Advances in Endocrinology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. The Efficacy of Anastrozole and Growth Hormone Therapy on Adult Height in Six Adolescent Males with Growth Hormone Deficiency or Idiopathic Short Stature Mon, 22 May 2017 09:05:37 +0000 Background. Data on adult height outcomes of the use of Anastrozole and Growth Hormone (GH) in pubertal males with Growth hormone deficiency (GHD) and Idiopathic short stature (ISS) are limited. Objective. We examined the effect of Anastrozole and GH therapy on near adult height (NAH) with pubertal males with GHD or ISS. Methods. Retrospective review of 419 charts from 2008 to 2015. The primary outcomes are NAH compared to mid-parental target height (MPTH) and predicted adult height (PAH). Results. We identified 23 patients (5 SGA/IUGR, 1 Noonan syndrome, 6 GHD, and 11 ISS). Six patients (4 GHD; 2 ISS) achieved NAH. Prior to Anastrozole treatment, the mean chronological age was years (range 13.7–14.4), bone age was years (range 12.5–14), mean height SDS was (range −0.8 to −2.3), and mean PAH was  cm (range 153.5–168.6). MPTH was 173.6 cm ± 7 (range 161.8–181.6). Patients received Anastrozole for an average of 30.5 months (range 19–36 months). At NAH, the mean chronological age was years (range 15.9–18.1 years) and height was  cm (range 168.5–173.4 cm). The mean height SDS improved to (range +0.08 to +1.92, ). Net height gain was 7.3 cm compared to pretreatment PAH () and overall the mean adult height remained 3.5 cm below MPTH. Conclusion. Anastrozole and GH therapy can be effective in augmenting adult height without significant side effects. However, the long-term safety and efficacy of aromatase inhibitor use in pediatrics remain limited. Serife Uysal, Juanita K. Hodax, Lisa Swartz Topor, and Jose Bernardo Quintos Copyright © 2017 Serife Uysal et al. All rights reserved. Evaluation of Prepubertal Patients with Suspected Neurosecretory Dysfunction of Growth Hormone Secretion: Diagnostic Steps and Treatment Response Thu, 23 Feb 2017 08:19:04 +0000 Background and Aims. Existence and diagnostic procedures of neurosecretory dysfunction of growth hormone (NSD) are still a matter of debate. The aim of our study was (a) to find out if prediagnostic auxological and laboratory data could serve as an indicator for pathologic and normal spontaneous GH-secretion and (b) to evaluate the response to GH-therapy in NSD-patients. Methods. Of 90 children (unicentric study) with normal response to GH-stimulation tests, in whom 12-hour night profiles for GH-secretion were performed, 49 were diagnosed with NSD (NSD group). Their auxologic data, IGF-I/IGFBP3-levels as well as the night profiles, were analysed and compared to those of the non-NSD group. Additionally, follow-up auxological data of the GH-treated NSD-patients were collected. Results. Prediagnostic auxologic and laboratory data did not differ between the two groups. Instead, for all analysed criteria of spontaneous GH-secretion (number of peaks, maximal and mean secretion) a significant difference was found. Children with NSD showed a good response to GH-treatment after 1 (H-SDS +0,77 ± 0,48) as well as 4 years (+1,51 ± 0,75). Conclusion. According to our results, analysing spontaneous GH-secretion remains the only method to identify NSD. Yet, as response to GH-treatment is comparable to results in idiopathic GHD, it is worth to consider this diagnosis. Carmen Sydlik, Claudia Weißenbacher, Julia Roeb, Susanne Bechtold-Dalla Pozza, and Heinrich Schmidt Copyright © 2017 Carmen Sydlik et al. All rights reserved. The Protective Effect of Testosterone on Indomethacin Induced Gastric Ulcer in Female Sprague Dawley Rats Thu, 10 Nov 2016 14:47:12 +0000 Gastric ulcer has shown association with changes in sex hormones, with impact exacerbated in males. Also, males are known to be more exposed to ulcer risk factors. This study investigates the effect of testosterone on indomethacin induced gastric ulcers in adult female rats. Eighteen female rats (225 ± 25 g body weight) were randomly assigned to 3 groups under standard laboratory condition. After acclimatization, animals fasted for 40 hrs but were given water ad libitum. Group A served as control while group B served as the ulcer control, in which ulcer was