International Journal of Endocrinology and Metabolism
Volume:7 Issue: 2, Jun 2009

In 1998 the definition of type 2 diabetes was revised, in particular the fasting plasma glucose (FPG) diagnostic level was lowered from 7.8 mmol/L to 7.0 mmol/L. The purpose of this study was to examine the effects of this change on patient demographics. Materials & We reviewed data from 1700 type 2 diabetes patients, who attended the St. Paul’s Hospital Diabetes Teaching and Train-ing Centre before (group 1) and after (group 2) the definition change. Demographical data from a baseline and follow-up were analyzed. The frequencies of patients in groups and cohorts <60 years of age and ≥60 years of age were calculated and HbA1c data was analyzed. Compared to Group 1, Group 2 was younger, had a significantly lower mean HbA1c level (7.3% vs 8.1%, p<0.0001), blood pressure (127/78 vs 133/82 mmHg, p<0.05) and cholesterol (5.2 vs 5.5 mmol, p<0.05) and was more often treated with multiple medications (p<0.001). Pa-tients in Group 2 were significantly more likely to meet the target HbA1c level of 7.0% than pa-tients in Group 1 (p<0.0001). It was also found that at baseline, patients ≥60 years old in Group 2 had significantly lower HbA1c values than those <60 years old (p<0.001). Since the change in the definition of type 2 diabetes, a greater frequency of patients presented with lower mean HbA1c values and met target HbA1c levels. Patients ≥60 years old initially presented with lower HbA1c levels than those <60 years old.

We aimed at determining the prevalence of osteoporosis and osteopenia in an urban population. DXA measurements were done at the lumbar spine (4914 females, aged 50 to 93 years and 111 males, aged 50-89) and at the femur (2943 females, aged 50-95 and 105 males, aged 51-92). Bone mineral density (BMD) and corresponding T-scores were analysed using multivariate regression models. In females, the prevalence rate of osteo-porosis was 19.56% (95% confidence interval (CI):18.46/20.69) at the lumbar spine and of os-teopenia 41.68% (95% CI: 40.29/43.07). The cor-responding numbers in males were 16.22 % (95% CI: 9.90/24.41) and 33.33% (95% CI: 24.67/42.91). In females osteoporosis rate at the femur was 18.99% (95% CI: 17.59/20.46) for the neck and 2.0% (95% CI: 1.53/2.58) for the tronchater, whe-reas the osteopenic rates were 54.57% (95% CI: 52.75/56.38) and 32.38% (95% CI:30.69/34.11) re-spectively. In males, osteoporosis rate at the fe-mur was 38.10% (95% CI: 28.79/48.09) for the neck and 13.33% (95% CI: 7.49/21.36) for the tron-chater, whereas the corresponding osteopenic rates were 46.67% (95% CI: 36.87/56.66) and 41.90% (95% CI: 32.34/51.93). A polynominal cu-bic model performed for age showed the steepest decline at the age of 55 years for the spine BMD (-0.973% change, 95% CI -1.031/-0.915) and at the age of 64 years for the femur BMD (-0.726% change, 95% CI -0.793/-0.658). Sensitive interventions and strate-gies for prevention of osteoporosis in urban populations need to be designed and imple-mentted.

Premature ovarian failure (POF) is characterized by hypergonadotropic amenorrhea, before the age of 40, for which the Inhibin α-subunit (INHα) gene is proposed as a candidate gene, due to its role in negative feedback control of FSH. In this study we aimed at demonstrating the candidate mutation as a gene variation associated with POF in Iranian population. Using DNA sequencing, DNA samples of 24 women with POF and 24 controls, aged below 40 years, were screened for mutations in the Inhibin gene. The 769G→A mutation in exon 2 of the Inhibin-α gene was found in four out of 24 idi-opathic POF patients. The results obtained in this study have shown that this variation is more frequent in patients with POF than in normal fertile pop-ulations of Iran.

Recent clinical studies have shown that moderate and severe traumatic brain injury (TBI) is a common cause of hypopituitarism. Mild TBI has also been associated with hypopituitarism, which since it is often not evaluated, the hypopituitar-ism may remain under diagnosed. In this study we aimed at determining the clinical and hor-monal profile of mild TBI patients admitted a year after their injury. The sample was a descrip-tive, prospective cohort in a tertiary hospital. A hypopituitarism clinical evaluation form was used to evaluate the patients for signs and symp-toms of hypopituitarism a year after mild TBI. Pituitary hormonal function was tested a year af-ter their injury for IGF-1, FT4, TSH, cortisol, LH, FSH and testosterone. Six male patients with mild TBI were studied. Mean age was 27  8 years old. All of them had intra-cranial hemorrhage on CT-scan and five underwent emergency decompressive cranial surgery. Evaluation was done 481  67 days after the event. Signs of hypopituitarism were not observed but symptoms of decreased vigor and weight gain was present in five of the six patients. IGF-1 was low in 33% (2/6) and tes-tosterone level was low in 17% (1/6).8 am cortisol levels were equivocal in 83% (5/6) but ACTH-stimulated cortisol values were normal. Thyroid function test were normal for all subjects. The most common symptoms were weight gain & decreased vigor. Signs of hypopi-tuitarism were not noted among the mild TBI pa-tients. Pituitary hormone testing revealed ab-normalities in the somatotrophic & gonado-trophic axes.

