Advances in Endocrinology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Endogenous Glucagon-Like Peptide-1 as a Potential Mediator of the Resolution of Diabetic Kidney Disease following Roux en Y Gastric Bypass: Evidence and Perspectives Thu, 18 Sep 2014 00:00:00 +0000 Diabetic kidney disease in patients with type 2 diabetes strongly correlates with the incidence of major cardiovascular events and all-cause mortality. Pharmacological and lifestyle based management focusing on glycaemic, lipid, and blood pressure control is the mainstay of treatment but efficacy remains limited. Roux en Y gastric bypass is an efficacious intervention in diabetes. Emerging evidence also supports a role for bypass as an intervention for early diabetic kidney disease. This paper firstly presents level 1 evidence of the effects of bypass on hyperglycaemia and hypertension and then summarises emerging data on its effects on diabetic kidney disease. Glucagon-like peptide-1 is implicated as a central mediator of diabetes resolution following bypass through the incretin effect. It has been ascribed vasodilatory, pronatriuretic, and antioxidant properties and its exogenous administration or optimisation of its endogenous levels via dipeptidyl peptidase IV inhibition results in antioxidant and antiproteinuric effects in preclinical models of DKD. Some evidence is emerging of translation of coherent effects in the clinical setting. These findings raise the question of whether pharmacotherapy targeted at optimising circulating hormone levels may be capable of recapitulating some of the effects of bypass surgery on renal injury. Neil G. Docherty and Carel W. Le Roux Copyright © 2014 Neil G. Docherty and Carel W. Le Roux. All rights reserved. Decreased Bone Mineral Density in Patients Submitted to Kidney Transplantation Is Related to Age, Body Mass Index, Time on Dialysis, and Hyperparathyroidism Mon, 18 Aug 2014 11:13:24 +0000 Background. Renal transplantation (Tx) influences bone mineral density (BMD) by several mechanisms. The main objective of this study was to correlate BMD and risk factors associated with bone loss in patients submitted to kidney Tx. Methods. We evaluated 88 individuals after renal Tx (median time = 31.5 months since Tx). All of them sustained glomerular filtration rate ≥60 mL/min/1.73 m2. BMD was measured by dual-energy X-ray absorptiometry (DXA, Prodigy-GE). Calcium, phosphate, albumin, creatinine, and intact parathormone (PTH) were measured at the same time. All statistical tests were two-sided and value less than 0.05 were accepted as significant for all analyses in this study. Results. Serum PTH was raised in 42% patients, but corrected calcium was normal in 83 patients. No fragility fracture was reported, but the overall prevalence of osteoporosis was 27.6% and lower than expected BMD (Z-score ≤ −2.0 SD) was observed in 28.4%. Patients with lower than expected BMD had higher PTH levels. Conclusions. Older age, lower body mass index (BMI), longer time on dialysis, and elevated PTH levels were identified as the main factors associated with lower BMD. Miguel Madeira, Mário Sérgio Zen, Paulo Gustavo Sampaio Lacativa, Carolina Hammes Torres, Ana Paula Pires Lázaro, Renato Torres Gonçalves, Laura Maria Carvalho de Mendonça, and Maria Lucia Fleiuss de Farias Copyright © 2014 Miguel Madeira et al. All rights reserved. Mechanisms of Action of Indigenous Antidiabetic Plants from the Boreal Forest of Northeastern Canada Sun, 10 Aug 2014 13:33:11 +0000 Indigenous populations in Canada possess a wealth of native traditional knowledge. However, their rates of Type 2 diabetes mellitus (T2DM), a disease that was unheard of in their midst 50 years ago, are the highest in the country. In an effort to cut the impact of T2DM epidemic on Indigenous health, the Canadian Institutes of Health Research funded the “CIHR Team in Aboriginal Antidiabetic Medicines (CIHR-TAAM).” The goal was to explore Boreal forest medicinal plants stemming from Indigenous Traditional Medicine to be included in T2DM care. Six out of nine communities of the Cree of Eeyou Istchee (CEI) participated in ethnobotanical studies that resulted in the identification of 17 potential antidiabetic plant species. These species were screened for antidiabetic activities using a platform of in vitro bioassays and in vivo models of T2DM. This paper summarizes results on the 10 most promising plant species, their active constituents, and the mechanisms behind their antidiabetic activities. In addition, potential herb-drug interactions were examined at the level of drug-metabolizing enzymes, notably the cytochrome P450 family. This review serves as a canvas onto which is discussed the value of Indigenous medicinal plants, future avenues of research, and the ethical approach required in this field. Hoda M. Eid and Pierre S. Haddad Copyright © 2014 Hoda M. Eid and Pierre S. Haddad. All rights reserved. Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed Wed, 25 Jun 2014 06:10:51 +0000 Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D. Volha V. Zhukouskaya, Alla P. Shepelkevich, and Iacopo Chiodini Copyright © 2014 Volha V. Zhukouskaya et al. All rights reserved. Is Dopamine an Iatrogenic Disruptor of Thyroid and Cortisol Function in the Extremely Premature Infant? Wed, 04 Jun 2014 12:25:15 +0000 Background. Dopamine is frequently used as an inotropic and vasoactive agent in neonatal intensive care units. Recent studies have reported that treatment with dopamine is associated with hypothyroxinaemia of prematurity. Objectives. The aim of this study was to determine if dopamine treatment in extremely premature infants altered thyroid and cortisol function. Methods. We prospectively measured plasma cortisol, TSH, free T4, total T4, and free triiodothyronine concentrations in babies born below 28 weeks’ gestation within 5 days of birth, who were either treated with dopamine (D+) or who did not receive any dopamine (D−) within 12 hours of birth. Clinical Risk Index for Babies scores, lowest mean arterial pressure and highest plasma lactate concentrations in the first 12 hours, were recorded. Results. There were 78 babies included in the study (43 males). Mean gestational age was 25 weeks and 3 days (SD 1.3 weeks). Univariate analyses showed significant differences in cortisol and thyroid function between D+ and D−. Multivariable analyses showed that dopamine, gestation, and CRIB were independent factors affecting FT4 concentrations. No independent factors were shown to affect cortisol or TSH concentrations. Conclusion. Dopamine administration appeared to affect FT4 concentrations but not cortisol concentrations. The mechanisms are unclear but the effect does not appear to be related to hypotension or tissue underperfusion. Sze M. Ng, Gabriella Watson, Mark A. Turner, Paul Newland, and A. Michael Weindling Copyright © 2014 Sze M. Ng et al. All rights reserved. Measuring Quality in Thyroid Cancer Surgery Thu, 22 May 2014 15:50:58 +0000 Many of the surgical quality measures currently in use are not disease specific. For thyroid cancer, mortality and even recurrence are difficult to measure since mortality is rare and recurrence can take decades to occur. Therefore, there is a critical need for quality indicators in thyroid cancer surgery that are easily measured and disease specific. Here we will review recent research on two potential quality indicators in thyroid cancer surgery. The uptake percentage on postoperative radioactive iodine scans indicates the completeness of resection. Another measure, the lymph node ratio, is the proportion of metastatic nodes to the total number of nodes dissected. This serves as a more global measure of quality since it indicates not only the completeness of lymph node dissection but also the preoperative lymph node evaluation and decision-making. Together, these two quality measures offer a more accurate, disease-specific oncologic indicator of quality that can help guide quality assurance and improvement. David F. Schneider and Rebecca S. Sippel Copyright © 2014 David F. Schneider and Rebecca S. Sippel. All rights reserved. Persistent Comorbidities in Cushing’s Syndrome after Endocrine Cure Sun, 04 May 2014 07:01:59 +0000 It was assumed that resolution of hypercortisolism in Cushing syndrome (CS) was followed by normalization of morbidity; however, in the last decade evidence is accumulating that patients with cured CS still have increased morbidity and mortality after the biochemical control of hypercortisolism. Patients with CS have an increased cardiovascular and metabolic risk and persistent accumulation of central fat, with an unfavorable adipokine profile, not only during the active phase of the disease but also long after biochemical remission. Clinical management should be particularly careful in identifying global cardiovascular risk, as a primary goal during the followup of these patients, aimed at improving global vascular morbidity. Moreover bone mass is reduced not only due to the endogenous hypercortisolism but also due to duration and dose of exogenous glucocorticoid (GC) replacement therapy after surgery. Thus, therapy in operated patients with inhibition of the hypothalamic-pituitary-adrenal axis should be reduced to the lowest dose and duration possible. Specific treatments should be considered in patients with decreased bone mass, aimed at reducing the increased fracture incidence. Finally, cognitive and health related quality of life impairments, described in active disease, are still abnormal after endocrine cure. Thus, residual morbidity persists in cured CS, suggesting irreversibility of GC-induced phenomena, typical of chronic hypercortisolism. Eugenia Resmini Copyright © 2014 Eugenia Resmini. All rights reserved. The Emerging Roles of Thyroglobulin Thu, 10 Apr 2014 00:00:00 +0000 Thyroglobulin (Tg), the most important and abundant protein in thyroid follicles, is well known for its essential role in thyroid hormone synthesis. In addition to its conventional role as the precursor of thyroid hormones, we have uncovered a novel function of Tg as an endogenous regulator of follicular function over the past decade. The newly discovered negative feedback effect of Tg on follicular function observed in the rat and human thyroid provides an alternative explanation for the observation of follicle heterogeneity. Given the essential role of the regulatory effects of Tg, we consider that dysregulation of normal Tg function is associated with multiple human thyroid diseases including autoimmune thyroid disease and thyroid cancer. Additionally, extrathyroid Tg may serve a regulatory function in other organs. Further exploration of Tg action, especially at the molecular level, is needed to obtain a better understanding of both the physiological and pathological roles of Tg. Yuqian Luo, Yuko Ishido, Naoki Hiroi, Norihisa Ishii, and Koichi Suzuki Copyright © 2014 Yuqian Luo et al. All rights reserved.