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Accumulating evidence suggest that in patients with diabetes mellitus, increased rate of lipoprotein oxidation and oxidative stress have important role in diabetic angiopathy, including nephropathy. To evaluate the association of oxidized low- density lipoprotein (ox-LDL) with the development of diabetic nephropathy, plasma level of ox-LDL were measured in 70 diabetic patients with macro and 63 patients with normoalbuminuria. The plasma oxidized- LDL level in patients with macroalbuminuria was higher than those in normoalbuminuric group, (85.72 ± 32.92 mu/L versus 75.07 ± 26.46 u/L, P= 0.041). hemoglobin A1C (HbA1C) levels were similar in diabetic patients with macro (9.0 ± 1.80%) and normoalbuminuria (8.52 ± 1.7%, P= 0.098). There was no significant correlation between the ox-LDL and HbA1C level. The significantly elevated plasma oxidized- LDL in patients with macroalbuminuria suggests that ox-LDL may play an important role in the progression of diabetic nephropathy.

Background: Subacute thyroiditis (SAT) is a self-limiting thyroid inflammatory disease occurring specifically after upper respiratory tract infections. Since COVID- 19 is a respiratory disease leading to multi-organ involvements, we aimed to systematically review the literature regarding SAT secondary to COVID-19. Methods: We searched Scopus, PubMed/MEDLINE, Cochrane, Web of Science, ProQuest, and LitCovid databases using the terms "subacute thyroiditis" and "COVID-19" and their synonyms from inception to November 3, 2022. We included the original articles of the patients with SAT secondary to COVID-19. Studies reporting SAT secondary to COVID-19 vaccination or SAT symptoms' manifestation before the COVID-19 infection were not included. Results: Totally, 820 articles were retained. Having removed the duplicates, 250 articles remained, out of which 43 articles (40 case reports and three case series) with a total of 100 patients, were eventually selected. The patients aged 18-85 years (Mean: 42.70, SD: 11.85) and 68 (68%) were women. The time from the onset of COVID-19 to the onset of SAT symptoms varied from zero to 168 days (Mean: 28.31, SD: 36.92). The most common symptoms of SAT were neck pain in 69 patients (69%), fever in 54 (54%), fatigue and weakness in 34 (34%), and persistent palpitations in 31 (31%). The most common ultrasonographic findings were hypoechoic regions in 73 (79%), enlarged thyroid in 46 (50%), and changes in thyroid vascularity in 14 (15%). Thirty-one patients (31%) were hospitalized, and 68 (68%) were treated as outpatients. Corticosteroids were the preferred treatment in both the inpatient and outpatient settings (25 inpatients (81%) and 44 outpatients (65%)). Other preferred treatments were nonsteroidal antiinflammatory drugs (nine inpatients (29%) and 17 outpatients (25%)) and betablockers (four inpatients (13%) and seven outpatients (10%)). After a mean duration of 61.59 days (SD: 67.07), 21 patients (23%) developed hypothyroidism and thus, levothyroxine-based treatment was used in six of these patients and the rest of these patients did not receive levothyroxine. Conclusion: SAT secondary to COVID-19 seems to manifest almost similarly to the conventional SAT. However, except for the case reports and case series, lack of studies has limited the quality of the data at hand. [ABSTRACT FROM AUTHOR]

