Inflammation as a Link between Obesity and Metabolic Syndrome

The metabolic syndrome is a complex of clinical features leading to an increased risk for cardiovascular disease and type 2 diabetes mellitus in both sexes. Visceral obesity and insulin resistance are considered the main features determining the negative cardiovascular profile in metabolic syndrome. The aim of this paper is to highlight the central role of obesity in the development of a chronic low-grade inflammatory state that leads to insulin resistance, endothelial and microvascular dysfunctions. It is thought that the starting signal of this inflammation is overfeeding and the pathway origins in all the metabolic cells; the subsequent increase in cytokine production recruits immune cells in the extracellular environment inducing an overall systemic inflammation. This paper focuses on the molecular and cellular inflammatory mechanisms studied until now

Obesit\uc3\ua0 ed ipertensione

none3noneFALOIA E; GIACCHETTI G; MANTERO F.Faloia, E; Giacchetti, G; Mantero, Franc

Corticotropin-releasing hormone and desmopressin tests in the differential diagnosis between Cushing's disease and Pseudo-Cushing state: a comparative study.

Abstract BACKGROUND: We recently proposed a new and effective way of interpreting human corticotrophin-releasing hormone (hCRH) and desmopressin (DDAVP) tests, for the differential diagnosis between Cushing's disease (CD) and pseudo-Cushing state (PC), based on the simultaneous analysis of ACTH and cortisol. OBJECTIVE: The study had the aims of comparing the diagnostic performance of the two tests and determining whether carrying out both tests was more beneficial than carrying out only one. PATIENTS AND MEASUREMENTS: We studied 30 CD, 18 PC and 12 control (CT) subjects: in these patients, hCRH test, DDAVP test, 24-h urinary free cortisol, serum cortisol after overnight 1-mg dexamethasone suppression test and serum cortisol circadian rhythm were performed. RESULTS: The hCRH test and the DDAVP test showed an identical and excellent diagnostic performance (sensitivity 96·6% and specificity 100% for both tests); moreover, the hCRH and DDAVP tests showed almost perfect diagnostic agreement (κ = 0·93; P < 0·05) with a significantly higher number of concordant diagnoses (58 cases of 60) than those resulting from all other possible combinations among the studied tests. Interestingly, there were no subjects in whom both hCRH and DDAVP tests gave a simultaneous misdiagnosis. CONCLUSIONS: Our study indicates that the hCRH and DDAVP tests have similar diagnostic performance and present excellent agreement, without giving simultaneous misdiagnosis in any subject. Because of these characteristics, the use of both tests offers the physician a valuable tool for those cases of hypercortisolism which are difficult to interpret

Adrenal incidentaloma

Incidentally discovered adrenal masses, or adrenal incidentalomas, have become a common clinical problem owing to wide application of radiologic imaging techniques. This definition encompasses a heterogeneous spectrum of pathologic entities, including primary adrenocortical and medullary tumors, benign or malignant lesions, hormonally active or inactive lesions, metastases, and infections. Once an adrenal mass is detected, the clinician needs to address two crucial questions: is the mass malignant, and is it hormonally active? This article provides an overview of the diagnostic clinical approach and management of the adrenal incidentaloma. Mass size is the most reliable variable to distinguish benign and malignant adrenal masses. Adrenalectomy should be recommended for masses greater than 4.0 cm because of the increased risk of malignancy. Adrenal scintigraphy has proved useful in discriminating between benign and malignant lesions. Finally, fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients and it may be useful in establishing the presence of metastatic disease. The majority of adrenal incidentalomas are non-hypersecretory cortical adenomas but an endocrine evaluation can lead to the identification of a significant number of cases with subclinical Cushing's syndrome (5-15%), pheochromocytoma (1.5-13%) and aldosteronoma (0-7%). The first step of hormonal screening should include an overnight low dose dexamethasone suppression test, the measure of urinary catecholamines or metanephrines, serum potassium and, in hypertensive patients, upright plasma aldosterone/plasma renin activity ratio. Dehydroepiandrosterone sulfate measurement may show evidence of adrenal androgen excess

Protective effect of leg fat against cardiovascular risk factors in obese premenopausal women

BACKGROUND AND AIMS: While the relationship between abdominal fat and cardiovascular risk (CVR) factors is well established, the possible protective role of peripheral fat against these factors has received less attention, particularly in severely obese individuals. The principal aim of this study was to analyse the relationship, if any, among amount of leg fat, CVR factors and body mass index (BMI) in obese premenopausal women. METHODS AND RESULTS: Subjects were 80 obese premenopausal women. Body composition was measured by dual energy X-ray absorptiometry (DEXA); CVR factors (blood pressure, plasma lipids, glucose) were determined and anthropometric measurements (waist and hip circumferences) taken. In severely obese women (BMI>40 kg/m(2)) leg fat correlated negatively with CVR factors, whereas metabolic parameters were not significantly different from those of subjects with BMI<40 kg/m(2). CONCLUSIONS: Leg fat seems to play a protective role against CVR factors in severely obese premenopausal women

Intracellular absorption of transdermal magnesium demonstrated by ESEM-EDS

Magnesium, the second most abundant intracellular cation in human body, plays a fundamental role in intracellular metabolism. As a cofactor in a huge number of key enzimatic reactions, magnesium is especially important for those enzymes that use nucleotides as cofactors or substrates (phosphotransferases, phosphohydrolases, etc.). The majority of magnesium studies were performed by detecting serum magnesium concentration, measure that doesn’t consider the intracellular uptake. In the present study, a different approach has been carried out. By means of an Environmental Scanning Electron Microscope (ESEM) equipped with an Energy Dispersive Spectroscopy (EDS) detector, the intracellular magnesium presence and uptake has been measured in a semiquantitative approach on samples of exfoliating epithelial cells from the oral mucosa [1]. The intracellular magnesium uptake has been experimentally induced by applying, twice a day and for 4 months, on the skin of healthy volunteers, a spray of a magnesium chlorate supersaturated solution. Epithelial cells and blood samples were collected at time zero and every 2 months of treatment. Despite the constant serum concentration of magnesium along the treatment and in absence of any side effect, the EDS analysis reveals a progressive and regular intracellular magnesium increasing of about 100% of the values at each experimental step. Results can confirm the high specificity and, more in general, the high reliability of the EDS analysis about a parameter that can result neglect utilizing only the serum concentration. Moreover, transdermal absorption of magnesium can represent an efficient way of magnesium administration, low dose and side effect free, to be utilize in chronic clinical magnesium deficiency [2]