مجله غدد درون ریز و متابولیسم ایران
سال دوم شماره 2 (پیاپی 6، تابستان 1379)

Congenital adrenal hyperplasia is due to enzymatic deficiencies in the pathway of steroid hormone synthesis. In order to provide normal growth and ideal height and prevent the complications due to inappropriate therapy in these patients, delicate points should be considered. Adrenocorticotropic hormone (ACTH) is mainly secreted during the night (2 to 9 a.m) and it seems that steroid administration during the night has more inhibitory effect on ACTH secretion. On the other hand, patient’s compliance is improved by lower divided drug dosage. We evaluated two methods of hydrocortisone administration in 67 patients (43 girls, 24 boys) during a 4-year period. At first patients were treated with 16±5mg/m2 of daily hydrocortisone in 3 divided doses with the largest dose in the morning over 20.8±5.6 months (old method). Then the same patients were treated with 15±3mg/m2 of daily hydrocortisone in two divided doses with the larger dose in the night over 20.6±5.7 months (new method). Serum 17OH-progesterone was measured every 3-6 months and patients were divided into two groups according to the level of 17-OHP (<10ng/ml or >10ng/ml) and analysed with Chi-square. Mean 17-OHP serum level was compared between these two methods. At the end of each therapeutic method, SDS for height, GVI (growth velocity of patients / normal growth velocity for age X 100), BMI (weight / (height)2), and WHI (patient’s weight / mean weight according to age height index X 100) were measured and analyzed using paired t test. There was no significant difference in mean SDS for height at the end of treatment with old and new methods (-0.38 ± 1.5 and –0.4 ± 1.4, respectively). There was also no significant difference in GVI between these 2 methods (89 ± 32 and 94 ± 34 in old and new methods, respectively). There was significant difference in BMI between old and new methods (19 ± 4.6 and 19.89 ± 5.3kg/m2, respectively) (P<0.001). WHI at the end of treatment with old and new methods were 116.7±23 and 119.8 ± 27, respectively, without any significant difference (P=NS). Serum 17OHP concentration was lower than 10ng/ml in 65.4% and 82.7% of patients in old and new methods, respectively, and the difference was statistically significant (P=0.003). Mean 17OHP level in new therapeutic method was significantly lower than that in old method (6.9±13 vs. 18.9±29ng/ml, P = 0.003). In both methods, patients didn’t complain of fatigue. In new therapeutic method, there was not any increase in hirsutism, virilism and skin pigmentation, and even improvement was observed in skin pigmentation. The findings showed that growth velocity doesn’t show significant difference between these two methods. There was an increase in body mass index (BMI) in new therapeutic method but no significant increase was observed in height-weight index. In new therapeutic method, serum level of 17OHP is better controlled and patients have better therapeutic compliance.

Tehran Lipid and Glucose Study is a study to determine the risk factors for atherosclerosis among Tehran urban population and develop population-based measures to change the lifestyle of the population and prevent incidence of diabetes mellitus and dyslipidemia. 17000 men and women between 3 and 69 years of age are randomly sampled from Tehran urban district 13 for assessment of conventional (i.e. smoking, diabetes and hypertension) and emerging (i.e. glucose intolerance, obesity, physical activity and diet) cardiovascular risk factors. In the baseline examination a general questionnaire on persons’ health condition and risk factors is filled up and a brief physical examination is done. Cardiovascular disease is assessed by using a 12-lead electrocardiogram and London School of Hygiene Cardiovascular (Rose) Questionnaire. The relationship between the conventional and emerging risk factors and vascular disease and markers of end-organ damage will be evaluated in the urban residents of Tehran. In the second phase of the study, healthy individuals will be followed up in a 10-year-long cohort to determine the trend of changes in lipid and glucose status and development of vascular complications. Selected people undergo interventions with modifications in their lifestyle to assess the efficacy of certain measures in preventing the development of diabetes mellitus and dyslipidemia.

