International Journal of Endocrinology and Metabolism
Volume:10 Issue: 4, Sep 2012

Type II diabetes mellitus is a complex heterogeneous group of metabolic conditions characterized by an increased level of blood glucose, due to impairment in insulin action and/or insulin secretion. Hyperglycemia is a major factor in the pathogenesis of atherosclerosis in diabetes. Oxidative modification of low density lipoprotein (LDL) is recognized as one of the major processes involved in the early stages of atherosclerosis in type II diabetes. LDL contains different antioxidants, which increase LDL resistance against oxidative modification, this is known as its antioxidant potential (AOP).. The present study has been carried out to investigate the sensitivity of LDL to oxidation, AOP of LDL and to assess whether hyperglycemia in diabetes mellitus is associated with increased LDL oxidizability, and whether these relationships are related to diabetic complications..Patients and This study was carried out on 100 diabetic subjects, divided into two groups according to their glycosylated hemoglobin (HbA1c) values, either regulated (< 0.50 M hexose/ M Hb) or unregulated (> 0.50 M hexose/ M Hb.) A further 50 healthy subjects were included to determine the sensitivity of LDL oxidation and measurement of LDL AOP. LDL from the serum sample was precipitated by the heparin-citrate precipitation method. The LDL fractions were exposed to oxidation with copper sulphate and their sensitivity to oxidation was evaluated. AOP was measured by taking measurements from 30 subjects in each group.. The sensitivity of LDL oxidation was significantly higher in both diabetic groups compared to the control group. AOP was significantly decreased in all diabetic groups compared to the control group.. In type II diabetes, the increased susceptibility of LDL to oxidation is related to hyperglycemia and low AOP.

Dyslipidemia is associated with cardiovascular morbidities and mortality. Currently, fasting lipid profile determination is used to monitor treatment response. Recently, postprandial lipemia is of increasing interest because of its atherogenic and thrombogenic potential and also was found to be more predictive for cardiovascular diseases.. To demonstrate postprandial lipemia among patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and even statin regimen..Patients and Patients aged 40-80 years old with cardiovascular diseases (i.e. coronary artery disease and cerebrovascular disease) more than 6 months, on statin treatment for more than 6 months and normal fasting lipid profile (according to NCEP ATP III guidelines) were included. Study exclusion criteria were pregnancy, acute cardiovascular events < 6 months, hepatic or renal failure. Finally, twelve patients were included.. The triglyceride level showed a significant rise from fasting to 2 hours after breakfast with a mean difference of 23.86 mg/dL (P =0.012). The level peaked at 4 hours after breakfast with a mean difference (MD) of 72.02 mg/dL (P =0.002). Subsequent triglyceride levels plateaued and were significantly higher than the baseline (P <0.05) until the 12th hour of observation. VLDL levels showed a similar pattern. Levels increased significantly from fasting to 2h after breakfast (mean difference: 4.49mg/dL, P = 0.007), then plateaued and further increased 4 hours after breakfast (MD: 14.01mg/dL, P = 0.002). VLDL levels were significantly higher than fasting (P < 0.05) and did not return to baseline until the 12th hour of observation. In contrast, the levels of total cholesterol, HDL and LDL decreased postprandially.. Triglyceride and VLDL peaking and plateauing were observed in patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and statin regimen. These findings may raise more attentions in monitoring and management of dyslipidemia in patients with cardiovascular and cerebrovascular events..

