International Journal of Endocrinology and Metabolism
Year:2017 | Volume:15 | Issue:2|Papers Count:10

Introduction: We present a rare case of chylothorax associated with an intrathoracic goiter in Graves’ disease that was treated with radioactive iodine.Case Report: A 23-year-old woman with Graves’ disease was referred to our clinic with a pleural effusion, dyspnea, characteristic bilateral proptosis, and a diffuse goiter. The pleural fluid biochemistry was consistent with chylothorax. However, the chylothorax did not decrease with conservative therapy. Therefore, RAI was administered. Subsequently, the chylothorax and goiter improved more quickly than expected.Conclusions: This case illustrates that chylothorax associated with a substernal goiter in Graves’ disease can be treated successfully with radioactive iodine instead of surgery.

This study aimed to determine the parental correlates of body weight status among adolescents in Tehran. The participants were 465 high school students and their parents who resided in Tehran. Body weight and height of the students were measured, and body mass index (BMI) -for-age and body weight status of the students were determined according to the world health organization growth reference (2007). Parents of the students completed a self-administered questionnaire including socio-demographic information, self-reported parental body weight and height, and parental perception of student’s body weight status. About half of the parents had an incorrect perception about body weight status of their children with higher rates of underestimation than overestimation. The percentage of parents who correctly perceived body weight status of the students decreased from 100.0% in severe thinness group to 14.0% in obese group. There were no significant associations between marital status, occupation, and education of parents and BMI-for-age of the students. While, both BMI of mother and BMI of father were significantly associated with students’ BMI-for-age (r=0.29 and r=0.27, respectively; P<0.05). A great number of parents had incorrect perception regarding body weight status of their offspring; this was true specifically for parents of overweight and obese students. Both parental BMI and parental perception regarding students’ body weight status were associated with students’ BMI-for-age, indicating the need for parental involvement in weight management programs targeting adolescents.

Background: Racial/ethnic disparities in the associations of body fatness with hormones and metabolic factors remain poorly understood.Therefore, we evaluated whether the associations of overall and central body fatness with circulating sex steroid hormones and metabolic factors differ by race/ethnicity.Methods: Data from 1, 243 non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican-American (MA) adultmenin the third national health and nutrition examination survey (NHANES III) were analyzed. Waist circumference (central body fatness) was measured during the physical examination. Percent body fat (overall body fatness) was calculated from bioelectrical impedance. Associations were estimated by using weighted linear regression models to adjust the two measures of body fatness for each other.Results: Waist circumference, but not percent body fat was inversely associated with total testosterone and SHBG in all three racial/ethnic groups after their mutual adjustment (all P<0.0001). Percent body fat (P=0.02), but not waist circumference was positively associated with total estradiol in NHB men; no association was present inNHWand MA men (P-interaction=0.04). Waist circumference, but not body fat was strongly positively associated with fasting insulin (all P<0.0001) and inversely associated with HDL cholesterol (all P 0.003) in all three racial/ethnic groups. Both percent body fat and waist circumference were positively associated with leptin (all P<0.0001) in all three racial/ethnic groups.Conclusions: There was no strong evidence in the associations of sex hormones and metabolic factors with body fatness in different racial/ethnic groups. These findings should be further explored in prospective studies to determine their relevance in racial/ethnic disparities of chronic diseases.

Background: Constitutional delay of growth and puberty (CDGP) can cause significant psychological distress in adolescent boys.Although testosterone usage in this group has not been shown to affect the final adult height, the effect on the first year height velocity has not been widely reported.Objectives: The aim is to determine whether testosterone treatment improves the first year height velocity in boys with CDGP when compared to boys with CDGP who go through puberty spontaneously Methods: Retrospective data from 23 adolescent boys with CDGP was analysed. Ten out of 23 boys (43%) received testosterone injection (testosterone enanthate, 125 mg), once every 6 weeks for 3 doses in total. Both the groups (treated and untreated) had their height, bone age and testicular volume measured at the baseline, The height velocity and final predicted adult height were compared at the end of one year between both the groups.Results: In the testosterone-untreated group, the mean (-SD) chronological age, bone age, height standard deviation scores (SDS) and testicular volume were 14.3 years (- 0.3), 12.1 years (- 1.6), -1.9 (- 0.8) and 4.7 mL (- 1.1) respectively. Within the testosteronetreated group the mean (- SD) chronological age, bone age, height SDS and testicular volume at presentation were 14.4 years (- 0.4), 11 years (- 1.6), -2.1 SD (- 0.6) and 4.5 mL - 1.2) respectively. The mean age of treatment with testosterone was 14.4 years (- 0.44). Themeanheight velocity one year after treatment was 8.4 cm/year (-1.7) in the testosterone treated groupwhencompared to 6.1 cm/year (-2.1) in the patients who did not receive treatment (P=0.01). There was no significant difference in the final predicted height between the 2 groups (P=0.15).Conclusions: Testosterone therapy improves the first year height velocity in boys with CDGP, without influencing their final predicted height.