Hashimoto's thyroiditis (HT) results from chemoattraction of inflammatory cells toward the thyroid gland by inducing the production of interferon-gamma (IFNγ)-induced protein 10 (IP10) by T helper (Th) 1 cells. Vitamin D may suppress the IFNγ-IP10 axis, but this new function of vitamin D has not yet been investigated in HT patients. In an intervention and control group, patients received 50000 IU cholecalciferol or placebo every week for three months, respectively. The CD4+ T cells of 40 patients were isolated, and the mRNA expression levels of vitamin D receptor (VDR), peroxisome proliferator-activated receptors (PPAR)-α, and PPAR-γ genes were determined by real-time PCR. ELISA method was used to determine serum levels of vitamin D, tumor necrosis factor-alpha (TNF-α), IFN-γ, and IP10. Vitamin D levels in the intervention group were significantly higher than in the placebo group after supplementation. PPAR-α and PPAR-γ gene expression levels did not differ significantly between the two groups. The serum levels of IP10, IFNγ, and TNF-α decreased significantly in the vitamin D group, as well as in the placebo group.  During this study, vitamin D levels significantly increased in the intervention group and inflammatory factors decreased. Based on the similar results obtained in the placebo group, further studies with larger sample sizes and longer intervention times are recommended. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Endocrinology & Metabolism is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective To study the prevalence and correlates of increased urinary albumin excretion (UAE) in an Iranian type 2 diabetic population. Methods Over a one year period since October 2002, 400 consecutive type 2 diabetic patients referred to an outpatient diabetes clinic, were enrolled in a cross sectional study. Subjects had no history of renal impairment or overt proteinuria. Data concerning demographic characteristics and cardiovascular risk factors were recorded and height, weight and blood pressure were measured. Glucose, cholesterol, HDL-C, LDL-C, triglyceride, apoprotein B, lipoprotein a, creatinine, and HbA1c were measured in fasting blood samples. Overnight twelve-hour UAE were assessed by immunoturbidometry method. Regression analyses were employed to determine the correlates of UAE. Results Out of 400 patients, 156 (40%) subjects had increased UAE (UAE ≥ 30 mg/24 hour). The UAE was higher in males compared to females (145.5 vs. 72.1 mg/day; p < 0.05); however, the age and HDL adjusted UAE levels were not significantly different between men and women (120.1 vs. and 87.9 mg/day; p = 0.37). Increased UAE was correlated with decreasing HDL-C and a longer duration of diabetes independent of other variables; increased UAE was correlated with HbA1c as well. Age, systolic and diastolic blood pressure, total cholesterol, LDL-C, triglyceride, apoprotein B, lipoprotein a, and GFR did not correlate with increased UAE. Conclusion In this study, increased UAE was considerably frequent among type 2 diabetic patients without any significant history of renal dysfunction. Albuminuria was found to be associated with dyslipidemia (low HDL-C), long duration of diabetes, and uncontrolled glycemia revealed by higher HbA1c.

Abstract Background Lithium-induced thyroid abnormalities have been documented in many studies. They may occur despite normal plasma lithium levels. The objectives of this study were: 1) to determine possible relationship between lithium ratio, defined as erythrocyte lithium concentrations divided by plasma lithium concentrations, and thyroid abnormalities in bipolar patients receiving lithium and 2) to find other possible risk factors for developing thyroid abnormalities in the subjects. Methods Sixty-eight bipolar patients receiving lithium therapy were enrolled in a cross-sectional evaluation of thyroid function test and thyroid size. Patients were divided into two groups based on their thyroid function tests and thyroid sizes. Erythrocyte and plasma lithium concentrations were determined by atomic absorption spectrometry for each patient. Lithium ratio was then calculated. Results No significant differences were found between age, positive family history of affective disorder, plasma lithium concentration, erythrocyte lithium concentration, and lithium ratio comparing the two groups. Thyroid abnormalities was significantly higher in women than in men (p < 0.05). Conclusions Lithium ratio does not appear to have a predictive role for thyroidal side effects of lithium therapy. Female gender was the main risk factor. We suggest more frequent thyroid evaluation of bipolar women who are treated with lithium.

Objective: A growing body of evidence shows a close relationship between oxidative stress and autoimmune conditions such as Hashimoto's thyroiditis (HT). Among different markers of oxidative damage, 8-hydroxydeoxyguanosine (8-OHdG) is a ubiquitous marker and broadly used in research studies. Therefore, this study aimed to measure the level of 8-OHdG in the sera of patients with HT and healthy control (HC) participants. Material and Methods: In this study, patients were diagnosed with clinical (n=23) and subclinical (n=25) hypothyroidism because of HT and compared with 35 healthy participants. 8-OHdG was measured using enzyme-linked immunosorbent assay in patients and HC participants. Results: No significant difference was observed in the mean serum 8-OHdG levels between patients and HC participants. Conclusion: The results of this preliminary study do not support the fact that the serum level of 8-OHdG is a biomarker of oxidative stress in patients with HT. However, more detailed studies are needed to reveal the exact role of 8-OHdG in this autoimmune disease of the thyroid gland. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Endocrinology & Metabolism is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Vitamin D is a modulator of immune functions. Investigations on the mechanisms of vitamin D action and pathogenesis of Hashimoto's thyroiditis (HT) have revealed that vitamin D can reduce damages to thyroid cells caused by autoreactive immune cells.Methods: Totally, 48 female patients with HT disease were introduced to the study by endocrinologists. Patients were divided into two major groups of 24 individuals and treated weekly with 50,000 IU of cholecalciferol (vitamin D group) or placebo (placebo group) using oral administration for 3 months. Eventually, 17 of the 24 patients in each group finished the study. Before and after supplementation, frequencies of Th1, Th17, Th2 and Tr1 cells and mean fluorescent intensity (MFI) of the associated cytokines, including IFN-γ, IL-17, IL-4 and IL-10, were assessed using flow cytometry. Furthermore, gene expression of IL-10 was assessed using real-time PCR.Results: Results of this study showed that cholecalciferol supplementation caused a significant decrease in Th17/Tr1 ratio. The proportion and MFI of Th1, Th2, Tr1 and Th17 cells included no significant changes in vitamin D group, compared to those in placebo group. Expression rate and MFI of IL-10 increased in both groups. This increase was higher in vitamin D group than placebo group with no significance.Conclusions: In this novel preliminary clinical trial study, supplementation with cholecalciferol in HT patients for 3 months changed the balance of CD4+ T-cell subsets to improve the disease control. However, further studies are necessary to investigate effects of vitamin D on immune functions in HT patients. [ABSTRACT FROM AUTHOR]

