International Journal of Endocrinology and Metabolism
Volume:11 Issue: 1, Jan 2013

Leptin, a protein released from adipose tissue, could have significant role in pathogenesis of obesity and type 2 diabetes mellitus. This study aimed to evaluate variations in serum leptin levels in non-obese subjects with type 2 diabetes mellitus (T2DM).Patients and We studied forty-one patients with type 2 diabetes. Fasting lipid profile, Hemoglobin A1c (HbA1c), serum leptin, insulin, and glucose levels were measured by standard methods. The serum leptin level in type 2 diabetic patients (19.32 ± 11.43 ng/mL) was significantly lower than that in non-diabetic subjects (32.16 ± 11.02 ng/mL). Serum leptin level was strongly and positively correlated with body mass index (BMI) (r = 0.658, P < 0.0001) and calculated body fat percentage (r = 0.431, P < 0.0001) in all the study subjects with a better corrlation in the control subjcts compared to control cases (r = 0.661 for BMI and r = 0.466 for body fat). On the other hand, leptin showed a positive and significant correlation with insulin and HOMA- β (homeostasis model assessment for β-cell function) in both groups. Furthermore, leptin related to homeostasis model assessment for insulin resistance (HOMA-IR) (r = 0.422, P = 0.006) was observed only in T2DM subjects. Leptin showed negative correlation with waist to hip ratio in diabetic (r = -0.407, P =0.008) and non-diabetic subjects (r = -0.318, P =0.049). In the regression model, BMI, HOMA-β, and gender were independent predictors of leptin in all subjects. However, in non-diabetic and diabetic subjects, β-cell function and insulin were independent predictors, respectively (P =0.01).. It is speculated that lower serum leptin levels in diabetic patients may be a consequence of male gender. Moreover, results suggest that serum leptin level in women is influenced differently than that in men.

Coronary artery disease is the single most important cause of mortality and morbidity in diabetic patients. Electrocardiographic stress test is a non-invasive modality to screen significant coronary involvement in minimally symptomatic diabetics. We investigated the Positive Predictive Value (PPV) of this test in comparison with coronary angiography. 130 diabetic patients with atypical chest discomfort were studied and tested using Exercise Tolerance Test (ETT) among which 100 cases showed positive results that further were studied invasively by selective coronary angiography. The positive predictive value of ETT for diagnosis of Coronary Artery Disease (CAD)among diabetic patients presented with atypical chest discomfort was 77%. We conclude that electrocardiographic stress test is a valuable inexpensive non-invasive screening test in diabetic patients with atypical chest discomfort.

The choice of what parameters are needed for the diagnosis of Metabolic syndrome (MetS) has been criticized due to the lack of an actual “gold standard” diagnostic test even in adults. This problem seems to be greater in children and adolescents. Stability assessment of factor structure underlying metabolic syndrome (MetS) components from childhood to adolescence in a panel studyPatients and A total number of 643 (305 boys and 338 girls) children (from 1999 to 2001), aged 6-10 years, with a complete median follow-up of 6.7 years (from 2006 to 2008) were selected among participants of Tehran Lipid and Glucose Study. We proposed 6 measured variables based on risk factors defined in Adult Treatment Panel III guidelines to describe clustering of MetS components. The Goodness of fit of the two-factor model, extracted from exploratory factor analysis, was appropriate for boys and girls in both stages of the study using confirmatory factor analysis. Systolic blood pressure (SBP) and triglycerides (TGs), with parameter estimates (PE) of 1 and 0.75, respectively, were the greatest risk factors at baseline in boys and girls. Waist circumference with PE of 0.88 and 0.62, and SBP with PE of 0.99 and 0.86 in adolescent boys and girls, respectively, were important risk factors. Our panel study supports the stability of the two-factor six-variable model across two developmental stages from childhood to adolescence, among which adiposity, SBP, and TG were the predominant risk factors.

The association between inflammatory markers and the combination of the smoking status plus a number of components of the metabolic syndrome was not fully evaluated in male Japanese subjects.. To demonstrate the association between inflammatory markers and the number of components of the metabolic syndrome by considering smoking status.Patients and A total of 3,017 male subjects (1,047 current smokers, 1,970 non-smokers) were included. Metabolic syndrome (MetS) was defined by the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The smoking status was categorized in a binary manner into current smokers or non-smokers. The geometric mean value of the serum CRP increased linearly as the number of components of MetS increased (P < 0.05). In contrast, the mean values of the total WBC, neutrophil, lymphocyte and monocyte counts showed peak values when the number of MetS components was 3 or 4. The log-transformed serum CRP levels and the WBC counts were significantly correlated with one another (P < 0.001), but Pearson’s correlation coefficient was under 0.3 for current smokers. Among several inflammatory markers, the serum CRP predominantly changed linearly as the number of MetS increased regardless of smoking status..

