مجله غدد درون ریز و متابولیسم ایران
سال پنجم شماره 1 (پیاپی 17، بهار 1382)

Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. Since the proportion of elderly individuals in the population is on the rise, this study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban elderly population. Materal and Among 15005 urban individuals, 3 years old and over, who have been chosen in cross-sectional phase of a longitudinal study in Tehran, there were 1799 people aged 60 years and over. The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity were determined in this population. Dietary intake was assessed in a subsidiary of 54 persons by means of a two 24-hour dietary recall questionnaire. The percentage of women with two or more CVD risk factors was significantly greater than those of men (74% vs 53%, p<0.001). One-forth of men and 55% of women had high serum cholesterol levels (240 mg/dl). Prevalence of diabetes mellitus and IGT was 26.2% and 20.8%, respectively. The prevalence of obesity (BMI30 kg/m2) was 15% for men and 36% for women. 55% of men and 94% of women had high levels of WHR (>0.95 in males and >0.8 in females). The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 60.5±8.0, 11.5±2.0, and 27.9±8.9, respectively. The prevalence of cardiovascular risk factors among Tehran urban elderly population is high. An effective strategy for life style modification is recommended for population approach to the cardiovascular risk factors in Tehran.

There is strong evidence to indicate that release of glucocorticoids from adrenal glands in emotional states modulates memory storage. The glucocorticoid receptor in the hippocampus may be a target of glucocorticoids in the modulation of memory processing. The aim of this study is to examine the role of the dorsal hippocampus (DH) glucocorticoid receptors on spatial memory in Morris Water Maze task. Male Long-Evans strain rats, weighing between 280 - 320 grams were surgically implanted bilaterally with cannulae aimed at the DH and were a week later trained in the Morris Water Maze task. The latency time to the fine plexiglass platform and the length of distances were used to measure spatial memory. Dexamethasone (0.1μg/0.6μL per side) as a glucocorticoid agonist and RU38486 (3 ng/0.6μL per side) as a glucocorticoid antagonist were injected bilaterally into DH immediately, and 60 and 120 min after training. Results indicated that infusion of the glucocorticoid agonist and antagonist immediately and 60 min, but not 120 min after training, into the DH significantly enhanced and impaired retention performance, respectively. The above results show that glucocorticoid receptor plays an important role in consolidation of spatial memory in the Morris Water Maze task for at least 60 min after training.

A bilateral relationship between GABA, an inhibitory neurotransmitter in the CNS, and hormones that regulate blood glucose has been reported. There are some reports that GABA via increasing Insulin plasma and decreasing Glucagon and somatostatine cause a decrease in blood glucose levels. To investigate the role of muscimol (GABA-A receptor Agonist) in this experimental study, male Albino mice (20-30 gram) were used. To measure blood glucose at specified intervals, serial blood collection from each animal was done by retro-orbital sinus puncture and glucose concentration was measured using -toluidin by spectrophotometer. For IP and ICV injections of muscimol 10 groups of mice were selected (5 for IP, 5 for ICV). Each of these groups received a different dose of muscimol. Immediately after every injection of musimol, a blood sample was taken, and this procedure was repeated every 30 minutes for 180 minutes. One-way ANOVA and Post Hoc were used to compare the results. The results indicated that intraperitoneal (IP) injection of 1,2,4 mg/kg doses of muscimol not only did not reduce blood glucose in the experimental group but with increase of the muscimol dose up to 6 mg/kg significantly increased blood glucose. The results however, also indicate that ICV injection of muscimol significantly reduces the blood glucose concentration (p<0.05). On the whole, it seems that in ICV injection, it is muscimol itself that affects blood glucose, while in IP injection it is metabolized, the metabolites resulting in the increased blood glucose. In other words effects of IP and ICV injection of muscimol differ. Since the effects of GABA-A receptors on blood glucose concentration are a complex phenomenon, further research seems vital.

