Insulin, Glucagon and Growth Hormone and CIMT in Glucose Intolerance

Objective: There is an increasing evidence that glucagon and growth hormone (GH)-insulin-like growth factor (IGF) axis may play an important role in glucose metabolism since early stages of glucose intolerance. Carotid intima media thickness is a marker for subclinical atherosclerosis. We aimed to evaluate glucagon, GH and IGF-1 in prediabetic states and their relationship with carotid intima media thickness. Methods: One hundred subjects underwent a 75 gr oral glucose tolerance test and were divided into 4 groups according to their state of glucose tolerance: (i) normal glucose tolerance (NGT)/Controls (n=21), (ii) impaired glucose tolerance (IGT) (n=35), (iii) impaired fasting glucose (IFG) (n=22), (iv) type 2 diabetes mellitus (n=22). Insulin, glucagon and GH were measured at 0, 60 and 120. minutes of OGTT and their area under the curve (AUC) were calculated. Fasting IGF-1 levels and carotid intima media thickness were determined in all participants. Results: AUC for Glucagon was significantly higher in subjects with IGT, IFG and type 2 diabetes mellitus compared to NGT subjects. AUC for GH was significantly higher in subjects with IFG compared to subjects with IGT, type 2 diabetes mellitus and NGT. Plasma IGF-1 levels were significantly lower in subjects with abnormal glucose tolerance. CIMT was significantly higher in IFG group and CIMT was found to be negatively correlated with IGF-1 levels in subjects with IFG. Conclusion: There are pathological alterations of glucagon, GH-IGF-1 and insulin in prediabetic stages. Among these alterations insulin resistance and IGF-1 are associated with CIMT. Further studies needed to investigate the role of treatments targeting insulin sensitivity will have an impact on the association between insulin and early atherogenesi

Neuropsychological Changes and Health-related Quality of Life in Patients with Asymptomatic Primary Hyperparathyroidism

Purpose: Data about neuropsychological impairment and health-related quality of life (HRQOL) in patients with asymptomatic primary hyperparathyroidism (APHPT) is limited. We aimed to investigate the HRQOL, neuropyschological impairment, including depression, anxiety in patients with APHPT who have mildly elevated serum calcium (Ca) levels. Material and Method: Thirty-seven patients with APHPT and 37 controls were included. The Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and the General Health Questionnaire were administered in all patients, HRQOL was investigated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Results: Serum levels of Ca and parathyroid hormone (PTH) were significantly higher in patients than in controls [(10.92 +/- 0.66 vs. 9.49 +/- 0.66, p= 0.016, and 133 (34-736) vs. 52.95 (25-75.50), p< 0.001), respectively]. The levels of serum vitamin D were lower in patients than in controls [12.85 (4.0-62.50) vs. 20.30 (5.90-55.00), p= 0.041)]. The patient group had higher BDI scores than controls (12.49 +/- 10.34 vs. 7.46 +/- 5.33, p= 0.011). Patients with APHPT showed lower scores in SF-36 mental health (60.55 +/- 20.75 vs. 69.62 +/- 14.31, p= 0.034), SF-36 physical functioning (55.83 +/- 27.30 vs. 75.67 +/- 24.18, p= 0.002), SF-36 social functioning (66.32 +/- 27.69 vs. 82.08 +/- 14.89, p= 0.003), and SF-36 emotional role functioning (42.55 +/- 37.85 vs. 69.30 +/- 35.43, p= 0.003). The patients showed higher STAI-1 scores (39.95 +/- 11.52 vs. 34.70 +/- 8.01, p= 0.026). We observed that STAI-1 score positively correlated with serum Ca level (r= 0.391; p= 0.018); and PTH (r= 0.341; p= 0.042). Discussion: Our study demonstrated that patients with APHPT have more depressive and anxiety symptoms and lower HRQOL. Our results suggest that HRQOL and neuropsychological changes should also be considered during the clinical follow-up of patients with APHT

