مجله غدد درون ریز و متابولیسم ایران
سال دهم شماره 1 (پیاپی 37، اردیبهشت 1387)

The aim of this study was to examine in the lipid profile during 3.6 years and anthropometric parameters in Iranian adults the changes during 3.6 year body mass index (BMI). Among participants of the Tehran lipid and glucose study (TLGS), 2940 non-diabetic adults, aged 20 years and older, who remained within the same BMI group during the two phases of the survey and were not taking lipid lowering drugs were investigated. We used ANCOVA and the repeated measures test for delineating short time trends in mean levels and ratios of serum lipids as well as anthropometric parameters across BMI groups (WHO classification). In all BMI groups the anthropometric indices of central and general obesity increased and total cholesterol (TC) (p<0.05) and high density lipoprotein cholesterol (HDL-C) (p<0.001) levels decreased in both genders. Among men, the greatest decline in total cholesterol levels was observed in obese persons (7%), whereas the greatest decline in HDL-C levels was observed in normal-weight persons (9%). A significant increase in TC/HDL was observed only in men, whereas among the normal-weight sub-group, TC/HDL increased both in men (9%) and women (6%). Despite increases in general and abdominal obesity parameters, we observed favorable trends in total cholesterol levels. However declines in HDL cholesterol levels, and resulting increases in TC/HDL, particularly among normal-weight persons, could serve as a warning for increased risk of ischemic heart disease.

Several studies suggest that CRP plays a role in the pathogenesis of diabetes in adults. We tested the hypothesis that elevated levels of CRP at baseline can predict later onset of type 2 diabetes mellitus. In a nested case-control study, serum level of CRP was measured from stored samples of 73 control and 80 cases from among participants of the Tehran Lipid Glucose Study, who had been followed for 3.6 years. In age adjusted model, levels of CRP were associated with an increased risk of type2 diabetes, OR 3/6 (95%CI: 1.5 – 8.2) for tertile 3 versus 1, p.001. However in multivariate analysis the association between CRP and type 2 diabetes was significantly decreased after adjustment for fasting plasma glucose, body mass index, family history of diabetes, HOMA-IR, OR. 8 (95%CI:0.2 – 2.8) for tertile 3 versus 1, p 0.7. Elevated levels of CRP were associated with an increased risk of type 2 diabetes however, the association was not independent of other diabetes risk factors, including fasting plasma glucose, body mass index, HOMA-IR and family history of diabetes.

Current evidence suggests that stressful experiences may affect both onset and exacerbation of type 1 or type 2 diabetes. The aim of this study was to assess the relation between the number of stressful life events and prevalence of glucose metabolism disorders (IGT, Diabetes) In this cross sectional study, 35-55 year old first degree relatives of type 2 diabetics without history of diabetes were included. Questionaires of stressful life events, physical activity and basic chacteristics were completed. Waist and hip circumference was also measured and OGTT was performed in all patients. Of 477 participants, 288, 146 and 43 were normal, IGT and diabetics respectively the mean number of stressful events for these groups was 3.15,3.55,3.91 (P=0.016), respectively. The prevalence of glucose metabolism disorders was 26.8 in those who reported no stress and 41.5% in participants with stressful events (p=0.03). The prevalence of diabetes was 25.6% vs. 3.2% in subjects with 8 or more stressful events in comparison to subjects with less than 8 stressful events. Considering the probable contribution of stress in the development of diabetes, it is suggested to evaluate the relationship between stress and diabetes as well as the role of education on coping with stress in diabetes prevention, specially in high risk groups, in a more precise manner.

Iron excess disturbs the antioxidant system through pro-oxidants mechanisms. In this study, oxidative stress indices were compared between iron deficient and healthy subjects and effects of iron supplementation with and/or without ascorbic acid on performance of the antioxidant defense system, levels of oxidative stress and iron status in iron deficient female students were determined. In this double-blind randomized clinical trial, 60 NAID and 30 normal students (control) were selected from 289 female students at the dormitory of Shaheed Beheshti University (MC), Tehran. Hemoglobin and serum ferritin concentrations were measured by cell counter and ELISA, respectively. After matching, NAIDM students were randomly assigned into the intervention group receiving 50 mg/d elemental iron supplements without (group I) and/or with (group II) 500 mg/d ascorbic acid for 12 weeks. Serum malondialdehyde (MDA), Total Antioxidant Capacity (TAC) and serum ascorbic acid were measured at the beginning and the end of the 6th and 12th weeks in the groups studied. Student's t and repeated measurements tests were employed to analyze the data using SPSS software. Mean TAC in group III was significantly higher in NAID subjects at the beginning of the study (3.87±0.47 vs 3.4±0.41 mmol/mL p<0.001). At the end, serum TAC significantly increased in supplemented subjects, not only compared to the baseline values (within group), but also in comparison with controls (between groups) (5.1±.3 vs 4.7±0.04 mmol/mL p<0.001). In contrast, serum MDA concentrations decreased from 1.7±0.14 to 1.1±0.09 nmol/mL (p<0.001) and from 1.9±0.18 to 1.7±0.15 nmol/mL (p<0.001) in groups I and II, respectively, after 6 weeks of supplementation. Serum MDA concentration however increased to 1.7±0.15 nmol/mL at the 12th week (p<0.001) although the same results were seen in group II, but the mean MDA concentration was significantly less than the value at the beginning (1.4±0.1 vs 1.9±0.18 nmol/mL p<0.03). It seems that the status of the anti-oxidant defense systems significantly improves among NAID young female subjects within the first few weeks after iron supplementation especially with ascorbic acid, an approach recommended for more efficient control of iron deficiency.

