مجله غدد درون ریز و متابولیسم ایران
سال ششم شماره 4 (پیاپی 24، زمستان 1383)

Despite recent literature indicating the association between low T3 levels and cardiovascular mortality in cardiac patients, the relationship between levels of T3 and cardiovascular risk factors in normal populations has not yet been investigated. Considering the increased mortality due to coronary artery disease in our country and the necessity to identify new risk factors, this study was performed to determine the relationship between T3 concentration and cardiovascular risk factors, in individuals, aged over 50, selected from among participants of the Tehran Glucose & Lipid Study (TLGS) population. The first phase of “Tehran Thyroid study” was performed within the framework of the TLGS with the aim of determining the prevalence of thyroid disorders in a subgroup of subjects of the TLGS. The population of the present study consists of subjects, aged over 50, selected from among the participants of the “Tehran Thyroid study”. In 250 adults, aged > 50 yrs, the level of T3 was measured and the relationship between cardiovascular risk factors and T3 concentration was investigated. This relationship was also investigated in two subgroups of these subjects, patients with “diabetes mellitus and IGT” & subjects with ECG evidence of myocardial infarction. Since all subjects had normal T3, quartiles for T3 in normal range were calculated first quartile: T3<132, second quartile: 132

Considering the higher prevalence of autoimmune thyroid disorders in iodine replete areas and implementation of an adequate and sustainable IDD control program in Iran, this study was performed to investigate and compare the prevalence of antithyroperoxidase (TPO-Ab) and antithyroglobuline (Tg-Ab) autoantibodies among a control group and patients with hypothyroidism, hyperthyroidism and simple goiter. Serum T4, T3, TSH, TPO-Ab and Tg-Ab were measured in 1019 females, 20-50 years old, with and without thyroid dysfunction (control group=130, hypothyroid=379, hyperthyroid=195, simple goiter=315). The results were analyzed using t-test, Chi-square and ANOVA statistical methods. In the control group, 67.7% were found to be negative for autoantibodies, as compared to 45.5%, 35.5%, and 17.4% of patients with simple goiter, hypothyroidism and hyperthyroidism, respectively (P= 0.000001). The difference observed in the prevalence of TPO-Ab among the 4 groups was significant (P=0.00001) and the highest prevalence was observed in hyperthyroid cases. The difference in the prevalence of TgAb and both TgAb and TPOAb between the 4 groups was not significant (P>0.05), but the means of TPOAb and TgAb in these groups differed significantly (P=0.00001). In patients with simple goiter and hypothyroidism, the prevalence of autoantibodies increased with age (P<0.0001). The higher prevalence of TPO-Ab among patients with thyroid dysfunction confirms the pathogenic role of TPO-Ab in autoimmune and non-autoimmune thyroid disorders, although the role of Tg-Ab cannot be ignored.

Because of the importance of the prediabetes state in increasing non-communicable diseases, evaluation and comparison of IFG and IGT, in terms of the non-communicable risk factors of these two conditions, can be of great help in the identification of metabolic characteristics. 4944 individuals, 30-60 yrs, were selected randomly from the TLGS population and after matching for age and sex, exclusion of known diabetics, and following ingestion of 75 gr glucose were divided into 5 groups based on FBS and OGTT isolated IFG (110 mg/dL ≤ FBS<126 mg/dL, n=79), isolated IGT (140≤ 2hpp < 200,n=435), IGT/IFG (having both IGT and IFG, n=73), new diabetes (2hpp ≥ 200 or FBS ≥ 126,n = 205) and normal (neither IFG nor IGT, n=750). Blood pressure, BMI, WHR and serum lipids were measured in all groups. Hypertension, anthropometric data (general and abdominal obesity) and high risk dyslipidemia were defined according to JNC VI,WHO and ATP III criteria respectively. We compared the mean values and prevalence of risk factors among the different groups. In the IGT group, the prevalences of hypertension, general and abdominal obesity and high serum total cholesterol (TC), triglycerides (TG) and LDL-C (38,39,73,37,44 and 32% respectively) were higher than in controls (P<0.001). The IFG group had higher prevalence of hypertension and high serum TG(40 and 35% respectively) vs controls (p=0.004 and 0.03 respectively). In the IFG/IGT group the prevalence of hypertension, general and abdominal obesity and high serum TG (48,50,75 and 48% respectively) were higher than in controls (P<0.001). There was a higher prevalence of general and abdominal obesity in IGT vs IFG (39 vs 28%,P=0.03 and 73 vs 64%,P=0.04 respectively). There was also a higher prevalence of general obesity in the IFG/IGT (50%) vs the IFG (P=0.003) or the IGT groups (P=0.04). No statistically significant difference was seen in the prevalence of high serum TC and LDL-C between the diabetes and IFG or IGT groups. The IFG/IGT group had no difference with the diabetes group in the prevalence of risk factors except high serum TG. The higher prevalence of some of the cardiovascular risk factors in IGT vs IFG could explain the difference in the cardiovascular events in these two groups. Lack of differences in the prevalence and mean values some of the cardiovascular risk factors in the prediabetes state vs overt diabetes calls for more attention to this stage for prevention of cardiovascular diseases.