In view of controversy regarding the role of human chorionic gonadotropin (hCG) as the stimulator of thyroid function in patients with trophoblastic tumors, especially hydatidiform mole, we conducted a study to explore whether a correlation between human chorionic gonadotropin and thyroid function is demonstrable in such patients. Forty-eight patients with hydatidiform mole, who had a drop in serum βhCG concentration below 5 mIU/ml during a period of eighteen months after evacuation, were selected. Serum βhCG, total T3, total T4 and serum TSH were measured both when βhCG was high and when it dropped to below 5 mIU/ml. Serum βhCG, total T3, and total T4 were measured with radioimmunoassay. The human TSH-coated tube assay was utilized for immunoradiometric assay of TSH. Among forty-three patients with βhCG concentrations exceeding 100 mIU/ml, total T4 values were higher than 8.8 μg/dl in thirty patients. The regression equation between total T4 and high βhCG levels was 6.36 with a P value of 0.00. The regression equation between FT4I and high βhCG level was 2.105 (P=0.002). The regression equation between high T3 and FT3I and high levels of βhCG was 133.39 and 37.3 respectively (P=0.026 and 0.024). The mean value of TSH was 0.9915 mIU/ml before and 1.533 mIU/ml after treatment. The regression equation between TSH and βhCG was 1.8448 (P=0.044). This study shows a strong correlation between high serum βhCG and total serum T4 and FT4I. There is also a correlation between high serum βhCG and total T3 and FT3I. There is a weak statistical correlation between high serum βhCG and low serum TSH.

Screening program for congenital hypothyroidism (CH) started in 1987 and had to be discontinued due to high prevalence rate of hyperthyrotropinemia in infants and subsequent increased recall rate. Recent surveys denote that more than 95% of Iranian households consume iodized salt, and nationwide measurement of urinary iodine concentration in schoolchildren showed absence of iodine deficiency. The present study compares CH screening results before and after iodine supplementation. In 1987-89, serum TSH concentration was measured in 1724 cord blood specimens and in 1998-99, TSH (IRMA) was measured in cord blood filter paper specimens of 2936 newborns. Those with TSH≥20mU/L were recalled and thyroid function tests were performed, using venous blood. Newborns were calssified into 3 groups according to TSH concentrations: 0-9.9, 10-19.9, and ≥ 20mU/L. In 1987-89, 81% and 14% and in 1998-99, 83.9% and 14.5% of the newborns had TSH values between 0-9.9 and 10-19.9 mU/L, respectively (p=NS). Corresponding values for TSH≥20mU/L were 5% and 1.6%, respectively (P<0.001). In 1997-98, 0.8%, 0.3% and 0.1% of all newborns had TSH values between 25.1-50, 35.1-50, and >50mU/L, respectively. Iodine sufficiency in I.R. Iran has caused significant decrease in neonatal hyperthyrotropinemia and recall rate of screening program for CH. Keywords:

In order to determine bone mineral density (BMD) in patients with simple goiter who were treated with either thyroid hormone (levothyroxine) or injection of iodized oil solution, 68 goiterous patients aged 51±6 (mean ± SD) were studied. 51 patients who had received suppressive doses of levothyroxine for 61±29 months (mean ± SD) were randomly allocated into three groups group I included 18 patients who were treated with one milliliter of iodized oil solution without receiving thyroxine group II, included 18 patients in whom treatment with suppressive doses of levothyroxine was continued, and group III included 15 patients who didn’t receive any treatment. The fourth group consisted of 17 controls who had never been treated with levothyroxine before. In groups I to IV the number of menopausal patients were 13, 13, 9, and 12 respectively. Serum T3, T4, TSH, T3RU, calcium, and phosphorus levels and urine calcium level were measured. BMD was determined in L2-L4 vertebrae, femoral neck (FN), femoral ward (FW) and femoral trochanter (FT) using lunar DPXL device (with DEXA method), approximately 6 months after the intervention. Serum T3, T4, T3RU, Calcium and phosphorus levels and urine calcium level were not significantly different among the groups. Serum TSH in group II was significantly lower than the other groups (P<0.004). BMD results showed no significant difference among the groups (for example BMD results in L2-L4 region in groups I to IV were 1.03±0.98, 1.1±0.32, 1±0.15, and 1.30±0.11, respectively). In all groups positive correlations were observed between the length of the menopause and reduction in BMD. There was no significant difference between BMD results in pre-menopausal and post-menopausal women in L2-L4 (1.09±0.19 vs 1.05±0.16), femoral neck (0.89±0.14 vs 0.85±0.17), femoral trochanter (0.73±0.12 vs 0.68±0.10), but BMD in femoral ward was significantly less in post-menopausal women compared with pre-menopausal subjects (0.65±0.12 vs 0.74±0.13 P<0.005). This study shows that administrating suppressive doses of levothyroxine and injecting iodized oil don’t reduce bone mineral density in pre and post-menopausal women 6 months after the intervention.

