International Journal of Endocrinology and Metabolism
Volume:6 Issue: 3, Sep 2008

Patients with IGT have increased risk of developing DM type II and non-communicable diseases in the future. The aim of this study was to determine the features of patients with IGT in Tehran and the cor-relation of IGT with other variables and risk factors of non communicable diseases. This study was a descriptive analytical and cross–sectional one, in which 960 of 9204 persons, participants of the first phase of Te-hran Lipid and Glucose Study (TLGS) were found to have IGT in the initial assessment; eight weeks later, a second OGTT was done, and 331 had IGT. DM and IGT diagnosis were based on WHO crite-ria; in this group, anthropometric indices, BP, serum glucose, and lipid level were assessed after 12 hours of fasting. Obesity was defined as BMI≥30 kg/m2 and over weight as BMI between 25 and 29.9 kg/m2. WHR over 0.8 in females and 0.95 in males were de-fined as truncal obesity. Hypertension was defined as SBP≥140 or DBP≥90 mmHg or taking anti hyper-tensive drugs. Statistical analyses were performed using independent T-test, and ANOVA. Totally 331 patients with IGT were studied, of whom 232 (70%) were female and 99 (30%) were male. In 43% of cases, BMI was ≥30. WHR was ab-normal in 83.7%; total cholesterol level in 32% was ≥240 mg/dL, LDL in 28.1% was ≥130 mg/dL and ≥ 160 g/dL in 24.8%; HDL in 32.9% of cases was <35 mg/dL. In 43.2% of cases, TG was ≥200 mg/dL. As-sessment of parameters according to BMI showed that mean cholesterol and triglyceride levels in obese patients were higher than the rest (p<0.05, p<0.001) and mean HDL cholesterol in obese pa-tients was lower (p<0.014). Exercise tolerance test (ETT) was performed in 199 patients, and was posi-tive in 14% . According to the results of this study, patients with IGT have a high risk of cardiovascular events because of multiple risk factors such as obe-sity, hypertension, smoking, and hyper lipidemia.

he search for discovery of new methods and medications for management of thyroid disorders has continued during the last few years, in the third millennium. New developments have been made both in the management of incurable disorders such as metastatic medullar thyroid carcinoma, and in the domain of conditions where endocrinologists have had difficulty in proper management strategies, such as Graves’ ophthlmapathy. Thyroid cancer is increasing at a rate more rapid than that of any solid tumor, and many of the genetic mutations or chromosomal translocations that cause papillary, follicular, or modularly thyroid carcinoma have been identified, thus providing new insights into tumor pathogenesis, diagnosis and treatment. The development of a medication in the management of metastatic medularly carcinoma is promising. It has been shown that Vandetanib decreases tumor size in some and prevents the progression of disease in other patients with metastatic medullary carcinoma.1 The disease control rate is 90% and this drug has demonstrated encouraging antitumor activity in patients with metastatic medullary cancer. Promising results have also been reported for the use of fluoropyrimidine carbamate (capecitabine) in the treatment of medullary thyroid and radioiodine-resistant differentiated thyroid carcinomas.2,3 This drug is converted to 5- fluoracil by thymidne phosphate inside targeted tissues.2Clinical management of benign thyroid nodules has been a dilemma for endocrinolo-gists. Although it has been recommended that nodules with negative FNA should not receive suppressive treatment, this approach is not acceptable for many patients who desire at least a decrease in the size of their thyroid nodules. Therefore, investigators have adapted modalities for reduction of nodule diameter, such as alcohol injection in the nodule, laser therapy4 and recently perc-utaneous radiofrequency thermal ablation of thyroid nodules. The latter method induces stable thyroid nodule shrinkage and may prevent further increase in the size of the nodule. This method is also effective in reducing volume of large hyperfunctioning thyroid nodules...