Transient hypocalcemia is one of the postoperative complications of thyroidectomy for thyroid nodules, and intraoperative and postoperative intact parathyroid hormone (iPTH) assays are used to predict postoperative hypocalcemia.. The current study was conducted to evaluate a single serum iPTH measurement on postoperative day 1 (POD 1) as a means to predict hypocalcemia occurrence after total thyroidectomy (TT)..Patients and The subjects consisted of 36 patients who underwent TT and 260 patients who underwent TT plus lymph node (LN) dissection for thyroid nodules treatment. The TT performance procedure to prevent postoperative hypoparathyroidism combines parathyroid gland preservation in situ with autotransplantation of resected or devascularized parathyroid glands. The patients’ serum iPTH level was measured on POD 1, and their serum calcium level was measured on POD 1 and on POD 3 while they were still inpatients. The serum iPTH level was subequently measured at each outpatient clinic visit until it recovered to the normal range.. Hypoparathyroidism after TT and TT plus LN dissection was ultimately diagnosed in a total of 229 patients, and in 69 of them hypocalcemia was diagnosed on POD 1. All of the 69 patients diagnosed with hypocalcemia received calcium and vitamin D supplementation therapy. The serum iPTH level of 67 of 229 patients was within normal range on POD 1, and four of them developed hypocalcemia on POD 1. Permanent hypoparathyroidism developed in 37 of 296 patients after undergoing TT or TT plus LN dissection for thyroid nodules in the hospital.. A single serum iPTH measurement on POD 1 is useful to determine whether or not to start calcium and vitamin D supplementation in order to maintain normocalcemia after surgery.

Pompe disease is an inherited metabolic disorder characterized by α-glycosidase deficiency, which leads to lysosomal glycogen accumulation in many different tissues. The infantile form is the most severe with a rapidly fatal outcome, while the late onset form has a greater phenotypic variability, characterized by skeletal muscle dysfunction and early respiratory involvement. Bone mineral density (BMD) has been recently reported to be reduced in many patients with both forms of the disease. Enzyme replacement therapy (ERT) is now available with an undefined, impact on BMD in patients with late onset disease.. The present study aimed to investigate BMD in patients with late onset form of Pompe disease before and after ERT initiation..Patients and Dual x-ray absorptiometry (DEXA) was examined in four newly diagnosed patients with late onset Pompe disease and in four adults under ERT before and after ERT initiation with a treatment duration of 18 to 36 months.. The initial DEXA showed normal total body BMD z-score in all the patients, while L2-L4 and femoral neck BMD was reduced in three and two patients, respectively. After ERT administration, two patients had an improvement in L2-L4 lumbar spine and one patient in femoral neck BMD z-score with values within normal range.. The results suggested that regional BMD may moderately reduce in some patients with the late onset form of Pompe disease, although profound osteopenia was not observed. The improvement of measurements in L2-L4 and femoral neck BMD zscore in some patients with low pre-treatment values after ERT administration needs to be confirmed in larger scale studies.

It is well established that the excess cellular cholesterol concentration, as well as high density lipoprotein (HDL) and total cholesterol levels are strongly correlated with the incidence of coronary artery disease (CAD). Reverse cholesterol transport (RCT) is a term used to describe the efflux of excess cellular cholesterol. ABCG8 is a member of ABCG family that play a critical role in this process.. The current study was conducted to investigate the effect of endurance exercise with or without Pistachia atlantica (Baneh) extraction on small intestine and kidney ABCG8 gene, also plasma high density lipoprotein (HDL-c), triglyceride (TG), total cholesterol (TC), glucose, and estrogen levels in female rats.. In this study twenty Wistar female rats (six to eight weeks old, 125-135 g weight) were used. Animals were randomly assigned into training (n = 10) and control (n = 10) groups and further divided into saline-control (SC), saline-training (ST), Baneh-control (BC), and Baneh-training (BT) groups. Training groups was given exercise on a motor-driven treadmill at 25 m/min (0% grade) for 60 min/day, 5 days/week for eight weeks. Animals were fed orally with Baneh extraction and saline for four week. After the last training session, rats were sacrificed, small intestine and kidney were excised, and ABCG8 expression was detected by Real-time PCR method. Plasma also was collected for plasma variable measurements. Statistical analysis was performed using a one way analysis of variance, and significance was accepted at P < 0.05. Correlation was calculated using the Pearson Product Moment correlation.. Exercise increased (P < 0.01) and Baneh reduced intestinal ABCG8 mRNA (P < 0.05). In kidney tissue, there wasn’t significant change between the groups (P < 0.40). Plasma HDL-C level was increased by exercise (P < 0.05) and decreased by Baneh (P < 0.02) that was correlated by intestine ABCG8 (r = 0.81, P < 0.001). Plasma TG and TC were unchanged, but glucose and estradiol were increased and decreased in Baneh groups (P < 0.02), respectively.. Our study shows that exercise increases intestinal ABCG8 mRNA, and Baneh can increase plasma glucose concentration and reduce ABCG8 expression, HDL-C, and estrogen levels probably due to high fatty acid components..

Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus, it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascular risk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascular risk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascular risk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients’ health integrity..

Von Hippel-Lindau (VHL) disease is a hereditary, autosomal dominant syndrome which is manifested by a range of different benign and malignant tumors. This disease can present with different clinical presentations such as; retinal angioma (RA), hemangioblastoma (HB) of the central nervous system (CNS), pheochromocytoma (Pheo), and epididymal cystadenoma. Tumors are usually accompanied with cysts.. As the disease can display different clinical presentations, which are mainly unspecific, and considering the importance of an early diagnosis and the proper and early management of it, this study was carried out to present a general overview of VHL. Moreover, the present article reviews screening methods and emphasizes the need for increasing the awareness of different health care professionals to diagnose and refer the patients in the early stages.. A thorough search of internet medical databases, such as PubMed, was carried out on known or suggested; clinical presentations, pathogenesis, screening, causes and criteria for diagnosis of patients and their referrals.. Our research demonstrated that VHL is caused by a mutation in the von Hippel-Lindau (VHL) gene. It also showed that different screening methods can be utilized for the early diagnosis and referral of patients. Different clinical presentations of the disease are also elaborated in some detail and their treatment options are discussed.. Considering the need for a multidisciplinary approach to VHL, especially, given the number of cases which have been reported and diagnosed in Iran, it is of great importance that clinicians remain vigilant in order to identify cases that present with clinical characteristics of the disease, and that they are prompt in referring them to a multidisciplinary VHL clinic. It is also important to establish links with existing VHL Family Alliances and other related organizations around the world..

Recombinant human thyroid-stimulating hormone(rhTSH) increases radioactive iodine uptake(RAIU) in selected populations, while lithium is used as an adjunct to radioactive iodine (RAI) therapy in Graves’ disease with low RAIU. In this report, both drugs used in combination, overcame low iodine-131 uptake in a Graves’ patient..Clinical Case: A 39-year old female with Graves’ disease, acquired thionamide-induced agranulocytosis, and severe hypokalemia, subsequently went into cardiorespiratory arrest. On resuscitation, she had ventricular tachyarrhythmias which were cardioverted using amiodarone. She was subsequently placed on IV hydrocortisone amiodarone and propranolol. On admission, she was normotensive, tachycardic, and afebrile. She had fine tremors, hyper reflexia, and diffuse, non-tender thyromegaly. Initial investigations showed normal complete blood count, hypokalemia and elevated alanine transaminase levels. Levels of thyroid stimulating hormone were low (0.03 uIU/L, N = 0.27-3.75). Thyroid ultrasound showed diffuse thyromegaly with uniform echopattern and normal color flow Doppler, radioiodine uptake showed low uptake at 0400h and 2400h (6% and 7%, respectively). In preparation for RAI therapy, she was given lithium 900mg/day for 12 days to increase RAI retention. To increase iodine-131 uptake, two doses of 0.9mg rhTSH were injected intramuscular, 24 hours apart, before RAI therapy. Repeat RAIU after the second dose of rhTSH showed more than a 5-fold increase in 0400h uptake compared with the baseline (32% vs. 6%). Exactly 24 hours after the second dose of rhTSH, she was given 25mCi of iodine-131. Thereafter, the patient’s clinical and biochemical markers continued to improve. She became hypothyroid and is currently on levothyroxine replacement therapy.. This case demonstrates the efficacy of combining rhTSH and lithium to overcome amiodarone-induced low iodine-131 uptake in Graves’ disease.

MEN-I is a rare genetic disorder classically characterized by a predisposition to tumors of the parathyroid glands, anterior pituitary gland, and pancreatic islet cells. We present a case of MEN-I syndrome diagnosed using predominantly nuclear medicine imaging followed by radionuclide therapy, thus emphasizing the role of nuclear imaging in diagnosing and treating MEN-I..