ENDOCRINE RESEARCH

The aims of this prospective study were to determine serum levels of creatine kinase (CK) in overt and subclinical hypothyroidism; to investigate the change in CK levels with treatment; and to evaluate the relationship between free triiodsothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) levels and the degree of skeletal muscle involvement, as determined by serum CK levels. Patients with hypothyroidism presenting to our endocrinology clinic were eligible for inclusion in this study. Patients with other causes of CK elevation were excluded. We included 28 patients ( 25 women and 3 men, ages 41.75 +/- 13.65 years) with overt hypothyroidism, 38 patients ( 37 women, 1 man, ages 40.55 +/- 10.48 years) with subclinical hypothyroidism, and 30 age- and gender-matched controls ( 27 women, 3 men, ages 40.81 +/- 11.20 years) in the study. Serum levels of TSH, FT4, FT3, and CK were measured in all subjects. CK elevation was found in 16 patients (57%) with overt hypothyroidism and in 4 patients (10%) with subclinical hypothyroidism. Although a statistically significant elevation of CK levels was found in patients with overt hypothyroidism when compared with patients with subclinical hypothyroidism and controls ( p = 0.0001, p = 0.01, respectively), no difference was found between the subclinical hypothyroidism and control groups ( p = 0.14). In hypothyroid ( overt and subclinical) patients, a positive correlation was found between CK and TSH (r = 0.432; p = 0.04), and a negative correlation between CK and FT3 ( r = -0.556; p = 0.002) and between CK and FT4 ( r = -0.448; p = 0.04). CK levels decreased to normal levels after thyroid function normalized with treatment. In conclusion, skeletal muscle is affected by hypothyroidism more profoundly in cases of overt hypothyroidism, less so when subclinical hypothyroidism is present

ENDOCRINE JOURNAL

The aims of this study were to: 1) determine the prevalence of hyperprolactinaemia in patients with newly diagnosed subclinical and overt hypothyroidism, and 2) investigate the change in PRL levels with treatment. In this observational study, patients with a new diagnosis of hypothyroidism in our endocrinology clinic were approached for participation, as were healthy controls. Patients with medical reasons for having elevated PRL levels, lactating and pregnant women were excluded from the study. No patient had kidney or liver disease. After examination to determine if clinical causes of PRL elevation were present, serum levels of thyrotropin (TSH), free thyroxine, free triiodothyronine and PRL were measured and correlation of PRL levels with the severity of hypothyroidism (overt or subclinical) was performed. Fifty-three patients (45 women, 8 men, mean age 45.3 +/- 12.2 years) had overt hypothyroidism. One hundred forty-seven patients (131 women, 16 men, mean age 42.9 +/- 12.6 years) had subclinical hypothyroidism. One hundred healthy persons (85 women, 15 men, mean age 43.9 +/- 11.4 years) participated as controls. The same blood tests were repeated in patients after normalization of TSH levels with L-thyroxine treatment. PRL elevation was found in 36% of patients with overt hypothyroidism, and in 22% of patients with subclinical hypothyroidism. PRL levels decreased to normal in all patients after thyroid functions normalized with L-thyroxine treatment. In the hypothyroid patients (overt and subclinical) a positive correlation was found between TSH and PRL levels (r=0.208, p=0.003). PRL regulation is altered in overt and subclinical hypothyroidism, and PRL levels normalize with appropriate L-thyroxine treatment

DIABETES OBESITY & METABOLISM

Background: Obesity is known to be a risk factor for type 2 diabetes mellitus (DM), arterial hypertension (HT) and hyperlipidaemia (HL), but the relationship between the duration of obesity and these outcomes is variable in the literature. Aims: The aims of this study were 1) to evaluate whether the duration of obesity is a risk factor for type 2 DM, HT and HL, 2) to determine the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 2 DM, HT and HL in the patients attending our clinic because of obesity and 3) to determine the correlation between DM, HT and HL and age, body mass index (BMI), duration of obesity and waist-hip ratio (WHR). Methods: Informed consent was obtained from 200 consecutive women presenting to our Endocrinology and Metabolism Unit for the first time because of obesity. The patient's history of the age at onset of obesity, HT and family history of DM were obtained. Anthropometric measurements and a 75-g oral glucose tolerance test (OGTT) were performed. Results: On OGTT, 15 (7.5%) had IFG, 36 (18%) had IGT and 18 (9%) had type 2 DM; in addition, 96 (48%) had HT and 76 (38%) had HL. Upon multivariate logistic regression analysis, age was a common risk factor for IGT, type 2 DM, HT and HL, and a family history of diabetes was an additional risk factor for type 2 DM. Conclusion: The duration of obesity, as reported by women presenting for treatment of obesity, is not a risk factor for type 2 DM, HT and HL

