Akromegalia może wiązać się z zaburzeniami rozkurczu dolnego zwieracza przełyku (LES)

  Introduction: Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients. Material and methods: The study was performed in an institutional referral centre at a tertiary care hospital. Twenty-three acromegaly patients (mean age 43.2 ± 13.2 years) and 25 sex- and age-matched healthy control subjects (mean age 48.6 ± 7.9 years) were recruited to a case-control study. Oesophageal manometry was performed using MMS (Medical Measurement Systems, Netherlands) Solar GI — Air Charged Intelligent Gastrointestinal Conventional Manometry. Results: In manometric measurements the lower oesophageal sphincter pressure was 18 ± 7 mmHg in acromegaly patients and 15.6 ± 4.4 mm Hg in controls, and there was no significant difference (p = 0.17). The percentage of relaxation was 64.8% and 81.8%, respectively, and it was significantly lower in acromegaly patients than in controls (p < 0.001). Additionally, the duration of relaxation was found to be 4 ± 1.9 seconds and 5 ± 1.7 seconds in patients and controls, respectively (p = 0.049). Conclusions: Our study has demonstrated a significant reduction in the percentage and duration of lower oesophageal sphincter relaxation in oesophagus motility even in acromegaly patients without any gastrointestinal symptoms. Further clinical and pathophysiological studies are required to clarify the underlying mechanisms of gastrointestinal motility disorders in acromegaly. (Endokrynol Pol 2015; 66 (4): 308–312)    Wstęp: Chociaż u pacjentów chorujących na akromegalię wykazano wydłużony czas pasażu żołądkowo-jelitowego, wpływ akromegalii na motorykę przełyku oraz powiązane z tym mechanizmy patologiczne nadal nie są wyjaśnione. Celem pracy było zbadanie za pomocą pomiarów manometrycznych czy motoryka przełyku ulega zmianie u pacjentów z aktywną akromegalią. Materiał i metody: Badanie przeprowadzono w ośrodku referencyjnym w szpitalu specjalistycznym. Dwudziestu trzech pacjentów chorujących na akromegalię (śr. wiek 43,2 ± 13,2 lat) oraz w grupie kontrolnej 25 osób dopasowanych pod względem płci i wieku (śr. wiek 48,6 ± 7,9 lat) zostało zakwalifikowanych do badania kliniczno-kontrolnego. Manometrię przełyku wykonano za pomocą MMS (Medical Measurement Systems, Holandia) Solar GI. Wyniki: W pomiarach manometrycznych u pacjentów ciepiących na akromegalię, ciśnienie dolnego zwieracza przełyku wynosiło 18 ± 7 mm Hg, a u osób kontrolnych wynosiło ono 15,6 ± 4,4 mm Hg, nie było więc znaczącej różnicy między grupami (p = 0,17). odsetek rozkurczu wynosił odpowiednio 64,8% i 81,8% i był on znacznie niższy u pacjentów z akromegalią (p < 0,001). Ponadto, długość trwania rozkurczu wynosiła odpowiednio 4 ± 1,9 sek. i 5 ± 1,7 sek. (p = 0,049). Wnioski: Niniejsze badanie wykazało znaczną redukcję odsetka i czasu trwania rozkurczu dolnego zwieracza przełyku w motoryce przełyku, nawet u pacjentów z akromegalią bez objawów żołądkowo-jelitowych. Należy przeprowadzić dalsze badania kliniczne i patofizjologiczne, aby wyjaśnić mechanizmy leżące u podłoża zaburzeń motoryki żołądkowo-jelitowej u pacjentów chorujących na akromegalię. (Endokrynol Pol 2015; 66 (4): 308–312)

The Impact of Propylthiouracil Therapy on Lipid Peroxidation and Antioxidant Status Parameters in Hyperthyroid Patients