We sought to compare methods currently used by physicians of the city of Yazd to treat hyperlipidemia and the standard recommended treatment of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). Methods and Materials: An observational, cross-sectional study was conducted on 146 adult patients, selected by random stratified sampling, from among patients admitted to medical diagnostic laboratories of Yazd. Inclusion criteria were: concentration of TG and Cholesterol ≥ 200mg/dL (or more) observed, following first visit to a physician. Serum of patients was collected for measuring HDL (and LDL) and a questionnaire was completed before and after treatment. The method used by these physicians was then compared to the NCEP-ATPIII recommended standard treatment. From 146 patients that participated in our study, 85 patients (58.2%) were female, 49 patients (33.6%) had DM, 11 female patients (12.9%) had had premature menopause, 9(6.2%) had a family history of early coronary disease, 8(5.5%) were smokers and 43(29.5%) had hypertension. Mean number of ischemic heart disease (I.H.D) risk factors in females were significantly less than in males (p=0.000). Mean H.D.L and cholesterol in females were significantly higher than in males (p=0.038 and p=0.031 respectively). Only 86 patients (58.9%) were treated according to recommended NCEP guidlines. Undertreatment was most common (31.5%). Patients with D.M., positive history of I.H.D, and LDL concentration over 160 mg/dL were more mismanaged. Physicians of Yazd poorly comply with NCEP-ATPIII, a problem is more noticeable in-patients at high risk for I.H.D.

It has been suggested that health professionals may consider discarding measurement of hip circumference from public health screening efforts. Before discarding the hip circumference in epidemiological surveys, it is important to consider whether any important information is likely to be lost. Here we aim to evaluate the relationship between hip circumference and metabolic risk factors in an urban adult population of Tehranian women. In a population-based cross-sectional study, a representative sample of 5720 women aged 18-74 years, participants of the Tehran Lipid and Glucose Study (TLGS), were enrolled. Demographic data was collected anthropometric indices and blood pressure were measured according to standard protocols. Hypertension was defined based on JNC VI. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as FPG≥126 mg/dL or 2hPG≥ 200 mg/dL. Lipid disorders and components of metabolic syndrome were considered based on ATP III. Mean age of women was 39.9±14.6 years. Mean BMI, WHR, waist and hip circumferences for subjects were 27.1±5.1 kg/m2, 0.83±0.08, 86.5±13.1 cm and 103.5±9.8 cm, respectively. Higher hip circumference was associated with lower levels of serum total- and LDL-cholesterol, serum triglyceride, fasting plasma glucose, 2-h plasma glucose, systolic and diastolic blood pressure. Subjects in the top quintile of hip circumference had higher values of serum HDL-cholesterol concentration compared to those in the lower category. After adjustment for potential confounding variables and anthropometric measures associated with higher hip circumference, a significant decreasing trend was observed for odds of having high LDL-cholesterol (odds ratios among quintiles: 1.00, 0.98, 0.97, 0.95, 0.84, respectively, P for trend=0.04), diabetes (1.00, 0.68, 0.58, 0.45, 0.42, P for trend= 0.01), hypertension (1.00, 0.96, 0.82, 0.78, 0.70, P for trend 0.02), low serum HDL-cholesterol (1.00, 1.03, 0.86, 0.82, 0.56, P for trend=0.04), elevated blood pressure (1.00, 0.99, 0.82, 0.70, 0.61, P for trend= 0.01) and abnormal glucose homeostasis (1.00, 0.69, 0.66, 0.54, 0.48, P for trend=0.01) among hip circumference quintile categories. Individuals in the upper quintile category of hip circumference had lower odds of having hypercholestrolemia (0.86 vs 1.00) and high serum triglyceride levels (0.74 vs 1.00) compared to those in the lowest category. Hip circumference is independently and inversely associated with metabolic risk factors. This study underscores the importance of continuation of the use of measuring hip circumference in epidemiologic surveys in Tehranian adult women.

