IRANIAN JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2006 | Volume:8 | Issue:2 (SN 30)|Papers Count:13

Introduction: Recent studies indicate a relationship between b-hCG and thyroid dysfunction. The aim of this study were evaluation of thyroid dysfunction in patients with hyperemesis gravidarum, evaluation of severity of hyperthyroidism, relation between b-hCG and hyperemesis gravidarum and outcomes of patients. Material and Methods: 135 patients with hyperemesis gravidarum admitted to Ob- Gyn hospital were selected and based on exclusion criteria, 103 pregnant women with hyperemesis gravidarum without any history of anti thyroid drugs consumption or other diseases were chosen. Each woman was examined for clinical signs of thyroid disease and underwent investigations for urine keton Na, k, liver function test, thyroid function test and diluted b-hCG. Results: 35 women had abnormal thyroid function tests with FT4l 4.74±0.54 and this in another group of 68 women was 2.9±0.39 (P<0.0001). b-hCGin the first group was 59406±14800 mU/mL and in the second was 6750±3476 mU/mL (P<0.0001). In 5 patients PTU was started due to the severe signs and symptoms of hyperthyroidism. Thyroid function tests (TFTS) were rechecked for other patients after 4 weeks routine therapy for hyperemesis gravidarum; TFTS normalized in 11 patients with hyperemesis gravidarum, but were abnormal in 22 patients, and PTU was started and anti-TPO anti-body was measured, which was positive in 3. Monthly TFT's were done and PTU was adjusted. Mean therapy was 2.76 months and 60.63 mg/d for Anti-TPO negative and 5.33 months and 170 mg/d for Anti-TPO positive patients. One month after delivery, thyroid function test was performed. PTU was continued in Anti-TPO positive patients but was discontinued in Anti-TPO negative during pregnancy with normal (TFTS) in all of the subjects following delivery. Conclusion: The prevalence of thyroid dysfunction in women with hyperemesis gravidarum was 35% of whom 20% needed low dose anti-thyroid theraphy of short duration, which resulted in significant improvement. A female predominance among offspring of mothers with hyperemesis gravidarum was seen, smilar to findings of other studies.

Introduction: Determination of thyrotropin, total and free thyroxine and triiodothyronine are widely used as diagnostic methods for thyroid function evaluation. There have been numerous reports of interferences in thyroid hormone immunoassays. Herein, a prominent positive interference is reported for a radioimmunoassay kit of total triiodothyronine. Materials and Methods: In this study, a total of 3471 patients, referred by endocrinologists, were examined by serum level measurement of thyroid stimulating hormone (TSH), total thyroxine (Td and triiodothyronine (T3).T3 analysis was made through a competitive solid-phase radio labeled (1125) immunoassay by T3 Izotop kit (Izotop Co. Budapest, Hungary). The presence of T3 assay interference was considered probable if the hormone profile was inconsistent with the clinical picture and/or the obtained value for T3 was extremely deviated from normal levels, i.e. it was above 780 ng/dL. For such patients, the possibility of T3 assay interference was investigated through re-measuring T3 level by another RIA kit (Immunotech kit, Marseille, France). Results: Among 3471 patients studied, 40 cases (36 women, 4 men), with a mean±Dage of 38.8±15.0 years, had T3 serum levels inconsistent with their clinical pictures and/or above 780 ng/dL. The mean serum levels of T4 and TSH in this group were 9.0%2.0 mg/Dl and 1.79±1.47mu/mL, respectively. In all these 40 cases, T3 level was in the normal range according to T3-lmmunotech kit (with a mean±SD of 132.k1±31.0 ng/dL), in accordance with their clinical pictures. Conclusion: Results clearly indicate the presence of positive interference(s) in some of T3 assays made with Izotop T3- RIA kits. The probable explanations for the observed positive interference are discussed.