Type 2 diabetes has an increasing prevalence and high cost of treatment. The goal of type 2 diabetes treatment is to control patients' blood glucose level by pharmacological interventions and to prevent adverse disease-related complications. Therefore, it is important to optimize the medication treatment plans for type 2 diabetes patients to enhance the quality of their lives and to decrease the economic burden of this chronic disease. Since the treatment of type 2 diabetes relies on medication, it is vital to consider adverse drug reactions. Adverse drug reaction is undesired harmful reactions that may result from some certain medications. Therefore, a Markov decision process is developed in this article to model the medication treatment of type 2 diabetes, considering the possibility of adverse drug reaction occurring adverse drug reaction. The optimal policy of the proposed Markov decision process model is compared with clinical guidelines and existing models in the literature. Moreover, a sensitivity analysis is conducted to address the manner in which model behavior depends on model parameterization and then therapeutic insights are obtained based on the results. The satisfying results show that the model has the capability to offer an optimal treatment policy with an acceptable expected quality of life by utilizing fewer medications and provide significant implications in endocrinology and metabolism applications. [ABSTRACT FROM AUTHOR]

Background: CD4+ T-cells play important roles in the pathogenesis of Hashimoto's thyroiditis (HT). However, there is limited data about characteristics and function of the newly interleukin (IL)-17-producing T-helper cells in this common autoimmune thyroid disorder. Aim: The purpose of this study was to assess the levels of T-helper 17-related cytokines in sera of patients with HT. Materials and Methods: Cytokine concentrations were measured in 48 patients with overt (n = 23) and subclinical hypothyroidism (25) and 35 healthy controls using enzyme-linked immunosorbent assay. Results: The serum levels of IL-17 were significantly higher in patients than controls (P = 0.001) while no differences were observed with regard to levels of IL-22 and IL-23 between patients and normal controls. Conclusion: These results suggest that IL-17 could play some role in the pathogenesis of HT. [ABSTRACT FROM AUTHOR]

Background: Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. Methods: Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. Results: Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6-0.92, P = 0.007). Conclusions: Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended. [ABSTRACT FROM AUTHOR]

Objective. Avascular necrosis of bone (AVN) is an important complication of systemic lupus erythematosus (SLE). Corticosteroid therapy has been underlined as a main risk factor for osteonecrosis. However, AVN development in patients who have never received corticosteroid and the absence of AVN in the majority of the patients, who received corticosteroid, propose a role for non-corticosteroid risk factors in AVN development. Methods. This case-control study included two subsets: oral corticosteroid (66 AVN and 248 non-AVN patients) and pulse-therapy subset (39 AVN and 312 non-AVN patients) who have attended our Lupus clinic from 1979 to 2009. Patients received similar cumulative dose corticosteroid, equal maximum dose and 1-year maximum dose of corticosteroid. The demographic data (including sex, age of disease onset, age at the diagnosis of AVN), organs involvement, SLE Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology-Damage index (SLICC/ACR-DI), number of disease flare ups were compared between two subsets. Results. The mean age of SLE onset was younger ( P value = 0.04) in the AVN patients. In oral corticosteroid subset, malar rash ( P value < 0.001) and oral ulcer ( P value = 0.003) were seen more frequently in non-AVN patients, whereas psychosis ( P value = 0.03) was significantly more prevalent AVN subset in oral corticosteroid subset. In corticosteroid pulse subset, no significant difference in clinical features was noted. Conclusion. In oral corticosteroid subset, younger age of disease onset and psychosis were significantly associated with AVN, whereas malar rash and oral ulcer showed negative association AVN. [ABSTRACT FROM AUTHOR]