Thalassemia major is a genetic disorder, in which blood transfusion is critical for the survival of patients. Over the course of the past two and three decades, hypertransfusion therapy in these patients has significantly increased life expectancy and quality of life. Unfortunately however this type of therapy has also increased the frequency of complications due to iron overload. Today endocrine abnormalities are far more common than before in beta-thalassemia patients. The aim of this study was to evaluate the prevalence of endocrine disturbances in patients with thalassemia major, aged over 10 years. Fifty-six patients, aged over 10 years, with thalassemia major were enrolled. Physicians collected demographic data and history of therapies as well as menstrual history in females. Patients were examined to determine their pubertal status and SDS of height for evaluation of short stature. For evaluation of glucose tolerance, fasting blood glucose and oral glucose tolerance tests were performed. Serum levels of calcium, phosphorous, thyroid stimulating hormone, free thyroxin, luteinizing hormone, and follicular stimulating hormone, estradiol in girls and testosterone in boys were measured. Fifty-six patients 10 to 27 years with thalassemia major old were evaluated. In this study, the prevalences of diabetes mellitus, impaired fasting glucose and impaired glucose tolerance test were 8.9%, 28.6% and 7.1% respectively. Short stature (SDS ≤ -2) was seen in 70% of boys and 73% of girls hypocalcaemia and primary overt hypothyroidism were present in 41% and 16% respectively 14.3% did not have any endocrine abnormalities. Despite recent therapy with Desferal in the management of beta-thalassemia major, the risk of secondary endocrine dysfunction remains high, with hypogonadism being one of the most frequent endocrine complications. Endocrine evaluation in patients with thalassemia major must be carried out regularly especially in those patients over the age of 10 years in Tabriz.

There are different prognostic factors in thyroid neoplasms. Cox2 is an enzyme which plays a role in the synthesis of prostaglandin. Increased expression of Cox2 has been reported in different kinds of cancers such as colorectal, stomach, lung, prostate, breast & thyroid. Thyroid malignancies are among the common malignancies of the endocrine system, and various molecular studies are being performed to determine their pathogenesis. To study the prevalence of Cox2 in malignant & benign neoplasms of the thyroid and its relationship with other clinical and pathological factors, we analyzed 200 paraffin blocks including 137 thyroid papillary carcinoma, 10 thyroid follicular carcinoma, 17 thyroid medullary carcinoma, 2 anaplastic cases, 27 thyroid follicular adenoma, 7 thyroid Hurthle cell adenoma using the immiunohistochemistry method for the Cox2 enzyme marker. Positive results obtained for cases Cox2 were 38.7% thyroid papillary carcinoma, 20% follicular carcinoma, 29.6% medullary carcinoma, 25.9% follicular adenoma, 28.5% hurthle cell adenoma. Statistical analysis showed no significant difference among various groups of thyroid neoplasms and expression of Cox2. Also, no relationship between vascular, lymphatic and capsule invasion and expression of Cox2 in malignant & benign neoplasms of the thyroid was found. It appears that Cox2 is not a suitable marker to distinguish between different types of thyroid neoplasm.