induced without treatment using indomethacin (40 mg/kg single orally dose). Group C was pretreated with testosterone (1 mg/kg IM) eight hours before ulcer induction. Eight hours after ulcer induction, animals were sacrificed and the stomach was harvested for analysis. Results showed a significant reduction in mucus content in groups C ( g) and B ( g) compared to A ( g). Gastric mucus pH was significantly acidic in group B () compared to C () and A (). There was a significantly higher ulcer index in group B ( mm) compared to C ( mm) and testosterone pretreatment resulted in a 21.74% ulcer inhibition. Although weak, the findings suggest that testosterone might protect the gastric mucosa against NSAIDs in females. U. Akpamu, H. O. Otamere, I. O. Ernest-Nwoke, C. N. Ekhator, and U. C. Osifo Copyright © 2016 U. Akpamu et al. All rights reserved. Predictors of Erectile Dysfunction in Men with Type 2 Diabetes Mellitus Referred to a Tertiary Healthcare Centre Sun, 13 Mar 2016 07:00:24 +0000 Background. The frequency of erectile dysfunction (ED) complicating diabetes mellitus (DM) is reportedly high. However, its risk factors have not been well studied. Methods. This was a cross-sectional study of 160 male type 2 DM adults, aged 30–70 years, attending a tertiary healthcare clinic. Demographic and relevant clinical information was documented. Erectile function was assessed using an abridged version of the International Index of Erectile Function (IIEF-5). All subjects were evaluated for central obesity, glycemic control, peripheral arterial disease (PAD), autonomic neuropathy, dyslipidemia, and testosterone deficiency. Results. 152 (95%) patients with a mean age of 60.3 ± 8.8 years completed the study. 71.1% had varying degrees of ED, while 58.3% suffered from a moderate-to-severe form. Independent predictors of ED [presented as adjusted odds ratio (95% confidence interval)] were longer duration of DM, 1.14 (1.02–1.28), PAD, 3.87 (1.28–11.67), autonomic neuropathy, 3.51 (1.82–6.79), poor glycemic control, 7.12 (2.49–20.37), and testosterone deficiency, 6.63 (2.61–16.83). Conclusion. The prevalence of ED and its severe forms was high in this patient population. Poor glycemic control and testosterone deficiency were the strongest risk factors for ED, making it possibly a preventable condition. Theophilus Ugwu, Ignatius Ezeani, Samuel Onung, Babatope Kolawole, and Rosemary Ikem Copyright © 2016 Theophilus Ugwu et al. All rights reserved. Thyroid Diseases in Omani Type 2 Diabetics: A Retrospective Cross-Sectional Study Thu, 17 Dec 2015 13:48:16 +0000 Background. Diabetes mellitus and thyroid diseases are common endocrine disorders in the general population and found to exist simultaneously. This study aimed to establish the prevalence of thyroid dysfunction among Omani type 2 diabetics and its association with glycemic control. Methodology. A retrospective cross-sectional randomized primary and secondary care based study of 285 Omani type 2 diabetics, ≥ 30 years of age with known thyroid function. The following parameters were examined: age, sex, duration of diabetes, duration of thyroid disease, thyroid morphology, thyroid function, thyroid antibodies, and the mean glycated hemoglobin (mean HbA1C). The prevalence of thyroid dysfunction was compared to an independent control group of randomly selected healthy individuals with known thyroid function. Results. Thyroid dysfunction was found in 12.6% of the diabetic patients compared to 4.9% in the control group. The prevalence was higher among the diabetic females (86%) compared to diabetic males (14%). The commonest thyroid dysfunction among diabetics was overt hypothyroidism (4.6%). Subclinical hypothyroidism was the commonest thyroid dysfunction seen in less controlled diabetics at a mean HbA1c of 7.8 (± 0.7). Conclusion. Screening for thyroid dysfunction in patients with type 2 diabetes mellitus should be routinely performed considering the higher prevalence of thyroid diseases in this group compared to the general population. Sanaa Al-Sumry, Thuraya Al-Ghelani, Huda Al-Badi, Mohammed Al-Azri, and Kawther Elshafie Copyright © 2015 Sanaa Al-Sumry et al. All rights reserved. Mean Platelet Volume in Hyperthyroid Toxic Adenoma Patients after Radioactive 131I Treatment