Background: Studies have suggested that oxidative stress is a common pathway of different leading mechanisms to diabetes complications. Oxidative stress play a crucial role in atherogenesis and cause oxidation of low density lipoprotein. Evidence has been shown that oxidized LDL in diabetic patients is higher than nondiabetic individuals. Regarding to known role of oxidative stress in developing of micro and macrovascular complications of diabetes and recent evidences about importance of IL-6 in initiating of inflammatory processes in atherosclerotic plaques formation and reports that shown the effects of Ox-LDL upon IL-6 release, in this study evaluation of serum levels of IL-6 and correlation of these two agents in diabetic patients in comparison with healthy persons was performed. Methods: This stratified cross-sectional study was conducted in diabetic clinic of Imam khomeini Hospital, Tehran University of Medical Sciences during 2009-2010, recruiting 40 type2 diabetic (T2DM) patients as cases and 40 healthy subjects as controls. FBS, lipid profile, HbA1c, oxidized- LDL and IL-6 levels were measured for both patients and controls after 12 hours fasting state. Results: The mean of Ox-LDL/LDL ratio in T2DM group (0.65±0.14) were significantly higher than control group (0.5±0.15) (p<0.001). The mean level of IL-6 in T2DM group were 2.6±1.8 pg/ml that was higher than control group (1.9± 0.8pg/ml) (p=0.05). BMI, systolic and diastolic blood pressures revealed significant correlation with IL- 6 level in diabetic group. There was no correlation between diabetes duration and IL-6 level. Conclusion: We concluded that diabetes, as an independent factor, is responsible for increased IL-6 in T2DM. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and correlates of increased urinary albumin excretion (UAE) in an Iranian type 2 diabetic population. Methods: Over a one year period since October 2002, 400 consecutive type 2 diabetic patients referred to an outpatient diabetes clinic, were enrolled in a cross sectional study. Subjects had no history of renal impairment or overt proteinuria. Data concerning demographic characteristics and cardiovascular risk factors were recorded and height, weight and blood pressure were measured. Glucose, cholesterol, HDL-C, LDL-C, triglyceride, apoprotein B, lipoprotein a, creatinine, and HbA1c were measured in fasting blood samples. Overnight twelve-hour UAE were assessed by immunoturbidometry method. Regression analyses were employed to determine the correlates of UAE. Results: Out of 400 patients, 156 (40%) subjects had increased UAE (UAE ≥ 30 mg/24 hour). The UAE was higher in males compared to females (145.5 vs. 72.1 mg/day; p < 0.05); however, the age and HDL adjusted UAE levels were not significantly different between men and women (120.1 vs. and 87.9 mg/day; p = 0.37). Increased UAE was correlated with decreasing HDL-C and a longer duration of diabetes independent of other variables; increased UAE was correlated with HbA1c as well. Age, systolic and diastolic blood pressure, total cholesterol, LDL-C, triglyceride, apoprotein B, lipoprotein a, and GFR did not correlate with increased UAE. Conclusion: In this study, increased UAE was considerably frequent among type 2 diabetic patients without any significant history of renal dysfunction. Albuminuria was found to be associated with dyslipidemia (low HDL-C), long duration of diabetes, and uncontrolled glycemia revealed by higher HbA1c. [ABSTRACT FROM AUTHOR]

Background: Lithium-induced thyroid abnormalities have been documented in many studies. They may occur despite normal plasma lithium levels. The objectives of this study were: 1) to determine possible relationship between lithium ratio, defined as erythrocyte lithium concentrations divided by plasma lithium concentrations, and thyroid abnormalities in bipolar patients receiving lithium and 2) to find other possible risk factors for developing thyroid abnormalities in the subjects. Methods: Sixty-eight bipolar patients receiving lithium therapy were enrolled in a cross-sectional evaluation of thyroid function test and thyroid size. Patients were divided into two groups based on their thyroid function tests and thyroid sizes. Erythrocyte and plasma lithium concentrations were determined by atomic absorption spectrometry for each patient. Lithium ratio was then calculated. Results: No significant differences were found between age, positive family history of affective disorder, plasma lithium concentration, erythrocyte lithium concentration, and lithium ratio comparing the two groups. Thyroid abnormalities was significantly higher in women than in men (p < 0.05). Conclusions: Lithium ratio does not appear to have a predictive role for thyroidal side effects of lithium therapy. Female gender was the main risk factor. We suggest more frequent thyroid evaluation of bipolar women who are treated with lithium. [ABSTRACT FROM AUTHOR]