Introduction: This study aims at determining the effects of the Dietary Approach to Stop Hypertension (DASH) eating plan on metabolic risks, in patients with metabolic syndrome. Materials and Methods: This was a randomized controlled outpatient trial conducted on 116 patients with metabolic syndrome. Three diets were prescribed for 6 months; a control diet, a weight reducing diet emphasizing on healthy food choice, and the DASH diet with reduced in calories and increased in fruit, vegetables, low fat dairies, whole grain and reduced in saturated fat, total fat, cholesterol and restricted to 2400 mg Na. The main outcome measures were the components of the metabolic syndrome. Results: Relative to the control diet, the DASH diet resulted in higher HDL (7 and 10 mg/dL), lower TG (-18 and -14 mg/dL), SBP (-12 and -11 mmHg), DBP (-6 and -7 mmHg), weight (-16,-14 Kg), FBS (-15 and -8 mg/dL), and weight (-16 and -15 kg), among men and women respectively. (all P<0.001). The net reduction among men and women in TG (-17 and -18 mg/dL), SBP (-11 and -11 mmHg), DBP (-5 and -6 mmHg) and FBS (-4 and -6 mg/dL), weight (-16,-15Kg) and increase in HDL (5 and 10 mg/dL) was higher in the DASH group (all p<0.05).The weight reducing diet resulted in significant change in TG(-13 and -10 mg/dL), SBP (-6 and -6 mmHg), weight (-13 and -12 kg) among men and women, respectively (all p<0.05). Conclusions: The DASH diet can likely reduce most of the metabolic risks both in men and women; the related mechanisms need further study.

Introduction: Because of the high prevalence of the metabolic syndrome in Iran, this study used factor analysis to examine how the major components of the metabolic syndrome relate to each other and the role of hyperlipidemia in Iranian subjects. Materials and Methods: 8990 subjects aged over 18 years, participants of the Tehran Lipid and Glucose Study, were selected. Anthropometry, blood pressure, serum glucose and lipid concentrations were measured to estimate the prevalence of the metabolic syndrome. Before and after excluding individuals with diabetes and hypertension, we used factor analysis to examine the pattern of the metabolic syndrome in 3956 men and 5034 women. Result: 26.6% of men and 36.3% of women had metabolic syndrome by ATPIII criteria and low HDL-C was the most frequent finding in subjects. Factor analysis reduced 8 anthropometric and metabolic variables into four uncorrelated factors. Four factors, which together account for 83.3% of the variance, can be identified: the first was obesity, blood pressure and hyperglycemia was second (hypertension) and the third factor was hypoglycemia. Dyslipidemia was the last factor and had a correlation with obesity. Conclusion: Findings support a concept in which the metabolic syndrome represents several distinct entities (dyslipidemia, obesity, hypertension and hyperglycemia) and obesity is the most important factor, having a strong correlation with dislipidemia in the Iranian population.

Introduction: Abdominal (central) adiposity is an outcome of changes in life styles and behaviors. This study aimed at determining the prevalence of central obesity and the associated factors in a population aged 20 to 70 years in an urban area of the Mazandaran province. Methods and Materials: A population based cross-sectional study was conducted with a sample of 3600 subjects in an urban area of the Mazandaran province using cluster sampling techniques in 2004. Anthropometric measures (height, weight, waist and hip circumference) were measured with standard methods and social, demographic, and some life style data such as age, sex, education level, occupation, marital status, marriage age, parental obesity, occupational activity, leisure time physical activity, exercise level and history of pregnancy and parity for women, were collected during interviews using questionnaires. To assess central obesity, we used a standard recommended WHO method based on waist circumference (WC). In statistical analysis, the logistic regression model was used to estimate the age adjusted odds ratio and its 95% confidence interval and P-value <0.05 was considered significant. Results: The mean (±SD) ages of men and women were 38.5±14.3, 37.5±13.0 years respectively. The mean (±SD) of WC was 89.3±11.5 for men and 87.8±13.6 for women. The prevalence of central obesity was 46.2% for women and 10.6% for men. The pattern of central obesity was significantly different in different age groups in both genders. The results of logistic regression model showed that the age adjusted odds ratio for central obesity was roughly 8.37, times greater in women compared with men (95% CI:7.03-10.21). The adjusted odds ratio decreased with increasing levels of education (P<0.0001) while the odds ratio was 0.20 for education at university level (95% CI: 0.14 - 0.28). The adjusted odds ratio increased 1.75 fold (95% CI: 1.55-2.05) in subjects with history of parental obesity; it tended to decrease with severe occupational activities (OR=0.39: 95% CI: 0.24-0.63), high physical activity level in leisure time (OR=0.84, 95%CI: 0.58-1.21) and exercise level >5 h/w (OR=0.67, 95% CI: 0.51- 0.87). The adjusted odds ratio also decreased significantly with marriage age and among women, it increased with parity while for >=5 parities, the age adjusted odds increased 3.3 fold (95% CI: 2.11- 5.17). Conclusion: These results revealed an increaliied rate of abdominal obesity in the adult urban population in particular for women; low levels of activity and low education, parity, family history of obesity, marriage at an earlier age, age and female gender are responsible for central obesity. Community-based multiple strategies are required to combat increasing rates of central obesity and the subsequent complications in the north of Iran.

