فهرست مطالب

International Journal of Endocrinology and Metabolism
Volume:22 Issue: 1, Jan 2024

  • تاریخ انتشار: 1402/12/21
  • تعداد عناوین: 6
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  • Navid Saadat, Safdar Masoumi, MohammadKarim Shahrzad, Fereidoun Azizi * Page 1
    Background

     Extended low serum thyrotropin (TSH) levels may increase the risk of cardiovascular events in patients with hyperthyroidism.

    Objectives

     This study aimed to compare the time spent with sustained normal TSH concentration following short- and long-term methimazole treatment.

    Methods

     A total of 258 patients with Graves’ hyperthyroidism completed 18 - 24 months of methimazole therapy and were randomized to discontinue treatment (n = 128, short-term group) or continue an additional 36 - 102 months of methimazole therapy (n = 130, long-term group). Clinical and laboratory evaluations were performed every 6 months for 132 months after randomization.

    Results

     There was no difference in serum-free thyroxine, triiodothyronine, and TSH concentrations between the 2 groups at the time of randomization. Of 128 patients in the short-term group, 5 left in follow-up, 2 became hypothyroid, 67 (54%) had a relapse of hyperthyroidism, and only 54 (44%) were euthyroid at the end of the study. Among 130 patients on the long-term methimazole therapy, 4 were left in follow-up, 24 developed hyperthyroidism, 4 developed hypothyroidism, and 98 (78%) were euthyroid 132 months post-randomization. Total time spent on euthyroidism was 90.4% ± 8.1% of the study period in the short-term and 95.8% ± 7.0% in the long-term treatment groups (P < 0.001). The lowest time spent in euthyroidism (74.6% ± 6.4% of the study period) belonged to 29 (24%) patients in the short-term group under levothyroxine therapy because of fluctuation in serum TSH. Patients in both groups with hyperthyroidism relapse who chose methimazole therapy spent >90% of the study time in euthyroidism.

    Conclusions

     In patients with Graves' hyperthyroidism, sustained normal serum TSH levels were more common in the long term as compared to the short-term methimazole treatment.

    Keywords: Euthyroidism, Methimazole, Therapy, Thionamide, TSH Receptor Antibody
  • AmirHossein Ghanooni, Mitra KazemiJahromi, Farhad Hosseinpanah * Page 2
    Introduction

     Primary aldosteronism (PA) is a clinical syndrome characterized by hypertension, suppressed plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC), and spontaneous hypokalemia.

    Case Presentation

     We present a 37-year-old normotensive female with hypokalemia, high plasma aldosterone level, and suppressed renin. The patient was treated with eplerenone and potassium chloride supplement. Further investigation with a computed tomography (CT) scan revealed a mass in the left adrenal. Laparoscopic adrenalectomy led to the diagnosis of adrenal adenoma.

    Conclusions

     Primary aldosteronism should be among the differential diagnoses in normotensive patients presenting with severe hypokalemia.

    Keywords: Primary Aldosteronism, Normotensive, Hypokalemia, Adrenal Tumor
  • Abdolreza Chary, Maryam Tohidi *, Mitra Hasheminia, Melika Golmohammadi, Reza Haji Hosseini, Mehdi Hedayati Page 3
    Background

     The contribution of high-density lipoprotein cholesterol (HDL-C) subclasses to incident cardiovascular disease (CVD) and coronary heart disease (CHD) remains a subject of debate.

    Objectives

     The objective of this study was to investigate these associations in a population with a high prevalence of dyslipidemia and CVD.

    Methods

     In a nested case-control study, HDL-C and its subclasses (HDL2-C and HDL3-C) in 370 age and gender-matched case and control subjects were determined. This study employed multivariable-adjusted conditional logistic regression to calculate the odds ratios (ORs) for the associations between HDL-C, HDL2-C, HDL3-C, and HDL2-C/HDL3-C (both as continuous and categorical variables) with incident CVD and CHD. The present study models were adjusted for a comprehensive set of confounders, including body mass index, current smoking, hypertension, type 2 diabetes mellitus, use of lipid-lowering drugs, family history of premature CVD, non-HDL-C, and triglycerides.

    Results

     In multivariate analysis, when considering lipoprotein parameters as continuous variables, a 1-unit increase in HDL-C and HDL3-C was associated with a reduced risk of incident CVD and CHD. For CVD, the ORs (95% confidence intervals [CI]) were 0.95 (0.92 - 0.98) and 0.95 (0.93 - 0.98) for HDL-C and HDL3-C, respectively. The corresponding values for CHD were 0.94 (0.91 - 0.97) and 0.94 (0.91 - 0.97). In the categorical approach to lipoprotein parameters, higher quartiles of HDL-C and HDL3-C, compared to the first quartile, were significantly associated with a lower risk of incident CVD and CHD. The ORs (95% CI) for the fourth quartiles were 0.43 (0.25 - 0.74, P for trend = 0.003) and 0.46 (0.27 - 0.78, P for trend = 0.005) for HDL-C and HDL3-C regarding CVD and 0.32 (0.17 - 0.59) and 0.32 (0.18 - 0.59) (all P for trend = 0.001) regarding CHD, respectively. Paradoxically, across quartiles of HDL2-C/HDL3-C, this lipid ratio was associated with a higher risk of CHD (92% higher risk in the fourth quartile).

    Conclusions

     The results showed that HDL3-C, but not HDL2-C, was primarily responsible for the protective effect of HDL-C against CVD, particularly CHD, in Iranian adults.