Background: This study was designed to present initial results on clinical presentation, therapeutic modalities, and outcome information of patients with pituitary tumors registered in Iran Pituitary Tumor Registry (IPTR). Methods: We collected data from a web-based electronic medical records of patients with various pituitary tumors referred to four tertiary care centers in the country. Retrospective analysis was performed on demographic, clinical, and therapeutic information of 298 patients including 51 clinically nonfunctioning adenoma (CNFA), 85 acromegaly, 135 prolactinoma, and 27 Cushing's disease (CD). Results: From October 2014 to July 2016, 298 people with the diagnosis of pituitary tumor were registered. Prolactinoma was the most prevalent tumor (45.3%), followed by Acromegaly (28.6%), CNFPA (17.1%), and CD (9%). Female dominance was seen among patients with prolactinoma and CD, while the majority of patients with CNFPA were male and acromegaly was equally distributed between men and women. Hypogonadal symptoms were almost always seen in all types of pituitary groups. Surgery alone was the most common therapeutic modality used in cases of acromegaly, CNFPA, and CD. However, medical therapy alone was frequently applied for cases of prolactinoma. Finally, biochemical cure was achieved in most cases of prolactinoma and CD, but only in 36.5% of acromegalics. Moreover, 80% of patients suffering from CNFPA showed no residual tumor in their imaging. Conclusion: In conclusion, this comprehensive tumor registry enables early identification, selection of best therapeutic approaches, and evaluation of long-term treatment outcomes. Furthermore, this registry can be used to improve surveillance protocols. [ABSTRACT FROM AUTHOR]

The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population in the Asian region.

Background: Hashimoto's thyroiditis (HT) is the most prevalent autoimmune disease, and there is no definitive treatment available for this disease. To find the appropriate therapeutic approach, it is necessary to determine the mechanism of this disease. To achieve this purpose, the frequency of CD4 + T cells was evaluated in patients with HT and compared with healthy individuals., Methods: Twenty-six female patients with HT, aged 20 - 45 years, enrolled in this study. Based on the level of thyroglobulin antibody (anti-TG) and anti-thyroid peroxidase antibody (anti-TPO) in serum of patients with HT, they were divided into two groups. The serum level of anti-TPO was above 100 IU/mL in the group 1 (n = 13), whereas the serum levels of both anti-TPO and anti-TG were above 100 IU/mL in the group 2 (n = 13). Eleven healthy women were considered control group, or group 3. Using flow cytometry, the frequency of T helper (Th)1, Th2, Th17, T regulatory type 1 (Tr1), and LT CD4 + IL-4 + IL-17 + cells and mean fluorescent intensity (MFI) of their related cytokines were evaluated., Results: The frequency of Th2 cells in the groups 1 (anti-TPO > 100) and 2 (anti-TPO > 100 and anti-TG > 100) were more than control group. Only the difference between groups 3 (healthy control) and 2 was significant (P = 0.022). The frequency of LT CD4 + IL-4 + IL-17 + cells in the group 1 was significantly more than group 3 (P = 0.027); However, the difference between group 2 and 3 was not significant (P = 0.126). The expression of interferon-gamma (IFN-γ) in the group 2 (P = 0.001) and group 1 (P = 0.001) was significantly higher than group 3. The frequency of Th17, Th1, and Tr1 cells and MFI of IL-17 and IL-10 were not significantly different between the study groups., Conclusions: In the present study, no significant differences were observed in the frequency of Th17 and Tr1 cells and in MFI of IL-17 and IL-10 in comparison to healthy individuals. Therefore, trying to make a change in the population of these cells probably does not have a significant therapeutic effect. Since Th2 cells and the expression of IFN-γ increased in women with HT, reducing the frequency of Th2 cells or the expression of IFN-γ may be effective in controlling the disease progression. It may be helpful for these patients to prevent the progression of the disease., Competing Interests: Conflict of Interests: The authors have no conflict of interest to declare., (Copyright © 2021, International Journal of Endocrinology and Metabolism.)