Mon, 23 Nov 2015 09:07:19 +0000 This study demonstrates that mean platelet volume (MPV) levels decrease after radioiodine (RAI) ablation therapy in hyperthyroid patients. Regarding the fact that large platelets are hemostatically more active, we suggest that hyperthyroid patients are at risk of cardiovascular disease despite all other cardiovascular risk factors. After RAI ablation therapy as MPV levels return to normal, cardiovascular risk for hyperthyroid patients reduces. Eda Simsek, Ozge Timur, Ayse Carlioglu, Senay Arikan Durmaz, Munir Demirci, and Hakan Sevimli Copyright © 2015 Eda Simsek et al. All rights reserved. Congenital Hypothyroidism: An Audit and Study of Different Cord Blood Screening TSH Values in a Tertiary Medical Centre in Malaysia Tue, 27 Oct 2015 11:27:23 +0000 Mothers are often discharged within 24 hours in most Asian countries. Therefore, our screening programs for congenital hypothyroidism (CH) must consider the value of cord blood TSH. Our objectives were to compare the incidence of CH, positive predictive values, and recall rates using different cord blood TSH values. We also reviewed the results of the second-screening program for premature babies. 99.7% () of all newborns were screened from 1st January 2009 to 31st December 2013. Babies with cord blood TSH > 25 mIU/L or 20–25 mIU/L and  pmol/L were recalled for a repeat venous TSH and FT4 on days 3–5 of life to confirm CH. Twenty-two babies were confirmed to have CH, an incidence of 1:1170. Five were premature. Eleven term babies had cord blood  mIU/L and six had values 25.1–30 mIU/L. Lowering the recall cut-off value to 20 mIU/L would double the recall rate from 0.63% () to 1.3% () with no additional cases detected, whereas using 30 mIU/L would have missed 35% of cases. The incidence of CH was similar, 1:1515, when using either cut-off 20 mIU/L or cut-off 25 mIU/L but lower, 1:2380, when using 30 mIU/L. We recommend the screening cord blood TSH cut-off should be 25 mIU/L and screening for premature babies should be continued. Sze Lyn Jeanne Wong, Muhammad Yazid Jalaludin, Azriyanti Anuar Zaini, Nurshadia Samingan, and Fatimah Harun Copyright © 2015 Sze Lyn Jeanne Wong et al. All rights reserved. Effects of Low-Dose Pioglitazone on Serum Levels of Adiponectin, Dehydroepiandrosterone, Amyloid Beta Peptide, and Lipid Profile in Elderly Japanese People with Type 2 Diabetes Wed, 21 Oct 2015 13:17:45 +0000 This study was performed to see how pioglitazone at low doses could affect blood biomarkers related to atherosclerosis and aging. The effects of an add-on treatment with pioglitazone (15 mg for males and 7.5 mg for females) for 6 months were assessed in 24 outpatients (12 males, 12 females) with type 2 diabetes aged ≥ 70 years. As doses of sulfonylurea were reduced in 10 patients, no significant differences in HbA1c and glucose levels were seen. After the treatment, serum levels of HDL cholesterol, arachidonic acid (predominant in males), and high-molecular-weight adiponectin significantly increased. The level of dehydroepiandrosterone sulfate significantly decreased. No significant changes were seen in those of small dense LDL cholesterol, high-sensitivity C-reactive protein, and amyloid beta peptides 1–40 and 1–42. There was a slight but significant increase in body weight, but apparent adverse effects were not observed. In conclusion, pioglitazone at low doses increased serum adiponectin, HDL cholesterol, and arachidonic acid levels but decreased serum dehydroepiandrosterone level, not associated with glycemia, in elderly Japanese people with type 2 diabetes. An optimal dose of pioglitazone should be sought for to minimize its adverse effects and to fully exert its pleiotropic effects such as antiatherosclerotic and antiaging effects. Yuji Aoki Copyright © 2015 Yuji Aoki. All rights reserved. Overview of Cellular Transplantation in Diabetes Mellitus: Focus on the Metabolic Outcome Tue, 10 Feb 2015 06:18:39 +0000 Diabetes mellitus is a metabolic disease possible to treat via several different therapeutic approaches. Since the advent of insulin in 1922, type 1 diabetes mellitus has become a chronic treatable disease. Nonetheless, type 1 diabetes mellitus can be a devastating disease when the macro- and microangiopathic