This study was performed on 17 hyperthyroid patients and 15 healthy controls. The patients were under propylthiouracil (PTU) therapy at a dosage of 3 x 100 mg/day for one month. Blood samples, taken at the beginning and on the 30th day of therapy, were analyzed for hormonal parameters (T3, T4, TSH), lipid peroxidation endproduct [thiobarbituric acid reactive substances (TBARS)] and antioxidant status parameters: glutathione (GSH), glutathione peroxidase (GSH-Px) and CuZn superoxide dismutase (CuZn SOD). Hyperthyroid patients were observed to have significantly higher TBARS, GSH and CuZn SOD levels than controls (P &#60; 0.05, P &#60; 0.001, P &#60; 0.001, respectively). PTU therapy caused a relief in oxidative stress as reflected by significantly decreased TBARS levels (P &#60; 0.001) and a selective modification in the antioxidant status parameters: significant decreases in GSH and CuZn SOD levels (P &#60; 0.001) and a significant increase in GSH Px (P &#60; 0.01) activity. Our findings suggest a selective modification of the antioxidative profile in hyperthyroidism. PTU should also be considered as an in vivo antioxidant, in addition to its antithyroid action.</p

Effect of stressful life events on the initiation of graves' disease

Objective. The aim of this study was to investigate the relationship between stressful life events (LESs) and its effect on the initiation of Graves' disease (GD) and toxic nodular goitre (TNG). Patients and method. Forty-five patients with GD, 24 patients with TNG and 36 healthy control (CG) were included to the study. Graves and TNG patients had diagnosed within the last 12 months, with clinical and biochemical confirmation in Endocrinology Metabolism Outpatient Clinic of Cerrahpasa Medical School. The Holmes-Rahe Stress Scale and the Life Experience Survey (LES) was the psychological evaluation instrument used in this study. Results. There was no significant difference according to Holmes-Rahe scale (Graves & TNG P = 0.329, Graves & Control P = 0.115, TNG and control P = 0.571). According to LES scale when negative event number, positive event number, neutral events and their effects are considered, between Graves and TNG groups no statistically difference was observed (P = 0.139, P = 0.083, P = 0.167, P = 0.162, P = 0.861). The number and impact of negative SLEs were significantly higher in GD compared to CG (P = 0.015, P < 0.001). Conclusion. According to LES scale GD patients has significant difference with respect to CG when negative event number and impact are considered

Evaluation of Androgen Levels in Patients with Acute Coronary Syndrome

Objectives: To determine plasma levels of free Testosterone (fT) and dehydroepiandrosterone sulphate (DHEA-S) in male patients with acute coronary syndrome. Methods: We checked the serum fT and DHEA-S levels of 30 healty male subjects and 64 male patients with acute coronary syndrome whose coronary artery diseases were confirmed by coronary angiography. Results: We observed no difference between two groups on the level of fT while DHEA-S level was significantly lower (p = 0.01). No correlation had existed between lipid parameters and levels of fT and DHEA-S. Conclusion: More comprehensive studies are needed about whether lower levels of DHEAS in patients are contributed to acute coronary syndrome or are the effect of disease. [Med-Science 2012; 1(4.000): 323-30

Polymorphism of the NFKB1 affects the serum inflammatory levels of IL-6 in Hashimoto thyroiditis in a Turkish population

Hashimoto thyroiditis (HT) is a chronic inflammatory autoimmune disease of thyroid gland affected by interaction of multiple genes and various cytokines. Variants in the genes coding for the NFKB and IKB proteins can be potentially involved in the development of the inflammatory diseases. NFKB, a key transcription factor of the regulation of immune responses, is interesting candidate for association studies about autoimmune disorder

Propylthiouracil-induced Anti-neutrophil Cytoplasmic Antibodies and Agranulocytosis together with Granulocyte Colony-stimulating Factor Induced Sweet's Syndrome in a Patient with Graves' Disease

Propylthiouracil (PTU) is an antithyroid drug which is known to cause drug-induced vasculitis. PTU is implicated in 80-90% of cases of anti-neutrophil cytoplasm circulating antibody (ANCA)-associated vasculitis caused by anti-thyroid drugs which induce ANCA production. Sweet's syndrome is characterized by fever, leucocytosis, neutrophilia and the sudden onset of painful skin lesions. The pathology of the disease is still unclear. Cytokine dysregulation including interleukin-6 and endogenous granulocyte colony-stimulating factor (G-CSF) are thought to play a role in the pathogenesis of Sweet's syndrome. PTU and G-CSF are known to cause Sweet's syndrome and other neutrophilic dermatosis. The presence of ANCA can have a diagnostic value in Sweet's syndrome. Systemic corticosteroids are the first-line therapy for both diseases. Here we report a female patient with Graves' disease who developed ANCA and Sweet's syndrome after using PTU and G-CSF