Paraoxonase (an HDL-associated enzyme) is believed to protect lipoproteins against peroxidation. Patients with end stage renal failure on hemodialysis are exposed to oxidative stress. In this study we investigated the status of paraoxonase activity, TAC and oxidized LDL in a population of diabetic and non-diabetic ESRD patients. The study population consisted of 46 patients with diabetes and 46 non diabetics and 46 control participants. Patients were selected from hemodialysis centers of Shaheed Beheshti University of Medical Sciences. Individuals with thyroid dysfunction, Cerebrovascular accident, recent coronary event, recent hospitalization or under treatment with lipid-lowering agents were excluded. A fasting predialysis sample was obtained. Paraoxonase activity was measured by spectrophotometer, measuring P-nitrophenol paraoxon after adding paraoxon to the sera and TAC by adding 20µL serum to PBS (80µmol/L, PH=7.4) and 6.1 µmol/L metmyoglobin and ABTS (as a chromogen and substrate) and hydrogen peroxide as a substrate. The decrease in blue-green color was measured by Elisa reader. 46 diabetic patients, 26 men and 20 women, aged 61.8±10 and 46 non diabetic ESRD patients, 25 men and 21 women, aged 61.5±9.9, and 46 healthy controls, 24 men and 22 women, aged 60.8±10.0 were studied. Significant reduction in serum paraoxonase activity in non diabetic ESRD and diabetic patients compared with control group was present (47.2±32.2 VS 9.5±48.6 VS 86.4±62.5 IU/mL, respectively). While these groups showed no significant change in oxidized LDL and TAC. Paraoxonase activity was significantly lower in non diabetic ESRD patients than diabetics. It has been shown that there is enhanced oxidative stress in patients with diabetes mellitus and chronic renal failure. Reduction in paraoxonase activity may have a role in this process.

In this study, we aimed at investigating the clinical picture, some biomedical tests, imaging studies and pathological findings, of patients with pheochromocytoma. The case histories of 60 patients with pheochromocytoma were reviewed to determine the clinical history, pathological and anatomical data, biochemical profile that led to the diagnosis of the disease and the method of localization of tumors. Paroxysmal hypertension was present in 98% of our patients and palpitation was present in 43% of our patients. Headache and perspiration were found in 71% and 68% of affected individuals respectively. We found the Vanillylmandelic acid test (biochemical test) and CT scan (imaging technique) to be sensitive tests for the diagnosis and localization of pheochromocytoma. However, MIBG (Meta-iodobenzylguanidine) had lower sensitivity in our series. When determination of VMA (Vanillylmandelic acid) was coupled to 24-hours urine norepinephrine, the diagnosis of pheochromocytoma can be made with high sensitivity. Clinical features seen in the patients in our study differed in some respects from those of some other reviews. Paroxysmal hypertension was much more common and palpitation was much less prevalent than other studies. Determination of VMA coupled to 24-hours urine norepinephrine may present an alternative to the 24-hour urine metanephrine measurement.

Recurrent spontaneous abortion (RSA) is a major problem in obstetrics and gynecology. Since today endocrinopathy is known to play a role in RSA, this prospective comparative study was conducted to determine endocrinologic abnormalities occurring during the follicular phase in women with RSA.

This study was conducted in Mirza Kochak Khan Hospital on a total of 108 women, 54 of who had RSA (study group) without any parental chromosomal rearrangement and 54 infertile women (control group) with tubal or male factor infertility without any history of abortion. The two groups were compared for concentration of hormones during their early follicular phases.

The means and standard deviations of ages were 27.55.1 in study and 28.15.6 in control groups without any significant difference. In the study group the mean serum prolactin was significantly higher than the control group (15.67.1 vs 123.9, p=0.002). The mean serum androstenedione in study and control groups were 1.90.7 and 1.30.4 respectively (P<0.001). Mean serum LH was 63.3 and 4.42 respectively (p=0.003). No significant differences between the two groups regarding means of FSH, TSH, Progesterone, 17-OH- progesterone, testosterone and estradiol were observed. In the study group the mean of BMI was significantly higher than in the control group (25.52.9 vs 22.61.7, p<0.001).

