitive function, higher‐level activities of daily living, handgrip strength, gait speed, physical activities, medication adherence, social network and quality of life decreased as the category increased. Although depressive tendency increased in Category II, there was no significant difference in muscle mass or prevalence of sarcopenia among the categories. Malnutrition was observed in Category III. Conclusions: DASC‐8 category was associated with frailty and several CGA components in older patients with cardiometabolic disease. Geriatr Gerontol Int 2020; 20: 1157–1163. [ABSTRACT FROM AUTHOR]

Aims: Sarcopenia is a serious problem because of its poor prognosis. Growth differentiation factor 15 (GDF15) is associated with mitochondrial dysfunction, inflammation, insulin resistance and oxidative stress, which may play crucial roles for the development of sarcopenia. We aimed to examine whether serum GDF15 level is associated with muscle mass, strength and lower extremity function in older patients with cardiometabolic disease. Methods: Serum GDF15 levels were measured in 257 patients with cardiometabolic diseases (including 133 patients with diabetes) who had visited the frailty clinic, using a latex turbidimetric immunoassay. Appendicular skeletal muscle index, handgrip strength, timed‐up‐and‐go test and gait speed were evaluated. Power, speed, balance and total scores based on the sit‐to‐stand test were calculated to assess lower extremity function. Results: The highest tertile of serum GDF15 was independently associated with low handgrip strength, low gait speed, long timed‐up‐and‐go time and scores of lower extremity function but not an appendicular skeletal muscle index in multiple logistic regression analyses after adjustment for covariates. Patients in the highest tertile of GDF15 were at the risk of having three to nine times lower grip strength, three times lower gait speed, five to six times lower mobility and five to 11 times reduction in lower extremity function as compared with those in the lowest GDF15 tertile dependent on the models. Conclusions: Elevated serum GDF15 level was independently associated with low muscle strength and lower extremity function in older patients with cardiometabolic disease. Serum GDF15 could be one of the biomarkers for muscle weakness and low physical performance. Geriatr Gerontol Int 2020; 20: 980–987. [ABSTRACT FROM AUTHOR]

A 47-year-old woman with a history of diabetes mellitus (DM) and obesity was admitted to our hospital for glucose control. She was detected to have hypertension (HT) and diagnosed with primary aldosteronism (PA) based on the high level of aldosterone to renin ratio and the results of the upright furosemide-loading test according to the criteria of the Japanese Society of Hypertension (JSH) guidelines. Computed tomography revealed left renal tumor and adrenocortical adenoma. She underwent left nephrectomy and adrenalectomy. The pathological findings were clear-cell renal cell carcinoma (RCC) and nonfunctional adrenocortical adenoma. Her nonneoplastic adrenal tissue histologically revealed CYP11B2-positive multiple adrenocortical micronodules (MNs) and concomitant paradoxical hyperplasia of the zona glomerulosa. Therefore, MNs were thought to be responsible for PA in this patient. After surgery, HT was improved, and the result of upright furosemide-loading test after 12 months of surgery did not fulfill the criteria of PA according to the JSH guidelines. However, the adrenocorticotrophic hormone stimulation test was positive; considering the possibility of slight aldosterone overproduction from the right adrenal gland, the administration of spironolactone was started. Herein, we report a rare case of RCC in conjunction with PA histologically associated with MNs. [ABSTRACT FROM AUTHOR]

Though excessive sodium intake is regarded as a crucial factor related to developing and worsening of diabetes complications, data on this topic in elderly patients with diabetes are sparse. We investigated the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65 - 85 years. The present analysis was conducted among Japanese patients with type 2 diabetes from outpatient clinics in 39 university and general hospitals in Japan. Data were analyzed on 912 individuals whose dietary intake at baseline was assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to diabetic retinopathy, overt nephropathy, cardiovascular disease, and all-cause mortality during 6 years. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders Mean sodium intake in quartiles ranged from 2498 mg to 5910 mg/day and more than three-quarters of participants had sodium intake more than the recommended dietary allowance by American Diabetes Association (< 2300 mg/day). After adjustment for confounders, HRs for complications in patients with sodium intake in the 2nd, 3rd, and 4th quartiles compared with sodium intake in the 1st quartile were analyzed, and no significant differences were shown between sodium intake and complications. Among patients whose vegetable intake was less than the average of 268.7 g, HRs for diabetic retinopathy in patients in the 2nd, 3rd, and 4th quartiles of sodium intake compared with the 1st quartile were 0.87 (95% CI, 0.31-2.41), 2.61 (1.00-6.83), and 3.70 (1.37-10.02), respectively. Findings indicated that high sodium intake under conditions of low vegetable intake is associated with elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes. Disclosure: C. Horikawa: None. T. Moriya: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. A. Araki: None. R. Aida: None. S. Tanaka: None. C. Kamada: None. S. Tanaka: None. Y. Yoshimura: None. R. Kodera: None. K. Fujihara: None. R. Kawasaki: None. Funding: Japan Society for the Promotion of Science (19H04028) [ABSTRACT FROM AUTHOR]

Excessive sodium intake is regarded as a crucial factor related to developing and worsening of cardiovascular disease (CVD). However, epidemiological studies on this topic in patients with type 2 diabetes are sparse. We investigated the associations between sodium intake and CVD risk in Japanese patients with type 2 diabetes from the analysis of pooled data from two nation-wide prospective longitudinal studies. Data were analyzed on 2428 individuals whose dietary intake at baseline was assessed by the Food Frequency Questionnaire based on food groups. Primary outcome was the 6-year risk of a CVD event. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders. Mean sodium intake in quartiles ranged from 2494 mg to 6166 mg/day and more than three-quarters of participants had sodium intake more than the recommended dietary allowance by American Diabetes Association (< 2300 mg/day). After adjustment for confounders, HRs for CVD in patients with sodium intake in the 2nd, 3rd, and 4th quartiles compared with sodium intake in the 1st quartile were analyzed, and no significant differences were shown between sodium intake and CVD [Q2: 0.77 (95%CI, 0.48-1.23); Q3: 1.03 (0.65-1.63); and Q4: 1.31 (0.80-2.14), trend p = 0.131]. Results of subgroup analysis according to age showed that patients aged 39 through 59 years in the higher quartiles of sodium intake compared with the 1st quartile had a significantly higher incidence of CVD [Q2: 1.37 (0.57-3.33); Q3: 1.68 (0.70-4.03); and Q4: 4.16 (1.63-10.58), trend p = 0.004]. However, no significant association between sodium intake and CVD in participants aged over 60 years. Findings indicated that high sodium intake is associated with elevated incidence of CVD in younger patients with type 2 diabetes. Disclosure: C. Horikawa: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. R. Aida: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. R. Kodera: None. K. Fujihara: None. T. Moriya: None. A. Araki: None. Funding: Japan Society for the Promotion of Science (19H04028) [ABSTRACT FROM AUTHOR]