Measurment of Ankle-Brachial Pressure Index, Homocystein Level, and Evaluation of Coronary Artery Disease Association with Other Macrovascular Diseases in Patients with Myocardial Infarction

We aimed to measure ankle-brachial pressure index (ABPI) and homocysteine levels, and to evaluate frequency of cerebrovascular disease (CVD) and/or peripheral arterial disease (PAD) combination of patients with myocardial infarction (MI). 39 patients (26 males, 13 females) with acute or subacute MI and 36 control cases (9 male, 27 female) were included in the study. ABPI and homocysteine levels were measured, and bilateral carotid-vertebral and bilateral lower extremity arterial Doppler ultrasonography, and coronary angiography were examined. Homocysteine was significantly higher in patient group than control group (p=0.0001). The ABPI was not significantly different in two groups (p=0.428). However the frequency of patients with lower ABPI (&#8804;0.9) was significantly higher compared to the frequency of control patients with lower ABPI (25.6% and 3%, respectively; p=0.02). The combination of the atherosclerotic findings in the carotid artery and coronary artery disease (CAD) were found significantly higher compared to that of the bilateral lower extremity (59%, 25.6%). Screening of CVD should be done in patients with MI history. Determining carotid arterial lesions may be useful for the early diagnosis and treatment of any possible CVD in cases with CAD. Studies with larger numbers of cases are needed. [Med-Science 2013; 2(4.000): 896-906

Investigation of the Vitamin D Receptor Polymorphisms in Acromegaly Patients

Objective. The genetic structural alterations in the majority of somatotroph adenomas are not clarified and the search for novel candidate genes is still a challenge. We aimed to investigate possible associations between vitamin D receptor (VDR) polymorphisms and acromegaly. Design, Patients, and Methods. 52 acromegaly patients (mean age 45.7±1.9 years) and 83 controls (mean age 43.1±2.6 years) were recruited to the study. VDR polymorphism was determined by polymerase chain reaction-based restriction fragment length polymorphism methods. Results. The distribution of VDR genotypes showed a significant difference in the frequencies of VDR FokI genotypes between patients and controls (P=0.034). VDR FokI ff genotype was significantly decreased in acromegaly patients (P=0.035) and carriers of FokI Ff genotype had a 1.5-fold increased risk for acromegaly (OR: 1.5, 95% CI: 1.07–2.1; P=0.020). IGF1 levels after treatment were significantly higher in patients carrying the Ff genotype compared to carrying ff genotype (P=0.0049). 25(OH)D3 levels were significantly lower in acromegaly patients (P<0.001). Conclusions. Our study suggests that VDR FokI genotypes might affect the development of acromegaly and VDR polymorphisms may play a role in the course of acromegaly as a consequence of altering hormonal status

Serum IGF-1 and IGFBP-3 levels in subclinical hypothyroid women

Thyroid status is known to influence growth in mammals. The aim of this study is to investigate the possible relationship between autoimmune subclinical hypothyroidism and growth hormone (GH), insulin-like growth factor-1(IGF-1) and insulin-like growth factor binding protein-3(IGFBP-3) levels. Thirty-five women with autoimmune subclinical hypothyroidism, 33 years of age, were used as controls and enrolled in the study. Free triiodothyronin (FT3), free thyroxin(FT4), thyrotropin(TSH), anti-thyroid peroxidase(Anti-TPO), anti-thyroglobuline(Anti-Tg), GH, IGF-1 and IGFBP-3 levels were measured in blood samples and correlations among these parameters were evaluated. We found no significant differences in GH, IGF-1 or IGFBP-3 between patients and controls. In patients and controls, there were no correlations among thyroid hormones and IGF-1 or IGFBP-3 levels, but GH levels were correlated with FT3, FT4 and TSH only in patients' group. In controls, only IGF-1 and IGFBP-3 levels were correlated. The present study suggests that subclinical hypothyroidism with high TSH and antibody status does not affect IGF-1 and IGFBP-3 levels in adult women. To our knowledge, this is the first study concerning the relationship between autoimmune subclinical hypothyroidism and IGF-1 and IGFBP-3 levels