complications take place after several years of illness. Starting from the eighties, pancreas/islet transplantation has become a potential innovative treatment of diabetes mellitus. The major advantage of pancreas/islet transplantation is the restoration of c-peptide cosecretion along with insulin; the major disadvantage is the need to administer immunosuppressive drugs which are diabetogenic themselves. Islet transplantation is the progenitor of more recent forms of cellular and stem cell therapies which will be reviewed herein. Cellular therapies for diabetes mellitus are still an experimental procedure. Herein we present the actual current achievements and an outlook of close future possible advancements in the area of cellular transplantation for the cure of diabetes mellitus. Livio Luzi, Stefano Benedini, Andrea Caumo, and Ileana Terruzzi Copyright © 2015 Livio Luzi et al. All rights reserved. Cystatin C and Its Role in Patients with Type 1 and Type 2 Diabetes Mellitus Mon, 05 Jan 2015 08:44:40 +0000 Diabetes mellitus is the commonest cause of CKD. It is the leading cause of new patients requiring renal replacement therapy, accounting for 40%, 34%, and 30% of cases in United States, Germany, and Australia, respectively. Recent studies have shown that a low-molecular weight protein, cystatin C, freely filtered by the kidneys is a novel biomarker that may be used for detection of early renal dysfunction in patients with type 1 or type 2 diabetes. Cystatin C has also been shown to detect cardiovascular disease in patients with diabetes and it may also be linked with incident type 2 diabetes in obese patients. We aim to review current evidence based literature on use of cystatin C for early detection of diabetic nephropathy due to type 1 and type 2 diabetes in comparison to conventional methods and explore its association with other comorbidities. Alaaeldin M. Bashier, Ayman Aly Seddik Fadlallah, Nada Alhashemi, Puja Murli Thadani, Elamin Abdelgadir, and Fauzia Rashid Copyright © 2015 Alaaeldin M. Bashier et al. All rights reserved. The Cost of Prolonged Hospitalization due to Postthyroidectomy Hypocalcemia: A Case-Control Study Sun, 28 Dec 2014 07:42:12 +0000 The aim of this study is to evaluate the additional costs associated with calcium monitoring and treatment as well as evaluate the incidence and predictors of postthyroidectomy hypocalcemia. Methods. This case-control study involved thyroidectomy and completion thyroidectomy patients operated on between January 2012 and August 2013. Cases were defined as requiring calcitriol supplementation, and controls did not require supplementation. Patient (age, sex), nodule (cytology, pathology), surgical data (neck dissection, parathyroid identification, and reimplantation), and hospital stay (days hospitalized in total and after drain removal) were compared. Comparisons were made using -tests and chi-square tests with an alpha of 0.05. The estimated cost associated with the extended stay was then compared with the cost of supplementation. Results. A total of 191 patients were evaluated (61 cases and 130 controls). Predictors of hypocalcemia include female age, neck dissection, and parathyroid reimplantation. Hypocalcemic patients were hospitalized for a longer period of time after drain removal (2.5 versus 0.8 days, ), and hospitalization costs after neck drain removal were higher in this group as well (8,367.32$ versus 2,534.32$, ). Conclusion. Postoperative hypocalcemia incurs significant additional health care costs at both the local and health care system levels. Navid Zahedi Niaki, Harmeet Singh, Sami P. Moubayed, Rebecca Leboeuf, Jean-Claude Tabet, Apostolos Christopoulos, Tareck Ayad, Marie-Jo Olivier, Louis Guertin, and Eric Bissada Copyright © 2014 Navid Zahedi Niaki et al. All rights reserved. Recent Developments in Diagnosis and Care for Girls in Turner Syndrome Sun, 16 Nov 2014 06:48:45 +0000 The past decade produced important advances in molecular genetic techniques potentially supplanting the traditional cytogenetic diagnosis of Turner syndrome (TS). Rapidly evolving genomic technology is used to screen 1st trimester pregnancies for sex chromosomal anomalies including TS, and genomic approaches are suggested for the postnatal diagnosis of