Introduction: Urbanization, industrialization, and related lifestyle changes in and the dietary transition to high fat and calorie diets are leading causes of the worldwide obesity epidemic. The aims of this study were to assess prevalence of overweight and obesity among future physicians. Methods and Materials: A cross-sectional study involving 282 female students aged 18-26 years. Weight and height were measured to 0.1 kg and was 0.1 cm respectively. Other information regarding behavior and socioeconomic factors were obtained using a questionnaire during interviews. Physical activity was measured using the Bake questionnaire. Overweight was defined as BMI of 25.0 to 29.9 kg/m2 and BMI>= 30.0 kg/m2 was defined as obese. A waist circumference (WC) of >= 80 cm or waist-to-hip ratio (WHR) of >=0.8 was considered to represent central obesity. Results: Findings revealed that 12.8% of students were overweight, 0.4% obese and 8.1% underweight. Central obesity was 10.2% (using the WC) and 14.8% (using WHR) cut-offs. Over half the subjects lach understanding of appropriate weight for their age. History of obesity in childhood and adolescence were factors affecting current BMI. Conclusion: Results indicate a prevalence of both over weight and underweight exist in this student group, along with a lack of accurate information on appropriate weight ranges. Educational programs to increase awareness are recommended.

Introduction: Obesity is one of the most important public health problems of adolescents in developed countries. Recently, the prevalence of obesity has increased dramatically among adolescents of developing countries as a result of changes in life style and rapid growth of urbanization of societies. Considering that adolescent obesity is related to an increased adult morbidity and mortality, the present study was carried out in high school girls aged 14-17 years living in Lahijan in 2000-2001 to determine the pattern of fat distribution and its relationship with Body Mass Index (BMI). Materials and Methods: In this descriptive-analytical study, 400 students were selected by random stratified sampling. Weight, height, waist and hip circumferences were measured and BMI and WHR were calculated. Data were analyzed using the SPSS program and Pearson correlation and ANOVA tests. Results: The prevalence's of obesity and overweight were 5.3% and 14.8%, respectively. On the basis of WHR, 21.5% of subjects and 66.7% of obese girls had a central pattern of fat distribution. A significant positive correlation was found between BMI and WHR (r=0.35, P<0.0001). Conclusion: Results showed that in obese adolescent girls, fat deposition occurs in the body's central regions. Since central obesity has been associated with an increased risk of cardiovascular disease, hypertension and type 2 diabetes mellitus, implementation and monitoring of individual and groups nutritional and physical activity programs is recommended for this age group. (as individuals and groups).

Introduction: Diabetes mellitus is a common endocrine disorder; recently diabetic patients are being encouraged to increase their fiber intake. The main aim of this study was to determine the effect of rice bran on blood glucose levels and plasma lipids in type II diabetic patients. Materials and Methods: This study was a double blind clinical Trial. 60 non-smoking diabetic patients, with no history of renal or liver disorder, or hypertension were selected and randomly divided in to the intervention and control groups. The first group were given 10g soluble rice bran twice daily (morning and before sleeping) and the second group took placebos. Blood glucose and plasma lipids levels were measured before and after the study. Data were analyzed using t-test and t SPSS and Food processor software. Results: Fasting serum glucose levels reduced significantly from 177±69 mg/dL to 142±42 mg/dL (P<0.001). Triglyceride levies reduced and HDL levels increased significantly (P<0.001) and (P<0.01). LDL and cholesterol also reduced, though not significantly. Conclusion: While rice bran had a significant reducing effect on blood glucose and triglyceride levels it increased HDL levels.