Context: The present review aimed at reviewing the effects of different statins on lipid profile, particularly in Asians.Evidence Acquisition: PubMed searches were conducted using the keywords ‘statin, effect, and lipid profile’ from database inception through March 2016. In this review, 718 articles were retrieved from the primary search. After reviewing the titles, abstracts, and full texts, we found that 59 studies met our inclusion criteria. These also included subsequent reference searches of retrieved articles.Results: CURVES study compared the effect on lipid profile between atorvastatin and other statins. This study demonstrated that low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TG) were reduced more with atorvastatin compared to simvastatin, pravastatin, lovastatin, and fluvastatin. However, simvastatin provided a greater elevation of high-density lipoprotein cholesterol (HDL-C) compared to atorvastatin. The STELLAR trial was based on dose-to-dose comparisons between atorvastatin and rosuvastatin efficacy in reducing LDL-C. Te present study also revealed that as the doses of rosuvastatin, simvastatin, and pravastatin increased, HDL-C also increased, with rosuvastatin having the greatest effect. However, HDL-C levels decreased as the dose of atorvastatin increased. The DISCOVERY study involving the Asian population revealed that the percentage of patients achieving the European goals for LDL-C and TC at 12 weeks was higher in rosuvastatin group compared to atorvastatin group.Conclusions: The effects of statins on lipid profile are dose dependent. Most studies showed that rosuvastatin has the best effect on lipid profile. Prescribing lower doses of statins in Asians seems necessary.

Background: Serum levels of triglycerides (TGs) are often found to be raised in type 2 diabetes mellitus (T2DM). TG levels³ 2.2 mM, systemic inflammation and oxidative stress (OS) are known to increase the risk of incident cardiovascular disease (CVD) substantially.In recent years, apolipoprotein A-V (Apo A-V protein) has attracted considerably as a modulator of circulating TG levels.Objectives: The study was conducted in order to evaluate the levels of Apo A - V proteins and markers of inflammation and OS in patients of T2DM with and without hypertriglyceridemia (HTG) and also to assess correlation between them.Methods: T2DM patients were categorized into two groups of 40 participants, according to criteria for risk of CVD: group 1/ controls (TG£ 1.65 mM, n=40) and group 2/ cases (TG ³ 2.2 mM, n=40). Despite the routine investigations, serum levels of Apo A-V, interleukin-6 (IL-6) and Insulin were estimated using ELISA, free fatty acids (FFA) with fluorometric assay and malondialdehyde (MDA) was measured using a spectrophotometer. Comparison of levels and correlation between variables was carried out with appropriate statistical tools.Results: Serum Apo A-V protein levels were found significantly lower (P=0.04) and MDAwas significantly higher (P=0.049) in cases.MDA correlated with TG levels positively (P=0.000) and negatively with high density lipoproteins (HDL) (P=0.000). However Apo A-V protein levels did not correlate with TG levels (P=0.819, r=-0.027), IL-6 (r=0.135, P=0.269), FFA (r=0.128, P=0.277) and MDA (r =-0.217, P=0.073). IL-6 levels significantly and positively correlated with HOMA-IR (r=0.327, P=0.004) in the all patients.Conclusions: In patients of T2DM, low levels of Apo A-V are associated with HTG, indicating that Apo A-V is linked with TG metabolism. Burden of oxidative stress is greater in HTG of T2DM as is evident from MDA levels and its correlation with TG levels.Since oxidative stress is an important patho-physiological basis which increases the risk of CVD in patients of T2DM with HTG.Further studies are required in order to explore the possible role of Apo A-V in TG metabolism in diabetes.