We aimed to determine response rate and to compare respondents and non-respondents in the Tehran Lipid and Glucose study according to their health status. In a nested case-control study conducted as a part of TLGS, questionnaires of the study were filled out, during face to face interviews by participants aged 20 years and over who had refused to participate the first time they were invited their data such as demographic (age, sex, marital status, and education) and medical and /or family history of cardiovascular or ischemic heart disease, stroke, diabetes, hypertension, and dyslipidemia were compared with a control group of respondents. After the first invitation, 15010 out of 27340 individuals agreed to participate in the study (54.9% response rate). From among non-respondents, 1370 were selected randomly and compared to 9994 controls. Non-respondents were younger than respondents. 55.6% of non-respondents and 46% of respondents were in the 20-39 year-old age group (p<0.001). The majority of non respondents were male, single, employed, and had higher educational levels than respondents (p<0.001). As far as the medical and/or familial history of the diseases mentioned was concerned, the non-respondents were in a better condition than the respondents they used less drugs (p<0.001). Prevalence of smoking was higher in non-respondents than in respondents (16.1% vs 11.8%, p<0.001). The 3 foremost reasons expressed by non respondents were “I do not have time” (45.9%) “I do not need to be examined\" (15.1%), and “I am not interested” (7.7%). Although, non-respondents were more healthy than respondents, this study has shown that need for medical care is an important issue in Iranian population studies. Appropriate and effective education is needed to motivate participation in population based surveys.

Considering the supportive role of the family and positive effect of marital relations hips have on the outcome of chronic diseases, this study was conducted with three aims. 1) Comparison of the family marital relationships of diabetics and controls, 2) Assessment of any correlation between family relation and age, sex, educational level, socioeconomic status, type of diabetes, duration of disease, kind of therapy and dose of drugs. 3) Comparison of the frequency of sexual dysfunction between the groups mentioned. Data were collected from 200 subjects (100 diabetic and 100 non-diabetic), with the GRIMS Family Relationship Questionnaire. All subjects were selected from the diabetes clinic in Shahrekord, in 1382. Diabetics and controls were not statistically different in sex, socioeconomic status or educational level, but where age was concerned, family marital relationships were worse among diabetics, type I diabetes, and those using more drugs in comparison to others (P<0.05). There was no correlation in between family marital relations and age, sex, socioeconomic status, educational level, kind of therapy or duration of disease (P>0.05). Relative frequency of sexual dysfunction and rate of decreased libido were higher in diabetics (76% and 29%) than thd controls (32% and 12%) (P<0.05). Differences found in marital relationships and sexual dysfunction can be related to each other and further studies on relation between sexual dysfunction and marital relationships in diabetic patients are recommended.

The risk factors of gestational diabetes mellitus (GDM) associated have been largely derived from populations of European extraction, and there are few studies examining this issue in Iran. According the ADA recommendation the cut- off point of screening test with 50 gr glucose to 130 mg/dL has been decreased, So this study was conducted to determine of the risk factors of GDM in Iranian pregnant women of Shahrood city and comparison the value of screening test with two different cut off points (130 and 140 mg/dL). In a general screening for 1310 pregnant women referring to the Fatemiyeh Hospital, 12 risk factors were considered at the first screening. On the other in order to determine the value of the screening test without taking into account the results of the initial screening test, the OGTT was done with 100 gr oral glucose for the first 459 pregnant women. All measurements of serum glucose were performed by the glucose oxidase method at the Fatemiyeh Hospital Laboratory. According to the Logistic model, the most important of risk factors included: Glucosuria, previous macrosomia, obesity, family history of diabetes, age ≥ 30 yr and previous unknown neonate’s death. Glucosuria had the highest odds ratio (OR=41.7,CI=15.7-110.3,P<0/001) and positive predictive value (P.P.V) (63%) and the lowest odds ratio was related to age ≥ 30yr (OR=3, CI=1.8-5, P<0/001). A sensitivity of 97%, specificity of 81%, P.P.V of 27% and a negative predictive value N.P.V of 99.7% of GCT 50gr were determined with a 130 mg/dL cut off point and a sensitivity of 85%, specificity of 88%, a P.P.V of 35% and N.P.V of 99% with a 140 mg/dL cut off point. Recognized risk factors of GDM were valid for our population. Use of 130 mg/dL as a cut off point in the screening test demonstrated a higher N.P.V and sensitivity, indicating this to be a better cut off point for diagnosis of women with GDM.