Thyroid disorders are common in women during pregnancy, when the excess or deficiency of maternal thyroid hormones has been associated with adverse health outcomes for both the mother and child. This study performed to study the prevalence of thyroid disorders and its effect on pregnancy outcomes in pregnant women. In 500 pregnant women in first trimester of pregnancy enrolled for the study, Serum Thyrotropin (TSH), Free T4 (FT4), and Free T3 (FT3) were measured by high-sensitive radioimmunoassay. Overt hyperthy-roidism was diagnosed when both TSH was suppressed and FT4 or FT3 were elevated. Sub-clinical hyperthyroidism was diagnosed when TSH was suppressed with normal FT4 and FT3. The diagnostic criteria for overt hypothyroidism was TSH > 4 mU/L accompanied by decreased FT4, and for subclinical hypothyroidism a TSH > 4 mU/L with normal FT4 level. Those with thyro-id disorders were referred to an endocrinologist for medical treatment and all subjects were fol-lowed until delivery. Mean age of women was 24.5±4.9 years. Hypothyroidism, both subclinical (7.4%) and overt (2.4%), was found in 49 (9.8%) women. Overt hyperthyroidism found in 3 (0.6%) and subclinical hyperthyroidism in 21 (4.2%) women and was considered a physiologic change of pregnancy. On follow up, 19 women (3.8%) had preterm labor, and 25 (5%) women developed pre-eclampsia. There was no significant differ-ence in the incidence of preterm labor and pre-eclampsia in pregnant women with or without thyroid dysfunction. Normal neonates were born to 498 women, while 2 (0.4%) euthyroid mothers delivered fetuses with anomalies. Although thyroid dysfunction is common in pregnant women, the prevalence of complications is not higher in patients with thy-roid dysfunction, as compared to normal euthy-roid controls.

Hyperthyroidism has been associated with cardiomyopathy and heart failure (HF). This study aims to evaluate clinical, laboratory and echocardiographic parameters, at admission and 12 months following euthyroidism restoration, in patients with hyperthyroidism-associated HF. Mechanisms underlying hyperthyroidism-associated HF and the outcomes of echocardiographic parameters along the study period are both discussed. Patients with newly di-agnosed overt hyperthyroidism and HF (Group 1), age and sex-matched euthyroid HF subjects (Group 2), and a control group were enrolled. In the 38-month study period, 56 patients were admitted for hyperthyroidism-associated HF, of whom 71% had a pre-existing, mainly hypertensive, cardiomyopathy vs 68% of Group 2 subjects. Mean heart rate was significantly higher in Group 1 than Group 2 (127±38 vs 110±17bpm; P <0.02); 30 Group 1 (54%) and 16 (29%) Group 2 patients presented with atrial fi-brillation. At admission, left ventricular ejection fraction (LVEF), end diastolic (LVEDD) and end systolic (LVESD) diameters were lower, whilst LV mass (LVM), interventricular septum thick-ness (IVST) and LV posterior wall thickness (LVPWT) were increased in both Groups com-pared to controls. At the end of the study, despite achievement of euthyroidism in all hyperthyroid patients, mean LVEF was not significantly different in Group 2 but was significantly lower in Group 1 patients compared to controls; LVM, IVST and LVPWT did not change in both study groups. In our series, newly diagnosed hyperthyroidism-associated HF had 2.4% preva-lence. At the end of the study, LVEF significantly improved in euthyroid, but not in hyperthy-roidism-associated HF patients compared to con-trols.

ongenital hyperinsulinism (CHI), a clinically and genetically heterogeneous disease, is the most common cause of persistent hypoglycemia in infancy. It is characterized by the unregulated secretion of insulin from pancreatic β-cells in re-lation to blood glucose concentration. The most common form of CHI is associated with auto-somal recessive mutations in genes ABCC8 and KCNJ11, encoding the two subunits of the pan-creatic β-cell ATP sensitive potassium channel (KATP). When the disease presents in the neo-natal period, early diagnosis and maintenance of normoglycaemia are essential to prevent adverse neurodevelopmental outcomes. Prenatal diagno-sis of CHI with a known mutation is a promising new avenue which will ensure early and appro-priate postnatal intervention and improved long term outcome. We report a case of neonatal CHI due to homozygous recessive mutation in the ABCC8 gene. The parents were asymptomatic carriers of ABCC8 gene. A review of literature and update on the genetics of the disease is pre-sented in this article.