Birth denotes a sharp transition from constant placental nutrient delivery to independent regu-lation of energy intake and expenditure. Adipo-nectin, ghrelin, insulin and leptin are key hor-mones regulating appetite and energy homeosta-sis and could therefore be crucial components of postnatal adaptation. We studied the changes and relationships in these hormones and their correlation to clinical variables during adaptation to extrauterine life. Plasma venous adipo-nectin, ghrelin, insulin and leptin concentrations were measured at birth and controlled during early postnatal days (59.4+15.4 [SD] h, range 36-93 h) for 38 healthy newborn infants [(20 male, 18 female), gestational age 40.2+0.9 wk (mean+SD), range 37.9 to 42.1 wk] born from uncomplicated pregnancies. Median adiponectin concentration at birth was at 25. 1 µg/mL (interquartile range 20. 0–29. 1 µg/mL) and during early postnatal days 17. 8 µg/mL (10.7-23.3; 95% CI of difference 26 to 46%). Median ghrelin concentration in cord plasma was 651 pg/mL (539-830) which during early postnatal days had decreased to 537 pg/mL (476-723; 95% CI 6 to 23%). At birth, median in-sulin concentration was 7.35 mU/L (6.53-9.43) and, during early postnatal days age, this was 4.35 mU/L (3.43-6.03; 95% CI 33 to 53%). At birth, median leptin concentration was 4.60 µg/L (3.51-5.84) and during early postnatal days was 0. 83 µg/L, (0. 65-1. 06; 95% CI 78 to 85%). At birth no correlation between hormone concentrations and gestational age or birth weight existed. During early postnatal days, adiponectin was positively (r=0. 49) correlated with ghrelin concentrations. In healthy term infants, the change from fetal to extrauterine life is accompanied by a decrease in circulating adiponectin, ghrelin, in-sulin and leptin suggesting distinct roles of these hormones in postnatal adaptation.

Cytological radiation damage to lymphocytes can result in augmentation of cells with micro-nuclei. In this study we investigated cytological radiation damage to peripheral blood lympho-cytes using the the micronuclei assay (MNA) me-thod, considering the value of 131I in diagnostic and therapeutic nuclear medicine and high ab-sorbed dose of 131I radioiodine in comparison with gamma emitters and the effect of type of radiation, dose and species on radiosensitivity of patient. At present no similar investigation from Iran has been reported evaluating the cytological radiotoxicity of therapeutic radiotracers such as 131I. We studied 22 patients with differential thyroid carcinoma referred for treatment with 100 or 150 mci 131I. Peripheral lymphocytes were harvested and isolated by a cytological method and assayed for frequency of micronuclei as a marker of cytological radiotox-icity before and one week after treatment. The means for micronuclei per one hundred binuclear lymphocytes were 6. 3±2.2 be-fore treatment and 9. 6±3.1 after treatment. These differences in the number of micronuclei was statistically significant (p<0. 05). High doses of radioiodine therapy used after surgery in differentiated thyroid car-cinoma can increase micronuclei among peri-pheral lymphocytes as an indirect marker of chromosomal aberrations and cytotoxic radiation damage.

Macroprolactinemia may account for a signifi-cant number of hyperprolactinemic sera includ-ing hyperandrogenemic women and this may lead to unnecessary diagnostic and therapeutic procedures and false exclusion of PCOS. The aim of this study was to evaluate macroprolactinemia in women with hyperandrogenemic symptoms and hyperprola-ctinemia. In a series of 200 hyper-androgenemic women aged 14-40 year, present-ing to the endocrine clinic of Ghaem Hospital between 2004-2006, serum prolactin was meas-ured. Those with hyperprolactinemia (prolactin >35μg/L), were studied for the presence of ma-croprolactinemia using the by polyethylenegly-col precipitation test (PEG). Mean age of hyperandrogenic women was 24.0±5.6 years; 38 (19%) of the patients had serum prolactin >30 µg/L and in 9 of them the rise was >35 µg/L. Macroprolactinemia was de-tected in 5 of those with serum prolactin >35 µg/L who also carried the diagnosis of PCOS. In the remaining 4 patients there was true hyper-prolactinemia and prolactin remained elevated after PEG precipitation test (52±10, vs 48±9 µg/L, respectively). It is necessary to rule out macropr-olactinemia in women presenting with hyperan-drogenemic symptoms and hyperprolactinemia to prevent false exclusion of PCOS. This may help to avoid expensive and unnecessary diag-nostic procedures and inappropriate use of do-paminergic agonists.