Diabetes Mellitus (DM), as a metabolic disease, causes numerous effects on the vascular, ocular, renal, neuronal, gastrointestinal and other systems. In this study the effects of vitamin E (vit. E) on DM induced changes in the small intestine of rats were studied morphologically and histologically. 24 wistar male rats (average weight 250gr, average age 8 months) were randomly selected. Diabetes Mellitus was induced by STZ (60 mg/Kg, i. p.) in 16 rats. All animals were classified in to 3 groups (n=8): control or non diabetic rats, diabetic non-treated, and diabetic treated by vit. E. In treated rats, vit. E (300 mg) was added to tap water. Animals were sacrificed following deep anesthesia using Hydrate chloral (0. 5 mL/100 gr B. W, i. p) at the end of 6th week of experimental protocols. The small intestines of all rats were cut after the mesenteric layers were precisely detached from the pyloric and illeocecal sphincters. Weight and length of intestines were assessed, and then 5 cm long samples were cut from the duodenum, jejunum and the ileum. Each sample was filled with 10% formalin buffer and after ligature of their two ends they were kept in 10% formalin buffer. The samples were histologically studied for villi length, crypt depth and muscular thickness. The results showed that intestinal length and weight, villi length, crypts depth and muscular thickness were increased in comparison with the control, non diabetic rats significantly. In the rats treated with vit.E, there were no differences in the mentioned items, in comparison with the control group. The results of this study demonstrate that vit. E as an antioxidant with decreasing effects on free radicals and oxidative stress, attenuates or prevents certain diabetic disorders.

In this study, the regulatory role of the ventromedial nucleus (VMN) of the hypothalamus on pituitary gland secretion, was studied. We investigated the influence of D2 receptors of the VMN on serum levels of sex hormones and prolactin. 35 adult male rats, weighing between 280-320g, were selected and cannulae were implanted bilaterally into the VMN. After the recovery period, rats were divided into 5 groups: sul (injected 8g sulpiride), sham-s (injected vehicle), Bromo (injected 25 g bromocriptin), sham b-operated (injected vehicle), S+B (injected sulpiride Bromcriptine). The drugs were injected daily into the VMN (0.5l/min) for 7 days, 0.5 hours after the last injection, the animals were decapitated and blood samples were collected. Serum levels of sex hormone and prolactin were measured by RIA method. The results of this study indicate that sulpiride and (or) Bromocriptine cannot change the serum level of prolactin, testosterone and estradiol but sulpiride increases serum level of progesterone and decreases the estradiol progesterone ratio, Bromocriptin showed the reverse effects. We conclude that D2 receptors of VMN have a role in the regulation of sex hormone secretion.

There is much evidence indicating that glucocorticoids receptors are highly involved in emotional learning and memory storage in many areas of the brain. The aim of the present study was to assess the role of glucocorticoid agonists and antagonists on the orbitofrontal cortex (OFC) in spatial memory processes (Acquisition, Consolidation and Retrieval) of the place avoidance learning task. Long-Evans strain rats, weighting 280-320 gr, (n=100, in 10 groups) were surgically implanted bilaterally with cannulae aimed at the OFC and were trained to avoid entrance to a 60 degree segment of the arena entering this was punished by mild footshock. The forbidden sector was defined by room cues during rotation in the light and by floor cues in the dark. Place avoidance training occurred in a single 30-min session and avoidance memory was assessed during a 30-min extinction trials, 24 hours later. The time of the first entrance and the number of entrances into the punished sector during extinction were used to measure the place avoidance memory. Bilateral injections of Dexamethasone (0.1μg/0.6 μl/side) as a glucocorticoid agonist and RU38486 (3ng/0.6 μl/side) as a glucocorticoid antagonist were injected to the OFC 5 min before acquisition, immediately, 60 and 120 min after training and 5 min before retrieval test. Control groups simultaneously received just the vehicle of the same volume, that was injected to the other groups. The results indicated that acquisition, consolidation and retrieval of spatial memory were not impaired (P>0.05). The findings above showed that the glucocorticoid receptors in OFC do not have an important role in modulation and storage of spatial memory related to emotional events in place avoidance learning tasks.

Bardet- Biedl syndrome is a rare autosomal recessive trait with retinitis pigmentosa, hypogonadism of various etiologies, polydactyly, obesity, learning difficulties and renal defects. We describe here the case of a 38 year old girl with Bardet – BiedL syndrome, diagnosed during adolescense according to retinitis pigmentosa, polydactyly, hypogonadism, obesity and learning difficulties. Three years ago, she presented with hypertension and renal failure. At imaging study, kidneys were enlarged with innumerable cysts scattered diffusely throughout renal cortex and medulla. The patient received conservative therapy until one year ago when she was referred to our hospital for kidney transplantion. She received preemptive renal allograft and was prescribed a triple immunosuppresive regimen. The course of the operation was complicated with wound infection and Guillain Barre syndrome. The patient was discharged in a good condition with normal kidney function. At our center, a Bardet- BiedLe patient with renal failure and cystic kidney disease successfully received a renal allograf.