Context: There are contradictory results on the effect of hypothyroidism on the changes in hemostasis. Inadequate populationbased studies limited their clinical implications, mainly on the risk of venous thromboembolism (VTE). This paper reviews the studies on laboratory and population-based findings regarding hemostatic changes and risk of VTE in hypothyroidism andautoimmune thyroid disorders.Evidence Acquisition: A comprehensive literature search was conducted employing MEDLINE database. The following words were used for the search: Hypothyroidism; thyroiditis, autoimmune; blood coagulation factors; blood coagulation tests; hemostasis, blood coagulation disorders; thyroid hormones; myxedema; venous thromboembolism; fibrinolysis, receptors thyroid hormone.The papers that were related to hypothyroidism and autoimmune thyroid disorder and hemostasis are used in this review.Results: Overt hypothyroidism is more associated with a hypocoagulable state. Decreased platelet count, aggregation and agglutination, von Willebrand factor antigen and activity, several coagulation factors such as factor VIII, IX, XI, VII, and plasminogen activator-1 are detected in overt hypothyrodism. Increased fibrinogen has been detected in subclinical hypothyroidism and autoimmunethyroid disease rendering a tendency towards a hypercoagulability state. Increased factor VII and its activity, and plasminogen activator inhibitor-1 are among several findings contributing to a prothrombotic state in subclinical hypothyroidism.Conclusions: Overt hypothyroidism is associated with a hypocoagulable state and subclinical hypothyroidism and autoimmune thyroid disordersmayinduce a prothrombotic state. However, there are contradictory findings for the abovementioned thyroid disorders.Prospective studies on the risk of VTE in various levels of hypofunctioning of the thyroid and autoimmune thyroid disorders are warranted.

Background: High-risk individuals for CHD could be diagnosed bysomenon-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ).Objectives: The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population.Methods: Participants comprised of 5431 individuals aged 30 years within the framework of Tehran lipidandglucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) History-Rose-ECG- (the reference group); (2) History-Rose+ECG-; (3) History-Rose-ECG+; (4) History-Rose+ECG+; and (5) History+. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors.Results: Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History+and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for History-Rose+ECG-, History-Rose-ECG+, and History-Rose+ECG+, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG.Conclusions: RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.

Background: Emerging evidence suggests that an increased arginase activity is involved in vascular dysfunction in experimental animals.Zingiber officinale Roscoe, commonly known as ginger, has been widely used in the traditional medicine for treatment of diabetes.Objectives: This study aimed at investigating the effects of the hydroalcoholic extract of Z. officinale on arginase I activity and expression in the retina of streptozotocin (STZ) -induced diabetic rats.Methods: In this experimental study, 16 male Wistar rats weighing 200 – 250 g were assessed. Diabetes was induced via a single intraperitoneal injection of STZ (60mg/kgbodyweight). The ratswererandomlyallocated into four experimental groups. Untreated healthy and diabetic controls received 1.5 mL/kg distilled water. Treated diabetic rats received 200, and 400 mg/kg of theZ. officinale extract dissolved in distilled water (1.5 mL/kg). Body weight, blood glucose and insulin concentration were measured by standard methods. The arginase I activity and expression were determined by spectrophotometric and western blot analysis, respectively.Results: Our results showed that blood glucose concentration was significantly decreased in diabetic rats treated with the extract compared to untreated diabetic controls (P<0.01). Treatment with 400 mg/kg of the extract reduced arginase I activity and expression (P<0.05). A significant elevation in body weight was observed in diabetic rats treated with the extract. Serum insulin was significantly increased in diabetic rats treated with 400 mg/kg of the extract compared to diabetic controls (P<0.05).Conclusions: Our results suggest that the Z. officinale hydroalcoholic extract may potentially be a promising therapeutic option for treating diabetes-induced vascular disorders, possibly through reducing arginase I activity and expression in the retina.

Context: Controlling diabetes, a worldwide metabolic disease, by effective alternative treatments is currently a topic of great interest.Camel milk is believed to be a suitable hypoglycemic agent in experimental animals and patients with diabetes. The current systematic review aimed at evaluating the effect of camel milk on diabetes.Evidence Acquisition: A comprehensive search was dine in PubMed and Scopus for all clinical trials and animal studies documented up to 2015, which focused on the effect of camel milk on diabetes markers. Studies which assessed the effects of camel milk, with no dose limit, on glucose parameters and lipid profiles in animals or humans with diabetes, were included. The quality of the included clinical trials was evaluated by the Delphi score checklist.Results: The initial search yielded 73 articles. After screening abstracts and full texts, 22 articles were included consisting of 11 animal studies and 11 clinical trials, 8 of which focusedontype 1 diabetes and the other three on type 2diabetes. All animal studies except for 1 show edsignificant reductions in at least 1 of the diabetes parameters such as blood glucose, insulin resistance, glycated hemoglobin, and lipid profile. In most of the clinical trials, the recommended dose of camel milk was 500 mL/day, which led to improvement of diabetes markers even after 3 months in patients with diabetes.Conclusions: Most of the studies in the current systematic review demonstrated the favorable effects of camel milk on diabetes mellitus by reducing blood sugar, decreasing insulin resistance and improving lipid profiles.