Disturbances of thyroid hormones metabolism and morphology are common in ESRD (End Stage Renal Disease) but data available shows discrepancies re-garding the post transplantation status of kidney re-cipients . The aim of this study was to assess thyroid function and morphology after kidney transplanta-tion surgery. Thirty-two kidney recepient patients, without previous history of thyroid disor-ders, were enrolled. Serum levels of creatinine TT3, TT4, RT3U, TSH and thyroid staging were obtained and echogenicity were determined by ultrasonogra-phy one week before and 1, 3 and 6 months after kidney transplant surgery. Thirty-two patients (22 males, 10 females) with mean±SD of age 38.2±12.6 years were evalu-ated. TT3, TT4 and RT3U levels significantly in-creased by improvement of graft function (p< 0.05) but in 7 patients with delayed graft function those values remained at lower levels. No cases with hy-perthyroidism or hypothyroidism were detected. Thyroid volume decreased and echogenicity in-creased after transplantation (p<0.05). Six patients had thyroid nodules and cysts before surgery and 2 new cysts were detected after surgery. There was no relationship between age, sex, type and duration of dialysis and thyroid function after transplantation. This study reveals a clear correlation be-tween thyroid function and morphology (volume and echogenicity) and improvement of kidney func-tion after transplantation; long-term follow-up is however required for evaluation of occurrence of thyroid nodules and malignancies following trans-plantation.
 
 

Oxidative stress is produced under diabetic con-ditions and possibly causes various forms of tis-sue damage in patients with diabetes. The aim of the study was to investigate the effect of ginger on the occurrence of oxidative stress in the small intestine of diabetic rats. Twenty-four male Wis-tar rats were divided into three groups: control group, nontreated diabetic group, and diabetic group treated with ginger powder as 5% of their daily food. After 6 weeks, lipid peroxidation, protein oxidation, superoxide dismutase (SOD), and catalase levels of the small intestine were measured. Diabetes caused significant increase of small intestine lipid peroxidation, protein oxida-tion, and SOD levels and decrease of catalase ac-tivity. Lipid peroxidation and protein oxidation were attenuated after consumption of ginger in the diabetic rats, and increased catalase activity. These findings indicate that ginger, as an oxidant, improves diabetes induced oxidative stress and its complications through prevention of lipid peroxidation and protein oxidation.

In patients with thyroid papillary carcinoma, performing an effective radioactive iodine abla-tion after total thyroidectomy requires adequate levels of serum thyrotropin. Administration of recombinant human thyroid stimulating hor-mone (rhTSH) is the current established method for patients with insufficient serum TSH levels four to six weeks after surgery and levothyroxine discontinuation. Two major problems with rhTSH are its cost and availability in most countries worldwide. We have used propylthiouracil (PTU), a routine anti-thyroid drug, for the first time to induce a TSH rise. Our patient was a 33-year-old woman with remnant thyroid tissue of 11. 5×4 mm after thyroidectomy. Her TSH was 12.7 µIU/ml, five weeks after surgery, and rose to 30. 0 µIU/ml after a 10 day trial of PTU. Radioiodine uptake index also increased from 28% to 56%. Radioiodine ablation was successfully done and patient showed no sign of recurrence or me-tastasis after 4 years. We propose that anti-thyroid drugs may be considered for post-operative induction of TSH rise in patients con-sidered for radioiodine ablation of thyroid can-cer. This may increase the chance of successful ablations with least possible cost.

Cushing''s syndrome results from inappropriate excessive endogenous glucocorticoids secretion. It may be due to ACTH-producing pituitary adenoma, Adrenocortical adenoma, iatrogen glu-cocorticoid use, or ectopic ACTH production. Pa-tients, who remain untreated, have high morbid-ity and a significant mortality. We describe a very challenging case of Cushing''s syndrome due an adrenal adenoma on a pancreatic mass. A 20-year-old woman presented with sign and symptoms of Cushing syndrome. Thorough basal and dynamic hor-monal assessment. In addition, the results of im-aging studies are presented. The source of ACTH secretion was adrenal adenoma, and hypercortisolism was con-trolled by adrenalectomy. A unique feature of this case is the fact that we observed an adrenal adenoma as a source of Cushing syndrome and an incidental nonfunctional pancreatic nesidiob-lastosis. The diagnosis of Cushing''s syn-drome may turn out to be sometimes a complex and time-consuming challenge in clinical endo-crinology.

Although the pathological association of thyroid and parathyroid diseases are common, an association be-tween parathyroid adenoma and thyroid cancer is rare. Concomitant thyroid cancer in patients with pHPT has been reported at varying frequencies. We report here a case of a 55 year–old man who was diagnosed with primary hyperparathyroidism (pHPT) due to a single parathyroid adenoma, con-firmed biochemically and radiologically. At operation, a nodule in the right thyroid lobe was found incidentally and excised. Histology of the nodule revealed papillary thyroid carcinoma (fol-licular variant).