Introduction: The prevalence of sexual dysfunction and marital dyssatisfaction is reported to be higher among diabetics than in the general population. Correlation between marital satisfaction and sexual dysfunction in these patients is controversial. This study assesses the correlation between marital satisfaction and sexual dysfunction in diabetic subjects. Materials and methods: In this cross-sectional study, 100 diabetics from a diabetes clinic in Shahrekord were selected.Presence of decreased libido and arousal sexual dysfunction were assessed in subjects, using the Laumann et al questionnaire. Golombok Rust linventory of Marital Satisfaction (GRIMS) was used to measure marital satisfaction. The mean score of the marital satisfaction was compared in subjects with and without each type of sexual dysfunction. Results: Decreased libido and arousal sexual dysfunction was seen in 76 (76%) and 32 (32%) subjects, respectively. Marital satisfaction was lower in those diabetics with decreased libido or arousal sexual dysfunction (p>0.05). Conclusion: According to this study, marital satisfaction is expected to be worse in diabetics with sexual dysfunction. It is therefore recommended that more attention be paid to diabetics with sexual dysfunction.

Introduction: Adenoma is one of the most common pituitary tumors, with diabetes Insipidus (DI) being one of the most common complications. This study was conducted with the following aims: a) determination of relative frequency of DI following hyphophyseal adenectomy, b) assessment of correlation between DI and some variables, c) study the clinical course of DI development after surgery of hyphophyseal adenoma. Materials and Methods: This prospective study was conducted between 1991-2001 in Baqyiatallah Hospital, Tehran, 50 Patients with pituitary adenoma without diabetes underwent trans-Sphenoidal (n = 35) or trans-cranial adenectomy (n = 15). Development, time of onset, duration of DI, and need to use Minirin was assessed in patients. DI was categorized to Immediate DI (IDI,S day 10) and Delayed DI (DDI,>day 10). Results: DI occurred in 15 cases (30%), of which, 10 had IDI (67%) and 5 cases had DDI (33%).DI developed in 5 (33.3%), 7 (46.6%), and 1 (6.6%) subjects, on days 1, 2 and 7 following their operation, respectively. DI was not correlated with sex, age and kind of surgery (p>0.05). DDI was seen more after trans-Cranial surgery than after trans-Sphenoid surgery (26.6%vs 2.8%, p=0.024). Of 15 cases of DI, 5 (33%) did not need Minirin,5 (33%) needed it just for one day, and 5 (33%) received it for 4-180 days (4, 11, 15, 62 and over 180 days). Conclusion: This study reported the relative frequency of hypophyseal adenectomy to be 33%. According to this study, one third of patients have self-limited DI and do not need drug therapy. However, we recommend that in patients with DI after these surgeries, early and routine prescription of Minirin should be avoided and treatment should be based on fluid replacement. This study also reported trans-Sphenoid surgery to be less frequently accompanied by DI, which seems to be an important factor in the selection of operation techniques for these surgeries.

Introduction: There is some evidence suggesting a probable beneficial effect of calcium intake on serum lipid profile. The objective of this study was to determine the effect of 1000 mg calcium supplementation for 30 days on serum lipid profiles in overweight or obese women. Materials and methods: A double blind randomized clinical trial was conducted in 44 overweight or obese adult women (Body mass index ³2Skg/m2, age: 25±6 years) randomly assigned to the calcium (receiving 1000 mg elemental calcium per day) or the placebo group. Serum lipids, lipoproteins and apolipoproteins including triglycerides, total cholesterol, HDL cholesterol, ApoA-I and Apo B were obtained at baseline and after the intervention period. Freidwald equation was used to calculate LDL cholesterol and VLDL cholesterol was calculated from TG divided by S. Dietary calcium and energy intake were estimated using 24 hour recall for 3 days. Statistical analyses were performed using SPSS software (version 9). P values < 0.05 were considered as statistically significant.Result: No significant differences were observed in dietary, anthropometric and serum variables between the two groups at the baseline. Although all serum total-, LDL cholesterol and triglycerides tended to increase in both study groups, total cholesterol elevation was only significant in the placebo group (p=0.01), and triglyceride and VLDL cholesterol only showed significant increase in the calcium group (p=0.03). LDL cholesterol elevation was significant in both groups (p<0.05); HDL cholesterol decreased significantly in both groups (p<0.01). Apolipoproteins did not change significantly in the study groups. No significant differences were observed in serum variables between groups after intervention. Conclusion: In the present study short term calcium supplementation in overweight or obese women's showed no beneficial effect on lipid profiles. Because of the limited studies available, further studies are recommended.