    Keywords: Cardiovascular Disease, Coronary Heart Disease, High-Density Lipoprotein, Subclass, HDL2-C, HDL3-C
  • Fatemeh Saffari, Ali Homaei, Venus Chegini, Amir Javadi, Victoria Chegini * Page 4
    Background

     Despite the progress made in the treatment of type 1 diabetes, the incidence of diabetic ketoacidosis (DKA) in children is still increasing, and its management requires hospitalization in the pediatric intensive care unit (PICU). It is important to find a new and low-risk treatment method to shorten the recovery time from DKA.

    Objectives

     This study aimed to evaluate the effectiveness and safety of integrating two different types of long-acting subcutaneous insulin into the standard treatment for DKA in children.

    Methods

     The study was conducted in the PICU, and comprehensive monitoring was performed throughout the process. Patients aged between 2 and 15 years were divided into three groups: two intervention groups receiving the addition of two types of long-acting insulin, Detemir and Glargine, to the standard treatment, and a control group. Each group consisted of 36 individuals. The impact of the intervention on the recovery time from DKA and the potential complications were investigated in all three groups.

    Results

     The analysis of the results revealed a significant difference in the duration of exiting the acute phase among the groups. Additionally, the post-hoc test demonstrated that the recovery time for ketoacidosis in the Detemir arm was significantly shorter than in the standard arm (P = 0.008). However, it is important to note that there were no significant differences in the occurrence of common complications among the three study groups.

    Conclusions

     Based on the findings, it appears that incorporating specific types of long-acting subcutaneous insulin into the standard treatment of DKA in children leads to a reduction in the resolution time of the acute phase of ketoacidosis. Importantly, this approach does not introduce additional complications. Consequently, it has the potential to optimize resource allocation and enhance patient care by freeing up beds in the PICU.

    Keywords: Children, Diabetic Ketoacidosis, Diabetes Type 1, Pediatric Intensive Care Unit, Insulin Analogues, Basal Insulin, Clinical Trial
  • Siham Rouf*, Latifa Yaqoubi, Hanane Latrech Page 5
    Introduction

    Rathke cleft cyst apoplexy is exceedingly rare, particularly in infants. The most prevalent clinical manifestations include headaches, visual field defects, and endocrine dysfunction. Treatment options range from surgery to conservative methods, taking into consideration the balance of benefits and risks, especially during critical life stages such as childhood.

    Case Presentation

    We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency.

    Conclusions

    For clinically asymptomatic children diagnosed with Rathke's cleft cyst apoplexy, adopting a conservative management approach is recommended, provided there is thorough clinical, biological, and radiological surveillance.

    Keywords: Rathke Cleft, Cyst Apoplexy, Conservative Treatment, GH Deficiency
  • Mitra Javan Amoli, Khosro Khademi Kalantari, Zeinab Ahmadpour Emshi, Aliyeh Daryabor, Sedigheh Sadat Naimi * Page 6
    Background

     Distal peripheral neuropathy (DPN) is a prevalent issue among patients with type 2 diabetes mellitus. Despite the widespread use of low-level laser therapy (LLLT) and limited use of Tecar therapy in physiotherapy for diabetics, the synergistic effect of these two interventions in a long-term follow-up has not yet been determined.

    Objectives

     This study aimed to compare the effects of Tecar therapy and LLLT separately and simultaneously over a 3-month follow-up period on clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN.

    Methods

     In this double-blind, randomized clinical trial, forty-five individuals with type 2 diabetes (30 women and 15 men) with DPN were randomly assigned to three groups of 15 people: Tecar-on + laser-sham, Tecar-on + laser-on, and laser-on + Tecar-sham. The patients received ten treatment sessions and were followed up for 3-months after the last session. Health-related quality of life was assessed using the WHOQOL-BREF Questionnaire, while clinical symptoms, including pain (measured with a Visual Analog Scale), functional balance (evaluated with the timed-up and go test), and neuropathy symptoms (assessed with the Michigan Questionnaire) were also recorded.

    Results

     Inter-group comparison after ten sessions revealed that the Tecar-on + laser-sham and Tecar-on + laser-on groups exhibited significant improvement in neuropathy symptoms compared to the laser-on + Tecar-sham group. Even after the 3-month follow-up, these two groups showed lasting improvement in all variables compared to the laser-on + Tecar-sham group (P < 0.05). The Tecar-on + laser-on group demonstrated a more enduring significant effect on pain scores (P = 0.035) compared to the Tecar-on + laser-sham group after the 3-month follow-up. In intra-group comparison, all three groups showed significant improvement in clinical symptoms and health-related quality of life after ten treatment sessions compared to before treatment (P < 0.05). Moreover, after the 3-month follow-up, both the Tecar-on + laser-sham group and the Tecar-on + laser-on group demonstrated a more lasting significant effect in all variables compared to before treatment (P < 0.05). For the laser-on + Tecar-sham group, a more durable improvement in health-related quality of life (P = 0.000) and neuropathy symptoms (P = 0.011) was reported after the 3-month follow-up compared to before treatment.

    Conclusions

     Although all three groups exhibited significant improvement in clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN after ten treatment sessions, the synergistic use of Tecar therapy and LLLT after a long-term follow-up period could lead to more durable therapeutic effects in improving these outcomes for individuals with diabetes.

    Keywords: Tecar Therapy, Low Power Laser Therapy, Peripheral Neuropathy, Type 2 Diabetes, Neuropathy Symptoms, Quality Of Life