It is established that serum level of leptin is affected by transitional phases of reproduction. It is also reported that the puberty is triggered when body fat and circulating levels of leptin exceed the critical thresholds, butthere is less focus on the serum level of leptin and its relationship with different phases of menstrual cycle and the fertility. The present study try to determines the serum concentration of leptin and fertility hormonesin the various phases of normal menstrual cycle of fertile women and compare. any difference in serum concentration between age groups of 18-30years and 31-41 years It is a well known fact that fertility start to decrease from age 31years.Patients and A total of 118 healthy fertile women with normal menstrual cycle aged between 18-40, were divided into two age groups (n = 65) 18-30years and (n = 53) 31-40years. Serum concentrations of leptin, estradiol, progesterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) were measured on day1 (menstrual phase), day7 (proliferative/follicular phase), day14 (ovulatory phase), day21 (luteal phase) and day 28(secretory phase) of the menstrual cycle. There was a significant increase (P < 0.05) in leptin levels on day14 (12.75 + 5.8ng/ml) and day 21 (12.91 + 3.2ng/ml) for age group18-30years compared to day14 (11.60 + 3.2ng/ml) and day 21 (11.60 + 3.2 ng/mL) for age group 31-40years. Leptin was positively correlated with FSH on day14, with LH on day 7 and day 21; likewise, with progesterone on day 21 and day 28 and with estradiol on day7 and day14 for both age groups. The serum leptin level was at the lowest level during the menstrual and secretory phase and the highest level was around the luteal phase. The significant increase ofleptin in the younger age group raise this question whether circulating leptin has any role to play in the age of pregnancy and fertility. Data in this study shows that leptin level was affected with increase in age; therefore changes in leptin level will affect fertility in this study suggest that there may be a relation between leptin levels and fertility.

A fall in plasma concentration of energy status related hormones (leptin, insulin-like growth factor-1 (IGF-1) and insulin) and body energy expenditure occurs in response to short term fasting. Nevertheless, the relations of the fasting-induced changes in energy related hormones and metabolites with fasting energy expenditure (FEE) under extended fasting condition have received little attention so far. It is not clear how energy status related hormones coordinate to cope with feed deprivation under extended fasting time conditions and how quickly these hormones re-bound to fed-state values in response to re-feeding. Thus the objectives of this study were: 1) to determine the effects of extended fasting on plasma concentration of leptin, IGF-1, insulin, glucose, NEFA, 3-β-hydroxybutyrate (BOHB) and urea; and 2) to study the relations of energy status related hormones with FEE and substrate oxidations under extended fasting conditions. Eighteen six-month-old growing lambs (9 females and 9 males) were fasted for three days. Blood samples were taken one hour before (-1H) and 48 and 72 hours after fasting (48H and 72H) and two hours after re-feeding (+2H) from jugular vein. During the last 22 hours of fasting, gas exchange (CO2 production and O2 consumption) were measured using an open-circuit indirect calorimeter. Respiratory quotient (RQ), FEE and relative proportions of oxidized protein, fat and carbohydrate were calculated. Plasma levels of leptin, insulin, IGF-1 and glucose decreased but NEFA and urea levels increased within 48H of fasting. Concentration of insulin significantly increased with extended fasting while leptin and IGF-1 levels remained constant. Glucose was the only blood variable that showed a quick re-bound within two hours after re-feeding. Leptin and IGF-1 showed significant positive relations with glucose and BOHB but negative relations with NEFA and Urea. Carbohydrate, fat and proteins contributed to 17%, 61% and 22% of FEE respectively in three-day-fasted lambs. FEE was negatively correlated with insulin and NEFA concentrations in plasma. Even though plasma levels of leptin and IGF-1 decreased and remained constant under extended fasting, neither leptin nor IGF1 re-bounded to fed-status values within two hours after re-feeding. Under extended fasting condition, firstly an insulin resistance develops and secondly, a fall in FEE through a switch from carbohydrate- to fat-based metabolism occurs and there is an evident negative correlation between FEE and plasma concentration of NEFA.

It is becoming evident that oral hormonal contraceptives –besides being well established contraceptives – seem to become important medications for many functional or organic disturbances. So far, clinical effectiveness has been shown for treatment as well as prevention of menstrual bleeding disorders and menstrual-related pain symptoms. Also this is true for premenstrual syndrome (PMS) and premenstrual disphoric disorder (PMDD). Particular oral contraceptives (OCs) containing anti-androgenic progestogens were shown to be effective medications for treatment of androgenisation symptoms (seborrhea, acne, hirsutism, alopecia). Through perfect suppression of the hypothalamic-pituitary-ovarian axis OCs have proven to be effective in elimination of persistent follicular cysts. Endometriosis/adenomyosis related pain symptoms are well handled similar to other drugs like Gonadotropine Releasing Hormone agonists but are less expensive, with less side effects, and possibility to be used for longer periods of time. This is also true for myoma. Pelvic inflammatory disease, rheumatoid arthritis, menstrual migraine, and onset of multiple sclerosis are prevented or delayed. Bone density is preserved and asthma symptoms improved. Endometrial hyperplasia and benign breast disease can be controlled. There is definitely a significant impact on risk reduction regarding endometrial, ovarian, and colon cancers. In conclusion, it needs to be recognized that oral combined hormonal contraceptives (estrogen/ progestogen combination) are – besides being reliable forms of contraception – are cost-effective medications for many medical disorders in women. Therefore, these contraceptives drugs are important for female and global health and should be used in clinical practice..