Opiates such as morphine administration, decrease serum level of pituitary–gonadal axis hormones in both sexes. On the other hand, morphine can be transferred from the mother the fetus and neonate via the placenta and milk. Thus maternal exposure to morphine during pregnancy and weaning may affect serum level of pituitary–gonadal axis hormones in off springs. Focus on the effect of the addiction of the pregnant mother on the health of the fetus and neonate has led to under recognition of possible male mediated effects. In this study, the effect of morphine addiction of the parents on the reproduction rate and pituitary gonadal axis hormone profile have been investigated. Forty female and 16 male albino Wistar rats (120-140 days old) were enrolled into the study. Animals were addicted by oral administration of incremental dose of morphine in drinking water for 21 days. Then male rats were placed with females in 6 groups: 1- male addict =test, 2-female addict=test 2, 3- male and female addict = test 3, and sham 1, sham2 and the control group. Morphine administration was also continued during pregnancy and weaning as well. At the time of puberty, blood samples were collected from the off springs and pituitary–gonadal axis hormones were measured. Morphine was in dissolved 3% sucrose and added into the drinking water of groups 1-3. The same amount of sucrose was added into the drinking water of the two sham groups. In female offspring of group1 (test 1) LH (0.086±0.04Iu/L) and 17β estradiol (93.2±5.92ng/L) were significantly reduced compared to the control values of 0.19±0.03 and 182.4±11.21 respectively. But no pituitary–gonodal axis hormones alteration occurred in male offspring of this group and offspring of group 2. There were no pregnancies in group 3. The results suggest that the female maternal morphine addiction disturb reproduction processes more them does male addiction.

Gamma-amino butyric acid (GABA), an amino acid, present in some inhibitory neurons of the central nervous system, is also found in relatively high levels in the islets of Langerhans. Results of different studies concerning the effect of GABA on insulin secretion are controversial. The aim of this study was to determine the role of GABA and GABAB receptors on glucose-stimulated insulin secretion in isolated islets of rats. The collagenase digestion technique was used to isolate the islets from pancreata of 45 male Wistar rats (200-250g). Insulin secretion was assessed in eight islets in each cup exposed to different concentrations of glucose (8.3 and 16.7 mM) in the presence or absence of GABA(25, 50, 100 µM), baclofen (10, 20, 50 µM) (GABAB agonist) and saclofen (50,100 µM) (GABAB antagonist). Insulin concentration was measured by the ELISA method. Insulin release was reported as mean±SEM U/islet/50min and p values of <0.05 were considered significant. GABA inhibited glucose (8.3 and 16.7 mM)-induced insulin secretion in isolated islets (P<0.05). Different concentrations of baclofen had no significant effect on glucose-induced insulin secretion however glucose (16.7mM) stimulated insulin secretion in the presence of 100 µM saclofen (91±8.8 µU/islet/60min) was significantly (p<0.05) higher compared to insulin secretion stimulated by 16.7mM glucose alone (67.7±2.58 µU/islet/60min). These findings indicate that GABA has an inhibitory effect on glucose-induced insulin secretion and therefore it may play a regulatory role in insulin secretion. This effect needs to be taken in to account in the pathophysiology of diabetes.

The purpose of this study was to determine and to assess the protective effect of vitamin E on cardiomyocyte apoptosis and oxidative stress status in the heart under hyperglycemic conditions, in vivo. Materias and Wistar male rats (n=16) at 6 months of age were made hyperglycemic by STZ. Same age, normal wistar rats (n=8) were used for comparison (controls). Diabetic rats were divided into two groups, the nontreated and those treated with vitamin E (300mg/kg/daily). Diabetic rats exhibited severe apoptosis in cardiomyocytes. Also significant increases in lipid peroxidation as measured by 8- isoprostan, protein oxidation as measured by protein carbonyl content and superoxide dismutase were observed after 6 weeks. Catalase activity was shown to increase in controls compared to nontreated rats. A distinct elevation in the HbA1C, QT interval and a decline in the activity of catalase were also observed. Vitamin E treated rats shown significant decline in apoptosis, lipid peroxidation, protein carbonyl and QT interval compared to nontreated rats. Vitamin E decreased the incidence of apoptosis in cardiomyocytes, lipid peroxidation and improve antioxidant enzyme in the diabetic hearts of rats. Further research to confirm the findings is recommended.

Primary amenorrhea is one of the most important complaint of women in reproductive age. To determine the causes responsible for primary amenorrhea this study was performed on the basis of clinical, sonography and laboratories investigations. This case series study was performed at Ayat –allah Taleghani teaching hospital during the years of 2003-5. Data were collected from the patients who attended or referred to the clinics of gynecology or endocrinology wards since 10 years ago. 53 cases were evaluated.Mean age of the patients was 26.82±7.24 years when they were visited at the clinics. The most common cause of primary infertility was mullerian dysgenesis (n=19) according to clinical, sonography and laboratories investigations. Hypogonadotropic hypogonadism and congenital adrenal hyperplasia were seen in 12 and 8 patients, respectively. 5 patients had gonadal dysgenesis. This study suggest that registration of patients with primary amenorrhea in research center, can be beneficial for diagnosis and intervention.