Exploring the high prevalence, comorbidities, and indicators of mild autonomous cortisol secretion in primary aldosteronism: a cohort study and systematic review
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Accuracy of semi-quantitative gold nanoparticle-based quick cortisol assay with and without adrenocorticotropic hormone infusion during adrenal vein sampling
Adrenal vein sampling (AVS) is the gold standard for diagnosing unilateral primary aldosteronism. Point-of-care rapid cortisol assays such as the gold nanoparticle based quick cortisol assay (QCA) are used to confirm accurate cannulation of the adrenal veins during the procedure and have improved AVS success rates. In this retrospective cohort study, we reviewed the results of consecutive AVS procedures (n = 37) performed with and without ACTH (synacthen) infusion between October 2020 and December 2022 at our institution. We compared (1) the accuracy of point-of-care QCA at semi-quantitatively assessing successful adrenal vein cannulation before and after ACTH infusion when compared with selectivity index based on laboratory cortisol measurements, (2) accuracy of QCA based on peripheral and adrenal vein cortisol levels and (3) the impact of time of day on the accuracy of QCA. We found the accuracy of QCA compared with formal laboratory cortisol measurements was 71% pre-ACTH and 100% post-ACTH (p-value < 0.001). Pre-ACTH, the accuracy of QCA was higher in the lowest (28–257 nmol/L) and highest (466–25130 nmol/L) adrenal vein cortisol tertiles compared to the mid-tertile. Post-ACTH, the accuracy of QCA remained high regardless of adrenal vein cortisol levels. Time of day did not affect the accuracy of the QCA. We conclude that during basal AVS subjective, visual estimates of adrenal vein cortisol levels using the QCA semi-quantitively should not be solely relied upon to guide catheter placement. These results will help guide clinicians in the appropriate clinical situations in which QCA should be used during AVS.
Childhood trauma cortisol and immune cell glucocorticoid transcript levels are associated with increased risk for suicidality in adolescence
Rising adolescent suicide rates present a growing unmet need. Childhood trauma (CT) has been associated with altered cortisol dynamics and immune cell glucocorticoid reactivity, yet their additive longer-term contributions to later suicide outcomes are less clear. The current study compared CT scores, resting salivary free cortisol and mononuclear cell gene expression levels of the nuclear receptor, subfamily 3, member 1 (NR3C1) coding the glucocorticoid receptor, and its co-chaperons FKBP prolyl isomerase 5 (FKBP5) and KIT Ligand (KITLG), between a cohort of adolescents presenting with a suicidal crisis requiring hospital treatment, and matched healthy controls. Childhood trauma scores and glucocorticoid measures were significantly altered among suicidal adolescents, and CT scores correlated with mononuclear cell glucocorticoid transcripts. Both CT scores and glucocorticoid measures explained substantial additive portions of the variance in adolescent suicidality. Long-term perturbations in cortisol dynamics and immune cell glucocorticoid response elements denote dysregulated immune stress reactivity, and may possess value in prediction and point to modifiable-risk factors in prevention of clinically significant suicidality during the brittle period of adolescence, years after childhood trauma exposure.
Bayesian p-curve mixture models as a tool to dissociate effect size and effect prevalence
Much research in the behavioral sciences aims to characterize the “typical” person. A statistically significant group-averaged effect size is often interpreted as evidence that the typical person shows an effect, but that is only true under certain distributional assumptions for which explicit evidence is rarely presented. Mean effect size varies with both within-participant effect size and population prevalence (proportion of population showing effect). Few studies consider how prevalence affects mean effect size estimates and existing estimators of prevalence are, conversely, confounded by uncertainty about effect size. We introduce a widely applicable Bayesian method, the p-curve mixture model, that jointly estimates prevalence and effect size by probabilistically clustering participant-level data based on their likelihood under a null distribution. Our approach, for which we provide a software tool, outperforms existing prevalence estimation methods when effect size is uncertain and is sensitive to differences in prevalence or effect size across groups or conditions.
Pancreatic endocrine and exocrine signaling and crosstalk in physiological and pathological status
The pancreas, an organ with dual functions, regulates blood glucose levels through the endocrine system by secreting hormones such as insulin and glucagon. It also aids digestion through the exocrine system by secreting digestive enzymes. Complex interactions and signaling mechanisms between the endocrine and exocrine functions of the pancreas play a crucial role in maintaining metabolic homeostasis and overall health. Compelling evidence indicates direct and indirect crosstalk between the endocrine and exocrine parts, influencing the development of diseases affecting both. From a developmental perspective, the exocrine and endocrine parts share the same origin—the “tip-trunk” domain. In certain circumstances, pancreatic exocrine cells may transdifferentiate into endocrine-like cells, such as insulin-secreting cells. Additionally, several pancreatic diseases, including pancreatic cancer, pancreatitis, and diabetes, exhibit potential relevance to both endocrine and exocrine functions. Endocrine cells may communicate with exocrine cells directly through cytokines or indirectly by regulating the immune microenvironment. This crosstalk affects the onset and progression of these diseases. This review summarizes the history and milestones of findings related to the exocrine and endocrine pancreas, their embryonic development, phenotypic transformations, signaling roles in health and disease, the endocrine-exocrine crosstalk from the perspective of diseases, and potential therapeutic targets. Elucidating the regulatory mechanisms of pancreatic endocrine and exocrine signaling and provide novel insights for the understanding and treatment of diseases.
The dual role of motivation on goals and well-being in higher vocational education students: a self-determination theory perspective
Students’ well-being has received increasing international attention. However, research on well-being among higher vocational education (HVE) students, particularly in non-WEIRD contexts, remains limited. This study addresses this gap by investigating the relationships between goals, motivation, and well-being for HVE students in China through the lens of self-determination theory. A survey was administered to 1106 HVE students at a vocational college in China to collect data on their goal content, motivation, and well-being. Quantitative analyses revealed that motivation plays a dual role, acting as both a mediator and a moderator in the relationship between goals and well-being. This dual role is crucial for understanding not only how goals influence well-being but also under what conditions different types of goals promote or hinder well-being. Specifically, intrinsic goals, when paired with autonomous motivation, were found to significantly predict increased well-being. While extrinsic goals combined with controlled motivation also reliably predicted well-being, this relationship should be interpreted cautiously within the specific cultural context of the study. Furthermore, positive relationships between extrinsic goals and well-being, as well as between amotivation and well-being, were observed, contrasting findings from ‘WEIRD’ contexts. This study provides novel insights into how motivation functions as both a moderator and mediator in the goal-well-being relationship within a ‘non-WEIRD,’ specifically Chinese, HVE context. These findings underscore the importance of supporting students in pursuing goals to enhance their well-being. Further research is needed to explore these relationships in diverse cultural settings.
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