Most pheochromocytomas are not suspected clinically while a high percentage of them are curable with surgery. We present the case of an adult cocaine-addicted male patient with an underlying pheochromocytoma and repeated myocardial infarctions. Computed tomography showed a left round adrenal mass, also high 24-hour urine levels of catecholamines and metanephrines were detected from urinalysis. The patient was given alpha and beta blockers, moreover a laparoscopic left adrenalectomy was performed. Cocaine can block the reuptake of noradrenaline, leading to increasing its concentration and consequently its effects as well, and induce local or diffuse coronary vasoconstriction in normal coronary artery segments per se, cocaine can also trigger pheochromocytoma crisis, and therefore, cardiac complications such as myocardial infarction due to these additive effects are intended to occur. For this reason, in the presence of typical clinical manifestations of pheochromocytoma, such as sustained or paroxysmal hypertension, headache, sweating, tachycardia and abdominal pain, probable association of this tumor in patients with cocaine abuse and associated cardiac complications must be ruled out..

A 64-year-old male presented with neurofibromatosis 1 and Cushing’s syndrome. Clinically he was over weight, depressed with extensive skin bruising and hypertension. His 24 hours urinary metanephrines, urinary 5HIAA, gut peptides and chromgranin levels were normal. His renal function and renal MRI scan was also normal. His cortisol failed to suppress on overnight dexamethsone suppression test. His low dose dexamethasone suppression with CRH stimulation showed failure of suppression of cortisol to < 50nmol/L and ACTH was measurable at 10ng/L on day 3. There was no response of ACTH or cortisol to CRH stimulation. His ACTH precursors were high at 126pmol/L consistent with defective pro-opiomelanocortin (POMC) processing suggesting an ectopic source of ACTH production. The MRI scan of his pituitary and CT scan of the adrenal glands was normal. His octreotide scan was negative. The source of his ectopic ACTH was most likely a large retroperitoneal plexiform neurofibroma seen on CT abdomen that had undergone malignant peripheral nerve sheath tumour transformation on histology. He was a poor surgical risk for tumour debulking procedure. In view of the available literature and role of c-kit signalling in neurofibromatosis, he was treated with Imitinib. Four months after the treatment his Cushings had resolved on biochemical testing. After a year his plexiform neurofibroma has not increased in size. To our knowledge, this is the first case of NF1 associated with clinical and biochemical features of Cushing’s secondary to ectopic ACTH due to MPNST in a plexiform neurofibroma and its resolution on treatment with imatinib..

Patients with intellectual disabilities may be treated with antipsychotic medications for a variety of diagnoses. Use of this category of medication can increase prolactin levels and place the patient at risk for sexual dysfunction and lower bone mineral density. The proposed mechanism of action is affinity for the dopamine receptor. Use of bromocriptine, a dopamine receptor antagonist, was proposed to attenuate hyperprolactinemia. The objectives of this study were to (1) review serum prolactin (PRL) elevations associated with the use of antipsychotic (AP) medications in an intellectually disabled adult population and (2) determine if any association existed between the level of elevation and AP used.Patients and Medical records for adult patients at two Oklahoma facilities for the intellectually disabled were reviewed to evaluate prolactin levels for individuals prescribed antipsychotics. A linear regression model was used to evaluate the relationship between prolactin levels with intellectual disability level, bromocriptine use, demographics, and antipsychotic. 73 (n = 53 males, n = 20 females) patients met criteria. The average age was 41.2 years. Nearly 70% of the patients had severe to profound levels of disability. 77% were prescribed second generation antipsychotics; 19% received first generation agents. Two variables, gender and bromocriptine use, were found to be significant predictors of prolactin levels. Mean prolactin level for females was 44 ng/mL (normal range: 4-30 ng/mL, males = 4-23 ng/mL). Patients who did not receive bromocriptine had mean levels of 23 ng/mL. No significant difference in prolactin levels was found for type of AP. Mean prolactin levels for females were significantly higher than for males. Both sexes were found to have higher-than-normal levels. Use of bromocriptine was associated with higher prolactin levels. In this population of patients, the type of AP used had no significance on prolactin levels.