NEUROENDOCRINOLOGY LETTERS

Acromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eighteen acromegaly patients (7 male, 11 female, mean age 42.8 +/- 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH, insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH = 2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 +/- 0.90 vs. 8.58 +/- 5.55 ng/mL, p=0.002), IGF-1 (338.30 +/- 217.90 vs. 509.60 +/- 293.58 ng/dL, p=0.06), GH after an OGTT (1.42 +/- 0.81 vs. 9.01 +/- 4.53 ng/mL, p=0.001), plasma homocysteine (12.85 +/- 4.47 vs. 18.20 +/- 4.99 mu mol/L, p=0.05), total cholesterol (164.0 +/- 20.81 vs. 188.0 +/- 22.26 mg/dL, p=0.05) and LDL cholesterol (81.0 +/- 9.64 vs. 116.70 +/- 13.03 mg/dl, p=0.01). Differences between the other parameters were not significantly different. Acromegaly patients with high GH levels after an OGTT have much higher levels of homocysteine than patients with lower GH levels. The role of elevated homocysteine levels as an independent cardiovascular risk factor in the mortality of acromegaly patients should be determined in future studies

TRACE ELEMENTS AND ELECTROLYTES

Objective: Iodine deficiency and related disorders are still major public health problems, with a high prevalence of endemic goiter in many regions of Turkey. In addition to measuring iodine excretion rates in patients with diffuse or nodular goiter, we examined plasma selenium concentrations, to see whether selenium deficiency might be related to goiterogenesis in our region. Methods: Seventy-two outpatients with goiter (67 female, 5 male; age 43.7 +/- 13.0 years) presenting consecutively to our university medical center endocrinology clinic, were included in the study group. The control group consisted of 30 subjects (25 female, 5 male; age 40.6 +/- 13.6 years) who were healthy and did not have any known thyroid disease. None of the subjects were using medications containing selenium or iodine. Serum thyroid hormones, plasma selenium and urinary iodine levels were measured, and an ultrasound of the thyroid was performed in both groups. Results: Serum thyroid hormone levels were in the normal range in both groups and the difference was not significant. Mean plasma selenium levels in the study and control groups were not significantly different (p = 0.30). However, urinary iodine excretion was significantly lower in the study group (17.4 +/- 12.6 mug/l vs 23.2 +/- 12.2 mug/l, p = 0.03). In both study and control group patients, a significant negative correlation between thyroid volume and urinary iodine levels was observed. Conclusion: Moderate to severe iodine deficiency is the primary etiologic factor for endemic goiter in our region. Plasma selenium levels were not related to the presence or absence of goiter in our population

NEUROENDOCRINOLOGY LETTERS

The normal functions of the pituitary gland may be suppressed when the gland is compressed onto the sella floor by arachnoid tissue extending through an impaired sella diaphragm. Interestingly, pituitary hormone hypo- and hypersecretion, including acromegaly, have been observed in patients with an 'empty sella' (1-4). This 'empty sella syndrome' has been classified into a primary form, in which no inciting factor (pituitary irradiation or surgery for a pituitary tumor) is present, and a secondary form, in which the empty sella occurs after pituitary procedures. In this report we describe a patient who presented with clinical and biochemical features of acromegaly and who had an empty sella on pituitary magnetic resonance imaging (MRI)

Plasma selenium and urinary iodine in patients with goiter

Objective: Iodine deficiency and related disorders are still major public health problems, with a high prevalence of endemic goiter in many regions of Turkey. In addition to measuring iodine excretion rates in patients with diffuse or nodular goiter, we examined plasma selenium concentrations, to see whether selenium deficiency might be related to goiterogenesis in our region. Methods: Seventy-two outpatients with goiter (67 female, 5 male; age 43.7 +/- 13.0 years) presenting consecutively to our university medical center endocrinology clinic, were included in the study group. The control group consisted of 30 subjects (25 female, 5 male; age 40.6 +/- 13.6 years) who were healthy and did not have any known thyroid disease. None of the subjects were using medications containing selenium or iodine. Serum thyroid hormones, plasma selenium and urinary iodine levels were measured, and an ultrasound of the thyroid was performed in both groups. Results: Serum thyroid hormone levels were in the normal range in both groups and the difference was not significant. Mean plasma selenium levels in the study and control groups were not significantly different (p = 0.30). However, urinary iodine excretion was significantly lower in the study group (17.4 +/- 12.6 mug/l vs 23.2 +/- 12.2 mug/l, p = 0.03). In both study and control group patients, a significant negative correlation between thyroid volume and urinary iodine levels was observed. Conclusion: Moderate to severe iodine deficiency is the primary etiologic factor for endemic goiter in our region. Plasma selenium levels were not related to the presence or absence of goiter in our population

Risk Factors For Postoperative Atrial Fibrillation

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