TS. Understanding the interpretation and limitations of new molecular tests is essential for clinicians to provide effective counseling to parents or patients impacted by these tests. Recent studies have advanced the concept that X chromosome genomic imprinting influences expression of the Turner phenotype and contributes to gender differences in brain size and coronary disease. Progress in cardiovascular MRI over the past decade has dramatically changed our view of the scope and criticality of congenital heart disease in TS. Cardiac MRI is far more effective than transthoracic echocardiography in detecting aortic valve abnormalities, descending aortic aneurysm, and partial anomalous pulmonary venous return; recent technical advances allow adequate imaging in girls as young as seven without breath holding or sedation. Finally, important developments in the area of gynecological management of girls and young women with TS are reviewed, including prognostic factors that predict spontaneous puberty and potential fertility and recent practice guidelines aimed at reducing cardiovascular risk for oocyte donation pregnancies in TS. Carolyn Bondy Copyright © 2014 Carolyn Bondy. All rights reserved. Angiotensin II, Vasopressin, and Collagen-IV Expression in the Subfornical Organ in a Case of Syndrome of Inappropriate ADH Thu, 06 Nov 2014 00:00:00 +0000 The syndrome of inappropriate antidiuretic hormone (SIADH) is a disease characterized by hyponatremia and hyperosmolarity of urine where vasopressin and angiotensin II are implicated in the alteration of salt water balance and cardiovascular and blood pressure regulation. The aim of this study is to analyse the expression of substances related with cardiovascular and salt water regulation in the subfornical organ in a case of SIADH. Two brains, one taken from a 66-year-old man with SIADH and the other from a 63-year-old man without SIADH, were used. Immunohistochemical study was performed using anti-angiotensin II, anti-vasopressin, and anti-collagen-VI as primary antibodies. Angiotensin and vasopressin immunoreaction were found in neurons, in perivascular spaces, and in the ependymal layer in the subfornical organ in both cases. However, in the SIADH case, the angiotensin II and collagen-IV expression in the SFO were different suggesting this organ’s possible participation in the physiopathology of SIADH. Emilia M. Carmona-Calero, Juan M. González-Toledo, Leandro Castañeyra-Ruiz, Ibrahim González-Marrero, María Castañeyra-Ruiz, Héctor de Paz-Carmona, Agustín Castañeyra-Ruiz, Nélida Rancel-Torres, and Agustín Castañeyra-Perdomo Copyright © 2014 Emilia M. Carmona-Calero et al. All rights reserved. Lipid Peroxidation and Antioxidant Status in Nonobese Type 2 Diabetes Mellitus Wed, 22 Oct 2014 12:17:24 +0000 The aim of the study was to investigate the association between lipid peroxidation and antioxidant status in nonobese type 2 diabetes mellitus (T2DM) and further to correlate whether their significant association is putatively associated with the pathogenesis of T2DM. A number of 102 nonobese T2DM subjects and 95 nondiabetic subjects as healthy controls were enrolled in this cross-sectional study. Serum samples were collected in cryovials for malondialdehyde (MDA) and thiol assays. Total thiol or sulfhydryl (–SH) groups in peripheral blood mononuclear cells (PBMCs) and sera, as well as level of MDA, a marker for lipid peroxidation in serum, were measured spectrophotometrically. Serum MDA level was found significantly higher whereas serum and PBMC total thiol levels were diminished significantly among nonobese T2DM subjects compared to HC subjects. Moreover, serum MDA level is found to have a significant inverse correlation with serum total thiol and PBMC thiol levels among DM subjects, but no significant correlation was observed in HC individuals. A significant inverse correlation between serum MDA and serum total thiol levels among nonobese T2DM subjects suggests a close association of increased oxidative stress with decreased antioxidant status in nonobese T2DM. Vineet Kumar Khemka, Subhadip Choudhuri, Anirban Ganguly, Arindam Ghosh, Aritri Bir, and Anindita Banerjee Copyright © 2014 Vineet Kumar Khemka et al. 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.