Recurrent spontaneous abortion is related to increased secretion of LH, prolactin and androstenedione in the follicular phase and BMI.

Calcium and vitamin D play major roles in calcium homeostasis and skeletal development, especially during pregnancy. This study was conducted to determine serum constituents related to calcium metabolism of pregnant women as compared to non-pregnant ones. In a cross sectional study, 48 pregnant women from 5 prenatal care centers, and 66 non-pregnant women randomly selected from the Tehran Lipid and Glucose Study population were enrolled in the study. A questionnaire was used to obtain demographic information for both groups. Venous blood samples were taken to measure serum calcium, phosphorus, magnesium, alkaline phosphatase, albumin, parathyroid hormones, 25-OH vitamin D and serum osteocalcin levels. The repeated measure procedure and Dunnett test were used for statistical analysis. Data were adjusted for age in both case and control groups. Significant differences were found in the mean serum levels of albumin, osteocalcin and alkaline phosphatase between three trimesters of pregnancy (P<0.001). These differences were also significant in comparison to the control group. The mean values of albumin were 4.8±0.3, 4.3±0.3, 4.4±0.4, and 5.0±2 in the first, second and third trimesters and the control group respectively. These values for osteocalcin were 12.7±8.5, 8.1±6.7, 5.6±5.0 and 15.3±9.4 respectively and those for alkaline phosphatase were 115±38, 125±37, 174±61 and 137±42 respectively. In the first trimester alkaline phosphatase and 25-OH vitamin D decreased and albumin, parathyroid hormone and osteocalcin increased. In the first trimester 20% and 40% had vitamin D<10 ng/ml and <20 ng/ml respectively. Significant changes in albumin, parathyroid hormone, osteocalcin and alkaline phosphatase are observed in pregnant women throughout pregnancy. Vitamin D decreases in the first trimester and 20% have vitamin D deficiency.

Adrenocortical tumors (ACT) are rare in children and few reports regarding this can be found in Iranian Medical literature. In this paper we present the clinical and laboratory data of 6 children with ACT who were referred either to the office of one of the authors (MSG), or to the Department of Endocrinology at Taleghani General Hospital and underwent operations there. In order to shed lighter on the secretory behavior of the tumors, a blood sample was drawn during surgery from the adrenal vein of the affected site and the hormonal values were compared with the constituents of samples drawn simultaneously from the peripheral vein. Patients were 2 boys and 4 girls. 5 patients presented with virilizing manifestations including hirsutism, acne, muscle growth, clitoromegaly or increased penile size. One patient presented with acute psychosis and massive gynecomastia. 3 patients had been diagnosed as cases of congenital adrenal hyperplasia (CAH) and were under treatment with corticosteroids. In 3 patients despite hypercortisolism having been proved, the patients didn’t have any symptoms or signs of Cushing’s syndrome. Serum testosterone and Dehydroepiandrosterone Sulfate (DHEA-S) were 276-695 ng/dl and 256-1790 μg/dl respectively in those who presented with virilization. In 3 patients with hypercortisolism, levels of 24-hour urinary free cortisol after dexamethasone were 31-154 μg. Hormonal evaluation of the adrenal vein revealed that testosterone, DHEA-S, estradiol, 17 OH progesterone and cortisol were directly released from the tumor and peripheral interconversion had a limited, if any role in the serum level of steroids. Ultrasound and CT Scan easily demonstrated tumors in the affected adrenal gland. Surgery was uneventful in all cases. The tumors weighed 36-103 gram. During the follow-up period, which was 3 months to 11 years (mean 5 years), no relapse was found. According to the results, ACT should be kept in mind in the differential diagnosis of all children and adolescents presenting with isosexual or heterosexual precocious puberty. Surgery is the treatment of choice and tumors weighing 100 gr or less have a favorable prognosis.