Dehydroepiandrosterone (DHEA) or its sulfate derivative (DHEA-S) is the major C19 steroid hormone secreted by adrenal cortex. It has been claimed that it has an inverse correlation with atherogenesis through its antiproliferative effect. But this correlation is a matter of controversy. The aim of this study was to examine the effect of DHEA-S on coronary artery disease (CAD). In a prospective randomized study, 202 patients with possible CAD who underwent coronary angiography between January 1999 and June 1999 were studied. They were allocated into two groups, group 1 (n=142 Female: 39, Male: 103) had more than 75 percent cross-sectional area narrowing of at least one coronary artery, and group 2 (n=60 Female: 28,Male: 32) had no coronary artery disease. The age range was 18-75 years, and it was matched between the two groups. Level of DHEA-S (measured by two different methods ELISA and RIA), fasting blood sugar, full lipid profile (TG, total cholesterol, LDL-C, HDL-C) were measured in the two groups. Other major coronary risk factors were also compared between the two groups. The level of DHEA-S had an inverse linear correlation with age (r = -0.34 and P<0.01). There was no statistically significant correlation between the level of DHEA-S and coronary artery disease in different age groups in males and females. Likewise, there was no statistically significant correlation between the level of DHEA-S and blood sugar (P=0.08), HDL (P=0.41), LDL (P=0.09), body mass index (P=0.4), hypertension and current smoking. The present study doesn’t confirm the inverse correlation between DHEA-S and coronary artery disease.

Since the normal values of thyroid volume ultrasonography results from European schoolchildren were endorsed by WHO, a few studies have addressed the limitation of the recommended references as universal normal values for thyroid volume. Our objective was to describe thyroid volume measured by ultrasonography in Tehran’s schoolchildren and compare these with WHO normal values. Cross-sectional studies were performed in 1186 schoolchildren aged 6-15 years in Tehran, 10 years after distribution of iodised salt. Data were collected on age, sex, weight, height, thyroid size by palpation and ultrasonography and urinary iodine. The 97th percentiles of thyroid volume for age/sex and body surface area (BSA) / sex were determined. The prevalence of goiter was 42% by palpation, 31% grade 1 and 11% grade 2. Median urinary iodine was 21.2 μg/dl. The 97th percentiles were comparable in girls and boys in all ages. According to the WHO thyroid volume references Tehran’s children did not have enlarged thyroids based on BSA and age, even in 11% of children with grade 2 (visible) goiter. In Tehran’s children, the best predictors of thyroid volume were BSA, height and weight. Using linear regression, the 97th percentiles of thyroid volume from Tehran’s children were lower than the corresponding references from WHO normal values. WHO-recommended references lacked normal values for 6% of schoolchildren with BSA<0.8 m2. Results indicate that a thyroid volume reference based on weight alone would perform as well as that based on BSA. In addition, until the adoption of a new applicable international reference for thyroid volume, the use of local references in the screening of children for thyroid enlargement is recommended.

Follicular carcinoma constitutes about 5 to 10 percent of thyroid cancers. It is characterized by the formation of more or less well-developed acini or follicles. We persent a case of follicular carcinoma with histological features of extensive nesting pattern and eosinophilic hyaline material deposition, resembling medullary thyroid carcinoma. However, the lesion consisted of thyroglobulin-positive and calcitonin-negative cells. This case illustrates the contribution of the immunohistochemical studies to the detection of the exact nature of thyroid tumors.