Value of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology

Background/aim: This study was performed to assess the diagnostic accuracy of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology and to differentiate Graves' disease from Hashimoto's thyroiditis. Materials and methods: Thirty patients with Hashimoto's thyroiditis and 22 patients with Graves' disease were evaluated with conventional ultrasonography and shear wave elastography by virtual touch tissue imaging quantification. Thirty healthy participants formed the control group. Ten elastographic measurements of each thyroid lobe were performed in all three study groups. The mean shear wave velocity was calculated and compared between the patients and controls. Results: The mean shear wave velocity of the controls (1.92 +/- 0.14 m/s) was significantly lower than that of the patients with Graves' disease (2.71 +/- 0.22 m/s) and Hashimoto's thyroiditis (2.50 +/- 0.20 m/s). Patients with Graves' disease had significantly higher shear wave velocities than those with Hashimoto's thyroiditis (P < 0.001). Conclusion: Shear wave elastography by virtual touch tissue imaging quantification can be used to discriminate a normal thyroid gland from diffuse thyroid gland pathology after conventional sonography and may assist in the diagnosis of Graves' disease and Hashimoto's thyroiditis

Evaluation of ambulatory arterial stiffness index in hyperthyroidism

Background/aim: Hyperthyroidism causes hemodynamic changes that are associated with adverse cardiovascular outcomes. Twentyfour-hour ambulatory blood pressure monitoring recordings provide us with some essential data: BP variability and ambulatory arterial stiffness index (AASI). In this study, we aimed to investigate AASI and short-term BP variability in both overt and subclinical hyperthyroidism and their relationship with thyroid hormones. Materials and methods: We enrolled 36 patients with subclinical hyperthyroidism, 23 patients with overt hyperthyroidism, and 25 healthy euthyroid controls. ABPM recording was performed for 24 h for all patients. Results: There were no statistically significant differences among the overt hyperthyroidism, subclinical hyperthyroidism, and control groups in terms of AASI (0.43 +/- 0.15, 0.38 +/- 0.12, 0.42 +/- 0.13, respectively; P = 0.315). Variability of diastolic BP was significantly higher in patients with overt hyperthyroidism than in patients with subclinical hyperthyroidism (14.8 +/- 2.6 vs. 12.8 +/- 2.5\%, P = 0.023). There were significant positive correlations between AASI and fT3 (r = 0.246, P = 0.02) and fT4 (r = 0.219, P = 0.04) while TSH was not correlated with AASI (r = 0.023, P = 0.838). After adjusting for confounders, age, 24-h systolic and diastolic BP, variability of systolic and diastolic BP, and fT4 were independent predictors of AASI (r2 = 0.460, P < 0.001). Conclusion: Although AASI did not differ between overt and subclinical hyperthyroidism, there was a positive relationship between AASI and free thyroid hormone levels. Furthermore, short-term BP variability was higher in overt hyperthyroidism than in subclinical hyperthyroidism

A Case Report of Bilateral Adrenal Sarcomatoid Carcinoma.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Sarcomatoid adrenal carcinoma is even more aggressive type of ACC. Bilateral malignant adrenal tumors are extremely rare except for those that represent metastasis from an extra-adrenal organ. Here we report a 53-year-old woman who presented with abdominal pain and weight loss. Abdominal computed tomography revealed bilateral adrenal masses and a mass in her liver. Surgical specimens showed pleomorphic tumor cells with epithelial and spindle cell morphology and immunohistochemical staining was compatible with sarcomatoid carcinoma. Sarcomatoid adrenal carcinoma should be kept in mind during the management of bilateral adrenal masses

Evaluation and follow-up of patients diagnosed with hypophysitis: a cohort study

Objective Primary hypophysitis might be challenging to diagnose, and there is a lack of evidence regarding optimal treatment strategies due to rarity of the disease. We aim to investigate the clinical features and compare the outcomes of different management strategies of primary hypophysitis in a large group of patients recruited on a nationwide basis.Design A retrospective observational study.Methods The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed.Results One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%.Conclusion The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases

Prevalence of Vitamin D Deficiency and Hypervitaminosis D Among Adult Patients Admitted to the Tertiary Care Hospitals in Turkey

Objective: Vitamin D deficiency is a common health problem around the world. This study aimed to evaluate the nationwide prevalence of vitamin D status in tertiary care hospitals in Turkey