Background: The purpose of present study was to investigate mitochondrial DNA copy number (mtDNAcn) and mtDNA damage in peripheral blood of patients with Hashimoto's thyroiditis (HT) and healthy controls (HC)., Methods: The relative mtDNAcn and oxidative DNA damage in this case-control study were measured in peripheral blood of 50 patients with Hashimoto's thyroiditis and 50 healthy controls using quantitative real-time PCR. The study was conducted in Tehran University of Medical Sciences hospital, Tehran, Iran in 2018., Results: HT patients had significantly higher mitochondrial DNA copy number and mitochondrial oxidative damage than the comparison group., Conclusion: These data suggest the possible involvement of mitochondria and oxidative stress in the pathophysiology of HT., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2021 Esfahanian et al. Published by Tehran University of Medical Sciences.)

Realizing the cause of Cushing's syndrome (CS) is one of the most challenging processes in clinical endocrinology. The long high dose dexamethasone suppression test (standard test) is costly and need an extended inpatient stay. In this study we want to show the clinical utility of the overnight 8 mg dexamethasone suppression test (DST) for differential diagnosis of CS in a referral center. Retrospectively from 2002-2005 we selected the patients of endocrinology ward in Imam Hospital who were admitted with the diagnosis of Cushing syndrome and had 8 mg DST (modified test) along with classic DST. In modified test a decrease in an 8 AM serum cortisol level of 50% or more is thought to indicate suppression and we compared the results of modified test with standard test. This test had been done on 42 patients: 10 male (23%) and 32 female (76%). The mean age of patients was 31.39 (15-63), 32 with proven pituitary Cushing's disease, 7 with primary adrenal tumors and 3 with ectopic ACTH syndrome. The standard test according to 50% suppression of UFC had 90.62% sensitivity, and according to 90% suppression had 43.75% sensitivity. The sensitivity of this test was 71.85% for serum cortisol suppression. The modified test (8 mg overnight DST) had 78% sensitivity. All of these tests had 100% specificity for the diagnosis of Cushing's disease. The positive predictive vale (PPV) of all of these tests was 100%. The negative predictive value (NPV) of modified test for the diagnosis of Cushing's disease was 58.82%. In standard test the NPV of serum cortisol was 52.6%, UFC 50% had 76.9% NPV and UFC 90% had 35.7% NPV. The results of serum cortisol suppression in modified test is better than standard test. Although 50% suppression of UFC in standard test had greater sensitivity than modified test, collecting of urine is difficult, time consuming and needing hospitalization, so we advice modified test that is much simpler and more convenient instead of standard test in the first step of evaluating the cause of Cushing's syndrome in referral centers.

Objective: To determine the distribution of solitary parathyroid adenoma over the parathyroid glands in a group of patients with primary hyperparathyroidism Design: A case-series., Place and Duration of Study: Departments of Surgery and Pathology at Shariati Hospital, Tehran, Iran, between the years 1981 and 2003., Patients and Methods: A retrospective review of surgery reports of 118 patients with primary hyperparathyroidism was performed. All of the patients had solitary parathyroid adenoma and the anatomical location of each adenoma was clearly defined during operation. Serum calcium, phosphorus and parathormone levels along with clinical characteristics were also included., Results: The distribution of adenomas over the superior and inferior parathyroid glands showed a significant higher incidence of adenoma in the lower parathyroids (p < 0.001). The right to left distribution of adenomas was not significant (p=0.4)., Conclusion: Surgical exploration for primary hyperparathyroidism should be initiated from the lower parathyroid glands provided that pre-operative localization scans are not helpful.

Hepatitis C virus (HCV) infection has been associated with a plethora of immune and autoimmune perturbations. A variety of conditions ranging from endocrinopathies to different skin diseases has been described in HCV infection. The aim of this study was to investigate the prevalence and clinical significance of HCV infection in patients with graves' disease (GD). A total of 55 patients with GD (30 women, 25 men, mean age: 35.24 +/- 12.27 years) and 50 control subjects (28 women, 22 men, mean age: 33.34 +/- 11.99 years) were examined. Third generation ELISA test was used for detection of antibodies to HCV in human sera, and anti-HCV seropositivity was confirmed by recombinant immunoblot assay (RIBA).All normal controls were anti-HCV negative whereas anti-HCV antibody was present in 1 patient with GD and confirmed by Western blotting. These results indicate that there was no significant difference of anti-HCV antibodies between patients and controls.In this study no relationship was found between GD and HCV infection, which imply that hepatitis C virus has not a direct causal role in the pathogenesis of GD, however, this does not rule out a "hit and run" virus induced disease.